Febrile, allergic, and nonimmune transfusion reactions

This chapter reviews a variety of acute, nonhemolytic, and noninfectious transfusion reactions, the most common of which are febrile, nonhemolytic transfusion reactions (FNHTRs) and allergic reactions. Other acute, nonhemolytic reactions are reported less frequently and include transfusion-related acute lung injury (TRALI) and anaphylactic or anaphylactoid reactions. Additional acute adverse effects can occur in massive transfusion because of the large volume of blood components transfused over a short period. The complications of massive transfusion include dilutional coagulopathy, hypothermia, citrate toxicity, and electrolyte disturbances, among others. Some patients cannot tolerate the acute increase in intravascular blood volume caused by transfusion and experience the complications of transfusion-associated circulatory overload (TACO). Acute reactions can be caused by the toxicity of chemicals that leach into blood components from blood storage containers or filters or by chemicals added to improve storage conditions, such as dimethyl sulfoxide (DMSO). Other reactions are caused by endogenous mediators generated in the blood during filtration, processing, or storage, such as bradykininmediated hypotensive reactions. It is important that these complications of transfusion be recognized by patient care teams and blood bank personnel, and that appropriate treatments and preventive measures be instituted for patient safety and well-being.