Most people experience no complications during a blood transfusion, but some have adverse reactions during or after treatment. Examples include a fever, chills, itching, or breathing difficulty.
According to the American Red Cross, people do not typically experience complications after having a blood transfusion, but they can happen occasionally and can range from mild to severe.
The
In this article, we discuss the potential reactions a person may experience due to a blood transfusion.
According to a
However, these symptoms can resolve with little or no treatment.
Signs that indicate a more severe reaction include:
- respiratory distress
- low blood pressure
- high fever
- red urine
Examples of acute transfusion reactions include the following:
Simple allergic reaction
Even when a person receives the correct blood type, allergic reactions can occur.
According to a 2013 article in the
- the donor blood containing specific plasma proteins that the recipient’s blood sees as allergens
- the donor blood containing food allergens, such as peanut or gluten
- antibodies in donor blood react with antibodies in the recipient’s blood
Symptoms
Symptoms are typically mild and include:
- rash
- itching
- hives
Treatment
Treatments for a mild allergic reaction include:
- stopping the transfusion
- taking an antihistamine to help treat an allergic reaction
Anaphylactic transfusion reaction
Anaphylactic reactions occur in those with immunoglobulin A (IgA) deficiencies and have IgA antibodies in their plasma.
The recipient’s anti-IgA antibodies can react with the IgA antibodies in the donor blood.
Symptoms
Symptoms typically include:
- flushed skin
- itching
- hives
- swelling
- difficulty breathing
- wheezing
- blue lips
- vomiting
- diarrhea
- low blood pressure
Treatment
If a person is experiencing any of the above symptoms, a nurse or doctor will stop the transfusion. After this, they will address the specific symptoms, which can include:
- intravenous (IV) epinephrine
- IV steroids
- antihistamines
- bronchodilators
Febrile non-hemolytic transfusion reaction
According to the
The fever is part of the person’s white blood cells response to the new blood.
Symptoms
Symptoms will depend on the severity and may include:
- body temperature higher than 38ºC (100.4ºF)
- fever and chills
If other symptoms are present, the person should contact their doctor.
Treatment
If FNHTR occurs during the transfusion, the healthcare professional will stop the procedure.
Treatment depends on the symptoms. However, according to the
- investigating all cases of fever as it may indicate a more severe cause
- taking the recommended dose of aspirin or acetaminophen
Acute hemolytic transfusion reaction
According to the
A
Symptoms
Symptoms can include:
- chills
- low blood pressure
- renal failure
- back pain
Less common symptoms include:
- flank pain
- fever
- red or brown urine
Treatment
If a person develops an acute hemolytic transfusion reaction, the doctor or nurse will stop the transfusion.
Treatment depends on the severity of the reaction and may include:
- IV fluids
- dialysis
- management of bleeding
- supportive care
Septic transfusion reactions
According to a 2012 article, septic transfusion reactions typically occur due to bacterial contamination of the donor blood components, most commonly from the platelet products.
The bacteria in platelets that can cause a septic transfusion reaction include Staphylococcus aureus and Staphylococcus epidermidis.
Symptoms
Symptoms can include:
- a fever
- chills
- low blood pressure.
Treatment
Septic transfer reactions require immediate attention. Management of the condition involves
- fluid management
- respiratory support
- antibiotic therapy.
Transfusion-related acute lung injury (TRALI)
This blood transfusion reaction develops very quickly. It happens when antibodies in the donor blood, such as human leukocyte antibodies, react with the recipient’s leukocytes, or white blood cells. This results in pulmonary edema, or excess fluid in the lungs.
According to the American Red Cross, no specific test exists to identify which blood products will cause TRALI.
Symptoms
Symptoms of TRALI include:
- severe shortness of breath
- fever
- low blood pressure
Treatment
Treatment depends on the severity of the symptoms:
- For mild cases, a person will need oxygen therapy.
- For more severe cases, a person may require artificial ventilation.
According to a 2012 article, most cases typically resolve within 48–72 hours. However, TRALI can be fatal and has a mortality rate of between 5–25%.
Transfusion-associate circulatory overload (TACO)
TACO occurs if a person’s circulatory system is unable to process the amount of blood or the speed at which they are receiving it. Doctors call this volume overload, and people who have heart or kidney conditions may develop it.
In TACO, the circulatory system becomes overwhelmed, resulting in pulmonary edema where the lungs fill up with excess fluid.
Symptoms
Symptoms of TACO usually occur within a few hours of or during the transfusion and include:
- rapid breathing
- coughing
- shortness
- high blood pressure
- rapid heartbeat.
Treatment
If symptoms occur during the transfusion, the doctor or healthcare professional will stop the procedure immediately.
According to LabMedicine, treatment for TACO depends on the severity.
