Possible Side Effects of Blood Transfusion

 

Most people who have a blood transfusion do not experience any side effects. But people can have reactions to any blood component. They might have this reaction during or after the transfusion, and some people don’t experience any effects until a few weeks or even months later.

Possible side effects include:

  • Fever - Fever is by far the most common side effect of blood transfusions, accounting for more than 90 percent of all transfusion complications. In addition to a fever, some people have chills, shortness of breath, a headache, or nausea. The fever might begin during the transfusion or within the first 24 hours after the transfusion. It can be uncomfortable but is not usually dangerous. Tylenol® (acetaminophen) can often reduce the fever and other symptoms. This fever is often caused by attacks of your antibodies (proteins that protect your body from foreign substances) against white cells in the donated blood. To prevent fever, many blood banks filter out the white blood cells from their blood products. This process is called leukoreduction.
  • Allergic reaction - Some patients have an allergic reaction to certain substances in the plasma of the donated blood. These patients often develop hives (also known as urticaria), which are itchy, swollen patches or bumps on the skin. They can also develop wheezing or swollen body tissues. Hives and other allergic symptoms are uncomfortable, but they are not dangerous and they usually go away after the patient takes antihistamines. If you develop an allergic reaction during or after a transfusion, you will probably be treated with an antihistamine beforehand if you have another transfusion.
  • Alloimmunization - Sometimes a patient who has received many blood product transfusions develops antibodies against parts of the red blood cells or platelets in a donated unit of blood. This is called alloimmunization and when it happens, the transfused blood products do not work properly. However, alloimmunization does not always cause any symptoms. Alloimmunization can be prevented by giving patients red blood cells that do not have the antigens that the patient’s antibodies attacked or by filtering white blood cells out of the blood product.
  • Transfusion-related acute lung injury (TRALI) - This reaction is very rare and very serious. It can even be life-threatening, especially if the patient is already very ill before the transfusion. You might have trouble breathing or develop a high fever. Medicines do not help but TRALI usually goes away by itself. The doctor might recommend oxygen and sometimes a breathing machine to help with the symptoms. If you have had TRALI after a previous transfusion, your doctor will try to prevent this from happening again by using diluted saltwater to remove most of the plasma from the blood.
  • Hemolytic reaction - In this very rare condition, the patient’s antibodies attack the transfused red cells and damage or destroy them because the patient’s blood does not match the transfused blood.
    • Acute immune hemolytic reaction - The reaction is acute if it happens during the transfusion. Symptoms can include chills, fever, pain in the chest and lower back, a rapid heartbeat, red or dark urine, and nausea. This is the most serious reaction that can happen after a blood transfusion because it can reduce the patient's blood pressure and cause potentially life-threatening bleeding or kidney damage. When a patient has an acute hemolytic reaction, the technician must stop the transfusion as soon as the reaction starts.
    • Delayed hemolytic reaction - Hemolytic reactions can also happen gradually, within days or weeks of the transfusion. Symptoms can include a fever and jaundice (yellow skin and eyes), but some patients have no symptoms. This type of reaction is more likely to happen in someone who has had several transfusions before. If a person who has had a delayed hemolytic reaction needs another blood transfusion, the blood units that are transfused must be tested to make sure that they don’t contain the antigen that the patient’s antibodies attacked.
  • Graft-versus-host disease (GVHD) - In GVHD, white blood cells from the transfused blood attack the patient’s tissues. GVHD is more common in patients who have a weakened immune system and who are receiving blood from donors who are relatives or whose tissue type is similar to theirs. Symptoms can include fever, liver problems, diarrhea, and rashes. To prevent GVHD, low doses of radiation are used to treat the donated units of blood and stop the white blood cells from working properly. The radiation does not affect red blood cells.
  • Infections - In very rare cases, patients get an infection from the transfused blood. Every unit of blood that is donated is tested for bacteria, viruses, and parasites that can cause infections, but none of these tests is completely accurate. The types of infections that can be given to patients from donated blood include:
    • Bacteria - Blood can be contaminated by tiny amounts of skin bacteria during the donation process. If patients receive platelets with these bacteria, they can become seriously ill soon after the transfusion starts. Since 2004, blood banks have tested platelets for bacteria before giving the platelets to patients.
    • Hepatitis B and C - Hepatitis is the most common disease that can be transmitted by a blood transfusion, although this is extremely rare (the risk is less than 1 in 1 million). Viruses that attack the liver cause hepatitis B and C. Although hepatitis does not necessarily cause any symptoms, it can cause liver failure and other complications. To reduce the risk of transmitting hepatitis through blood transfusions, blood banks ask potential donors about their hepatitis symptoms and risk factors. Blood banks also test donated blood for hepatitis B and C viruses and liver problems that could be signs of other types of hepatitis. Patients can also reduce their risk of hepatitis B infection by getting the hepatitis B vaccine.
    • Human immunodeficiency virus (HIV) - HIV is the virus that causes acquired immunodeficiency syndrome (AIDS). Blood banks routinely test every unit of donated blood for HIV and ask potential donors about their HIV risk factors and symptoms. As a result of these precautions, the risk of HIV transmission through a blood transfusion is extremely small—less than 1 in 1.9 million.

This content was last reviewed August 15, 2010 by Dr. Reshma L. Mahtani.
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