Blood Transfusion Reactions: Symptoms & Treatment Options

A Blood Transfusion Reaction is defined as an event that occurs whenever there is an adverse reaction resulting due to transfusion of blood or one of its components. The reactions are quite variable where in some cases there may no symptoms or complications while in others it may cause life threatening complications. Blood Transfusion Reaction can occur at the time of transfusion or some days or even weeks after it. A reaction occurring during a blood transfusion is called Acute Blood Transfusion Reaction and a reaction occurring a few days after transfusion is called delayed Blood Transfusion Reaction.^{[1, 2, 3]}

It is quite a challenge to accurately diagnose this condition as it often causes symptoms that mimic several other medical issues as well. However, most common presenting features of Blood Transfusion Reaction include fever, chills, rashes, and itching. There are many symptoms of this condition which do not require any treatment and resolve spontaneously. However, aggressive treatment becomes necessary in cases where the person experiences problems with breathing, fever, hypotension, hematuria as all of these symptoms point to a severe reaction.^{[1, 2, 3]}

There are various types of Blood Transfusion Reactions and include acute hemolytic and delayed hemolytic reaction, febrile non-hemolytic, anaphylactic reaction, allergic reaction, septic reaction, and transfusion related acute lung injury. If a physician feels that a person is having a reaction then he or she should immediately stop the transfusion and start treatment.^{[1, 2, 3]} This article highlights some of the symptoms and treatment options available for Blood Transfusion Reactions.

An adverse reaction to a blood transfusion can be best judged by the following symptoms to include fever, chills, urticaria, and itching. These symptoms generally resolve and do not require any specific treatment. A more severe reaction can be judged by respiratory distress, hypotension, hematuria and high fever. As stated, Blood Transfusion Reactions are of two types, the symptoms and treatment options for which have been detailed below.^[3]

Acute Transfusion Reactions: These include:

1. Simple Allergic Reaction: These reactions can occur despite the recipient getting the correct blood type. The reactions primarily occur as a result of the presence of certain plasma proteins in the donor blood that the recipient blood perceives as allergen. It can also be caused due to donor blood containing food allergens, or presence of certain antibodies in the donor blood that react with the antibodies present in the recipient blood. The symptoms of these reactions are generally mild and include itching, rash, and hives.^[3] Treatment: Stopping the transfusion is the primary treatment for an allergic reaction. The patient can also be given antihistamine to manage the symptoms of the reaction.^[3]
2. Anaphylactic Transfusion Reaction: This occurs in people who have IgA deficiencies and have IgA antibodies in their plasma. These antibodies in the recipient blood may react with the antibodies in the donor blood causing symptoms like itching, hives, flushed skin, problems with breathing, wheezing, lips becoming cyanotic, vomiting, and hypotension.^[3] Treatment: The frontline treatment is stopping the transfusion and then addressing the symptoms. This will be done by way of intravenous epinephrine and steroids, antihistamines, and bronchodilators.^[3]
3. Febrile Non-Hemolytic Transfusion Reaction: This is the most common type of Blood Transfusion Reaction and involves a significant rise in body temperature during the transfusion or a few hours after it. The rise in temperature is a reaction of the recipient white blood cells to the new blood from the donor. The symptoms of this reaction are variable and depend on the severity of the condition and may include high fever and chills.^[3] Treatment: In cases of this reaction, blood transfusion is topped immediately. In majority of the cases, the symptoms of the reaction are mild and resolve with treatment. Acetaminophen or aspirin are the most preferred medications; however, if other symptoms are present then more investigations need to be done to get to the bottom of the cause and start treatment for it.^[3]
4. Acute Hemolytic Transfusion Reaction: This type of reaction occurs either during the transfusion, immediately after or about 24 hours after it. This basically occurs when there is a mismatch of blood types. As soon as the transfusion begins, the body of the recipient starts destroying the new blood causing variety of symptoms to include hypotension, chills, renal failure, and back pain. Rarely, it may cause fever and hematuria.^[3] Treatment: The transfusion will first be stopped and depending on the severity of the symptoms IV fluids or dialysis may be started.^[3]
5. Septic Transfusion Reactions: This reaction occurs when the platelets of the donor blood get contaminated with bacteria. The symptoms of these reactions include fever, chills, and hypotension.^[3] Treatment: This type of Blood Transfusion Reaction requires emergent treatment which involves respiratory support, antibiotics, and fluid management.^[3]

Delayed Transfusion Reactions: Some of the types of this Blood Transfusion Reaction include:^[3]

1. Delayed Hemolytic Transfusion Reaction – This reaction occurs when recipient antibody reacts to red cell antigens. The symptoms of this reaction become evident between 24 hours to one month after the transfusion. These antibodies can be acquired by the recipient through previous pregnancies or blood transfusions. These antibodies gradually decrease with time. Some of the symptoms of this reaction include fever, jaundice, pain in the abdomen, hypertension, dark colored urine, and labored breathing.^[3] Treatment: In most of these cases, there is no treatment required aside from hydration in severe cases.^[3]
2. Posttransfusion Purpura: This is quite rare and it occurs when the recipient develops antibodies that start destroying the platelets. This results in the levels of the platelets to decline. Symptoms of this reaction include fever, chills, and bleeding from the GI tract.^[3] Treatment: Treatment is usually supportive. However, IV immunoglobulins and steroids are sometimes used.^[3]

In conclusion, a Blood Transfusion Reaction can cause a variety of complications depending on the type of reaction that have been detailed above. Some of the complications include kidney failure, injury to the lungs, and formation of blood clots. It is essential for a person who suspects that he or she may be having Blood Transfusion Reaction to consult a physician to determine a cause and start treatment for it.^{[1, 2, 3]}

The Center for Disease Control states that every year approximately 17.2 million units of blood products are transfused every year in the United States and in majority of the cases there are no reactions observed. However, in case if a person develops some reaction and has symptoms like shortness of breath, hypotension, or hematuria it is better to go to the emergency room for treatment as it may indicate a Blood Transfusion Reaction, especially if a person has had a blood transfusion lately.^[3]

References:

Also Read:

• What is Blood Transfusion & When Do We Need It?
• Blood Groups and Matching: Under What Conditions Is Blood Transfusion Done & the Needed Precautions
• Blood Transfusion: Risks, Complications, Safety Measures