Medicine: 41 items Pedaitric: 55

Anemia: 8 items Anemia: 12 items

Bleeding: 8 items Bleeding: 12 items
Malignancy: 8 items Malignancy: 12 items
Polycythemia: 2 Items Polycythemia: 3 items
Hypercoagulable: 6 items Hypercoagulable : 4 items
Blood transfusion 6 items Blood transfusion: 7 items
Stem Cell: 3 items Stem Cell: 3 items

Public Health 6 items

BLOOD TRANSFUSION AND
TRANSFUSION REACTION
BLOOD SELECTION
Blood Groups

Phenotype Genotyp Antibodies

present in the
(blood Type) e
blood serum
IA IA
A Or Anti B
IA I
IB IB
B Or Anti A
IB I

AB IA IB -

O ii Anti A and B
Blood Groups

Rh group Rh antigen Rh antibody

Rh positive None

Rh negative Anti- D
Selection of Blood
Red cell transfusion
There must be ABO and Rh D
compatibility between the donors red cells
and the recipients plasma.
Group A individuals can receive blood from Group A
and O donors
Group B individuals can receive blood from Group B
and O donors

World Health Organization: Blood Transfusion Safety

Selection of Blood
Red cell transfusion
There must be ABO and Rh D
compatibility between the donors red cells
and the recipients plasma.
Group O individuals can receive blood from Group
O donors only
Group AB individuals can receive blood from Group
AB donors, and also from Group A, B and O donors

World Health Organization: Blood Transfusion Safety

Selection of Blood
Plasma and Components containing
Plasma
In plasma transfusion, group AB plasma can be
given to a patient of any ABO group because
it contains neither anti-A nor anti-B antibody
Group AB plasma (no antibodies) can be given to
any ABO group patients
Group O plasma (anti-A + anti-B) can be given to
Group O patients only

World Health Organization: Blood Transfusion Safety

Selection of Blood
Plasma and Components containing Plasma
In plasma transfusion, group AB plasma can be
given to a patient of any ABO group because
it contains neither anti-A nor anti-B antibody
Group A plasma (anti-B) can be given to Group O
and A patients
Group B plasma (anti-A) can be given to Group O
and B patients

World Health Organization: Blood Transfusion Safety

BLOOD TRANSFUSION
Blood Transfusion Practice
THE DECISION to transfuse, like any other
therapeutic decision, should be based on
the risks, benefits, and alternatives of
treatment.
PRINCIPLES OF CLINICAL
TRANSFUSION PRACTICE
Transfusion is only one part The patient with acute blood
of the patients management. loss should receive effective
resuscitation (intravenous
Prescribing should be based
replacement fluids, oxygen,
on national guidelines on the
etc.) while the need for
clinical use of blood, taking
transfusion is being assessed
individual patient needs into
Transfusion should be
account.
prescribed only when the
Blood loss should be benefits to the patient are
minimized to reduce the likely to outweigh the risks.
patients need for transfusion.
PRINCIPLES OF CLINICAL
TRANSFUSION PRACTICE
The patients haemoglobin
value, although important,
should not be the sole
deciding factor in starting
transfusion.This decision
should be supported by the
need to relieve clinical signs
and symptoms and prevent
significant morbidity or
mortality
The clinician should be aware
of the risks of transfusion-
transmissible infections in the
blood products that are
available for the individual
patient.
The clinician should record
the reason for transfusion
clearly.
Blood Products
(Definition of Terms)
Blood product Any therapeutic substance
prepared from human blood

