COMPLICATIONS
■ In massive transfusion(>10 units of PRBCs)
■ Coagulopathy
■ Routine transfusion of platelets and FPP is discouraged. Transfuse
platelets and FFP based on clinical evidence of abnormal bleeding
and abnormal laboratory values.
■ Hypothermia
■ Hypocalcemia (from binding to citrate preservative)
■ Treat symptomatic hypocalcemia with calcium gluconate.
■ Febrile transfusion reaction
■ Most common transfusion reaction
■ Characterized by fevers/chills, malaise
■ Treatment is symptomatic.
■ Hemolytic transfusion reaction
■ Most serious transfusion reaction, typically due to clerical error
■ ABO incompatibility →lysis of transfused RBCs →hemoglobinemia
and hemoglobinuria.
■ Characterized by immediate fevers/chills, headache, N/V, dark urine,
hypotension
■ Treatment includes stopping the transfusion, immediate vigorous
crystalloid infusion, and diuretic therapy to maintain urine output at
1–2 mL/kg/hr.
■ Allergic reaction
■ Urticaria or hives (rarely anaphylaxis)
■ Treatment is symptomatic.
■ Transfusion-related acute lung injury (TRALI)
■ Indistinguishable from acute respiratory distress syndrome
■ Treatment is supportive. Stop transfusion.
■ No evidence for use of steroids, antihistamines, or diuretics
■ Delayed transfusion reaction
■ May occur within 3–4 weeks after transfusion as a primary or amnestic
response to RBC antigen
■ Characterized by fall in hemoglobin and rise in bilirubin
■ Treatment is supportive.
■ Transfusion-associated graft versus host disease
■ Occurs in immunocompromised patients from infusion of immuno-
competent T lymphocytes, effectively resulting in an unintentional
bone marrow transplant; carries 80% mortality
■ Characterized by rash, elevated LFTs, pancytopenia
■ Prevention is key: Use irradiated blood products in immunocompro-
mised patients.
■ Transmitted viral infection
■ Hepatitis B (1:60,000 units transfused) > hepatitis C (1:1.6 million) >
HIV (1:2 million).
■ May transmit CMV, EBV, parvovirusPLATELETSOne unit of platelets is sufficient to raise platelet count by 10,000/μL. Cross-
matching is notnecessary (though Rh matching is recommended). The nor-
mal dosage is 4–6 units of platelets (200 mL volume) per transfusion.RESUSCITATION
The most common transfusion
reaction = febrile transfusion
reaction.The most serious transfusion
reaction = hemolytic
transfusion reaction.Patient receiving blood
transfusion may develop
urticaria or hives, but
anaphylaxis is rare.Graft versus host disease is an
extremely rare but usually
fatal complication of a
transfusion. Give irradiated
blood products to
immunocompromised
patients.