Adverse effects of blood transfusion

							Adverse effects of blood
      transfusion
          Adverse effects of blood
                transfusion
• Immediate adverse effects        • Late adverse effects
• Acute haemolytic transfusion     • Iron overload
  reaction                         • Graft Vs Host disease
• Delayed haemolytic transfusion   • Immunosuppression
  reaction                         • Transfusion transmitted
• Non haemolytic febrile             infections
  transfusion reaction
• Allergic reactions
• Anaphylaxis
• Transfusion related acute lung
  injury (TRALI)
• Fluid overload
      Immediate haemolytic
       transfusion reaction
• Due to ABO incompatibility
• Causes IV haemolysis
• Mediated via Ig M
• Can lead to DIC and haemoglobinaemia
  leading to acute renal failure
• Often due to misidentifications
Delayed haemolytic transfusion
          reaction
• Causes extravascular haemolysis
• Mediated via igG
• 7-10 days after transfusion patient gets
  pallor, jaundice and splenomegaly
• Due to the Abs that are not detected at
  crossmatch due to low titres
• Needs identification of the Ab and for
  future transfusions use blood with no Ag
  for which the Abs are formed
     Non haemolytic febrile
      tranfusion reaction
• Due to Abs in the recipient against the
  white cells of the donor unit
• Seen in patients who receive frequent
  transfusions
• Can be minimized by depleting white cells
  of the donor unit by washing or filtering
          Allergic reactions
• Often due to plasma proteins
• Manifest in the form of urticarial rash
• Can minimized by washing the transfusion
  unit in saline
         Anaphylactic shock
• Often due to congenital absence of Ig A
  patients who gets exposed to Ig A due to a
  transfusion, and is identified as a foreign
  protein
• Needs immediate managment
Transfusion related acute lung
        injury (TRALI)
• Patient develops adult respiratory distress
  syndrome few hours after transfusion
• Due to Abs in the donor unit against
  patients white cells
• Causes pulmonary odema and the
  patients need ventilation
• Often the donor is a multiparous woman
 Acute haemolytic transfusion
          reaction
• Due to ABO incompatibility.
• Signs and symptoms may occur after only
  5-10 ml of blood transfused.
• Can activate complement and cause DIC.
• If AHTR is suspected the transfusion must
  be stopped and urgent steps taken to
  confirm or exclude this possibility
         Signs and symptoms
•   Concious patient:Symptoms
•   Feeling of apprehension or something wrong
•   Agitation
•   Flushing
•   Pain at venepuncture site
•   Pain at abdomen, flank or chest
•   Signs:
•   Fever,
•   Hypotension,
•   Generalised oozing from venupuncture sites
•   Haemoglobinaemia
•   Haemoglobinuria
                Management
•   Stop transfusion. Continue iv line with N. Saline
•   Insert bladder catheter and monitor urine flow
•   Give fluids to maintain urine output >1.5ml/kg/hr
•   If bacterial contamination suspected treat with
    broad spectrum antibiotics.
•   If DIC suspected treat with blood products
    according to the coagulation screen
•   Investigations:
•   FBC, platelet count, DAT, plasma Hb
•   Repeat compatibility testing
•   Coagulation screen (PT, APTT, Fibrinogen)
•   Blood urea, serum creatinine, serum electrolytes.
         Late adverse effects

•   Iron overload
•   Graft Vs Host disease
•   Immunosuppression
•   Transfusion transmitted infections
                Iron overload.
• With every trasfusion iron enters body
• But removal from the body is difficult
• Patients on frequent transfusion may develop
  tissue damage due to parenchymal iron
  overload
  – Liver :Cirrosis,
  – Endocrine organs: Hormone abnormalities
  – Heart: cardiac failure are common
• Needs iron chelation
  – Parnteral iron chelators: desferal
  – Oral iron chelators
    Graft Versus Host Disease
• This is the opposite of graft rejection
• The graft rejects the recipient. T lymphocytes of
  the transfusion mounts an immune reaction
  against the recipient
• Common in immune suppressed recipients and
  when there is good tissue compatibility (HLA)
• Patients develop abnormal liver function,
  gastrointestinal symptoms and dermaological
  manifestations
• Prevented by inactivating the T cells by
  irradiation
• Common in neonatal transfusions
 Transfusion transmitted infections
• Common infections are
   –   Hepatitis B & C
   –   HIV I & II
   –   Malaria
   –   CMV
   –   Variant form of Crutz Fetz Jacob Disease
• Prevented by pretransfusion testing
• Buffy coats are removed from all the transfusion
  units in Europe to prevent unidentified infections
  that will be identified in future
        Immune suppression
• Due to exposure of the recipients to large
  number of different Ags
• Common in patients who receive pooled
  blood products
• Eg Haemophilia: Factor VIII concentrate