Medical Oncologist
CION Cancer Clinics
Transfusion reactions: the signs, and what happens next | CION Cancer Clinics
Most transfusion reactions are mild. The usual signs are a rise in temperature, shivering, itching or hives, and they tend to start while the blood is going in. Tell the nurse at once and they will stop the transfusion and check you. Breathlessness, chest or back pain, swelling of the face, or dark urine later on need help straight away. This page explains the types, what the team does, and who is more at risk. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · 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 transfusion reaction are there?
- What will the nurse and doctor do?
- What do the words on a reaction report mean?
- Who is more likely to have a reaction, and what can this page not tell you?
- What do families believe about transfusion reactions?
- Common questions about transfusion reactions
The short answer
What does a transfusion reaction feel like?
Most transfusion reactions are mild: a rise in temperature, shivering, an itchy rash or hives. Tell the nurse the moment you notice anything new, and they will slow or stop the blood straight away.
When reactions usually happen
Most reactions start during the transfusion, often in the first part of it. That is why the nurse checks your temperature, pulse and blood pressure before it starts, again soon after, and at intervals until it finishes. A smaller group of reactions appears later, sometimes after you have gone home.
Why speaking up early matters
Many patients stay quiet because they do not want to trouble a busy nurse, or because they assume a shiver is just the cold ward. Say it anyway. A reaction caught early is usually simple to manage. The nurse would much rather check ten false alarms than miss one real reaction.
If you are the family member sitting beside the bed
You may notice a change before the patient does, especially if they are drowsy after surgery. Restlessness, a flushed face, fast breathing or confusion are all worth pointing out.
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Signs that need help at once
During a transfusion, call the nurse immediately for breathlessness, chest or back pain, swelling of the lips, tongue or face, a sudden feeling that something is very wrong, or feeling faint. After you go home, go to the nearest emergency department the same day for breathlessness, a high fever, yellow eyes or very dark urine. Say you recently had blood. Do not wait to see if it passes.
Not sure whether this applies to you?
Ask an oncologistThe main types
Which kinds of transfusion reaction are there?
They differ in cause, in timing and in how serious they are. The nurse and doctor work out which one it is from what they see and from blood tests.
Fever and shivering
The most common kind. Your body reacts to white cells or proteins in the donor blood. It is uncomfortable and usually settles quickly.
Allergic reaction
Itching, raised red patches (hives) or a rash. Mild ones are common. A severe allergic reaction, called anaphylaxis, affects breathing and blood pressure and is rare.
Too much fluid
Blood given faster than the heart can handle can cause breathlessness and a cough. Older people and those with heart or kidney problems are more at risk.
Blood group mismatch
Rare, and serious. Your body attacks the donor red cells. It can cause fever, back pain, dark urine and low blood pressure.
Other rare kinds
- Lung injury from the transfusion
- Infection from the unit
- A delayed reaction days later
If a reaction starts
What will the nurse and doctor do?
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The transfusion is paused
The nurse stops the blood first, then looks at you. The drip line is usually kept open with a plain fluid so medicines can be given quickly.
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Your signs are checked
Temperature, pulse, blood pressure, breathing and oxygen level are measured, and your skin is looked at for a rash or swelling.
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The bag and wristband are checked again
The team confirms the unit really was meant for you. This takes a minute and rules out the most serious cause.
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A doctor decides on treatment
A mild reaction may need only a medicine for fever or itching. A serious one is treated as an emergency on the spot.
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Samples go to the blood bank
The bag and fresh blood and urine samples may be sent for testing. The blood bank records the reaction so future units can be chosen with care.
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On your notes
What do the words on a reaction report mean?
- Haemolytic reaction
- Your immune system destroys the donor red cells. Usually due to a blood group mismatch.
- Anaphylaxis
- A severe allergic reaction affecting breathing and blood pressure. It needs emergency treatment.
- TACO
- Fluid overload from the transfusion. The lungs become wet and breathing gets harder.
- TRALI
- A rare lung injury linked to the transfusion, causing sudden breathlessness.
