Blood Transfusion
Complications
Immunological
Immunomodulation. Transfusions suppress the immune system causing increased post op infection, tumour recurrence and activation of latent viral infections.
Donor antigens and recipient antibodies.
Immediate haemolysis (ABO incompatibility). Fever, rash, hypotension, dyspnoea, back pain, DIC, ARF, haemoglobinuria. Rx as for anaphylaxis and promote diuresis to prevent deposition Hb in tubules. Mortality 50%. Send samples of donor and recipient blood.
Delayed haemolysis (minor groups). 7-21 days post transfusion. Fever, anaemia, jaundice.
Non-haemolytic febrile reactions from leucocyte antigens. Can reduce rate of infusion but can only distinguish from haemolytic reaction by direct antiglobulin test (or later evidence of haemolysis), so better to stop it. Less common now leucodepletion.
Allergic reactions. IgE mediated causing itching urticaria and fever. Very rarely anaphylaxis.
Rhesus +ve blood to -ve woman of childbearing age.
Donor antibodies against host antigens. Incidence reduced by leucodepletion since 1999.
TRALI. Most common cause morbidity and mortality. Causes ARDS. Immune or non-immune (lipids on donor RBCs). Neutrophil granulocytes migrate to lungs where trapped and damage endothelium. Mortality 15%.
Graft vs host disease if immunosuppressed. 90% mortality. Very rare now leucodepletion.
Infective
Bacterial
Gram -ve proliferate at 4 degrees. Gram +ve at room temp (PLT).
Bags dark or contain bubbles.
Viral
Tested for Hep B and C, HIV 1 and 2, syphilis, CMV, human T cell lymphotrophic virus.
Blood not taken if have had malaria or within 6/12 of visiting endemic area.
Prion
Leucodepletion (95%) to reduce risk of CJD. FFP from US.
Metabolic
Hyperkalaemia rarely a problem as rapidly taken up by RBCs
Hypocalcaemia - Citrate (trace only in packed cells but lots in FFP and PLT) binds Ca and also metabolised to bicarb in a few mins. Can cause alkalosis and therefore hypocalcaemia.
Impaired O2 delivery as L shift.
Hypothermia (stored at 4 degrees)
Other
Coagulation abnormalities
o Dilutional
o DIC - Inadequate perfusion from haemorrhage causes DIC with consumption of clotting factors and PLT.
Overload.
Thrombophlebitis and extravasation
Air embolism
Microaggregates
Massive transfusions
5u in 1h or 10 in 6h or replacement blood vol in 24h.
Complications as above esp.:
Impaired coag. FFP/PLT/Cryo when clinical or lab evidence of need.
Impaired O2 delivery.
Hypothermia.
Hypocalcaemia. 5mls 10% Ca gluconate if evidence.
Initial acidosis followed by alkalosis.
ARDS.
