Complications blood transfusion

By S.Hina Rizvi

Indications for Red Blood Cells Hb <70g/L; although lower thresholds may be

acceptable in patients without symptoms and where specific therapy (eg iron) is available.

Transfusion may be indicated at higher thresholds for specific situations:

Hb <70-100g/L during surgery associated with major blood loss or if evidence of impaired oxygen transport

Hb <80g/L; patients on a chronic transfusion regimen or during marrow suppressive therapy (for symptom control and appropriate growth)

Hb <100g/L; only for very select populations (eg. neonates

 ClinicalSituation  Indication for Platelet Transfusion

Bone marrow failure

Plt <10x109/L if no other risk factors for bleeding (see below)Plt <20x109/L if risk factors present (fever, antibiotics, haemostatic failure, risk of intracranial haemorrhage)

Surgery/invasive procedure

Plt <50x109/L. However, higher counts may be needed in surgery with high risk of bleeding eg. neurosurgery

Platelet function DefectsTransfuse if there is bleeding or high risk of bleeding, regardless of actual platelet count

Bleeding/Massive transfusion

Maintain Plt >50x109/L if thrombocytopaenia likely contributing to bleedingMaintain Plt >100x109/L in the presence of diffuse microvascular bleeding (DIC) or CNS trauma

Indications for Platelets

Table 1: Indications for Platelet transfusion

Indications for Fresh Frozen Plasma FFP is appropriate for the following: Warfarin effect, in the presence of life-threatening

bleeding in addition to the use of vitamin K and vitamin-k dependent clotting factor concentrates for bleeding with abnormal coagulation

Liver disease, if bleeding with abnormal coagulation. Acute DIC when there is bleeding and abnormal

coagulation Following massive transfusionor cardiac bypass for

bleeding in the presence of abnormal coagulationIndications for Cryoprecipitate Cryoprecipitate is indicated for: Fibrinogen deficiency, in the setting of clinical bleeding, an

invasive procedure, trauma or DIC

 Blood product  Formula for calculatingtransfusion volume

 Pack sizes Rate

Red Blood Cells Packed cells (mls)= wt (kg) x Hb rise required(g/L) x 0.4 (eg.10kg child requiring Hb to rise from 60 to 110g/L: 10 x 50 x 0.4=200ml)

250-300ml/pack;50 -60 ml/Pedipack

Transfusion will be started at a slower rate (eg. Half the rate) for the first 15minutes. If no adverse effects occur, increase the transfusion to a 2-4hourly rate depending on the patient's condition and fluid balance

Platelets 5 - 20 ml/kg(5 - 10 ml/kg will raise platelet count by 50 - 100x 109 /L)

Neonatal/ paediatric <40kg patients:•Paediatric (single donor) -40 - 60 ml•Apheresis (single donor) split into4 - 8 x 40 - 60 ml packsPaediatric > 40kg or adult:•Apheresis (single donor) >200ml or split into 2 x > 100ml packs•Pooled from 4-5 donors - >160ml 

3ml/kg/hr over 2-3 hours.(occasionally platelets aregiven over 30 minutes, butthis may contribute to anincreased risk of some reactions (fever/chills) andfluid overload)

 FFP 10 - 20 ml/Kg  300ml/pack 50ml/pack (for neonatal use)

 Start at no more than 5ml/min.

 Cryoprecipitate 5-10 ml/kg 30-40 ml/pack  Start at no more than 5ml/min.

Table 2: Transfusion volumes and rates

Complications during transfusion: The most common immediate adverse reactions to

transfusion are fever, chills and urticaria. The most potentially significant reactions include acute

haemolytic transfusion reactions, bacterial contamination of blood products and transfusion related acute lung injury.

During the early stages of a reaction it may be difficult to ascertain the cause.

All suspected transfusion reactions must be reported to the issuing blood bank immediately. The on-call haematologist will contact the clinical area to provide advice regarding investigation and ongoing transfusion support.