Cansu ÖZDEMIRAL, Elif SOYAK AYTEKIN, Barıs KUSKONMAZ, Fatma VISAL OKUR, Deniz CAGDAS, Bulent Enis SEKEREL
Asthma Allergy Immunology - 2026;24(1):26-32
Acute transfusion reactions (ATRs) in children represent a heterogeneous group of allergic, immunologic, and non-immunologic events that can be life-threatening and clinically indistinguishable, particularly in immunocompromised cohorts. This case-based narrative review explores the spectrum of pediatric ATRs, focusing on pathophysiological mechanisms, diagnostic hurdles, and management strategies. The discussion is framed by two pediatric cases involving four distinct ATRs: first, a child with DOCK8 deficiency undergoing hematopoietic stem cell transplantation who experienced urticaria and subsequent anaphylaxis due to suspected passive allergen transfer; and second, a child with malignancy who developed febrile non-hemolytic and acute hemolytic reactions despite ABO compatibility. These scenarios are analyzed alongside critical entities such as transfusion-associated circulatory overload (TACO) and transfusion-related acute lung injury (TRALI). This review underscores the need for heightened clinical vigilance and highlights passive allergen transfer as an increasingly recognized mechanism essential to enhancing pediatric transfusion safety.
