Blood Transfusion: Risks, Allergic Reactions & More

Administration of blood to replace blood lost by the body

Blood transfusion is an effective medical procedure that involves transferring blood or blood components from one person to another, either directly or through donated blood products. This practice has been used since the early 20th century and has saved countless lives. Blood transfusions are used to treat various conditions including severe injury or trauma, anemia, bleeding disorders, and cancer. During a transfusion, donor blood is screened for compatibility in order to reduce the risk of complications. Donated blood is also tested for infectious diseases such as HIV and hepatitis. After the process is complete, the recipient receives healthy red blood cells capable of replacing lost or damaged ones. Furthermore, other components of donated blood can help replace lost proteins, replace fluids, and boost overall immunity. With proper screening and testing procedures in place, a successful blood transfusion can be very beneficial for both donors and recipients alike. Please keep reading for details on the following topics:

Indications for blood transfusion

Signs of an allergic reaction to blood

Risks of blood transfusions

Blood transfusion procedure

When to seek urgent medical care

Indications for blood transfusion include:

Severe Bleeding: Transfusions are often necessary to replace blood lost due to trauma, surgery, or childbirth.
Anemia: When red blood cell count is low, causing symptoms like fatigue, weakness, and shortness of breath, transfusions may be used to increase oxygen-carrying capacity.
Sickle Cell Disease: Patients with sickle cell anemia may require transfusions to manage complications and prevent crises.
Cancer Treatment: Chemotherapy and radiation therapy can lower blood cell counts, necessitating transfusions to maintain adequate levels.
Bone Marrow Disorders: Conditions like aplastic anemia, myelodysplastic syndrome, and leukemia may require transfusions due to bone marrow dysfunction.
Major Surgery: Some surgeries, especially those involving significant blood loss or lengthy procedures, may necessitate transfusions to maintain blood volume and oxygen delivery.
Certain Medical Conditions: Conditions such as thalassemia, hemophilia, and immune thrombocytopenia may require transfusions to manage symptoms and complications.
Organ Transplants: Patients undergoing organ transplantation may require transfusions to support them during surgery and postoperative recovery.
Severe Infections: In cases of severe sepsis or septic shock, transfusions may be necessary to improve oxygen delivery and support vital organ function.
Hemorrhagic Shock: Transfusions can be critical in stabilizing patients experiencing shock due to acute blood loss.

Blood selection for transfusion involves several steps to ensure compatibility and minimize the risk of adverse reactions. Here’s an overview of the process:

Blood Typing: The ABO blood group system classifies blood into four major types: A, B, AB, and O, based on the presence or absence of specific antigens on red blood cells. Additionally, blood is classified as Rh-positive or Rh-negative based on the presence or absence of the Rh antigen. Blood typing is typically done using laboratory tests to determine the donor’s and recipient’s blood type.
Crossmatching: After blood typing, a crossmatch test is performed to further ensure compatibility between the donor’s blood and the recipient’s blood. This involves mixing a sample of the donor’s blood with a sample of the recipient’s blood plasma to check for any adverse reactions, such as agglutination (clumping) or hemolysis (destruction of red blood cells). A compatible crossmatch indicates that the donor’s blood is suitable for transfusion to the recipient.
Antibody Screening: In addition to ABO and Rh typing, antibody screening is conducted to detect any unexpected antibodies in the recipient’s blood that could react with donor blood antigens. This is especially important for patients who have received multiple transfusions or have been pregnant, as they may have developed antibodies against specific blood antigens.
Specialized Testing: In certain cases, additional testing may be required to ensure compatibility, such as identifying specific antigen systems (e.g., Kell, Duffy, Kidd) or performing extended crossmatching for patients with a history of transfusion reactions or complex antibody profiles.
Donor Screening: Donor blood undergoes rigorous screening for infectious diseases, including HIV, hepatitis B and C, syphilis, and other blood-borne pathogens. Donors are also screened for risk factors that may affect the safety of the donated blood, such as recent travel to areas with endemic diseases or behaviors associated with increased transmission risk.

