COMPLICATIONS OF BLOOD TRANSFUSION
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This document discusses complications that can arise from blood transfusions. It classifies complications into three categories: immune-mediated reactions, non-immune mediated reactions, and infectious complications. Immune-mediated reactions include hemolytic transfusion reactions, febrile non-hemolytic reactions, allergic reactions, anaphylaxis, graft-versus-host disease, TRALI, post-transfusion purpura, and alloimmunization. Non-immune reactions include fluid overload, hypothermia, electrolyte abnormalities, iron overload, and hypotensive reactions. Infectious complications can occur from viruses like HIV, hepatitis B and C, bacteria that can grow in cold storage, and other infectious agents like malaria. Prevent
![Hemolytic transfusion reactions
• Occurs-preformed antibodies donor RBCs.
• Major-ABO incompatibility.
• Minor-Rh, K, jk, Fy incompatibility.
• CF: hypotension, tachypnea, tachycardia, fever,
chills, hemoglobinuria, hemoglobinemia, flank
pain.
• Immune complexescomplement
cascadehemolysis.
• Immune complexesrenal tubulesacute
tubular necrosisAKI[Acute Kidney Injury]](https://image.slidesharecdn.com/vikram-130624081129-phpapp01/85/COMPLICATIONS-OF-BLOOD-TRANSFUSION-5-320.jpg)
![Anaphylactic reaction
• Severe, few milliliters.
• CF: dyspnea, cough, nausea, vomiting,
hypotension, bronchospasm, loss of
consicousness, respiratory arrest, shock.
• Rx: stop, epinephrine 0.5-1 ml, 1:1000 dilution
S/C, glucocorticoids[if severe]
• IgA deficienct individuals-IgA deficient plasma,
washed cellular blood components.](https://image.slidesharecdn.com/vikram-130624081129-phpapp01/85/COMPLICATIONS-OF-BLOOD-TRANSFUSION-9-320.jpg)
![Alloimmunization
• Women of child bearing age group who are
sensitized to RBC antigens[D, E, kell or duffy].
• HDNB.
• Dx: matching for D antigen is the only pre
transfusion selection test to prevent RBC
alloimmunization.
• Rx: leukoreduction of cellular components.](https://image.slidesharecdn.com/vikram-130624081129-phpapp01/85/COMPLICATIONS-OF-BLOOD-TRANSFUSION-14-320.jpg)
COMPLICATIONS OF BLOOD TRANSFUSION
- 2. Introduction • 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. Classification • Classified based on etiology. 1. Immune mediated reactions. 2. Non immune mediated reactions. 3. Infectious complications.
- 4. Immune mediated reactions 1. Hemolytic transfusion reactions. 2. Febrile non-hemolytic transfusion reactions. 3. Allergic reactions. 4. Anaphylactic reactions. 5. Graft versus host disease. 6. TRALI. 7. Post transfusion purpura. 8. Alloimmunization.
- 5. Hemolytic transfusion reactions • Occurs-preformed antibodies donor RBCs. • Major-ABO incompatibility. • Minor-Rh, K, jk, Fy incompatibility. • CF: hypotension, tachypnea, tachycardia, fever, chills, hemoglobinuria, hemoglobinemia, flank pain. • Immune complexescomplement cascadehemolysis. • Immune complexesrenal tubulesacute tubular necrosisAKI[Acute Kidney Injury]
- 6. Cont… What to do..??? • Acute--transfusion is stopped immediately, intravenous access maintained. • Delalyed-anamnestic reaction, memory cells. • Diuresis-furosemide 20-40mg.IV or inj.Mannitol 20% 100ml IV. • Monitor urine output, Hb in urine. • Blood bank-recheck, repeat crossmatching. • Investigations-LDH,indirect bilirubin, haptoglobin, PT, aPTT, fibrinogen, platelet count, DAT.
- 7. Febrile non-hemolytic transfusion reactions. • Cellular blood components. • Mild nature. • CF: chills rigors, >=1 degree C raise of temp. • Fever-other causes ruled out. • Antibodies against Donor WBCs&HLA antigens. • Multiply transfused pt.& multiparous women. Prvention: leukoreduction before storage.
