Complications of Blood Transfusions
Complications of Blood Transfusions
Complications of Blood Transfusions
Early Complications:
• Hemolytic reactions (immediate and delayed)
• Non-hemolytic febrile reactions
• Allergic reactions to proteins, IgA
• Transfusion-related acute lung injury
• Reactions secondary to bacterial contamination
• Circulatory overload
• Air embolism
• Thrombophlebitis
• Hyperkalemia Citrate toxicity Hypothermia
• Clotting abnormalities (after massive transfusions)
Late complications:
• Transmission of infection
• Viral (hepatitis A, B, C, HIV, CMV) Bacterial (Salmonella)
• Parasites (malaria, toxoplasma) Graft-vs-host disease
• Iron overload (after chronic transfusions) Immune sensitization (Rhesus D antigen)
1-Acute hemolytic transfusion reactions
Acute hemolytic transfusion reactions occur when ABO-incompatible blood is
transfused, resulting in recipient antibodies attaching to donor RBC antigens and forming an
antigen-antibody complex. This antigen-antibody complex activates complement, resulting
in intravascular RBC lysis with release of RBC stroma and free Hb. Immune system activation
also results in bradykinin release (leading to hypotension) and mast cell activation (causing
serotonin and histamine release). The net result may be shock, renal failure due to Hb
precipitation in renal tubules, and DIC. Many signs and symptoms of an acute hemolytic
transfusion reaction appear immediately and include fever, chest pain, anxiety, back pain,
and dyspnea. Many are masked by general anesthesia, but clues to the diagnosis include
fever, hypotension, hemoglobinuria, unexplained bleeding, or failure of Hct to increase after
transfusion.
8- Coagulopathy
A massive transfusion of RBCs may lead to a dilutional coagulopathy, as
plasma-reduced RBCs contain neither coagulation factors nor platelets. Secondly,
hemorrhage, as a consequence of delayed or inadequate perfusion, can result in DIC. This
causes consumption of platelets and coagulation factors and may account for the numerical
distortion of clotting studies appearing out of proportion to the volume of blood transfused.
9- Hypothermia
Red blood cells are stored at 4 degrees Celsius. Rapid transfusion at this
temperature will quickly lower the recipient’s core temperature and further impair
hemostasis. Hypothermia reduces the metabolism of citrate and lactate and increases the
likelihood of hypocalcemia, metabolic acidosis and cardiac arrhythmias. A decrease in core
temperature shifts the oxyhemoglobin dissociation curve to the left, reducing tissue oxygen
delivery at a time when it should be optimized.