Reaction Type

Signs and Symptom

Etiology

Clincical Action

Allergic

(Mild)

Pruritus, urticaria (hives)

Antibodies to plasma proteins

Steps 1‑3 above; administer antihistamines (P0, IM, or IV); resume transfusion if improved; if no improvement in 30 minutes treat as below.

Allergic

(Moderate to Severe)

Hives, Dyspnea, abdominal pain, hypotension, nausea, anaphylaxis

Antibodies to plasma proteins, including IgA

Steps 1‑5 above; administer antihistamines, epinephrine, vasopressors, and corticosteriods as needed; avoid future reactions by premedication and use of washed red cells.

Febrile (mild to moderate)

Fever, chills, rigors, anxiety, mild dyspnea

Antibodies to leukocyte antigens, (Mostly HLA), cytokines

Steps 1‑5 above; mild‑administer antipyretics as needed; leukocyte antigens,                avoid future reactions by premedication and use of leukocyte‑reduced red cells and platelets.

Acute Lung Injury

Fever, chills, dyspnea, respiratory failure

Antibodies from donor plasma to recipient WBC

Supportive therapy for respiratory failure, oxygen, mechanical ventilation, leukocyte‑reduced blood components until etiology is clear (donor vs recipient antibody).

Acute Hemolytic

Anxiety, chest pain, flank pain, dyspnea, chills, fever, shock, unexplained bleeding, hemoglobinemia / hemoglobinuria, cardiac arrest

Hemolytic transfusion reaction; usually due to ABO incompatibility

Steps 1‑5 above; treat shock with vasopressors, IV fluids, corticosteriods as needed; maintain airway; increase renal blood flow (IV fluids; furosemide); maintain a brisk diuresis; monitor renal status for acute renal failure. Monitor coagulation status for DIC; administer blood components as needed after etiology is clear.

Septic / Toxic

Chills, fever, hypotension

Bacteria from contaminated blood

Steps 1‑5 above; treat shock with vasopressors, IV fluids. Culture patient and bag.