Adverse Effects of Blood Transfusion

Blood transfusion is a critical component of modern medicine, essential for the management of severe anemia, hemorrhage, and certain hematologic disorders. However, despite significant improvements in transfusion safety measures, adverse effects may still occur. Understanding these adverse reactions is vital for optimizing patient outcomes and minimizing risks.

Overview

Adverse effects of blood transfusion include a spectrum of immune and non-immune complications ranging from mild allergic reactions to life-threatening events such as transfusion-related acute lung injury (TRALI) and hemolytic transfusion reactions. Careful monitoring and evidence-based practices are essential to mitigate these risks.
(Source: Chapter 113 - Harrison's Principles of Internal Medicine)

Pathophysiology

Transfusion reactions are broadly categorized as immune-mediated or non-immune-mediated:

Immune-mediated: Result from alloimmunization, preformed antibodies, or hypersensitivity to donor antigens (e.g., ABO incompatibility, anti-HLA antibodies).
Non-immune-mediated: Stem from the physical or chemical properties of blood components or contamination with pathogens.
Both mechanisms can activate inflammatory pathways, leading to systemic and organ-specific effects.

(Source: Transfusion Therapy - Harrison's Principles of Internal Medicine)

Clinical Presentation

Signs

Fever (≥38°C or a rise by 1–2°C within 4 hours)
Rash or urticaria
Dyspnea and hypoxemia
Hypotension
Hemoglobinuria

Symptoms

Chills, rigors
Back or flank pain
Nausea/vomiting
Chest tightness
Respiratory distress

Diagnostic Criteria

Warning signs suggestive of acute transfusion reactions include: - Sudden fever or chills - Unexplained hypotension - New onset dyspnea or hypoxemia - Acute hemoglobinuria or dark urine - Disseminated intravascular coagulation (DIC) - New skin rash or swelling

(Table 113-5 provides main warning signs; see Transfusion Adverse Reactions - Harrison's Principles of Internal Medicine)

Diagnostic Approach

Initial Assessment
Immediate cessation of transfusion if a reaction is suspected
Clinical evaluation for severity and type of reaction
(Approach to Suspected Acute Transfusion Reaction)
Laboratory Studies
CBC, direct antiglobulin (Coombs) test, renal and liver function
Blood cultures if sepsis is suspected
(Lab Value Interpretations, Hemolytic Workup)
Imaging
Chest x-ray for suspected TRALI or TACO
(Chest X-Ray Interpretation)
Differential Diagnosis
Consider alternative causes: sepsis, anaphylaxis, volume overload, hemolysis
(Allergic Reaction, 04 Vault/Amboss Library/On-call survival guide/Anaphylaxis, Acute Hemolysis, Infection)

Management

Acute Management

Stop Transfusion Immediately
Maintain IV access with normal saline
Supportive care (oxygen, fluids, vasopressors as needed)
Treat specific complications (e.g., epinephrine for anaphylaxis, diuretics for TACO)
Notify transfusion service/blood bank for investigation
(Emergency Protocols for Transfusion Reactions)
Medications
Antihistamines for minor allergic reactions
Corticosteroids in severe cases or those with history of multiple allergies
Antimicrobials if sepsis is suspected
(Medication Guidelines for Transfusion Reactions)

Long-term Management

Monitor for delayed complications (e.g., alloimmunization, iron overload)
Iron chelation for repeated transfusions
(Iron Overload Management, Chronic Care Protocols)
Patient education and documentation of reactions for future transfusions
(Patient Blood Management Programs, Transfusion Reaction Registry)

Complications

Potential complications include: - Acute Hemolytic Transfusion Reaction - Delayed Hemolytic Reaction - Febrile Non-Hemolytic Reaction - Allergic and Anaphylactic Reaction - Transfusion-related Acute Lung Injury (TRALI) - Transfusion-associated Circulatory Overload (TACO) - Transfusion-transmitted Infections (e.g., HIV, hepatitis B/C, bacterial sepsis) - Iron Overload - Hypocalcemia and Hyperkalemia (especially with massive transfusion) - Graft-versus-host Disease (Source: Complication Management in Transfusion Therapy)

Prognosis

The prognosis varies by complication: - Most minor reactions are self-limiting. - Severe reactions (TRALI, TACO, severe hemolysis) can be fatal, especially in vulnerable populations. - Prompt recognition and intervention are critical for improving outcomes. - Long-term risks (iron overload, alloimmunization) require ongoing surveillance and management. (Source: Prognostic Factors in Transfusion Medicine)

References

(Source: Chapter 113 - Harrison's Principles of Internal Medicine)
(Source: Complications of Blood Transfusion - Contin Educ Anaesth Crit Care Pain)
(Source: Blood Product Transfusion in Adults: Indications, Adverse Reactions, and Modifications - Am Fam Physician)
(Source: Immunologic Transfusion Reactions)
(Source: Massive Transfusion-associated Complications)

Clinical Pearls:
Close monitoring during transfusion and prompt recognition of adverse reactions are crucial. Patient blood management strategies can minimize transfusion needs and associated risks. Always document transfusion reactions for future care planning.

For further reading, see: - Transfusion Reactions - Patient Blood Management Guidelines - Infectious Risks of Blood Transfusion - Massive Blood Transfusion Protocols