Any potentially adverse sign or symptom resulting from a blood transfusion.

Acute reaction

  • Intravascular haemolysis (ABO incompatibility): severe, life threatening
  • Bacterial contamination
  • Anaphylactic reaction
  • Circulatory overload
  • Allergic (mild, mucocutanoeus)
  • Febrile, non-haemolytic transfusion reaction

Delayed reaction

  • Infusion of large volumes of blood and IV fluids may cause haemostatic defects or metabolic disturbances
  • Transfusion-transmitted infections

General principles

  • Acute reactions may occur in 1-2% of patients. Rapid recognition and management of these may save the
    patient’s life
  • Errors and failure to follow correct procedures are the most common causes of life threatening acute haemolytic reactions
  • ALWAYS store blood used for the compatibility testing for 7 days at 2-8°C for possible investigation on transfusion reactions
  • In a conscious patient with a severe haemolytic transfusion reaction, signs/symptoms may appear within
    minutes of infusing only 5-10 mL of blood

    • A nurse should observe the patient for the first 10 minutes after a new blood unit is started, and vital signs recorded
    • In an unconscious or anaesthetised patient, hypotension and uncontrolled bleeding may be the only signs of a transfusion problem

If any reaction is noted

  • Stop the transfusion, and remove the giving set. Prior to disconnecting, the unit must be closed to avoid reflux of patient blood into the donor blood
  • Check the blood pack labels and patient’s identity. If there is a discrepancy, consult the blood bank
  • Get a post-transfusion sample, patient’s urine sample, and the transfused unit. Re-grouping and testing are done on both patient and transfused samples
  • Immediately report all suspected acute transfusion reactions to the hospital blood bank laboratory that works
    with the clinician
  • For all category 2 and 3 reactions, record the following in the patient’s notes: type of reaction, time reaction occurred from start of transfusion, volume, type, and pack numbers of blood products transfused
  • The type of reaction should be diagnosed, and a quick and clear investigation should be started in the hospital blood bank laboratory
    • Bacterial contamination of red cells or platelet concentrates is an under-recognised cause of acute
      haemolytic transfusion reactions
    • Patients who receive regular transfusions are at particular risk of acute non-haemolytic febrile reactions. With experience, these can be recognized so that transfusions are not delayed or stopped unnecessarily

Infections are the most serious delayed complications of transfusions. Therefore, record all transfusions accurately
in the patient’s case notes, and consider transfusion in the differential diagnosis.