COMPLICATIONS OF BLOODTRANSFUSIONB.VikramRoll no:20
Introduction• Adverse reactions to blood componentsoccurs despite multiple tests, checkups, &inspections.• Many reactions are not life threatening &serious reactions present with mild symptomsand signs.
Classification• Classified based on etiology.1. Immune mediated reactions.2. Non immune mediated reactions.3. Infectious complications.
GVHD• Allogenic stem cell transplantation.• TAGVHD-donor lymphocytes recognise host HLAantigens as foreignimmune response.• CF: fever, diarrhea, cutaneous eruption, liverfunction abnormalities.• Marrow aplasia, pancytopenia.• Rx: highly reistant to immunospressive therapies,glucocorticoids, cyclosporine, anti thymocyteglobulin, ablative therapy, allogenic bone marrowtransplantation.
Cont…• CF: appear 8-10 days, death occurs-3-4 weekspost transfusion.• Prevention: irradiation-cellular components-2500cGy.• Risk-fetuses-intrauterine transfusions,immuno compromised pt. lymphoma pt.• Blood relatives-blood donation-discouraged.• If, no other option, always irradiated.
TRALI• Presents as acute respiratory distress eitherduring or with in 6hrs. of transfusion.• CF: respiratory compromise, non cardiogenicpulmonary edema.• CXR: bilateral interstitial infiltrates.• Anti HLA antibodies against recepient leukocytes.• Dx: testing donor plasma for anti-HLA antibodies.• Rx: supportive, recovery without sequle.
Posttransfusion purpura:• Thrombocytopenia- 7 to 10 days aftertransfusion.• Platelet specific antibodies-recepient serum.• Antigen-HPA-1a on platelet glycoprotein 3areceptor.• Rx: IV immunoglobulin, plasma pheresis.
Alloimmunization• Women of child bearing age group who aresensitized to RBC antigens[D, E, kell or duffy].• HDNB.• Dx: matching for D antigen is the only pretransfusion selection test to prevent RBCalloimmunization.• Rx: leukoreduction of cellular components.
• Iron overload:• Each RBC unit contains 200-250 mg iron.• After 100 units of transfusion, CF of ironoverload as endocrinological, hepatic, cardiacare common.• Prevention: erythropoietin as alternatetherapy• Hypotensive reactions: pt. using ACEinhibitors.• Bradykinin is degraded by ACE.• No intervention needed.
Infectious complications• Viral: HCV – common, asymptomatic tochronic active hepatitis.• HIV-1—HIV-1, p24 antigen—detected by NAT.• HBV—risk of transmission is more than HCV.• Vaccination-for long term transfusion therapy.• West nile virus-asymptomatic to fatal.• HTLV-1T- cell leukemia, lymphoma.
• Bacterial: relative risk is more than viral.• Yersinia,pseudomonas,serratia,escherichiacan growin cold temperatures.• CF:fever, chills, progress to septic shock&DIC.• Endotoxins-culprits.• Rx: stop, reversing shock, broad spectrumantibiotics.• Other infectious agents: malaria, chagasdisease, babesiosis,dengue.