Transfusion reaction

Last reviewed: 25 Feb 2023
Last updated: 07 Jun 2019



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 transfusion reaction


delayed transfusion reaction



Jordan A. Weinberg, MD, FACS

Associate Professor of Surgery

Creighton University School of Medicine

St. Joseph’s Hospital and Medical Center




JAW declares that he has no competing interests.

Peer reviewers

Christoph Pechlaner, MD

Associate Professor of Medicine

Innsbruck Medical University




CP declares that he has no competing interests.

Marisa Marques, MD

Professor of Pathology

University of Alabama at Birmingham Hospital




MM declares that she has no competing interests.

  • Differentials

    • Transfusion-associated sepsis
    • Non-immune-mediated haemolysis
    • Transfusion-associated circulatory overload
    More Differentials
  • Guidelines

    • A compendium of transfusion practice guidelines
    • Transfusion handbook
    More Guidelines
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