SCHOOL OF MEDICINE

DEPARTMENT OF ANESTHESIA

Complication of blood transfusion

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 Outline
Definition of blood transfusion
Purposes of blood transfusion
Components of blood (for transfusion)
Grouping and cross matching
Complications of blood transfusion
Infection
Circulatory overload
Massive transfusion and its complication
Electrolyte disturbance and hypothermia
Immunosuppression

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 Definition
• Blood transfusion is the transfusion of the whole blood or its
component such as blood cells or plasma from one person to
another person.
• Blood transfusion involves two procedure that is
– Collection of blood from donor
and
– Administration of blood to the recipient.

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 Purposes
• To restore the blood volume when there is sudden loss of blood
due to hemorrhage.
• To raise the Hb level in cases of severe anemia
• To treat deficiencies of plasma protein, clotting factors or
hemophilic globulin etc.
• To provide antibodies to those persons who are sick and having
lowered immunity.
• To replace the blood loss by hemolytic agents with fresh blood
• To improve the leukocyte count in blood as in agranulocytosis.
• To combat infection in leucopenia
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 Components of blood (for transfusion)
• Each unit of blood is tested for evidence of hepatitis-b,
hepatitis-c, human immuno deficiency virus I&II and syphilis.
• The blood is then processed into sub-components.
These are-
– Whole blood
– Packed cell volume
– Fresh frozen plasma
– Platelets
– Cryoprecipitate
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 Components of blood (for transfusion)
Whole blood
 Is unseparated blood containing an anticoagulant – preservative
solution.
 One unit of whole blood contains
– 450 ml of donor blood.
– 50 ml of anticoagulant-preservative solution.
– Hemoglobin approx.12g/ml & haematocrit 35%- 45%.
– No functional platelets.

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 Components of blood (for transfusion)
• Stored between +2 and +6 degrees centigrade in a blood
bank refrigerator.
• Transfusion should be started within 30 minutes of removal
from the refrigerator and completed within 4 hours of
commencement because changes in the composition may
occur due to red cell metabolism.

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 Components of blood (for transfusion)
Packed red cells
 Are cells that are spun down and concentrated.
 One unit of packed red cells is approx. 330 ml and has a
haematocrit of 50-70%.
 They are stored in a SAG-M (saline-adenine- glucose-
mannitol) solution to increase their shelf life to 5weeks at 2-
6degrees centigrade.

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 Components of blood (for transfusion)
Fresh frozen plasma
 Is rich in coagulation factors.
 It is separated from whole blood and stored at-40 to -50
degrees centigrade with a 2year shelf-life.
 It is the first line therapy in the treatment of coagulopathic
haemorrhage

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 Components of blood (for transfusion)
Cryoprecipitate
 Is a supernatant precipitate of fresh frozen plasma and is rich in factor VIII
and fibrinogen. And also von Willebrand factor, factor XIII and fibronectin
 It is stored at -30 degrees centigrade with a 2 years shelf life.
 Indicated in low fibrinogen states (<1g/l) or in cases of factor VIII
deficiency (hemophilia-a), von will brand's disease and as a source of
fibrinogen in disseminated intravascular coagulation.
 Pooled units containing 3-6 gms fibrinogen in 200-500 ml raises the
fibrinogen level by approx. 1g/L.
 Must be infused within 6 hours.
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 Blood grouping and cross matching
 Each person has one of the following blood types:
A, B, AB, or O.
 O can be given to anyone but can only receive O.
 AB can receive any type but can only be given to AB.
 Also, every person's blood is either
 Rh-positive or
 Rh-negative.
 People with Rh-positive blood can get Rh-positive or Rh-negative blood.
But people with Rh-negative blood should get only Rh- negative blood.

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8/31/2021 12
 Contents

Complications of blood transfusion

 Acute hemolysis
 Allergy and anaphylaxis
 Transfusion-related acute lung injury
 Bacterial contamination of blood

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 Introduction
• Blood transfusion is the process of transfering blood products in
to one's circulation intravenously.
• Transfusions are used for various medical conditions to replace
lost components of the blood.
• Early transfusions used whole blood, but modern medical
practice commonly uses only components of the blood, such as
red blood cells, white blood cells, plasma, clotting factors and
platlets.

