Hazards of blood transfusion

• Citrate toxicity—hypocalcaemia is rarely a problem and the prophylactic use of calcium supplementation is not recommended.

• Potassium load — potassium returns to cells rapidly but hyperkalaemia may be a problem if blood is stored at room temperature.

• Sodium load — from citrate if the transfusion is massive.

• Hypothermia — can be avoided by warming blood as it is transfused.

• Jaundice — haemolysis of incompatible or old blood.

• Pyrexia — immunological transfusion reactions to incompatible red or white cells or platelets.

• DIC — partial activation of clotting factors and destruction of stored cells, either in old blood or when transfusion is incompatible.

• Anaphylactoid reaction — urticaria is common and probably due to a reaction to transfused plasma proteins; if severe it may be treated by slowing the transfusion and giving chlorpheniramine 10mg IV/IM. In severe anaphylaxis, in addition to standard treatment, the transfusion should be stopped and saved for later analysis and a sample taken for further cross-matching.

• Transmission of disease — including viruses, parasites (malaria), prions.

• Transfusion-related acute lung injury (TRALI) and other immune reactions.

• A multicentre trial suggested liberal transfusion in the critically ill produced less favourable outcomes, particularly in younger, less sick patients, than using a trigger haemoglobin of 7g/dl.

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