Transfusion Reactions
PREPARED BY MR. ABHIJIT DAS
Definition
These are adverse reactions
that happen during a blood
transfusion.
Types of Transfusion Reactions
A. Immune (Immunological) Reactions
These occur when the recipient’s immune system reacts
against the donor’s blood cells.
1. Acute Hemolytic Transfusion Reaction
(AHTR)
- Cause:
Transfusion of wrong
blood group, especially ABO mismatch.
- Onset:
Immediately or within 24 hours.
- What
happens: The recipient’s antibodies destroy donor RBCs.
- Symptoms:
Fever, chills, chest or
back pain, red/brown urine, low blood pressure, shock.
- It
is a medical
emergency.
2. Febrile Non-Hemolytic Reaction (FNHTR)
- Cause:
Reaction between recipient's
antibodies and donor white cells.
- Symptoms:
Fever, chills, feeling uneasy during or after transfusion.
- Common
but not dangerous.
- Prevention:
Use of leukocyte-reduced
blood. [Leukocyte-reduced blood (also called leukoreduced blood) is
blood from which most white blood cells (leukocytes) have been removed.]
3. Allergic Reaction (Mild Urticaria)
- Cause:
Recipient reacts to proteins
in donor plasma.
- Symptoms:
Itching, skin rash (hives), redness.
- Management:
Stopping transfusion briefly, giving antihistamines.
- Transfusion
can often be restarted.
4. Anaphylactic Reaction
- Rare
but severe.
- Seen
in: IgA-deficient individuals.
- Reaction:
When such a person receives donor blood containing IgA, their anti-IgA antibodies
attack it → causing a severe anaphylactic reaction.
- Symptoms:
Difficulty breathing, low blood pressure, shock, vomiting.
- Immediate
treatment: Adrenaline, oxygen, stopping
transfusion.
5. Delayed Hemolytic Transfusion Reaction
(DHTR)
- Cause:
Recipient forms antibodies
against minor RBC
antigens (like Kidd, Duffy).
- Onset:
After 3–14 days
of transfusion.
- Symptoms:
Jaundice,
unexplained drop
in hemoglobin.
- Often
missed unless closely monitored.
6. Graft-versus-Host Disease (GVHD) – Very
Rare but Fatal
- Cause:
Donor’s T-lymphocytes
attack recipient’s
tissues.
- Seen
in: Immunocompromised patients.
- Prevention:
Use irradiated
blood to kill donor T-cells.
B. Non-Immune (Non-Immunological) Reactions
These are not caused by immune system attacks, but by
other factors.
1. Iron Overload (Hemosiderosis)
- Cause:
Multiple transfusions
over time.
- Effect:
Excess iron deposits
in heart, liver.
- Prevention:
Iron chelation
therapy (e.g., deferoxamine).
2. Citrate Toxicity
- Cause:
Massive transfusion — too much citrate (from stored blood) binds calcium. [Citrates
are added to stored blood as an anticoagulant to prevent
clotting]
- Result:
Low calcium levels
(hypocalcemia).
- Symptoms:
Tingling (pins-and-needles feeling on the skin), muscle cramps, irregular
heartbeat.
- Treatment:
IV calcium.
- Note:
Citrate binds to it and makes it inactive temporarily
3. Bacterial Contamination
- Cause:
Blood infected with bacteria
during collection or
storage.
- Symptoms:
High fever, chills, vomiting, septic shock.
- Prevention:
Proper screening, use of blood within safe storage period.
4. Air Embolism
- Rare.
- Cause:
Air enters the
bloodstream during transfusion.
- Result:
Chest pain, breathlessness, sudden collapse.
5. Hypothermia
- Cause:
Rapid transfusion
of cold-stored blood.
- Prevention:
Warm the blood before transfusion.
Graft: any tissue or cells taken from a donor.
Host: recipient.
Irradiated blood: blood is
treated with radiation