Complications of Packed Red Cell Transfusions

Study Notes

Clotting abnormalities can occur due to dilution effect, especially in trauma patients
To reduce the risk of clotting impairment, fresh frozen plasma and platelets should be administered concurrently, typically for patients receiving more than 4 units of RBCs

Hypocalcaemia: chelation of calcium by the calcium binding agent in the preservative results in reduced serum calcium level
Hyperkalaemia: due to partial haemolysis of the red blood cells and the resultant release of intracellular potassium

Rapid transfusion of blood products kept at cool temperatures can lead to a drop in the patient's core temperature
Regular monitoring of core body temperature is required during blood product transfusion

Acute Haemolytic Reaction: a serious reaction caused by transfusion of the incorrect blood type, the most common cause being ABO blood group incompatibility
Symptoms include urticaria, hypotension, fever, haemoglobinuria, and evidence of haemolysis
Diagnosis confirmed by reduced Hb, low serum haptoglobin, high LDH and bilirubin, and a positive Direct Antiglobulin Test (DAT)
Treatment involves urgently informing the blood bank, stopping the transfusion, and providing supportive measures like fluid resuscitation and oxygen supplementation
Transfusion Associated Circulatory Overload (TACO): presents with dyspnoea and features of fluid overload
Treatment involves oxygen and diuretic therapy, with 20mg furosemide prophylactically prescribed during the transfusion to prevent overload
Transfusion Related Acute Lung Injury (TRALI): a form of Acute Respiratory Distress Syndrome (ARDS), a non-cardiogenic cause of pulmonary oedema
Treatment involves high flow oxygen and urgent chest radiograph, with specialist and intensive care input urgently required

Mild Allergic Reaction: patient complains of pruritus (itching), treated with an anti-histamine

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