In general, should such signs occur, the transfusion is stopped immediately, the venous line is kept open with normal saline, and the physician is notified. If the condition is not corrected, a flaccid paralysis develops, affecting the muscles of respiration and eventually the heart muscle, which can lead to cardiac arrest. High levels of potassium in donor blood are likely to occur when the bank blood is several days old. It is estimated that the breakdown of red cells in the stored blood increases the level of potassium at the rate of one milliequivalent per liter per day. The ACD anticoagulant binds with calcium ions in the recipient's blood, removing them from circulation and thereby reducing the calcium level below that essential for normal coagulation.
Circulatory overload is a possibility any time blood is administered rapidly in large amounts.
Patients who are particularly susceptible to this eventuality are the very young, the very old, and those suffering from a pre-existing cardiopulmonary or renal problem. Another difficulty that may be encountered when blood is administered rapidly under pressure is that of air embolism. Every patient receiving a blood transfusion should be monitored closely for early signs of transfusion reactions and complications. Transfusion of whole blood is a highly complex procedure and is not without danger to the patient. Should early signs of a reaction develop, the transfusion should be discontinued and the physician notified immediately.