What is the prevalence of transfusion reactions in the US?

Updated: Jan 12, 2021
  • Author: S Gerald Sandler, MD, FCAP, FACP; Chief Editor: Emmanuel C Besa, MD  more...
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Approximately 20.9 million units of blood components, including approximately 13.8 million units of whole blood or red blood cells, were transfused in 2011 in the United States; this was a decrease of 11.6% from 2008, and most likely reflects growing adoption of blood management processes. Adverse transfusion reactions were reported to hospital transfusion services for 0.24% of transfused components. [25, 13]

The frequency of specific types of reactions is as follows:

  • TRALI: Estimated to occur in 0.014-0.08% of blood component transfusions or in 0.04-0.16% of patients transfused [27, 28, 29, 30, 31, 32, 33]

  • Circulatory (volume) overload: Varies with concurrent illness; overall risk approximately 1 in 100 [32]

  • Bacterial contamination/endotoxemia: The incidence of septic reactions may be as high as one case per 700 pooled random donor platelet concentrates and one case per 4000 single-donor (apheresis) platelet products. In a study of 1,004,206 apheresis platelet collections, 186 (1:5399) had confirmed-positive bacterial cultures. [34] The frequency of sepsis associated with bacterially contaminated RBCs is estimated to be one in 250,000. [35] The frequency of contaminated RBCs based on culturing was one in 38,465 or 2.6/100,000 units. [36, 37]

  • Acute hemolytic, immune mediated (fatal): One case per 250,000-600,000 population

  • Acute hemolytic, immune mediated (nonfatal): One case per 6000-33,000 population

  • Acute hemolytic, nonimmune: Infrequent

  • Febrile, nonhemolytic: The frequency of febrile nonhemolytic transfusion reactions increases directly with the number of previous transfusions or pregnancies in the recipient, as well as the presence of leukocytes and/or plasma in the transfused component. Of nearly 100,000 units of whole blood and RBCs transfused, less than 1% resulted in a febrile reaction, and only 15% experienced a second reaction when subsequently transfused. [38]

  • Allergic: One case per 333 population

  • Anaphylactic: The estimated frequency is one in 20,000 to 47,000 blood components transfused [39]

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