Of serious known risks, transfusion of an incompatible blood component may result in acute hemolysis. If severe, this can cause DIC, acute kidney injury, and death. Preventable errors responsible for most of such reactions frequently include mislabeling of a specimen or incorrectly transfusing a patient not slated for those products. The rate of such errors in the United States is estimated to be 1 in 14,000 units, but these events are likely underreported (Lerner, 2010). A transfusion reaction is characterized by fever, hypotension, tachycardia, dyspnea, chest or back pain, lushing, severe anxiety, and hemoglobinuria. Immediate supportive measures include stopping the transfusion, treating hypotension and hyperkalemia, provoking diuresis, and alkalinizing the urine.
Transfusion-related acute lung injury (TAIl) is the most common cause of transfusion-related mortality. The syndrome is characterized by severe dyspnea, hypoxia, and noncardiogenic pulmonary edema that develop within 6 hours of transfusion (Peters, 2015). TRALI is estimated to complicate at least 1 in 12,000 transfusions (Carson, 2017). Although the pathogenesis is incompletely understood, injury to the pulmonary capillaries may arise from anti-human leukocyte antigen (HA) and neutrophil (HNA) antibodies in donor plasma (Lerner, 2010). A delayed form ofTRALI has been reported to begin 6 to 72 hours following transfusion (Marik, 2008). Management is supportive and may include mechanical ventilation (Chap. 47, p. 919).
Bacterial inection from transfusion of a contaminated blood component is unusual because organism growth is discouraged by refrigeration. The most often implicated contaminants of red cells include Yersinia, Pseudomonas, Serratia, Acinetobacter, and Escherichia species. The more important risk is from bacterial contamination of platelets, which are stored at room temperature. Current estimates are that 1 in 1000 to 2000 platelet units are contaminated. Death from transfusion-related sepsis is 1 per 17,000 for single-donor platelets and 1 per 61,000 for apheresis-donor packs (Lerner, 2010).
iral inection risks from transfusion have been curtailed. he risk of HIV or hepatitis C virus infection in screened blood is estimated to be 1 case per 1 to 2 million units transfused (Carson, 2017; Stramer, 2004). The risk for HIV-2 infection is less. Other viral infections include hepatitis B transmission, which is estimated to be < 1 per 100,000 transused units Qackson, 2003). Because of its high prevalence, cytomegalovirus-infected leukocytes are often transfused. hus, precautions are taken for immunosuppressed recipients, keeping in mind that this includes the fetus.
Also, risks for transmitting West Nile virus, human T -lymphotropic virus type I, parvovirus B 19, and toxoplasmosis are slight (American Association of Blood Banks, 2013;
Foroutan-Rad, 2016). Finally, Zika virus has emerged as another relevant transfusion-transmitted infection (Motta, 2016). The Food and Drug Administration (2016) revised recommendations for collection of all whole blood components to include testing for Zika virus. This practice has been airmed by the Centers for Disease Control and Prevention (2016).