Blood Transfusion Complications

Fluid overload/acute left ventricular failure

Febrile non-haemolytic transfusion reaction

Mild allergic reaction

Acute haemolytic transfusion reaction

Hypersensitivity/anaphylaxis

Transfusion-related acute lung injury

Bacterial contamination

Fluid Overload/ Acute Left Ventricular Failure 

• Anticipate volume overload by giving furosemide 20mg IVI slowly with each unit of blood and transfuse slowly over 4-6 hours. Aim to give not more than 2 units per day. 
• Symptoms and signs include: breathlessness, basal crepitations, tachycardia, initial hypertension, possible raised JVP 
• Stop transfusion 
• High concentration oxygen 
• Furosemide 40mg IVI 
• Once patient has been stabilised, can reconsider transfusing at a later stage, very slowly with furosemide (as above) 

Febrile Non-haemolytic transfusion reaction 

• Mild fever, temperature rise < 1,5º C, possibly shivering and general discomfort 
• Usually towards end of transfusion or up to 2 hours after completed 
• Patient otherwise stable 
• Give paracetamol 
• Reduce transfusion rate 
• Observe more frequently 

Mild allergic reaction 

• Quite common, especially if large volumes of plasma, e.g. FFP, platelets 
• Urticaria with / without itch within minutes of starting transfusion 
• Patient otherwise stable 
• Give antihistamine, e.g. chlorpheniramine 10mg slow IV or IMI if not thrombocytopenic 
• Stop transfusion 
• If no progression after 30min, may continue at slower rate 

Acute haemolytic transfusion reaction 

• Infusion of ABO incompatible blood 
• Reaction most severe if group A red cells infused to group O 
• A few millilitres of blood will usually cause symptoms within minutes 
• Before transfusing, always check patient and donor details and that correct blood has been issued. 
• Acute onset – within minutes of starting transfusion: 
  • Pain with oozing at venepuncture site, chest pain, hypotension or hypertension, tachycardia 
  • Stop transfusion (keep all units to send back to blood bank) 
  • Keep line open with 0,9% saline and resuscitate as required 
  • Consider inotrope support for prolonged hypotension 
  • Monitor vital signs, temperature and urine output 
  • Manage patient according to clinical developments 
  • If possible, admit to ICU 

Hypersensitivity/anaphylaxis 

• Rare but life-threatening 
• More common with rapid infusion of plasma e.g., FFP and Platelets 
• Symptoms and signs, usually in early part of transfusion: 
  • Hypotension, chest pain, breathlessness, signs of bronchospasm 
  • periorbital and laryngeal oedema, urticaria, erythema and conjunctivitis 
  • nausea, vomiting, abdominal pain, 
• Stop transfusion 
• Maintain IV access 
• Administer high concentration oxygen 
• Chlorpheniramine 10-20mg IVI over 1-2 minutes 
• Hydrocortisone 100-200 mg IVI 
• Adrenaline 0.5-1 mg (0.5-1 ml of 1/1000) IMI 
• Salbutamol 2.5-5 mg by nebuliser 

Transfusion-related acute lung injury 

• Usually within 6 hours of transfusion 
• Develops breathlessness and non-productive cough 
• Hypotension with shock is common 
• May have fever/chills and may develop monocytopenia or neutropenia 
• CXR – bilateral nodular infiltrates in batwing pattern, typical of ARDS 
• Resuscitate, avoid diuretics, steroids of uncertain benefit 
• Refer to critical care unit, haematology advice 

Bacterial contamination 

• Rare, but more likely with platelets than with red cells 
• Acute, severe reaction 
• Hypertension/ hypotension, rigors, collapse 
• Treat as for acute haemolytic reaction, i.e. resuscitation 
• Start antibiotics immediately, either obtain microbiology consult or if necessary, start with broad spectrum cover, e.g.: 
  • Ceftriaxone 1g IV daily (2g if very severe infection) – gram - 
  • Teicoplanin 400mg IV bd x 2 doses, then daily – gram + 
• Send blood for microbiology