Transfusion reactions

Acute adverse reactions to blood transfusion have been explored several times in the CICM Part II exam:

However, the vast majority of these were clinically oriented data analysis questions, or SAQs dealing with specific complications such as TRALI. Questions about generic complications of blood transfusion have mainly remained in the First Part exam:

Thus, what follows is a brief summary to inform the last-minute revision for the red haze panic of the last days. A more complete discussion of adverse effects of blood transfusion is carried out elsewhere.

Acute immunological complications

  • Acute hemolytic transfusion reactions
  • Febrile nonhemolytic transfusion reactions
  • Tranfusion-associated lung injury (TRALI)
  • Allergic reactions to blood products

Acute non-immunological complications

  • Transfusion-associated circulatory overload (TACO)
  • Bacterial sepsis due to contaminated blood products
  • Hypocalcemia due to citrate
  • Hyperkalemia due to high PRBC K+ content
  • Acidosis due to high PRBC lactate content
  • Hypothermia due to use of recently refrigerated PRBCs
  • Dilutional coagulopathy due to inappropriate blood product replacement proportions
  • Dilutional thrombocytopenia due to lack of platelet replacement

Delayed immunological complications

  • Delayed hemolytic transfusion reactions
  • Transfusion-related immune modulation (TRIM)  
  • Microchimerism - the persistence of an allogeneic cell population of leucocytes
  • Posttransfusion graft-vs-host disease (due to non-leukodepleted PRBCs)
  • Posttransfusion purpura

Delayed non-immunological complications

  • Transfusion-transmitted diseases, eg. HIV, Hep C
  • Iron overload
  • Creutzfeld-Jacob disease


NZBLOOD Transfusion Medicine Handbook (2008)

Bux, Jürgen, and Ulrich JH Sachs. "The pathogenesis of transfusion‐related acute lung injury (TRALI)." British journal of haematology 136.6 (2007): 788-799.

Fontaine, Magali J., et al. "Diagnosis of transfusion-related acute lung injury: TRALI or not TRALI?." Annals of Clinical & Laboratory Science 36.1 (2006): 53-58.

Kleinman, Steven, et al. "Toward an understanding of transfusion‐related acute lung injury: statement of a consensus panel." Transfusion 44.12 (2004): 1774-1789.

Gajic, Ognjen, Michael A. Gropper, and Rolf D. Hubmayr. "Pulmonary edema after transfusion: how to differentiate transfusion-associated circulatory overload from transfusion-related acute lung injury." Critical care medicine 34.5 (2006): S109-S113.

Vincent, E. Chris, and Tracy Willett. "Post-Transfusion Purpura." The Journal of the American Board of Family Practice 4.3 (1991): 175-177.