Whole blood Unseparated blood collected into

an approved container containing
an anticoagulant-preservative
solution
Blood Products
(Definition of Terms)
Blood A constituent of blood, separated
component from whole blood, such as:
Red cell concentrate
Red cell suspension
Plasma
Platelet concentrates
Plasma or platelets collected by
apheresis
Cryoprecipitate, prepared from
fresh frozen plasma: rich in Factor
VIII and fibrinogen
Blood Products
(Definition of Terms)
Plasma derivative Human plasma proteins prepared
under pharmaceutical
manufacturing conditions, such as:
Albumin
Coagulation factor
concentrates
Immunoglobulins
RED CELL
TRANSFUSION
WHOLE BLOOD
(450 ml whole blood donation contains:)
Description Up to 510 ml total volume
(volume may vary in accordance
with local policies)
450 ml donor blood
63 ml anticoagulant-preservative
solution
Hgb approximately: 12 g/ml
Haematocrit: 35%45%
No functional platelets
No labile coagulation factors
(V and VIII)
WHOLE BLOOD
(450 ml whole blood donation contains:)
Infection risk Not sterilized, so capable of
transmitting any agent present in
cells or plasma which has not
been detected by routine
screening for transfusion-
transmissible infections, including
HIV-1 and HIV-2, Hepatitis B and C,
other hepatitis viruses, syphilis,
malaria and Chagas disease
WHOLE BLOOD
(450 ml whole blood donation contains:)
Indications Red cell replacement in Acute
Blood Loss with Hypovolaemia
Exchange transfusion
Patients needing red cell
transfusions where red cell
concentrates or suspensions are
not available

Contraindications Risk of volume overload in

patients with:
Chronic anaemia
Incipient cardiac failure
 Ideal component for patients who have
sustained acute hemorrhage of 25% total
blood volume loss
Provides both oxygen-carrying capacity and
volume expansion.
WHOLE BLOOD
(450 ml whole blood donation contains:)
Administration Must be ABO and RhD
compatible with the recipient
Never add medication to a unit of
blood
Complete transfusion within 4
hours of commencement
Transfusion should be started
within 30 minutes of removal
from refrigerator
RED CELL CONCENTRATE
(Packed red cells, plasma-reduced blood)
Description 150200 ml red cells from which
most of the plasma has been
removed
Hgb approximately: 20 g/100 ml
(not less than 45 g per unit)
Haematocrit: 55%75%
RED CELL CONCENTRATE
(Packed red cells, plasma-reduced blood)
Infection risk Same as whole blood

Storage Same as whole blood

Indications Replacement of red cells in

anaemic patients
Use with crystalloid replacement
fluids or colloid solution in acute
blood loss

