Acute haemolytic transfusion reaction occurs during or immediately after transfusion and is usually the result of a clerical error, with misidentification of the patient or mislabelling of the blood product.[3]Panch SR, Montemayor-Garcia C, Klein HG. Hemolytic transfusion reactions. N Engl J Med. 2019 Jul 11;381(2):150-62.
http://www.ncbi.nlm.nih.gov/pubmed/31291517?tool=bestpractice.com
[4]Laureano M, Khandelwal A, Yan M. Canadian Blood Services. Clinical guide to transfusion: transfusion reactions (chapter 10). Oct 2022 [internet publication].
https://professionaleducation.blood.ca/en/transfusion/clinical-guide/transfusion-reactions
In the US, the incidence of red-cell products transfused to the wrong patient is estimated to range from 1/12,000 to 1/19,000 transfusions.[10]Linden JV, Wagner K, Voytovich AE, et al. Transfusion errors in New York state: an analysis of 10 years' experience. Transfusion. 2000 Oct;40(10):1207-13.
http://www.ncbi.nlm.nih.gov/pubmed/11061857?tool=bestpractice.com
[11]Spiess BD. Risks of transfusion: outcome focus. Transfusion. 2004 Dec;44(12 Suppl):4S-14S.
http://www.ncbi.nlm.nih.gov/pubmed/15585000?tool=bestpractice.com
[12]Karim F, Moiz B, Shamsuddin N, et al. Root cause analysis of non-infectious transfusion complications and the lessons learnt. Transfus Apher Sci. 2014 Feb;50(1):111-7.
http://www.ncbi.nlm.nih.gov/pubmed/24239270?tool=bestpractice.com
Mortality from an acute haemolytic transfusion reaction is estimated to occur in approximately 1:600,000-1.5 million transfusions.[6]American Red Cross. A compendium of transfusion practice guidelines: fourth edition. 2021 [internet publication].
https://www.redcrossblood.org/content/dam/redcrossblood/rcb/biomedical-services/components/compendium_v_4.0.pdf
[13]Sazama K. Reports of 355 transfusion-associated deaths: 1976 through 1985. Transfusion. 1990 Sep;30(7):583-90.
http://www.ncbi.nlm.nih.gov/pubmed/2402771?tool=bestpractice.com
Febrile non-haemolytic transfusion reaction is one of the more common transfusion reactions. In the clinical setting of universal leukoreduction of the blood supply, the frequency of febrile non-haemolytic transfusion reaction is 0.15% to 0.19% for red cells and 0.11% to 0.15% for platelets. Where non-leukoreduced products are routinely administered, the frequency is higher, at 0.33% to 0.37% for red cells and 0.45% to 2.18% for platelets.[14]Yazer MH, Podlosky L, Clarke G, et al. The effect of prestorage WBC reduction on the rates of febrile nonhemolytic transfusion reactions to platelet concentrates and RBC. Transfusion. 2004 Jan;44(1):10-5.
http://www.ncbi.nlm.nih.gov/pubmed/14692961?tool=bestpractice.com
[15]Paglino JC, Pomper GJ, Fisch GS, et al. Reduction of febrile but not allergic reactions to RBCs and platelets after conversion to universal prestorage leukoreduction. Transfusion. 2004 Jan;44(1):16-24.
http://www.ncbi.nlm.nih.gov/pubmed/14692962?tool=bestpractice.com
[16]King KE, Shirey RS, Thoman SK, et al. Universal leukoreduction decreases the incidence of febrile nonhemolytic transfusion reactions to RBCs. Transfusion. 2004 Jan;44(1):25-9.
http://www.ncbi.nlm.nih.gov/pubmed/14692963?tool=bestpractice.com
Allergic reactions are common, with an overall incidence of 0.4% to 3% of transfusions.[6]American Red Cross. A compendium of transfusion practice guidelines: fourth edition. 2021 [internet publication].
https://www.redcrossblood.org/content/dam/redcrossblood/rcb/biomedical-services/components/compendium_v_4.0.pdf
[17]Tobian AA, King KE, Ness PM. Transfusion premedications: a growing practice not based on evidence. Transfusion. 2007 Jun;47(6):1089-96.
http://www.ncbi.nlm.nih.gov/pubmed/17524101?tool=bestpractice.com
Most reactions involve urticaria alone. Anaphylactic reactions are rare, occuring in about 1/20,000 to 1/50,000 transfusions.[6]American Red Cross. A compendium of transfusion practice guidelines: fourth edition. 2021 [internet publication].
