Severe Transfusion Reactions

Transfusion reactions are adverse reactions caused by donated blood components or plasma and can cause harm to the recipient. Transfusion reactions can be classified as mild, moderate or severe.

Severe transfusion reactions (STRs) are potentially life-threatening and require immediate medical intervention. They can be caused by technical mistakes, biological factors and other factors such as an allergic reaction. As per the American Red Cross, some of the known severe transfusion reactions include:

Hemolytic transfusion reaction
Acute lung injury/Transfusion-related acute lung injury (TRALI)
Febrile non-hemolytic transfusion reaction
Transfusion-associated circulatory overload (TACO)
Allergic reaction to human serum albumin
Infectious disease transmission

Hemolytic transfusion reaction is one of the most dangerous STRs and is caused by mismatched blood components. The incompatibility can be due to Human Leukocyte Antigen (HLA) typing or due to mistakes in ABO typing.

Acute lung injury is another serious form of STR and is caused by the infusing of biologic response mediators present in the donor’s plasma. TRALI can affect the pulmonary and cardiovascular systems by directly inducing lung injury thus leading to respiratory distress.

TACO is an adverse reaction caused by rapid infusing of donor blood components such as packed red blood cells (RBCs). It results in overhydration that can cause the blood pressure to drop and can also lead to congestive heart failure.

Allergic reactions are not serious but can cause temperature, chills, low blood pressure, rash, hives, itching, chest discomfort and difficulty in breathing. Allergic reactions can be caused by human serum albumin, which is present in some donor blood components.

Early indications of a severe transfusion reaction can include fever, chills, chest discomfort, difficulty in breathing, back pain, nausea, fever, rapid heart rate and possibly an allergic reaction. It is important to stop the transfusion immediately and call for medical support.

Most blood components are tested for infectious disease but there is still a risk of transmitting an infectious disease. The risk is greater with older blood stored for longer periods of time.

STRs are rare, but it is important to be aware of the potential risks associated with donor blood transfusion. If a patient is experiencing signs or symptoms of a severe transfusion reaction, the transfusion should be stopped and medical support should be sought.