Complications of Blood Trasfusion

1. By Nisreen Hunedy MBBCh
General Surgery Unit D

2. Risks of Blood Transfusion
• Blood transfusion reactions may be broadly
classified as:
• Infectious
• Non Infectious

3. Infectious Risks
• Bacterial contamination due to inadequate aseptic
technique during collection or to transient
asymptomatic donor bacteremia.
• Hepatitis A,B,C,D may occur after transfusion of any
blood product.
• HIV infection wether HIV-1 or HIV-2.
• Cytomegalovirus (CMV).
• Parasitic infections: malaria, Chagas and syphilis.
• Creutzfeldt-Jakob disease (vCJD, or mad cow
disease) and it’s variants.

5. Non Infectious Risks
• The noninfectious risks are generally
immunologically mediated.
• Reactions can occur as a result of the antibodies
such as those of (Anti-A or Anti-B) or ones that
have been formed as a result of prior exposure to
donor RBCs, WBC, platelets, or proteins.

6. Acute Hemolytic Transfusion Reaction
(AHTR)
• AHTR usually results from recipient plasma
antibodies to donor RBC antigens.
• ABO incompatibility is the most common cause
of AHTR.
• Antibodies against blood group antigens other
than ABO can also cause AHTR, such as anti-
Kidd, anti-Lewis, and anti-Duffy.
• Mortality: ~10%

7. AHTR
• Hemolysis is Intravascular.
• Hemoglobinuria results with varying degrees of
acute renal failure and possibly DIC.
• An acute phase usually develops within 1h of
initiation of transfusion.
AB & Complement of
Reciepent + Ag of
Donor RBC = Ag AB
Immune Compex
•Hemlolysis
•Activation of Kinin
system=Bradykinn
•Release of Histamine
+Serotonin from Mast
cells
•Increase
premeability+
Arteriol Dilation
=Hypotension
•Bronchospasm

8. Signs and Symptoms of AHTR
• Dyspnea.
• Discomfort and anxiety.
• Fever/chills.
• facial flushing.
• Nausea & vomiting.
• severe pain may occur, especially in the lumbar
area.
• Shock may develop, causing a rapid, weak
pulse; cold, clammy skin; low blood pressure.
• hemoglobinemia, hemoglobinuria.
If AHTR occurs while the pt. is
under GA, the only symptom
may be hypotension,
uncontrollable bleeding from
incision sites and mucous
membranes, or dark urine
that reflects hemoglobinuria.

9. Management of AHTR
• If AHTR is suspected;
transfusion should be stopped.
• Recheck the sample and
patient identifications & begin supportive
treatment.
•
The goal of initial therapy is to:
• Achieve and maintain adequate blood pressure.
• Maintain renal blood flow and function.

10. Delayed Hemolytic Transfusion
Reaction (DHTR)
• Patient has been sensitized to an RBC antigen
from a previous transfusion or pregnancy.
• Hemolysis is Extravascular.
• Patient has very low antibody levels and negative
pre transfusion tests.
• DHTR Occurs usually in 1 to 4 wk following
transfusion.

11. DHTR
• Patients may be asymptomatic or have a slight
fever.
• Results in a slight rise in LDH , Bilirubin and a
+ve Coombs test.
• Usually mild and self-limiting.
• May only present as an unexplained drop in Hb
to the pre transfusion level occurring 1 to 2 wk
post transfusion.

12. Transfusion-Related Acute Lung Injury
(TRALI)
• TRALI is a noncardiogenic pulmonary edema.
• Caused by HLA Antibodies in donor plasma that
agglutinate and degranulate recipient
granulocytes within the lung.
• Most common cause of transfusion-related
death (45% of deaths reported to the FDA).
• Incidence is 1 in 5,000 to one in 10,000.
• Pre existing Inflammatory condition increases
the risk.

13. TRALI
• Granulocytes within the pulmonary capillaries
release mediators that cause pulmonary
capillary leakage.
• Acute respiratory symptoms develop;
• S/S include: dyspnea, cyanosis, chills, fever and
hypotension.
• Chest x-ray has a characteristic pattern of
pulmonary edema and bilateral infiltrates.

14. Pre&Posttransfusionx-rayandCT
Normal chest x-ray (A) and
thoracic CT imaging (B) in a
24-year-old man presenting
with very severe aplastic
anaemia and fever.
Following transfusion of two
packed red blood cell
concentrates and one whole
blood-derived platelet
concentrate, the patient
developed dyspnoea and
severe hypoxaemia within a
few hours. Subsequent
radiographic imaging of the
chest showed massive
pulmonary congestion with
diffuse fluffy infiltrates (C
and D), consistent with the
diagnosis of transfusion-
related acute lung injury
(TRALI).

15. TRALI

16. How To Manage TRALI
• When TRALI is suspected blood
transfusion should be stopped.
• Treatment is mostly supportive.
• Hemodynamic and Ventilatory
support is given.
¡No Role for Diuretics or Steriods in this situation

17. Febrile Nonhemolytic Transfusion
Reaction
• Antibodies directed against WBC HLA of donor
blood.
• Common in multitransfused or multiparous
patients.
• Increase of ≥ 1° C, chills, and sometimes
headache and back pain.
• Most febrile reactions are treated successfully
with Acetaminophen.

18. Allergic Reaction
Minor Allergic Reaction Anaphylactic Reaction
• Usually due to allergens in
donor plasma.
• Commonly reported reaction
(1-3%)
• C/P Include urticaria, edema,
occasional dizziness, during or
immediately after the
transfusion.
• Allergic reactions are IgE
mediated ;HSR1.
• Treatment: Anti-histamine
• Due to hypersensitivity to Ag
in donor blood/ or AB from a
donor with Hypersensitivity.
• C/P: dyspnea, bronchospasm,
hypotension, laryngeal edema,
chest pain and shock.
• Treatment:
a) Stop blood transfusion.
b) Anti-histamine is given.
c) Respiratory and
Cardiovascular support.

19. Complication of Massive Blood
Transfusion
• Hypothermia.
• Dilutional coagulopathy.
• Citrate toxicity.
• Hyperkalaemia.
• Hypocalcaemia, Hypomagnesaemia.
• Metabolic acidosis.
• Transfusion-related circulatory overload (TACO)
Massive transfusion is
defined, in adults, as
replacement of
>1 blood volume in 24
hours or >50%
of blood volume in 4 hours

20. 0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Transfusion Related Deaths
2008 2012

21. Complication/Risk Summary
Immunological:
•Hemolytic
•NHTR
•Allergic
•TRALI
Non
Immunological:
•Bacterial
Contamination
•Circulatory
Overload
Immediate
Immunological:
•Hemolytic
•GVHD
Non
Immunological:
•Iron Overload
•Disease
Transmission
Delayed

22. • Zero-risk blood supply is not possible.
• "The safest unit of blood is still,
unfortunately, the one that is not given“