TRIP definitions of transfusion reactions and incidents
Severity and imputability of transfusion reactions are assessed according the levels defined by the International Society of Blood Transfusion and International Haemovigilance Network
Nonhemolytic transfusion reaction (NHTR)
Rise in temperature of ≥ 2oC (with or without rigors/chills) during or in the first two hours after a transfusion, with normalisation within 24 hours after the transfusion, OR rigors/chills with or without a rise in temperature within the same time limits, without other relevant symptoms or signs and without features or findings of bacteremia, hemolysis or serological incompatibility.
Mild (nonhemolytic) febrile reaction
Rise in temp. ≥1°C (<2°C) during or in the first two hours after a transfusion with normalisation within 24 hours after the transfusion, without other relevant symptoms or signs and without features or findings of bacteremia, hemolysis or serological incompatibility.
Acute hemolytic transfusion reaction
Signs or symptoms of hemolysis occurring within a few minutes of commencement or until 24 hours after a transfusion, such as a drop in systolic and/or diastolic blood pressure of ≥ 20 mmHg fever/chills, nausea/vomiting, back pain, dark or red urine, no or poor increase of Hb level or an unexpected drop in Hb.
Delayed hemolytic transfusion reaction
Signs or symptoms of hemolysis occurring from 24 hours to a maximum of 28 days after transfusion, such as: unexplained drop in hemoglobin, dark urine, fever or chills, or laboratory findings indicating hemolysis.
TRALI (Transfusion-related acute lung injury)
Features of acute lung injury such as dyspnoea and hypoxia during or within 6 hours after a transfusion; chest X-ray shows bilateral pulmonary infiltrates.
Transfusion-associated circulatory overload (TACO)
Features of circulatory overload such as dyspnoea, orthopnoea, cyanosis, tachycardia >100/min. or raised central venous pressure during or within six hours of transfusion. Chest X-ray consistent.
Anaphylactic transfusion reaction
Rapidly developing allergic reaction occurring within a few seconds after the start of transfusion or up till a short time after transfusion with features such as inspiratory and expiratory stridor, fall in systolic and/or diastolic blood pressure ≥ 20mm Hg, nausea/vomiting, diarrhoea, back pain, skin rash.
Other allergic reaction
Allergic phenomena such as itching, redness or urticaria but without respiratory, cardiovascular or gastrointestinal features, arising from a few minutes of starting transfusion until a few hours after its completion.
After receiving a transfusion, demonstration of clinically relevant antibodies against blood cells (irregular antibodies, HLA or HPA antibodies) that were not present previously (as far as is known in that hospital).
Post-transfusion purpura (PTP)
Transient serious thrombocytopenia possibly with bleeding manifestations 1-24 days after transfusion of a red cell or platelet concentrate.
Clinical symptoms of bacteremia/sepsis arising during, directly after or some time subsequent to a blood transfusion, with a relevant positive patient blood culture result; it may or may not be possible to
Post-transfusion viral infection
Clinical features of a viral infection after a blood transfusion within a period corresponding to the incubation period of that infection, or serological results indicating the presence of a viral infection within a period corresponding to the time course of the infection.
Shortness of breath or hypoxia during or within 24 hours after a blood transfusion, and the criteria for TRALI, circulatory overload, anaphylactic or other allergic reaction are not met. Respiratory problems are the most prominent feature and they cannot be explained by the patient’s underlying pathology or other known specific causes.
Iron overload induced by frequent transfusion with a minimum ferritin level of 1000 micrograms/l, with or without organ damage.
Transfusion-associated graft versus host disease (TA-GvHD)
Clinical features of graft versus host disease such as erythema which starts centrally, watery diarrhoea, fever and rise in liver enzymes 1-6 weeks (usually 8-10 days) after transfusion of a T-cell containing (nonirradiated) blood component.
Other transfusion reaction
Transfusion reaction which does not fit into the categories above.
Incorrect blood component transfused (IBCT)
All cases in which a patient was transfused with a component that did not fulfil all the requirements of a suitable component for that patient, or that was intended for a different patient.
Incorrect blood component transfused in the past (additional category)
On investigation of a transfusion reaction or incident it is discovered that the patient previously received an incorrect blood component.
Any error that, if undetected, could have led to a wrong blood group result or issue or administration of an incorrect blood component, and which was detected before transfusion.
Error or incident in the transfusion chain that does not fit into any of the above categories, for instance patient transfused whereas the intention was to keep the blood component in reserve, or transfusing unnecessarily on the basis of an incorrect Hb result or avoidable wastage of a blood component.
Bacterial contamination of a blood component
Relevant numbers of bacteria in a (remnant of) blood component or in the bacterial screen bottle of a platelet component, or in material from the same donation, demonstrated in the approved way with laboratory techniques, preferably including typing of the bacterial strain or strains.
Note: This commonly occurs in the setting of the routine bacterial screening of platelet concentrates, which are distributed “negative to date”. If there is subsequently a positive screening result the hospital is notified by the blood supplier Sanquin. As of 2016, hospitals are requested only to report these cases to TRIP if the recipient has a reaction.
Look-back by the supplier
Retrospective notification of a possibly infectious donation, leading to investigation of the recipient for that infection.
Occurrence of clinical signs / symptoms in a patient associated with the presence of free hemoglobin in a transfused product (from recovered blood).
Clotting problems associated with incomplete removal of added heparin during automated blood recovery method.
Calculated risk situation
A situation where the clinician knowingly decides to proceed with transfusion in the presence of an increased risk or anticipated side effect of the transfusion and where the intended benefit from transfusion is deemed to justify the risk of harm and its possible severity.