Signs and symptoms would indicate potential complications of the blood transfusion
See also the separate Blood Products for Transfusion article. Show
What is a blood transfusion?Blood transfusion can be life-saving and provides great clinical benefit to many patients but it is not without risks[1]:
Growing awareness of avoidable risk, and improved reporting systems, have led to a culture of better safety procedures as well as steps to minimise the use of transfusion. The reporting rate of transfusion errors is improving although un-reporting of some serious adverse reactions still occasionally occurs[2]. Alternative approaches to patient management should be used to reduce or eliminate the need for transfusion whenever possible[3]. Causes of acute complications of transfusion[4]Early complications of transfusion are rare, occurring in fewer than 1 in 1,000 transfusions; however, they tend to be more severe[5]. Acute haemolytic transfusion reaction
Infective shock
Transfusion-related acute lung injury (TRALI)
Fluid overload
Non-haemolytic febrile reactions to transfusion of platelets and red cells
Severe allergic reaction or anaphylaxis
Blood transfusion reaction symptoms[4]Symptoms or signs may occur after only 5-10 ml of transfusion of incompatible blood so patients should be observed closely at the start of each blood unit transfused. Symptoms
Signs
Investigation[4, 8]Initial treatment of acute transfusion reactions (ATRs) should be directed by symptoms and signs. Treatment of severe reactions should not be delayed until the results of investigations are available. In all moderate and severe transfusion reactions, standard investigations, including FBC, renal and liver function tests and assessment of the urine for haemoglobin, should be performed. If febrile symptoms of moderate severity are sustained, implicated units should be returned to the laboratory for further investigation, the blood service contacted immediately so that associated components from the implicated donation can be withdrawn and the patient sampled for repeat compatibility and culture. Patients who have experienced moderate or severe allergic reactions should have IgA levels measured. Low levels found on screening, in the absence of generalised hypogammaglobulinaemia, should be confirmed by a more sensitive method and IgA antibodies should be checked. Patients with IgA deficiency diagnosed after an ATR should be discussed with an allergist or immunologist regarding future management. In the absence of platelet or granulocyte transfusion refractoriness, or acute post-transfusion thrombocytopenia or leukopenia, investigation of the patient with ATR for leukocyte, platelet or neutrophil-specific antibodies is not indicated.
Blood transfusion reaction treatment and management[4, 8]All patients should be transfused in clinical areas where they can be directly observed and where staff are trained in the administration of blood components and the management of transfused patients, including the emergency treatment of anaphylaxis. Patients should be asked to report symptoms which develop within 24 hours of completion of the transfusion. If a patient being transfused for haemorrhage develops hypotension, a careful clinical risk assessment is required. If the hypotension is caused by haemorrhage, continuation of the transfusion may be life-saving. However, if the blood component is considered the most likely cause of hypotension, the transfusion must be stopped or switched to an alternative component and appropriate management and investigation commenced.
Delayed complications of transfusion[4]Delayed haemolysis of transfused red cells
Development of antibodies to red cells in patient's plasma (alloimmunisation)
Development of antibodies that react with antigens of white cells or platelets
Post-transfusion purpura
Graft-vs-host disease (GvHD)
Transfusion-associated GvHD is preventable with the irradiation of cellular blood products. Patients requiring irradiated blood include:
They should be given an information leaflet and card informing them of their need for irradiated blood and must inform any clinical staff dealing with them in the future. Iron overload
Infection
Immunomodulation[10]Concerns have been raised that tumour recurrence rates and postoperative infection rates are raised after transfusion of allogeneic red blood cells, platelet concentrates, or plasma units in cancer patients. There is increasing clinical evidence that this may actually lead to negative clinical outcomes by affecting patients' immune defence, stimulating tumour growth, tethering, and dissemination. There is no question that critically ill patients with life-threatening low blood cell counts or bleeding need transfusion. However, until clinical trials provide further evidence, the routine use of transfusion in critically ill cancer patients should be considered on an individual basis, and the risks and benefits evaluated as with any other treatment. Surveillance and reporting[1]
Improving safety[1, 4]Reducing transfusion errors
Reducing unnecessary transfusion
Patient information[4]Currently there is no legal requirement in the UK to obtain formal consent from patients (with use of consent forms, etc) prior to transfusion of blood products. However it is good practice to discuss:
Any patient judged competent who chooses not to accept a transfusion needs to be treated with respect and sensitivity, acknowledging their values, beliefs and cultural background. Jehovah's Witnesses are encouraged to carry documentation detailing their wishes about any future medical intervention, and medical staff must take full account of this. Where refusing blood or blood components, they should sign the appropriate form, indicating an informed refusal. What are the symptoms of a blood transfusion reaction?Symptoms of a blood transfusion reaction, while uncommon, include fever, chills, and respiratory distress. However, these symptoms can resolve with little or no treatment. Even when a person receives the correct blood type, allergic reactions can occur.
What happens when incompatible blood is transfused?When incompatible blood is transfused, the recipient will experience transfusion reaction. Transfusion reaction is when the antibodies in the recipient’s plasma attack and destroy donor blood. The effects of a transfusion reaction can range from mild to deadly.
What are the risks of a blood transfusion?According to the American Red Cross, people do not typically experience complications after having a blood transfusion, but they can happen occasionally. The Centers for Disease Control and Prevention (CDC) state that the most common adverse reactions are allergic and febrile (fever) transfusion reactions.
What is a febrile transfusion reaction?, a febrile non-hemolytic transfusion reaction (FNHTR) is the most common reaction. It involves an unexplained rise in temperature during or 4 hours after the transfusion. The fever is part of the person’s white blood cells response to the new blood.
What are the 5 types of transfusion reactions?Types of transfusion reactions include the following: acute hemolytic, delayed hemolytic, febrile non-hemolytic, anaphylactic, simple allergic, septic (bacterial contamination), transfusion-related acute lung injury (TRALI), and transfusion-associated circulatory overload (TACO).
What is the most serious complication of blood transfusion?Simultaneous symptoms of allergic reaction Allergic reactions The most common complications of transfusion are Febrile nonhemolytic reactions Chill-rigor reactions The most serious complications, which have very high mortality rates, are Acute hemolytic... read more are common.
What are the signs and symptoms of hemolytic transfusion reaction?Symptoms. Back pain.. Bloody urine.. Chills.. Fainting or dizziness.. Fever.. Flank pain.. Flushing of the skin.. Are there complications with blood transfusions?Blood transfusions are generally considered safe, but there is some risk of complications. Mild complications and rarely severe ones can occur during the transfusion or several days or more after. More common reactions include allergic reactions, which might cause hives and itching, and fever.
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