Blood Transfusion Complications Flashcards
What are early transfusion complications?
<24h
Acute haemolytic reactions (ABO or Rh)
Anaphylaxis
Bacterial contamination
Febrile reaction
Allergic reactions (itch, urticaria, mild fever)
Fluid overload Transfusion Associated circulatory overload TACO
Transfusion related acute lung injury TRALI - ARDS due to antileucocyte antibodies in donor plasma
What are late transfusion complications?
> 24h
Infections (e.g virsues, hepatitis B/C, HIV, bacteria, protozoa)
Iron overload
Graft Versus Host Disease
Post-transfusion purpura - potential lethal fall in platelet count 5-7d post transfusion
What are massive blood transfusions?
Replacement fo individuals entire blood volume (>10U) within 24h
Early haematology support and blood bank advice
How should blood be transfused in heart failure?
If Hb<50g/L with heart failure packed red cell is essential
Give each unit over 4h with furosemide (e.g. slow IV/PO) with alternate units
Check for raised JVP and basal lung crackles
Consider CVP line
What is autologous transfusion?
Patients having their own blood stored pre-op for later use
Erythropoietin can increase yield of autologous blood in normal people
What is acute haemolytic transfusion reaction?
CF?
Mx?
Mismatch of blood group resulting in intravascular haemolysis
Fever Abdominal/chest pain Agitation Hypotension Flushing DIC
Stop transfusion Check identity and name on unit Generous fluid resuscitation with saline Inform the lab Send unit + FBC, U&E, clotting, cultures & urine to lab Treat DIC
What is non-haemolytic febrile transfusion traction?
Shivering and fever usually 1/2 or one hour after starting transfusions
Due to WBC HLA antibodies
Often the result of sensitisation by previous pregnancies or transfusions
Stop tranfusion
Give an antipyretic - paracetamol
Monitor closely
If recurrent use WBC filter
CF and Mx of anaphylaxis in blood transfusion?
Bronchospasm Hypotension Dyspnoea Wheezing Cyanosis Soft tissue swelling
Stop the transfusion
Maintain airway
Oxygen
IM adrenaline 0.5mg
Chlorphenamine 10mg slow IV
Anaesthetist
Fluids
What is TRALI? CF? Mx?
Dyspnoea Cough Hypoxia Fever Hypotension CXR white-out
Within 6h of transfusion
STOP transfusion
100% O2
Treat as ARDS: ventilate if required, circulatory support
Donor removed from donor panel
What is TACO? CF? Mx?
Fluid overload resulting in pulmonary oedema
Dyspnoea Hypoxia Tachycardia Raised JVP Basal crepitations May be hypertensive - difference from TRALI
STOP transfusion
Give O2 and diuretic eg. furosemide 40mg IV
Consider CVP line
What are signs of bacterial contamination of blood product? Mx?
Rapid onset fever
Hypotension
Rigors
Stop the transfusion
Check identity against name on unit
Send unit + FBC, U&E, clotting, cultures and urine to lab
Start broad spectrum ABX
What infection can be transmitted via blood transufsion?
variant Creutzfield-Jacob disease
Products are no leucodepleted to reduce vCJD infectivity present
Recipients of blood components excluded from donating blood
