Noninfectious transfusion-associated adverse events

Abstract

Blood transfusion is one of the most common medical procedures performed in the United States. Although it is a relatively safe form of therapy, adverse events still occur and could be potentially fatal. Transfusion-associated adverse events often present with non-specific, overlapping symptoms, such as fever, short of breath, which could be hard to be distinguished from the patient's underlying medical conditions and go underreported. Adverse event recognition, reporting and collaborative management between treating clinical team and blood bank are crucial for transfusion safety. Transfusion-associated adverse events are mainly categorized into infectious (transfusion transmitted infection) and non-infectious transfusion reactions. Non-infectious transfusion reactions range in frequency from the most common transfusion reactions [allergic and febrile non-hemolytic transfusion reactions (FNHTRs)], relatively common reactions [delayed serological/hemolytic transfusion reaction, transfusion associated circulatory overload (TACO), transfusion-related acute lung injury (TRALI)], to rare reactions [such as anaphylaxis, post-transfusion purpura (PTP), transfusion-associated graft-versus-host disease (TA-GvHD), etc.]. Transfusion could also lead to alloimmunization, immunomodulation, and other adverse events. Transfusion reactions in pediatric populations are similar to adults in nature but also differ in some respects. Significant advancement has been made over the past decade in our understanding of transfusion reactions. This review focuses on non-infectious transfusion reactions, including clinical presentations, diagnostic criteria, pathophysiology, treatment, prevention, and mitigation strategies.