Recognition of acute transfusion reactions
Category 1: mild reactions
- signs
- localized cutaneous reactions (urticaria, rash)
- symptoms
- possible cause
Category 2: moderately severe reaction
- signs
- flushing
- urticaria
- rigors
- fever
- restlessness
- tachycardia
- symptoms
- anxiety
- pruritus
- palpitations
- mild dyspnoea
- headache
- possible cause
- hypersensitivity (moderate-severe)
- febrile non haemolytic transfusion reactions
- antibodies to white blood cells, platelets
- antibodies to proteins including IgA
- possible contamination with pyogens and/or bacteria
Category 3: life threatening reactions
- signs
- rigors
- fever
- restlessness
- hypotension (fall of ≥20% in systolic BP)
- tachycardia (rise of ≥20% in heart rate)
- haemoglobinuria (red urine)
- unexplained bleeding (DIC)
- symptoms
- anxiety
- chest pain
- pain near infusion site
- respiratory distress/shortness of breath
- loin/back pain
- headache
- dyspnoea
- possible cause
- acute intravascular haemolysis
- bacterial contamination and septic shock
- fluid overload
- anaphylaxis
- transfusion-associated acute lung injury (TRALI)
Reference:
- Soutar R, McSporran W, Tomlinson T, et al. Guideline on the investigation and management of acute transfusion reactions. Br J Haematol. 2023 Jun;201(5):832-44.