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 Complication of blood transfusion
Transfusions of blood products can be associated with several
complications, many of which can be grouped as
immunological, infectious and massive blood transfusions.
 Immune complications:
Immune complications following blood transfusions are
primarily due to sensitization of the recipient to donor red
cells, white cells, platelets, or plasma proteins. Less
commonly, the transfused cells or serum may mount an
immune response against the recipient.
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 CONT…
Immune coplications can be
 Hemolytic reactions involve specific destruction of the
transfused red cells by the recipient’s antibodies. Less
commonly, hemolysis of a recipient’s red cells occurs as a
result of transfusion of red cell antibodies.
• Hemolytic reactions commonly classified as
acute(intravascular) and delayed (extravascular) hemolytic
reactions.

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 CONT…
 Non hemolytic rections are due to sensitization of the recipient to
the donor’s white cells, platelets, or plasma proteins; the risk of
these reactions may be minimized by the use of leuko reduced
blood products.
• Febrile reactions
• Urticarial reactions
• Anaphylactic reactions
• Transfusion -related acute lung injury
• Graft versus host disease
• Post transfusion purpura
• Transfusion related immunoEthiopia
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modulation
is Ethiopia 17
 CONT…
 Infectious complications
 Bacteria
 Viral
 Parasitic

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 CONT…
 Massive blood transfusions are most often defined as the
need to transfuse one to two times the patient’s blood
volume. For most adult patients, that is the equivalent of 10–
20 units.

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 Acute hemolytic reactions
• Acute hemolytic reactions occur with administration of ABO
incompatible blood and characterized by intravascular
destruction of red blood cells with in 24 hrs after transfusions
and sever in 6% of cases.
• It can be caused by:-
-administration of wrong blood type
- errors in the laboratory technical
-clerical nature

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 CONT…
 symptoms of acute hemolytic reaction following blood
transfusions
In awake patient
 Fever
 Chills
 Nausea
 Chest and flank pain

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 CONT…
In anesthetized patient
 Hyperthermia
 Unexplained tachycardia
 Hypotension
 Hemoglobinurea
 DIC
 Shock
 Kidney failure
NB:- the severity of reaction often depends upon the volume of
incompatible blood that have been adminstered.
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 Investigation
It can be diagnose as one or more of the following
 Fall in hemoglobin
 Rise in lactate dehydrogenase(LDH)
 Positive direct antiglobulin test(DAT)
 Positive crossmatch

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 Management
1) If a hemolytic reaction is suspected, the transfusion should
be stopped immediately and the blood bank should be
notified.
2) The unit should be rechecked against the blood slip and the
patient’s identity bracelet.
3) Blood should be drawn to identify hemoglobin in plasma, to
repeat compatibility testing, and to obtain coagulation
studies and a platelet count

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 Manag…
4) A urinary catheter should be inserted, and the urine should
be checked for hemoglobin.
5) Osmotic diuresis should be initiated with mannitol and
intravenous fluids.

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 Allergy and anaphylaxis
• Allergic reactions are the most common type of transfusion
reaction
• Usually mild but can range from simple urticarial reactions to
life threatening anaphylaxis
• Allergic reactions occur when patients have antibodies that
react with proteins in transfused blood components.

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 Cont…
• Anaphylaxis occurs where an individual has previously been
sensitised to an allergen present in the blood and, on re-
exposure, releases immunoglobulin E (IgE) or IgG antibodies.
• Individuals with severe IgA defiency may develop antibody to
IgA and, with repeated transfusion, are at high risk of allergic
reaction.

