Complications of blood transfusion and management

1. COMPLICATIONS OF
BLOOD TRANSFUSION
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By Dr. Ibrahim
Khalil El-
Nakhal

2. INTRODUCTION
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• Adverse reactions to blood components
occurs despite multiple tests, checkups &
inspections.
• Many reactions are not life threatening &
serious reactions present with mild symptoms
and signs.

3. SAFE BLOOD
Blood for transfusion is considered safe when it is:
• Donated by a carefully selected, healthy donor.
• Free from infections that could be harmful to the
recipient.
• Processed by reliable methods of testing,
component production, storage and transportation.
• Transfused only upon need and for the patient’s
health and wellbeing
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4. BLOOD COMPONENTS
• Red Blood Cells (RBC’s)
• Platelets
• Plasma
 Cryoprecipitate
 Others : Plasma proteins, Intravenous
immunoglobulin (IVIG), Coagulation Factors, albumin, Anti-
D, Growth Factors, Colloid volume expanders.
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5. TRANSFUSION REACTIONS
Transfusions of blood products are associated with
several complications
• Immunologic reaction
 Acute (intravascular) hemolytic reactions.
 Delayed (extravascular) hemolytic reactions.
 Febrile non-hemolytic reactions.
 Allergic (urticarial) reactions.
 Transfusion-related acute lung injury.
 Transfusion-associated circulatory overload.
 Post-transfusion purpura.
 Graft-vs.-host disease.
• Infection 5

6. ACUTE HEMOLYTIC REACTIONS
•Are defined
"fever and other symptoms/signs of
hemolysis within 24 hours of transfusion; confirmed
by one or more of the following:
a fall of Hb, rise in lactate dehydrogenase (LDH),
positive direct antiglobulin test (DAT), positive cross
match"
Intravascular lysis of transfused RBCs by complement, IgM
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• This is due to destruction of donor red blood cells by
preformed recipient antibodies.
• Most often this occurs because of in ABO blood type
between the donor and the recipient.

7. • Fever, chills, chest pain, back pain,
hemorrhage, increased heart rate,
shortness of breath, and rapid drop in
blood pressure.
Complications: renal failure, DIC,
ARDS, death
Mortality: ~10%
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PRESENTATION

8. MANAGEMENT
• STOP TRANSFUSION.
• ABC’s.
• Maintain IV access and run IVF (NS or LR).
• Monitor and maintain BP/pulse.
• Give diuretic.
• Obtain blood and urine for transfusion reaction workup.
• Send remaining blood back to Blood Bank.
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9. DELAYED HEMOLYTIC REACTIONS
• Occur more than 24 hours after a transfusion. They usually
occur within 28 days of a transfusion.
They can be due to either a low level of antibodies present,
which are not detectable on pre-transfusion testing; or
development of a new antibody against an antigen in the
transfused blood. Therefore, delayed hemolytic reaction does
not manifest until after 24 hours when enough amount of
antibodies are available to cause a reaction. The red blood
cells are removed by macrophages from the blood circulation
into liver and spleen to be destroyed, which leads to
extravascular hemolysis.
This process usually mediated by anti-Rh and anti-Kidd
antibodies.
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10. • Fever, chills, leukocytosis, anemia
Complications: renal failure, DIC, sickle
cell crisis.
Mortality: rare.
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PRESENTATION

11. FEBRILE NO HEMOLYTIC
REACTIONS
• Definition: Rise in patient temperature >1°C
(associated with transfusion without other fever
precipitating factors).
Along with allergic transfusion reactions, the
most common type of blood transfusion
reaction and occur because of the release of
inflammatory chemical signals released by
white blood cells in stored donor blood or
attack on donor's white blood cells by
recipient's antibodies.
This type of reaction occurs in about 7% of
transfusions.
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12. • Fever and/or chills.
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PRESENTATION

