Hemolytic reactions occur when the recipient's serum contains antibodies directed against the corresponding antigen found on donor red blood cells. This can be an ABO incompatibility or an incompatibility related to a different blood group antigen.
Disseminated intravascular coagulation (DIC), renal failure, and death are not uncommon following this type of reaction.
The most common cause for a major hemolytic transfusion reaction is a clerical error, such as a mislabelled specimen sent to the blood bank, or not properly identifying the patient to whom you are giving the blood. DO NOT ASSUME IT IS SOMEONE ELSE'S RESPONSIBILITY TO CHECK!
Allergic reactions to plasma proteins can range from complaints of hives and itching to anaphylaxis. Such reactions may occur in up to 1 in 200 transfusions of RBCs and 1 in 30 transfusions of platelets.
White blood cell reactions (febrile reactions) are caused by patient antibodies directed against antigens present on transfused lymphocytes or granulocytes. The risk for febrile reaction is 1 in 1,000 to 10,000.
Symptoms usually consist of chills and a temperature rise > 1 degree C.
Transfusion related acute lung injury (TRALI)
TRALI is now the leading cause for transfusion-related mortality. It is caused most often when donor plasma contains HLA or leukocyte (usually granulocyte) specific antibodies. Recipient leukocytes may be 'primed' by underlying illness to become more adherent to pulmonary alveolar epithelium. Introduction of the donor antibodies into the recipient causes granulocyte enzymes to be released, increasing capillary permeability and resulting in sudden respiratory distress from pulmonary edema, typically within 6 hours of tranfusion. Leukopenia may transiently occur. Most cases improve within 2 days.
TRALI most often occurs with administration of blood products with plasma, such as FFP. Use of plasma from men reduces the incidence of TRALI, since women who have been pregnant are more likely to have higher titer HLA antibodies.
Bacterial contamination of blood can occur during collection. Bacteria can grow during storage at room temperature and during refrigeration (psychrophilic organisms). Platelet products carry the greatest risk, because they are stored at room temperature. Transfusing a contaminated unit can result in septic shock and death.
Circulatory overload can occur with administration of blood or any intravenous fluid, particularly in patients with diminished cardiac function.
RBC transfusions can expose the patient to RBC antigens not recognized as self. If an antibody is produced, future transfusions can be delayed because extended donor blood typing will be required to identify compatible units.
O negative blood released uncrossmatched in emergencies could result in a hemolytic transfusion reaction if the patient has an alloantibody produced after a previous transfusion.
Alloantibody production in a female can result in hemolytic disease of the newborn.
Platelets contain HLA and A & B antigens. Prior exposure to non-self HLA antigens (from WBC contamination of red cell products) can result in antibodies that will render future platelet transfusions useless.
Graft Versus Host Disease (GVHD)
GVHD is a situation where transfused lymphocytes engraft and multiply in immunocompromised patients (e.g., bone marrow transplant patients). The newly engrafted lymphocytes attack the host. This is the opposite of a host rejecting a transplanted organ (e.g., a heart).
Transfusion-associated graft versus host disease (TAGVHD) is a different disease from GVHD in allogeneic bone marrow transplant recipients. TAGVHD is uniformly fatal and untreatable. It occurs when the blood products contain T-lymphocytes and attack many host tissues. It occurs when the recipient is immunocompromised
TAGHVD is prevented by gamma-irradiating the blood products to be transfused.