Complications of Blood transfusion and their management

A. Transfusion Reactions:

May be allergic or hemolytic

1. Hemolytic reactions: can be acute or delayed

Acute Hemolytic reactions:

  • It is usely due to ABO incompatibility, there is intravascular hemolysis
  • As low as 10 ml of blood can produce hemolytic reactions
  • Clinically, patients presents with complains of pain and burning in vein and fever with chills and rigor, nausea and vomiting, flushing, chest and flank pain and dyspnea.
  • It is confirmed by hemoglobinuria
  • ARF can occur due to blockage of tubules


  • Stop infusion
  • Recheck the blood details
  • Maintain urine output by mannitol and fruit administration
  • Alkalinize urine
  • Hemodialysis

Delayed Hemolytic Reactions:

  • Are extravascular hemolytic reactions
  • Mainly due to Rh system and other system incompatibility eg. Kell Duffy
  • These reactions are mild and seen after 21 days
  • Diagnosed by Coomb’s test
  • Treatment is supportive

2. Allergic reaction:

  • These are mainly mild, seen as urticaria and are mainly due to plasma proteins
  • Treatment is antihistaminics and steroids
  • If anaphylaxis occurs, stop transfusion
  • Adrenaline and steroids

B. Febrile Reactions:

Due to infusion of white cell microaggregates
Can be minimized by using microfilter blood sets with pore size 20-40 micrometer
Generally require no treatment

C. Infectious Complications:

  • Hepatitis: 90% are due to hepatitis C virus
  • Other viral diseases like CMV, EBV, HTLV-1, HTLV-2, parvovirus
  • Bacterial infections like Pseudomonas, Staphylococcus, Syphillis, Brucellosis, Salmonella, Yirsenia and rickettsial disease
  • Parasitic infections like malaria, toxoplasmosis, filariasis, trypanosomiasis, Creuz-Jackobs Disease (prion)

D. Fluid Overloading and Pulmonary Edema

E. Metabolic Complications:

  • Hyperkalemia
  • Hypocalcemia
  • Acid-base abnormalities

F. Coagulation abnormailities:

Occurs due to dilution of coagulation factors and platelets
Treatment is fresh blood
Fresh frozen Plasma
Specific blood components therapy

G. Hypothermia: Blood should be warmed before use

H. Immunosuppression- graft vs host reaction

I. Tissue hypoxia – due to shift of oxygen dissociation curve to left due to decreased 2,3 DPG

J. Endotoxaemia and Septicaemia

K. ARDS (Acute Respiratory Distress Syndrome) – now known as TRALI (Transfusion Related Acute Lung Injury)

L. Disseminated Intravascular Coagulation (DIC)

Leave a Reply

Your email address will not be published. Required fields are marked *