Last reviewed: 5 Oct 2024
Last updated: 06 Aug 2024
Summary
Definition
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
Full details
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
Full details
Risk factors
- prior pregnancy
- previous transfusion
- history of transplantation
- IgA deficiency
- immunocompromise
- history of transfusion reaction
Full details
Diagnostic tests
1st tests to order
- direct antiglobulin test
- visual inspection of post-transfusion blood sample
- repeat ABO testing on post-transfusion blood sample
- post-transfusion urinalysis
Full details
Tests to consider
- serum IgA levels
- anti-IgA antibody testing
- serum tryptase level
- serum alloantibody screen
- serum LDH
- serum bilirubin
- gram stain and culture of component and post-transfusion recipient samples
- biopsy of skin, gut or liver
- 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
Full details
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
- Nonimmune-mediated hemolysis
- Transfusion-associated circulatory overload (TACO)
More DifferentialsGuidelines
- Guidelines on the investigation and management of acute transfusion reactions
- Canadian Blood Services clinical guide to transfusion
More Guidelines- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer