Blood transfusions

Indications
- Restore circulating blood volume
- Replace clotting factors
- Improve oxygen carrying capacity of the blood

Complications
Circulatory overload
Prevent by giving, packed cells, frusemide, monitoring CVP.
Intervention, stop transfusion, sit upright, reassure

Disease transmission
- Hepatitis B
- Hepatitis non - A - non - B
- Cytomegalovirus
- Malaria
- Syphilis
- HIV
Prevent by, screening

Pyrogenic reactions
Due to agglutinations following transfusion of antigens,

Prevent by,
- removal of leucocytes and platelets from donor blood
- antipyretics or steroids

Due to bacterial contamination,

S+S, fever
flushing
headache
substernal pain
D+V
Hypotension
Abdominal and extremities pain

Prevent by,
- Keeping blood cool
- No pre transfusion warming
- Inspect for gas bubbles and colour change

Intervention,
- Stop transfusion
- Blood cultures
- Treat septicaemia

Allergic reactions
S+S
- Flushing
- Itching and rash
- Urticaria, (hives)
- Wheezing and laryngeal oedema

Prevention
- Ask about allergic history
- Prophylactic antihistamines in some cases

Intervention
- Stop transfusion
- Adrenaline to hand

Haemolytic reactions
Incompatibility causing agglutination and subsequent haemolysis

Use a blood filter to filter out clots

S+S
- Chilliness fever
- Loin pain
- Feeling of head fullness
- Oppressive feelings in the chest
- Anxiety
- Tachycardia
- Tachypnoea
- Hypotension
- Haemoglobinuria
- Oozing from venepuncture sites

Prevention
Correct identification of blood and patient
Stay with patient for first 15 -30 minutes
Start transfusion very slowly

Intervention
- stop infusion
- summon help
- maintain renal perfusion, eg. diuretics
- maintain circulating volume
- catheter to monitor urine volumes

Haemolytic transfusion reactions may occur one to two weeks after infusion.

Hyperkalcemia
S+S
- GI symptoms
- weakness
- parathesia of extremities
- apprehension
- slow pulse
- cardiac arrest

Prevention
Don`t use old blood
Don't abuse packs of blood
New blood for large transfusions

Hypocalcaemia
Results from large volumes of citrate.

S+S
- tingling
- muscle cramps
- hyperactive reflexes
- convulsions
- carpopedal spasms
- laryngeal spasms

Haemosiderosis
Iron overload
Air embolism
S+S
chest pain
cough
dysponea

Cold blood
Rapid infusion of cold blood can cause cardiac arrest.