Version 2.0 Acute Blood Transfusion Complications 21/05/2012
Causes
Acute haemolytic transfusion reaction
• Incompatible transfused RBC react with patient's own ABO antibodies or other RBC
antigen alloantibodies (e.g. anti Rh D, Rh E, Rh c and Kell). C’ can be activated and → DIC.
• Usually patient sample mislabelled. 1:3 risk of ABO incompatibility if random RBCs given.
• Non-ABO red cell antibody haemolytic reactions tend to be less severe but the Kidd and
Duffy antigens also activate complement and can cause severe intravascular haemolysis.
Infective shock
• Risk~1:2,000,000
• HIV 1, HTLV (10% Aborigine’s carry), Parvovirus B19, CMV, Hep A/B/C/NANB, syphilis,
malaria, S.epidermidis, CJD, Yersinia. Blood screened for HIV, Hep C, CMV.
Fluid overload
• Diuretics may be used if this is a concern.
Severe allergic reaction or anaphylaxis
• To proteins in transfused blood components.
• Reduced by pre-washing RBCs (but decreases shelf life to 24hrs).
Non-haemolytic febrile reactions to transfusion of platelets and red cells
• Fevers due to patient antibodies to transfused white cells.
• Multiparous women and those who have received previous transfusions are most at risk.
Transfusion Related Acute Lung injury(TRALI)
• Donor Ab to patient leucocytes
• Severe reaction with fever, non-productive cough and breathlessness.
• CXR shows multiple perihilar nodules with infiltration of the lower lung fields.
Allo-immunisation
• E.g. dev of anti-RhD in RhD- pat receiving RhD+ → haemolytic disease of the newborn
Graft-vs-Host Disease (GVHD)
• Transfusion of immunocompetent lymphocytes into immunodepressed patient
• Prevented by irradiating the blood first.
Immunomodulation
• Possible ↑tumour recurrence and ↑post-operative infection rates. No clear evidence.
Other complications
• Citrate toxicity if rapid transfusion - ↓pH, metallic taste, ?↓Ca2+
• Hyperkalaemia
• Hypernatraemia – from sodium citrate
• Jaundice (30% RBCs don’t survive transfucion)
• Iron overload
Management
Assessment: ?shock, fever, pain (infusion site, back, chest). Is there haemolysis, ARF, DIC
(haematuria, puncture site oozing, etc).
Mx: Stop transfusion and recheck patient & blood product. Assess severity:
• Mild (T↑<1.5°C, no rash/shock) - recommence at slower rate,
• Mod (T↑<1.5°C, rash, no shock) – give antihistamine + antipyretic & restart after 30min,
• Severe (shock, haemolysis) - cease transfusion, resuscitate, and send blood samples
(Coombs, FBC, rpt XM, coags) & blood product to lab for retesting.
Causes
Acute haemolytic transfusion reaction
• Incompatible transfused RBC react with patient's own ABO antibodies or other RBC
antigen alloantibodies (e.g. anti Rh D, Rh E, Rh c and Kell). C’ can be activated and → DIC.
• Usually patient sample mislabelled. 1:3 risk of ABO incompatibility if random RBCs given.
• Non-ABO red cell antibody haemolytic reactions tend to be less severe but the Kidd and
Duffy antigens also activate complement and can cause severe intravascular haemolysis.
Infective shock
• Risk~1:2,000,000
• HIV 1, HTLV (10% Aborigine’s carry), Parvovirus B19, CMV, Hep A/B/C/NANB, syphilis,
malaria, S.epidermidis, CJD, Yersinia. Blood screened for HIV, Hep C, CMV.
Fluid overload
• Diuretics may be used if this is a concern.
Severe allergic reaction or anaphylaxis
• To proteins in transfused blood components.
• Reduced by pre-washing RBCs (but decreases shelf life to 24hrs).
Non-haemolytic febrile reactions to transfusion of platelets and red cells
• Fevers due to patient antibodies to transfused white cells.
• Multiparous women and those who have received previous transfusions are most at risk.
Transfusion Related Acute Lung injury(TRALI)
• Donor Ab to patient leucocytes
• Severe reaction with fever, non-productive cough and breathlessness.
• CXR shows multiple perihilar nodules with infiltration of the lower lung fields.
Allo-immunisation
• E.g. dev of anti-RhD in RhD- pat receiving RhD+ → haemolytic disease of the newborn
Graft-vs-Host Disease (GVHD)
• Transfusion of immunocompetent lymphocytes into immunodepressed patient
• Prevented by irradiating the blood first.
Immunomodulation
• Possible ↑tumour recurrence and ↑post-operative infection rates. No clear evidence.
Other complications
• Citrate toxicity if rapid transfusion - ↓pH, metallic taste, ?↓Ca2+
• Hyperkalaemia
• Hypernatraemia – from sodium citrate
• Jaundice (30% RBCs don’t survive transfucion)
• Iron overload
Management
Assessment: ?shock, fever, pain (infusion site, back, chest). Is there haemolysis, ARF, DIC
(haematuria, puncture site oozing, etc).
Mx: Stop transfusion and recheck patient & blood product. Assess severity:
• Mild (T↑<1.5°C, no rash/shock) - recommence at slower rate,
• Mod (T↑<1.5°C, rash, no shock) – give antihistamine + antipyretic & restart after 30min,
• Severe (shock, haemolysis) - cease transfusion, resuscitate, and send blood samples
(Coombs, FBC, rpt XM, coags) & blood product to lab for retesting.