13. MANAGEMENT
• Stop Transfusion.
• Use of Antipyretics.
• Use of Corticosteroids for severe
reactions.
• Use of Narcotics for shaking chills.
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14. PREVENTION
• Prevented by leukoreduction “ the
filtration of donor white cells from red
cell product units”
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15. ALLERGIC TRANSFUSION
REACTIONS
• Are caused by IgE anti-allergen
antibodies. When antibodies are bound
to its antigens, histamine is released
from mast cells and basophils. Either IgE
antibodies from the donor's or
recipient's side can cause the allergic
reaction. It is more common in patients
who have allergic conditions such as
Allergic rhinitis.
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16. PRESENTATION
• Urticaria, flushing, dyspnea and
vomiting.
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17. MANAGEMENT
• Can be controlled by stopping the
transfusion and giving antihistamines.
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18. ANAPHYLACTIC REACTIONS
• Are rare life-threatening allergic
conditions caused by IgA anti-plasma
protein antibodies. For patients who have
selective immunoglobulin A deficiency.
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19. PRESENTATION
• Fever, wheezing, coughing, shortness of
breath, and circulatory shock.
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20. MANAGEMENT
• stop and Urgent treatment with
epinephrine is needed.
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21. POST-TRANSFUSION
PURPURA
• Is an extremely rare complication that
occurs after blood product transfusion
and is associated with the presence of
antibodies in the patient's blood
directed against both the donor's and
recipient's platelets HPA (human platelet
antigen). Recipients who lack this
protein develop sensitization to this
protein from prior transfusions or
previous pregnancies.
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22. PRESENTATION
• thrombocytopenia, bleeding into the
skin and purpura.
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23. MANAGEMENT
• Intravenous immunoglobulin (IVIG) is
treatment of choice or plasma pheresis.
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24. TRANSFUSION-ASSOCIATED
ACUTE LUNG INJURY (TRALI)
• Is a syndrome that is similar to Acute
respiratory distress syndrome (ARDS),
which develops during or within 6 hours
of transfusion of a plasma-containing
blood product.
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25. PRESENTATION
• Fever, hypotension, shortness of
breath, and tachycardia.
• For a definitive diagnosis to be made,
symptoms must occur within 6 hours of
transfusion, hypoxemia must be
present, there must be radiographic
evidence of bilateral infiltrates and there
must be no evidence of left atrial
hypertension (fluid overload).It occurs in
15% of the transfused patient with
mortality rate of 5 to 10%.
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26. MANAGEMENT
• Treatment is supportive.
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27. TRANSFUSION ASSOCIATED
CIRCULATORY OVERLOAD (TACO)
• Is a common, yet underdiagnosed,
reaction to blood product transfusion
consisting of the new onset or
exacerbation of three of the following
within 6 hours of cessation of
transfusion : acute respiratory distress,
elevated brain natriuretic peptide (BNP),
elevated central venous pressure (CVP),
evidence of left heart failure, evidence of
positive fluid balance, and/or
radiographic evidence of pulmonary
edema. 27

28. TRANSFUSION-ASSOCIATED
GRAFT VERSUS HOST DISEASE
• Frequently occurs in immunodeficient
patients where recipient's body failed to
eliminate donor's T cells. Instead,
donor's T cells attack the recipient's
cells. It occurs one week after
transfusion.
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29. PRESENTATION
• Fever, rash, diarrhea are often
associated with this type of transfusion
reaction.
• Mortality rate is high, with 89.7% of the
patients died after 24 days
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30. MANAGEMENT
• Immunosuppressive treatment is the most
common way of treatment. Irradiation and
leukoreduction of blood products is
necessary for high risk patients for prevent
T cells from attacking recipient cells.
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31. INFECTION
• Sources :
 Contaminated equipment.
 Nonsterile procedure.
 Donor skin.
 Donor blood.
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32. 32
• Viral:
 HCV.
 HIV.
 HBV risk of transmission is more than HCV.
 Vaccination for long term transfusion
therapy.
 West Nile virus.
 Human T-cell leukemia virus type 1 : also
called the adult T-cell lymphoma virus type 1,
it is a retrovirus.
 Cytomegalovirus.
 Parvovirus.

33. 33
• Bacterial:
 Yersinia.
 Pseudomonas.
 Serratia marcescens.
 Escherichia coli.
can grow in cold temperatures.
• Endotoxins

34. PRESENTATION
• Fever, chills, septic shock and DIC.
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35. MANAGEMENT
• Stop, reversing shock and broad
spectrum antibiotics.
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36. 36
• Other infectious agents:
 Malaria.
 Chagas disease caused by protist Trypanosoma
cruzi.
 Babesiosis caused by Babesia.
 Dengue fever caused by the dengue virus.
 Leishmania.
 Variant Creutzfeldt–Jakob disease (vCJD).

37. MASSIVE BLOOD
TRANSFUSION
• Massive Blood Transfusion can be:
 >10 units within 24 hours.
 Transfusion >4 units in 1 hour.
 Replacement of 50% of blood volume in
3‐4 hours.
 A rate of loss >150 ml/hour.
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38. COMPLICATION OF MASSIVE
BLOOD TRANSFUSION
• Acidosis :
More likely due to inadequate treatment
of hypovolemia than due to the effects of
transfusion.
Management: bicarbonate or other
alkalizing agents
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39. 39
• Hyperkalemia:
The storage of blood results in a small increase
in extra‐cellular potassium concentration, which
will increase the longer it is stored.
• Citrate toxicity:
is rare, but is most likely to occur during the
course of a large volume transfusion of whole
blood.
• Hypocalcaemia:
particularly in combination with hypothermia
and acidosis, can cause a reduction in cardiac
output, bradycardia, and other dysrhythmias.
• Metabolic alkalosis.

40. 40
• Iron overload:
Each RBC unit contains 200-250 mg of iron.
Occur After 100 units of transfusion.
Management: erythropoietin as alternate therapy.
• Fluid overload:
Presentation: cough, chest pain and frothy sputum.
Management: vasodilators and diuretics.
•Hypothermia:
Rapid infusion of refrigerated or frozen
components.
Presentation: Cardiac arrhythmias.
Management: in line blood warmer.