Classification & incidence of adverse events
Each blood product transfused carries a small risk of an adverse effect.
Fever, chills and urticaria are the most common manifestations of transfusion reactions.
Potentially significant and life-threatening reactions include acute and delayed haemolytic transfusion reactions, transfusion associated sepsis, anaphylaxis and Transfusion-related acute lung injury (TRALI).
It is important to recognise, respond to and report adverse events.
Once you recognise an adverse reaction, follow the steps for managing suspected transfusion reactions.
Classification of Transfusion-related Adverse Reactions and Estimated Incidence
|Haemolytic ABO/Rh mismatch||1:40,000c|
|Haemolytic fatal||1:1.8 millionc|
|Febrile non-haemolytic transfusion reactions||0.1%–1% of transfusions with universal leucocyte depletionc|
|Mild allergic reactions (urticarial)||1%–3% of transfusionsc|
|Severe allergic reactions (anaphylaxis)||1:20,000–1:50,000b,c|
|Transfusion-related acute lung injury (TRALI)||1:1,200–1:190,000c|
|Massive transfusion complications||Variablec,d|
|Non-immune mediated haemolysis (physical or chemical destruction of blood)||Rarec|
|Transfusion associated sepsis (for clinically apparent reactions) due to platelets||At least 1:75,000a|
|Transfusion associated sepsis (for clinically apparent reactions) due to red cells||At least 1:500,000b|
|Transfusion-associated circulatory overload (TACO)||Less than 1% of patientsc|
|Delayed haemolytic transfusion reaction||1:2,500–1:11,000c,d|
|Transfusion-associated graft versus host disease (TA-GVHD)||Rarec|
|Alloimmunisation - RBC antigens||1:100c|
|Alloimmunisation - HLA antigens||1:10c|
|Transfusion-related immune modulation (TRIM)||Not knownc|
|Iron overload requiring chelation therapy||May occur after 10–20 RBC unitse|
|Iron overload with organ dysfunction||May occur after 50-100 RBC unitsc|
|Transfusion-transmissible infections||For incidence rates refer to risk estimates for transfusion-transmissible infections|
Note: *Includes overseas data. Risks per unit transfused unless specified.
a. Eder et al. Bacterial screening of apheresis platelets and the residual risk of septic transfusion reactions: the American Red Cross experience (2004-2006). Transfusion 2007;47:1134–1142.
b. Kuenert MJ et al. Transfusion-transmitted bacterial infection in the United States, 1998 through 2000. Transfusion 2001;41:1493–1499.
c. Roback JD (ed). Non-infectious complications of blood transfusion. Chapter 27, AABB Technical Manual. 17th edition. AABB, Bethesda, 2011.
d. Popovsky M (ed). Transfusion reactions, 3rd edition. AABB Press, Bethesda, 2007.
e. Brittenham GM. Iron-chelating therapy for transfusional iron overload. New England Journal of Medicine 2011 Jan 13;364(2):146–156.