Non-infectious transfusion associated adverse events and their mitigation strategies

Ruchika Goel, Aaron A. R. Tobian and Beth H. Shaz


Blood transfusions are lifesaving therapies; however, they can result in adverse events, which can be infectious or more commonly non-infectious. The most common non-infectious reactions include febrile non-hemolytic transfusion reactions, allergic transfusion reactions, transfusion associated circulatory overload, transfusion related acute lung injury, and acute and delayed hemolytic transfusion reactions. These reactions can be asymptomatic, mild or potentially fatal. There are several new methodologies to diagnose, treat and prevent these reactions. Hemovigilance systems for monitoring transfusion events have been developed and demonstrated decreases in some adverse events, such as hemolytic transfusion reactions. Now vein-to-vein databases are being created to study the interactions of the donor, product, and patient factors in the role of adverse outcomes. This article reviews the definition, pathophysiology, management, and mitigation strategies, including the role of the donor, product, and patient, of the most common non-infectious transfusion-associated adverse events. Prevention strategies, such as leukoreduction, plasma reduction, additive solutions and patient blood management programs, are actively being employed to enhance transfusion safety. Understanding the incidence, pathophysiology and current management strategies will help create innovative products and continually hone in on best transfusion practices which suit individualized patient needs.

  • Submitted October 9, 2018.
  • Accepted December 26, 2018.