COMPLICATIONS OF MASSIVE TRANSFUSION

Massive transfusion is defined as

Replacement of a blood volume equivalent within 24hrs
>10 RBC units within 24 hrs.
Transfusion > 4 RBC units in 1 hr
Replacement of 50% of blood volume in 3hrs

Its complications can be broad divided into

The classification is as follows:
 Hypothermia: Hypothermia(since RBC are stored in 4C) rapid transfusion lower patient
core temperature this can be prevented by warming
 Metabolic: Acidosis, Hyperkalemia,metabolic alkalosis,TRALI
 Hemostatic: Citrate toxicity and hypocalcemia, Depletion of fibrinogen and coagulation
factors, Depletion of platelets, Disseminated intravascular coagulopathy (DIC), Reduced
2,3 diphosphoglycerate (2,3 DPG), Microaggregates

Pathophysiology of transfusion related acute lung injury

Transfusion-related acute lung injury (TRALI) is a severe and potentially life-threatening
complication that can occur after blood transfusions. The pathophysiology of TRALI is complex
and not fully understood, but it is believed to involve an immune-mediated reaction and an
inflammatory response. Here's an overview of the pathophysiology of TRALIM

Immune-mediated reaction: TRALI is often associated with the presence of leukocyte

antibodies in the blood products being transfused. These antibodies can target antigens on the
surface of white blood cells (neutrophils, in particular) in the recipient's lungs.

Activation of neutrophils: When the transfused antibodies interact with the recipient's white
blood cells (neutrophils), it triggers their activation and adhesion to the endothelial cells that
line the blood vessels in the lungs.

Release of inflammatory mediators: The activated neutrophils release a variety of

inflammatory mediators, including cytokines, chemokines, and reactive oxygen species. These
substances cause damage to the endothelial cells and increase the permeability of the
pulmonary capillaries.

Increased capillary permeability: The increased permeability of the pulmonary capillaries leads
to leakage of fluid and proteins from the bloodstream into the lung interstitium and alveoli.

Pulmonary edema: As fluid accumulates in the lungs, it leads to pulmonary edema (fluid-filled
lungs). This impairs gas exchange and can cause severe respiratory distress.
 Management of TRALI
Immediate actions to take when TRALI is suspected include (1) stopping the transfusion, (2)
supporting the patient’s vital signs, (3) determining the protein concentration of the pulmonary
edema fluid via the endotracheal tube, (4) obtaining a complete blood count and chest
radiograph, and (5) notifying the blood bank of possible TRALI so that other associated units can
be quarantined.

Shock is a life-threatening medical condition that occurs when there is a severe decrease in
blood flow throughout the body. This results in insufficient oxygen and nutrients being delivered
to the body's tissues and organs, which can lead to organ failure and death if not promptly
treated.

The main types of shock include:

Hypovolemic Shock: This type of shock occurs when there is a significant loss of blood or fluid
from the body, such as in cases of severe bleeding, dehydration, or burns.
Management of Hypovolemic Shock:

 Control bleeding if present.

 Administer intravenous fluids and blood products to replace lost volume.
 Elevate the legs if no spinal injury is suspected.
 Identify and treat the underlying cause of fluid loss.

Cardiogenic Shock: Cardiogenic shock happens when the heart is unable to pump enough blood
to meet the body's demands. It can be caused by conditions like heart attacks, severe heart
failure, or arrhythmias.

Management of Cardiogenic Shock

 Administer medications to improve heart function and blood pressure.
 Provide oxygen support.
 Consider interventions like angioplasty or stent placement in case of a heart attack.
 In severe cases, mechanical support devices like intra-aortic balloon pumps or
ventricular assist devices may be used.
Distributive Shock: Distributive shock occurs when there is an abnormal distribution of blood
flow within the body. The most common types are:
a. Septic Shock: Caused by severe infections, resulting in a systemic inflammatory response.
b. Anaphylactic Shock: Caused by severe allergic reactions to allergens like food, medications,
or insect stings.
c. Neurogenic Shock: Caused by spinal cord injuries or severe emotional distress, leading to a
sudden drop in blood pressure.
Management of Distributive Shock
 Administer antibiotics and fluids promptly in septic shock.
 Treat the underlying cause of the allergic reaction and administer epinephrine in
anaphylactic shock.
 For neurogenic shock, focus on stabilizing the spine and providing fluid support.

Obstructive Shock: This type of shock occurs when there is a physical obstruction that prevents
adequate blood flow, such as in cases of pulmonary embolism, cardiac tamponade, or tension
pneumothorax.
Management of Obstructive Shock
 Treat the underlying cause of the obstruction, such as relieving tension pneumothorax or
draining pericardial fluid in cardiac tamponade.
 Administer fluids and medications to support blood pressure.