Transfusion reactions to plasma constituent of whole blood; their pathogenesis and treatment by washed red blood cell transfusions.

EACTIONS to the transfusion of blood are ordinarily classified as pyrogenic, allergic or hemolytic. The first two are relatively minor in importance, but hemolytic transfusion reactions, usually due to the use of incompatible blood, are severe and may be lethal. Another type of reaction to whole blood, not previously described, was observed by us in at least ii cases during the past three years. This was characterized clinically by chills, fever, aching sensation in the back, and down the legs, and often by a lack of erythrocytic response to the transfusion, although no definite evidence of increased hemolysis was present. Analysis of such reactions demonstrated that they were due to a constituent in the plasma, and could be prevented by the complete removal of plasma from the red cells by thorough washing of the blood with normal saline. The use of washed red cell transfusions in the cases showing these reactions was often life-saving, particularly in acquired hemolytic anemia. The present report deals with ii cases showing such reactions to whole blood, subsequently treated successfully with saline washed red cell transfusions. Evidence for a factor in normal plasma as the cause of the reactions is presented.