Complications of blood transfusion

Immunological complications:

• Alloimmunisation (doesn’t cause problems with the first transfusion)
• Incompatibility
• Haemolytic transfusion reactions:
• Immediate (usually due to ABO incompatibility):

• Rigors
• Lumbar pain
• Dyspnoea
• Hypotension
• Haemoglobinuria
• Renal failure
• DIC (disseminated intravascular coagulation)

• Delayed:

• Anaemia and jaundice ~1 week post-transfusion

• Non-haemolytic (febrile) transfusion reactions:
• Usually caused by leucocyte antibodies in the recipient’s serum acting against transfused leucocytes, leading to the release of pyrogens
• TRALI (transfusion-related acute lung injury):
• Is caused by potent leucocyte antibodies in the plasma of donors (who are often multiparous women)
• Characterised by:
• Dyspnoea
• Fever
• Cough
• Shadowing in the perihilar and lower lung fields on the CXR

• Anaphylaxis:
• Transfusion should be stopped
• Adrenaline 0.5mg IM
• Chlorpheniramine 10mg IV
• Endotracheal intubation may be required

Non-immunological complications:

• Transmission of infection (all rare):
• Hepatitis (<1 in 200,000 units in UK)
• HIV (<1 in 3,000,000 units in UK)
• Other viruses (e.g. CMV, EBV)
• Parasites (e.g. malaria, toxoplasmosis)
• Syphilis
• Circulatory failure due to volume overload
• Iron overload (multiple transfusions)
• Massive transfusion of stored blood may cause bleeding and electrolyte changes
• Thrombophlebitis
• Air embolism