Hematologist
CION Cancer Clinics
Transfusion reactions: what they feel like and what to do | CION Cancer Clinics
Most transfusion reactions feel like a sudden chill, a rising temperature, or itchy raised patches on the skin. Rarer, serious reactions bring breathlessness, chest or back pain, swelling of the face, or dark urine. Tell the nurse at once if anything changes. After going home, go to the nearest emergency department or call 108 for any serious sign. This page explains each symptom and what the team does next. 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 does a transfusion reaction feel like?
- Which kinds of reaction are there, and how do they show?
- What happens when a reaction starts?
- Can a reaction start after I have gone home?
- What do families often get wrong about reactions?
- What do the words in the transfusion notes mean?
- Common questions about transfusion reactions
The short answer
What does a transfusion reaction feel like?
Most transfusion reactions feel like a sudden chill, a rising temperature, or itchy raised patches on the skin. A few feel much worse: sudden breathlessness, tightness in the chest, pain in the back, or a feeling that something is badly wrong. Whatever you feel, tell the nurse straight away. The transfusion can be paused within seconds.
When reactions usually happen
Many reactions start early, while the first part of the bag is running. That is why the nurse checks your temperature, pulse and blood pressure at the start and stays close for the first stretch of time. Some reactions start towards the end of the bag. A smaller group appear hours or days after you have gone home.
Most reactions are mild
Blood and platelet transfusions are given every day in haematology wards, and most go through with no trouble at all. When a reaction does happen, it is usually a mild fever or a rash that settles once the transfusion is slowed or stopped. People who have had many transfusions, such as those with leukaemia or thalassaemia, are a little more likely to react, because the body may have formed antibodies against donor cells.
This page describes symptoms. It cannot tell you which reaction you had. Only the team that gave the blood can work that out, using tests on you and on the bag.
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Signs that cannot wait
If you are in hospital, press the call bell and say "I think I am reacting to the blood" if you feel breathless, wheezy, faint, have chest or back pain, swelling of the lips or face, or shaking chills. If you have gone home and any of these start, or you pass very dark or red urine, go to the nearest emergency department or call 108. Say that you had a transfusion and when. Do not wait to see whether it passes.
Not sure whether this applies to you?
Ask an oncologistSymptom by symptom
Which kinds of reaction are there, and how do they show?
Symptoms overlap, so your team treats the reaction first and works out the type afterwards.
Fever and chills
The most common kind. You feel cold and shivery, then hot. It is usually caused by your body reacting to white cells or chemicals in the bag. It is often mild, but a fever can also be the first sign of a serious reaction, so it is always checked.
Itching and hives
Raised, itchy red patches, often on the chest, arms or neck. This is a mild allergic reaction to proteins in the donor plasma. It is common with platelets and plasma.
Serious if it comes with
- Swelling of lips, tongue or face
- Wheezing or a tight throat
- Feeling faint or dizzy
Breathlessness
Can come from too much fluid going in too fast, which strains the heart, or from a rare lung reaction to the donor blood. Older people and those with heart or kidney problems are more at risk of the fluid kind.
Back pain, dark urine, feeling very unwell
These can mean donor red cells are being broken down in your blood. It is rare, and it is one of the most serious reactions. It needs urgent treatment.
On the ward
What happens when a reaction starts?
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The transfusion is stopped
The nurse stops the blood at once but keeps the drip line open with a plain fluid, so medicines can go in quickly if needed.
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Checks at the bedside
Temperature, pulse, blood pressure, breathing and oxygen levels are measured. The nurse checks your name band against the label on the bag once again.
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A doctor sees you
The doctor decides how serious the reaction is. Mild itching may be treated and the transfusion restarted slowly. A fever or anything more serious usually means that bag is not used again.
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Samples are sent
A fresh blood sample and a urine sample are usually taken. The bag goes back to the blood bank so both can be tested.
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It is written in your notes
The reaction is recorded, so future transfusions can be planned around it. You may be given filtered or washed blood next time, or medicines beforehand.
Delayed reactions
Can a reaction start after I have gone home?
Yes, though it is less common. Some reactions appear days after the transfusion, once the body has made antibodies against the donor cells. These are usually slower and milder than reactions on the ward, but they still need to be checked.
What a delayed reaction can look like
You may notice a new fever, yellowing of the skin or the whites of the eyes, dark urine, or tiredness that returns sooner than expected. A blood test may show your haemoglobin has dropped again, even though you were just transfused. Call your haematology team the same day if you notice any of these.
Why this matters more in blood cancer
If your white cell count is low after chemotherapy, a fever at home is treated as an emergency whatever the cause. Do not assume it is only the transfusion. Go to the emergency department, and say you are on treatment for a blood cancer and recently had blood.