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 Essential feature
• Nonhemolytic in nature
• Allergic transfusion reactions are common and generally
mild, presenting as urticaria (hives) and pruritus (itching)
• For a mild allergic reaction, a transfusion can be paused, the
patient given appropriate medication (e.g. diphenhydramine)
and if symptoms resolve completely,

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 Cont…
• The transfusion may continue with observation; this is the
only transfusion reaction that does not require a complete
stop of the transfusion with a workup
• Anaphylaxis is rare; historically attributed to IgA deficiency
• IgA deficient patients should have an appropriate workup and
do not require washed products unless a documented severe
reaction has occurred in the past.

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 Incidence
• Mild reactions: 0.03 - 0.61% RBC transfusions; 0.3 - 6%
platelet transfusions; 1 - 3% plasma transfusions
• Anaphylaxis: 1/20,000 - 1/47,000 transfusions
• Most commonly occur following platelet or plasma
transfusions but can occur following any blood component
transfusion
• Leukoreduction does not reduce the incidence

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 Presentation/Symptoms
• Symptoms or signs may occur after only 5-10 ml of
transfusion of incompatible blood, but can occur up to 4
hours following transfusion
• so patients should be observed closely at the start of each
blood unit transfused.
• Fever is not a symptom of allergic or anaphylactic reactions
• The earlier in the transfusion the reaction starts, generally
the more severe it is

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 Cont…
Mild allergic reactions:
• Urticaria, flushing, pruritus, mild / localized angioedema
(eyes, lips, throat fullness)
Severe / anaphylactic reactions:
• Allergic symptoms plus hypotension, dyspnea with or without
signs of airway obstruction (wheezing, stridor), angioedema,
abdominal pain, vomitting, loss of consciousness, shock

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 Cont…
• Symptoms
• Feeling of apprehension or 'something wrong'.
• Flushing.
• Chills.
• Pain at the venepuncture site.
• Myalgia.
• Nausea.
• Pain in the abdomen, flank or chest.
• Shortness of breath.
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 Cont…
• Signs
• Fever (rise of 1.5°C or more) and rigors.
• Hypotension or hypertension.
• Tachycardia.
• Respiratory distress.
• Oozing from wounds or puncture sites.
• Haemoglobinaemia.
• Haemoglobinuria.
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 Investigation
Basophil activation test (BAT):
 Basophil activation assessed using flow cytometry
 May be useful in the diagnosis of allergic transfusion reactions but not commonly
performed
IgA deficiency evaluation:
 Immunoglobulin serum concentrations (IgM, IgG, IgA)
 If severe IgA deficiency (< 0.05 mg/dL, typical adult normal range: 70 - 400 mg/dL
depending on laboratory assay), perform anti-IgA antibody ELISA
 Evaluation in children should occur after 6 months of age; in children younger than
4 years, the diagnosis is considered preliminary as levels may normalize into
adolescence

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 Prevention
 Prophylactic premedication is not recommended in patients with
no history of allergic reaction
 History of allergic reactions:
 Premedication with antihistamines, H2 receptor antagonists or
corticosteroids may be helpful depending on previous reaction
severity
 Patients with history of severe reactions:
 Washed products (pRBCs, platelets) to remove donor plasma may
be indicated
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 Cont…
 Platelets in platelet additive solution (PAS) may eliminate reactions
with better posttransfusion platelet increases than washed platelets
 Solvent detergent treated plasma
 IgA deficient patients:
 Majority do not require washed or modified products; trial with
unmodified products first
 If a history of anaphylactic reactions to transfusion, washed pRBCs
and platelets, PAS platelets and IgA deficient plasma (rare donor
program) may be indicated
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 Managment
 Urticarial reaction (only):
• Stop the transfusion
• Administer antihistamine
• Symptom resolution: restart the transfusion, no laboratory work up required
• No symptom resolution: discontinue the transfusion, provide supportive care, report
reaction to transfusion service
 All other reactions:
• Stop the transfusion
• Provide supportive care including but not limited to: epinephrine (intramuscular injection is
first line for anaphylaxis), H1 and H2 receptor antagonists,
• corticosteroids, respiratory support
• Report reaction to transfusion service

