Transfusion Complication

Aka: Transfusion Complication

1. See Also
   1. Blood Transfusion
   2. Transfusion Hemolysis
2. Complications: Acute (within minutes to 24 hours)
   1. Immune reaction (observe patient closely for the first 15 minutes of transfusion)
      1. Transfusion Hemolysis
      2. Allergic Reaction
         1. Reaction to antigens in donor's blood, not the blood type itself
      3. Anaphylaxis
         1. Associated with IgA deficient patients exposed to IgA in donor blood
      4. Urticaria
   2. Febrile Nonhemolytic Transfusion Reaction (FNHTR)
      1. Fever within 24 hours of transfusion sometimes associated with chills or rigors
      2. Diagnosis of exclusion - first rule out other causes of fever (e.g. Sepsis)
      3. More common with repeat transfusions or in pregnancy
      4. Less common now since most centers filter pRBCs of Leukocytes prior to storage
      5. Now Platelet Transfusions are most commonly associated with FNHTR
   3. Circulatory Overload
      1. Infants
      2. Renal insufficiency
      3. Cardiac insufficiency (CHF)
   4. Complication of Massive Transfusion
      1. Hyperkalemia
      2. Ammonia toxicity
      3. Citrate toxicity
      4. Dilutional Coagulopathy
      5. Thrombocytopenia
   5. Intravenous Access Complication
      1. Secondary Sepsis from bacterial contamination of blood product
      2. Air embolism
      3. Thrombophlebitis
   6. Transfusion-Related acute lung injury (TRALI)
      1. Acute pulmonary edema within 6 hours of transfusion (non-cardiac)
      2. Leading cause of transfusion associated mortality
      3. Associated with ANCA and HLA Antibody mediated lung injury
      4. May be associated with plasma donated by multiparous women
3. Complications: Delayed
   1. Delayed hemolytic reaction
   2. Iron Overload (Hemochromatosis)
   3. Post-transfusion Purpura
   4. Transfusion-associated graft-versus-host disease
      1. Onset 6 weeks after transfusion
      2. Presents with rash, fever, Diarrhea, liver abnormalities, and Pancytopenia
      3. Fatal in 90% of cases
      4. Donor Lymphocyte reaction against host tissue
      5. Risk factors include immunosuppresion
4. Causes: Infection
   1. Hepatitis BVirus Infection (1 in 350,000)
   2. Hepatitis CVirus Infection (1 in 1.8 Million)
   3. Human T-Lymphotrophic Virus 1 or 2 (1 in 2 Million)
   4. Human Immunodeficiency Virus (1 in 2.3 Million)
   5. Malaria (rare)
   6. Babesiosis (rare)
   7. Pandemic Influenza (rare)
   8. Human Herpes Virus 8 (rare)
   9. West Nile Virus (rare)
   10. Creutzfeldt-Jakob Disease (rare)
   11. Syphilis
   12. Cytomegalovirus (CMV)
   13. Toxoplasmosis
   14. Brucellosis
5. References
   1. Hendrickson (2009) Anesth Analg 108(3): 759-69
   2. Sharma (2011) Am Fam Physician 83(6): 719-24