Blood product transfusion complications may be broadly classified into the following:
•immunological: acute haemolytic, non-haemolytic febrile, allergic/anaphylaxis
•infective
•transfusion-related acute lung injury (TRALI)
•transfusion-associated circulatory overload (TACO)
•other: hyperkalaemia, iron overload, clotting
below are short summaries of some of the key features —
Acute haemolytic transfusion reaction
Acute haemolytic transfusion reaction results from a mismatch of blood group (ABO) which causes massive intravascular haemolysis. This is usually the result of red blood cell destruction by IgM-type antibodies.
Symptoms begin minutes after the transfusion is started and include a fever, abdominal and chest pain, agitation and hypotension.
Treatment should include immediate transfusion termination, generous fluid resuscitation with saline solution and informing the lab
Complications include disseminated intravascular coagulation, and renal failure
Non-haemolytic febrile reaction
Febrile reactions
•due to white blood cell HLA antibodies
•often the result of sensitization by previous pregnancies or transfusions
•paracetamol may be given
Allergic/anaphylaxis reaction
Allergic reactions to blood transfusions are caused by hypersensitivity reactions to components within the transfusion. Symptoms typically arise within minutes of starting the transfusion and severity can range from urticaria to anaphylaxis with hypotension, dyspnoea, wheezing, and stridor, or angioedema.
Simple urticaria should be treated by discontinuing the transfusion and with an antihistamine. Once the symptoms resolve, the transfusion may be continued with no need for further workup.
More severe allergic reaction or anaphylaxis should be treated urgently. The transfusion should be permanently discontinued, intramuscular adrenaline should be administered and supportive care. Antihistamine, corticosteroids and bronchodilators should also be considered for these patients.
Transfusion-related acute lung injury (TRALI)
A rare but potentially fatal complication of blood transfusion. Characterised by the development of hypoxaemia / acute respiratory distress syndrome within 6 hours of transfusion. Features include:
•hypoxia
•pulmonary infiltrates on chest x-ray
•fever
•hypotension
Transfusion-associated circulatory overload (TACO)
A relatively common reaction due to fluid overload resulting in pulmonary oedema. As well as features of pulmonary oedema the patient may also by hypertensive, a key difference from patients with TRALI.
Infective
Transmission of vCJD
•although the absolute risk is very small, vCJD may be transmitted via blood transfusion
•a number of steps have been taken to minimisethis risk, including:
•from late 1999 onward, all donations have undergone removal of white cells (leucodepletion) in order to reduce any vCJD infectivity present
•from 1999, plasma derivatives have been fractionated from imported plasma rather than being sourced from UK donors. Fresh Frozen Plasma (FFP) used for children and certain groups of adults needing frequent transfusions is also imported
•from 2004 onward, recipients of blood components have been excluded from donating blood