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Other serious transfusion reactions and events

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:

  • fever (≥38oC or change of ≥1oC from pre‑transfusion level)
  • chills
  • cold
  • rigor
  • other symptoms of discomfort.

Allergic reaction

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

  • rash
  • allergic dyspnoea (stridor, cyanosis, wheezing)
  • angioedema
  • generalised pruritis
  • urticaria.

Anaphylactic or anaphylactoid 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 (AHTR)

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:

  • acute respiratory distress and
  • diffuse bilateral lung infiltrations in the lung radiograph and
  • occurrence during or within 6 hours of completion of the transfusion and
  • no evidence of transfusion-associated circulatory overload (TACO).

Transfusion transmitted infections (TTI)

Bacterial infection

Transfusion transmitted bacterial infection should be clinically suspected if:

  • fever >39°C or a change of >2°C from pre‑transfusion value and
  • rigors and
  • tachycardia >120 beats/min or a change of >40 beats/min from pre‑transfusion value or a rise or drop of 30mmHg in systolic blood pressure within 4 hours of transfusion are present.

Possible transfusion transmitted bacterial infection:

  • detection of bacteria by approved techniques in the transfused blood component but not in the recipient's blood or
  • detection of bacteria in the recipient's blood following transfusion but not in the transfused blood component and no other reasons are ascertainable for the positive blood culture.

Confirmed transfusion transmitted bacterial infection:

  • detection of the same bacterial strain in the recipient's blood and in the transfused blood product by approved techniques.

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 (TA-GVHD)

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

  • fever
  • rash
  • liver dysfunction
  • diarrhoea and
  • cytopenia.

TA-GVHD 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.