Complications of Blood Transfusions Flashcards
General complications of packed red cell transfusions
Clotting abnormalities
Electrolyte abnormalities
Hypothermia
Explain clotting abnormalities in packed red cell transfusions
Due to dilution effect as the packed red cells transfused do not contain any platelets or clotting factors.
How to reduce the risk of any clotting impairment
FFP and platelets should be administered concurrently.
Typically done for patients receiving more than 4 units of RBCs
Two main electrolyte abnormalities in blood transfusion
Hypocalcaemia due to the chelation of calcium by the calcium binding agent in the preservative.
Hyperkalaemia due to inevitable partial haemolysis of the RBCs and the resultant release of intracellular potassium
Why might hypothermia happen in blood transfusion?
Blood products are thawed from frozen and then kept at cool temperatures.
They may not be up to body temp by time of transfusion especially if it is a major haemorrhage.
Acute transfusion complications
Acute haemolytic reaction
Transfusion associated circulatory overload
Transfusion related acute lung injury TRALI
Mild allergic reaction
Non-haemolytic febrile reactions
Anaphylaxis
Infective/Bacterial shock
Explain acute haemolytic reaction
ABO incompatibility due to transfusion of incorrect blood type.
The donor RBCs are destroyed by recipient’s antibodies.
Clinical presentation of Acute haemolytic reaction.
Urticaria
Hypotension
Fever
May have evidence of haemoglobinuria from rapid haemolysis.
Investigations
Reduced Hb
Low serum haptoglobin
High LDH
High bilirubin
+ve Direct antiglobulin test (DAT)
Management
Urgently inform blood bank (they may have dispensed further incorrect blood)
Stop transfusion
Start supportive measures with fluid resus and O2.
Seek specialist advice for further management.
Explain Transfusion associated circulatory overload.
Presents with dyspnoea and features of fluid overload.
A common problem in those who are already overloades, like heart failure.
Management
Urgent CXR
Treatment via O2 and diuretic therapy
Prophylaxis of transfusion associated circulatory overload.
At risk of overload…
20mg furosemide prophylactically during the transfusion.
Explain transfusion acute lung injury.
A form of ARDS and a non-cardiogenic cause of pulmonary oedema.
This means that the patient will be dyspnoeic and have features of pulmonary oedema on clinical examination.
Management of TRALI
High mortality
High flow oxygen and urgent CXR + speciliast and ICU input urgently