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 Transfusion-related acute lung injury
Definition:
• TRALI :is a clinical syndrome in which there is acute, non cardiogenic
pulmonary edema associated with hypoxia that occurs during or after a
transfusion.
• It presents as an acute respiratory distress syndrome (ARDS) either during
or within 6 h of transfusion.
• is the most common cause of major morbidity and death after transfusion.
• caused by donor antibodies reacting with leucocyte antigens in the
recipient.
• Which occur with the absence of other possible cause of pulmonary
oedema.
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 Incidence
Immune TRALI is an overall frequency of 1 in 5000 transfused
units.
The exact incidence is unknown.
Non-immune TRALI with a frequency of 1 in 1100.
The incidence higher in high plasma component in
comparison with packed cells and cryoprecipitate.

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 Etiology
• True TRALI should not have any risk factors for acute lung injury according to diagnostic
criteria.
• TRALI is caused by damage to pulmonary vasculature from neutrophil-mediated in
forms of human neutrophil antigen (HNA). Or
• human leukocyte antigen (HLA) antibodies in donor blood which bind to antigens of a
recipient.
•  A two-hit hypothesis applies in this clinical syndrome:
 Neutrophil sequestration occurs in the pulmonary vasculature. and
  neutrophils activate to damage the endothelial layer, causing leakage of protein and
fluid into alveolar space.

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 Pathogenesis
 Two different mechanisms for the pathogenesis of TRALI have
been identified :
immune (antibody-mediated)
non-immune
 Immune TRALI results from the presence of leucocyte antibodies in the plasma of
donor blood directed against human leucocyte antigens (HLA) and human
neutrophil alloantigens(HNA) in the recipient.
 Antibodies present in the recipient only rarely cause TRALI.
 leucocyte antibodies cannot be detected in either donor or recipient.

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 CONT…
 In these cases it is possible that reactive lipid products released
from the membranes of the
donor blood cells act as the trigger.
 This is known as non-immune TRALI .
 The target cell in both forms of TRALI is the neutrophil granulocyte.
These cells migrate to the lungs where they become trapped within
the pulmonary microvasculature. Oxygen free radicals and
other proteolytic enzymes are then released which destroy the
endothelial cells of the lung capillaries.
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 CONT…

• A pulmonary capillary leak syndrome develops with the

exudation of fluid and protein into the alveoli resulting in
pulmonary oedema.

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 Clinical feature
The major sign and symptom resulting from non-cardiogenic pulmonary
edema:
Hypoxemia
 dyspnea
cyanosis
fever
 tachycardia and
Hypotension
CXR finding : bilateral pulmonary infiltration
Invasive monitoring in TRALI demonstrates normal intracardiac pressures.

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 Investigation
 A definitive diagnosis requires antibody detection.
 By Clinical features
 Radiographic appearance
 Invasive monitoring in TRALI demonstrates

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 Prevention
 Screening of all donors for anti-neutrophil or anti-HLA
antibodies. 
 Use of pre-storage leukoreduced blood.
 Appropriate utilization of blood products. Using blood
products only when clinically indicated may reduce the
frequency of TRALI.

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 Managment
o Immediate management of TRALI is to stop the transfusion
and  notify the blood bank to screen the donor unit for
antileukocyte antibodies, anti-HLA or anti-neutrophil-specific
antibodies.
o Supportive measures must be taken to improve oxygenation.

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 Bacterial contamination of blood
• More common and more severe with platelet transfusion (platelets
are stored at room temperature)
• Organisms
Platelets—Gram (+) organisms, ie Staph/Strep
RBC’s—Yersinia, enterobacter
• Symptoms :
 Rigor, chills, fever
 Shock, usually within minutes of starting transfusion
 Respiratory distress, wheezing and oxygen desaturation
 Pain up arm , Chest and back / loin pain Nausea
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 CONT…
• Although uncommon, but this type of specific reaction can
have a rapid onset and high mortality in recipients.
• The presence of bacteria in transfused blood may lead either
to febrile reactions in the recipient ( due to pyogens ) or
serious manifestations of septic or endotoxic shock.
• Commonly caused by endotoxin produced by bacteria
capable of growing in cold temperatures such as
Pseudomonas species, E. coli, Yersinia enterocolitica.

