Case history
Case history #1
A 60-year-old woman receives a red-cell transfusion following total hip arthroplasty. Midway through the transfusion, she complains of chills, and her temperature rises from 99.7°F (37.6°C) to 102°F (38.9°C). She remains hemodynamically stable. The transfusion is stopped, and laboratory evaluation demonstrates a negative direct antiglobulin test. Her fever resolves shortly after the discontinuation of the transfusion.
Case history #2
A 30-year-old man with multiple extremity injuries following a motor vehicle collision is stable but anemic. Shortly after a transfusion begins, the patient complains of pruritus of the neck and chest. He is noted to have developed an urticarial rash on the chest. The transfusion is stopped and an antihistamine administered. The patient's symptoms promptly resolve.
Other presentations
Febrile nonhemolytic transfusion reaction and allergic urticarial reaction are the most common acute transfusion reactions seen in clinical practice. Acute hemolytic transfusion reactions are less common and may present similarly to febrile nonhemolytic transfusion reactions, but tend to rapidly progress toward hemodynamic shock, renal failure and disseminated intravascular coagulation. Delayed reactions are also less common and include delayed hemolytic transfusion reactions (usually mild or subclinical in nature), transfusion-associated graft-versus-host disease (presents with a maculopapular rash and gastroenteritis), and post-transfusion purpura (presents with mucosal bleeding and thrombocytopenia).
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