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.
That is why this presentation sheds light on the common adverse effects of blood transfusion:
- Hemolytic reactions
- Allergic reactions
- Febrile non-hemolytic reactions
- Transfusion-related acute lung injury (TRALI)
- Delayed hemolytic reactions
- Iron overload
- Transfusion-Associated Circulatory Overload (TACO)
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.
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
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).
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.
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.
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.
Risk Factors Associated With The Adverse Effects
Image: Blood type incompatibility. From Freepik
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 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. 
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.  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. 
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
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.
- Timely reporting of any adverse reactions as well as detailed documentation of the reaction, action taken, and patient response are crucial for future references.
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.
Image credit: Alena_z on Freepik
In conclusion, healthcare professionals and patients must understand the common adverse effects of blood transfusion. That is why it is important to emphasise the need for vigilant monitoring, preventive measures, patient empowerment, and ongoing improvement in blood transfusion. This holistic understanding ensures a safer transfusion environment for everyone involved.
1. JPAC, Transfusion Handbook Adverse Effects of Transfusion PDF [Internet 2014]. Accessed 14 December 2023
2. Monica V, Kiran D. Effect of Blood Storage on Complete Biochemistry ResearchGate. January 2015 Journal of Blood Disorders & Transfusion 06(06) DOI:10.4172/2155-9864.1000329
3. The World Health Organization Haemovigilance. [Internet, n.d.] Accessed, 14 December 2023
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