Sun28November0333PM 8

Regarding the hazards of blood transfusion:

True / False

Transfusion associated circulatory overload is associated with raised brain natriuretic peptide Correct

Hepatitis B viral infection is not possible because of screening Correct

Hypotension following a blood transfusion is more likely in patients taking angiotensin converting enzyme inhibitors Correct

Transfusion related lung injury is an immune reaction to leucocytes Incorrect answer selected

An increase of 1°C following a blood transfusion is most likely due to a non-haemolytic transfusion reaction Correct

Explanation

Transfusion-associated circulatory overload (TACO) is an under-reported complication of blood transfusion. It has all the clinical hallmarks of cardiogenic pulmonary oedema usually occurring within six hours of a transfusion. The pre- to post-transfusion brain natriuretic peptide ratio >1.5 is diagnostic. Children and the elderly are particularly at risk.

Transfusion related lung injury (TRALI) is mediated by immune and non-immune mechanisms. Its incidence can be reduced by:

Universal leucodepletion of units of blood

Using pooled plasma donations to dilute any antibodies

The exclusive use of male donors for all FFP and plasma for platelet pools, and

Selective screening and exclusion of donors at high risk of having anti-leucocyte antigen antibodies.

The incidence of viral infection from blood transfusion is:

Hepatitis B - 1:450,000

Hepatitis C - 1:32,000,000

HIV - 1:5,000,000.

Non-haemolytic febrile transfusion reactions are common. When symptoms are mild, they require little intervention other than treating with paracetamol. Patients present with an unexpected temperature rise (=38ºC or =1ºC above baseline, if baseline =37ºC) during or shortly after transfusion. This is usually an isolated finding. Occasionally the fever is accompanied by chills, rigors, increased respiratory rate, change in blood pressure, anxiety and a headache.

Less commonly these signs may may also feature as a result of acute haemolytic reaction, transfusion transmitted bacterial infection and TRALI.

Isolated hypotension may occur following a blood transfusion from non-immune mechanisms. It is more likely in patients taking angiotensin converting enzyme inhibitors.

Reference:

Clevenger B, Kelleher A. Hazards of blood transfusion in adults and children. Contin Educ Anaesth Crit Care Pain. 2014;14(3):112-118.

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