Adverse transfusion reactions:Adverse transfusion reactions are unwanted or harmful responses that can occur as a result of receiving a blood transfusion. While blood transfusions are generally safe, adverse reactions can happen in some cases. Here are some common types of adverse transfusion reactions in the presentation

1. ADVERSE EFFECTS OF BLOOD
TRANSFUSION
Dr. Dipiya Tikoo
(MD Pathology)

2. Transfusion of blood and its product is, ordinarily, a safe and effective way of correcting hematological
defects but adverse effects do occur during or after transfusion and they are commonly called blood
transfusion reactions.
These untoward effects vary from being relatively mild to lethal and some of them can be prevented
while others cannot.
The time between the suspicion of a transfusion reaction and the investigation and the initiation
of a appropriate treatment should be as short as possible.
The transfusionist nurses/clinicians in the wards, the medical officers and the
technicians in the blood banks must have the knowledge about the transfusion
reactions and its management.

3. • Categories of Transfusion Reactions:
REACTION
Acute/Immediate (onset
within < 24 hours)
Delayed (onset within
days or months)
Immunological
Haemolytic
Febrile nonhemolytic
Allergic
Anaphylactic
TR- acute Lung Injury
Hemolytic
Post-transfusion purpura
TR- Graft-vs-host disease
Non-Immunological
Circulatory Overload
Bacterial contamination of
donor blood unit
Transmission of infectious
organisms
Iron Overload
Complications associated with Massive Transfusion

4. Immediate /Acute Complications
• Febrile Non hemolytic Transfusion(FNHTR)
Manifests with fever, chills (sometimes),flushing, headache, anxiety,
itching and tachycardia.
Begins 30 – 60 mints following the start of transfusion.
Common in -recipients of multiple transfusions
- women who have had multiple pregnancies (Prior
sensitisation)

5. Mechanism of FNHTR:
- Release of cytokines from leucocytes during storage of blood
- Reaction of alloantibodies in the recipient with transfused white cells
leading to release of pyrogens
Diagnosis based on eliminating other causes of fever such as HTR, bacterial
contamination of donor blood unit, TRALI, underlying disease in the patient
Management : Stopping transfusion
Workup for haemolytic transfusion reaction /bacterial contamination of
blood unit
Administration of oral or rectal antipyretics (paracetamol) and im/iv
antihistaminic
Prevention : In regularly transfused patients , slow speed of
transfusion(upto 4 hours for 1 unit of whole blood)
Administration of antipyretics before starting transfusion
OR if this doesn’t work – leucocyte depleted blood is given.

6. • Mechanism :
Characterized by acute intravascular
hemolysis by transfusion of
incompatible red cells (ABO
incompatibility)
Binding of antibodies in patients
circulation to donor red cells leads to
activation of complement cascade and
hemolysis
Mediated by IgM anti A or anti B
antibodies
Mismatched ABO transfusion mostly occurs due to clerical error: -Incorrect identification
of recipient during sample collection or during transfusion
-Incorrect labelling of smaple tubes or incorrect filling of request form

7. Signs and symptoms of acute HTR appear within minutes of starting
transfusion(only 5 -10 ml of blood can trigger the reaction)
- C/O : -pain or heat at the infusion site
- Substernal pain
- Restlessness, loin and back pain
- Fever, rigors ,breathlessness
- Tachycardia ,hypotension and bleeding manifestations
- Severe cases: fatal, death due to shock, renal failure , DIC
Treatment : Acute HTR is an Emergency
-Immediate discontinuation of transfusion
-Maintenance of iv access with normal saline
- Management of hypotension, renal failure and DIC

8. • Allergic reactions: (develop within minutes of
starting transfusion)
- Mild urticaria
- Rash
- Pruritis
-Mechanism : Reaction between some plasma
proteins and corresponding IgE antibodies in
recipient's plasma- release of histamine
- Mx: -Rate of transfusion should be slowed ,
- Antihistamine administered
• Anaphylactic Reaction: (Rare- develops within
minutes of starting the transfusion)
- Hypotension
- Shock
- Breathlessness
- No fever
- Mechanism : Activation of complement and
generation of anaphylatoxins(C3a, C5a)
- Mx: Transfusion to be immediately stopped
and administer adrenaline and hydrocortisone

9. Transfusion associated Lung Injury (TRALI)
- Occurs within 1 to 4 hours of starting transfusion
- Characterised by fever, chills, repiratory distress,
dry cough
- X-ray shows diffuse pulmonary infiltrates
- Mechanism: Potent Leucoagglutinins in the donor
blood is incompatible with the granulocytes of the
recipient- react with them and form leucocyte
aggregates.
- After getting into pulmonary microcirculation ,
increase in vascular permeability.
- Treatment is supportive

