Blood Transfusion

1. Increase oxygen carrying capacity
2. Restore blood volume in acute blood loss

Other Factors to be Considered Before Blood Transfusion:

1. The patient's symptoms, signs, and functional capacities
2. The presence of cardiorespiratory, vascular, and central nervous system disease
3. The cause and anticipated course of the anemia
4. Alternative therapies such as recombinant human erythropoietin (EPO) therapy

Acute transfusion reactions present as adverse signs or symptoms during or within 24 hours of a blood transfusion. The most frequent reactions are fever, chills, urticaria, or shortness of breath, which resolve promptly without specific treatment or complications. More serious reactions, such as hemolysis or sepsis, are potentially fatal.

Transfusion reactions require:

• Immediate recognition
• Laboratory investigation
• Clinical management

If a transfusion reaction is suspected during blood administration, the safest practice is to:

• Stop the transfusion and
• Keep the intravenous line open with 0.9% sodium chloride (normal saline)
• A clerical check of the blood unit label and patient should be performed
• Return blood product to the blood bank, and a transfusion reaction investigation should be initiated

Immune Reactions:

• Acute (hemolytic/non-hemolytic)
• Delayed

Non-Immune Reactions:

• Acute
• Delayed

Immune-Mediated Transfusion Reactions

Acute Reactions:

• Hemolytic (Donor’s RBC + recipient’s antibody → RBC Destruction)
• Non-hemolytic (e.g., febrile, urticarial, anaphylactic reactions)
• Transfusion-related acute lung injury (TRALI)

Delayed Reactions:

• Hemolytic (following non-ABO incompatibility)
• Alloimmune (development of antibodies following blood transfusion)
• Graft vs. host disease (donor's T-cell lymphocytes proliferate in response to recipient’s histocompatibility antigen)
• Platelet refractoriness (following anamnestic production of antiplatelets leading to platelet destruction)

Non-Immune Mediated Transfusion Reactions

Acute Reactions:

• Hemolytic (RBCs in-vitro hemolysis following damage)
• Embolic phenomenon (Air, Thrombus)
• Metabolic:
• Hyperkalaemia
• Hypocalcaemia
• Hypothermia
• Citrate toxicity
• Circulatory overload

Delayed Reactions:

• Iron overload
• Infections/contamination:
• Viral (e.g., HBV, HCV, HGV, HIV, HHV-8, CMV, EBV, HTLV 1 & 2)
• Bacterial (e.g., E. coli, Pseudomonas)
• Parasitic (e.g., malaria, Toxoplasma, Leishmania, Lyme, Babesiosis)

A. Quality Improvement

• Proper specimen identification
• Proper patient identification
• Eliminate error in antibody identification
• Eliminate error in incompatibility testing

B. Safe Procedures

• Maintain asepsis
• Transfuse screened blood only
• Transfusion reaction records and reporting
• Transfusion reaction laboratory investigations within 24 hours of the reaction