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11-13-2009, 02:01 PM
Complication of blood transfusion
(A) Due to transfusion of foreign substances:
1- Incompatible blood transfusion:
· Aetiology:
Transfusion of a donor group differ from that of the patient . Either A.B.O systems or other subgrouping system.
· Pathology :
1- Destruction of the donor RBCS by the recepient antibodies.
2-Hemoglobin of the destructed RBCS will be precipitated on the renal tubules and small coronary vessels "D.I.C"® chest pain with pain in loin
3- Tubular necrosis will occur leading to renal failure
4- The D.I.C lnitiated by RBCS destructed may lead to consumption coagulopathy ® bleeding tendency.
5-Destruction of RBCS® release of K to blood ® hyperkalaemia.
· Clinical Picture:
(a) In comatosed or anaesthetized patient:
1- Hypotension and tachycardia "unexplained".
2- Abnormal intra-operative tissue bleeding.
3- Fever and Flushing.
4- Haemoglobinuria "From the catheter"
(b)In conscious patient:
Beside the above picture the patient will complain of:
1- Headache, nausea and vomiting.
2- Tight constricting chest pain and pain in the loins.
3- Later on, renal failure may occur and oliguria will be noticed.
¦ Treatment:
1- Stop transfusion immediately.
2- Plenty of fluids® correct hypotension and correct renal perfusion.
3- Corticosteroids ®¯ the reaction and ® correct hypotension.
4- Alkanization of urine ® to wash the acid haematin.
It is done by giving Na HCO3 solution I.V.
5- Forced diuresis using mannitol ® wash the precipitated haematin.
6- If renal failure occurs manage as a case of acute renal failure.
2) Allergic Reaction:
· Aetiology: Allergens in the donor's blood as white cells and platelets.
· Pathology: Anaphylactic reaction.
· Cl. Picture: Skin rash with itching Rarely laryngeal odema and collapse.
· Treatment: 1- Stop transfusion.
2- Give antihistaminic..
3- Corticosteroids may be needed in severe reactions.
3) Pyrexial Reaction:
·It is the commonest complication.
· Aetiology: Transfer of pyrogenic substances present in the blood stored in glass containers.
· Cl. Picture: 1- Pyrexia. 2-Headache, nausea and vomiting.
· Treatment:
1- Stop transfusion "difficult to diff. from incompatible transfusion."
2- Antipyretic drugs
3- Using plastic containers reduce the incidence of this reaction.
4) Toxaemia:
· Aetiology: Transfusion of contaminated blood containing endotoxins of gram-ve bacteria.
· Cl. Picture: That of septicaemia fever with chills ® Hypotension ® Prostration
· Treatment:
1- Corticosteroids. 2- Antipyretics. 3- Antibiotics.
5) Transmission of Disease:
Hepatitis, Acquired Immuno deficiency syndrome [AIDS], Syphilis, Malaria.
6) Micro circulation Blockade:
· Aetiology: Transfusion of micro-emboli with the banked blood.
· Pathology: The emboli will accumulate in the lung.
· Clinical Picture: Acute respiratory distress.
· Treatment:It can be avoided by using 40 micron mesh filter for each Blood unit.
B) Complication due to massive Blood Transfusion:
1- Hyperkalaemia:
· Aetiology: ­ K in the stored blood. why?
· Cl. Picture: Cardiac arrhythmia.
· Treatment: Induction of K excretion.
2- Citrate intoxication:
· Aetiology: ­ citrate in transfused blood.
· Pathology: Citrate binds with ca ® ca citrate ® hypocalcaemia.
· Clinical Picture: Cardiac arrhythmia.
· Treatment: 10 ml Ca gluconate is given for each two units of blood.
3- Cardiac Arrest:
· Aetiology: * Hypothermia ® cold blood transfusion.
* Hyperkalaemia. * Hypocalcaemia.
· C.l.p.& ttt: That of cardiac arrest.
4- Haemorrhagic diathesis:
· Aetiology : Either due to consumption coagulopathy after D.I..C.or due to dilution of blood with transfused blood which has no coagulation factors .
· Diagnosis: Subcutaneous petichae or continuous ooze from the surgical wound.
· Treatment: Fresh frozen plasma transfusion.
(C) Other complications :
(1) Hepatic coma :
· Aetiology: ammonia in the patient's blood ® Hepatic coma in a patient with hepatic cirrhosis .
(2) Complications of I.V. infusion :
· Air embolism, Phlebitis, Volume overload.
(3) Post-transfusion jaundice:
· Due to destruction of RBCs of old blood, stored more than 3 weeks.
Trials to Reduce Risks of Transfusion:
A) Autologous blood transfision: in which patients receive their own previously donated blood in elective surgery. This reduces the needs for homologous blood and minimize complications.
B) Frozen blood: Blood may be frozen and stored for long periods at very low temperatures of -80 to – 190 degrees C. The technique includes adding glycerol to freshly collected blood after removing the plasma to protect the red cells during freezing and thawing processes.
This can solve the problem of difficulty in continuous blood supply from blood banks.
· Advantages of frozen blood:
1) Red cells supply for transfusion is increased much.
2) Rare blood types are preserved in sufficient quantities for time of need.
3) Blood is collected and reserved for patients who insist on auto-transfusion.
4) Forzen blood is free from white cells and platelets which is ideal for transfusing, patients during cardio-pulmonary bypass and transplantation recipient.
5) Frozen blood seems to be free from viable hepatitis viruses.
Disadvantages of frozen blood:
1) Special freezing, thawing and storage facilities are needed.
2) Limited stability of red cells after thawing.
3) Absence of coagulation factors, platelets and white cells.
SOURCE: DR. AYMAN SALEM'S BOOK
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