Transfusion Medicine

This section focuses on the various types of blood products, indications for transfusion, and noninfectious complications associated with blood transfusion. Red blood cells are the most frequently used blood component.

Blood Products and Indications

Product	Indication
Red blood cells	To improve oxygen-carrying capacity and relieve symptomatic anemia Chronic transfusion for sickle cell disease
Platelets	Transfusion thresholds vary by patient needs but are aimed to maintain hemostasis
Granulocytes	Critically ill neutropenic patients, especially those with documented fungal infections and no clinical response to antimicrobiologic treatment
Fresh frozen plasma	Disseminated intravascular coagulation Massive blood transfusions Coagulation factor deficiency with active bleeding in the absence of specific factor concentrate
Cryoprecipitate	Hypofibrinogenemia Factor XIII deficiency

Preparation of Blood Products

Leukoreduction: decreases the number of white blood cells (WBCs) in transfused blood to reduce the number of febrile nonhemolytic transfusion reactions and transfusion-associated cytomegalovirus infection; used in immunocompromised (oncology, transplant recipient) patients
Irradiation: inactivates WBCs not removed through leukoreduction to prevent transfusion-associated graft-versus-host disease; used in immunocompromised (oncology, transplant recipients), newborns and premature infants
Washing: removes plasma proteins that cause allergic reactions and removes high levels of extracellular potassium from red blood cells; used in patients with IgA deficiency and considered in patients with history of severe allergic reactions to blood products

Transfusion Complications

Transfusion of blood products can lead to both infectious or noninfectious complications. Improvements in donor and product screening have resulted in very low rates of infection transmission, but the risk has not been completely eliminated. The following table highlights some immediate noninfectious complications of blood transfusion. In addition, patients receiving chronic red-cell transfusions are also at risk of iron overload, which is associated with significant clinical effects.

Complications of Blood Product Transfusions

Complication	Symptoms	Management
Febrile non hemolytic transfusion reaction	Fever Chills Diaphoresis	Stop the transfusion immediately Treat as infectious etiology if patient is immunocompromised Supportive care as needed
Allergic reaction	Ranges from itching or hives to more-severe allergic reactions or anaphylaxis	Stop the transfusion immediately Itching/hives: administer antihistamine and may resume transfusion if symptoms resolve More-severe reactions: administer steroids or epinephrine, or both Do not restart transfusion with same product
Acute hemolytic transfusion reaction	Most often a result of ABO incompatibility Fever, chills, dyspnea Tachycardia Tachypnea Hypotension Pallor Abdominal pain Oliguria Hemoglobinuria	Stop the transfusion immediately Initiate workup for hemolytic reaction according to institutional protocols Supportive care as needed
Transfusion-related acute lung injury (TRALI)	Fever, chills, dyspnea Cyanosis Bilateral pulmonary infiltrates Occurs 1-6 hours after transfusion	Stop the transfusion immediately Supportive care: supplemental oxygen and/or mechanical ventilation if needed; usually self-limited
Transfusion-associated cardiac overload (TACO)	Respiratory distress Hypoxia Crackles Hypertension, tachycardia Wide pulse pressure Often in patient with known cardiac compromise Occurs within 6 hours of transfusion	Diuretics Phlebotomy Supplemental oxygen