Blood transfusions can have the possible side effects below in older adults, especially those with underlying health conditions.

Allergic reactions

An allergic reaction after a blood transfusion can occur in any patient, including elderly patients. Symptoms of an allergic reaction can be diagnosed with hives. Those hives can range from mild to life-threatening anaphylaxis (a severe, whole-body reaction).

Transfusion-related acute lung injury (TRALI)

TRALI is a rare but severe side effect of blood transfusion. It can be referred to as acute respiratory distress. In other words, it is an immune response to transfused blood components.


Blood transfusions carry a high risk of infection. It can be a notable concern for elderly patients with weakened immune systems. However, the risk of developing a condition can be minimized by carefully examining the donor’s blood.

Iron overload

Repeated blood transfusions can cause iron overload; the more red blood cells are present, the more iron they will bind. It can be a concern for elderly patients who have diagnosed or underlying liver and heart disease.

Fluid overload/hypervolemia

Older people may be more susceptible to fluid overload. It is referred to as hypervolemia. Fluid overload is a condition in which edema occurs. This condition can lead to congestive heart failure or pulmonary edema (edema in the lungs).

Blood type incompatibility

Blood type incompatibility is when the blood groups of the donor and receiver do not match. To prevent this condition, the transfusing blood must be carefully checked with the receiver’s blood type. The risk of blood type incompatibility may be higher in older adults due to prevailing medical conditions.

Hemolytic reactions

Hemolytic reactions are transfusion reactions that occur when the receiver’s immune system attacks and destroys transfused blood’s red blood cells. Hemolytic reactions are rare but life-threatening, especially febrile nonhemolytic reactions.

What are the risk factors associated with blood transfusion in older adults?

There are several risk factors related to blood transfusion in older adults. Some are mentioned below.

Underlying health conditions

Older people usually have multiple underlying health conditions, such as heart disease, lung disease, and diabetes. Such medical conditions can increase the risk of complications during and after a blood transfusion.

Previous transfusions

Older people with a history of receiving blood from different donors are at higher risk of complications, like iron overload.


As we age, the immune system ages. The immune system becomes less efficient at identifying and fighting off foreign invaders, such as viruses and bacteria. Due to an inefficient immune system, there is an increased risk of infections and immune-mediated reactions.


Elderly patients may take multiple medications that can interact with transfused blood products, such as anticoagulants or immunosuppressive drugs. These interactions can increase the risk of bleeding or infections.

Blood type

Older adults may have a rare blood type, which can increase the risk of transfusion reactions if the blood type is not checked correctly. Having a rare blood type also may delay the availability of compatible blood types.

What are the preventive and management steps during blood transfusion in older adults?

There are many ways to prevent and manage complications during a blood transfusion in older adults. Some are mentioned below.

Careful patient selection

Before transfusing blood, healthcare providers or hospital setups should carefully assess the patient’s medical history and overall health status to minimize any risk factors contributing to developing complications.

Use of compatible blood

To decrease the risk of transfusion reactions, healthcare providers should reassure that the transfused blood is compatible with the patient’s blood type and other medical conditions.


During the transfusion, healthcare providers should monitor the patient for signs of complications, such as fever, chills, and shortness of breath. Vitals should also be monitored before, after, and during transfusions.

Hydration and electrolyte management

Blood transfusions can sometimes lead to fluid overload or electrolyte imbalances, specifically in older adults with underlying chronic diseases. Adequate hydration and electrolyte management can help prevent this condition.


If the patient is assessed thoroughly, healthcare providers may prescribe some medications to minimize the risk of transfusion reactions and other complications.

Smaller transfusion volumes

Older people are more susceptible to volume overload, so smaller transfusion volumes may prevent this risk.

Post-transfusion monitoring

After the transfusion, healthcare providers must monitor the patient for any sign of complication, such as fever or infection.

Treating complications

If complications occur, adequate treatment can help minimize the risk of it turning into a chronic condition. Treatment may include administering medications to manage symptoms, additional blood transfusions, or other immediate medical help.


In conclusion, blood transfusions can be effective for older adults. However, there are potential risks and side effects associated with blood transfusions, especially for immune-depressed older adults with underlying health conditions. In addition, transfusion reactions can occur in older people, and common transfusion reactions include hemolytic reactions, febrile nonhemolytic reactions, and transfusion-related acute lung injury.

To manage and minimize the risks associated with transfusions, healthcare providers must carefully assess the patient’s medical history before transfusing blood. Taking steps such as using compatible blood products, monitoring the patient closely for signs of complications, and managing electrolyte imbalances effectively prevent complications. In addition, individualized treatment plans can also be developed for each patient to prevent and manage potential complications during and after the blood transfusion.

Finally, transfusable blood can be in short supply and unavailable in times of great demand, or where storage is not available. 

Dr. Irfan Siddique is a GMC-registered Medical Doctor with more than four years of post-graduation experience in child and adolescent healthcare. He has done his Bachelor of Medicine and Bachelor of Surgery (MBBS) from the University of Health and Sciences, Lahore. Afterward, he was positioned at Children’s Hospital, Faisalabad, where he ran Outpatient Department for four years. Currently, he is performing his duties as Medical Doctor at St. Barts Health NHS Trust, London.