Hazards of Blood Transfusion: Causes, Clinical Features, and Management of Transfusion Reactions

Transfusion Reactions

Hazards of blood transfusion.

Answer. The following are the hazards of blood transfusion:

Transfusion Reactions—Incompatibility

Blood Transfusion Causes

• Mistake in crossmatching: This is a technical error, if the serum is old or labeling is wrong.
• Due to transfusion of blood which is already hemolysed by warming, over freezing or shaking.
• Due to transfusion of blood after expiry date.

“Causes Of Blood Transfusion Reactions”

Clinical Features of Mismatched Blood Transfusion

• Presence of rigors and fever. Patient may complain of nausea, vomiting, headache, pain in the loins, tingling sensation in the extremities.
• There can be chest pain and dyspnea.
• If the patient is already in shock, it may become more pronounced instead of curing it. Gradually, he will lose consciousness.
• Urine output decreases, and hemoglobinuric may occur within 2 to 3 hours.
• Jaundice may appear within 24–36 hours, this is the confirmatory evidence of mismatching.
• Ultimately renal failure sets in due to the blockage of renal tubules by hematic pigment.

“Symptoms Of Transfusion Reactions”

Blood Transfusion Treatment

• Transfusion should be stopped immediately.
• Fresh blood specimen of venous blood and urine from the patient should be sent to laboratory for rechecking along with the rejected blood pack.
• IV flids should be started instead of blood.
• Alkalization of blood to be done by isotonic solution of sodium lactate and 10 mL of sodium bicarbonate to facilitate precipitation of hematin pigments.
• Frusemide 80–120 mgIVshould be givenfor forced diuresis.
  This maybe repeated, ifurine outputis increased to 30 mL/h.
• Antihistamine and hydrocortisones should be given.
• In very severe cases. hemodialysis should be undertaken.

Pyrexial reactions

It is common to see simple reactions like pyrexia, chills, rigors, restlessness, headache, tachycardia, nausea and vomiting.

Pyrexial reactions Causes

• Improperly sterilized drip sets.
• Presence of pyrogens in the donor set.
• Transfusion of infected blood.
• Very rapid transfusion

“Step-By-Step Guide To Identifying Transfusion Reactions”

Pyrexial reactions Prevention

These reactions can be prevented by using sterilized plastic disposable sets.

Pyrexial reactions Treatment

Transfusions should be stopped immediately though temporarily.
Antihistaminics and antipyretics should be given.
After his condition returns to normal, blood transfusion can be restarted.

“Best Ways To Manage Transfusion Reactions”

Allergic Reactions

Usually, within few hours of transfusion, patients may get mild urticaria, tachycardia, fever and dyspnea.
He may even go into severe anaphylactic shock.

Allergic Reactions Treatment

Transfusion should be stopped. Antihistamines and cortisones should be given. Shock should be treated.

Allergic Reactions Transmission Of Diseases

• Serum hepatitis: Hepatitis B is a common disease which can be transmittd during blood transfusion.
  The symptoms usually appear within 3 months.
• AIDS: HIV can be transmittd from the donor’s blood to the recipient.
• Bacterial infection: This occurs due to faulty storage technique.
  This should be treated with higher antibiotics otherwise patient may go into septicemia.

Reaction Due To Massive Blood Transfusion

“Massive blood transfusion implies single transfusion of 8-10 units of blood in 24 hours.”

• Acid-base imbalance results in significant metabolic alkalosis.
• Hyperkalemia
  • Citrate toxicity: After massive blood transfusion, increased citrate level consumes ionized calcium from patient’s body.\The body compensates it by rapidly mobilizing calcium from the bones.
  • Rarely when hypocalcemia is recognized calcium can be infused.
• Hypothermia: During massive blood transfusion, cold blood is rapidly infused from the refrigerator to the patient. His temperature may drop by 3 to 4°C.
• Failure of coagulation: After massive blood transfusion, the natural process of coagulation may fail due to dilution of platelets and various clottng factors. .
• Disseminated intravascular coagulation (DIC): This may occur after a massive blood transfusion. Actually, it occurs after mismatched blood transfusion.

“Risk Factors For Transfusion Reactions”

Complications of over transfusion

These complications may be seen in patients with chronic anaemia, in children and elderly patients.

They should receive packed cells rather than whole blood.

Transfusions should be given slowly for 4–6 hours and after some intervals.

Elderly patients should be given packed cells with diuretics.

“Understanding The Causes Of Blood Transfusion Hazards”

Complications of intravenous transfusions

Thrombophlebitis and air embolism.

Pulmonary Complications

Syndrome of transfusion—related acute lung injury is defied as a noncardiogenic pulmonary edema related to transfusion.