Last reviewed: 25 Feb 2023
Last updated: 07 Jun 2019
Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- chills
- flushing
- dyspnoea
- fever
- chest, abdominal, flank, and back pain
- hypotension
- bleeding from mucous membranes, GI tract, or urinary tract
More key diagnostic factors
Other diagnostic factors
- headache
- nausea and vomiting
- anxiety
- pain along the infused extremity
- pruritus
- urticaria
- angio-oedema
- jaundice
- rales
- red urine
- stridor or bronchospasm
- pallor
- maculopapular rash
- diarrhoea
- disseminated purpura
- exfoliative dermatitis with mucocutaneous involvement
Other diagnostic factors
Risk factors
- prior pregnancy
- previous transfusion
- history of transplantation
- IgA deficiency
- immunocompromise
- history of transfusion reaction
More risk factors
Diagnostic investigations
1st investigations to order
- direct antiglobulin test
- visual inspection of post-transfusion blood sample
- repeat ABO testing on post-transfusion blood sample
- post-transfusion urinalysis
More 1st investigations to order
Investigations to consider
- serum IgA levels
- anti-IgA antibody testing
- serum alloantibody screen
- serum LDH
- serum bilirubin
- Gram stain and culture of component and post-transfusion recipient samples
- skin biopsy
- HLA typing
- platelet antibody screen
- serum haptoglobin
- serum potassium
- serum bicarbonate
- serum calcium
- serum creatinine
- FBC
- D-dimer
- PT and PTT
- chest x-ray
- arterial blood gas
More investigations to consider
Treatment algorithm
ACUTE
acute transfusion reaction
ONGOING
delayed transfusion reaction
Contributors
Authors
Jordan A. Weinberg, MD, FACS
Associate Professor of Surgery
Creighton University School of Medicine
St. Joseph’s Hospital and Medical Center
Phoenix
AZ
Disclosures
JAW declares that he has no competing interests.
Peer reviewers
Christoph Pechlaner, MD
Associate Professor of Medicine
Innsbruck Medical University
Innsbruck
Austria
Disclosures
CP declares that he has no competing interests.
Marisa Marques, MD
Professor of Pathology
University of Alabama at Birmingham Hospital
Birmingham
AL
Disclosures
MM declares that she has no competing interests.
Differentials
- Transfusion-associated sepsis
- Non-immune-mediated haemolysis
- Transfusion-associated circulatory overload
More DifferentialsGuidelines
- A compendium of transfusion practice guidelines
- Transfusion handbook
More GuidelinesLog in or subscribe to access all of BMJ Best Practice
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