hematology and oncology
Complications of Transfusion
Introduction
Themost common complicationsof transfusion are Febrile nonhemolytic transfusion reaction None Chill-rigor reactions Themost serious complications,which have very high mortality rates, are Acute hemolytic transfusion reaction (AHTR) (AHTR) due to ABO incompatibility Graft-vs-host disease (GVHD) (GVHD) Transfusion-associated circulatory overload (TACO) (TACO) Transfusion-related acute lung injury (TRALI) (TRALI) Other complicationsinclude Allergic reactions None Altered oxygen affinity None Delayed hemolytic transfusion reaction None Infectious complications None Post-transfusion purpura None Early recognition of symptoms suggestive of a transfusion reaction and prompt reporting to the blood bank are essential. The most common symptoms are chills, rigor, fever, dyspnea, light-headedness, urticaria, itching, and flank pain. If any of these symptoms (other than localized urticaria and itching) occur, the transfusion should be stopped immediately and the IV line kept open with normal saline. The remainder of the blood product and clotted and anticoagulated samples of the patient’s blood should be sent to the blood bank for investigation. NOTE:The unit in question should not be restarted, and transfusion of any previously issued unit should not be initiated.Further transfusion should be delayed until the cause of the reaction is known, unless the need is urgent, in which case type O Rh-negative red blood cells (RBCs) should be used. Hemolysis of donor or recipient RBCs (usually the former) during or after transfusion can result from ABO and Rh typing , plasma antibodies, or hemolyzed or fragile RBCs (eg, by overwarming stored blood or contact with hypotonic IV solutions). Hemolysis is most common and most severe when incompatible donor RBCs are hemolyzed by antibodies in the recipient’s plasma. Hemolytic reactions may be acute (within 24 hours) or delayed (from 1 to 14 days). 