Immune-mediated and non-immune-mediated reactions have both similarities and differences. Generally, the clinical symptoms of a transfusion reaction will be the same for both types of reactions. These symptoms can present as a fever, nausea or vomiting, chills and rigors, shock, disseminated intravascular coagulation, or respiratory distress, just to name a few. Both responses also are broken up into acute reactions, less than 24 hours, and delayed reactions, greater than 24 hours. Immune-mediated reactions are reactions that happen because of your body having an immune response due to antigen-antibody complexes, complement activation, or cytokine release because of the transfusion and your red blood cells are breaking down. A non-immune-mediated reaction happens because of something that was wrong with the unit that they received, an underlying condition that the patient has, or how the unit was infused, and this causes red blood cells to break down. An example of an immune-mediated transfusion reaction that breaks down red blood cells is acute hemolytic transfusion reaction. This can happen when there are clerical errors that lead to the wrong ABO type to be given and causing complement to activate. In a delayed hemolytic transfusion, the cause can be an alloantibody that was below a positive titer before transfusion and increased posttransfusion. An example of a non-immune-mediated transfusion reaction is sepsis. Sepsis can happen when bacteria is present in the blood products that are received, and they are directly put into your bloodstream. Another example is transfusion hemosiderosis, which is also referred to as iron overload. This is often associated with patients that have to get many transfusions over their lifetime, such as patients that have thalassemia or sickle cell disease since there is persistent hemolysis, and the excess iron is collected in macrophages that are found in assorted tissues in the body.
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