Medical Oncologist
Blood counts
Blood transfusion reactions
Most transfusions pass without anything happening at all. When a reaction does occur it is usually a fever, shivering or itching, it appears in the first stretch, and it settles once the transfusion is stopped and treated. What matters is that somebody says something early rather than enduring it quietly.
NG
Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
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The short answer
What can go wrong during a transfusion?
Most transfusions pass without anything happening at all. When a reaction does occur it is usually a fever, shivering or itching, it appears in the first stretch, and it settles once the transfusion is stopped and treated. Serious reactions are uncommon.
What matters is that somebody says something early. The nurse is watching for it, the observations are taken for it, and a reaction caught in the first minutes is straightforward. One that is endured quietly for half an hour is not.
Press the call bell rather than waiting to be sure
Patients and families sit through shivering or breathlessness hoping it will pass, because they do not want to make a fuss. Nobody in a day-care unit minds a call bell that turns out to be nothing. Deciding what counts is the nurse's job, not yours.
Never adjust anything yourselves
Do not slow the drip, stop it, silence an alarm or unclamp the line. Call, and let the staff do it. Stopping a transfusion correctly is part of how a reaction is treated.
Attendants: stay in the room for the first stretch if you can. That is when most reactions appear.
!
Press the call bell at once for any of these
Shivering, or feeling suddenly cold · a fever · breathlessness or a tight chest · itching, a rash, hives or flushing · swelling of the face, lips or tongue · pain in the back, the chest or at the drip site · dark or red-coloured urine · feeling suddenly very unwell or frightened without being able to explain why · the pump alarming. Do not wait to see whether it settles, and do not slow, stop or adjust the drip yourselves. At home after a transfusion, the same list means going to the nearest emergency department the same day.
Not sure whether this applies to you?
Ask an oncologistThe kinds of reaction
What can happen, and how common it is
- Fever and shivering
- The commonest reaction by some margin. Usually a response to white cells in the unit rather than anything dangerous, and it is why many patients receive filtered units. Treated by stopping, giving medicine and often restarting.
- Itching, rash or hives
- An allergic response to something in the plasma. Common, usually mild, and treated with an antihistamine. Often the transfusion can continue afterwards under closer observation.
- Breathlessness from too much fluid
- More likely in older people and those with heart or kidney problems. The transfusion is slowed or stopped and a water tablet may be given. This is one reason packed cells are used rather than whole blood.
- A severe allergic reaction
- Uncommon. Swelling of the face or tongue, difficulty breathing, a widespread rash, feeling suddenly very unwell. Treated immediately and effectively, which is exactly why you are watched closely.
- A wrong-unit reaction
- Rare, and the reason your name and number are checked over and over. It causes back or chest pain, dark urine and severe illness soon after starting. The repeated checks exist to prevent it.
- Delayed reactions
- Occasionally a fever, a falling haemoglobin or yellowing of the eyes appears days later. Report anything new in the week after a transfusion and mention that you had one.
What the team does
What happens when a reaction is reported
Knowing the sequence makes it much less frightening to watch.
The transfusion is stopped
First action, immediately, with the line kept in place. That alone settles many reactions. The unit and the giving set are kept rather than discarded, because they may need checking.
Then
- Observations are taken at once
- Your identity and the unit are rechecked
Treatment is given
Usually something for fever or an antihistamine for itching, and occasionally more than that. For a fluid overload, a water tablet and oxygen. Most reactions respond quickly.
A decision is made about continuing
Some transfusions restart more slowly under closer watch, and some are abandoned and the unit returned. Both are normal outcomes. Ask which applies and why.
Ask afterwards
- What the reaction was
- What will be done differently next time
It is recorded for next time
Future transfusions may use filtered units, or you may be given medicine beforehand to prevent a repeat. Make sure the reaction is written in your own file as well as the hospital's.
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Being straight with you
What this page cannot tell you
It cannot tell you what a particular symptom means in your case. Shivering may be a mild reaction to white cells or the first sign of something serious, and the two are told apart by observations and examination rather than by reading. That is why the answer is always to call rather than to assess it yourself.
It also cannot tell you whether you will react. Most people do not, and having reacted once does not mean you will again, particularly once filtered units or preventive medicine are used.
The risks are small and the benefit is usually clear
Nothing here is a reason to refuse a transfusion that has been recommended. A haemoglobin low enough to need transfusing carries its own risks, and screening, matching and bedside checks make the procedure considerably safer than most families assume.
What to do next
Ask the nurse what to watch for before the transfusion starts. Stay in the room for the first stretch. Press the call bell for anything on the warning list rather than waiting. Ask afterwards what any reaction was and what will change next time. And write it in your own file.
Commonly believed
Four beliefs that make reactions worse
"I should not trouble the nurse unless it is serious."
Deciding what counts as serious is their job. A reaction caught in the first minutes is straightforward and one endured for half an hour is not, and nobody in a day-care unit is irritated by a call bell that turns out to be nothing.
"We will just slow the drip down and see."
Never adjust, slow, stop or unclamp the line yourselves, and never silence an alarm. Stopping a transfusion properly is part of how a reaction is treated, and the unit has to be kept for checking.
"Having one reaction means transfusions are unsafe for me."
Most reactions are mild and preventable next time, using filtered units or medicine given beforehand. Having reacted once does not mean you will again. Make sure it is recorded so the precautions are actually applied.
"Once the transfusion is finished, nothing more can happen."
Occasionally a fever, a falling haemoglobin or yellowing of the eyes appears days later. Report anything new in the week afterwards and say that you had a transfusion, because it changes how it is investigated.
Questions we are asked
Common questions about transfusion reactions
How common are reactions?
Most transfusions pass without anything happening. When reactions occur they are usually mild, most often a fever, shivering or itching, and they settle once the transfusion is stopped and treated. Serious reactions are uncommon.
When do reactions usually appear?
Most often in the first stretch, which is why the transfusion runs slowly at the start and observations are taken shortly after it begins. Stay in the room during that period if you are the attendant.
Why do they keep checking my name?
Because giving the wrong unit to the wrong patient is the rare but serious reaction, and repeated identity checks by two staff are what prevent it. Answer every time, and treat it as the system working.
Will the transfusion be abandoned if I react?
Sometimes it is restarted more slowly under closer watch, and sometimes it is stopped and the unit returned. Both are normal. Ask which applies to you and what will be done differently next time.
Can a reaction be prevented next time?
Often, using filtered units or medicine given before the transfusion. Make sure the reaction is recorded in your own file as well as the hospital's, and mention it at every subsequent transfusion.
Can I catch an infection from a transfusion?
Every unit is screened before use and the risk is very small. The commoner problems are the reactions described here, which is why you are watched closely throughout rather than left alone.
What should we watch for after going home?
A fever, breathlessness, dark urine, yellowing of the eyes, or a rash in the days afterwards. Report any of these the same day and say that you had a transfusion, because it changes how they are investigated.
Should we refuse a transfusion because of these risks?
No. A haemoglobin low enough to need transfusing carries its own risks, and screening, matching and bedside checks make the procedure safer than most families assume. Ask your team to explain the reasoning if you are unsure.
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Sources
- Cancer Research UK — Blood transfusions
- Macmillan Cancer Support — Blood transfusions
- National Cancer Institute — Chemotherapy and You
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