The prognosis for each immune-mediated transfusion reaction varies considerably according to the type of reaction.
Acute haemolytic transfusion reaction
The severity of these reactions varies greatly and is related to the volume of incompatible blood transfused.[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
Mortality from acute haemolytic transfusion reaction is reported at around 1 per 1.8million transfused RBC units.[49]Vamvakas EC, Blajchman MA. Transfusion-related mortality: the ongoing risks of allogeneic blood transfusion and the available strategies for their prevention. Blood. 2009 Apr 9;113(15):3406-17.
https://ashpublications.org/blood/article/113/15/3406/24952/Transfusion-related-mortality-the-ongoing-risks-of
http://www.ncbi.nlm.nih.gov/pubmed/19188662?tool=bestpractice.com
Febrile non-haemolytic transfusion reaction
These episodes are benign in nature and self-limited, resolving shortly after discontinuation of the transfusion. If no clinical concern for haemolysis exists, transfusion may be resumed. Alternatively, the patient may be transfused with a new component.[1]Soutar R, McSporran W, Tomlinson T, et al. Guideline on the investigation and management of acute transfusion reactions. Br J Haematol. 2023 Jun;201(5):832-44.
https://onlinelibrary.wiley.com/doi/10.1111/bjh.18789
http://www.ncbi.nlm.nih.gov/pubmed/37211954?tool=bestpractice.com
Allergic reaction
Most episodes are relatively mild (primarily urticarial reactions) and respond promptly to antihistamine administration. Anaphylactic reactions, however, may result in severe morbidity (such as anoxic brain injury) or mortality if hypoxia is profound and/or prolonged.
Delayed haemolytic transfusion reaction
Most episodes are benign in nature and self-limited, or even subclinical.
Transfusion-associated graft-versus-host disease
Almost universally fatal.[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
[30]Dwyre DM, Holland PV. Transfusion-associated graft-versus-host disease. Vox Sang. 2008 Aug;95(2):85-93.
http://www.ncbi.nlm.nih.gov/pubmed/18544121?tool=bestpractice.com
Post-transfusion purpura
Spontaneous recovery, usually within a few weeks.[47]Mueller-Eckhardt C, Kiefel V. High-dose IgG for post-transfusion purpura--revisited. Blut. 1988 Oct;57(4):163-7.
http://www.ncbi.nlm.nih.gov/pubmed/3139110?tool=bestpractice.com
[48]Anderson D, Ali K, Blanchette V, et al. Guidelines on the use of intravenous immune globulin for hematologic conditions. Transfus Med Rev. 2007 Apr;21(2 suppl 1):S9-56.
http://www.ncbi.nlm.nih.gov/pubmed/17397769?tool=bestpractice.com