Complications of intravenous transfusion_Complications of intravenous transfusion

In our daily life, getting sick is a common thing. Sometimes the illness is serious and we need to go to the hospital for examination. We all know that bleeding occurs during many major surgeries, which requires intravenous blood transfusions. However, because the blood is not from the body, the body will have adverse reactions. Many people experience fever or allergies after intravenous blood transfusion. This article introduces the complications of intravenous blood transfusion, let’s take a look.

(I) Fever reaction

This is the most common early transfusion complication. Fever reactions usually occur within 1 to 2 hours after blood transfusion, first with chills, chills, and high fever, with body temperature as high as 39 to 40°C, accompanied by headache, sweating, nausea, vomiting, and skin flushing. Symptoms last for 15 minutes to 2 hours and then subside. Most people do not see any changes in blood pressure.

1. The main causes are pyrogens, immune reactions, bacterial contamination and hemolysis.

2. After the symptoms of fever reaction appear, the blood transfusion rate should be slowed down immediately. In severe cases, the blood transfusion should be stopped and symptomatic treatment should be given.

3. Preventive measures: Strict disinfection and use of pyrogen-free technology. Multiparous women or patients who have undergone repeated blood transfusions should be transfused with blood components that have been depleted of white blood cells and platelets (such as washed red blood cells).

(ii) Allergic reaction

Allergic reactions are uncommon and usually occur immediately after the transfusion of a small amount of blood products, but can also occur during or after a transfusion. The main symptoms are skin erythema, urticaria and itching, cough, dyspnea, wheezing, facial flushing, abdominal pain and diarrhea, confusion, shock, etc., which can be life-threatening.

1. The main cause is antigen-antibody reaction, activated complement and release of vasoactive substances.

2. The first step in treatment is to stop blood transfusion immediately and keep intravenous infusion unobstructed. Antihistamines, epinephrine, hydrocortisone, etc. can be used. Those with dyspnea should undergo endotracheal intubation or tracheotomy to prevent suffocation.

(III) Hemolytic reaction

This is the most serious complication. Typical symptoms are chills, high fever, difficulty breathing, back pain, chest tightness, headache, shock, hemoglobinuria, abnormal bleeding, hemolytic jaundice, etc. after transfusing a small amount of blood, which can lead to death. The earliest signs of the patient during the operation were unexplained hypotension and bleeding from the wound.

1. The vast majority of causes are immune, that is, caused by the transfusion of red blood cells that do not match the AB0 blood type. A few are non-immune, such as the transfusion of hypotonic fluids, freezing or overheating that destroys red blood cells, etc.

2. When a hemolytic reaction is suspected during treatment, blood transfusion should be stopped and rechecked. The focus of treatment is: anti-shock, protection of renal function, and prevention and treatment of DIC.

3. Prevention mainly lies in strengthening work responsibility, strict verification, and using the same type of blood for transfusion.

(IV) Bacterial contamination reaction

It is less common, but the consequences are serious. If the blood is contaminated by non-pathogenic bacteria, due to its low toxicity, it may only cause some symptoms similar to fever reaction. However, if the pathogen is highly toxic, shock and DIC will occur immediately after injection.

1. Cause: There are loopholes in aseptic technology during blood collection and storage, resulting in bacterial contamination.

2. Treatment: Stop blood transfusion, smear examination and bacterial culture, and provide effective anti-infection and anti-shock treatment.

3. In every aspect of prevention, aseptic operation and inspection system must be strictly followed.

(V) Cyclic overload

For patients with impaired heart function, the elderly, young children or patients with chronic severe anemia (decreased red blood cells and increased blood volume), too rapid or excessive blood transfusion may cause acute heart failure and pulmonary edema. It may manifest as increased heart rate, difficulty breathing, cyanosis, coughing up bloody frothy sputum, distended neck veins, moist rales in the lungs, increased venous pressure, and signs of pulmonary edema on chest radiographs. Severe cases may be fatal.

1. Treatment should include immediate cessation of blood transfusion, semi-sitting position, oxygen inhalation, cardiotonic therapy and diuresis. If the treatment is ineffective, apply tourniquets to the limbs in rotation to reduce the amount of blood returning to the heart.

2. Prevention lies in strictly controlling the rate of blood transfusion. For patients with severe anemia, concentrated red blood cells should be transfused as the main treatment.

6. Transfusion-related acute lung injury

The mechanism of its occurrence is the presence of leukolectin or HLA-specific antibodies in the plasma of the blood donor. Clinical manifestations include acute dyspnea, severe bilateral pulmonary edema and hypoxemia, which may be accompanied by fever and hypotension. Prevention is to not use plasma transfusions from multigravid donors.

7. Transfusion-related graft-versus-host disease

As immunocompetent lymphocytes are transfused into a severely immunodeficient recipient, the transfused lymphocytes react to the recipient's tissues. Immune-active lymphocytes can be removed by irradiation.

8. Disease transmission

Including Epstein-Barr virus, cytomegalovirus, hepatitis virus, HIV, Brucella infection, syphilis, malaria, etc.

9. Immunosuppression

Blood transfusion can reduce the recipient's nonspecific immune function and suppress specific immune function, increasing the risk of postoperative infection and tumor occurrence.