Question 16

List the potential problems resulting from blood transfusion and methods used to 
minimise them.

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College Answer

This question required a broad answer. It was generally well answered. Those candidates who scored well had a good structure to their answers e.g. grouping potential electrolyte disturbances together, and infectious risks together etc. and including methods used to minimise these risks in appropriate detail.


Complication Management strategy
Acute hemolytic transfusion reactions
  • Stop transfusion
  • Re-crossmatch
  • Maintain blood pressure with vasopressors (there may be cytokine shock)
  • Maintain adequate urine output to prevent haem-associated ATN
Febrile nonhemolytic transfusion reactions
  • Stop transfusion
  • Antipyretic agents
Allergic reaction to blood products
  • Stop transfusion
  • Antihistamine and corticosteroid
Tranfusion-associated lung injury
Transfusion-associated circulatory overload
  • Stop transfusion
  • Administer a diuretic
  • Consider a venodilator (eg. GTN) to decrease preload
  • Ventilate with a higher PEEP
Bacterial sepsis
  • Management of sepsis as per usual routine
  • Inform blood bank regarding contaminated blood products
  • Perform a blood culture and Gram stain on the bag of PRBCs
  • Keep the bag and giving set
Hypocalcemia due to citrate
  • Calcium replacement
Hyperkalemia due to high PRBC K+ content
  • Routine management of hyperkalemia (eg. calcium gluconate, bicarbonate)
  • Tincture of time, if your liver is normal
  • Dialysis, if the clearance mechanisms are impaired
  • Aggressive rewarming
  • You should have used a blood warmer
Dilutional coagulopathy
  • Blood products will need to be replaced - FFP and cryoprecipitate to start with
Dilutional thrombocytopenia
  • Platelet transfusion
Delayed hemolytic transfusion reactions
  • Maintain blood pressure with vasopressors (there may be cytokine shock)
  • Maintain adequate urine output to prevent haem-associated ATN
Transfusion-related immune modulation
  • Using leukodepleted PRBCs, surprisingly, is not protective.
  • Monitor for GVHD and autoimmune diseases
Transfusion-transmitted diseases
  • Councelling of the affected
  • Post-exposure prophylaxis, if relevant
  • Antiviral therapies
Posttransfusion graft-vs-host disease
  • Immunosuppression
Posttransfusion purpura
  • IV immunoglobulin
  • Plasmapheresis
  • Generally, management resembles the management for TTP


NZBLOOD Transfusion Medicine Handbook (2008)

Bux, Jürgen, and Ulrich JH Sachs. "The pathogenesis of transfusion‐related acute lung injury (TRALI)." British journal of haematology 136.6 (2007): 788-799.

Fontaine, Magali J., et al. "Diagnosis of transfusion-related acute lung injury: TRALI or not TRALI?." Annals of Clinical & Laboratory Science 36.1 (2006): 53-58.

Kleinman, Steven, et al. "Toward an understanding of transfusion‐related acute lung injury: statement of a consensus panel." Transfusion 44.12 (2004): 1774-1789.

Gajic, Ognjen, Michael A. Gropper, and Rolf D. Hubmayr. "Pulmonary edema after transfusion: how to differentiate transfusion-associated circulatory overload from transfusion-related acute lung injury." Critical care medicine 34.5 (2006): S109-S113.

Vincent, E. Chris, and Tracy Willett. "Post-Transfusion Purpura." The Journal of the American Board of Family Practice 4.3 (1991): 175-177.