急性溶血性输血反应在输血过程或输血后立即发病,常由错误引起。在美国,据估计红细胞成分错误输给患者的几率在 1/12,000 到 1/19,000 次输血之间。[1]Linden JV, Wagner K, Voytovich AE, et al. Transfusion errors in New York state: an analysis of 10 years' experience. Transfusion. 2000;40:1207-1213.http://www.ncbi.nlm.nih.gov/pubmed/11061857?tool=bestpractice.com[2]Spiess BD. Risks of transfusion: outcome focus. Transfusion. 2004;44(12 Suppl):4S-14S.http://www.ncbi.nlm.nih.gov/pubmed/15585000?tool=bestpractice.com 据估计,急性溶血性输血反应死亡率为 1:800,000 次输血。[3]Sazama K. Reports of 355 transfusion-associated deaths: 1976 through 1985. Transfusion. 1990;30:583-590.http://www.ncbi.nlm.nih.gov/pubmed/2402771?tool=bestpractice.com2008 年在英国,报告给 SHOT 关于血液成分输血错误的发生率是每 100,000 例中 16.8 例,共 262 起血制品输错。[4]Serious Hazards of Transfusion. SHOT report 2008. http://www.shotuk.org (last accessed 8 August 2017).http://www.shotuk.org/wp-content/uploads/2010/03/SHOT-Report-2008.pdf
发热性非溶血性输血反应是一种更常见的输血反应。临床上血制品普遍经过去白细胞,发热性非溶血性输血反应发生频率对红细胞制品是 0.15% 到 0.19%,对血小板制品为 0.11% 到 0.15%。在常规输非去白血液制品时,这一反应的发生率更高,红细胞制品为 0.33% 到 0.37%,血小板制品为 0.45% 到 2.18%。[5]Yazer MH, Podlosky L, Clarke G, et al. The effect of prestorage WBC reduction on the rates of febrile nonhemolytic transfusion reactions to platelet concentrates and RBC. Transfusion. 2004;44:10-15.http://www.ncbi.nlm.nih.gov/pubmed/14692961?tool=bestpractice.com[6]Paglino JC, Pomper GJ, Fisch GS, et al. Reduction of febrile but not allergic reactions to RBCs and platelets after conversion to universal prestorage leukoreduction. Transfusion. 2004;44:16-24.http://www.ncbi.nlm.nih.gov/pubmed/14692962?tool=bestpractice.com[7]King KE, Shirey RS, Thoman SK, et al. Universal leukoreduction decreases the incidence of febrile nonhemolytic transfusion reactions to RBCs. Transfusion. 2004;44:25-29.http://www.ncbi.nlm.nih.gov/pubmed/14692963?tool=bestpractice.com
变态反应也常见,输血过程中的总发病率为 0.4% 到 3%。[8]Tobian AA, King KE, Ness PM. Transfusion premedications: a growing practice not based on evidence. Transfusion. 2007;47:1089-1096.http://www.ncbi.nlm.nih.gov/pubmed/17524101?tool=bestpractice.com大多数反应只会出现荨麻疹。过敏反应罕见 (1/20,000 到 1/50,000 次输血)。[9]Domen RE, Hoeltge GA. Allergic transfusion reactions: an evaluation of 273 consecutive reactions. Arch Pathol Lab Med. 2003;127:316-320.http://www.archivesofpathology.org/doi/10.1043/0003-9985(2003)127%3C0316:ATR%3E2.0.CO;2?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmedhttp://www.ncbi.nlm.nih.gov/pubmed/12653575?tool=bestpractice.com[10]Stainsby D, Jones H, Asher D, et al. Serious hazards of transfusion: a decade of hemovigilance in the UK. Transfus Med Rev. 2006;20:273-282.http://www.ncbi.nlm.nih.gov/pubmed/17008165?tool=bestpractice.com尽管很难精确界定,但是据估计迟发性溶血性输血反应的发病率大约为 1/2500。[2]Spiess BD. Risks of transfusion: outcome focus. Transfusion. 2004;44(12 Suppl):4S-14S.http://www.ncbi.nlm.nih.gov/pubmed/15585000?tool=bestpractice.com[11]Vamvakas EC, Pineda AA, Reisner R, et al. The differentiation of delayed hemolytic and delayed serologic transfusion reactions: incidence and predictors of hemolysis. Transfusion. 1995;35:26-32.http://www.ncbi.nlm.nih.gov/pubmed/7998064?tool=bestpractice.com输血相关性移植物抗宿主病鲜有发生,大多数限于使用免疫抑制的患者。[12]Mazzei CA, Popovsky MA, Kopko PM. Noninfectious complications of blood transfusion. In: Roback JD, Combs MR, Grossman BJ, et al., eds. Technical Manual, 16th Ed. Bethesda, MD: American Association of Blood Banks; 2008:715-749.输血后紫癜相应比较少见,男女发病率为 5 比 1。[12]Mazzei CA, Popovsky MA, Kopko PM. Noninfectious complications of blood transfusion. In: Roback JD, Combs MR, Grossman BJ, et al., eds. Technical Manual, 16th Ed. Bethesda, MD: American Association of Blood Banks; 2008:715-749.据估计输血相关急性肺损伤 (TRALI) 发病率在所有输血案例中为 0.04% 到 0.1% 之间。[13]Finlay HE, Cassorla L, Feiner J, et al. Designing and testing a computer-based screening system for transfusion-related acute lung injury. Am J Clin Pathol. 2005;124:601-609.http://www.ncbi.nlm.nih.gov/pubmed/16146824?tool=bestpractice.com[14]Rana R, Fernandez-Perez ER, Khan SA, et al. Transfusion-related acute lung injury and pulmonary edema in critically ill patients: a retrospective study. Transfusion. 2006;46:1478-1483.http://www.ncbi.nlm.nih.gov/pubmed/16965572?tool=bestpractice.com在美国 TRALI 是输血相关死亡的主要原因,输血相关死亡的发生率据估计在 5% 到 8%。[15]Silliman CC, Ambruso DR, Boshkov LK. Transfusion-related acute lung injury. Blood. 2005;105:2266-2273.http://www.ncbi.nlm.nih.gov/pubmed/15572582?tool=bestpractice.com[16]Looney MR, Gropper MA, Matthay MA. Transfusion-related acute lung injury: a review. Chest. 2004;126:249-258.http://www.ncbi.nlm.nih.gov/pubmed/15249468?tool=bestpractice.com