Adverse Effects of Transfusion

 Blood transfusion is a life saving procedure in an

appropriate setting and there are no side-effects in
majority of cases.
 However, it is a potentially harmful procedure and every
recipient of transfusion is at risk of an adverse reaction.

ACUTE HEMOLYTIC TRANSFUSION REACTION :

 This is a medical emergency and results from

intravascular destruction of donor red cells by antibodies
in the recipient.
 It results from transfusion of ABOmismatched blood to
the recipient due most commonly to a clerical error.
 Pathophysiology consists of antigen-antibody reaction
that leads to complement activation and intravascular
hemolysis.
 . This causes hypotension, shock, acute renal failure, and
disseminated intravascular coagulation
 Signs and symptoms include fever, pain at the infusion
site, loin pain, tachycardia, hemoglobinuria, and
hypotension.
Laboratory features are:

• Hemoglobinemia (pink coloration of plasma after

centrifugation of post-transfusion sample)

• Positive direct antiglobulin test

• Hemoglobinuria

• Schistocytes (fragmented red cells) and spherocytes on

blood smear

• Elevated indirect serum bilirubin..

FEBRILE NON-HEMOLYTIC TRANSFUSION
REACTION:

 This is the most common transfusion reaction

 . It occurs in about 1% of all transfusions and is defined
as an unexplained rise of temperature of atleast 1°C
during or shortly after transfusion.
 It is caused by the release of pyrogenic cytokines from
white cells (during storage of blood unit
 .. This reaction is common in multiply-transfused
patients.
 Signs and symptoms include fever, chills, and
tachycardia. Diagnosis depends on exclusion of other
causes of febrile transfusion reaction.
BACTERIAL CONTAMINATION OF DONOR UNIT
 Transfusion of an infected blood product is more
common with platelet concentrates since platelets are
stored at a higher temperature (20-24°C) that promotes
multiplication of contaminating bacteria.
 Organisms depend on the nature of blood product.
Platelets are usually contaminated with gram-positive
cocci, while red cells are contaminated with Yersinia
enterocolitica, Escherichia coli, or Pseudomonas species.
 Signs and symptoms include high grade fever with rigors,
hypotension, and shock.
 Laboratory studies include inspection of blood bag for
discoloration, and Gram staining and culture of blood
from the blood bag and from the recipient. Direct
antiglobuin test is negative.

TRANSFUSION-ASSOCIATED LUNG INJURY

This is an acute respiratory disorder that manifests with fever,
chills, dyspnea, and dry cough.
X-ray shows diffuse pulmonary infiltrates.
One probable mechanism is reaction of anti-HLA or anti-
neutrophil antibodies in donor blood with leukocytes of the
recipient leading to the formation of leukocyte aggregates;
these aggregates deposit in pulmonary vasculature and cause
increased vascular permeability and pulmonary edema.
ANAPHYLACTIC REACTION
 This rare reaction occurs in IgA-deficient recipients in
whom anti-IgA antibodies react with IgA in donor
plasma, leading to activation of complement and
formation of anaphylatoxins (C3a and C5a). Signs and
symptoms include development of acute hypotension,
shock, and dyspnoea after transfusion of a few drops of
blood.

ALLERGIC REACTION
 This results from type I hypersensitivity reaction to some
donor plasma proteins. It is the second most frequently
reported transfusion reaction.
 Signs and symptoms include mild urticaria, rash, and
pruritus.

 VOLUME OVERLOAD

 This occurs if transfusion rate is too rapid, or excessive,

or if cardiac or renal impairment is present.
 It causes cardiac failure and lung edema.