DAMOAH GODWIN AWERE

INDEX NUMBER: 9673717

MBCHB2

Transfusion reactions are defined as adverse events associated with the transfusion of whole
blood or one of its components. These may range in severity from minor to life-threatening.
Reactions can occur during the transfusion (acute transfusion reactions) or days to weeks later
(delayed transfusion reactions) and may be immunologic or non-immunologic. A reaction may be
difficult to diagnose as it can present with non-specific, often overlapping symptoms. The most
common signs and symptoms include fever, chills, urticaria (hives), and itching. Some symptoms
resolve with little or no treatment. However, respiratory distress, high fever, hypotension (low blood
pressure), and red urine (hemoglobinuria) can indicate a more serious reaction.

Types of transfusion reactions include: acute hemolytic, delayed hemolytic, febrile non-hemolytic,
anaphylactic, simple allergic, septic (bacterial contamination), transfusion-related acute lung
injury (TRALI), and transfusion-associated circulatory overload (TACO). All suspected reactions
should result in immediately stopping the transfusion and notifying the blood bank and treating
clinician.

Etiology
Immune-mediated transfusion reactions typically occur due to mismatch or incompatibility of the
transfused product and the recipient. They include naturally occurring antibodies in the blood
recipient (such as anti-A, anti-B which are typically responsible for acute hemolytic transfusion
reactions) as well as antibodies made in response to foreign antigens (alloantibodies). These
alloantibodies account for many reactions including mild allergic, febrile non-hemolytic, acute
hemolytic and anaphylactic. Antibodies present in the blood donor can also cause reactions and are
thought to be involved in transfusion-associated lung injury (TRALI).

Non-immunologic reactions are usually caused by the physical effects of blood components or the
transmission of disease. Bacterial contamination, for example, results in septic transfusion reactions
and is caused by bacterial and/or endotoxin contamination of a blood product. This may happen at
the time of collection due to inadequate blood donor arm disinfection, the presence of bacteria in
the donor’s circulation at the time of collection, or due to improper product handling after
collection.

Transfusion reactions can also occur unrelated to factors intrinsic to the blood. Examples of these
include transfusion-associated volume overload (TACO) and hypothermia.

Acute Transfusion Reactions

Mild allergic: Attributed to hypersensitivity to a foreign protein in the donor product.

Anaphylactic: Similar to a mild allergic reaction, however resulting in a more severe reaction.
Sometimes this can occur in a patient with IgA deficiency who makes alloantibodies against IgA and
then receives blood products containing IgA.
Febrile non-hemolytic: Generally thought to be caused by cytokines released from blood donor
leukocytes (white blood cells).
Septic: Caused by bacteria or bacterial byproducts (such as endotoxin) which may contaminate
blood.
Acute hemolytic transfusion reactions: Can result in intravascular or extravascular hemolysis,
depending on the specific etiology (cause). Immune-mediated reactions are often a result of
recipient antibodies present to blood donor antigens. Non-immune reactions are possible, and occur
when red blood cells are damaged before transfusion (e.g., by heat or incorrect osmotic conditions).
Transfusion-associated circulatory overload (TACO) : Occurs when the volume of the transfused
component causes hypervolemia (volume overload).
Transfusion-related acute lung injury: Acute lung injury is due to antibodies in the donor product
(human leukocyte antigen or human neutrophil antigen) reacting with antigens in the recipient. The
recipient’s immune system responds and causes the release of mediators that lead to pulmonary
edema. Possibly contributing to this are clinical conditions that predispose the patient including
infection, recent surgery, or inflammation.
Delayed Transfusion Reactions

Delayed hemolytic transfusion reaction: Typically caused by an anamnestic response to a foreign

antigen that the patient was previously exposed to (generally by prior transfusion or pregnancy).
Transfusion-associated graft-versus-host disease: Results from engraftment of donor
lymphocytes (commonly found in cellular blood products) into an immunocompromised recipient’s
bone marrow. The donor lymphocytes recognize the patient as foreign and react against the
recipient’s body. The patient’s immune system is unable to clear the foreign lymphocytes. This is
rare but often fatal.