National Blood Authority
A report by the National Blood Authority Haemovigilance Advisory Committee


The following definitions and descriptions are used in the Australian National Haemovigilance Data Dictionary.

Sentinel event

ABO incompatibility

The transfusion of ABO incompatible product(s) resulting in an acute haemolytic transfusion reaction. Generally major ABO red blood cell mismatches result in significant morbidity or mortality, but minor incompatibilities may be innocuous and not result in harm. Incompatible platelet and plasma transfusions may or may not result in haemolysis and harm.

Haemolytic transfusion reactions (HTR) are clinically suspected if one or more of the following is present in a temporal association with transfusion:

It should be noted that adverse events attributed to transfusion of ABO incompatible products are included in the Incorrect Blood Component Transfused (IBCT) category. Such events could equally be described as acute haemolytic transfusion reactions, but the key failure is IBCT. Transfusion of ABO incompatible products to a patient is considered a 'sentinel event' and is also subject to other reporting channels outside of the National Haemovigilance Program.

Other serious transfusion reactions and events

Severe febrile non-haemolytic transfusion reaction (FNHTR)

Presents with one or more of the following during or within 4 hours of transfusion without any other cause such as haemolytic transfusion reaction or infection:

Severe allergic reaction

One or more of the following without hypotension, and within 24 hours of transfusion:

Anaphylactoid or anaphylactic reaction

Allergic reaction with hypotension (drop in systolic BP ≥30mmHg) during or within 24 hours of transfusion or intractable hypotension or shock with loss of consciousness during transfusion, and without any indication of other cause.

Acute haemolytic transfusion reactions (other than ABO incompatibility)

Acute transfusion reactions occur within 24 hours of transfusion. They may have immune or non-immune aetiology.

Delayed haemolytic transfusion reaction (DHTR)

Occurs between 1 and 28 days post-transfusion, and is the result of other atypical red blood cell alloantibodies.

Transfusion-associated circulatory overload (TACO)

Features respiratory distress, tachycardia, increased blood pressure, typical signs of cardiogenic lung oedema in the chest x-ray, evidence of a positive fluid balance and/or a known compromised cardiac status during or within 12 hours after transfusion.

Transfusion-related acute lung injury (TRALI)

TRALI may be immune or non-immune. Serological confirmation is not required for diagnosis. Clinical TRALI features:

Transfusion transmitted infections (TTI)

Bacterial infection

Transfusion transmitted bacterial infection should be clinically suspected if:

Possible transfusion transmitted bacterial infection:

Confirmed transfusion transmitted bacterial infection:

Viral infection

Following investigation, the recipient has evidence of infection post-transfusion and no clinical or laboratory evidence of infection prior to transfusion and either, at least one component received by the infected recipient was donated by a donor who had evidence of the same infection, or, at least one component received by the infected recipient was shown to have been contaminated with the virus. Reports should at least consider HIV, Hepatitis B, Hepatitis C and CMV.

Parasitic infection

Detection of the same parasite in the recipient's blood and parasite or specific antibodies in the donor blood.

Transfusion-associated graft versus host disease (TGVHD)

TGVHD clinically features the following 1-6 weeks post transfusion, with no other apparent cause:

TGVHD is confirmed by GVHD-typical biopsy and genetic analysis to show chimerism of donor and recipient lymphocytes.

Post-transfusion purpura (PTP)

Clinically features purpura and thrombocytopenia within 12 days of transfusion. PTP is confirmed by the detection of platelet specific antibodies (usually anti-HPA-1a) in the recipient's blood, and detection of the antithetical antigen on the donor platelets, or by a positive platelet X-match.

Incorrect blood component transfused (IBCT)

A patient receives a blood component destined for someone else, or receives a component not to specification. For instance, an immune compromised patient may require irradiated cellular products but receive ordinary banked blood instead. No distinction is made whether or not harm was done.

Definitions for contributory factors

Table 38: ANHDD definitions for contributory factors

Field Value

Explanatory note

None identified

No contributory factors have been attributed to the adverse event

Product characteristic

The product contributed to the reaction due to an inherent but not necessarily faulty characteristic (such as an allergic or anaphylactic reaction to a product; unknown significance of anti-HLA antibodies)

Transfusion in emergency setting

The transfusion was administered under emergency conditions

Deliberate clinical decision

The decision to transfuse was made with clinical forethought, and with due consideration of the possibility of a transfusion reaction


Event(s) during prescribing or ordering the product contributed to the transfusion reaction

Specimen collection/labelling

Event(s) during specimen collection or labelling contributed to the transfusion reaction

Laboratory (testing/dispensing)

Event(s) during laboratory pre-transfusion testing or dispensing of the product contributed to the transfusion reaction

Transport, storage, handling

Event(s) during the transport, storage or handling of the product contributed to the transfusion reaction

Administration of product

Event(s) during the administration of the product contributed to the transfusion reaction

Indications did not meet hospital transfusion guidelines

The clinical indications for transfusion did not meet hospital transfusion guidelines

Did not adhere to hospital transfusion procedures

The transfusion procedures did not adhere to hospital transfusion procedures

Other (specify)

Free-text field. Please specify the event(s) that contributed to the adverse transfusion reaction


  1. Multiple entries allowed
  2. At least one value to be returned

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