Practical Clinical Hazards Of Transfusion Therapy Of Medical Importance To Be Aware Of
Blood Transfusion Techniques
Despite the huge medical significance of transfusion therapy, it still has its hazards. The main known complications are febrile reactions, allergic manifestations, bacterial complications, hemolytic reactions, hemorrhagic reactions, immune reactions, non-hemolytic reactions and hemosiderosis. All these complications would be discussed in brief.
Infantile Hemorrhagic Reaction
Some Of The Hazards
These are caused by pyogenic substances present in the material or in the infusion set. Sometimes, these indicate bacterial contamination.
Allergic conditions like urticaria and edema may occur due to antigen antibody reactions.
If the blood is heavily infected, severe reactions set in even with the introduction of a small quantity of blood. Shock may ensue which may be followed by disseminated intravascular coagulation (DIC).
Circulatory overloading, air embolism, thrombophlebitis, pulmonary embolism etc, may develop if the infusion is not carefully supervised.
These develop due to citrate toxicity, potassium toxicity, toxic substances eluted from synthetic containers and vasoactive substances.
These reactions usually develop due to the presence of incompatible antibody in the recipient’s plasma which cause destruction of donor red cells. Less commonly potent antibodies such as anti-A or anti-B present in donor plasma may react with the homologous antigens present in the recipient’s red cells and provoke hemolysis.
This complication may be encountered after massive transfusions using stored blood.
Various types of immunological reactions may develop varying in severity from fatal reaction to mild symptoms. Among this, hemolytic reactions due to transfusion of incompatible blood or hemolysed blood is the commonest. This manifests with pain in the back, dyspnea and circulatory collapse. At times, persistent hypotension may be the only finding. In severe cases, jaundice, hemoglobinuria and anuria develop within 24 hours. Renal failure may be fatal. Rarely, DIC may follow ABO incompatibility.
The Remaining Hazards
These may vary from simple allergic reactions to fatal anaphylaxis. Antibodies to drugs such as penicillin may be present in the donor’s blood causing allergic reactions in the recipient.
Transmission of disease
Several diseases are transmitted by blood. These are hepatitis virus (Virus B and non-A, non-B), cytomegalovirus, EB virus, syphilis, brucellosis, malaria, trypanosomiasis and probably acquired immunodeficiency syndrome (AIDS). The infectivity of T. Pallidum is lost on storing the blood at 40C for four days or more.
In subjects receiving repeated transfusions, iron overload may occur leading to deposition of Iron in reticulo-endothelial and parenchymal tissue. Usually, this complication is seen in persons who have received 100 units of more of blood.
Any reaction occurring in the patient within 48 hours of transfusion should be reported to the blood bank. Whenever there are good grounds for suspecting any untoward reaction, the transfusion should be discontinued, and the patient should be monitored.
© 2014 Funom Theophilus Makama