: Blood transfusion is one of the most common procedure in hospitals to assist in saving millions of lives each year. However, their use is often associated with untoward effects causing Adverse Transfusion reactions (ATR). This study aims to collect and analyze reports of unexpected events or reactions in blood and blood product recipients in a secondary care hospital. ATRs were monitored in recipients of blood or blood products in a 150-bedded hospital through a prospective observational study over a period of eight months. The severity of ATR was determined by using a grading scale from 1 (mild) to 5 (death). Imputability score was applied to find the likelihood that the transfusion caused the reaction. Descriptive statistics were applied to present data in number and percentages. The incidence rate of ATRs was calculated by taking number of a particular ATR as the numerator of the total number of transfusions. Analysis comprised of 165 transfusions comprising whole blood (100; 66.66%), PRBC (48; 29.09%), platelets (9; 4.84%), and FFP (8; 4.84%), of these, majority was indicated in cardiac (42; 24.45%), orthopedic (34; 20.64%), and renal system disorders (28; 16.96%). Majority of ATRs were evidenced for whole blood (55%) followed by PRBC (52%). Most of the reactions were AHTR (23.64%), febrile (17.58%), and allergic (10.91%) in nature. Majority of reactions were acute, no serious (Grade 1 = 50.91%; Grade 2 = 24.24%) and probable (35.15%) to transfusion while only 2 reactions (1.21%) were categorized as certain. Clerical errors were identified in 98 (59.33%) transfusions. Majority of ATRs were acute, nonserious, mildly severe, and probably linked with the suspected blood component. A high number of clerical errors indicated a need for a system to minimize human errors to reduce the risk of transfusion-related untoward effects..