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Non - immune Reactions

You are here : Home/ Blood Bank Zone/ Adverse Reactions to Blood Transfusion/ 6. Non - immune Reactions

6. Non-immune Reactions

Bacterial contamination of blood

Bacterial contamination of blood may occur due to incorrect phlebotomy, during component preparations or during storage. With strict adherence to appropriate protocol for phlebotomy and adequate equipment for storage being available, this is fortunately a rare complication.

Clinical features

The symptoms when they occur are severe and are due to endotoxin produced by gram-negative bacteria., The patient has
* high grade fever
* nausea, vomiting
* diarrhoea
* abdominal cramps
* haemoglobinuria
* shock
* DIC and renal failure

Management

1. Stop the transfusion immediately
2. Examine bag for discoloration/clots/colour of the blood and plasma/interface of cells and plasma.
3. Send blood from blood bag, tubing and recipient (post-transfuion) for culture at 4�C, 22�C and 37�C. Cultures must be done for bacteria (aerobic and ana�robic) and fungi.
4. Keep intravenous line patent
5. Give broad-spectrum antibitics, steriods and dopamine to manage shock.

Prevention

1. Maintain strict aseptic precautions during phlebotomy.
2. Store blood under adequate storage conditions.
3. Maintain aseptic precautions during component prepartion
4. Maintain the donor room area clean.
5. Reagents used for cleaning the venepuncture site must be sent for bacteriologic examination at periodic intervals to check for contamination.

Circulatory overload

Patient with compromised cardiopulmonary function may not tolerate a rapid increase in blood volume and develop hypervolemia. This is specially se�n in infants and elderly patients.

Clinical features

During the transfusion the patient deelops
* Sudden severe headache
* Techyacardia
* Dyspnoea
* Cough
* Cyanosis
* Qrthopnoea

Management

1. Stop the infusion immediately.
2. Place patient in a sitting position.
3. Give diuretics.
4. Give oxygen, if required.

Prevention

1. Slow infusion to be given to patients at risk (lml/kglhour)
2. Give diureties before starting the transfusion

Iron overload

Each unit of red cells contains 200mg of iron. Patients who are on long term transfusion therapy such as thalassaemics, accumulate iron and develop organ dystinction due to deposition of iron. Treatment is by chelating agents such as desferrioxamine or newer compounds such as oral iron chelator L1.

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