Blood Transfusion Risks

In cases of severe loss of blood, health and strength can be restored by transfusion of blood. During blood transfusion, the most common components of blood that are transfused are plasma, platelets or red blood cells. It is very important to match the blood type of the donor and the person who is going to accept the transfusion because a transfusion reaction may occur during the process. Though rare, these reactions can lead to harmful effects on the lungs and kidneys of a person.

Major Blood Transfusion Risk

There are several possible blood transfusion risks, and the main risks have been listed below:

1. Febrile Reaction

The person develops a fever suddenly within 24 hours of or during blood transfusion. Fever may be associated with symptoms of headache, chills, nausea or a general feeling of malaise.

Febrile reactions are often caused by the body's response to the white blood cells present in the donated blood. These reactions are more common in individuals who have received previous transfusions or in females who have several pregnancies.

Patients who are prone to develop febrile reactions or who have developed these reactions are often given blood with white blood cells or leucocytes removed. And the symptoms of this reaction may be alleviated by using acetaminophen (Tylenol).

2. Transfusion-Related Acute Lung Injury

Though transfusion related acute lung injury or TRALI occurs rarely, it is one of the serious blood transfusion risks. It usually occurs to all type of blood transfusion, but it is more common when more plasma is transfused, such as when platelets or fresh frozen plasma is transfused.

The reaction often begins within 1-2 hours of beginning transfusion, but can occur anytime up to 6 hours after a transfusion. The major symptom of this reaction is difficulty in breathing which can be life threatening. Hence, if it is suspected that the patient is developing TRALI during transfusion, transfusion should be stopped immediately. Doctors now believe that several factors are involved in the illness, such as recent surgery, cancer treatment, trauma, having an active infection, etc., and medicines seem provide no help.

3. Acute Immune Hemolytic Reaction

Though very rare, acute immune hemolytic reaction is one of the serious blood transfusion risks. It occurs when the blood types of the donor and recipient are not competent. The red blood cells of the transfused blood are attacked by the antibodies in the patient’s blood. The cells thus break open, releasing harmful products into the blood of the patient.

The common symptoms of this reaction are fever, chills, nausea, and chest and lower back pain. The kidneys may get damaged badly and require dialysis. Death may occur due to a hemolytic reaction if the transfusion is not stopped immediately.

4. Delayed Immune Hemolytic Reaction

In this type of reaction, the patient's body attacks the antigens, excluding the ABO antigens, present on the transfused blood cells slowly, which are destroyed several days or even weeks after the blood transfusion.

Usually no symptoms are present, but it can destroy red blood cells in the transfused blood and lead to a fall of red blood cell count in the patient. Rarely, the kidneys may get affected and may require treatment. This type of reaction usually occurs in people who have had transfusions in the past. In this case, blood transfused must not contain the antigen that has been attacked by the body.

5. Graft-Versus-Host Disease

Among all blood transfusion risks, this type of reaction occurs when white blood cells are transfused during blood transfusion in a patient whose immune system is very weak. The white blood cells present in the transfused blood attack the cells of the patient receiving the blood. The reaction is more common when the blood transfused is obtained from a relative or a person who has the same type of tissue as of the patient.

If the white blood cells in the transfused blood are not recognized as foreign by the immune system of the patient, they will survive and can later attack the patient's body tissues. Symptoms like liver problems, fever, rash and loose stools may occur with one month of blood transfusion.

6. Infections

Some infectious particles such as the HIV may survive in the transfused blood and can infect the patient undergoing blood transfusion. For safety of the blood, donated blood is now carefully screened by blood banks. The risk of getting a virus during a transfusion is quite low.

The risk of getting HIV is only around 1 in 2 million, that for hepatitis B is only around 1 in 205,000 and that for hepatitis C is 1 in 2 million. Variant Creutzfeldt-Jakob disease (vCJD), similar to Mad Cow disease, is a fatal disorder of the brain. The risk of getting vCJDfrom blood transfusion is very low, but the transmission is possible; hence, a person who has been exposed to vCJD is not eligible for blood donation.

The blood may get contaminated by small amount of bacteria from the skin during blood donation. This may cause a serious illness in the patients minutes or hours after beginning the transfusion.

7. Allergic Reaction

Allergic reaction is also one of the blood transfusion risks. Some patients may develop allergic reaction to blood transfused during a transfusion. Allergic reaction can occur even when the blood transfused if of the correct blood type. The symptoms may be severe or mild and include chest pain, back pain, anxiety, difficulty in breathing, low blood pressure, a quick pulse, chills, fever, clammy skin, flushing and nausea. The transfusion should be stopped immediately if allergic reaction is observed.

8. Fluid Overload

Occasionally, a large volume of blood is transfused in a short time and the body cannot cope with it properly. This type of reaction is referred to as fluid overload. It occurs more commonly in elderly patients, in those who are frail or have serious illness (such as heart disease) or in patients whose body weight is low.

Heart failure can occur as a result of excess fluid. Fluid can also fill the lungs leading to shortness of breath. The reaction is treated by prescribing a diuretic to remove excessive fluid from the patient’s body and by decreasing the transfusion speed in future transfusions.

9. Iron Overload

The last one of blood transfusion risks is iron overload. Large quantity of iron may get accumulated in the blood if you get too many transfusions. This is referred to as iron overload. Patients suffering from blood disorders such as thalassemia or who require multiple transfusions are at an increased risk of developing iron overload. Liver, heart and other parts of the body may be damaged by iron overload. Iron chelation therapy may be applied to patients with iron overload.

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