Febrile Patient has antibodies against donor WBCs (F>M).
Transfused cytokines.

Tylenol (before or after).

Use Leukoreduced products.

More frequent with cellular products containing WBCs.

Must be at least 1 C (1.8 F) increase over normal baseline (pre-transfusion) temperature.


Patient has allergy to something in the transfused plasma (nuts, strawberries, penicillin). Rash, hives. No signficant change in BP or T.

1:333 Benadryl (before or after).  
Anaphylactic/ Anaphylactoid Severe allergic reaction, with circulatory collapse, laryngeal edema. Hypotension, without fever. 1:20,000-
May require intubation, pressure support, ICU.

About 1 death/year.

Septic Reaction

Due to bacterial contamination of unit (usually at time of donor phlebotomy).
High Fever (>2 C, hypotension.

Plts 1:5000
RBCs 1:250,000
Broad spectrum antibiotics.

Plts: Staph epi
RBCs: Yersinia enterocolitica

Fatal in ~1:50,000 plt transfusions.

(Transfusion Associated Circulatory Overload)

Volume overload with cardiogenic edema. Normal to elevated BP.

Varies with health status. Up to 10% in elderly. Diuretics, O2.

More likely when whole blood is used.

BNP may be elevated.
5-15% mortality.

(Transfusion-Related Acute Lung Injury)
Donor anti-HLA antibodies react with patient WBCs. Get caught up in pulmonary vascular bed and cause non-cardiogenic edema. May have low BP. Usually occurs 2-6 hours after transfusion. 1:5000 May require fluids.
Diuretics make worse.

More likely with Plasma components.

More likely with female DONORs.
UK uses only male plasma.

BNP < 250
5-10% mortality.

Acute Hemolytic Transfusion Reaction Due to patient getting an ABO-incompatible unit. Usually due to an error in patient identification. Hemaglobinuria, pain at IV site, "Feeling of impending doom," fever, circulatory collapse.

1:600,000 fatal

Est. 1:6000-
1:33,000 non-fatal

"Compatible Mistransfusions" (near misses) are even more frequent.

Circulatory support, renal support, dialysis.

Most likely and more severe in group O patients.

This is why Kaiser-WLA uses a double-check system.

Non-immune hemolysis from small needles, hypotonic solution, overheating or freezing RBCs.

Delayed Hemolytic/
Delayed Serologic Transfusion Reaction
Due to a non-ABO incompatibility. Patient makes antibodies to transfused red cells, hemolyses them over a 2-14 days. Fever, LDH, elevated bilirubin, jaundice.   Usually none. Positive DAT
Post-transfusion purpura