Blood Transfusion Complications

Blood transfusions always come with various side effects and complications. The health team, especially the doctors and nurses should be responsible in educating the patients receiving blood transfusion regarding the reason of the transfusion, its benefits and risks involve and the expected outcomes during transfusions. It is also important that we obtain a signed consent from the patients agreeing to undergo a transfusion. Nursing management is focused on recognizing, preventing and intervening complications.

Acute Hemolytic Reaction – This is the most dangerous and most fatal transfusion reaction there is. Thus happens when the blood donor is incompatible to the blood recipient. Antibodies present in the blood recipient plasma combine with the antigens of the donor plasma causing the destruction of red blood cells in the circulation. This type of reaction can occur very quickly just after transfusing 10 mL of blood. Symptoms include fever, chills, low back pain, nausea, chest tightness, dyspnea and anxiety. When RBCs are destroyed, the hemoglobin is released in the urine. This leads to hypotension, bronchospasm and vascular collapse that may be eventually cause acute renal failure. The transfusion should be stopped eventually and reassessment of the patient should be initiated (blood volume and renal perfusion).  Laboratories (blood and urine specimen) should be evaluated.

Delayed Hemolytic Reaction – After transfusion, reactions may be delayed; antibodies react a little later and have increased in time. This occurs within 14 days after transfusion. Signs and symptoms include fever, increased bilirubin levels, decreased or absent haptoglobin, anemia, and jaundice,

Febrile Non – Hemolytic Reaction – This is the most common type of transfusion reaction. This reaction is caused by anti – bodies to donor WBC’s that are still present in the blood unit or blood component. Patients with febrile non – haemolytic reaction manifests fever (starts two hours after the transfusion), chills and muscle stiffness. In order to prevent such, before transfusion, he blood can undergo a leukocyte reduction filter to eliminate WBC’s in the blood component. Antipyretics are given as ordered, tepid sponge bath is rendered and continuous monitoring is done.

Allergic Reaction – This reaction is due to a sensitivity reaction to a plasma protein from the blood being transfused. Symptoms include flushing, itching and urticaria, severe allergic reaction includes bronchospasms, laryngeal edema and shock. Management includes administration of antihistamines, epinephrine and corticosteroids as ordered.

Circulatory Overload – If too much blood is transfused then this may cause circulatory overload or hpervolemia. Signs and symptoms would be orthopnea, dyspnea, tachycardia and anxiety, crackles, neck vein distention and hypertension. Slowing the rate of transfusion and administering diuretics as ordered is the intervention for such. Oxygen inhalation can also be initiated.

Bacterial Contamination – Contaminated blood products are very dangerous since it may transmit a disease or infection to the recipient. Signs and symptoms of bacterial contamination are fever, chills and hypotension. Antibiotics are administered as ordered to treat the infection as early as possible.


More information about blood transfusion complications

Byron Webb Romero, RN, MSN

Finished BSN at Lyceum of the Philippines University, and Master of Science in Nursing Major in Adult Health Nursing at the University of the East Ramon Magsaysay Memorial Medical Center. Currently working at Manila Doctors College of Nursing as a Team Leader for Level I and II, Lecturer for Professional Nursing Subjects, and also a Clinical Instructor.

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