Transfusion Reactions: Adverse Effects, Causes and Treatment

A blood transfusion or putting donated blood into a patient’s bloodstream is a procedure used to save lives. It is performed in people undergoing surgery, or in cases of serious loss of blood. A blood transfusion is a delicate procedure that should involve matching blood types to avoid adverse reactions. Having said this, blood transfusions are not always successful and may end up with reactions. Although this is rare, transfusion reactions can cause irreparable damage to kidneys and lungs. They can even be life-threatening.

Signs of Blood Transfusion Reactions

Signs of an Immediate Transfusion Reaction

Blood transfusion takes about half an hour for a pint of blood. The procedure can take longer if more blood is needs to be transfused. A blood transfusion is stopped immediately if the following adverse reactions occur:

  • Difficulty in breathing and fainting
  • High fever and chills
  • A profound sense of dread like something is gravely wrong
  • Uncontrollable itching, swelling or hives
  • Blood in the urine
  • A large swelling at the point of transfusion. Apart from the large swelling, the transfusion point will be painful, and you have a burning sensation.
  • Blood coming out of the site
  • Nausea and vomiting

Signs of a Delayed Transfusion Reaction

Delayed blood transfusion reactions usually occur between day three and day ten after the transfusion. Watch out for the following symptoms:

  • Headaches, blurred vision, and seizures
  • Yellowish eyes and skin
  • Fatigue and body weakness
  • Difficulty in breathing
  • Fever and chills
  • Bruises
  • Passing very little urine or total lack of urination
  • Dark urine

Possible Complications of a Transfusion Reaction

While transfusion reactions may occur, they are usually not serious. However, the following transfusion reactions can be severe and life-threatening:

  • Pulmonary edema – when the lung collects excess fluids
  • Acute kidney failure
  • Anemia
  • Shock resulting from inadequate blood flow

When Should I Seek Immediate Care?

Seek immediate medical attention in case of the following:

  • You experience chest pains and shortness of breath.
  • You experience headaches and are seeing double.
  • You notice purple spots and patches all over your body.
  • You feel sweaty and cold, your fingernails appear blue and you feel disoriented.
  • You are feeling weak after seven days of transfusion.
  • You develop jaundice – yellow eyes and yellowish skin.

What Causes Blood Transfusion Reactions?

Immune-Related Transfusion Reactions

Immune-related reactions occur when your immune system attacks components of the transfused blood or when there is an allergic reaction. The reactions may include:

  • Itching
  • Hives
  • Wheezing
  • Fever

Although rare nowadays, most of these reactions are caused by mistakes made in matching the donated blood to the recipient’s blood.

However, transfusion reactions can still occur even when everything was done correctly. These reactions are usually mild to moderate although some can be extreme and life-threatening.

Immune-related reactions include:

  • Nonhemolytic fever is the most common type of blood transfusion reactions and is likely to recur with a patient who has had more than one blood transfusion. The reaction does not destroy the red blood cells. It happens when the immune system mistakenly identifies transfused blood components as harmful and begins to attack them. This reaction is combated by thorough screening before transfusion.
  • Hemolytic transfusion reactions involve the destruction of red blood cells. They can be life- threatening or cause serious problems. The reaction is due to a mismatch in the rhesus factor. This causes the recipient body’s immune system to attack the transfused blood, destroying the red blood cells,
  • Mild hemolytic transfusion reactions are caused by a mismatch in one or more of the 100 minor blood types. They are not as serious as a mismatch between blood types or rhesus factors.
  • An immune reaction to platelets in transfused blood can cause transfusion reaction, involving the destruction of transfused platelets.

Nonimmune Reactions

Nonimmune blood transfusion reactions usually happen because there is too much fluid caused by transfusion. It mostly happens to first-time patients of a blood transfusion. The condition is treated by putting the patient on medication to increase urination and thereby rid the body of the excess fluid.


Infection occurs when the transfused blood is already infected by bacteria and parasites. Bacterial infection can happen during or after the transfusion and can result in systemic infection. This is, however, very unlikely because of the stringent measures involved in drawing, handling and transfusing blood.

What Increases My Risk of a Blood Transfusion Reaction?

  • Previous transfusion – if you have had a blood transfusion before, chances are that your blood will reject the new blood, with your immune system perceiving the new blood as antigens. If this happens, the body produces antibodies to combat the perceived threat.
  • If you have been pregnant before – the changes that your body undergoes during pregnancy can affect your blood and make it more sensitive to new blood.
  • Preexisting medical conditions – if you are a person living with sickle-cell anemia, chances are that your blood will attack the new blood cells. This form of anemia requires frequent transfusion, hence increasing the risk of blood transfusion reactions.

How Is a Blood Transfusion Reaction Treated?

Various medications can be given in this case:

  • Antihistamines to reduce the effects of allergic reactions such as itching and swelling
  • Antipyretic to reduce fever
  • Epinephrine emergency medication given in case the antihistamines are not working
  • Steroids to reduce inflammation and help clear the air passages
  • Bronchodilators to relax the muscles in the airways when they tighten as a consequence of an allergic reaction
  • Vasopressors to increase your blood pressure and prevent the patient from going into shock as a result of reduced blood pressure
  • IV fluids to help your kidneys get rid of the destroyed red blood cells. They also prevent your blood pressure from getting too low.

How Can I Help Prevent Another Blood Transfusion Reaction?

  • Always give your complete medical history. Even details that you think are unimportant can help save your life. Give details such as previous pregnancies, previous blood transfusion, and preexisting conditions.
  • Alert your doctor or nurse immediately if you feel that something is wrong. They will stop the transfusion and deal with the issue.
  • Request for autologous blood donation (donating blood for your own transfusion a few weeks before the procedure). This minimizes the risk of blood transfusion reaction significantly.
  • Always carry your blood transfusion details with you on a bracelet or card. This will go a long way in helping you in case the reaction starts randomly. 
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