Complications of transfusion

[Dianne]

The most common complications of transfusion are

Febrile nonhemolytic reactions
Chill-rigor reactions

The most serious complications, which have very high mortality rates, are

Acute hemolytic reaction (AHTR) due to ABO incompatibility
Graft-vs-host disease (GVHD)
Transfusion-associated circulatory overload
Transfusion-related acute lung injury (TRALI)

Other complications include

Allergic reactions
Altered oxygen affinity
Delayed hemolytic transfusion reaction
Infections
Post-transfusion purpura

Early recognition of symptoms suggestive of a transfusion reaction and prompt reporting to the blood bank are essential. The most common symptoms are chills, rigor, fever, dyspnea, light-headedness, urticaria, itching, and flank pain. If any of these symptoms (other than localized urticaria and itching) occur, the transfusion should be stopped immediately and the IV line kept open with normal saline. The remainder of the blood product and clotted and anticoagulated samples of the patient’s blood should be sent to the blood bank for investigation. NOTE: The unit in question should not be restarted, and transfusion of any previously issued unit should not be initiated. Further transfusion should be delayed until the cause of the reaction is known, unless the need is urgent, in which case type O Rh-negative red blood cells (RBCs) should be used.
Hemolysis of donor or recipient RBCs (usually the former) during or after transfusion can result from ABO/Rh incompatibility, plasma antibodies, or hemolyzed or fragile RBCs (eg, by overwarming stored blood or contact with hypotonic IV solutions). Hemolysis is most common and most severe when incompatible donor RBCs are hemolyzed by antibodies in the recipient’s plasma. Hemolytic reactions may be acute (within 24 hours) or delayed (from 1 to 14 days).