Administration Same as whole blood

RED CELL CONCENTRATE
(Packed red cells, plasma-reduced blood)
3 mL PRBC/kg will raise
Hb by approximately 1 gm/dl
Hct by approximately 3%
In normal sized adult (70 kg) 1 unit PRBC
will raise the
Hct by 3 - 4% or 1 gm/dl
RED CELL CONCENTRATE
(Packed red cells, plasma-reduced blood)
Exchange transfusion
Term infants -- 80-160ml/kg
Preterm infants -- 100-200ml/kg
Routine (neonates and children)
10-20 ml/kg
Desired Hct actual Hct x weight (kg)
Desired Hb actual Hb x weight (kg) x 3
Red Cell Transfusion
Increases oxygen-carrying capacity in the
anemic patient.
Adequate oxygenation can be maintained
with a Hemoglobin content of 70 g/L in the
normo-volemic patient without cardiac
disease;
Co-morbid factors often necessitate transfusion
at a higher threshold
Red Cell Transfusion
The decision to transfuse should be guided
by the clinical situation and not by an arbitrary
laboratory value.
In the critical care setting,
Liberal use of transfusions to maintain near-
normal levels of hemoglobin may have
unexpected negative effects on survival.
In most patients requiring transfusion
Levels of hemoglobin of 100 g/L are sufficient to
keep oxygen supply from being critically low.
Red Cell Transfusion
(Pediatric)
Transfusions may be given more stringently
to children because:
Normal hemoglobin levels are lower in healthy
children than in adults
Children do not have the underlying
cardiorespiratory and vascular diseases that
develop with aging in adults.
Red Cell Transfusion
(Pediatric)
Children should be better able to
compensate for RBC loss.
In the peri-operative period, for example, it is
unnecessary for most children to maintain
hemoglobin levels of 80 g/L or greater, a level
frequently desired for adults.
 INFANTS WITHIN THE FIRST 4 MO
CHILDREN AND ADOLESCENTS
OF LIFE
Acute loss of >25% at Hemoglobin of <13.0 g/dL
circulating blood volume and severe pulmonary
Hemoglobin of <8.0 g/dL in disease
the perioperative period Hemoglobin of <10.0 g/dL
Hemoglobin of <13.0 g/dL and moderate pulmonary
and severe cardiopulmonary disease
disease Hemoglobin of <13.0 g/dL
Hemoglobin of <8.0 g/dL and severe cardiac disease
and symptomatic chronic Hemoglobin of <10.0 g/dL
anemia and major surgery
Hemoglobin of <8.0 g/dL Hemoglobin of <8.0 g/dL
and marrow failure and symptomatic anemia
Guidelines for Pediatric Red Blood Cell
Transfusions
THE DECISION TO TRANSFUSE
SHOULD NOT BE BASED ON THE
HAEMOGLOBIN LEVEL ALONE, BUT
ALSO ON A CAREFUL ASSESSMENT
OF THE PATIENTS CLINICAL
CONDITION.
PLATELET
CONCENTRATES
PLATELET CONCENTRATES
(prepared from whole blood donations
Description Single donor unit in a volume of
5060 ml of plasma should
contain:
At least 55 x 109 platelets
<1.2 x 109 red cells
<0.12 x 109 leucocytes
Unit of issue May be supplied as either:
Single donor unit: platelets
prepared from one donation
Pooled unit: platelets prepared
from 4 to 6 donor units pooled
into one pack to contain an adult
dose of at least 240 x 109 platelets
PLATELET CONCENTRATES
(prepared from whole blood donations
Infection risk Same as whole blood, but a
normal adult dose involves
between 4 and 6 donor exposures
Bacterial contamination affects
about 1% of pooled units

Storage Up to 72 hours at 20C to 24C

(with agitation)
Longer storage increases the risk
of bacterial proliferation and
septicaemia in the recipient
PLATELET CONCENTRATES
(prepared from whole blood donations
Indications Treatment of bleeding due
to:
Thrombocytopenia
Platelet function defects
Prevention of bleeding due to
thrombocytopenia, such as in
bone marrow failure
 Thrombocytopenia is a risk factor for
hemorrhage, and platelet transfusion reduces
the incidence of bleeding.
The threshold for prophylactic platelet
transfusion is 10,000/L.
In patients without fever or infections, a
threshold of 5000/L may be sufficient to prevent
spontaneous hemorrhage.
For invasive procedures, 50,000/L platelets is
the usual target level.

CHILDREN AND ADOLESCENTS
OF LIFE
PLTs < 50 109/L and
bleeding
PLTs < 50 109/L and an
invasive procedure
PLTs < 20 109/L and marrow
failure with hemorrhagic risk
factors
PLTs < 10 109/L and marrow
failure without hemorrhagic
risk factors
PLTs at any count, but with
PLT dysfunction plus bleeding
or an invasive procedure
INFANTS WITHIN THE FIRST 4 MO
PLTs < 100 109/L and
bleeding
PLTs < 50 109/L and an
invasive procedure
PLTs < 20 109/L and
clinically stable
PLTs < 100 109/L and
clinically unstable
PLTs at any count, but with
PLT dysfunction plus
bleeding or an invasive
procedure

