Blood Transfusion Reactions

TYPE PATHOGENESIS CLINICAL PRESENTATION TIMING
Allergic/anaphylactic reaction Type I hypersensitivity reaction against plasma proteins in transfused blood. IgA-deficient individuals must receive blood products without IgA. Urticaria, pruritus, fever, wheezing, hypotension, respiratory arrest, shock. Within minutes to 2–3 hours
Febrile nonhemolytic transfusion reaction Two known mechanisms: type II hypersensitivity reaction with host antibodies against donor HLA and WBCs; and induced by cytokines that are created and accumulate during the storage of blood products. Fever, headaches, chills, flushing. Within 1–6 hours
Acute hemolytic transfusion reaction Type II hypersensitivity reaction.

Intravascular hemolysis (ABO blood group incompatibility) or extravascular hemolysis (host antibody reaction against foreign antigen on donor RBCs).

Fever, hypotension, tachypnea, tachycardia, flank pain, hemoglobinuria (intravascular hemolysis), jaundice (extravascular). Within 1 hour
Transfusion-related acute lung injury Donor anti-leukocyte antibodies against recipient neutrophils and pulmonary endothelial cells. Respiratory distress and noncardiogenic pulmonary edema. Within 6 hours

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