eMedicine Specialties > Hematology > Transfusion Medicine

Transfusion Reactions: Follow-up

Author: S Gerald Sandler, MD, FACP, FCAP, Professor of Medicine and Pathology; Director, Transfusion Medicine, Department of Laboratory Medicine, Georgetown University Hospital
Coauthor(s): Viviana V Johnson, MD, FCAP, Medical Director, Transfusion Services and Armed Services Blood Bank Center, National Naval Medical Center
Contributor Information and Disclosures

Updated: Oct 4, 2009

Follow-up

Deterrence/Prevention:

  • Persons known to have formed red cell alloantibodies as the result of previous transfusions or pregnancy should be informed and provided with a written report that lists the antibodies to be presented to the transfusion service if additional transfusions are required at another hospital.
  • Ask patients scheduled for red cell transfusions about any history of previous transfusions and if they are aware of any complications or blood bank antibody problems.
  • Obtain details of any previous transfusions during the medical history or when obtaining the patient's informed consent for a transfusion.
  • In cases of transfusion reaction, retype the donor and recipient RBCs. A discrepancy between the original ABO type and the repeat ABO typings should raise the urgent question of whether a mix-up of blood samples could place another patient at risk of a similar mismatched transfusion.

Complications:

  • Acute hemolytic reactions (antibody mediated): Renal failure and DIC are potential complications for patients who survive the initial acute reaction.
  • Acute hemolytic reactions (non–antibody mediated): Transfusion of serologically compatible but hemolyzed red cells results in acute hemoglobinemia and hemoglobinuria. Rarely, short- or long-term complications occur.

Prognosis:

  • Acute hemolytic reactions (antibody mediated): Most severe and fatal reactions result from inadvertent transfusion of group AB or group A red cells to a group O recipient.
  • Acute hemolytic reactions (non–antibody mediated) are typically benign.
  • Nonhemolytic febrile reactions are discomforting but typically benign.
  • Allergic reactions are benign but bothersome to recipients.
  • Anaphylactic reactions are potentially, but rarely, fatal.
  • TRALI: Fatal cases are reported. Early and intensive pulmonary support reduces the risk of a fatal outcome.
  • Circulatory (volume) overload: The outcome varies with the overall clinical status of the patient.
  • Bacterial contamination/endotoxemia is potentially fatal and may be caused by gram-positive or gram-negative bacteria. Early diagnosis, initiation of broad-spectrum antibiotics, and other intensive supportive measures may reverse the outcome of an otherwise fatal complication of transfusion.

Miscellaneous

Medicolegal Pitfalls

  • Many hospitals have separate informed consent forms for blood transfusions. Before ordering a blood transfusion, the physician should explain the expected benefits and potential risks to the patient and obtain signed informed consent.
  • Chart notes for transfusion reactions:
    • The medical record should contain a description of all acute transfusion reactions.
    • If the wrong blood was transfused to the wrong patient, the medical record should contain details of the clinical events and medical management.
    • Speculation on the source of human error is not an appropriate entry.
    • All transfusion events involving human error should be reported to the hospital's risk manager.
 


More on Transfusion Reactions

Overview: Transfusion Reactions
Differential Diagnoses & Workup: Transfusion Reactions
Treatment & Medication: Transfusion Reactions
Follow-up: Transfusion Reactions
Multimedia: Transfusion Reactions
References
Further Reading
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References

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Further Reading

Additional Resources

  • Brecher ME, ed. Technical Manual. 15th ed. Bethesda, Md: American Association of Blood Banks Press; 2005.
  • Hillyer CD, Silberstein LE, Ness PM, Anderson KC, Roback JD, eds. Blood Banking and Transfusion Medicine. 2nd ed. Philadelphia, Pa: Churchill Livingstone; 2007.
  • Hillyer C, Strauss RG, Luban NLC, eds.   Handbook of Pediatric Transfusion Medicine. San Diego, Calif: Elsevier Academic Press; 2004.
  • Petz LD, Garratty G, eds. Immune Hemolytic Anemias. 2nd ed. Philadelphia, Pa: Churchill Livingstone, 2004.

Related eMedicine Topics

Clinical Trials

Clinical Guidelines

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Keywords

transfusion reactions, blood transfusions, blood products, hemolytic transfusion, acute hemolytic transfusion reactions, transfusion complications, transfusion syndrome, blood product reactions, allergic transfusion reaction, blood type, blood group incompatibility, circulatory volume overload, anaphylactic transfusion reaction, blood anaphylaxis, hemolytic reactions, allergic reactions, anaphylactic reaction, anaphylaxis, transfusion-related acute lung injury, TRALI, transfusion-related lung injury, ABO antibody reaction, blood contamination, contaminated blood

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Contributor Information and Disclosures

Author

S Gerald Sandler, MD, FACP, FCAP, Professor of Medicine and Pathology; Director, Transfusion Medicine, Department of Laboratory Medicine, Georgetown University Hospital
S Gerald Sandler, MD, FACP, FCAP is a member of the following medical societies: American Association of Blood Banks, College of American Pathologists, International Society of Blood Transfusions, and Medical Society of the District of Columbia
Disclosure: Nothing to disclose.

Coauthor(s)

Viviana V Johnson, MD, FCAP, Medical Director, Transfusion Services and Armed Services Blood Bank Center, National Naval Medical Center
Viviana V Johnson, MD, FCAP is a member of the following medical societies: American Association of Blood Banks and College of American Pathologists
Disclosure: Nothing to disclose.

Medical Editor

Pradyumna D Phatak, MBBS, MD,, Chair, Division of Hematology and Medical Oncology, Rochester General Hospital; Clinical Professor of Oncology, Roswell Park Cancer Institute
Pradyumna D Phatak, MBBS, MD, is a member of the following medical societies: American Society of Hematology
Disclosure: Novartis Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Ronald A Sacher, MB, BCh, MD, FRCPC, Professor, Internal Medicine and Pathology, Director, Hoxworth Blood Center, University of Cincinnati Academic Health Center
Ronald A Sacher, MB, BCh, MD, FRCPC is a member of the following medical societies: American Society of Hematology
Disclosure: Glaxo Smith Kline Honoraria Speaking and teaching; Talecris Honoraria Board membership

CME Editor

Rajalaxmi McKenna, MD, FACP, Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Emmanuel C Besa, MD, Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Thomas Jefferson University
Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, and New York Academy of Sciences
Disclosure: Nothing to disclose.

 
 
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