Educational thread on complications of blood transfusion. Not medical advice. Open to feedback and corrections! The incidence rates are as reported in the USA.
#MedX #Hematology #Transfusion #Bloodbank #InternalMedicine #MedEd
#MedX #Hematology #Transfusion #Bloodbank #InternalMedicine #MedEd
1/Acute hemolytic transfusion reaction
-Due to ABO incompatibility
-Incidence: 1:110000 transfusions
-70% of cases due to RBCs and 30% due to platelet transfusion
-50% of ABO-incompatible RBC transfusions are inconsequential, and 5% are fatal
-Positive Direct antiglobulin test
-Due to ABO incompatibility
-Incidence: 1:110000 transfusions
-70% of cases due to RBCs and 30% due to platelet transfusion
-50% of ABO-incompatible RBC transfusions are inconsequential, and 5% are fatal
-Positive Direct antiglobulin test
2/Febrile nonhemolytic transfusion reaction
-Occur due to leukocyte-derived cytokines
-Incidence: 1:1100 transfusions
-Temperature rise >/= 1 C, or to >38 C within 4 hours of cessation of transfusion
-Incidence significantly decreased due to leukoreduction of blood products
-Occur due to leukocyte-derived cytokines
-Incidence: 1:1100 transfusions
-Temperature rise >/= 1 C, or to >38 C within 4 hours of cessation of transfusion
-Incidence significantly decreased due to leukoreduction of blood products
3/Allergic transfusion reaction
-Incidence: 1:1200 transfusions
-Platelet transfusions are most often associated
-8% of these are severe
-Patients with severe reactions (stridor, wheezing, hypotension, GI symptoms) should be tested for IgA deficiency and anti-IgA antibodies
-Incidence: 1:1200 transfusions
-Platelet transfusions are most often associated
-8% of these are severe
-Patients with severe reactions (stridor, wheezing, hypotension, GI symptoms) should be tested for IgA deficiency and anti-IgA antibodies
4/Transfusion-associated circulatory overload (TACO)
-Incidence: 1:9000 transfusions
-Higher risk in older, volume-overloaded patients and with multiple transfusions within 6 hours
-May occur up to 12 hours after transfusion
-Treat the patient as you would to volume overload
-Incidence: 1:9000 transfusions
-Higher risk in older, volume-overloaded patients and with multiple transfusions within 6 hours
-May occur up to 12 hours after transfusion
-Treat the patient as you would to volume overload
5/Transfusion-related acute lung injury (TRALI)
-Caused by neutrophil and endothelial activation
-Incidence: 1:140000 transfusions, commonest with platelet transfusion
-Occurs within 6 hours of cessation of transfusion
-Noncardiogenic pulmonary edema
-Supportive management
-Caused by neutrophil and endothelial activation
-Incidence: 1:140000 transfusions, commonest with platelet transfusion
-Occurs within 6 hours of cessation of transfusion
-Noncardiogenic pulmonary edema
-Supportive management
6/Hypotensive transfusion reactions
-Related to the generation of bradykinin, causing vasodilation and hypotension
-Incidence: 1:32000 transfusions, more common with RBCs and platelets
-Patients on ACE inhibitors are at risk
-Typically self-limiting with cessation of transfusion
-Related to the generation of bradykinin, causing vasodilation and hypotension
-Incidence: 1:32000 transfusions, more common with RBCs and platelets
-Patients on ACE inhibitors are at risk
-Typically self-limiting with cessation of transfusion
7/Transfusion associated dyspnea
-Acute respiratory distress within 24 hours of transfusion cessation
-Diagnosis of exclusion, where allergic transfusion reaction, TACO, and TRALI have been excluded
-Incidence: 1:28000 transfusions
-Acute respiratory distress within 24 hours of transfusion cessation
-Diagnosis of exclusion, where allergic transfusion reaction, TACO, and TRALI have been excluded
-Incidence: 1:28000 transfusions
8/Delayed hemolytic transfusion reaction
-Alloantibody-related delayed hemolysis
-Incidence: 1: 32000 transfusions
