Table 2:
Signs and symptoms of acute transfusion reactions
| Sign/symptom | Type of reaction | Comments |
|---|---|---|
| Fever* | FNHTR, AHTR, TRALI (with respiratory symptoms) or a septic reaction (bacterial contamination). This could also be unrelated to the blood transfusion. | Can coexist with other symptoms such as chills, rigors, myalgia, nausea or vomiting, dyspnoea, hypotension (≥30 mmHg below the baseline) and tachycardia (heart rate of >40 bpm above the baseline).8 |
| Urticaria, hives or pruritus | Allergic TR or anaphylaxis. | Can be mild and localised or more severe with generalised urticaria. |
| Angioedema | Allergic TR or anaphylaxis. | May be preceded by a tingling sensation around the face and lips. |
| Dyspnoea or hypoxia | TRALI, TACO, TAD or a severe allergic TR. | Severe dyspnoea without shock may occur in TRALI or TACO. TAD is a diagnosis of exclusion. Therefore patients should be assessed for other causes of dyspnoea before making this diagnosis. |
| Stridor or bronchospasms | Allergic TR/anaphylaxis or TACO. | - |
| Pulmonary oedema | TACO or TRALI. | - |
| Hypotension† | AHTR, severe allergic TR, anaphylaxis, septic reaction (bacterial contamination), TRALI, TACO, TAD or a hypotensive reaction (bradykinin-mediated hypotension). This could also be unrelated to the transfusion. | Isolated hypotensive reactions are a diagnosis of exclusion and occur within an hour of transfusion, in the absence of allergic or anaphylactic symptoms. These reactions usually require no or only minor interventions.1 Patients on ACE inhibitors are at risk. The risk is higher with bedside leukofiltration. |
| Pain | FNHTR (generalised aches), AHTR (pain at the infusion site, abdomen, chest or loins) or an anaphylactic reaction (chest pain). | - |
| Severe anxiety or feelings of impending doom | AHTR or a septic reaction (bacterial contamination). | Mild anxiety is common in patients undergoing transfusions, especially for the first time. However, patients should be assessed for any TRs if anxiety develops. |
| Acute onset of bleeding | DIC can be associated with AHTR or a septic reaction (bacterial contamination). | - |
FNHTR = febrile non-haemolytic transfusion reaction; AHTR = acute haemolytic transfusion reaction; TRALI = transfusion-related acute lung injury; TR = transfusion reaction; TACO = transfusion-associated circulatory overload; TAD = transfusion-associated dyspnoea; DIC = disseminated intravascular coagulation.
*
Defined as a temperature of ≥38 °C and a rise of 1–2 °C from the baseline;1
†
Defined as a drop in systolic and/or diastolic blood pressure by >30 mmHg and a systolic blood pressure of ≤80 mm.1