Complications of blood transfusion

[Ref: PK1:p255]

Background

• About 3% of patients receiving transfusions have reactions
• Fatal reactions occur in 1 in 50,000 transfusions

Immunological reactions

Immediate or delayed

Immediate reactions

Massive intravascular haemolysis
* Due to IgM or IgG antibodies activating complement system
* e.g. ABO antibodies

Severity depends on the recipient's titre of antibodies

Reactions associated with coating of RBC with IgG
--> Extravascular haemolysis
--> Less severe
* e.g. Rh antibodies

Severe haemolytic transfusion reactions include

• Urticaria
• Flushing
• Chest pain
• Dyspnoea
• Rigors
• Tachycardia
• Shock
  --> May progress to bleeding and renal shutdown

RBC destruction can lead to:

• Jaundice
• Haemoglobinuria
• Disseminated intravascular coagulation (DIC)

Delayed reactions

If recipient develops antibodies to antigens present on donor RBC during or after transfusion
--> Secondary response with rapid rise of IgG antibodies
* More frequently with antigens of Kidd (Jk), Duffy (Fy), Rhesus (Rh), Kell (K), and S blood group systems

• White cell reactions
  * Febrile reaction in 2% of all transfusions
• Graft-vs-host reaction
  * Rare
  * Deposition of donor lymphocytes in recipient's skin, liver, or GIT
  --> Leading to rash, hepatitis, or diarrhoea
• Post-transfusional purpura
  * Consumptive thrombocytopenia
  * Occurs 7-10 days after transfusion
  * Usually self-limiting, lasting for 2-6 weeks
• Anaphylaxis to plasma proteins
  * Usually occurs in IgA-deficient patients whose sera contain anti-IgA antibodies

Non-immunological reactions

Septicaemia

Approximately 3 in 1000 units of blood may be contaminated with bacteria
* e.g. pseudomonas

Risk is higher with platelet
* Due to its storage at higher temperatures

May have signs of Gram-negative endotoxaemia

Blood-borne disease

• Hepatitis B and C
• CMV
  * Likely to cause trouble for newborn, transplant patients and open-heart cardiac patients
• HIV
• Malaria, toxoplasmosis, syphilis

Other complications

• Air embolism
• Circulatory overload
• Iron overload