Whenever an adverse transfusion reaction is suspected, the transfusion should be immediately halted and an investigation performed according to the established procedures of the institution. For institutions reporting adverse transfusion reactions to INBC for investigation, report the information using the Transfusion Reaction Report (PDF). For institutions that perform their own investigations, reactions may need to be reported to INBC due to attributes specific to the donor or the processing of the blood product (e.g. bacterial contamination of a blood unit, or suspected Transfusion Related Acute Lung Injury). Report the information telephonically at 509-624-8591. The following table list symptoms associated with various types of reactions.

IMMEDIATE TRANSFUSION REACTIONS (MINUTES TO HOURS, WITHIN 24 HOURS)

Type of Reaction: Symptoms
Immune-mediated hemolysis Fever (increase >1C or 2F)
Chills, rigos
Pain (infusion site, back, flanks, chest and/or abdomen)
Hypotension (decrease > 20 mmHg)
Nausea, vomiting
Dyspnea
Flushing
Hemoglobinemia
Hemoglobinuria
Bilirubinemia/bilirubinuria
Oliguria/anuria
Acute pancreatitis
Shock
Generalized bleeding (DIC)
Transfusion Associated Sepsis Fever > 39C (increase > 2C or 3.5F)
Chills, rigors
Hemoglobinuria
Oliguria/anuria
Generalized bleeding (DIC)
Tachycardia
Hypotension (decrease > 20 mmHg)
Shock
Febrile non-hemolytic reaction Fever (increase >1C or 2F)
Chills, rigors
Transfusion-related acute lung injury                       Dyspnea
Hypoxemia (O2 Sat < 90% on room air)
Infiltrates on chest radiograph
Pulmonary edema
Fever
Hypotension (occasionally hypertension)
Transient leukopenia
Occurs within 6 hours of transfusion
Absence of evidence of circulatory overload
Transfusion associated cardiac overload         Dyspnea
Orthopnea
Hypertension
Tachycardia
Headache
Pulmonary edema
Congestive heart failure
Anaphylactic Reactions< May occur after only a few mL of blood component
Hypotension
Cough, wheezing, dyspnea
Nausea, vomiting, cramps
Diarrhea
Shock
Urticaria (hives)  Erythematous macular rash
Generalized rash
Hives
Pruritis, itching
Absence of fever
Non-immune hemolysis Symptoms may be similar to immune hemolysis
Etiology: Thermal (including improper storage, heating, freezing)
Mechanical (pumps, pressure cuffs)
Osmotic (drugs, hypotonic solution)

DELAYED TRANSFUSION REACTION (DAYS TO WEEKS, > 24 HOURS)

Type of Reaction Symptoms
Delayed hemolytic reaction Anemia, falling Hematocrit
Hyperbilirubinemia, jaundice Fever, chills
Sickle cell crisis
Pain, dyspnea, renal failure rare
Post transfusion purpura Sensitization to platelet antigens due to pregnancy or transfusion
Severe thrombocytopenia
Unresponsive to platelet transfusion
Purpura, mucosal, GI, or CNS hemorrhage
Transfusion associated graft versus host disease Diffuse maculopapular exanthem
Watery diarrhea
Fever
Abnormal liver function tests
Bone marrow aplasia