- placing the person in an upright position is often sufficient to treat mild TACO
- treating a person with diuretics to remove excess fluid may help resolve more advanced TACO
- intubating to improve respiration is sometimes necessary in severe cases
Examples of delayed transfusion reactions include the following:
Delayed hemolytic or delayed serologic transfusion reaction
A delayed hemolytic or delayed serologic transfusion reaction occurs when an antibody that the recipient already has reforms and reacts to red cell antigens. Reactions can occur between
A person can acquire these antibodies through previous pregnancies or transfusions. These particular antibodies decrease over time to undetectable levels. Those with the antibodies have a higher chance of developing these transfusion reactions.
Symptoms
Symptoms typically include:
- fever
- jaundice
- abdominal pain
- dark urine
- high blood pressure
- labored breathing
Treatment
According to LabMedicine, these transfusion reactions tend to be mild and do not require treatment. If the reaction is significant, hydration is important.
Transfusion-associated graft versus host disease (TAGVHD)
According to the
However, it is a very rare occurrence, and it has become less prevalent since the introduction of the irradiation of blood products. Blood irradiation involves exposing the blood components to ultraviolet light.
Symptoms
According to the
- rash
- nausea
- vomiting
- diarrhea
- abdominal pain
- fever
- bone marrow failure
Treatment
Doctors find TAGVHD challenging to treat, and as a result, mortality rates are between 90–100%.
- Prevention is the best form of treatment. Using irradiation can help prevent the chance of a person developing TAGVHD.
Posttransfusion purpura (PTP)
The
Symptoms
According to a 2019 article, symptoms of PTP can include:
- bleeding of the gastrointestinal tract and urinary tract
- fever and chills
Treatment
Treatment may include:
- supportive care
- IV immunoglobins and steroids
According to the authors of Transfusion Medicine for Pathologists: A Comprehensive Review for Board Preparation, Certification, and Clinical Practice, it is important to note that transfusion reactions are rarely fatal. The incidence of fatal reactions can vary from 1 in 0.6 million to 2.3 million.
A summary of the blood transfusion reactions are as follows:
Acute reactions
| Reaction | Prevalence | Symptoms | Onset | Severity | Treatment |
| Simple allergic | 1–3% of all transfusions | Rash, itching, and hives | During or within 4 hours | Mild | Antihistamines |
| Anaphylactic | 1 in 20,000–30,000 transfusions | Flushed skin, itching, hives, swelling, difficulty breathing, wheezing, blue lips, vomiting, diarrhea, low blood pressure | Seconds to minutes at the beginning of the transfusion | Potentially fatal | IV epinephrine, antihistamines, IV steroids, bronchodilators |
| Febrile nonhemolytic transfusion reaction | 1–3% per unit of blood transfused | Rise in temperature by at least 1% and chills | Within | Mild | Antipyretics |
| Acute hemolytic transfusion reaction | 2–8% per 10,000 units f blood transfused | Fever, flank pain, low blood pressure, renal failure, and difficulty breathing | During, immediately afterward, or within | Potentially fatal | Supportive therapy using IV fluids, dialysis if necessary, and management of bleeding |
| Septic transfusion reaction | 1 in 3000–5000 units of platelets | Fever, chills, and hypotension | Within 4 hours | Potentially fatal | Antibiotic therapy, fluid management, respiratory support |
| TRALI | 0.4% per 100,000 units of plasma | Difficulty breathing, fever, and high blood pressure | During or within 6 hours | Potentially fatal | Respiratory support |
| TACO | Potentially 6% in critically ill patients | Shortness of breath, rapid breathing, or cough | During or within 4–6 hours | Potentially fatal | Person needs to sit upright and diuretics |
Delayed reactions
| Type | Prevalence | Symptoms | Onset | Severity | Treatment |
| Delayed hemolytic or delayed serologic transfusion reaction | 1 in 2500 | Fever, jaundice, dark urine, stomach pain, labored breathing, high blood pressure | 3–10 days | Mild | Close monitoring and hydration |
| TAGVHD | Exact prevalence is unknown, but the reaction is very rare | Rash, abdominal pain, nausea, vomiting, fever, and bone marrow failure | Potentially fatal | Prevention: Irradiation of blood products | |
| PTP | 1 in 25,000–100,000 | 5–10 days | Potentially fatal | Supportive using IV immunoglobin an steroids |
The outlook depends on which reaction a person is experiencing. However, serious blood transfusion reactions are uncommon.
Healthcare providers, blood banks, and hospitals take many precautions to help reduce the chance of a transfusion reaction from occurring.
Depending on the type of transfusion reaction, complications can include:
- renal failure
- lung injury
- blood clots
A person should notify a healthcare professional if they experience any of the symptoms mentioned in this article.
A person can learn more about the potential risks and complications here.
According to the
If someone has a blood transfusion and experiences symptoms, such as shortness of breath, low blood pressure, red or brown urine, flank pain, or other serious side effects, they should see a doctor immediately.
Q:
Can a person do anything to help reduce the chance of a blood transfusion reaction from occurring?
A:
No, unfortunately, you cannot reduce your chances of having a blood transfusion reaction. However, if you have had one previously, then you should let your doctor know before receiving another transfusion. Also, you should let your doctor and healthcare team know if you have had previous transfusions so they can look out for any reactions.
— Alana Biggers, MD. MPH
Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.