Transfusion reactions

By Tedler D. Depaynos, MD

“ We had to assure him that we never experienced or heard such unfortunate incident in our practice and our facilities in our local hospitals as well as our local Red Cross are high tech.”

While we were enjoying our Jollibee merienda with a young resident MD, a long time friend with his young wife whom we have not seen for quite some time suddenly joined us. He was very interested about our blood facilities in our locality which made us curious. We learned that he has a chronic blood dyscrasia and from time to time he underwent blood transfusion to correct his severe anemia. He works in a southern province where his wife originated and for his routine procedure he is sometimes admitted in an Emergency Hospital near his place of work. In one incident while undergoing blood transfusion, he saw a ward mate in the hospital who was likewise undergoing the same procedure but suddenly became dyspnic, underwent emergency cardio-pulmonary resuscitation or CPR and eventually was transferred to the Intensive Care Unit or ICU. Although he was not able to confirm it, the rumor was that the patient was given an “incompatible blood”. Hence, his interest in our local blood facilities was understandable.
We had to assure him that we never experienced or heard such unfortunate incident in our practice and our facilities in our local hospitals as well as our local Red Cross are high tech.
His interest then extended on the possible complications of blood transfusions. Our young MD companion responded with a thorough lecture while consuming his apparently favorite food.
A very serious transfusion reaction is when the antibodies of the blood of the recipient react with the antigen of the blood of the donor. In short, they may be different types and are not compatible! This results in the immediate hemolysis of the donated blood resulting in intravascular coagulation, shock and renal failure. Even after the administration of a few millimeters of blood, pain at the transfusion site occurs, with fever, flushing and generalized bleeding. There could be chest or even back pains. When this is noticed, the blood transfusion should be immediately discontinued and the patient is treated aggressively.
With modern technology, blood typing is very accurate. In the hospital where the young MD is connected, however, the rule is that before they transfuse blood processed from other institutions, the hospital would re-examine the blood before transfusing. If the patient or the relatives do not consent to the re-examination, a waiver is given to them to sign so that if anything happens, the transfusing institution would not be blamed.
We got reminded of the experience of an elder colleague when he was a medical intern in a medical institution in Metro Manila that he once related. It was around 4 decades ago, when they had a very unfortunate case where a patient was given blood that was intended for another patient. It was simply due to clerical error! So that before the giving of blood, a double or even a triple check should always be done.
I could also recall an old professor of mind lecturing that hemolysis may occur after several days after the blood transfusion. It is very, very rare but my old professor mentioned it as a warning. In retrospect and with a smile, perhaps the lab facilities during those ancient times were not yet high tech as now.
There are some cases where the patient experiences itchiness, redness and develops papules on the skin during transfusion. These could just be plain allergy and anti allergic medications are immediately given. The patient however is closely monitored for the possibility of anaphylactic shock!
Fever may also develop suddenly during the transfusion and although these could just be simple reactions between the donor’s and the recipient’s blood it could also be an early sign of blood reaction. The blood is usually immediately discontinued and hemolysis should be ruled out. If no serious blood reaction is noted, antipyretics are usually given and the response is usually significant.
Again for emphasis, patients undergoing blood transfusion are closely monitored. As a rule, when any untoward signs and symptoms occur, the transfusion is discontinued and the donor blood is replaced. Why take the risk? It is of course the decision of the attending MD especially if the condition of the patient is serious and the availability of the blood is not reliable.
In the screening of blood donors, the young MD mentioned that they are very strict in inquiring about the health history of the donors. Viruses could be transmitted especially the Hepatitis Viruses. Other diseases could also be transmitted like syphilis and malaria.
Bacteria from the site of needle insertion in the skin of the donor may also enter the donor blood and may multiply. The blood is an excellent culture media and rapidly becomes infected. And this may cause sepsis on the recipient! Hence, very strict aseptic procedure is also emphasized.
Our friend had other interesting questions but the young MD appeared to have a very tight schedule and had to leave. Our friend then ordered a take home package for him to express his thanks.**

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