Overview Common/minor adverse reactions to blood transfusion febrile non-hemolytic transfusion reaction occurs a few hours after a transfusion presents with minor fever/chills caused by host antibody response to donor WBC antigens responds well to NSAIDs (no therapy needed) no hemodynamic abnormalities transfusion-related acute lung injury (TRALI) aka leukoagglutination reaction antibodies in donor blood against receipient white cells occurs 30 minutes after transfusion shortness of breath common transient infiltrates seen on chest radiograph treatment none resolves spontaneously IgA deficiency anaphylaxis against donor IgA (the patient has no IgA and forms an immune response against it) immediately after receiving transfusion patient experiences hypotension shortness of breath tachycardia labs normal LDH and bilirubin (against the IgA not the RBC's) treatment/prevention use blood donations from IgA deficient donors minor blood group incompatibility immune reaction to Kell, Lewis, Duffy, or Kidd antigens or Rh incompatibility presents as delayed jaundice, poor increase in hematocrit from transfusion, but otherwise asymptomatic treatment none resolves spontaneously Serious adverse reactions to blood transfusion ABO incompatibility occurs duringa transfusion acute symptoms of hemolysis (hypotension, tachycardia) other symptoms include back pain, chest pain, dark urine labs LDH and bilirubin are elevated haptoglobin decreased treatment stop transfusion and obtain sample for direct Coombs test dilutional pancytopenia infusions of RBCs/fluids dilutes blood cells through plasma expansion and results in pancytopenia Other effects citrate toxicity an anticoagulant used in blood products chelates calcium and magnesium normally rapidly metabolized by liver may cause hypocalcemia and hypomagnesemia leading to paresthesias hyperkalemia RBC's leak K+ during storage pseudohyperkalemia damage to RBC's from tourniquet placement or a lab phenomena requires no treatment, not genuine hyperkalemia coagulopathy may require transfusion of FFP and platelets