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Transfusion Risks7. Transfusion RisksPlasticizer toxicityPlasticizers are chemicals used for making the plastic blood bags more malleable. The plasticizer used is di-2-ehtylhexylphthalate (DEHP). This is thought to be chronogenic and its breakdown products produce peroxisomes which cause damage to organs. Electrolyte toxicity Hyperkalemia due to transfusion of stored blood is a rare occurrence and is associated with massive transfusion.! Citrate toxicity Rapid transfusion of coated blood can lead to a fall in the calcium levels due to the chelating action of citrate. If the liver function is normal, citrate is metabolized to bibonate and rarely causes any problem. Citrate toxicity may be seen in patients undergoing cytapheresis or rarely in those receiving massive transmission. Clinical features range from mild circumoral paraesthesia to tetany. If symptoms are severe calcium may be given. However, calcium should neer be added to the blood bag as it may lead to clotting of blood. The reaction is mild, self-limiting and can be treated by slowing the rate of transfusion. Air embolism This type àf reaction was encountered when evacuated glass bottles were used for collection of blood. Air may enter the patient’s circulation by roller pumps present in transfusion devices. Clinical features Patients may pt acute cardiopulmonary insufficiency * Acute cyanosis * Cough * Pain in the chest * Shock If not treated immediately, death may occur. Management 1. Stop the transfusion. 2. Place the patient head down on the left side. Cardiac arrest due to hypothermia Hypothermia may occur when large quantities of cold blood are given rapidly. The lowers the temperature of the sinoatrial node causing ventricular fibrillation or cardiac arrest. Prevention 1. Do not transfuse blood rapidly. 2. For routine transfusion, do not warm the blood. 3. If blood is to be warmed, use an electric blood warmer. Keep the temperature below 38°C. Do not heat blood in a microwave/under running tap water. Records of transfusion reactions Records of all reactions must be maintained in the transfusion centre. the results of investigation done to evaluate the reactions must be filed. The consequences and mortality associated with transfusion must be recorded. Records must be maintained for 5 years. At the end of the year the reactions must be evaluated and the source of error in each case compiled. This will help the transfusion centre to take adequate preventive measures. The hospital transfusion committee should look into the causes of transfusion reactions and take steps to prevent these reactions. Summary Transfusion of blood is frequently associated with adverse reactions. These may be divided into immunological or non-immunological. Acute intravascular haemolytic reactions are associated wfth high mortality. These result most often from ABO imcompatibility. As human error is the most common cause of these reactions, all efforts should be made to prevent such errors. All reactions should be adequately evaluated and recorded.
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