A. General risks of transfusion
1. Blood component transfusions are costly in terms of both of the following.
a. Costs related to the procurement/production of components
b. Potential complications for patients receiving blood
i. Acute intravascular hemolysis, extravascular
hemolysis, anaphylaxis, transfusion-related acute
lung injury, and graft-versus-host disease are potentially life-threatening noninfectious complications
ii. Other noninfectious complications resulting in morbidity include fluid overload, sodium overload, iron
overload, febrile reactions, allergic reactions, and
delayed hemolytic reactions.
iii. With continuing improvements in screening, the
incidence of transfusion-acquired infections is
decreasing rapidly. However, as long as the blood
components are derived from human blood donations, the risk of acquiring blood-borne pathogens
2. These risks must be balanced by consideration of the expected benefits each time a transfusion with blood-derived components is contemplated. For these reasons, obtain informed consent from patients/parents before nonemergency transfusions.
B. Prevention of transfusion-acquired cytomegalovirus (CMV)
Transfusion-acquired CMV can produce significant morbidity and mortality in immunosuppressed patients.
Transfusion-acquired CMV may be prevented by
Providing CMV-seronegative blood products for CMV-negative patients, or
If CMV-seronegative blood products are not available, filtering blood components (red cell concentrates and platelet concentrates) with leukocyte-depleting filters capable of >3 log removal of white blood cells.
C. Prevention of graft-versus-host reaction
1. The incidence of transfusion-acquired graft-versus-host
disease can be decreased by
a. Avoiding directed blood donations by close relatives
(except when indicated for aggressive bone marrow
rescue procedures), and
b. Irradiating all blood transfusion components with the
potential to contain leukocytes (red cell concentrates,
white cell concentrates, and platelet concentrates; the
recommendation for irradiation of plasma has not
been clearly substantiated). The generally recommended dose for irradiation of blood products is
1500-2500 cGy to the midplane with at least 1500 cGy
in the field.
2. In addition, the use of a leukocyte-depleting filter where
applicable will contribute to decreasing the risk of graft-
D. Reduction of leukocyte sensitization
The use of leukocyte-depleted blood components can decrease the incidence of alloimmunization and platelet transfusion refractoriness.
E. Reduction of immunomodulation effects of transfusion
The immunomodulating effects of transfusion appear to be related to the presence of lymphocytes in blood components. Removal of the transfused lymphocytes can decrease the immunosuppression secondary to transfusion. An additional postulated complication of the immunomodulation of transfusions is a decrease in the effectiveness of the individual's own natural immune mechanisms of cancer control.
Reduction in and treatment of febrile transfusion reactions
Febrile transfusion reactions are associated with the presence of leukocytes in the transfused products as well as tumor necrosis factor, interleukin-1, -6, and -8, and other cytokines released by the leukocytes.
Cytokines released into the plasma of blood components from the granulocytes increase with storage time.
Prestorage filtration of cellular blood components appears to be the most effective method to decrease these reactions.
Rule out serious red cell transfusion reaction in patients with febrile transfusion reactions.
Treat febrile transfusion reactions in patients who are otherwise not at risk for sepsis with antipyretics and meperidine (0.5-1.0 mg/kg) for rigors. Some febrile transfusion reactions can be prevented with premedication with antipyretics and Benadryl.
Take cultures from patients who have febrile reactions at the time of transfusion and are at risk for sepsis and treat patients with antibiotics if appropriate.
Storage of platelets at room temperature increases the risk of sepsis as a complication of platelet transfusion.
Precautions to ensure that the correct product is given to the correct patient
It is essential that the blood sample taken for type and screen and cross-match is clearly labeled and checked with the patient's identification. Before administering the blood product, check the physician order, patient identification, and blood product type and numbers. Clerical error and misidentification are major risks of transfusion. When error is suspected
Inspect anticoagulated and centrifuged blood specimen from the patient for reddish discoloration of the plasma.
Inspect urine for dark discoloration of hemoglobinuria.