10 Adverse Effects of Transfusion AKA Transfusion Reactions

immune or non-immune reaction to a current transfusion

Immune or non-immune reaction subsequent to / after the completion of the transfusion, aka, post-transfusion

➢ Immunologic
✓ Hemolytic
✓ Febrile
✓ Allergic
✓ Transfusion-Related Acute Lung Injury
➢ Non-Immunologic
✓ Bacterial Contamination
✓ Transfusion-Associated Circulatory Overload

➢ Immunologic
✓ Hemolytic
✓ Graft vs Host Disease
✓ Cytomegalovirus
➢ Non-Immunologic
✓ Iron Overload
✓ Disease Transmission

1. STOP the transfusion
2. Open the IV line for administration of medication, when needed
3. Monitor the patient
4. Blood Bank performs Transfusion Reaction Investigation
5. Blood / blood component (including IV set) returned to the Blood Bank, when indicated

- acute hemolytic transfusion reaction
- immediate reaction

➢ Feeling of heat along the infusion arm
➢ Anxiety / Apprehension / Immediate "Feeling of Doom"
➢ Tachycardia / Dyspnea
➢ Severe hypotension* / Shock / Drastic drop in blood pressure
➢ Hemolysis (Intravascular)* / Hemoglobinemia / DIC (Disseminated Intravascular Coagulation)
➢ Low Back Pain
➢ Chest Pain
➢ Hematuria (bloody urine)
➢ Kidney Failure*
➢ Could cause death*

❑ Common Cause
➢ ABO Incompatibility
➢ As little as 5-20 mls of RBCs transfused
❑ Human Error (70%) Causes
➢ Mis-identification of Patient
➢ Staff Hurriedness and Wrong Patient Transfused
➢ Patient Relocated and Wrong Patient Transfused
➢ Mass Casualties and Poorly-Identified Patient

➢ Administer, when appropriate
✓ Diuretics
✓ Analgesics
✓ Pressors for hypotension
➢ Infusion of hemostatic components, if bleeding

➢ Proper Identification of Patient / Ensure Positive Identification; Do NOT Use Room # as an Identifier
➢ Mass Casualties - Triage Properly and Properly Identified Patient
➢ Properly labeled specimen
➢ ABO Match to Patient / Accurate Testing
➢ Accurate labeling of unit to patient

1. Wrong blood in tube (WBIT)
2. Lack of electronic systems for patient identifacation
3. Manual laboratory processes

O platelets contain anti-A, anti-B, and anti-A,B

A "non-hemolytic febrile reaction" refers to a transfusion reaction where a patient experiences a fever (often with chills) during or shortly after receiving a blood product, but without any damage to the red blood cells (hemolysis) occurring; it's usually caused by an immune response to white blood cells present in the donated blood, most commonly seen in patients with antibodies against donor leukocyte antigens due to prior transfusions or pregnancy.

❑ Signs & Symptoms
➢ Fever
➢ Chills
➢ Headache
➢ Anxiety
➢ Tachycardia

➢ WBCs Found in Blood / Blood Components
➢ Platelets Found in Blood / Blood Components

➢ Antipyretic medication (Usually Tylenol)

➢ Transfuse Leuko-reduced Blood / Blood Components

- immediate reaction
- can be mild or severe

❑ Signs & Symptoms
➢ Urticaria / Sudden Rash Appearance
✓ Neck Area
✓ Arms
✓ Chest / Back Area
➢ Itching / Pruritis
➢ Flushing
❑ Advanced Signs & Symptoms
➢ Dyspnea
➢ Throat Swelling / Tongue Swelling
➢ Hypotension
➢ Cardiac Arrhythmia

➢ Something in the donor's blood that caused the recipient to
react
➢ Plasma proteins (IgA Deficiency - rare genetic condition) - very
severe and is life threatening

IgA deficient blood!

➢ Antihistamines, e.g., Benadryl
➢ Slow down transfusion rate

Diphenhydramines or epinephrine

➢ For patients with a history of allergic reactions, the patient is given antihistamine / Benadryl prior to transfusion.
➢ Give IgA deficient blood / blood products; rare donor
➢ In RBC products, additive solutions, e.g., Adsol® is used to replace residual plasma component.
➢ In platelet products, InterSol®, a platelet additive solution, replaces the plasma component.

1. ACUTE HTR or AHTR
2. Transfusion Fatality
3. Febrile (non-hemolytic) transfusion reaction
4. Allergic Reaction
5. TRALI
6. Bacterial Contamination
7. TACO

transfusion related acute lung injury
❑ The second leading cause of transfusion-related mortality in the USA in 2021
❑ Incidence - 1:5,000 transfusion

➢ Occurs during or within 6 hrs following transfusion
➢ Respiratory Distress / Severe Hypoxemia / ARDS (Acute
Respiratory Distress Syndrome)
➢ Dyspnea or Tachypnea
➢ Hypotension
➢ Pulmonary Edema

XRAY

➢ HLA antibodies found in blood / blood products - donors were usually from multiparous females

➢ O2support
➢ Mechanical Ventilatory Support / Intubation
➢ Improvement seen within 48 hrs from treatment

➢ Blood products from males
➢ Blood products from females tested for HLA Abs

Transfused blood contaminated with bacteria

- Although UNCOMMON, can have rapid onset and high mortality in recipients
- it can lead to febrile reactions, or even more serious like septic or endotoxic shock

an endotoxin from a bacteria which is capable of growing in cold temps, such as: Pseudomonas species, E. coli, Yarsinia enterocolitica

