Hematologist
CION Cancer Clinics
A reaction during a blood transfusion: what to do right now | CION Cancer Clinics
Tell the nurse immediately and press the call bell. Do not touch the drip or wait to see if it passes. Most reactions, like itching or shivering, are mild and settle with treatment, but the early signs of serious ones look similar. If you are home and feel breathless, faint or pass dark urine after a transfusion, call 108 or go to the nearest emergency department. At CION Cancer Clinics, our haematology team supports patients and families through treatment, cost questions and life at home.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- What should you do the moment something feels wrong?
- What kinds of transfusion reaction are there?
- What will the nurse and doctor do next?
- What do the words on the reaction report mean?
- What do families often get wrong about reactions?
- What does a reaction mean for your next transfusion?
- Common questions about transfusion reactions
Do this first
What should you do the moment something feels wrong?
Tell the nurse straight away, out loud, and press the call bell. Do not wait to see whether it settles. If you are at home after a transfusion and you feel breathless, faint or very unwell, call 108 or go to the nearest emergency department now.
Why speed matters here
Most reactions to a blood transfusion are mild, such as an itchy rash or a shiver. A few are serious, and in the first minutes the mild and the serious can look alike. The nurse cannot tell which one it is until they have looked at you. That is why the right move is always to speak up early, even if it feels like a fuss over nothing.
What not to do yourself
Do not pull out the drip, change the speed of the pump or take a tablet you brought from home to calm the itch. The team needs the line in place so they can give medicine quickly if they need to. Leave every decision about pausing or restarting the blood to them.
This page explains what happens. It cannot tell you which reaction you are having. Only the team at the bedside can.
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Signs that cannot wait, even after you have gone home
Call 108 or go to the nearest emergency department the same day if you have any of these during or after a transfusion: trouble breathing, swelling of the lips, tongue or throat, a racing heart or feeling faint, shivering with a high temperature, very dark or red urine, yellowing of the eyes, or pain in the chest or lower back. Say that you had blood recently.
Not sure whether this applies to you?
Ask an oncologistWhat it might be
What kinds of transfusion reaction are there?
They range from a nuisance to a true emergency. The signs overlap, which is why the team checks every one the same careful way.
Itching and hives
Raised, itchy patches on the skin. This is the most common kind and is usually mild. It is a reaction to proteins in the donor's plasma, the liquid part of the blood.
Fever and chills
A rise in temperature with shivering. Often harmless, but a fever can also be the first sign of a more serious reaction or of bacteria in the bag, so it is always checked.
Severe allergic reaction
Swelling of the face or throat, wheezing and a sudden drop in blood pressure. Rare, and it needs treatment within minutes.
Too much fluid
Blood given faster than the heart can handle leads to breathlessness and a cough. Older people and those with heart or kidney problems are more at risk.
Wrong-group or antibody reaction
Your immune system attacks the donor red cells. Signs include fever, back pain, dark urine and feeling very unwell. This is why the bag is checked against your wristband every time.
Delayed reaction
Some reactions show up days later, as tiredness, yellow eyes or dark urine. People who have had many transfusions, such as those with thalassaemia, are more likely to meet this.
At the bedside
What will the nurse and doctor do next?
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The transfusion is paused
The team stops the blood but keeps the line in your vein open with a plain drip. That way they can give medicine quickly if it is needed.
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They check you and the bag
Your pulse, blood pressure, temperature, breathing and oxygen are measured. The label on the bag is checked again against your wristband and your blood request form.
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Treatment for what they find
An antihistamine for itching, a medicine for fever, oxygen for breathlessness, or emergency treatment for a severe allergic reaction. The doctor chooses, not the family.
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Samples go to the laboratory
A fresh blood sample and often a urine sample are taken. The bag and its tubing are sent back to the blood bank so they can be tested too.
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A decision about the rest of the blood
For a mild itch that settles, the doctor may restart the same unit slowly. For anything more, that unit is not used again and a new one is matched.
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It is written in your record
The reaction is reported to the blood bank and noted in your file, so every future transfusion is planned with it in mind.
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On your discharge note
What do the words on the reaction report mean?
- Cross-match
- The test that checks a donor unit is safe to give to you. It is repeated after a reaction.
- DAT or direct Coombs test
- A blood test that looks for antibodies stuck to red cells. A positive result can point to your immune system attacking donor cells.
- Non-haemolytic fever reaction
- A fever during transfusion where red cells are not being destroyed. Usually mild.
- TACO
- Fluid overload from the transfusion. The lungs become wet and you feel breathless.
- TRALI
- A rare lung injury linked to the transfusion that causes sudden breathlessness. It needs urgent care.
Commonly believed
What do families often get wrong about reactions?
"A small itch is nothing. We should not disturb the nurse."
An itch is often harmless, but it can also be the first sign of a bigger allergic reaction. The nurse would far rather check a rash that turns out to be mild than miss one that is not. Always tell them.
"One reaction means you can never have blood again."
