Common accidents with blood transfusions and how to handle

The article was consulted professionally by Specialist I Huynh Kim Long – Emergency Resuscitation Doctor – Emergency Resuscitation Department – Share99 Da Nang International Hospital. Dr Huynh Kim Long has extensive experience in the treatment of Resuscitation – Emergency and Emergency Stroke in adults.

Blood transfusion is a condition in which a person receives blood or blood products (emia, thromboemboyeritis, plasma) from others. This is a fairly common measure to reimburse lost blood or correct abnormalities in the blood without other measures to replace it. Blood transfusions do not cause pain, can be a bit uncomfortable because the needle attaches to the arm vein but there are still cases of dangerous accidents that need to be handled in a timely manner.

Blood transfusion accidents are classified into different forms, due to which the typical causes have the following groups:

1.1 Immune blood transfusion accidents

Hematoma response due to blood transfusion:

• Usually due to total blood transfusions or incompaties with the ABO blood group, the antibody anti-A or B is found in the patient's plasma causing emia with the corresponding antigen transmitted, resulting in an endvascular hemolysis.
• Patients often present with fever, malaria tremor or back pain (due to anemia and muscle spasms), shortness of breath, respiratory failure, anuria, hypotension and shock, hemolytic hematuria.
• These clinical manifestations usually take place in 3 stages: the shock stage, the anuria stage and the recovery stage.

Late hemoma reaction after blood transfusion:

• This is due to the fact that there is a second immune phenomenon against urethrobial co-gens produced about 1-2 weeks after the blood recipient comes into contact with the foreign antigen.
• Patients often do not have specific clinical manifestations for hemorrhaging, if there is a severe hemorrhaging, there may be manifestations such as malaria tremors, jaundice, anemia,…

Fever reaction after non-hemorrhaetic blood transfusion:

• Caused by a lack of leukocya and tinglet groups between the giver and the recipient leads to , interactions that release fever-causing substances.
• Fever may be accompanied by tremors that occur during or after a blood transfusion.

Allergic reactions due to blood transfusions:

• Urticaria (itchy aggregate): caused by plasma anomalies and other plasma-containing products that lead to the release of histamine, which is common in people with a history of allergies.
• Anaphylactic reactions: patients with manifestations such as anaphylalactic shock, shortness of breath, hypotension, bronchospasm, vomiting, abdominal pain, sweating …

Co-immune reactions:

• This is because the patient's body has an immune response to co-antigens in the infusion, which usually occurs after blood transfusion or pregnancy.
• Patients often present with emergency hematoma or late hemoma after blood transfusions or have a condition that does not respond to blood transfusions.
• In newborns, immune thrombolysis is manifested by post-birth spot haemorrhagic syndrome, with severe hemorrhagic manifestations such as meningeal hemorrhage, digestive hemorrhage.

1.2 Infectious blood transfusion accidents

• Hepatitis caused by blood transfusions:
  • The most common is HCV hepatitis.
  • Hepatitis patients often do not have or present less jaundice, may have fatigue, poor appetite, gastrointestinal disorders, joint pain or mild fever.
• HIV and HTLV-1 infection: Due to routine HIV screening, HIV infection after blood transfusions is low.
• Malaria parasite infections, syphilis spiral infections, septic blood are also at risk of contraction after blood transfusions.

1.3 Complications caused by large blood transfusions

• Circulation overload: due to the rapid transmission of too large amounts of blood causing circulation overload in patients with heart or lung disease, causing right heart failure, acute pulmonary edema, blue-violet, shortness of breath,…
• Citrate intoxication: due to the side effects of citrate used to fight blood clots, causing cardiac dysfunction due to decreased blood calci.
• Hyperkalemia: due to potassium contained in the blood transmitted after storage.

Dealing with accidents during blood transfusions depends on the extent of the accident and take appropriate measures.

2.1 Initial handling

• Immediately lock the blood transfusion to prevent the amount of blood from continuing into the recipient's body.
• Assess the signs of survival of the person.
• Identify or exclude the risk of blood transfusions that do not dissolve the red blood cell group, through: examination, comparison of patient records, identification of ABO blood type.
• Determine the extent of the accident.

2.2 For mild reactions

• It is necessary for the blood to slow down and take antiallergenic drugs.
• Close monitoring of the clinical condition, if not improved or bad progress should be treated as average reactions.

2.3 For average reactions

• Immediately stop the blood transfusion.
• Maintain intravenous transmission with a 0.9% NaCl physiological saline solution.
• Treatment of appropriate symptoms such as warming when cold trembles or antiallergetic, antipyretic.
• Monitor urine color and flow.

2.4 For severe reactions

• Immediately stop the blood transfusion.
• If there are signs of anaphylactic shock, it must be treated immediately according to the Ministry of Health regimen with: Adrenalin, antihistamine, corticoid …
• Intravenous transmission with NaCl physiological saline of 0.9% is required to maintain blood pressure.
• Maintain respiration and oxygen support.
• If the patient shows signs of bronchospasm it is necessary to use intravenous corticoids and bronchodilators.
• If there are signs of 3dular overload it is possible to use intravenous diabetics with furosemid.
• Treatment of invascular scattered coaculation disorders.
• Use antibiotics against broad-spectrum infections if there is a blood infection.