Risks of a Blood Transfusion

Hospitals are required by accrediting and regulatory agencies (i.e., Joint commission, AABB, CAP and the FDA) to ensure appropriate use of blood products. While this reduces risks, it does not eliminate them completely. Hospitals are required to review blood transfusion practices and adverse outcomes. Policies and procedures are consistently revised and reviewed, and monitored to ensure that they are followed correctly. However, occasionally hazards and side effects occur pertaining to transfusion of blood products.

Who Receives Transfusions

• Blood transfusions are used to treat patients who have suffered a significant loss of blood due to injury or surgery. Patients with varied types anemia, such as iron or B12 deficiency, may also received a transfusion.

Immediate Immune Reaction

• There are several possible immediate reactions a patient can suffer following a blood transfusion. A hemolytic transfusion reaction is the destruction of transfused red blood cells due to blood type incompatibility. Allergic reactions are possible and usually occur as urticaria (hives), but may also include wheezing and edema reactions. These reactions can't be predicted but once they occur, they can be treated with antihistamines, steroids or epinephrine. Anaphylactic reaction symptoms are severe dyspnea (trouble breathing), pulmonary edema, a rare but dangerous complication requiring immediate treatment with corticosteroids and epinephrine. The reaction that is most likely to cause death is transfusion related acute lung injury (TRALI), which is caused by massive leaking of fluids and protein into the lungs within six hours of transfusion. The specific mechanism is not clear. Treatment consists of aggressive respiratory support.

Delayed Immune Reaction

• Delayed hemolytic transfusion reaction varies from a mild to a severe life-threatening reaction. Features include fever, lower than expected blood hemoglobin concentration with associated jaundice and can occur 5 to 10 days after transfusion.

  Post transfusion purpura (PTP) is a rare syndrome characterized by the development of a dramatic yet self-limiting thrombocytopenia (low platelet count), typically occurring 7 to 10 days after blood transfusion. This is usually seen in a patient with a history of sensitization by either pregnancy or previous transfusion.

  In a bleeding patient, a high dose of intravenous immune globulin (IGIV) may promptly correct the platelet deficiency. Graft versus host disease (GVHD) is a rare but extremely dangerous condition that occurs when T-lymphocyte blood cells in the transfused component cause reaction against tissue antigens in the recipient. Severely immunocompromised individuals, such as patients with cancer or AIDS, are at greatest risk but GVHD has been reported in people with healthy immune systems usually when the transfused component is from a blood relative.

Infectious Disease Risks

• Transmission of infectious disease may occur because the product is made of human blood. Blood donors are screened to prevent those infected with HIV, hepatitis or sexually transmitted diseases from donating. Although there is a detailed screening process, it is possible, in rare cases, for diseased blood to be transfused.

Benefits vs. Risks

• A blood transfusion is a procedure that has inherent risk. However, the benefits of this frequently life saving treatment far outweigh the risks. Transfusion reactions are rare and frequently easily managed by medical staff. Each hospital or medical center has a transfusion committee that monitors justification for transfusion and the practices associated with it to ensure patient safety.