Analysis of clinical presentations of allergic transfusion reactions and febrile non-haemolytic transfusion reactions in paediatric patients.

Abstract

Like adults, children can have allergic transfusion reactions (ATRs) and febrile non-haemolytic transfusion reactions (FNHTRs). But published information about the incidence of paediatric ATR and FNHTR is scarce. This retrospective study was conducted from April 2002 to June 2018 on children who had ATRs and/or FNHTRs to platelet (PLT), red blood cell (RBC) or washed PLT/RBC concentrate transfusions. We analysed ATR/FNHTR clinical presentations, such as severity, time of occurrence and other features when they occurred. During the study, 2742 children received 23444 bags of PLT and RBC concentrate (including washed products). ATRs occurred in 100 cases (3·6% of total patients), caused by 201 products (0·9% of total products). In contrast, 28 patients (1·0% of total patients) had 42 FNHTRs caused by 42 products (0·2% of total products). Upon analysis of cases with detailed clinical information, the median onset time for ATRs and FNHTRs was 2·0h after the start of transfusion. Of the 40% of ATRs that necessitated the discontinuation of blood transfusions, 10% escalated to anaphylaxis. Compared with minor ATRs, anaphylaxis tended to develop quickly. Moreover, 96% of patients with FNHTRs had a fever less than 39°C. There were no associations between blood product types and numbers or occurrence patterns of these reactions. The occurrence of ATRs and FNHTRs in children was variable, although there are common features such as severity and time of occurrence.