- 8. Allergic reactions • Utricarial, mild nature—plasma proteins. • Temporary stop, symptomatic Rx. • Rx: diphenhydramine 50mg orally or IM. • CF Resolve-transfusion resume. • H/O allergic reactions-pre medicated. • Extremely sensitized pt.—cellular component wash.
- 9. Anaphylactic reaction • Severe, few milliliters. • CF: dyspnea, cough, nausea, vomiting, hypotension, bronchospasm, loss of consicousness, respiratory arrest, shock. • Rx: stop, epinephrine 0.5-1 ml, 1:1000 dilution S/C, glucocorticoids[if severe] • IgA deficienct individuals-IgA deficient plasma, washed cellular blood components.
- 10. GVHD • Allogenic stem cell transplantation. • TAGVHD-donor lymphocytes recognise host HLA antigens as foreignimmune response. • CF: fever, diarrhea, cutaneous eruption, liver function abnormalities. • Marrow aplasia, pancytopenia. • Rx: highly reistant to immunospressive therapies, glucocorticoids, cyclosporine, anti thymocyte globulin, ablative therapy, allogenic bone marrow transplantation.
- 11. Cont… • CF: appear 8-10 days, death occurs-3-4 weeks post transfusion. • Prevention: irradiation-cellular components- 2500cGy. • Risk-fetuses-intrauterine transfusions, immuno compromised pt. lymphoma pt. • Blood relatives-blood donation-discouraged. • If, no other option, always irradiated.
- 12. TRALI • Presents as acute respiratory distress either during or with in 6hrs. of transfusion. • CF: respiratory compromise, non cardiogenic pulmonary edema. • CXR: bilateral interstitial infiltrates. • Anti HLA antibodies against recepient leukocytes. • Dx: testing donor plasma for anti-HLA antibodies. • Rx: supportive, recovery without sequle.
- 13. Posttransfusion purpura: • Thrombocytopenia- 7 to 10 days after transfusion. • Platelet specific antibodies-recepient serum. • Antigen-HPA-1a on platelet glycoprotein 3a receptor. • Rx: IV immunoglobulin, plasma pheresis.
- 14. Alloimmunization • Women of child bearing age group who are sensitized to RBC antigens[D, E, kell or duffy]. • HDNB. • Dx: matching for D antigen is the only pre transfusion selection test to prevent RBC alloimmunization. • Rx: leukoreduction of cellular components.
- 15. Non Immunologic Reactions • Fluid overload: blood components are excellent volume overloaders. • CF: cough, chest pain,. Frothy sputum. • Rx:vasodilators, diuretics. • Hypothermia: rapid infusion of refrigerated/frozen components. • Cardiac arrythmias. • In-line warmerprevention.
- 16. Electrolyte toxicity: • hyperkalemiaRBC leakage during storage. • Neonates&pt. with renal failurerisk. • Prevention: washed RBCs. • Hypocalcemia: circumoral numbness, tingling sensationcitrate chelates calcium thereby inhibiting coagulation cascade. • Metabolic alkalosis.
- 17. • Iron overload: • Each RBC unit contains 200-250 mg iron. • After 100 units of transfusion, CF of iron overload as endocrinological, hepatic, cardiac are common. • Prevention: erythropoietin as alternate therapy • Hypotensive reactions: pt. using ACE inhibitors. • Bradykinin is degraded by ACE. • No intervention needed.
- 18. Infectious complications • Viral: HCV – common, asymptomatic to chronic active hepatitis. • HIV-1—HIV-1, p24 antigen—detected by NAT. • HBV—risk of transmission is more than HCV. • Vaccination-for long term transfusion therapy. • West nile virus-asymptomatic to fatal. • HTLV-1T- cell leukemia, lymphoma.
- 19. • Bacterial: relative risk is more than viral. • Yersinia, pseudomonas,serratia,escherichiacan grow in cold temperatures. • CF:fever, chills, progress to septic shock&DIC. • Endotoxins-culprits. • Rx: stop, reversing shock, broad spectrum antibiotics. • Other infectious agents: malaria, chagas disease, babesiosis,dengue.
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