-If alloantibodies are formed within days of transfusion, they are likely previously sensitized; if formed within weeks, a new primary alloantibody response
-Alloantibody-related delayed hemolysis
-Incidence: 1: 32000 transfusions
-If alloantibodies are formed within days of transfusion, they are likely previously sensitized; if formed within weeks, a new primary alloantibody response
9/Hyperhemolytic transfusion reaction
-Reported in sickle cell disease and thalassemia patients
-Destruction of both donor and recipient RBCs, causing severe anemia
-Often requires aggressive immunosuppression, IVIG, and EPO for the treatment
-Unclear mechanism
-Reported in sickle cell disease and thalassemia patients
-Destruction of both donor and recipient RBCs, causing severe anemia
-Often requires aggressive immunosuppression, IVIG, and EPO for the treatment
-Unclear mechanism
10/Transfusion-associated GVHD
-Incidence: less than 1:10 million transfusions
-Due to engraftment of donor lymphocytes in an immunosuppressed recipient (Hematological malignancy (HSCT)
-Nearly 100% mortality
-Prevention with transfusion of irradiated blood components
-Incidence: less than 1:10 million transfusions
-Due to engraftment of donor lymphocytes in an immunosuppressed recipient (Hematological malignancy (HSCT)
-Nearly 100% mortality
-Prevention with transfusion of irradiated blood components
11/Post transfusion purpura
-Severe thrombocytopenia (< 10000) caused by anti-platelet alloantibodies, most often anti-HPA-1a
-Incidence: 1:10 million transfusions
-1-3 weeks after transfusion
-30% of cases have a severe hemorrhage, 10% have a fatal hemorrhage
-IVIG to treat
-Severe thrombocytopenia (< 10000) caused by anti-platelet alloantibodies, most often anti-HPA-1a
-Incidence: 1:10 million transfusions
-1-3 weeks after transfusion
-30% of cases have a severe hemorrhage, 10% have a fatal hemorrhage
-IVIG to treat
12/Transfusion-related bacterial infection
-Incidence: 1:200000 to 1:1000000 transfusions
-Often due to room temperature storage (Platelet component)
-Baseline thrombocytopenic and neutropenic patients are at higher risk for septic reactions, commonly due to Staphylococcus aureus
-Incidence: 1:200000 to 1:1000000 transfusions
-Often due to room temperature storage (Platelet component)
-Baseline thrombocytopenic and neutropenic patients are at higher risk for septic reactions, commonly due to Staphylococcus aureus
13/Transfusion-related viral infections
-Hepatitis B: Incidence of 1:1.5 million transfusions
-Hepatitis C: Incidence of 1:1.6 million transfusions
-HIV: Incidence of 1:1.8 million transfusions
-HTLV: Incidence of 1:3.3 million transfusions
-Hepatitis B: Incidence of 1:1.5 million transfusions
-Hepatitis C: Incidence of 1:1.6 million transfusions
-HIV: Incidence of 1:1.8 million transfusions
-HTLV: Incidence of 1:3.3 million transfusions
14/Transfusion-related West Nile virus infection
-Reported in some endemic areas of the US in the past
-Incidence decreased significantly due to the screening of pooled samples
-The last case in the United States reported in 2012
-Reported in some endemic areas of the US in the past
-Incidence decreased significantly due to the screening of pooled samples
-The last case in the United States reported in 2012
15/Transfusion-related parasitic infections
-Some cases of Babesia are reported in the United States
-Some cases of Babesia are reported in the United States
16/Other reported transfusion-related infections across the globe
-Malaria, Parvovirus B19, variant Creutzfeldt-Jacob disease, dengue fever, hepatitis A, and Anaplasma phagocytophilum
-Malaria, Parvovirus B19, variant Creutzfeldt-Jacob disease, dengue fever, hepatitis A, and Anaplasma phagocytophilum
17/Reference: Goldman Cecil Medicine, 27thEdition. Volume 1. Chapter 162, Transfusion Medicine, By Drs. Beth H. Shaz and Christopher D Hillyer. Pages 1199 to 1206.
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