24th July 2024

Complications of blood products

It is important to remember that blood transfusions, whilst increasingly safe, can have side effects. Patients must be informed of the risks prior to starting a transfusion. Note also that if a patient receives a blood transfusion, they cannot donate blood in the future.

Common complications include:

• ABO incompatibility: occurs when the blood group of transfused blood is incompatible with the recipient blood group, for example group AB blood being given to a patient who is O group. A serious haemolytic reaction will occur, potentially causing cardiovascular instability.
• Transfusion-associated circulatory overload (TACO): often associated with patients with heart failure who receive a transfusion. The patient presents with dyspnea, oxygen requirement and bilateral infiltrates on chest X-ray. Usually, this occurs within 6 hours of transfusion. As with pulmonary oedema, treat with diuretics.
• Transfusion-related acute lung injury (TRALI): presents with hypoxia (due to non-cardiogenic pulmonary oedema), fever and often hypotension. It is thought to be immune mediated. Typically, symptoms appear around 6 hours post transfusion. Treatment is supportive and discussion with intensive care may be needed. TRALI is rare, with an incidence of 1 in 150,000  units transferred.
• Bacterial contamination can occur, especially with platelet transfusions which are stored at 22-24°C (a temperature compatible with bacterial growth). Symptoms are similar to an acute sepsis response, with hypotension, tachycardia and fever. The transfusion should be stopped and the ‘sepsis 6’ protocol initiated.
• Febrile non-haemolytic transfusion reactions (common): typically, the patient develops a temperature whilst having a transfusion but is otherwise well. Paracetamol, slowing the transfusions and close observation is usually sufficient. However, fever may be the first symptom of a more serious reaction and thus close observation is advised.