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 Source of infection
• Infection of stored blood is extremely rare.
• Skin contaminants are not infrequently present in freshly
donated blood but these organisms ( predominantly
staphylococci ) do not survive storage at 4 º C although they
will grow profusely in platelet concentrates stored at 22 º C.

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 Cont…
• Healthy donor who are bacteremic at the time of donation.
The majority are due to Yersinia enterocolitica, which grows
well in red cell components due to its dependence on citrate
and Iron.
• Gram negative, endotoxin – producing contaminants found
in dirt, soil and faeces may rarely grow in the storage
condition of blood.…

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 CONT…
According to CDC , most are caused by blood components
contaminated by Yersinia enterocolitica, Since 1987, from 20
cases reported to CDC, 12 are caused by this organism.

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 Clinical manifestation
• Usually appear rapidly during transfusion or within about 30
minutes after transfusion with dryness, flushing of skin.
• Fever, Hypotension, Chills, Muscle pain, vomiting, Abdominal
cramps, Bloody diarrhoea, Hemoglobinuria, Shock, Renal
failure, DIC.

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 Managment
• Rapid recognition is essential Immediately stop the transfusion.
• Therapy of shock, steroids, vassopressors, fluid support, respiratory
ventilation and maintenance of renal function.
• Broad spectrum IV antibiotics (penicillin or cephalosporin and gentamicin )
• The blood component unit and any associated fluids and transfusion
equipment should be sent immediately to blood bank for investigation ie:
 gram stain and culture.
 Blood C & S from the recepient.

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 Prevention
• Strict adherence to policies & procedures regarding blood
component collection, storage, handling,and preparation is
essential to reduce the risk.
• Visual Inspection of components before release from the
transfusion service include
• any discolouration, visible clots, or hemolysis.
• Ensure the blood components are infused within standard
time limits ( 4 hours ).

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 CONT…
• Blood packs should never be opened for sampling, if any
open method of preparation has been used, the unit should
be transfused within 24 hours.
• Blood should always be kept in accurately controlled
refrigerators (with alarms), maintained strictly at 2 – 6 º C,
the blood should never be removed and taken to the ward or
OT until it is recquired.

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 References

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 Complications of blood transfusion
Early Late
• Circulatory overload
• Infection
• Electrolyte disturbance
– Hyperkalaemia – Viral (hepatitis A, B, C, HIV, CMV)
– Hypocalcaemia – Bacterial (Treponema pallidum,
• Hypotermia Salmonella)
• Acute hemolysis – Parasites (Malaria, Toxoplasma)
• Allergy and anaphylaxis • Immunosuppression
• Transfusion-related acute lung injury
• Bacterial contamination
• Massive transfusion and its complication

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 Electrolyte disturbance

Hypocalcaemia
• Calcium is an important co-factor in coagulation, and has a key
role in mediating the contractility of myocardial, skeletal and
smooth muscles.
• RBCs in additive solution contain only traces of citrate, however,
FFP and platelets contain much higher concentrations.
• Citrate binds calcium, thus lowering the ionized plasma calcium
concentration.
• In normal physiology, this is usually prevented by rapid hepatic
metabolism unless the patient is hypothermic.
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 Electrolyte disturbance…

• Hypocalcaemia results in hypotension, reduced pulse

pressure, elevated ST segments
and prolonged QT intervals on the ECG.
• If there is clinical, biochemical or ECG evidence of
hypocalcaemia, it should be treated with slow IV injection of
calcium gluconate.

