Blood Transfusion Reactions

LECTURE 9: BLOOD TRANSFUSION REACTIONS
Is the occurrence of signs of RBC destruction after blood transfusion either in the intravascular
or extravascular environment of the body system. Its monitoring and investigations is part of
haemovigilance which can be defined as an organized surveillance procedures related to serious
adverse or unexplained transfusion events in donor or recipient and epidemiological follow-up of
the donor. Such undertaking involve important stakeholder such as Doctors, Nurses and Medical
laboratory officers as advocated for by the Kenya National Blood Transfusion service (NBTS).
The result of such reactions includes haemoglobinuria, fever, sweat, raised pulse rate chills, chest
pain and vomiting, jaundice and many more depending on the type and when transfusion
reaction occurred. They are categorized as follows;
i) Intravascular reactions
This haemolytic reaction is immediate. It may happen if blood is given as a result of clerical
error and it is mainly caused by cold natural antibodies of the ABO incompatible blood. It is
severe and can be lethal .Its symptoms include fever, headache, vomiting, chest and backache
shock vomiting and sweating.
ii) Extravascular reactions
This haemolytic reaction is delayed and is caused by antibodies of other blood groups [1]. The
red blood cells are coated by invading IgG and are then removed by spleen and finally destroyed
by the reticuloendothelial system.
NB: Blood transfusion is a process and a type of tissue transplant that MUST be monitored from
the begging to the end (from the first drop to the last drop).
In any case clinical signs suggestive of BTRs are developed, these must be documented,
transfusion stopped, pre-transfusion sample kept and laboratory notified to ascertain the reaction.
Laboratory investigations transfusion reactions
When a transfusion reaction has occurred or a patient develops features suggesting severe
transfusion reaction, transfusion should be stopped immediately and the following specimens be
brought to the laboratory for investigations:
1. Patient pre-transfusion clotted blood sample (usually present in the lab)
2. Patient post-transfusion blood sample collected from the opposite arm aliquoted as
follows
a. In EDTA container
b. In heparin or 3.2% tri-sodium citrate
c. In plain bottle
3. Donor blood remainder in the pack
4. Post transfusion urine (patient urine passed 24 hours after reaction).
The specimens should be handled in the following manner
I. Re-group donor’s post and pre-transfusion sample as well as patient’s pre-transfusion
sample this rules out ant possibility of erroneous grouping.
II. Repeat compatibility testing of the donor’s blood with patient pre and post transfusion
samples. This is to rule out any reaction due to allo-antibodies.
III. Centrifuge and examine from EDTA TUBE transfusion sample for free haemoglobin and
jaundice to rule out if haemolysis ever took place.
IV. Do antibody screening test on patient’s post and pre-transfusion samples .This is to rule
out reaction due to irregular antibodies.

V. Make a peripheral blood film of the post transfusion EDTA sample and examine for
spherocytosis schistocytosis
VI. Do osmotic fragility test using patient’s heparinized sample
VII. Examine the color of blood sample in the pack directly for evidence of gross bacterial
contamination and set up blood cultures from it at 20 0c and 370c .If the clinical picture is
suggestive of bacterial infection blood cultures must be taken from the patient and broad
spectrum intravenous antibiotic administered.
VIII. Perform direct Coombs test (DCT)/Direct antihuman globulin Test (DAHT). This is the
most important and basic test .It rules out if the reaction ever occurred at all.
IX. Examine post-transfusion urine for haemoglobinuria and urobilinogen.
X. Perform the following biochemical studies patient’s post-transfusion sample for
a. Methaemoglobin (raised in intravascular reaction)
b. Haptohaemoglobin (reduced in intravascular reaction)
c. Bilirubin levels (raised in intravascular reaction)

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LECTURE 9: BLOOD TRANSFUSION REACTIONS

haemovigilance which can be defined as an organized surveillance procedures related to serious

adverse or unexplained transfusion events in donor or recipient and epidemiological follow-up of

reaction occurred. They are categorized as follows;

shock vomiting and sweating.

ii) Extravascular reactions

by the reticuloendothelial system.

brought to the laboratory for investigations:

1. Patient pre-transfusion clotted blood sample (usually present in the lab)

b. In heparin or 3.2% tri-sodium citrate

3. Donor blood remainder in the pack

4. Post transfusion urine (patient urine passed 24 hours after reaction).

The specimens should be handled in the following manner

I. Re-group donor’s post and pre-transfusion sample as well as patient’s pre-transfusion

sample this rules out ant possibility of erroneous grouping.

samples. This is to rule out any reaction due to allo-antibodies.

jaundice to rule out if haemolysis ever took place.

out reaction due to irregular antibodies.

VI. Do osmotic fragility test using patient’s heparinized sample

spectrum intravenous antibiotic administered.

IX. Examine post-transfusion urine for haemoglobinuria and urobilinogen.

X. Perform the following biochemical studies patient’s post-transfusion sample for

a. Methaemoglobin (raised in intravascular reaction)

b. Haptohaemoglobin (reduced in intravascular reaction)

c. Bilirubin levels (raised in intravascular reaction)

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