Adverse Outcomes in Blood and Blood Component Therapy Henry O. Ogedegbe, Ph.D., BB(ASCP), C(ASCP)SC, Assistant Professor Department of Environmental Health, Molecular and Clinical Sciences, Florida Gulf Coast University, 10501 FGCU Blvd. South, Fort Myers, FL 33965-6565 Tel: 941-590-7486 Fax: 941-590-7474 E-mail: Abstract A blood transfusion is a special kind of transplantation and/or medical therapeutic intervention that carries with it great benefits and risks to the recipient. It involves the transfer of living tissue from one person to another and thus a recipient of a transfusion may experience an adverse reaction to the product during or soon after the transfusion. It is imperative that laboratory, nursing and clinical staff understand the different types of transfusion reactions so that they can deal with the situation when it occurs. The adverse transfusion reactions may be classified as immune mediated or non-immune mediated. The immune mediated transfusion reactions are usually due to alloantibodies formed after a previous exposure to foreign antigen through pregnancy, transfusion or transplantation and may result in a hemolytic or non-hemolytic transfusion reaction. A transfusion reaction may be immediate or delayed and when hemolysis is involved, it is usually either intravascular or extravascular. The non-hemolytic reactions include febrile non-hemolytic transfusion reactions, allergic reactions and anaphylactic reactions. Cytokines have been implicated as contributing to the febrile reaction experienced by the transfusion recipient. The cytokines may be released into the blood or blood components by contaminating leukocytes in the products. Leukocytes may also cause alloimmunization, and transmission of infectious diseases, transfusion-related acute lung injury, and immunomodulation. Adverse effects of transfused cellular blood components therefore may depend not only on the number of residual leukocytes in the blood or blood components, but also on the timing of the leukocyte removal. Extra care must be taken to ensure that the products transfused into a patient are safe and incapable of causing adverse reactions. In spite of all the care and good intensions exercised by the laboratory, nursing and clinical staff involved with transfusion therapy, accidents still occur. Many of these accidents are clerical in nature and therefore easily preventable if standard operating procedures are adhered to.
Background A blood transfusion may be considered a special kind of transplantation, and medical therapeutic intervention that carries with it many benefits and risks to the recipient. It involves the transfer of living tissue from one person to another. At times, a recipient of a blood or blood component transfusion may experience an adverse reaction as a result of the transfusion. Because of the risk of morbidity and mortality associated with transfusion therapy, no transfusion should be given until the decision is made that it is absolutely necessary and even then it must be done with the utmost care. The adverse and at times very severe transfusion reactions experienced by some recipients of blood and blood components therapy, have various causes some of which include the presence of red blood cell (RBC), leukocyte or plasma protein antibodies in the recipient and bacterial contamination of the transfused components. Fever, rigor, and dyspnea are common manifestations of these reactions, which may be mediated by cytokines or biological response mediators (BRMs), complement, or endotoxin. Hypotension with or without urticaria or erythema may also be a prominent feature, and bradykinin (BK) has also been implicated as mediator.1 As little as 10 to 15 ml of incompatible blood have been shown to trigger a transfusion reaction.
To prevent these potentially life threatening events from occurring, it is imperative that the clinical, nursing and laboratory staff understand the different types of transfusion reactions and how to deal with them when