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 Electrolyte disturbance…
Hyperkalaemia
• During blood storage, there is a slow but constant leakage of potassium
from the cells into the surrounding plasma along a concentration gradient
as a result of sodium potassium ATPase pump failure.
• The plasma level of potassium may increase by 0.5-1.0mmol/L per day of
refrigerator storage.
• After transfusion, the RBC membrane Na+–K+ ATPase pumping
mechanism is re-established and cellular potassium reuptake occurs
rapidly.
• Hyperkalaemia rarely occurs during massive transfusions unless the
patient is also hypothermic and acidotic.
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 Hypothermia
 RBCs are stored at 4oC. Rapid transfusion at this temperature
will quickly lower the recipient’s core temperature and further
impair haemostasis.
 A decrease in core temperature shifts the oxyhaemoglobin
dissociation curve to the left, reducing tissue oxygen delivery at
a time when it should be optimized.
 This reduction in temperature can be minimized by warming all
IV fluids and by the use of forced air convection warming
blankets to reduce radiant heat loss.

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 Massive blood transfusion and its complication

• Is the replacement of more than 50 % of a patient's blood

volume in 12 to 24 hours or it is the transfusion of more than
10 units of PRBCs in a 24-hour period.
• There is no clear indication for MBT in any case.
• The decision to transfuse is based on the physiological state
of the patient, evidence of amount of blood loss ,potential
for ongoing hemorrhage.

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 Cont………….
Clinical scenario for MBT
 Haemorrhagic shock
- Obstetric patients
- Severe trauma
 Exchange transfusion
 Cardiopulmonary bypass

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 Con’t ………
Goals of massive blood transfussion
Correct volume deficit
Achieve haemostasis
Consider component therapy

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 Complications of MBT
• Acidosis
• Hyperkalaemia
• Citrate toxicity and hypocalcaemia
• Depletion of fibrinogen and coagulation factors
• Depletion of platelets
• Disseminated intravascular coagulation (DIC)
• Hypothermia
• Micro aggregates
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Acidosis
 During blood storage, red cell metabolism generates acids. At the
end of 21 days, the pH may be as low as 6.9 .
Acidosis in a patient receiving a large volume transfusion is more
likely to be the result of inadequate treatment of hypovolaemia
than due to the effects of transfusion.
Under normal circumstances, the body can easily neutralise this
acid load from transfusion

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DEPLETION OF FIBRINOGEN AND COAGULATION
FACTORS
Plasma undergoes progressive loss of coagulation factors during
storage, particularly factors V and VIII,unless stored at -25 degree
Celsius or colder.
 Red cell concentrates and plasma reduced units lack coagulation
factors which are found in the plasma component.
Dilution of coagulation factors and platelets will occur following
administration of large volumes of replacement fluids.
 Massive or large volume transfusions can result in disorders of
coagulation.

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Con’t…..
• Coagulation proteins
• Resuscitation results in gradual dilution of plasma
clotting proteins
• Bleeding due to dilution can occur when the level of
coagulation proteins falls to 25 % of normal. (8- 10
units)

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DEPLETION OF PLATELETS
Each 10 - 12 units can produce a 50 % fall in the
platelet count; thus, significant thrombocytopenia
can be seen

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 DISSEMINATED
INTRAVASCULAR
COAGULATION(DIC)
DIC is the abnormal activation of the coagulation and fibrinolytic
systems, resulting in the consumption of coagulation factors and
platelets.
DIC may develop during the course of massive blood transfusion,
although its cause is less likely to be due to the transfusion itself
than related to the underlying reasons for transfusion, such as:
Hypovolemic shock
Trauma
Obstetric complications

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MICROAGGREGATES
o White cells and platelets can aggregate together
in stored whole blood, forming micro aggregates.
o During transfusion, particularly a massive transfusion, these micro
aggregates embolism to the lung and their presence there has been
implicated in the development of Adult Respiratory Distress
Syndrome(ARDS).
o However, ARDS following transfusion is most likely to be primarily
caused by tissue damage from hypovolemic shock.

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Circulatory overload
• Transfusion-associated circulatory overload (TACO) can present in a
similar fashion to TRALI but is much more commonly seen.
• Unlike TRALI, circulatory overload is associated with central venous
pressure elevation and cardiac failure.

