ADVERSE EFFECTS OF BLOOD TRANSFUSION
IHTR due to extravascular hemolysis.
TRANSFUSION REACTION
 any unfavorable transfusion-related event
occurring in a patient during or after transfusion
of blood components.
Typical causes of transfusion-associated deaths:
 Acute hemolysis
 Acute pulmonary edema
 Bacterial contaminatiion of product
 Delayed hemolytic reactions
 Anaphylaxis
 External hemolysis
 Damaged blood component
 Transfusion associated GVHD
Four leading causes of error:
1. Improper specimen identification
2. Improper patient identification
3. Antibody identification error
4. Crossmatch procedure error
HEMOLYTIC TRANSFUSION REACTION
A. Immediate hemolytic transfusion reaction
occurs very soon after the transfusion of
incompatible RBCs.
 warming signs include hemoglobinuria,
abnormal bleeding at the surgical
wound site & hypotension. -
underlying cause is transfusion of ABO-
incompatible blood
 most IHTR’s are caused by clerical
errors.
B. Delayed hemolytic transfusion reaction
 result of an anamnestic response in a
patient who has previously been sensitized
by transfusion, pregnancy or transplant and
in whom antibody is not detectable by
standard pretransfusion methods.
Two different types of DHTR:
1. Secondary (anamnestic) response to transfused
RBCs
2. Primary alloimmunization
Clinical signs and symptoms are mild compared to
NONHEMOLYTIC TRANSFUSION REACTION
A. Immediate nonhemolytic transfusion reaction
1. Febrile reaction
 is the most commonly encountered type of
transfusion reaction.
 defined as a 1°C temperature rise
associated w/ transfusion and having no
medical explanation other than blood
component transfusion.
 caused by leukocyte antibodies present in
the patient's plasma
 common signs and symptoms include fever
w/ or w/o chills and rarely hypotension.
2. Allergic(Urticarial) transfusion reaction - are as
commonly reported as FNHTRs.
cause by two possible reasons:
a. The donor plasma has foreign protein (allergen)
that reacted w/ the patient's immunoglobulin E
reagin or immunoglobulin G(lgG) or both.
b. The donor plasma has reagins that combine
with the patient's allergens in the plasma. -
signs & symptoms include local
erythema(redness), pruritus(itching) and
hives(raised, firm red welts)
3. Anaphylactic & anaphylactoid reactions Are of the
immediate hypersensitivity type of immune system
response.
 Can range from mild urticaria and pruritus to
severe shock & death.
Two significant features distinguish anaphylaxis
reaction from other types of transfusion reactions:
a. Fever is absent
b. Clinical signs & symptoms occur after
transfusion of just a few milliliters of plasma or
plasma-containing blood components
4. Noncardiogenic pulmonary edema
reactions(TRALI)
 the cause is not well understood, the most
consistent finding is leukocyte antibodies in
donor or patient plasma.
5. Transfusion-associated circulatory overload
 a good example of an iatrogenic(physician-
caused) transfusion reaction. Patients at
 significant risk include children, elderly
patients and patients w/ chronic
normovolemic anemia, cardiac
disease,thalassemia major or sickle cell
disease.
 the most frequent cause is the transfusion of a
unit at too fast arate.
6. Bacterial contamination reactions
 deaths caused by bacterial contamination of
the blood components are usually due to
 Yersinia enterocolitica. Others may be due to
E. coli & Pseudomonas species. This is
attributed to the endotoxin produced by
these bacteria.
7. Physically or chemically induced transfusion
reaction
 includes physical RBC damage, depletion &
dilution of coagulation factors and platelets,
hypothermia, citrate toxicity, hypokalemia or
hyperkalemia & air embolism.
B. Delayed nonhemolytic transfusion reaction
1.Alloimmunization
 may result from prior exposure to donor
blood components.
2.Post-transfusion purpura
 Characterized by a rapid onset of
thrombocytopenia as a result of anamnestic
production of platelet alloantibody. -Usually
occurs in multiparous females.
3.Transfusion-associated graft-versus-hos disease
(TAGVHD)
 a complication of blood component therapy
or bone marrow transplantation.
 High-risk individuals include those with
lymphopenia, newborn infants who are
recipients of exchange transfusion, fetuses
receiving intrauterine transfusion,
immunodeficient individuals and patients
receiving blood components from blood
relatives.
4.Iron Overload
 also known as transfusion hemosiderosis.
 a long term complication of RBC transfusion.
5.Immunosuppression
 a generalized, nonspecific effect that
diminishes the activity of the recipient’s
immune system soon after blood transfusion.
6.Transfusion transmitted diseases
 HIV, Hepatitis, HTLV, WNV, Syphilis, Malaria,
Babesia
Laboratory investigation for HTR
A. Immediate procedure
 Clerical checks
 Visual inspection of serum and plasma for free
hemoglobin (pre & post transfusion)
 DAT (posttransfusion sample)
B. “As required procedure”
 ABO & Rh typing (pre&post)
 Major compatibility testing (pre & post)
 Antibody screen (pre & post)
 Alloantibody formation
 Free hemoglobin in first voided urine
posttransfusion
 Unconjugated bilirubin 5-7 hrs. post
transfusion
C. Extended procedures
 -Gram stain & bacterial culture of unit
 -Quantitative serum hemoglobin
 -Serum haptoglobin (pre & post)
 -Peripheral blood smear
 -Coagulation & renal output studies
 -Hemoglobin electrophoresis
 -Urine hemosiderin
 -Serial hemoglobin, hematocrit & platelet
counts
CROSSMATCH TESTING
 testing of the patient’s serum with the donor red
blood cells including an antiglobulin phase or
simply an immediate spin phase to confirm ABO
compatibility. -the term “compatibility test” &
crossmatching are two different things. A
crossmatch is only part of a pretransfusion
compatibility test.
Two types of crossmatching:
1. Major crossmatch - donor's red cells and
patient's serum
2. Minor crossmatch - donor's serum and patients
red cells.
Serologic crossmatch tests:

a. Immediate spin crossmatch

 to detect ABO incompatibility.

b. Antiglobulin crossmatch
 to detect clinically significant
antibodies such as anti-Jk, anti-K
and anti-Fy.
 enhancement media may be
applied to enhance antigen-
antibody reactions such as albumin,
LISS, polyethylene glycol and
polybrene. For greatest sensitivity,
an antiglobulin reagent containing
both antiIgG and anticomplement is
used for the final phase.