Background: Numerous factors may underlie an acute transfusion reaction. The readily available data showing the prevalence and the risk factors of transfusion reactions in Bali are scarce. Objectives: Our study aimed to reveal the prevalence and the risk factors of acute blood transfusion in Pediatric Patients in Sanglah General Hospital, Bali, Indonesia. Methods: A cross-sectional study using consecutive sampling was conducted from August 2015 to August 2016 (13 months). We collected the data from the medical records of our pediatric patients in the pediatric wards, neonatal intensive care unit (NICU), and pediatric intensive care unit (PICU). We examined the relationship between the occurrence of acute transfusion reactions and the types of blood transfusion, the history of blood transfusion, and the age of the patients. Results: A total of 107 acute transfusion reactions occurred from 3,251 blood transfusions. When acute transfusion reactions occurred, the patients were more likely to be over 12 months old compared to 0 to 12 months old (POR=2.81, 95%CI 1.78-4.58, p<0.05). Alternatively, when the transfusion reactions occurred, the patients were more likely to receive thrombocyte concentrate transfusion compared to other blood components (OR=8.11, 95%CI 5.36-12.31, p<0.05). Conclusion: The prevalence of acute transfusion reactions was 3.3%. The pediatric patients who had acute transfusion reactions were more likely to be over 12 months old or more likely to receive a platelet concentrate.