Immunologic blood transfusion reactions:
Type
Pathogenesis
Timing
Clinical presentation
Blood type
Allergic/anaphylactic reaction
- Type I hypersensitivity reaction against plasma proteins in transfused blood.
- IgA-deficient individuals should receive blood products without IgA.
Within minutes to 2–3 hr (due to release of preformed inflammatory mediators in degranulating mast cells)
- Allergies: urticaria, pruritus.
- Anaphylaxis: wheezing, hypotension, respiratory arrest, shock
Acute hemolytic transfusion reaction
- Type II hypersensitivity reaction.
- Typically causes intravascular hemolysis (ABO blood group incompatibility).
During transfusion or within 24 hr (due to preformed antibodies)
Fever, hypotension, tachypnea, tachycardia, flank pain, hemoglobinuria (intravascular), jaundice (extravascular)
Febrile nonhemolytic transfusion reaction
- Cytokines created by donor WBCs accumulate during storage of blood products.
- Reactions prevented by leukoreduction of blood products.
Within 1–6 hr (due to preformed cytokines)
- Fever, headaches, chills, flushing.
- More common in children
Transfusion-related acute lung injury
Two-hit mechanism:
- Neutrophils are sequestered and primed in pulmonary vasculature due to recipient risk factors
- Neutrophils activated by product (eg, antileukocyte antibodies) in transfused blood release inflammatory mediators → ⬆️capillary permeability → pulmonary edema.
Within minutes to 6 hr
Respiratory distress, noncardiogenic pulmonary edema
Delayed hemolytic transfusion reaction
- Anamnestic response to a foreign antigen on donor RBCs (Rh [D] or other minor blood group antigens) previously encountered by recipient.
- Typically causes extravascular hemolysis.
- Onset over 24 hr.
- Usually presents within 1–2 wk (due to slow destruction by reticuloendothelial system)
- Generally self-limited and clinically silent.
- Mild fever, hyperbilirubinemia
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