Blood Transfusion Risks
OVERVIEW
Blood transfusion complications may be early or late and include:
- Haemolytic
- Allergic
- Infection
- Other – blood age factors, hypothermia, citrate, TACO, K+
EARLY
- TACO (transfusion associated circulatory overload)
- TRALI (transfusion related acute lung injury)
- haemolytic reactions (incompatibility – ABO, Rh, Kidd)
- fever
- allergy (mild -> anaphylaxis)
- infection: bacterial contamination
- air embolism
- hypothermia
LATE
- viral infection: hepatitis B (~1 in 750,000), HIV (<1 in a million), CMV
- bacterial infection: Treponema pallidum, Salmonella, Yersinia, Pseudomonas, Staphylococcus spp
- parasitic infection: malaria (<1 in a million), toxoplasmosis
- prion infection
- GVHD (graft versus host disease)
- immune sensitisation (Rh D antigen)
- TRIM (transfusion-related immunomodulation); leading to increased risk of: infection, tumour recurrence, activation of latent viral infections, recurrent miscarriages
RISKS WITH OLDER RBCs
- Transfusion of RBCs older than 2-3 weeks may be associated with additional risks due to the presence of ‘storage lesions’
- See Storage Lesions
References and Links
CCC Transfusion Series
Blood Products: Cryoprecipitate, Fresh Frozen Plasma (FFP), Platelets, Red Cells (RBCs)
>>> Factor Concentrates: Prothrombinex, Factor VIIa, Fibrinogen Concentrate
Reversal Agents:
>>> Rivaroxaban / Apixaban / Enoxaparin: Andexanet Alfa, Rivaroxaban and Bleeding
>>> Dabigatran: Idarucuzimab, Dabigatran and bleeding
>>> Heparin: Protamine
>>> Warfarin: Vitamin K, FFP, PTx, Warfarin Refersal, Warfarin Toxicity
Testing: Coagulation Studies, TEG / ROTEM (Thromboelastography), Platelet function assays
Conditions: Acute Coagulopathy of Trauma, Disseminated Intravascular Coagulation (DIC), Massive Blood Loss
General Topics: Blood Bank, Blood Conservation Strategies, Blood Product Compatibilities, Blood Transfusion Risks, Massive Transfusion Protocol (MTP), Modifications to Blood Components, Procedures and Coagulopathy, Storage Lesions, TRALI, Transfusion Literature, Transfusion Reactions
Journal articles
- Kuriyan M, Carson JL. Blood transfusion risks in the intensive care unit. Crit Care Clin. 2004 Apr;20(2):237-53, ix. PMID: 15135463.
- Maxwell MJ, Wilson MJA. Complications of Blood Transfusions. Contin Educ Anaesth Crit Care Pain. 2006;6(6): 225-229. doi: 10.1093/bjaceaccp/mkl053 [Free Fulltext]
[cite]
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC