Mild allergic transfusion reaction

Mild allergic transfusion reaction

Updated: 07/28/2025

© Jun Wang, MD, PhD

 

General features

  • AKA urticarial transfusion reaction
  • Very common

Clinical presentations

  • Rapid onset, a few minutes after transfusion started
  • Usually NO fever
  • Usually localized urticaria (hives)
  • May cause severe edema around eyes and lips (angioedema), laryngeal edema, or mild respiratory symptoms

Key pathogenesis

  • Usually IgE mediated (type I hypersensitivity) reaction toward plasma protein in donor units
  • Activation of mast cells results in production of histamine and other cytokines

Laboratory findings

  • Non-specific

Management

  • Antihistamine: Benadryl (diphenhydramine)
  • Consider washed RBCs (donor plasma removed)
  • Transfusion may resume after hives cleared

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