Table 4: Summary of the nature and frequency of noninfectious risks associated with red blood cell and plasma transfusion
Complication	Usual cause	Frequency
Acute hemolytic reaction121,122,123	ABO incompatability	1 per 25 000 RBC units
Delayed hemolytic reaction122,123­126	Hemolysis due to minor blood group incompatability	1 per 2500­9000 RBC units
RBC alloimmunization127	Recipient antibody response to donor antigen	About 8% of patients transfused with RBCs
Nonimmune hemolytic reaction122,128	Physical or chemical degradation of RBCs (freezing, heating or addition of a hemolytic drug or solution)	Unknown
Febrile, nonhemolytic reaction or chills without fever122,123,129	Recipient antibody to donor WBC or platelet antigen or accumulation of cytokines in blood units during storage or both	1 per 100 RBC units
Anaphylaxis122,123,128	Complement activation	1 per 20 000­50 000 units (RBC or plasma)
Urticarial reactions122,123	Antibody-mediated response to donor plasma proteins	1 per 100­300 plasma transfusions (probably similar with RBC transfusions)
Transfusion-related acute lung injury122,123	Complement-mediated pulmonary edema	Unknown
Graft-versus-host disease79,130,123,131,132	Engraftment of immunocompetent donor lymphocytes in host	Unknown
Postransfusion purpura122,133,134	Recipient develops antibodies against donor and recipient platelets	Unknown
Passive alloimmune thrombocytopenia135,136	Donor blood contains platelet-specific alloantibody that results in abrupt thrombocytopenia in the recipient	Rare
Circulatory overload122,131	Excess intravascular volume	1% of transfused patients
Hypothermia, coagulopathy, acid­base disturbances, hypocalcemia, electrolyte abnormalities and citrate toxicity associated with massive transfusion88,90,94,137­140	Loss, consumption or dilution of blood elements	Related to volume transfused, unlikely to be seen when < 1.5 blood volumes replaced
Iron overload	Chronic RBC transfusion therapy (each unit contains 200 mg of iron)	Variable, according to number of RBC units transfused; begins after the tranfusion of > 20 RBC units

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