Last reviewed: 10 Apr 2021
Last updated: 07 Jun 2019



History and exam

Key diagnostic factors

  • chills
  • flushing
  • dyspnea
  • fever
  • chest, abdominal, flank, and back pain
  • hypotension
  • bleeding from mucous membranes, GI tract, or urinary tract

Other diagnostic factors

  • headache
  • nausea and vomiting
  • anxiety
  • pain along the infused extremity
  • pruritus
  • urticaria
  • angioedema
  • jaundice
  • rales
  • red urine
  • stridor or bronchospasm
  • pallor
  • maculopapular rash
  • diarrhea
  • disseminated purpura
  • exfoliative dermatitis with mucocutaneous involvement

Risk factors

  • prior pregnancy
  • previous transfusion
  • history of transplantation
  • IgA deficiency
  • immunocompromise
  • history of transfusion reaction

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

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
  • CBC
  • D-dimer
  • PT and PTT
  • chest x-ray
  • arterial blood gas

Treatment algorithm


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 reviewersVIEW ALL

Associate Professor of Medicine

Innsbruck Medical University




CP declares that he has no competing interests.

Professor of Pathology

University of Alabama at Birmingham Hospital




MM declares that she has no competing interests.

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