Most people who have a reaction go on to have more transfusions safely. The team may choose a specially prepared unit, give a medicine beforehand or run the blood more slowly. Your record tells them what to plan for.
"Blood from a family member is safer, so reactions will not happen."
Blood from a relative still goes through the same tests and can still cause a reaction. In some situations blood from close relatives carries its own extra risks. Let the blood bank match the unit, whoever donated it.
"Once we are home, anything that happens is not about the blood."
Some reactions appear days later. Dark urine, yellow eyes, fever or new breathlessness after a transfusion should be reported to your team, and the serious signs need an emergency department the same day.
Afterwards
What does a reaction mean for your next transfusion?
A reaction changes how your next transfusion is planned, not whether you can have one. Tell every hospital that gives you blood what happened last time, even if it was mild.
Who needs extra care
People who need blood again and again, such as those with thalassaemia, sickle cell disease, aplastic anaemia (where the marrow stops making enough blood cells) or blood cancers, are more likely to build antibodies.
What to ask your haematologist
Ask what type of reaction it was, whether it is written on your card, and whether you need specially prepared blood next time. Ask whether a medicine before the transfusion makes sense for you. Do not start one on your own. At CION, Dr. Basudev Pokhrel and the haematology team review your transfusion history and coordinate with the blood bank that supplies your units.
What this page cannot tell you
It cannot tell you how serious your own reaction was, or why it happened. The laboratory results and the doctor who saw you are the only reliable answer. If a report confuses you, bring it to your next visit rather than guessing.
Questions we are asked
Common questions about transfusion reactions
My father started shivering during his blood transfusion. What should I do?
Call the nurse at once and press the call bell. Shivering can be a mild fever reaction, but it can also be the start of something more serious. Do not touch the drip or the pump. The nurse will pause the blood, check his temperature and pulse, and call the doctor if needed.
Is a rash during a transfusion dangerous?
Usually it is a mild allergic reaction to proteins in the donor plasma. It still needs to be seen by the nurse, because a rash can come before swelling of the lips or throat. If you notice wheezing, a hoarse voice or feeling faint along with the rash, say so immediately.
Can a reaction happen after we leave the hospital?
Yes. Some reactions appear later, sometimes days afterwards. Watch for dark or red urine, yellow eyes, fever, unusual tiredness or breathlessness. Call your treating team for milder changes. For trouble breathing, chest pain or fainting, call 108 or go to the nearest emergency department.
Will they restart the same bag of blood?
Sometimes. If the only problem was a mild itch that settled quickly with treatment, the doctor may restart that unit slowly. For a fever, breathing trouble or any sign of a more serious reaction, the unit is stopped for good and sent back for testing. That decision belongs to the doctor.
Why did they take more blood from me after the reaction?
The fresh sample lets the laboratory check whether your red cells are being destroyed, repeat the cross-match and look for antibodies. A urine sample may be checked for blood too. Together these tell the team what kind of reaction it was and how to plan your next transfusion.
Can I take my usual allergy tablet before the next transfusion?
Ask your haematologist first. For some people a medicine before the transfusion is sensible, and for others it only hides early warning signs. Do not start, skip or change any medicine around a transfusion on your own. The treating team decides and writes it into your plan.
My child has thalassaemia and needs regular blood. Are reactions more likely?
Children who need frequent transfusions are more likely to develop antibodies over time, which can make matching harder. Keep a record of every reaction and every blood bank used. Ask the haematologist whether specially prepared or more closely matched blood is right for your child.
Does a reaction mean the hospital made a mistake?
Not usually. Most reactions happen even when every check was done correctly, because each person's immune system responds differently to donor blood. Wrong-blood errors are rare, and the bedside check against your wristband exists to stop them. If you have concerns, ask the team to explain what the tests showed.
Your Haematologist
Meet CION's haematologist. One specialist for your blood report and your plan.
Dr. Basudev Pokhrel reviews blood counts, transfusion needs and blood disorders, and works with the CION tumour board on blood cancers.
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Where to find us
Our centres in and around Hyderabad
Addressed by landmark, because that is how this city navigates. A haematology consultation can be booked at any of these centres through one helpline, and your team will tell you where each test or treatment takes place.
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Sources
- NHS — Blood transfusion
- National Heart, Lung, and Blood Institute — Blood Transfusion
- Cancer Research UK — Blood transfusion
- American Cancer Society — Blood Transfusion and Donation
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Very Low Haemoglobin: When It Is an EmergencyWhen a transfusion is urgent in the first placeEmergency Card for Blood Disorder PatientsRecord your reaction history where every hospital will see itSickle Cell Crisis: When to Go to HospitalFor families who manage regular transfusionsBenign Haematology EmergenciesEvery blood disorder emergency in one place
Talk to us
Had a reaction and worried about the next transfusion?
Tell us what happened and share your reports. A haematologist will look at your transfusion history and explain what to ask before the next unit. One helpline serves every CION centre.