Question 3

Outline the potential adverse consequences of blood transfusion.

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College Answer

As only an outline was asked for, a brief statement about each complication was sufficient. Better
answers were structured using a classification of: Acute Immunological, Acute Non Immunological, Delayed Immunological and Delayed Non-immunological. Examples of expected detail would include the following:
E.g. Bacterial infection – a statement outlining the incidence of bacterial infection, a common causative organism or why bacterial infections are more commonly associated with platelet transfusions than red cells would have scored the marks allocated to ‘bacterial infection’.
E.g. Acute Haemolytic Transfusion Reaction – a statement about red cells being destroyed due to incompatibility of antigen on transfused cells with antibody of the recipient and an approximate incidence scored the marks allocated to AHTR.
An excellent resource is the Australian Red Cross transfusion website as listed in the suggested reading section of the syllabus.


Following the advice of the examiners, the following list of complications was cobbled together from the Australian Red Cross "Adverse events overview" page

Acute immunological complications

  • Acute hemolytic transfusion reactions
  • Febrile nonhemolytic transfusion reactions
  • Tranfusion-associated lung injury (TRALI)
  • Allergic reactions to blood products

Acute non-immunological complications

  • Transfusion-associated circulatory overload (TACO)
  • Bacterial sepsis due to contaminated blood products
  • Hypocalcemia due to citrate
  • Hyperkalemia due to high PRBC K+ content
  • Acidosis due to high PRBC lactate content
  • Hypothermia due to use of recently refrigerated PRBCs
  • Dilutional coagulopathy due to inappropriate blood product replacement proportions
  • Dilutional thrombocytopenia due to lack of platelet replacement

Delayed immunological complications

  • Delayed hemolytic transfusion reactions
  • Transfusion-related immune modulation (TRIM)  
  • Microchimerism - the persistence of an allogeneic cell population of leucocytes
  • Posttransfusion graft-vs-host disease (due to non-leukodepleted PRBCs)
  • Posttransfusion purpura

Delayed non-immunological complications

  • Transfusion-transmitted diseases, eg. HIV, Hep C
  • Iron overload
  • Creutzfeld-Jacob disease


Sihler, Kristen C., and Lena M. Napolitano. "Complications of massive transfusion." CHEST Journal 137.1 (2010): 209-220.

Capon, Stephen M., and Dennis Goldfinger. "Acute hemolytic transfusion reaction, a paradigm of the systemic inflammatory response: new insights into pathophysiology and treatment." Transfusion 35.6 (1995): 513-520.

Perrotta, P. L., and E. L. Snyder. "Non-infectious complications of transfusion therapy." Blood reviews 15.2 (2001): 69-83.

Beauregard, Patrice, and Morris A. Blajchman. "Hemolytic and pseudo-hemolytic transfusion reactions: an overview of the hemolytic transfusion reactions and the clinical conditions that mimic them." Transfusion medicine reviews 8.3 (1994): 184-199.

Reed, William, et al. "Transfusion-associated microchimerism: a new complication of blood transfusions in severely injured patients." Seminars in hematology. Vol. 44. No. 1. WB Saunders, 2007.

Anderson, Kenneth C., and Howard J. Weinstein. "Transfusion-associated graft-versus-host disease." New England Journal of Medicine 323.5 (1990): 315-321.

Yokoyama, Ana Paula Hitomi, et al. "Diagnosis and Management Of POST-Transfusion Purpura-Case Report." Blood 122.21 (2013): 4834-4834.