Image of a blood bag on a drip stand during blood transfusion

Introduction

Image: Blood Transfusion.  Photo by Aman Chaturvedi on Unsplash

By Foluke Akinwalere. Freelance Health Writer. With medical review and editorial support by the DLHA Team.

Blood transfusion plays a crucial role in saving lives and improving health outcomes. But beyond the life-saving narrative of blood transfusion, there are risks associated with this modern intervention.

For instance, mistakes in identifying patient blood samples and components lead to many preventable severe adverse effects. Approximately 1 in 13,000 blood component units are transfused to the wrong patient, and up to 1 in 1,300 pre-transfusion blood samples are taken from the wrong patient.[1]

That is why this presentation sheds light on the common adverse effects of blood transfusion:

Immediate reactions 

• Hemolytic reactions
• Allergic reactions
• Febrile non-hemolytic reactions
• Transfusion-related acute lung injury (TRALI)

Delayed reactions

• Delayed hemolytic reactions
• Infection
• Iron overload
• Transfusion-Associated Circulatory Overload (TACO)

Patient lying on a hospital bed with apparent fever folowing blood transfusion

Immediate Reactions of Blood Transfusion

Image: Patient with fever after blood transfusion. Photo credit by annastills of Freepik

Immediate recognition and management are crucial for these reactions. Symptoms appear within minutes or up to 24 hours after transfusion.

• Hemolytic Reactions

Rapid destruction of transfused red blood cells, often due to blood type incompatibility.   Symptoms include fever, chills, back pain, Hemoglobinuria (red or brown urine), and Hypotension

• Allergic Reactions 

Sensitivity to plasma protein in the transfused blood, particularly IgA antibodies.  Symptoms include itching, urticaria (hives), wheezing, and Anaphylaxis (severe cases).

• Febrile Non-Hemolytic Reactions 

This is caused by the patient’s immune response to transfus d white blood cells due to released cytokines during blood storage, causing symptoms like fever, chills, and headache.
 

• Transfusion-Related Acute Lung Injury (TRALI) 

Results from immune response to transfused white blood cells, leading to lung injury.  Symptoms are acute respiratory distress, Hypoxemia (low blood oxygen), fever, and hypotension (low blood pressure).

Image of a man holding on to his abdomen in apparent pain due to liver issues following blood transfusion.

Delayed Reactions of Blood Transfusion

Image: Liver dysfunction as a result of iron overload

They may occur 24 hours or months after transfusion.
 

• Delayed Hemolytic Reactions

Results from a slower immune response to minor incompatibilities, gradually destroying transfused red blood cells. Symptoms are jaundice, anaemia, and fatigue.
 

• Infections

Although rare due to rigorous screening, infections can still be transmitted through bacteria, viruses, or parasites, through unsafe blood transfusion, causing symptoms that range from mild fever to severe systemic effects.
 

• Iron Overload 

Accumulation of iron from frequent transfusions, particularly in patients with chronic conditions like thalassemia can lead to gradual organ damage. Symptoms include joint pain, abdominal pain, or liver dysfunction
 

• Transfusion-Associated Circulatory Overload (TACO) 

This is caused by the rapid infusion of a large volume of blood, especially in patients with compromised cardiac function. Symptoms such as dyspnea, cough, hypertension, and peripheral edema can manifest.

Multiple vials containing blood samples from blood draw.

Risk Factors Associated With The Adverse Effects

Image: Blood type incompatibility. From Freepik

• Patient-Related Factors

Patients with a history of previous transfusions may develop antibodies against specific blood components, which may increase the risk of hemolytic reactions. 

Individuals with compromised immune systems, whether due to medical conditions or treatments, are more susceptible to infections and may experience worsened reactions.
 

• Blood-Related Factors

Blood Type Incompatibility:  ABO and Rh incompatibility between donor and receiver can trigger immediate and severe hemolytic reactions.

Prolonged storage of blood units can alter the biochemical composition of red blood cells, reducing their ability to survive in the patient's bloodstream after transfusion. It is better that patients should receive fresh blood with less than 7 days of storage to reduce non-viable RBC levels. [2]

Hands clasping an image of a drop of blood

Prevention And Correction Of Adverse Effects

Image: Safe blood for patient safety

The WHO suggests that haemovigilance should be integrated into national blood and health policies and systems. [3]  This allows for ongoing improvement in the quality of the transfusion process which includes taking corrective and preventive actions to enhance patient safety and outcomes, as well as donor safety, while also reducing wastage. [3]  

Starting from pre-transfusion considerations to vigilant monitoring during and after the procedure, patient safety must involve a comprehensive approach in terms of:
 

• Blood typing and crossmatching
• Leukoreduction (removal of white blood cells)
• Monitoring of vital organs such as blood pressure, heart rate, and temperature during transfusion.
• Educating healthcare professionals on early signs such as facial swelling or back pain

Collage image showing part of a stethoscope, a synringw and needle, pills and cuts of heart representation

How To Manage Adverse Effects Of Blood Transfusion

Image: From Freeepik

Swift and precise responses are critical to ensure patient safety and well-being.  

• Immediate response protocols, such as stopping the transfusion, supportive care, and medications for pain and symptoms.

• Regular monitoring, follow-up care, and a proactive approach are essential to identify and manage delayed reactions. 

• Medications for specific reactions,  for example, administration of antihistamines, corticosteroids, or diuretics for allergic reactions.

• Timely reporting of any adverse reactions as well as detailed documentation of the reaction, action taken, and patient response are crucial for future references.

A doctor provising information at the bedsie of a patient lying on a bed

Educating Patients on the Adverse Effects of Blood Transfusion

Image: Patient being informed about blood transfusion during the consent process. Photo from Freepik.

Empowering patients with knowledge about potential adverse effects is a key component of ensuring their safety and well-being during and after blood transfusion.
 

• Importance of Informed Consent 

  • Patients should be informed about the purpose, benefits, and potential risks of blood transfusion during the consent process.

• Recognising Signs of Adverse Reactions at Home 

  • Patients and their caregivers must be educated on recognising early signs after returning home. 
  • Clear instructions on when and how to seek immediate medication attention in case of suspected reactions must be given.