By carefully matching donor blood to recipient blood based on ABO and Rh compatibility, conducting crossmatching tests, screening for unexpected antibodies, and ensuring donor blood safety through rigorous testing, blood selection for transfusion aims to minimize the risk of adverse reactions and maximize patient safety.

Blood Compatibility

This refers to the ability of donor blood to be safely transfused into a recipient without causing adverse reactions. Compatibility is determined by the presence or absence of specific antigens on the surface of red blood cells and the presence of corresponding antibodies in the recipient’s blood plasma. Here’s a summary of blood compatibility based on the ABO blood group system and the Rh factor:

ABO Blood Group System:
- Type A: Can receive blood from type A or type O donors.
- Type B: Can receive blood from type B or type O donors.
- Type AB: Can receive blood from type A, type B, type AB, or type O donors (universal recipient).
- Type O: Can only receive blood from type O donors (universal donor).
Rh Factor:
- Rh-positive (Rh+): Can receive Rh-positive (Rh+) or Rh-negative (Rh-) blood.
- Rh-negative (Rh-): Can only receive Rh-negative (Rh-) blood.

It’s important to note that this is a general overview, and there are other factors to consider, such as compatibility for specific antigens beyond the ABO and Rh systems, as well as any special requirements or antibodies present in the recipient’s blood. Always consult with a healthcare professional or blood bank for specific compatibility testing and recommendations.

The blood transfusion procedure typically involves the following steps:

Patient Assessment: Before transfusing blood, healthcare providers assess the patient’s medical history, current condition, and the need for transfusion based on symptoms, laboratory tests, or clinical indications.
Informed Consent: Healthcare providers explain the risks, benefits, and alternatives of the procedure to the patient or their authorized representative. Informed consent is obtained before proceeding with the procedure.
Blood Ordering: Based on the patient’s blood type and any specific requirements, such as irradiated or leukoreduced blood, healthcare providers order the appropriate blood products from the blood bank or transfusion service.
Blood Collection: Donated blood undergoes a series of tests to screen for infectious diseases and ensure compatibility with the recipient. Once cleared, the blood is collected from the donor and processed into various components, such as red blood cells, plasma, and platelets.
Blood Matching: Blood typing and crossmatching are performed to match the donor blood with the recipient’s blood type and screen for any compatibility issues. Antibody screening may also be conducted to detect unexpected antibodies in the recipient’s blood.
Preparation: Prior to the transfusion, healthcare providers verify the patient’s identity using two unique identifiers, such as name and date of birth, and confirm the blood product’s compatibility with the patient’s blood type.
Transfusion Setup: A dedicated intravenous (IV) line is established, typically in a vein in the arm or hand, using a sterile technique. Blood transfusion tubing with an inline filter is connected to the IV line, and the blood product is hung on an IV pole.
Vital Signs Monitoring: Before, during, and after the procedure, healthcare providers monitor the patient’s vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect any adverse reactions.
Transfusion Administration: The transfusion begins at a slow rate (typically 2-4 milliliters per minute) for the first 15 minutes to monitor for any immediate reactions. If no adverse reactions occur, the rate may be increased gradually, following institutional guidelines.
Observation: Throughout the transfusion, healthcare providers closely monitor the patient for signs of adverse reactions, such as fever, chills, rash, shortness of breath, or chest pain. If any symptoms arise, the transfusion is stopped immediately, and appropriate interventions are initiated.
Post-Transfusion Monitoring: After the transfusion is completed, healthcare providers continue to monitor the patient for any delayed reactions or complications. Documentation of the transfusion, including the volume of blood administered and any adverse events, is recorded in the patient’s medical record.
Disposal: Once the transfusion is finished, the blood transfusion tubing, IV catheter, and any unused blood products are disposed of according to hospital protocols for biohazardous waste.

