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-transmitted bacterial infection (TTBI), 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
| Adverse event | Incidence* | |
|---|---|---|
| Acute haemolytic transfusion reaction (AHTR) | 1:76 000b | |
| Fatal acute haemolytic reaction | 1:1.8 millionb | |
| Febrile non-haemolytic transfusion reaction (FNHTR) | 0.1%–1% of transfusions with universal leucocyte depletionb | |
| Mild allergic reactions (urticarial) | 1%–3% of transfusionsb | |
| Severe allergic reactions (anaphylaxis) | 1:20 000–1:50 000b | |
| Transfusion-related acute lung injury (TRALI) | 1:1200–1:190 000b | |
| Adverse event | Incidence* | |
|---|---|---|
| Complications of massive transfusion | Variableb,c | |
| Non-immune mediated haemolysis (physical or chemical destruction of blood) | Rarec | |
| Transfusion transmitted bacterial infection (for clinically apparent reactions) due to platelets | Approximately 1:250 000a | |
| Transfusion transmitted bacterial infection (for clinically apparent reactions) due to red cells | Approximately 1:2.5 milliona | |
| Transfusion-associated circulatory overload (TACO) | Up to 1:100 of transfused patientsb | |
| Adverse event | Incidence* | |
|---|---|---|
| Delayed haemolytic transfusion reaction (DHTR) | 1:2500–1:11 000b,c | |
| Post-transfusion purpura (PTP) | Rareb | |
| Transfusion-associated graft versus host disease (TA-GVHD) | Rareb | |
| Alloimmunisation - RBC antigens | 1:100b | |
| Alloimmunisation - HLA antigens | 1:10b | |
| Transfusion-related immune modulation (TRIM) | Not knownb | |
| Adverse event | Incidence* | |
|---|---|---|
| Iron overload requiring chelation therapy | May occur after 10–20 RBC unitsd | |
| Iron overload with organ dysfunction | May occur after 50-100 RBC unitsb | |
| Transfusion-transmissible infections | For incidence rates refer to risk estimates for transfusion-transmissible infections | |
Note: *Includes overseas data. Risks per unit transfused unless specified.
References
a. Thyer J, Perkowska-Guse Z, Ismay SL, Keller AJ, Chan HT, Dennington PM, et al. Bacterial testing of platelets - has it prevented transfusion-transmitted bacterial infections in Australia? Vox Sang 2018; 113: 13-20.
b. Savage WJ, Hod EA. Non-infectious complications of blood transfusion. Chapter 22, AABB Technical Manual. 19th edition. AABB, Bethesda, 2017.
c. Popovsky M (ed). Transfusion reactions, 4th edition. AABB Press, Bethesda, 2012.
d. Brittenham GM. Iron-chelating therapy for transfusional iron overload. New England Journal of Medicine 2011 Jan 13;364(2):146–156.