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• It occurs in rapidly transfusing a patient who is euvolemic
and not actively bleeding.
• Infants, Children, the elderly, those with compromised
cardiac, renal, or pulmonary function, and patients in states
of plasma volume expansion (normovolemic chronic anemia,
thalassemia major, and sickle cell disease) are especially at
risk.

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 Signs and symptoms of transfusion induced hypervolemia
• It may be initially difficult to distinguish from hemolytic
transfusion reaction, febrile nonhemolytic transfusion reaction,
and allergic reactions.
• The absence of hemoglobinuria and hemoglobinemia or a
positive posttransfusion DAT distinguishes hypervolemia from
immune hemolysis, the absence of fever, chills from febrile
reaction and urticaria from allergic reactions.

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 Con’t
• Manifestations are headache , tachypnea, Cough, dyspnea,
cyanosis, tachycardia, orthopnea, chest discomfort, rales,
distension of jugular veins, and other manifestations of
congestive heart failure.
Complication
Pulmonary edema
• in TACO is cardiogenic in origin and may result in the
development or exacerbation of congestive heart failure.

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 Management and Prevention
• Stopping transfusion until the diagnosis is determined,
• Administering diuretics and supportive therapy oxygen, and
phlebotomy as indicated, and
• Resuming the transfusion at a slower rate while monitoring
for recurrence of symptoms and signs of hypervolemia.
 Patients at risk should receive smaller aliquots of blood
infused at slower rates (1 to 4 mL/ kg/ hr) in as concentrated
a form as possible.

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 Transfusion-Transmitted Infections
 Current testing of donor blood prior to release of blood
components includes the following:
• Antibodies to
– HIV types 1 and 2
– hepatitis C virus
– hepatitis B
– human lymphotrophic virus types I and II
– Trypanosoma cruzi
– Treponema pallidum.

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 CONT…
• Blood supply is not currently routinely tested include the
following:
– Hepatitis A virus
– parvovirus B19
– The protozoal disease toxoplasmosis which affects mainly
immunocompromised patients

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 Immunologic effects of blood transfusion
 Another effect of receiving a blood transfusion,is
immunosuppression, causes a decreased immune response
that compromises patients' ability to fight off infection or
tumor cells.
 These effects sensitization and immunosuppression are
thought to be due largely to white blood cells present in the
transfusion product.

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 Immunosupression …….
 Viruses known to suppress cellular immunity are:-
– cytomegalovirus(CMV)
– Human immunodefficency virus(HIV)
 These viruses are transmitted during blood transfussion and they
altered immune responses following RBC transfusions may predispose
critically ill transfusion recipients to nosocomial infections.
 Use of leukocyte-depleted packed RBC units may decrease the risk of
infection, but this technique remains to be proven in critically ill
children.

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 Immunosupression ….
Immunosuppression is one of the common complication of blood
transfusion in a patients with:-
 cardiac surgery,
 colonic cancer, and
 renal transplant
these patients have decreased T-lymphocyte proliferation,
depression of natural killer cells, decreased B-lymphocyte reactivity
against antigens, and decreased macrophage phagocytosis

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 Immunosupression ….
When there is those findings,the risks of immunosuppression
should be taken into consideration when deciding to transfuse.
 However, fear of immunosuppression should not override the
need for appropriate blood replacement in the acute setting
 Blood transfusion can impair the immune system. Evidence
indicates that transfused red blood cells (RBCs) may result in
clinically important immune suppression in the recipient

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 Immunosupression ………

• Blood transfusion is associated with numerous clinical

phenomena attributable to immune suppression.

• Homologous blood transfusion is associated with declines in

lymphocyte numbers and inhibition of lymphocyte function.

• For patients undergoing surgical procedures, the receipt of

homologous blood increases the risk of postoperative infectious
complications.
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 Immunosupression ……
• Patients with malignancies have significantly increased
recurrence and mortality rates when removal of their tumor
is accompanied by the administration of blood.

• Women suffering recurrent abortion may carry to term

following transfusion of spouse leukocytes.

• And transfusion inhibits wound healing.

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 References

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 Any Comment & Question????
Thank you for attention !!!

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