Complications of Blood Transfusion

Overview

• Blood transfusion complications are categorized into: immune, infectious, and massive blood transfusion complications.
• Massive blood transfusion involves additional major issues.

Immune Complications

Hemolytic Reactions

1. Major Incompatibility
   • Caused by mismatched blood due to errors (e.g., sampling, labeling).
   • Leads to intravascular hemolysis.
   • Symptoms: Hematuria, loin pain, fever, chills, oliguria, acute renal tubular necrosis.
   • Treatment: Stop blood transfusion, recheck blood, IV fluids, monitor urine output, diuretics (Furosemide, Mannitol).
2. Minor Incompatibility
   • Due to antibodies attacking minor antigens.
   • Symptoms: Malaise, jaundice, fever.
   • Treatment: Supportive care.

Non-Hemolytic Reactions

1. Febrile Reaction

   • Due to sensitization of WBCs and platelets.
   • Symptoms: Increased temperature.
   • Treatment: Use leukocyte-depleted blood.

2. Allergic Reaction

   • Allergies to plasma products.
   • Symptoms: Chills, rigors, rashes.
   • Treatment: Antihistamines (e.g., Chlorpheniramine Maleate).

3. Transfusion-Related Acute Lung Injury (TRALI)

   • Due to anti-leukocyte antibodies in transfused plasma.
   • Causes leukocyte aggregation in pulmonary circulation leading to non-cardiogenic pulmonary edema.
   • Symptoms: Mild dyspnea to acute respiratory distress syndrome (ARDS).
   • Treatment: Supportive therapy.

4. Congestive Cardiac Failure (CCF)

   • Due to rapid transfusion of whole blood in anemic patients.
   • Symptoms: Volume overload.
   • Treatment: Slow transfusion, use packed RBCs, Furosemide.

Infectious Complications

• Diseases: HIV, Hepatitis, Malaria, Syphilis.
• Prevention: Screen donated blood carefully.

Complications of Massive Blood Transfusion

Definitions

• Massive Blood Transfusion Criteria:

  • 500 mL in 5 minutes

  • 4 RBC units within 1 hour

  • 50% blood volume within 6 hours

  • 10 units of packed cells or a blood volume in 24 hours.

Risks

• Citrate Toxicity: Hypocalcemia due to citrate preservative causing calcium decrease.
• Thrombocytopenia: Decreased platelets.
• Clotting Factor Deficiency: Leading to DIC.
• Acute Lung Injury: As a risk, similar to TRALI.

Protocol

• MTP (Massive Transfusion Protocol)
  • Send samples for cross-matching.
  • Initially request 4 units of O-negative RBCs.
  • Obtain blood products box-by-box as necessary.
  • Terminate MTP if bleeding stops.
  • If bleeding continues, alternate between box 3 and box 4.

Monitoring

• Monitor Acid-base status, Hemoglobin, Platelets, PT, APTT, Fibrinogen, Serum Calcium.

Management of DIC

• Disseminated Intravascular Coagulation leads to severe fibrinogen deficiency (afibrinogenemia).
• Treatment: Replace fibrinogen (Cryoprecipitate, other clotting factors).

Summary

• Immune Complications: Hemolytic (Major & Minor), Non-Hemolytic (Febrile, Allergic, TRALI, CCF).
• Infectious Complications: HIV, Hepatitis, Malaria, Syphilis.
• Massive Blood Transfusion Complications: Hypocalcemia, Thrombocytopenia, Acute Lung Injury, DIC.