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COMPLICATIONS OF BLOOD
TRANSFUSION
B.Vikram
Roll no:20
Introduction
• Adverse reactions to blood components
occurs despite multiple tests, checkups, &
inspections.
• Many reactions are not life threatening &
serious reactions present with mild symptoms
and signs.
Classification
• Classified based on etiology.
1. Immune mediated reactions.
2. Non immune mediated reactions.
3. Infectious complications.
Immune mediated reactions
1. Hemolytic transfusion reactions.
2. Febrile non-hemolytic transfusion reactions.
3. Allergic reactions.
4. Anaphylactic reactions.
5. Graft versus host disease.
6. TRALI.
7. Post transfusion purpura.
8. Alloimmunization.
Hemolytic transfusion reactions
• Occurs-preformed antibodies donor RBCs.
• Major-ABO incompatibility.
• Minor-Rh, K, jk, Fy incompatibility.
• CF: hypotension, tachypnea, tachycardia, fever,
chills, hemoglobinuria, hemoglobinemia, flank
pain.
• Immune complexescomplement
cascadehemolysis.
• Immune complexesrenal tubulesacute
tubular necrosisAKI[Acute Kidney Injury]
Cont…
What to do..???
• Acute--transfusion is stopped immediately,
intravenous access maintained.
• Delalyed-anamnestic reaction, memory cells.
• Diuresis-furosemide 20-40mg.IV or inj.Mannitol
20% 100ml IV.
• Monitor urine output, Hb in urine.
• Blood bank-recheck, repeat crossmatching.
• Investigations-LDH,indirect bilirubin, haptoglobin,
PT, aPTT, fibrinogen, platelet count, DAT.
Febrile non-hemolytic transfusion
reactions.
• Cellular blood components.
• Mild nature.
• CF: chills rigors, >=1 degree C raise of temp.
• Fever-other causes ruled out.
• Antibodies against Donor WBCs&HLA
antigens.
• Multiply transfused pt.& multiparous women.
Prvention: leukoreduction before storage.
Allergic reactions
• Utricarial, mild nature—plasma proteins.
• Temporary stop, symptomatic Rx.
• Rx: diphenhydramine 50mg orally or IM.
• CF Resolve-transfusion resume.
• H/O allergic reactions-pre medicated.
• Extremely sensitized pt.—cellular component
wash.
Anaphylactic reaction
• Severe, few milliliters.
• CF: dyspnea, cough, nausea, vomiting,
hypotension, bronchospasm, loss of
consicousness, respiratory arrest, shock.
• Rx: stop, epinephrine 0.5-1 ml, 1:1000 dilution
S/C, glucocorticoids[if severe]
• IgA deficienct individuals-IgA deficient plasma,
washed cellular blood components.
GVHD
• Allogenic stem cell transplantation.
• TAGVHD-donor lymphocytes recognise host HLA
antigens as foreignimmune response.
• CF: fever, diarrhea, cutaneous eruption, liver
function abnormalities.
• Marrow aplasia, pancytopenia.
• Rx: highly reistant to immunospressive therapies,
glucocorticoids, cyclosporine, anti thymocyte
globulin, ablative therapy, allogenic bone marrow
transplantation.
Cont…
• CF: appear 8-10 days, death occurs-3-4 weeks
post transfusion.
• Prevention: irradiation-cellular components-
2500cGy.
• Risk-fetuses-intrauterine transfusions,
immuno compromised pt. lymphoma pt.
• Blood relatives-blood donation-discouraged.
• If, no other option, always irradiated.
TRALI
• Presents as acute respiratory distress either
during or with in 6hrs. of transfusion.
• CF: respiratory compromise, non cardiogenic
pulmonary edema.
• CXR: bilateral interstitial infiltrates.
• Anti HLA antibodies against recepient leukocytes.
• Dx: testing donor plasma for anti-HLA antibodies.
• Rx: supportive, recovery without sequle.
Posttransfusion purpura:
• Thrombocytopenia- 7 to 10 days after
transfusion.
• Platelet specific antibodies-recepient serum.
• Antigen-HPA-1a on platelet glycoprotein 3a
receptor.
