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2256 pages added, reviewed or updated during the last month (last updated: 21/4/2021)

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acute complications

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Acute transfusion reactions (ATRs) may vary in severity from mild febrile or allergic reactions to life-threatening events. These include:

  • febrile non-haemolytic transfusion reactions – usually clinically mild.
  • allergic transfusion reactions – ranging from mild urticaria to life-threatening angio-oedema or anaphylaxis.
  • acute haemolytic transfusion reactions – e.g. ABO incompatibility.
  • bacterial contamination of blood unit – range from mild pyrexial reactions to rapidly lethal septic shock depending on species.
  • transfusion-associated circulatory overload (TACO).
  • transfusion-related acute lung injury (TRALI)

Severe ATRs occur in about 1 in 7000 units transfused.

  • careful monitoring of patients during transfusion is important
  • patients should be asked to report symptoms that arise during the transfusion and for at least the next 24 hours.

If a patient develops new symptoms or signs during a transfusion:

  • stop the transfusion and maintain venous access with physiological saline.
  • monitor  vital signs and start resuscitation if necessary
  • as soon as possible, check that the identification details of the patient, their ID band and the compatibility label of the component match.
  • inspect the component for abnormal clumps or discoloration.
  • if the presumed ATR is severe or life threatening the transfusion must be discontinued and immediate medical review arranged.
  • note: if a patient being transfused for haemorrhage develops hypotension, careful clinical assessment is essential as this may be due to continuing blood loss and continuation of the transfusion may be life-saving.
  • perform standard investigations (except for patients with mild allergic or febrile reactions)
    • e.g. - full blood count, renal and liver function tests and assessment of urine for Hb
    • further tests are determined by the symptoms and clinical signs 

The British Committee for Standards in Haematology (BCSH) Guideline on the Investigation and Management of Acute Transfusion Reactions provides a flowchart for the recognition and management of ATR based on presenting symptoms and clinical signs.


Last reviewed 01/2018