Keep a note of the date and type of every transfusion. It helps any doctor who sees you work out what is going on.Leave a number, we will call you
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Commonly believed
What do families often get wrong about reactions?
"If I mention the itching, they will stop my blood and I will get weaker."
A mild reaction is often treated and the transfusion continued. Hiding symptoms is far riskier, because a mild start can be the early part of a serious reaction. The nurse needs to know.
"A reaction means the blood bank gave the wrong blood."
Almost always it does not. Most reactions happen with correctly matched blood, because the body reacts to proteins or white cells that matching does not cover. Checks are still done to rule out a mix-up.
"Blood from a family member will never cause a reaction."
Family blood can still cause reactions. Blood from close relatives can carry a particular risk for people with weak immunity, which is why it is often treated with radiation before use.
"After one reaction, I can never have a transfusion again."
Most people who react once go on to have further transfusions safely. The team plans around it, sometimes with filtered blood, slower rates or medicines beforehand.
In your notes
What do the words in the transfusion notes mean?
- Haemolytic reaction
- Donor red cells are being broken down in your body. It can be sudden on the ward, or delayed by days.
- Anaphylaxis
- A severe, whole-body allergic reaction with breathing trouble or a fall in blood pressure. It is treated as an emergency.
- TACO
- Transfusion-associated circulatory overload. Too much fluid for the heart to handle, causing breathlessness.
- TRALI
- Transfusion-related acute lung injury. A rare reaction in which the lungs fill with fluid, usually soon after the transfusion.
- Leucodepleted
- Blood with most white cells filtered out. It lowers the chance of fever reactions.
- Crossmatch
- The test that checks donor blood is compatible with yours before it is given.
Questions we are asked
Common questions about transfusion reactions
How do I know if I am having a reaction or just feeling cold?
You often cannot tell on your own, and you do not need to. Cold fluid can make your arm feel chilly, but shivering, a hot face, itching, breathlessness or pain are not normal. Tell the nurse about any change. Checking takes a minute and is always the right call.
Are platelet transfusions more likely to cause a reaction?
Mild reactions such as fever, chills and hives are seen more often with platelets than with red cells. Platelets are stored warm and carry more plasma, which can trigger these responses. Serious reactions remain uncommon. If you react often, your team can look at other types of platelet product.
Can I be given medicine to stop reactions before a transfusion?
Sometimes. If you have reacted before, your doctor may give an antihistamine or paracetamol beforehand. This is not done for everyone, because it can hide early signs of a reaction. Do not take anything yourself before a transfusion unless your haematology team has asked you to.
My father is elderly and got breathless during blood. Why?
In older people, and in those with heart or kidney problems, fluid going in too quickly can strain the heart and cause breathlessness. The team usually slows the transfusion, sits him up and may give a medicine to pass urine. Future bags may be given more slowly, one at a time.
Can I catch an infection from a transfusion?
Donated blood in India is screened for HIV, hepatitis B, hepatitis C, syphilis and malaria, which makes infection uncommon. Rarely, bacteria in a bag, more often a platelet bag, can cause a sudden high fever and shivering during the transfusion. This is treated as an emergency.
Will one reaction affect my future treatment?
It usually changes how blood is given, not whether it is given. The reaction goes in your records, and the blood bank may test for antibodies. Next time you might receive filtered, washed or specially matched products. Always tell a new hospital that you have reacted before.
Is it safe to have a transfusion as a day-care patient and go home?
For many people, yes. You are watched through the transfusion and for a short time after. Before you leave, ask who to call if you feel unwell that night. Anyone with a low white cell count and a fever at home should go to the emergency department at once.
What should I bring or say before my next transfusion?
Tell the nurse about any earlier reaction, even a mild rash, and bring a record of past transfusions if you have one. Mention new medicines and any breathing or heart problems. Confirm your full name and date of birth when asked, every time, even if it feels repetitive.
Your Haematologist
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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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Sources
- NHS — Blood transfusion: risks
- National Heart, Lung, and Blood Institute — Blood Transfusion
- American Cancer Society — Blood Transfusion and Donation
- NICE — Blood transfusion (NG24)
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
Irradiated and Leucodepleted Blood ProductsThe filtered and treated blood used to lower reaction riskWhen a Platelet Transfusion Is GivenWhy platelets are transfused in the first placeNeutropenic Fever: The Single Most Important EmergencyWhy fever with a low count needs the emergency departmentPlatelet RefractorinessWhen platelet transfusions stop raising the countCounts, Fever and Infection in HaematologyThe full guide to counts and infection
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