Paper I
Question
Complications of blood transfusion
Answer
Immunologic (immune-mediated) complications
- Acute haemolytic transfusion reaction: ABO incompatibility — complement-mediated intravascular haemolysis, potentially fatal
- Delayed haemolytic transfusion reaction: Sensitization to minor blood group antigens (Rh, Kell, etc.)
- Febrile non-haemolytic transfusion reaction: Anti-leukocyte antibodies/cytokines accumulated in stored blood — most common transfusion reaction
- Allergic/urticarial reactions: Hypersensitivity to donor plasma proteins
- Anaphylactic reaction: Severe, in IgA-deficient recipients with anti-IgA antibodies
- Transfusion-related acute lung injury (TRALI): Donor anti-leukocyte antibodies causing acute pulmonary oedema
- Graft-versus-host disease: In immunocompromised recipients receiving non-irradiated blood
- Post-transfusion purpura
Non-immunologic complications
- Transfusion-associated circulatory overload (TACO): Volume overload, especially in cardiac/renal patients
- Transmission of infections: HIV, hepatitis B/C, CMV, bacterial contamination/sepsis
- Iron overload: With repeated/chronic transfusions
- Citrate toxicity/hypocalcaemia: With massive/rapid transfusion
- Hyperkalaemia: With massive transfusion of stored blood (potassium leaks from stored red cells)
- Hypothermia: With rapid infusion of cold blood products