Guidelines for Pediatric Platelet Transfusions

PLATELET CONCENTRATES
(prepared from whole blood donations
Contraindications Not generally indicated for
prophylaxis of bleeding in surgical
patients, unless known to have
significant pre-operative platelet
deficiency
Not indicated in:
Idiopathic autoimmune thrombocytopenic
purpura (ITP)
Thrombotic thrombocytopenic purpura
(TTP)
Untreated disseminated intravascular
coagulation (DIC)
Thrombocytopenia associated with
septicaemia, until treatment has
commenced or in cases of hypersplenism
PLATELET CONCENTRATES
(prepared from whole blood donations
Dosage 1 unit of platelet concentrate/10
kg body weight: in a 60 or 70 kg
adult, 46 single donor units
containing at least 240 x 109
platelets should raise the platelet
count by 2040 x 109/L
Increment will be less if there is:
Splenomegaly
Disseminated intravascular
coagulation
Septicaemia
TRANSFUSION OF PLATELET CONCENTRATES

Dose units: Platelet concentrate from 1 donor unit (450

ml) of whole blood contains about 60 x 109/L

Dosage Volume Platelet concentrate

Up to 15 kg 1 platelet conc. 3050 ml* 60 x 109 /L
1530 kg 2 platelet conc. 60100 ml 120 x 109 /L
>30 kg 4 platelet conc. 120400 ml 240 x 109 /L

* For small infants, the blood bank may remove part of

the plasma before transfusion
PLATELET CONCENTRATES
(prepared from whole blood donations
Administration After pooling, platelet concentrates
should be infused as soon as possible,
generally within 4 hours, because of
the risk of bacterial proliferation
Must not be refrigerated before
infusion as this reduces platelet
function
Should be infused over a period of
about 30 minutes
Do not give platelet concentrates
prepared from RhD positive donors
to an RhD negative female with
childbearing potential
PLATELET CONCENTRATES
(prepared from whole blood donations
Complications Febrile non-haemolytic and
allergic urticarial reactions are not
uncommon, especially in patients
receiving multiple transfusions
 PLATELET CONCENTRATES

The goal of platelet therapy is to control

or stop the bleeding. The clinical
response is more important than the
platelet count.
FRESH FROZEN
PLASMA
FRESH FROZEN PLASMA
Description Pack containing the plasma
separated from one whole blood
donation within 6 hours of
collection and then rapidly frozen
to 25C or colder
Contains normal plasma levels of
stable clotting factors, albumin and
immunoglobulin fibrinogen,
Antithrombin, Proteins C and S.
Factor VIII level at least 70% of
normal fresh plasma level
FRESH FROZEN PLASMA
Unit of issue Usual volume of pack is
200300 ml
Smaller volume packs may be
available for children

Infection risk If untreated, same as whole blood

Very low risk if treated with
methylene blue/ultraviolet light
inactivation
FRESH FROZEN PLASMA
Storage At 25C or colder for up to 1
year
Before use, should be thawed in
the blood bank in water which is
between 30C to 37C.
Higher temperatures will destroy
clotting factors and proteins
Once thawed, should be stored in
a refrigerator at +2C to +6C
FRESH FROZEN PLASMA
Indications Replacement of multiple
coagulation factor deficiencies:
Liver disease
Warfarin (anticoagulant) overdose
Depletion of coagulation factors in
patients receiving large volume
transfusions
Disseminated intravascular
coagulation (DIC)
Thrombotic thrombocytopenic
purpura (TTP)
 INFANTS, CHILDREN AND ADOLESCENTS

Severe clotting factor deficiency and

bleeding
Severe clotting factor deficiency and an
invasive procedure
Emergency reversal of warfarin effects
Dilutional coagulopathy and bleeding
Anticoagulant protein (antithrombin III,
proteins C and S) replacement
Plasma exchange replacement fluid for
thrombotic thrombocytopenic purpura

Guidelines for Pediatric Plasma Transfusions

FRESH FROZEN PLASMA
Precautions Acute allergic reactions are not
uncommon, especially with rapid
infusions
Severe life-threatening
anaphylactic reactions occasionally
occur
Hypovolaemia alone is not an
indication for use
FRESH FROZEN PLASMA
Dosage Initial dose of 15 ml/kg

