What should be the focus of history in the evaluation of transfusion reactions?

Updated: Jan 12, 2021
  • Author: S Gerald Sandler, MD, FCAP, FACP; Chief Editor: Emmanuel C Besa, MD  more...
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A history of previous blood transfusions or pregnancy is often present but is not essential for the diagnosis of a febrile nonhemolytic transfusion. Acute transfusion reactions caused by ABO antibodies, transfusion-related acute lung injury (TRALI; from donor's antibodies), allergy, IgA/anti-IgA anaphylaxis, or sepsis may occur during the first transfusion or subsequent transfusions.

Persons known to have formed red cell alloantibodies as the result of previous transfusions or pregnancy should be informed and provided with a written report listing the antibodies to be presented to the transfusion service if additional transfusions are required at another hospital.

Red cell antibodies may decrease in titer and, although remaining clinically important, may not be detected by routine compatibility testing before future red cell transfusions. Ask patients scheduled for red cell transfusions about any history of previous transfusions and if they are aware of any complications or blood bank antibody problems. Obtain details of any previous transfusions during the medical history or when obtaining the patient's informed consent for a transfusion.

In individuals with sickle cell disease, clinical manifestations of delayed hemolytic transfusion reactions (DHTRs) usually appear 5–15 days after the triggering transfusion, and include hemoglobinuria, jaundice, and pallor due to acute hemolysis. In addition, patients may have signs and symptoms that mimic severe vaso-occlusive crisis (ie, pain, fever, and acute chest syndrome), as well as profound anemia, often with reticulocytopenia. If DHTR is misdiagnosed as vaso-occluisive crisis and the patient is treated with an additional transfusion, this may further exacerbate hemolysis and clinical symptoms and cause life-threatening multiorgan failure. [5, 6]

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