This is an acute (<24 hours) immunological adverse reaction. In most cases, symptoms are mild.

Timing: most commonly occurs at the end of transfusion or soon after

Frequency: 0.1 - 1.0% of transfused leukocyte depleted blood components

Cause: accumulation of cytokines in blood components, HLA or leukocyte-specific antibodies

Symptoms: an increase of ≥1°C or fever > 38°C, chills, feeling unwell

Treatment: unpleasant but not life-threatening, treated with antipyretics

This is an acute (<24 hours) immunological adverse reaction. May be life threatening.

Timing: is most common at the beginning of the transfusion or within the first 15 minutes

Frequency: 1:76,000 red blood cell transfusions

Cause: typically ABO blood group disparity- often associated with incorrect patient sampling or the wrong unit being given

Symptoms: fever, chills, drop in blood pressure, abdominal or chest pain, nausea and vomiting, kidney failure, diffuse intravascular coagulation

Treatment: Give fluids and painkillers. Maintain blood pressure and urine output.

This is a delayed immunological side effect.

Timing: occurs 5-10 days after transfusion

Frequency: 1:2500-11,000

Cause: Previous history of antibody in a recipient against a red cell antigen. Most often Rhesus, Kidd, Kell or Duffy antibodies which have been produced during pregnancy or previous transfusion of red blood cell concentrate.

Symptoms: Erythrocyte breakdown, jaundice, unexplained drop in hemoglobin

Treatment: No specific reaction other than antibody diagnosis required for any subsequent intervention

This is an acute life-threatening adverse reaction.

Timing: Soon after starting blood component transfusion

Probability: 1:75,000 f. platelet transfusion, 1:500,000 f. RBC transfusion

Cause: Bacterial-contaminated blood components E.g. Pseudomonas, Yersinia, Staphylococcus.

Symptoms: fever, chills, hypotension (shock), acute kidney injury, disseminated intravascular coagulation

Treatment: Maintain blood pressure and keep the intravenous infusion open, send samples from blood recipients and blood components for microbiological culture, broad spectrum antibiotic treatment

This is an acute (<24 hours) immunological adverse reaction.

Timing: occurs shortly after component transfusion starts

Propability: 1-3% of transfusions

Cause: Allergic reaction to allergens or plasma proteins in the components

Symptoms: Hives, wheezing, coughing

Treatment: Interrupt blood transfusion and give antihistamines

Note! Transfusion may be continued if a rash of urticaria is exclusively present. Give antihistamines prophylactic measures.

This is an acute life-threatening adverse reaction.

Timing: May occur after administration of only a few milliliters of a blood component

Probability: 1:20. 000 - 50,000

Cause: most commonly seen in a recipient with IgA deficiency who has already developed antibodies to IgA during pregnancy or blood transfusion

Symptoms: Hypotension, allergic rash, dyspnea, nausea, vomiting, diarrhoea, shock

Treatment: Maintain blood pressure and maintain intravenous infusion, adrenaline, fluid infusion and intubation

Note! Washed red cells/platelets or donating blood components from IgA-negative donors in case of IgA deficiency may be prophylactic.

This is an acute potentially life-threatening adverse reaction.

Timing: occurs during component transfusion or < 6 hours after component transfusion

Probability: 1:1,200 to 1:190,000

Cause: Usually HLA or HNA antibody in the donor against the recipient, lipids in the component

Symptoms: Sudden shortness of breath, difficulty breathing within 6 hours of blood transfusion, precipitated oxygen saturation, pulmonary oedema on chest X-ray

Treatment: Supportive care, oxygen, mechanical ventilation

Note! Potential preventive measures are dismissing blood donors if causality is proven

Timing: occurs during or following a blood component transfusion

Propablity: < 1%

Cause: Transfusion is faster/greater than the circulatory system can receive, most often in heart failure, infants and older people

Symptoms: Difficulty breathing, cough, rapid pulse, hypertension, pulmonary oedema

Treatment: Oxygen, diuretics

Note! Can be prevented by slow infusion of blood components

This is a delayed life-threatening adverse reaction.

Timing: occurs 4-30 days after component transfusion

Probability: Rare

Cause: Transfused lymphocytes attack the cells of the patient (immunosuppressed)

Symptoms: fever, rash, diarrhoea, cytopenia

Treatment: Supportive care, high mortality

Note! Can be prevented by the use of irradiated blood components

This is a delayed potentially dangerous side effect.

Timing: Appears 5-12 days after blood component transfusion

Propability: Rare

Cause: Platelet aggregation due to immune response, patient develops platelets antibody to an antigen that he/she does not have, often anti-HPA1a

Symptoms: Platelet deficiency, skin bleeding, other bleeding

Treatment: Plasma exchange or immunoglobulin

Note! Can be prevented by administration of HPA-1a negative blood components