Administration Must normally be ABO compatible

to avoid risk of haemolysis in
recipient
No compatibility testing required
Infuse using a standard blood
administration set as soon as
possible after thawing
Labile coagulation factors rapidly
degrade; use within 6 hours of
thawing
CRYOPRECIPITATE
CRYOPRECIPITATE
Description Prepared from fresh frozen plasma
by collecting the precipitate
formed during controlled thawing
at +4C and resuspending it in
1020 ml plasma
Contains about half of the Factor
VIII and fibrinogen in the donated
whole blood: e.g.
Factor VIII: 80100 iu/ pack;
Fibrinogen: 150300 mg/pack
CRYOPRECIPITATE
Infection risk As for plasma, but a normal adult
dose involves at least 6 donor
exposures

Storage At 25C or colder for up to 1

year
CRYOPRECIPITATE
Indications As an alternative to Factor VIII
concentrate in the treatment of
inherited deficiencies of:
von Willebrand Factor (von
Willebrands disease)
Factor VIII (haemophilia A)
Factor XIII
As a source of fibrinogen in
acquired coagulopathies: e.g.
disseminated intravascular
coagulation (DIC)
CRYOPRECIPITATE
Administration If possible, use ABO-compatible
product
No compatibility testing required
After thawing, infuse as soon as
possible through a standard blood
administration set
Must be infused within 6 hours of
thawing
CRYOPRECIPITATE-
DEPLETED PLASMA
CRYOPRECIPITATE-DEPLETED
PLASMA
Description Plasma from which approximately
half the fibrinogen and Factor VIII
has been removed a
cryoprecipitate, butwhich contains
all the other plasma constituents
 Transfusion Reactions

Immediate effects Delayed Effects

Hemolytic reactions
Hemolytic reaction
Febrile reactions
Allergic reaction Alloimmunization
Hyperkalemia
Infectious complications
Circulatory overload
Reactions due to Hemosiderosis
Contaminated bld
Transfusion Reactions
Manifestations of Adverse reaction
Fever with or without chills
most common symptom of Hemolytic transfusion
reaction
Chills with or with out fever
Pain at the transfusion site or in the chest,
abdomen or flanks
Blood pressure changes
Transfusion Reactions
Manifestations of Adverse reaction
Blood pressure changes
Acute
Hypertension
Hypotension
Circulatory shock in combination with fever, severe
chills and high-cardiac-output suggest -- Sepsis or
HTR
 Guidelines for the recognition acute
transfusion reactions

Category 1: MILD REACTIONS

Signs Possible Cause
Localized Cutaneous Hypersensitivity (mild)
reactions
Urticaria
Rash

Symptoms
Pruritus (itching)
 Guidelines for the recognition of acute
transfusion reactions

Category 2: MODERATELY - SEVERE REACTIONS

Signs Symptoms Possible Cause
Anxiety Hypersensitivity
Flushing
Pruritus (mod-severe)
Urticaria
Febrile NH
Rigors Palpatations
Ab to WBC
Fever Mild Dyspnea
Ab to proteins
Restlessness Headache
such as IgA
tachycardia Contamination
with pyrogens
and/or bacteria
 Guidelines for the recognition of acute
transfusion reactions

Category 3: LIFE-THREATENING REACTIONS

Signs Symptoms Possible Cause
Rigors Anxiety Acute intravascular
Fever Chest pain haemolysis
Restlessness Bacterial contamination
Pain near infusion site
Tachycardia (rise of and septic shock
>20% in heart rate Respiratory distress/
shortness of breath Fluid overload
Hypotension
Anaphylaxis
(fall of >20% in Loin/ back pain
systolic BP) Transfusion associated
Dyspnea
Haemoglobuniria acute lung injury
(red urine) Headache
Unexplained
bleeding (DIC)
 Hemolytic reactions

Non-immune mediated (physical destruction)

