APPENDIX 8: Common Complications Associated with Transfusion of a Blood Component Common Complications Associated with Transfusion of a Component Problem Likely Timing of Event Severity Management and Prevention Acute Event Intravascular Haemolysis ABO incompatibility Almost immediately following of transfusion Potentially fatal 10% Mortality Check for DIC and renal failure Maintain BP and renal perfusion Contact: On-call Haematologist, T P, Transfusion Laboratory Initiate RED Safety Learning Event report (Datix) TACO (Transfusion Associated Circulatory Overload) Rapidly infused, large volume infusions or high TACO risk patients Occurs usually within 2 - 6 hours of transfusion Potentially fatal Accurate assessment of patients at risk of TACO Careful attention to fluid balance Consider appropriateness of transfusion Consider rate of transfusion and diuretic cover Initiate Safety Learning Event report (Datix) TRALI (Transfusion Related Acute Lung Injury) Leucocyte Antibodies in donor blood During or within 6 hours of transfusion – RARE but can be confused with ARDS (Acute Respiratory Distress Syndrome) Potentially fatal Manage as for ARDS refer to Critical Care Team Chest X-Ray – shows bilateral pulmonary infiltrates Initiate AMBER Safety Learning Event report (Datix) TAD (Transfusion Associated Dyspnoea) Transfusion of donor blood and patient Respiratory distress within 24 hours of transfusion and no other associated cause Potentially fatal Assess respiratory distress CXR Oxygen saturations and ABG’s Initiate Safety Learning Event report (Datix) grade appropriately Anaphylaxis IgA Antibodies in donor or recipient Immediate Potentially fatal Maintain ABC’s and follow Anaphylaxis Policy Initiate Safety Learning Event report (Datix) grade appropriately Septic Shock Bacterial contamination During transfusion Potentially fatal Manage septicemia Initiate Safety Learning Event report (Datix) grade appropriately
Febrile, Anti-leucocyte antibodies Up to several hours post transfusion Unpleasant but not usually life threatening Treat with Anti-pyretic (e.g. Paracetamol 1g) Initiate Safety Learning Event report (Datix) grade appropriately Urticaria IgE Antibodies in blood During transfusion Unpleasant but not usually life threatening Treat or prevent with Antihistamine (Oral or IV) Initiate Safety Learning Event report (Datix) grade appropriately Delayed Event Delayed haemolytic reaction IgG Antibodies to donor blood 2 – 26 days post transfusion Not usually life threatening Poor response to transfusion Jaundice Send samples for investigation Review transfusion needs TA-GvHD (Transfusion Associated Graft Versus Host Disease) Donor lymphocytes Extremely rare up to 30 days following transfusion Usually fatal None seen in the last 10 years following leucocyte depletion Irradiated blood to ‘at risk’ groups Post Transfusion Purpura (PTP) Recipient antibodies against HPA system 5 – 12 days post transfusion Rare but treatable Contact Bloodbank to arrange patient investigation at platelet laboratory Post Transfusion Infection Infected donor blood Post transfusion Rare Depends on virus Seek specialist medical advice Iron overload patients Occurs either with single episode of or long term transfusion therapies Rare but treatable if diagnosed Use iron chelation therapy or venesection Monitor LFT’s and cardiac enzymes Consider cardiac scans