Blood transfusion reaction A hemolytic transfusion reaction is a serious complication that can occur after a blood transfusion. The reaction occurs when the red blood cells that were given during the transfusion are destroyed by the person's immune system. When red blood cells are destroyed, the process is called hemolysis. There are other types of allergic transfusion reactions that do not cause hemolysis. A complication of blood transfusion where there is an immune response against the transfused blood cells.
Blood is classified into four different types: A, B, AB, and O. Another way blood cells may be classified is by Rh factors. People who have Rh factors in their blood are called "Rh positive." People without these factors are called "Rh negative." Rh negative people form antibodies against Rh factor if they receive Rh positive blood. There are also other factors to identify blood cells, in addition to ABO and Rh. Your immune system can usually tell its own blood cells from those of another person. If you receive blood that is not compatible with your blood, your body produces antibodies to destroy the donor's blood cells. This process causes the transfusion reaction. Blood that you receive in a transfusion must be compatible with your own blood. This means that your body does not have antibodies against the blood you receive. Most of the time, a blood transfusion between compatible groups (such as O+ to O+) does not cause a problem. Blood transfusions between incompatible groups (such as A+ to O-) cause an immune response. This can lead to a serious transfusion reaction. The immune system attacks the donated blood cells, causing them to burst. Today, all blood is carefully screened. Transfusion reactions are rare.
Symptoms may include any of the following: Symptoms of a hemolytic transfusion reaction most often appear during or right after the transfusion. Sometimes, they may develop after several days (delayed reaction).
If symptoms occur during the transfusion, the transfusion must be stopped right away. Blood samples from the recipient (person getting the transfusion) and from the donor may be tested to tell whether symptoms are being caused by a transfusion reaction. Mild symptoms may be treated with:
Outcome depends on how severe the reaction is. The disorder may disappear without problems. Or, it may be severe and life threatening.
Complications may include:
Tell your health care provider if you are having a blood transfusion and you have had a reaction before.
Donated blood is put into ABO and Rh groups to reduce the risk for transfusion reaction. Before a transfusion, recipient and donor blood are tested (cross-matched) to see if they are compatible. A small amount of donor blood is mixed with a small amount of recipient blood. The mixture is checked under a microscope for signs of antibody reaction. Before the transfusion, your provider will usually check again to make sure you are receiving the right blood.
Hall JE, Hall ME. Blood types; transfusion; and tissue and organ transplantation. In: Hall JE, Hall ME, eds. Guyton and Hall Textbook of Medical Physiology. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 36. Savage W. Transfusion reactions to blood and cell therapy products. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 119. Shaz BH, Hillyer CD. Transfusion medicine. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 167.
Last reviewed on: 1/19/2021 Reviewed by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
 Blood transfusions are a life-sustaining and life-saving treatment but they aren’t without risk. Conditions that warrant blood transfusions range from acute trauma to intraoperative blood loss to compromised blood-cell production secondary to disease or treatment. If you’re a nurse on the front line of patient care, you must be adept at administering blood products safely and managing adverse reactions with speed and confidence. Why reactions occurBlood transfusion reactions typically occur when the recipients immune system launches a response against blood cells or other components of the transfused product. These reactions may occur within the first few minutes of transfusion (classified as an acute reaction) or may develop hours to days later (delayed reaction). If red blood cells are destroyed, the reaction may be classified further as hemolytic all other types of reactions are broadly classified as nonhemolytic. Some reactions result from infectious, chemical, or physical forces or from human error during blood-product preparation or administration. (For details on types of reactions, signs and symptoms, appropriate interventions, and prevention methods, see A closer look at transfusion reactions by clicking on the PDF icon above) Before starting the transfusionSafe practice starts with accurate collection of pretransfusion blood samples for typing and crossmatching. Some facilities may require a second authorized staff member to witness and sign the form as the phlebotomist obtains the specimen. Also take these other key actions before you begin the transfusion:
PremedicationTo help prevent immunologic transfusion reactions, the physician may order such medications as acetaminophen and diphenhydramine before the transfusion begins to prevent fever and histamine release. Febrile nonhemolytic transfusion reactions seem to be linked to blood components, such as platelets or fresh frozen plasma, as opposed to packed red blood cells; thus, premedication may be indicated for patients who will receive these products. Such reactions may be mediated by donor leukocytes in the plasma, causing allosensitization to human leukocyte antigens. Cytokine generation and accumulation during blood component storage may play a contributing role. Leukocyte-reduced and irradiated blood productsUse of blood products that have been leukocyte-reduced, irradiated, or both has been shown to reduce complications stemming from an immunologic response. In organ transplant candidates, these products reduce the risk of graft rejection. Administering the transfusionMake sure you know the window of time during which the product must be transfused starting from when the product arrives from the blood bank to when the infusion must be completed. (See Quick guide to blood products by clicking on the PDF icon above). Failing to adhere to these time guidelines increases the risk of such complications as bacterial contamination. Detecting and managing transfusion reactionsDuring the transfusion, stay alert for signs and symptoms of a reaction, such as fever or chills, flank pain, vital sign changes, nausea, headache, urticaria, dyspnea, and broncho spasm. Optimal management of reactions begins with a standardized protocol for monitoring and documenting vital signs. As dictated by facility policy, obtain the patients vital signs before, during, and after the transfusion. If you suspect a transfusion reaction, take these immediate actions:
Also return the blood product to the blood bank and collect laboratory samples according to facility policy. If and when clinically necessary, resume the transfusion after obtaining a physician order. Carefully document transfusion-related events according to facility policy; be sure to include the patients vital signs, other assessment findings, and nursing interventions. Most fatal transfusion reactions result from human error. The most important step in preventing such error is to know and follow your facilities policies and procedures for administering blood products. Be aware, though, that prevention isn’t always possible which means you must be able to anticipate potential reactions and be prepared to manage them effectively. To promote good patient outcomes, you must be knowledgeable about the best practices described in this article. Selected references Silvergleid A. Immunologic blood transfusion reactions. UpToDate. October 17, 2008. www.uptodate.com/patients/content/topic.do?topicKey=~EE8E1UGcUSyKQT. Accessed December 22, 2008. Sabrina Bielefeldt and Justine DeWitt are Oncology Certified Nurses at Georgetown University Hospital in Washington, D.C. Ms. Bielefeldt is the Clinical Manager and Ms. DeWitt is a Clinical Nurse IV on the Inpatient Hematology Oncology unit. Ms. DeWitt also serves as Co-Chair of the hospitals Nursing Practice Council. |
A nurse is caring for a client who is receiving a blood transfusion. the client reports flank pain
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