Biomedical Engineering Reference
In-Depth Information
Table 11.2
Transfusion therapy—the common adverse effects
Febrile non-hemolytic transfusion reaction (FNHTR);
Transfusion-induced immunomodulation (immunosuppression);
Hemolytic transfusion reaction (HTR);
Hypotensive reactions;
Transfusion-related acute lung injury (TRALI);
Platelet transfusion refractoriness;
Post-transfusion purpura;
Allergic and anaphylactic reactions;
Vasovagal syncope;
Circulatory overload;
Transmission of parasites and bacteria (transfusion-associated sepsis);
Complications of massive transfusion and apheresis;
Transfusion-induced hemosiderosis;
Transfusion-associated graft versus host disease (TA-GvHD);
Transfusion-transmitted (blood-borne) infections
blood granulocyte count of normal donors. Both higher granulocyte count in donor's
circulation and processing of larger blood volume provide collection of evidently
greater granulocyte doses (6-8×10
10
/unit), compared with previously acceptable
doses (1-2 × 10
10
/unit). Consequently, renewed interest has extended the use of
granulocyte transfusions in the treatment of transplanted adult patients in whom
critical neutropenia (transfusion trigger £ 200-500/ mL) was complicated by severe
bacterial and/or fungal infections [
1,
33
] .
Adverse Effects of Transfusion Therapy
Blood is a living tissue, and its transfusion from one individual to another is not free
of hazards. Transfusion adverse effects (reactions or complications) might be immu-
nologically or non-immunologically mediated, immediate or delayed, and may vary
from mild to fatal. A variety of transfusion adverse effects are still a major concern
in transfusion therapy (Table
11.2
) [
1,
34
] .
The most important hazards of transfusion are transfusion-transmitted infections
and acute HTR caused by the use of ABO-incompatible RBCs. The advent of AIDS
has raised concern regarding blood-borne diseases. Blood transfusion is safer than
ever before through continual improvements in safe donor recruitment, i.e., screen-
ing (e.g., removal of high-risk donors), testing of each donation with a panel of viral
markers, and appropriate clinical use of blood. The risk of residual infections is
further reduced through inactivation of pathogens in blood components [
35,
36
] . As
mentioned, RBC transfusions are rarely, if ever, justified in the treatment of patients
with Hb approximately l00 g/L. If Hb concentrations range between 60 and l00 g/L,
the occurrence and the intensity of symptoms and signs of inadequate tissue oxy-
genation will be essential for decision making concerning transfusion. For RBC