10. Circulatory Overload:
- Can develop if the rate of transfusion is too rapid
(before compensatory redistribution can occur)
- Can develop if the fluid is excessive
- Can develop if there is renal or cardiac dysfunction
- Treatment consists of propping up the patient in a
sitting position
- Administration of oxygen and iv diuretics
Bacterial contamination of donor unit:
-Septicemic shock
- More common with platelet concentrates than with
whole blood or packed cells
- Reason being that the platelet concentrates are stored
at higher temperature (20-24 degree C) favouring the
proliferation of contaminating bacteria
- Causes- incomplete sterilization of skin during
venepuncture, Tiny breaks in the plastic bag, etc
- The usual organism causing contamination in blood
stored at 2-6 degree C is PSEUDOMONAS
- In platelet concentrates- STAPHYLOCOCCUS
- C/F- Resembles those of Acute HTR
- Treatment- High doses of antibiotics and supportive
measures
- Diagnosis- Gram staining and culture of blood from
blood bag

11. Delayed Complications
Delayed Hemolytic Transfusion Reaction:
Previous sensitization to certain red cell antigens by previous transfusion / pregnancy
-Conc of antibody is very low (hence cannot be detected pre transfusion)
-On reexposure to the same red cell antigen , there is secondary immune response that causes
destruction of transfused red cells (extravascular)
Patient develops fever, anaemia, jaundice -5 to 10 days post transfusion
Post transfusion Purpura : Severe thrombocytopenia can rarely develop – 5 to 10 days post transfusion
-Previous sensitization of the recipient to a platelet antigen (HPA-1a) during pregnancy, following
reexposure to the same antigen through transfusion, the antibodies paradoxically cause destruction of
patients own platelets. (negative for HPA-1a)
-Condition is potentially fatal
-Treatment is plasma exchange and iv immunoglobulins

12. Transfusion associated GvHD:
- Can develop following – Blood transfusion in immunodeficient individuals (BMT, Premature infants, etc)
- GvHD results from engraftment in the recipient of donor lymphocytes that react against host tissues
- About 10-12 days following transfusion, the patient develops fever, skin rash, vomiting, diarrhoea, hepatitis,
pancytopenia
- Usually fatal
- Management includes irradiation of blood before transfusion to prevent proliferation of donor lymphocytes and
avoid GvHD

14. Transmission of infectious organisms :
- The organsims likely to be transmitted by transfusion are those that are prevalent in a particular geographic
area or population
- In India, pretransfusion testing of donor blood for these agents is currently mandatory (prior consent not
necessary)for-
- Hepatitis B virus
- Hepatitis C virus
- HIV1 , HIV 2
- Treponema pallidum
- Malarial Parasite
- 2 prinicipals can prevent the above-
- Blood should be collected only from voluntary , non renumerated donors. All high risk- drug abusers,
homosexuals, prostitutes, etc) and professional donors must be excluded
- All blood donations should be tested for infectious agents by screening tests.

16. Iron overload : Each unit of blood contains about 200g of iron , physiological daily requirement is 1mg.
There is no physiological mechanism for removal of excess iron. Therefore , patients receiveing regular long
term blood transfusion therapy (thalassaemics) inevitably develop iron overload.
Deposition of extra iron in heart, liver and endocrine glands cause respective organ failure
Mx: Iron chelating therapy with desferrioxamine should be instituted early in these patients to minimise iron
accumulation

17. COMPLICATIONS ASSOCIATED WITH MASSIVE BLOOD TRANSFUSION
Massive Blood transfusion refers to the replacement of patients blood loss with transfusion of stored blood equivalent
to total blood volume within 24 hours or it is traditionally defined as transfusion of 10 units of packed red blood cells
(PRBCs) within a 24 hour period
Need for MBT: Emergency involving an accident or an obstetric problem. Rapid loss of large amount of blood needs
urgent correction to restore blood volime and to maintain tissue perfusion, oxygenation and haemostasis.
Complications: - Due to storage: storage of blood at 2-6 degree celcius for 48 hours leads to loss of platelet function,
loss of labile coagulation factors. Therefore, rapid infusion of large volumes of stored blood leads to dilution of
platelets and coagulation factors.
-Hyperkalemia (release of potassium from stored red cells)
-Hypocalcemia (binding of calcium by citrate anticoagulant)
-Hypothermia (rapid infusion of large quantity of cold blood)- cardiac arrythmias
-Microaggregates of platelets and leucocytes can migrate to lungs-ARDS (removed through special filters)

18. Thank you