Epidemiology

Acute hemolytic 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][4]​​​​ 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][11][12]​​​ Mortality from an acute hemolytic transfusion reaction is estimated to occur in approximately 1:600,000-1.5 million transfusions.[6][13]

Febrile nonhemolytic 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 nonhemolytic transfusion reaction is 0.15% to 0.19% for red cells and 0.11% to 0.15% for platelets. Where nonleukoreduced 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][15][16]

Allergic reactions are common, with an overall incidence of 0.4% to 3% of transfusions.[6][17] Most reactions involve urticaria alone. Anaphylactic reactions are rare, occuring in about 1/20,000 to 1/50,000 transfusions.[6][18][19] Although difficult to determine precisely, the incidence of delayed hemolytic transfusion reaction is estimated to be approximately 1/2500 transfusions.[11][20]​​​ Transfusion-associated graft-versus-host disease is rarely observed, and is largely confined to patients with immunosuppression.[9][21] Post-transfusion purpura occurs relatively uncommonly, with an incidence of less than 1 in 2,000,000 in the US.[6]​ It is observed more commonly in females than males, most often in multiparous, middle-aged women.[22]​ Transfusion-related acute lung injury (TRALI) incidence is estimated to be between 0.04% and 0.1% of all transfusions.[23][24]​ TRALI is the leading cause of transfusion-related mortality in the US.[4][25][26]

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