SIGNS OF AN ALLERGIC REACTION TO BLOOD, also known as transfusion reactions, may include:

Fever: An unexplained increase in body temperature above normal levels.
Hives: Red, itchy welts on the skin that may appear suddenly and can vary in size and shape.
Shortness of Breath: Difficulty breathing or feeling breathless, which may indicate a respiratory reaction.
Pain: Discomfort or soreness at the injection site or in other parts of the body.
Rapid Heart Rate: An elevated heart rate, also known as tachycardia, which may accompany other symptoms of an allergic reaction.
Chills: Shivering or feeling cold despite normal room temperature, often accompanied by other symptoms.
Low Blood Pressure: Hypotension, characterized by a drop in blood pressure, which can lead to dizziness or fainting.

RISK AND COMPLICATIONS

Allergic Reactions: These can range from mild itching and hives to severe anaphylaxis, potentially causing difficulty breathing and a drop in blood pressure.
Hemolytic Reactions: Occur when the recipient’s immune system attacks the transfused blood, leading to the destruction of red blood cells. This can result in fever, chills, nausea, and potentially life-threatening complications such as kidney damage.
Transfusion-Related Acute Lung Injury (TRALI): A rare but serious reaction characterized by acute respiratory distress, often occurring within hours of transfusion.
Transfusion-Associated Circulatory Overload (TACO): When blood transfusion is administered too rapidly or in excessive amounts, it can lead to fluid overload, causing symptoms such as shortness of breath, coughing, and pulmonary edema.
Infections: While rigorous screening is done to minimize the risk, there is still a small chance of transmitting infections such as HIV, hepatitis B and C, syphilis, and West Nile virus through transfusion.
Iron Overload: Frequent blood transfusions can lead to an accumulation of iron in the body, known as hemochromatosis, which can cause damage to organs such as the liver, heart, and pancreas.
Graft-Versus-Host Disease (GVHD): A rare complication where transfused donor T cells attack the recipient’s tissues, leading to symptoms ranging from rash and diarrhea to multiorgan failure.
Delayed Hemolytic Reaction: An immune response that occurs days to weeks after transfusion, resulting in the destruction of transfused red blood cells.
Febrile Non-Hemolytic Reaction: Characterized by fever and chills without evidence of hemolysis, typically caused by immune response to donor white blood cells or cytokines.
Citrate Toxicity: Anticoagulant citrate is used to prevent blood clotting during storage, but excessive citrate infusion can lead to metabolic disturbances such as hypocalcemia and metabolic alkalosis.

WHEN TO SEEK URGENT MEDICAL CARE

Seek urgent medical care if you experience any of the following symptoms during or after a blood transfusion:

Shortness of Breath: Difficulty breathing or feeling like you can’t get enough air.
Chest Pain: Pain or discomfort in the chest, which may radiate to the shoulders, arms, neck, or jaw.
Severe Allergic Reaction: Symptoms may include hives, itching, swelling (especially of the face, lips, tongue, or throat), wheezing, or difficulty swallowing.
Fever: A temperature above 100.4°F (38°C) during or shortly after the transfusion may indicate an infection or other adverse reaction.
Chills: Shivering or feeling cold despite normal room temperature, which may accompany a fever or allergic reaction.
Nausea or Vomiting: Persistent nausea or vomiting, especially if accompanied by other symptoms such as abdominal pain or fever.
Dizziness or Fainting: Feeling lightheaded, dizzy, or fainting may indicate a drop in blood pressure or other cardiovascular issues.
Unusual Bleeding or Bruising: Excessive bleeding from the IV site, nosebleeds, or easy bruising may suggest a problem with clotting factors.
Back Pain: Severe pain in the back, chest, or abdomen, particularly if it is sudden or sharp in nature.
Changes in Mental Status: Confusion, disorientation, agitation, or loss of consciousness may be signs of a severe reaction or complication.

Disclaimer: The information provided in this content is for general informational purposes only. It is not intended as medical or healthcare advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare professional with any questions you may have regarding a medical condition or healthcare decisions.