Clinical characteristics, recurrence patterns, and re-transfusion outcomes of allergic transfusion reactions in children: A 10-year cohort study.

Abstract

Background: Allergic transfusion reactions (ATRs) are among the most common adverse events associated with blood transfusion in children. However, data regarding recurrent ATRs, transfusion-associated anaphylaxis, and their clinical outcomes remain limited. We aimed to investigate the incidence, clinical characteristics, recurrence patterns, and potential risk factors for ATRs in pediatric patients.

Methods: This retrospective observational study included pediatric patients who developed ATRs at a tertiary referral center between August 2016 and August 2026. Clinical records, transfusion characteristics, laboratory findings, management strategies, and follow-up data were reviewed. Recurrent ATRs were evaluated only among patients who underwent repeated transfusions. Comparisons between groups were performed using exact non-parametric statistical methods.

Results: Among 37,496 transfusions, 69 ATR episodes occurred in 47 patients, corresponding to an overall incidence of 0.18%. Platelet concentrates were associated with the highest ATR rate (0.51%), followed by fresh frozen plasma (0.15%) and erythrocyte suspensions (0.09%). Mucocutaneous manifestations predominated, whereas transfusion-associated anaphylaxis occurred in 9 episodes (13%), corresponding to 24 per 100,000 transfusions. Among 37 patients who underwent repeated transfusions, recurrent ATRs occurred in 13 (35%). No significant associations were identified between recurrent ATRs and the type of blood component, history of allergic disease, elevated total IgE levels, or the severity of the index reaction. Premedication before the index ATR did not differ significantly between patients with and without recurrent ATRs. Importantly, no patient experienced recurrent anaphylaxis during follow-up; subsequent transfusions were either well tolerated or associated only with mild cutaneous manifestations.

Conclusion: ATRs in children encompass a broad clinical spectrum ranging from mild cutaneous reactions to anaphylaxis. Recurrent ATRs are common among children requiring repeated transfusions, but reliable clinical predictors of recurrence were not identified. Our findings suggest that continued transfusion therapy may be feasible with careful clinical monitoring and an individualized management approach.