Aims: The study aims to assess the incidence, causality, and severity of adverse transfusion reactions in patients transfused with blood or blood components at a secondary care referral hospital. Study Design: A prospective observational study was conducted in the secondary care referral hospital located in rural settings of Anantapur district, Andhra Pradesh, India. The study was conducted for a period of six months from May 2019 to October 2019 Methodology: All the patients transfused with blood or blood components in the hospital located in Andhra Pradesh during those six months study period were included. The transfusion reactions were reported to the blood bank in the Adverse Transfusion Reaction Report Form (ATRRF). Descriptive statistics were used to represent the adverse transfusion reactions. Results: From 2549 transfusions, 30 adverse transfusion reactions were reported (1.17%).Most of the reactions reported were febrile non-hemolytic transfusion reactions FNHTRs (73.3%) followed by allergic reactions (20.0%). Transfusion reactions were predominant in females 21 (70.0%) than males 9 (30.0%). Most of the reactions were confirmed/definite (46.6%) in causality assessment and moderate (63.3%) in severity assessment. The incidence of adverse transfusion reactions was found to be 1.17%. Conclusion: The study concludes that there was a low incidence of adverse transfusion reactions indicating probably underreporting in the healthcare system. This would be due to lack of knowledge regarding importance of surveillance and reporting of adverse transfusion reactions by blood or blood components. There was a need to conduct continuous educational programs (CEP) on hemovigilance system towards healthcare providers to improve the reporting practice. The study provides insights about type of adverse transfusion reactions and their causality and severity. This data helps in motivating the healthcare staff to report ATRs and also to develop strategies to handle preventable ATRs.