Try the all-new QuickBooks Online for FREE.  No credit card required.

Adverse effects of blood transfusion

Document Sample
Adverse effects of blood transfusion Powered By Docstoc
					Adverse effects of blood
          Adverse effects of blood
• 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
• 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
• 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
• 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
• 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
•   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
  – 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
• Prevented by inactivating the T cells by
• 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

Description: Bleeding disorders and blood transfusion