https://www.redcrossblood.org/content/dam/redcrossblood/rcb/biomedical-services/components/compendium_v_4.0.pdf
[18]Domen RE, Hoeltge GA. Allergic transfusion reactions: an evaluation of 273 consecutive reactions. Arch Pathol Lab Med. 2003 Mar;127(3):316-20.
https://meridian.allenpress.com/aplm/article/127/3/316/453670/Allergic-Transfusion-ReactionsAn-Evaluation-of-273
http://www.ncbi.nlm.nih.gov/pubmed/12653575?tool=bestpractice.com
[19]Stainsby D, Jones H, Asher D, et al. Serious hazards of transfusion: a decade of hemovigilance in the UK. Transfus Med Rev. 2006 Oct;20(4):273-82.
http://www.ncbi.nlm.nih.gov/pubmed/17008165?tool=bestpractice.com
Although difficult to determine precisely, the incidence of delayed haemolytic transfusion reaction is estimated to be approximately 1/2500 transfusions.[11]Spiess BD. Risks of transfusion: outcome focus. Transfusion. 2004 Dec;44(12 Suppl):4S-14S.
http://www.ncbi.nlm.nih.gov/pubmed/15585000?tool=bestpractice.com
[20]Vamvakas EC, Pineda AA, Reisner R, et al. The differentiation of delayed hemolytic and delayed serologic transfusion reactions: incidence and predictors of hemolysis. Transfusion. 1995 Jan;35(1):26-32.
http://www.ncbi.nlm.nih.gov/pubmed/7998064?tool=bestpractice.com
Transfusion-associated graft-versus-host disease is rarely observed, and is largely confined to patients with immunosuppression.[9]Foukaneli T, Kerr P, Bolton-Maggs PHB, et al. Guidelines on the use of irradiated blood components. Br J Haematol. 2020 Dec;191(5):704-24.
https://onlinelibrary.wiley.com/doi/10.1111/bjh.17015
http://www.ncbi.nlm.nih.gov/pubmed/32808674?tool=bestpractice.com
[21]Mazzei CA, Popovsky MA, Kopko PM. Noninfectious complications of blood transfusion. In: Roback JD, Combs MR, Grossman BJ, et al., eds. Technical Manual, 16th Ed. Bethesda, MD: American Association of Blood Banks; 2008:715-49. Post-transfusion purpura occurs relatively uncommonly, with an incidence of less than 1 in 2,000,000 in the US.[6]American Red Cross. A compendium of transfusion practice guidelines: fourth edition. 2021 [internet publication].
https://www.redcrossblood.org/content/dam/redcrossblood/rcb/biomedical-services/components/compendium_v_4.0.pdf
It is observed more commonly in females than males, most often in multi-parous, middle-aged women.[22]Hawkins J, Aster RH, Curtis BR. Post-transfusion purpura: current perspectives. J Blood Med. 2019;10:405-15.
https://www.dovepress.com/post-transfusion-purpura-current-perspectives-peer-reviewed-fulltext-article-JBM
http://www.ncbi.nlm.nih.gov/pubmed/31849555?tool=bestpractice.com
Transfusion-related acute lung injury (TRALI) incidence is estimated to be between 0.04% and 0.1% of all transfusions.[23]Finlay HE, Cassorla L, Feiner J, et al. Designing and testing a computer-based screening system for transfusion-related acute lung injury. Am J Clin Pathol. 2005 Oct;124(4):601-9.
http://www.ncbi.nlm.nih.gov/pubmed/16146824?tool=bestpractice.com
[24]Rana R, Fernandez-Perez ER, Khan SA, et al. Transfusion-related acute lung injury and pulmonary edema in critically ill patients: a retrospective study. Transfusion. 2006 Sep;46(9):1478-83.
http://www.ncbi.nlm.nih.gov/pubmed/16965572?tool=bestpractice.com
TRALI is the leading cause of transfusion-related mortality in the US.[4]Laureano M, Khandelwal A, Yan M. Canadian Blood Services. Clinical guide to transfusion: transfusion reactions (chapter 10). Oct 2022 [internet publication].
https://professionaleducation.blood.ca/en/transfusion/clinical-guide/transfusion-reactions
[25]Silliman CC, Ambruso DR, Boshkov LK. Transfusion-related acute lung injury. Blood. 2005 Mar 15;105(6):2266-73.
http://www.ncbi.nlm.nih.gov/pubmed/15572582?tool=bestpractice.com
[26]Looney MR, Gropper MA, Matthay MA. Transfusion-related acute lung injury: a review. Chest. 2004 Jul;126(1):249-58.
http://www.ncbi.nlm.nih.gov/pubmed/15249468?tool=bestpractice.com