Last reviewed: 24 Nov 2022 Show Last updated: 07 Jun 2019 SummaryPrompt recognition of an immune-mediated transfusion reaction is fundamental to improving patient outcome. Immune-mediated transfusion reactions can be classified as acute or delayed. Acute reactions occur within 24 hours of transfusion and include acute hemolytic, febrile nonhemolytic, allergic, and transfusion-related acute lung injury (TRALI). Delayed reactions occur days to weeks after the transfusion and include delayed hemolytic transfusion reactions, transfusion-associated graft-versus-host disease, and post-transfusion purpura. Although infrequent, nonimmune transfusion reactions, including hemolysis, transfusion-associated sepsis, and circulatory overload, should be considered in the differential diagnosis. Acute hemolytic transfusion reactions are most often the result of clerical error. Identification is critical because of the high probability of a second patient receiving the wrong blood product at the same time. Treatment depends upon the type of transfusion reaction. Although pretransfusion prophylactic acetaminophen and diphenhydramine are often routinely administered, there is little evidence to support this practice. DefinitionThis topic will mainly address immune-mediated transfusion reactions, which comprise an array of distinct adverse clinical responses to transfusion. They are mediated by the interaction of recipient antibodies to foreign antigens contained in any allogeneic blood products. Acute immune-mediated transfusion reactions occur immediately following, or within 24 hours of, transfusion. They include acute hemolytic, febrile nonhemolytic, allergic (with or without anaphylaxis), and transfusion-related acute lung injury (TRALI). Delayed immune-mediated transfusion reactions occur within days to weeks of transfusion and include delayed hemolytic transfusion reaction, graft-versus-host disease, and post-transfusion purpura. History and examKey diagnostic factors
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More investigations to consider Treatment algorithmacute transfusion reactiondelayed transfusion reactionContributorsAuthorsJordan A. Weinberg, MD, FACSAssociate Professor of Surgery Creighton University School of Medicine St. Joseph’s Hospital and Medical Center Phoenix AZ JAW declares that he has no competing interests. Peer reviewersChristoph Pechlaner, MDAssociate Professor of Medicine Innsbruck Medical University Innsbruck Austria DisclosuresCP declares that he has no competing interests. Marisa Marques, MDProfessor of Pathology University of Alabama at Birmingham Hospital Birmingham AL DisclosuresMM declares that she has no competing interests.
What is the most common cause of acute hemolytic transfusion reactions?Human error is the most common cause of AHTRs due to ABO incompatibility. The error could be made in many places: during the initial blood draw, issuing of the blood product, and transfusing product to the wrong patient.
What causes acute hemolytic reaction during blood transfusion?Acute HTRs occurring during or within 24 h after administration of a blood product are usually caused by transfusion of incompatible red blood cells (RBCs), and, more rarely, of a large volume of incompatible plasma. Delayed HTRs are caused by a secondary immune response to an antigen on the donor's RBCs.
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Which of the following is considered a primary cause of acute hemolytic transfusion reactions?
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