Risk factors for hemolytic transfusion reactions resulting from ABO and minor red cell antigen incompatibility: From mislabeled samples to stem cell transplant and sickle cell disease

Blood Rev. 2021 Jan;45:100719. doi: 10.1016/j.blre.2020.100719. Epub 2020 Jun 6.


Advances in laboratory testing, pathogen reduction and donor qualification have dramatically reduced the risk of acquiring an infection from a blood transfusion. Despite this progress, the most feared complication of transfusion - a hemolytic reaction due to incompatibility between donor and recipient - remains, with essentially no recent progress in the prevention or recognition of this rare but frequently lethal complication. Herein, the role that compatibility testing and transfusion practice play in the occurrence of acute hemolysis are described, with a special emphasis on clinical scenarios confer an increased risk of a severe hemolytic reaction in response to red blood cell or platelet transfusion. In addition, the signs and symptoms of a severe hemolytic reaction are summarized, along with the initial approach to clinical management.

Keywords: Blood transfusion; Hematological emergencies; Transfusion reactions.

Publication types

  • Review

MeSH terms

  • ABO Blood-Group System / immunology*
  • Anemia, Hemolytic / diagnosis
  • Anemia, Hemolytic / etiology
  • Anemia, Sickle Cell / blood
  • Anemia, Sickle Cell / complications
  • Anemia, Sickle Cell / therapy
  • Blood Group Antigens / immunology*
  • Blood Grouping and Crossmatching
  • Disease Management
  • Disease Susceptibility
  • Hemolysis / immunology
  • Humans
  • Platelet Transfusion
  • Risk Factors
  • Stem Cell Transplantation / adverse effects
  • Stem Cell Transplantation / methods
  • Transfusion Reaction / diagnosis
  • Transfusion Reaction / etiology*


  • ABO Blood-Group System
  • Blood Group Antigens