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. 2020 Sep 9;26:100514. doi: 10.1016/j.eclinm.2020.100514

Table 1.

Transfusion reaction signs/symptoms and management [3].

Transfusion Reaction Type Signs/Symptoms Management
Febrile nonhaemolytic transfusion reaction (FNHTR) Increase in temperature by ≥1 °C and/or temperature ≥38 °C
+/- transient hypertension, chills, rigors, and discomfort		 Stop transfusion, initiate transfusion reaction work-up looking for signs of infection and haemolysis, provide antipyretic/supportive care
Allergic transfusion reaction Mild: rash, pruritus, urticaria, localized angioedema
Severe: anaphylaxis (bronchospasm, respiratory distress, hypotension in addition to mild symptoms)		 Mild: Stop transfusion. Administer antihistamine +/- corticosteroid, if symptoms resolve transfusion can be restarted.
Severe/anaphylactic: Stop transfusion. Rapidly administer intramuscular epinephrine +/- antihistamine (H1 and H2), bronchodilator, corticosteroid. Do not resume transfusion.
Transfusion associated circulatory overload (TACO) New onset or worsening of ≥3 of the following within 6 h of transfusion cessation:
  • •

    Respiratory distress

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    Elevated brain natriuretic peptide

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    Raised central venous pressure

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    Left heart failure

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    Positive fluid balance

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    Pulmonary edema

 Stop transfusion. Administer supplemental oxygen and diuretics as needed. Consider prolonging the time of transfusion for future transfusions. Consider prophylactically administering diuretics before or after future transfusions.
Transfusion-related acute lung injury (TRALI) Dyspnea, tachypnea, hypoxemia, +/- fever, hypothermia, rigors, hypotension, hypertension, or tachycardia. (Symptoms typically within 6 h of end of transfusion, though delayed cases are possible)
Transient leukopenia may be observed. Bilateral interstitial infiltrates on imaging.		 Stop transfusion. Supportive management with supplemental oxygen, mechanical ventilation if needed (restrictive tidal volume), and restrictive fluid strategy.
Septic transfusion reaction Fevers (increase in temperature by ≥1 °C and/or temperature ≥38 °C; increase by ≥2 °C heightens clinical suspicion), rigors, hypotension. Diagnosis requires isolation of organism from blood product and patient. Stop transfusion. Blood cultures should be obtained from the patient and from the blood product. Broad-spectrum antibiotics should be started.
Acute haemolytic transfusion reaction Fever, chills, back/flank pain, hypotension, dyspnea. May have haemoglobinuria, haemoglobinemia, acute renal failure, disseminated intravascular coagulation, shock, death. Stop transfusion. Supportive management.