• Rx: IV immunoglobulin, plasma pheresis.
Alloimmunization
• Women of child bearing age group who are
sensitized to RBC antigens[D, E, kell or duffy].
• HDNB.
• Dx: matching for D antigen is the only pre
transfusion selection test to prevent RBC
alloimmunization.
• Rx: leukoreduction of cellular components.
Non Immunologic Reactions
• Fluid overload: blood components are
excellent volume overloaders.
• CF: cough, chest pain,. Frothy sputum.
• Rx:vasodilators, diuretics.
• Hypothermia: rapid infusion of
refrigerated/frozen components.
• Cardiac arrythmias.
• In-line warmerprevention.
Electrolyte toxicity:
• hyperkalemiaRBC leakage during storage.
• Neonates&pt. with renal failurerisk.
• Prevention: washed RBCs.
• Hypocalcemia: circumoral numbness, tingling
sensationcitrate chelates calcium thereby
inhibiting coagulation cascade.
• Metabolic alkalosis.
• Iron overload:
• Each RBC unit contains 200-250 mg iron.
• After 100 units of transfusion, CF of iron
overload as endocrinological, hepatic, cardiac
are common.
• Prevention: erythropoietin as alternate
therapy
• Hypotensive reactions: pt. using ACE
inhibitors.
• Bradykinin is degraded by ACE.
• No intervention needed.
Infectious complications
• Viral: HCV – common, asymptomatic to
chronic active hepatitis.
• HIV-1—HIV-1, p24 antigen—detected by NAT.
• HBV—risk of transmission is more than HCV.
• Vaccination-for long term transfusion therapy.
• West nile virus-asymptomatic to fatal.
• HTLV-1T- cell leukemia, lymphoma.
• Bacterial: relative risk is more than viral.
• Yersinia,
pseudomonas,serratia,escherichiacan grow
in cold temperatures.
• CF:fever, chills, progress to septic shock&DIC.
• Endotoxins-culprits.
• Rx: stop, reversing shock, broad spectrum
antibiotics.
• Other infectious agents: malaria, chagas
disease, babesiosis,dengue.
THANK YOU

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COMPLICATIONS OF BLOOD TRANSFUSION

  • 2. Introduction • Adverse reactions to blood components occurs despite multiple tests, checkups, & inspections. • Many reactions are not life threatening & serious reactions present with mild symptoms and signs.
  • 3. Classification • Classified based on etiology. 1. Immune mediated reactions. 2. Non immune mediated reactions. 3. Infectious complications.
  • 4. Immune mediated reactions 1. Hemolytic transfusion reactions. 2. Febrile non-hemolytic transfusion reactions. 3. Allergic reactions. 4. Anaphylactic reactions. 5. Graft versus host disease. 6. TRALI. 7. Post transfusion purpura. 8. Alloimmunization.
  • 5. Hemolytic transfusion reactions • Occurs-preformed antibodies donor RBCs. • Major-ABO incompatibility. • Minor-Rh, K, jk, Fy incompatibility. • CF: hypotension, tachypnea, tachycardia, fever, chills, hemoglobinuria, hemoglobinemia, flank pain. • Immune complexescomplement cascadehemolysis. • Immune complexesrenal tubulesacute tubular necrosisAKI[Acute Kidney Injury]
  • 6. Cont… What to do..??? • Acute--transfusion is stopped immediately, intravenous access maintained. • Delalyed-anamnestic reaction, memory cells. • Diuresis-furosemide 20-40mg.IV or inj.Mannitol 20% 100ml IV. • Monitor urine output, Hb in urine. • Blood bank-recheck, repeat crossmatching. • Investigations-LDH,indirect bilirubin, haptoglobin, PT, aPTT, fibrinogen, platelet count, DAT.
  • 7. Febrile non-hemolytic transfusion reactions. • Cellular blood components. • Mild nature. • CF: chills rigors, >=1 degree C raise of temp. • Fever-other causes ruled out. • Antibodies against Donor WBCs&HLA antigens. • Multiply transfused pt.& multiparous women. Prvention: leukoreduction before storage.
