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Toronto Notes 2019 Blood Products and Transfusions
Hyperkalemia
• due to K+ release from stored RBC
• riskincreaseswithstoragetimeandifbloodisirradiatedandriskdecreasesifgivenfreshblood • occursin5%ofmassivelytransfusedpatients
• treatment:seeNephrology,NP13
Citrate Toxicity
• occurswithmassivetransfusioninpatientswithliverdisease–patientsareunabletoclearcitratefrom blood
• citrate binds to Ca2+ and causes signs and symptoms of hypocalcemia
• treatment:IVcalciumgluconate(10mLforevery2unitsofblood)
Dilutional Coagulopathy
• occurswithmassivetransfusion(>10units)
• pRBCcontainsnoclottingfactors,fibrinogen,cryoprecipitate,orplatelets • treatment:FP,cryoprecipitate,andplatelets
Delayed Blood Transfusion Reactions
IMMUNE
Delayed Hemolytic
• duetoalloantibodiestominorantigenssuchasRh,Kell,Duffy,andKidd
• levelofantibodyattimeoftransfusionistoolowtocausehemolysis;laterthelevelofantibodyincreases
due to secondary stimulus and causes extravascular hemolysis
• occurs5-7daftertransfusion
• presentation:anemiaandmildjaundice
• treatment:nospecifictreatmentrequired;importanttonoteforfuturetransfusion
• N.B.serologictransfusionreactionsarethedevelopmentofalloantibodiesintheabsenceoffrank
hemolysis
Transfusion-Associated Graft Versus Host Disease
• transfusedT-lymphocytesrecognizeandreactagainst“host”(recipient)
• occurs4-30dfollowingtransfusion
• mostpatientsalreadyhaveseverelyimpairedimmunesystems(e.g.Hodgkinlymphomaorleukemia) • presentation:fever,diarrhea,liverfunctionabnormalities,andpancytopenia
• canbepreventedbygivingirradiatedbloodproducts
NONIMMUNE
Iron Overload
• duetorepeatedtransfusionsoverlongperiodoftime(e.g.β-thalassemiamajor)
• cancausesecondaryhemochromatosis
• treatment:ironchelatorsorphlebotomyifnolongerrequiringbloodtransfusionandnotanemic
Viral Infection Risk
• HBV1in1.1to1.7million
• HCV1in5to7million
• HIV1in8to12million
• HumanT-lymphotropicvirus(HTLV)1in1to1.3million • otherinfectionsincludeEBV,CMV,WNV(WestNilevirus)
Hematology H55
Allogeneic SCT GVHD
To reduce risk of GVHD development after allogeneic SCT, administer Inhibitors of T-cell activation, including cyclosporin A or tacrolimus