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

CCC Transfusion Series

Blood Products

Cryoprecipitate, Fresh Frozen Plasma (FFP), PlateletsRed Cells (RBCs)

Concentrates: Prothrombinex, Factor VIIa, Fibrinogen Concentrate

Reversal

Rivaroxaban / Apixaban / Enoxaparin: Andexanet Alfa, Rivaroxaban and Bleeding

DabigatranIdarucuzimabDabigatran and bleeding

HeparinProtamine

WarfarinVitamin K / FFP / PTx, Warfarin Reversal, Warfarin Toxicity

Testing

Coagulation StudiesTEG / ROTEM (Thromboelastography)Platelet function assays

General Topics

Acute Coagulopathy of TraumaBlood BankBlood conservation strategiesBlood Product Compatibilities, Blood transfusion risksDisseminated Intravascular CoagulationMassive blood lossMassive transfusion protocol (MTP)Modifications to blood components,Procedures and CoagulopathyStorage LesionsTRALITransfusion Literature Summaries, 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 this article as: Chris Nickson, "Blood Transfusion Risks," In: LITFL - Life in the FastLane, Accessed on February 1, 2023, https://litfl.com/blood-transfusion-risks/.

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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