- Antibodies
- Proteins your body makes against foreign cells. Previous transfusions or pregnancies can leave antibodies that make matching harder.
Being straight with you
Who is more likely to have a reaction, and what can this page not tell you?
Anyone can react to a transfusion, even after several uneventful ones. Some people are more at risk, and the team should know about them before the blood is ordered.
Tell the team if any of these apply
You have reacted to blood before. You have had many transfusions in the past. You have been pregnant, which can leave antibodies behind. You have a heart or kidney problem, which raises the chance of fluid overload. You have serious allergies. None of these stop you having blood. They change how it is chosen and how closely you are watched.
What the page cannot tell you
A list of symptoms is not a diagnosis. A shiver after surgery may have nothing to do with the blood, and a rash may come from an antibiotic. Only the team at your bedside can sort out the cause. Nor can it tell you whether a past reaction will happen again. The blood bank's records and your doctor are the right places to ask.
If you have had a reaction before, ask for it to be written in your discharge summary so any future hospital knows.Commonly believed
What do families believe about transfusion reactions?
"A reaction means the blood bank gave the wrong blood."
Almost never. Most reactions happen with correctly matched blood, because the body reacts to proteins or white cells in it. A true mismatch is rare, and the bedside checks exist to catch it.
"After one reaction, I can never have blood again."
Most people can. The blood bank may choose specially treated units, or the doctor may give medicine beforehand. You will be watched more closely next time.
"Shivering during a transfusion is just the cold."
It may be, but it is also one of the commonest early signs of a reaction. Tell the nurse and let them decide.
"Once the transfusion is finished, the risk is over."
Most reactions happen during it, but some appear hours or days later. Know the warning signs before you leave hospital.
Questions we are asked
Common questions about transfusion reactions
What are the first signs of a transfusion reaction?
The early signs are usually a rise in temperature, shivering, itching, a rash or hives, and feeling flushed or restless. More serious signs are breathlessness, chest or back pain, and swelling of the face or lips. Tell the nurse about any of these straight away, even if it seems small.
Can a reaction happen days after the transfusion?
Yes, though it is uncommon. A delayed reaction can show as fever, yellowing of the eyes or skin, dark urine or unexpected tiredness. If you notice these after going home, go to a hospital the same day and tell them you recently had blood, so they can check for it.
Will they restart the blood after a mild reaction?
Sometimes. If the reaction was mild, settled quickly and checks show nothing serious, the doctor may restart the same unit more slowly. If there is any doubt, the unit is stopped for good and sent to the blood bank for testing. That decision belongs to the doctor at your bedside.
Can medicines stop a reaction before it starts?
For people who have had repeated mild reactions, a doctor may give a medicine such as an antihistamine or paracetamol before the next transfusion. It is not given routinely to everyone. Do not take anything on your own beforehand, because it can hide the early signs the nurse is watching for.
Is a reaction more likely with platelets or plasma?
Allergic reactions such as hives and itching are somewhat more common with platelets and plasma than with red cells. Most are mild. The watching and checks are the same whichever part of the blood you receive, so tell the nurse about any new symptom.
I am diabetic and older. Am I at higher risk?
Diabetes itself does not raise the risk of most reactions. Age, and especially heart or kidney problems, can raise the chance of fluid overload. The team may give the blood more slowly, one unit at a time, and sometimes give a water tablet. Mention every condition you have when blood is discussed.
Will a reaction affect my cancer operation or recovery?
Most mild reactions have no lasting effect on your surgery or recovery. A serious reaction may mean a longer stay or closer monitoring for a while. Your surgeon can explain what it means in your own case once the cause is known.
Should my family stay with me during a transfusion?
Where ward rules allow it, a family member sitting nearby can help, particularly if the patient is drowsy or does not like to complain. They should call the nurse for any change they notice. They should not adjust the drip or give food, drink or medicines without asking.
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Sources
- NHS — Blood transfusion: risks
- NICE — Blood transfusion (NG24)
- Macmillan Cancer Support — Cancer information and support
- American Cancer Society — Cancer treatment types
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.
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