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Complications
of Transfusion Complications of transfusion -
serious complications are rare, the most important is ABO
incompatibility which in the majority of cases is the result of
misidentification. In order
to prevent this the Trust has a firm policy that all samples must be
adequately identified Ref. Hospital Transfusion Policy. Urine may contain haemoglobin i.e. will be pink and clear or there may be
oliguria. Management : 1. Stop red cell
transfusion 2. Give saline or
Gelofusine according to BP 3. Give Ofloxacin 200mg
iv stat 4. Take samples for
repeat grouping, Coomb's test and coagulation screen 5. If DIC is present
give fresh frozen plasma and consult haematologist for advice Non-haemolytic febrile transfusion reactions are the commonest problem and
are usually caused as a result of antibodies in the patient's blood to
proteins or white cell/platelet residue in the transfused blood.
These normally require only paracetamol but in more severe cases
Piriton and Hydrocortisone may help. TRALI - Transfusion Related Acute Lung Injury or adult respiratory
distress syndrome is a poorly understood complex. TRALI is a complex disorder with
a partly immunological basis which may be associated with anti-white
cell antibodies in the patient's serum however the immunological tests
are both insensitive and non-specific.
This usually presents as respiratory distress in the context of
multiple transfusions and as multiple transfusions are generally given
to sick patients, it is not always possible to determine whether the
respiratory problems are the result of complications of transfusions or
of the underlying disorder. In
the presence of hypoxia, anaesthetic advice should be sought with
respect to assisted ventilation. The
treatment is supportive. POST TRANSFUSION PURPURA Purpura associated with
thrombocytopenia may occur following transfusion of red cells as a
result either of antiplatelet A1 antibodies or an immune complex
formation. Contact
consultant haematologist who will arrange the necessary investigations. P0LYTHAEMIA Spurious polycythaemia may be the result of bad venesection technique i.e.
prolonged use of a tourniquet can increase the Hb. and all borderline
levels should be repeated preferably avoiding prolonged venestasis.
Smoking may cause polycythaemia and carboxyhaemoglobin level will
demonstrate how much of the haemoglobin is inactivated - subtracting
this from the total haemoglobin will give the corrected value. Polycythaemia should be suspected
if the haemoglobin is above 18 in men or 16.5 in women.
It is classified into primary and secondary, the commonest cause
of secondary polycythaemia is secondary to COAD or congenital heart
problems and therefore clinical evaluation should be directed towards
these. Rarely it may be the
result of a tumour producing erythropoietin or EPO like activity.
These can occur in kidney, brain and uterus.
Primary proliferative polycythaemia (polycythaemia vera) is often
associated with raised white count and platelets.
Cases of suspected primary proliferative polycythaemia should be
referred to a haematologist for treatment.
Relative polycythaemia - pseudonyms Guy's Box Syndrome or stress
polycythaemia occurs because of reduced plasma volume and is often
associated with hypertension or obesity and is particularly common in
young middle aged males. Treatment
of hypertension where present often improves the Hb. The management of relative
polycythaemia is problematic and there is no evidence base for
venesection to improve survival or reduce complications.
Occasional patients with relevant symptoms may achieve some
benefit from venesection. However
many such patients have a reduced total blood volume and therefore
venesection may cause clinically significant hypotension. |
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