Initiate IV antibiotic therapy

➢ Use aseptic technique, when collecting donor blood
➢ Use sterile docking technique, when transferring aliquots of products
➢ Use bacterial tests prior to transfusion
➢ Use Pathogen Reduction Technology (PRT)

Transfusion-associated circulatory overload
- a serious complication that can occur during a blood transfusion, where the patient's circulatory system becomes overloaded with too much fluid,

TACO

➢ Occurs within 12 hrs following transfusion
➢ Respiratory Distress / Hypoxemia accompanied by cough, chest tightness
➢ Dyspnea
➢ Hypertension
➢ Jugular Vein Distention
➢ Pulmonary Edema

XRAY

Fluid overload from blood transfusion, either by single (babies, elderly) or multiple (normal adults) units

➢ Place patient in the upright (sitting) position
➢ Administer O2, when indicated
➢ Administer diuretics, when indicated

1. Delayed Hemolytic Transfusion Reaction (DHTR)
2. Transfusion-Associated (TA) Graft VS Host Disease (GVHD) aka TA-GVHD
3. Cytomegalovirus (CMV) Infection
4. Post-Transfusion Purpura (PTP)

- Delayed hemolytic transfusion reaction (DHTR)
- a late-onset adverse reaction to a blood transfusion that occurs more than 24 hours after the transfusion

- usually caused by an undetecetd RBC antibody (Ex. anti-Jka)

patient is usually asymptomatic with only a drop in Hgb / Hct

about 7-14 days after transfusion

❑ Usually extravascular hemolysis is seen
❑ Lab test evidence:
✓ Smoky grey serum may be seen
✓ Weak Positive or Positive DAT
✓ Weak reacting Ab; C' is bounded to RBC

➢ Fever
➢ Malaise

Transfusion-associated (TA) Graft VS Host disease (GVHD)

- Occurs in immunosuppressed recipients (e.g., neonates, cancer patients on chemotherapy).
- Fatality is extremely high (> 90%) once the disease progresses.

- T-lymphs
- The common cause is the transfusion of donor T-lymphocytes (T-cells) into an immunocompromised recipient whose own immune system fails to suppress the transfused donor T-cells. The donor T-cells acknowledge the "foreign" environment (not in the original donor's body), rapidly replicate, and begin to attack the recipient's organs & skin.

2 days to 6 weeks after transfusion

➢ Rash & Fever
➢ Diarrhea
➢ Pancytopenia
➢ Liver Dysfunction / Jaundice

EXTREMELY HIGH
prevention is the BEST treatment

➢ Irradiated Blood / Blood Components
➢ HLA-matched organ donor

➢ Administration of anti-rejection medication therapy, e.g., immunosuppressants, prior to and following transplantation

It is caused by a virus, herpesvirus

Can cause death in neonates and in allogeneic Bone Marrow Transplant (BMT) patients

WBCs

➢ Infant - rash; jaundice; enlarged liver / spleen; pneumonia; seizures
➢ Adults - sometimes asymptomatic; can exhibit flu-like / mononucleosis symptoms; leukopenia; gastroenteritis, or pneumonia.

➢ Transfusion of CMV positive blood where blood donor was not tested for CMV / donor status for CMV is unknown

20 - 60 days after transfusion

antiviral therapy (Oral or IV)

➢ Serologic test for CMV. If found negative, blood is labeled as "CMV Neg."

- post-transfusion purpura (PTP)
- delayed immune complication presented
- a rare but serious complication that can occur after a blood transfusion

- Thrombocytopenic purpura appears
- bleeding from mucous membranes (eg. nose or gums), GI bleeding, hematuria

a rare autoimmune blood disorder that causes a low platelet count, which leads to easy bruising and bleeding

5-10 days post-transfusion

Usually febrile reaction symptoms - so fever symptoms

usually caused by platelet AB (eg. anti-HPA-1a)

IV Ig

1. Iron Overload . Hemosiderosis
2. Air Embolus
3. Hypocalcemia
4. Hypothermia

❑ Condition typically seen in chronically-transfused patients, e.g., Sickle Cell, Thalassemia, etc.
❑ Liver & cardiac iron concentration noted with MRI; Fe+2 lab test elevated

➢ Reduce frequency of transfusion - by erythropoietin administration; stimulates patient to make his / her own RBCs
➢ Infusion of iron-chelating agents

❑ Chronic fatigue
❑ Frequent infections
❑ Nerve system disorders
❑ Joint pain
❑ Hair or skin pigment changes

- a rare but potentially fatal complication that can occur during a blood transfusion when an air bubble blocks a blood vessel
- air infusion via IV line

➢ Sudden shortness of breath
➢ Coughing
➢ Hypotension
➢ Acute cyanosis - bluish tint to skin

➢ Lay patient on left side for mild cases
➢ Hyperbaric chamber treatment for severe cases

medical condition where there is too little calcium in the blood

➢ Tingling sensation / Paresthesia
➢ Cardiac arrhythmia
➢ Tetany - muscle tightens/locks

infusion of calcium supplements

medical emergency when the body temperature drops below 95F (35C)

rapid infusion of cold blood / blood products

- feeling cold / shivering
- cardiac arrhythmia

use blood warmer

Disease transmission! - certain diseases can be transmitted via a blood / blood component transfusion

Hepatititis B

HIV

Hepatitis C

- Herpes Simplex Virus (both HSV1 & HSV2)
- Group B Streptococcus (GBS)
- Cytomegalovirus (CMV)

these diseases can be passed onto the developig fetus

Molecular diagnostic tests