Adverse Effects of Blood Transfusion

Adverse Effects of Blood Transfusion

• Adverse events include incidents and adverse reactions, with fatalities being a possibility.
• In FY2015, 42 fatality reports were associated with transfusion recipients, with 80% attributed to transfusion.

Recognition and Evaluation of Transfusion Reactions

• Clinical recognition involves nurses and physicians immediately stopping the transfusion if an infusion is still in process.
• Steps to take:
  • Stop the transfusion (Step 1)
  • Investigate the transfusion reaction (Step 2)
• Send appropriate specimens to the laboratory for investigation.
• Laboratory investigation involves MedTech and lab technicians identifying possible hemolytic transfusion reactions.

Noninfectious Transfusion Reactions

Febrile Nonhemolytic Transfusion Reaction (FNHTR)

• Mimics more serious and severe transfusion reactions
• Characterized by:
  • Fever > 100.4°F (38°C) or a change of at least 1.8°F (1.0°C) within 4 hours after transfusion

Transfusion-Related Acute Lung Injury (TRALI)

• Rare event associated with acute respiratory distress
• Characterized by:
  • Chills/rigors, headache, cold feeling, mild dyspnea, and mild nausea/vomiting
• Leading cause of mortality due to adverse reactions to transfusion

Alloimmunization to RBC Antigens

• Development of non-ABO antibodies following RBC transfusion, pregnancy, or transplantation
• Includes:
  • Absence of acute lung injury (ALI) prior to transfusion
  • ALI during or within 6 hours after transfusion
  • Evidence of hypoxemia by blood gas or oxygen saturation testing
  • Radiographic evidence of bilateral pulmonary edema (bilateral "white out")

Acute Hemolytic Transfusion Reaction (AHTR)

• Accelerated destruction of transfused RBCs due to antibody-mediated incompatibility
• Characterized by:
  • Fever, pain in lower back, hypotension, shock
• Laboratory diagnosis:
  • Elevated blood urea nitrogen (BUN) and creatinine
  • Appearance of spherocytes on peripheral blood smear examination

Delayed Hemolytic and Serologic Transfusion Reaction (DHTR)

• Appears 7-10 days post-transfusion
• Characterized by:
  • Evidence of hemolysis, including inadequate rise in hemoglobin
  • Appearance of spherocytes on peripheral blood smear examination
• "Delayed TRALI" refers to when criteria for TRALI are present but the onset is 6-72 hours after transfusion

Transfusion-Associated Circulatory Overload (TACO)

• Fluid overload occurring within 6 hours after transfusion
• Risk factors:
  • Emergency surgery
  • Chronic kidney disease
  • Left ventricular heart dysfunction
  • Increased intraoperative fluid administration

Transfusion-Associated Dyspnea (TAD)

• Dyspnea occurring within 24 hours after transfusion
• Characterized by:
  • Difficulty in breathing
  • Dyspnea
• Could lead to severe anaphylactic reactions resulting in cardiopulmonary resuscitation/death

Transfusion-Associated Graft-Versus-Host Disease (TA-GVHD)

• Very high mortality rate
• Clinical syndrome developing from 2 days to 6 weeks after transfusion, characterized by:
  • Skin rash
  • Diarrhea
  • Fever
  • Enlarged liver
  • Elevated liver enzymes

Post-Transfusion Purpura

• Laboratory diagnosis:
  • Thrombocytopenia
  • Drop in platelet count
• Characterized by:
  • Slightly raised dark red-purple patches on the skin
  • Bleeding from mucous membranes (e.g., gums, nose)
  • GI bleeding
  • Hematuria