Overheating-use of improvised blood warmers
Forceful transfusion-pressure cuffs
Small bore needles(?)
Using same line for hypotonic solutions or drugs
Bacterial growth in blood units
Hemolytic reactions
Non-immune mediated (physical
destruction)
Treatment
Depends upon the severity of reaction
Severe reaction, hypotension, shock and renal
dysfunction -- Intensive management
Hemoglobinuria or Hemoglobinemia --
Supportive therapy
Hemolytic reactions
Immune mediated
Patient Ab reacting with donor Ag
Wrong blood given
Due to rxn with ABO, Rh, Lewis, Kelly
Severity depends upon the amount transfused
(as small as 10-15ml)
Hemolytic reactions
Immune mediated
The most dramatic and challenging adverse
event of blood transfusion.
There is rapid destruction of blood cells.
Most commonly occurs
Whole blood
Packed red cell
Hemolytic reactions
Immune mediated
Can also occur in
Fresh frozen plasma
Platelet concentrate
Other plasma derived
Hemolytic reactions
Immune mediated
Acute Hemolytic Transfusion Reaction
Immediately after or with in 24 hours of a
transfusion
Incidence: 1 in 12000 to
1 in 35000 transfusion
Mortality: 1 in 100000 to
1 in 600000 transfusion
Hemolytic reactions
Immune mediated
Delayed Hemolytic Transfusion Reaction
Recognized 3 to 10 days after transfusion
 Hemolytic reactions
Immune Mediated

Signs and Symptoms of Acute Immune Mediated

Fever Dyspnea
Chills and rigors Diarrhea
Anxiety Hypotension
Feeling of dread Hemoglobinuria
Facial flushing Pallor
Oliguria Icterus
 Hemolytic reactions
Immune Mediated

Signs and Symptoms of Acute Immune Mediated

Back pain Anuria
Flank pain Pain on the
Nausea transfusion site
Vomiting Diffuse bleeding
Chest pain Jaundice
Abdominal pain
 Hemolytic reactions
Immune Mediated

Signs and Symptoms of Chronic Immune

Mediated
Fever Jaundice
Chills and rigors Oliguria
Pallor Anuria
Diffuse bleeding
Hemolytic reactions
Stop Transfusion
Severity depends on amount (as small as
30ml)
Maintain adequate systemic arterial blood
Pressure and tissue perfusion by
hydration
Normal saline solution
Prevent renal failure (100ml/hr urine
output/use of diuretics)
Hemolytic reactions
Vaso-active agents (dopamine)
DIC cryoprecipitate, platelet
Investigate
Blood typing
Coombs test
If positive identify antibody responsible
Urine hemoglobin
Culture of the remaining blood
Febrile Non-Hemolytic Reaction
Due to anti-leukocyte Antibody against
White cell and platelet of donor
Mild reaction
rule out Hemolytic Transfusion reaction
bacterial contamination
Febrile Non-Hemolytic Reaction
43% - 75% of all transfusion reaction
0.5% - 1.4% on non-leukocyte
reduced red blood cell
15% recurrence rate
Febrile Non-Hemolytic Reaction
Fever
Chills with no reason
Temperature increase of >1C associated with
transfusion and without any other explanation
Febrile Non-Hemolytic Reaction
Treatment
Antipyretics/steroids

Antihistamines not indicated -- not involve

histamine release

if frequent -- washed Rbc

Allergic Transfusion Reaction
A rare complication of transfusion of
blood components or plasma derivatives
Can occur in (most common):
Plasma rich blood component like Platelet
concentrate
FFP/Cryoprecipitate
Can also occur:
Packed red cells
Allergic Transfusion Reaction
The risk is increased by rapid infusion,
typically when fresh frozen plasma is used as
an exchange fluid in therapeutic plasma
exchange.