  • 8. Allergic reactions • Utricarial, mild nature—plasma proteins. • Temporary stop, symptomatic Rx. • Rx: diphenhydramine 50mg orally or IM. • CF Resolve-transfusion resume. • H/O allergic reactions-pre medicated. • Extremely sensitized pt.—cellular component wash.
  • 9. Anaphylactic reaction • Severe, few milliliters. • CF: dyspnea, cough, nausea, vomiting, hypotension, bronchospasm, loss of consicousness, respiratory arrest, shock. • Rx: stop, epinephrine 0.5-1 ml, 1:1000 dilution S/C, glucocorticoids[if severe] • IgA deficienct individuals-IgA deficient plasma, washed cellular blood components.
  • 10. GVHD • Allogenic stem cell transplantation. • TAGVHD-donor lymphocytes recognise host HLA antigens as foreignimmune response. • CF: fever, diarrhea, cutaneous eruption, liver function abnormalities. • Marrow aplasia, pancytopenia. • Rx: highly reistant to immunospressive therapies, glucocorticoids, cyclosporine, anti thymocyte globulin, ablative therapy, allogenic bone marrow transplantation.
  • 11. Cont… • CF: appear 8-10 days, death occurs-3-4 weeks post transfusion. • Prevention: irradiation-cellular components- 2500cGy. • Risk-fetuses-intrauterine transfusions, immuno compromised pt. lymphoma pt. • Blood relatives-blood donation-discouraged. • If, no other option, always irradiated.
  • 12. TRALI • Presents as acute respiratory distress either during or with in 6hrs. of transfusion. • CF: respiratory compromise, non cardiogenic pulmonary edema. • CXR: bilateral interstitial infiltrates. • Anti HLA antibodies against recepient leukocytes. • Dx: testing donor plasma for anti-HLA antibodies. • Rx: supportive, recovery without sequle.
  • 13. Posttransfusion purpura: • Thrombocytopenia- 7 to 10 days after transfusion. • Platelet specific antibodies-recepient serum. • Antigen-HPA-1a on platelet glycoprotein 3a receptor. • Rx: IV immunoglobulin, plasma pheresis.
  • 14. Alloimmunization • Women of child bearing age group who are sensitized to RBC antigens[D, E, kell or duffy]. • HDNB. • Dx: matching for D antigen is the only pre transfusion selection test to prevent RBC alloimmunization. • Rx: leukoreduction of cellular components.
  • 15. Non Immunologic Reactions • Fluid overload: blood components are excellent volume overloaders. • CF: cough, chest pain,. Frothy sputum. • Rx:vasodilators, diuretics. • Hypothermia: rapid infusion of refrigerated/frozen components. • Cardiac arrythmias. • In-line warmerprevention.
  • 16. Electrolyte toxicity: • hyperkalemiaRBC leakage during storage. • Neonates&pt. with renal failurerisk. • Prevention: washed RBCs. • Hypocalcemia: circumoral numbness, tingling sensationcitrate chelates calcium thereby inhibiting coagulation cascade. • Metabolic alkalosis.
  • 17. • Iron overload: • Each RBC unit contains 200-250 mg iron. • After 100 units of transfusion, CF of iron overload as endocrinological, hepatic, cardiac are common. • Prevention: erythropoietin as alternate therapy • Hypotensive reactions: pt. using ACE inhibitors. • Bradykinin is degraded by ACE. • No intervention needed.
  • 18. Infectious complications • Viral: HCV – common, asymptomatic to chronic active hepatitis. • HIV-1—HIV-1, p24 antigen—detected by NAT. • HBV—risk of transmission is more than HCV. • Vaccination-for long term transfusion therapy. • West nile virus-asymptomatic to fatal. • HTLV-1T- cell leukemia, lymphoma.
  • 19. • Bacterial: relative risk is more than viral. • Yersinia, pseudomonas,serratia,escherichiacan grow in cold temperatures. • CF:fever, chills, progress to septic shock&DIC. • Endotoxins-culprits. • Rx: stop, reversing shock, broad spectrum antibiotics. • Other infectious agents: malaria, chagas disease, babesiosis,dengue.