Transfusion complication

Common Complication:
  • The most common complications of transfusion are febrile nonhemolytic and chill-rigor reactions.
  • The most serious complications are acute hemolytic reaction due to ABO incompatible transfusion and transfusion-related acute lung injury, which have very high mortality rates 
Complications of Massive Blood Transfusion
  • Coagulopathy
  1. The most common cause of bleeding following massive blood transfusion is dilutional thrombocytopenia
  • Citrate Toxicity
  1. Citrate is used as an anticoagulant in the stored blood.
  2. Citrate has a property to bind calcium, this calcium binding by the citrate preservative can become significant following transfusion of large volumes of blood or blood products.
  3. Hypocalcemia results in some patients after massive transfusion, to prevent this, the transfusion rate should not exceed 1 unit every 5 minutes.
  4. Citrate also has an affinity for magnesium ion and the occurrence of hypomagnesemia in the setting of massive transfusion is seen (rarely).
  • Hypothermia
  1. Blood is stored at a temperature of 2°C-6°C. So massive blood transfusion can result in hypothermia.
  2. Hypothermia due to massive transfusion can result in venticular arryhthmia.
  • Acid-Base Balance 
  1. The most consisent acid base abnormality after massive blood transfusion is postoperative metabolic alkalosis.
  • Serum Potassium Concentration
  1. The extracellular concentration of Potassium in stored blood steadily increases with time due to lvsis of BBC's.
  2. Hyperkalemia can develop regardless of the age of the blood when transfusion rate exceede 100m1/min. 688
  • Oxygen Affinity Changes
  1. 2,3 DPG is greatly reduced in RBC's after about 3 weeks of storage, this increases hemoglobin's affinity for oxyen and adversely affects oxygen delivery to tissues.
  • Acute Respiratory Distress syndrome
  • Coagulation Factor Depletion 
Delayed hemolytic transfusion reaction:
  • After transfusion with RBCs bearing RBC antigenantigen, a primary or anamnestic response may result (usually in 1 to 4 wk) and cause a delayed hemolytic transfusion reaction.
  • Patients may be asymptomatic or have a slight fever. Rarely, severe symptoms occur. 
  • Usually, only destruction of the transfused RBCs (with the antigen) occurs, resulting in a falling Hct and a slight rise in LDH and bilirubin.
Allergic reactions:
  • Type II hypersensitivity
  • These reactions are usually mild, with urticaria, edema, occasional dizziness, and headache during or immediately after the transfusion. Simultaneous fever is common 
Volume Overload:
  • The high osmotic load of blood products draws volume into the intravascular space over the course of hours, which can cause volume overload in susceptible patients (eg, those with cardiac or renal insufficiency). 
  • RBCs should be infused slowly.
  • The patient should be observed and, if signs of heart failure (eg, dyspnea, rales) occur, the transfusion should be stopped and treatment for heart failure begun.
Acute lung injury TRALI: 
  • An infrequent complication caused by anti-HLA and/or anti-granulocyte antibodies in donor plasma that agglutinate and degranulate recipient granulocytes within the lung. 
  • Acute respiratory symptoms develop, and chest x-ray has a characteristic pattern of noncardiogenic pulmonary edema.
  • After ABO incompatibility, this is the 2nd most common cause of transfusion-related death
Graft-vs-host disease (GVHD):
  • Transfusion-associated GVHD is usually caused by transfusion of products containing immunocompetent lymphocytes to an immunocompromised host.
  • The donor lymphocytes attack host tissues.
  • GVHD can occur occasionally in immunocompetent patients
Acute hemolytic transfusion reaction (AHTR):
  • Usually results from recipient plasma antibodies to donor RBC antigens. 
  • ABO incompatibility is the most common cause of AHTR.
  • Complement mediated Hemolysis is seen in Acute Hemolytic blood transfusion reactions
  • Antibodies against blood group antigens other than ABO can also cause AHTR
Mismatched blood transfusion:
  • General oozing from wound (excessive bleeding)
  • Severe & progressive hypotension
  • Tachycardia
  • LIrticarial rash
  • Bronchospasm, raising airway pressure on intermittent positive pressure ventilation
  • Later jaundice & oliguria (5-10%)
Exam Question of:
  • Hyperkalemia,Hypomagnesaemia, Hypocalcaemia,Citrate toxicity , Hypothermia are the Complication of blood transfusion
  • Metabolic alkalosis is most likely to occur after recieving several units of blood transfusion
  • Most common blood transfusion reaction is Febrile non hemolytic reaction
  • Blood transfusion reaction is Type II hypersensitivity
  • In a 3 year old child, most common cause of hepatitis B is Blood transfusion
  • Mismatched blood transfusion manifests intraoperatively as Hypotension & Excessive bleeding from site of wound
  • Massive transfusion in previous healthy adult male can cause hemorrhage due to Dilutional thrombocytopenia
  • Complement mediated Hemolysis is seen in Acute Hemolytic blood transfusion reactions
  • Triad following massive blood transfusion includes Alkalosis, hypothermia, hyperkalemia
  • Most common cause for complication of blood transfusion is Human error 
  • Hypothermia ,Hypocalcemia, Hypokalemia, Hypernatremia are seen in Massive blood transfusion 

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