Cytokines in the plasma may be one cause of

bronchoconstriction and vasoconstriction in
occasional recipients.
Allergic Transfusion Reaction
Allergic transfusion reaction
Due to binding of soluble substance in

donor plasma with IgE antibodies

release of histamine
Allergic Transfusion Reaction
Uncomplicated allergic transfusion
reaction
45% of all transfusion Reaction
Anaphylactoid reaction
1%-3% of transfusion
Anaphylaxis
0.002%-0.005% per transfused product
Allergic Transfusion Reaction
Allergic transfusion reaction
Urticaria (diffuse or local)
Discontinue temporarily but need not be
stopped
Stopped if with other systemic
manifestation such as hypotension, GI
manifestation
Anti histamines
Allergic Transfusion Reaction
Anaphylactoid Anaphylaxis
reaction Severe form (life
Mild form of: threatening
Fever Fever
Chills Chills
Nausea
Nausea
Vomiting
Vomiting
Diarrhea
And/or Diarrhea
Urticaria And/or Urticaria
Allergic Transfusion Reaction
Anaphylaxis (life threatening)
May include several systems
Respiratory (cough, wheezing, chest
tightness)
GI (vomiting, diarrheas, nausea)
Circulatory (arrhythmias)
Ig A deficiency
Allergic Transfusion Reaction
Treatment
Stop transfusion
Depends upon severity
Hypotension fluids, epinephrine
Bronchospasm B2 agonist, Theophyline
Post transfusion purpura
Thrombocytopenia 5 to 21 days
Patient makes an alloantibody in response
to platelet antigens in the transfused blood
that for a period of time (7-48days) causes
destruction of autologous antigen-negative
platelets.
Sign/Symptoms: Thrombocytopenia that is
frequently profound, purpura, or bleeding
Post transfusion purpura
Treatment
Platelet transfusion is of very little value -
should be reserved for patients with active
bleeding.
Therapeutic plasma exchange may be
beneficial.
Transfusion related Acute Lung
Injury
Rare
Mortality: 10%
Abrupt onset of non cardiogenic
pulmonary edema
Rapid failure of pulmonary function usually
presents within 1 to 4 hours of starting
transfusion, with diffuse opacity on the
chest X-ray.
Transfusion related Acute Lung
Injury
Presence of antibodies in the donor
plasma reactive to recipient leukocyte
antigens

Production of inflammatory mediators

during storage of cellular blood
components
Transfusion related Acute Lung
Injury
Symptoms
Respiratory distress
Fever
Chills
Increased respiratory rate
Cough
Tachycardia
Transfusion related Acute Lung
Injury
Most resolve within 72 hours
Treatment
Support (O2, ventilation)
Severe cases may require assisted
ventilation with high FIO2.
Circulatory overload
Fluid overload can result in heart failure and
pulmonary edema.
May occur when:
Too much fluid is transfused
The transfusion is too rapid
Renal function is impaired.
Fluid overload is particularly likely to happen in
patients with:
Chronic severe anaemia
Underlying cardiovascular disease.
Circulatory overload
May complicate up to 1 in 100
transfusion
Symptoms
Dyspnea
Orthopnea
Cough
Tachycardia
Hypertension
Infectious
Bacterial /Viral
Can occur in:
Packed red cells
Plasma rich blood component (most
common)
Platelet concentrate
FFP/Cryoprecipitate
 Bacterial Infections
Packed red cells
2.6 per 100000 transfusions
Symptoms

Temperature Dyspnea
higher than 38.5 Diarrhea
Rigors Shock
Hypotension Oliguria
Nausea DIC
Vomiting
Bacterial Infections
Platelet concentrate (common)
8-80 per 100000 units transfused
(random)
Symptoms
Symptoms may begin during or shortly after
transfusion or begin up to 2 weeks after
transfusion:
Fever, Chills, Hypotension
Viral Infections
Hepatitis
Hepatitis A
Rare
1:1million
Hepatitis B
1:63000
Hepatitis C
Hepatitis D
Viral Infections
Human Herpes Infection
CMV
EBV