Blood Transfusion: Risks, Complications, Safety Measures

Blood transfusion is a widely followed medical activity during accidents or surgical procedures. There are many regional blood centers across the globe to collect blood from voluntary donors to fulfill requests from patients in need. The reports from the national health survey suggest that it is easy to persuade regular donors owing to their desire to donate blood. The reports also say that the proportion of female donors is higher as compared to male donors. Still, due to the risk of anemia or erythropoiesis, they refrain from being a regular donor. Although in recent years, direct blood transfusion, as well as a donation, has witnessed a reduction. The primary cause for this fall is attributed to the reluctance of donors regarding the misconception of HIV transmission.

Blood transfusion has been associated with the risk of various infections and other transmitted diseases. But over the years, this estimation of the perceived risk of transmitted disease through blood transfusion has significantly decreased. It is because now donors are remotely screened by various tests, one example being the polymerase chain reactions before they are allowed to donate blood. Even the blood conserved for later use is also checked to be free from any infectious conditions. Some of the common risks associated with blood transfusion are as follows:

HIV or Human Immunodeficiency Virus is the most common form of fatal infection that can be easily transmitted through blood transfer. Such cases were observed in late 1982 and early 1983, and since then, the Public Health Services have recommended that people who are at an increased risk of HIV infection must refrain from a blood transfusion. Nowadays, a series of antigen tests are done before a blood transfusion to ensure no HIV positive candidates are involved in the process

Before the healthcare industry developed the vaccination for Hepatitis B and Hepatitis C, Hepatitis Virus was one of the most common viral infections transmitted through blood. Previously the number of patients infected with Hepatitis Virus used to be 1 in 10, which then gradually dropped and is now reduced to 1 in 1,00,000 blood transfusions. As compared to the last 20-30 years, the risk of transmission of Hepatitis and the mortality rate through blood transfusion has significantly decreased, and now it rarely forms a cause of infection

Blood transfusion has been the medium to carry various viral diseases among the donor and the recipient. It generally depends on the prevalence rate of a specific virus in the area, in which both the candidates of blood transfusion belong. The common viral conditions that have been known to infect transfusion patients are Hepatitis G, Hepatitis A, Parvovirus B19, and HTLV. The development of infection varies from year to year and is generally observed in pregnant women, anemic patients, or patients suffering from the impaired immune system

This risk of developing platelet-related sepsis is high when the transfusion is from multiple donors. It is due to the short shelf life of the platelets that make them vulnerable to bacterial contamination. The common symptoms observed in patients suffering from platelet sepsis by bacteria infection blood transfusion are mild fever, acute hypotension, and even death in severe cases. If the patient has signs of illness after six hours of transfusion, it is essential to run a bacterial contamination test, and empirical antibiotic therapy should be given

The main reason that contributes to the decay of red blood cells is bacterial. The most common organism being Yersinia enterocolitica. Usually, bacterial contamination occurs if the blood is stored for a longer duration.

But in most cases, even after blood transfusion, people have been reported the problem of red blood sepsis. Blood with severe contamination can be easily detected before transfusion. The contaminated blood will have a darker color due to hemolysis and reduced oxygen supply that helps doctors to identify the blood contamination

Hemolytic reactions are seen when a different blood group is transfused in the system, and it starts forming a clot. It is an antigen and antibody-mediated response that rejects the blood from non-matching donors. Although there has been a significant advancement in the study of antigen and their importance, hemolytic reactions continue to be an issue during transfusion. The primary factor for this mishap during transfusion has been traced to the laboratory level mismatching during blood sample tests.

Besides, many patients show a delayed hemolytic reaction manifestation of the routine antibody assay is not able to detect the mismatch. This risk of hemolytic reaction is more in patients suffering from sickle cell anemia.^[1]

Massive blood transfusion is considered as a lifesaving treatment option for patients who are succumbing to hemorrhagic shock. But there are significant complications associated with Mass Blood Transfusions like infections, immunologic reactions, and physiological difficulties. Some commonly observed conditions are mass blood coagulation, thrombocytopenia, hypothermia, electrolyte abnormality, and acid-base disorders. All these issues are the cumulative effect of units of red blood cells transfused, prolonged storage duration of the stored blood, and the type of leukocytes present in the donor blood.

Some common protocols are required to be followed to reduce the complications associated with Mass Blood transfusion. Warming the stored blood and blood products like platelets to body temperature are one measure for safe transfusion. Other measures include the prevention of bleeding and coagulation or their prompt control.^[2]

The presence of foreign protein elements in the donor plasma is a major cause of allergic reactions due to blood transfusion. They are immunoglobulin E mediated with Pruritus and Urticaria being the most common ones. Although anaphylactic reactions are rare, dyspnea, bronchospasm, laryngeal, edema, and cardiovascular complications can arise. In such cases, to make sure that safe blood transfusion takes place, antihistamines therapy should be done, and if required, washed red blood cells devoid of plasma and immunoglobulin A should be used for transfusion.^[3]

On clinical grounds, there are various methods of prevention and precaution to ensure that safe blood transfusion occurs. Still, an important intervention that remains untouched is the patient’s role throughout the blood transfusion trajectory. The technical advancement accompanied by experienced medical staff has been reported to provide promising results to minimize the error during the blood transfusion. But in addition to all this, patient involvement will open a new path to ensure safe practice.

Research in this aspect has revealed that people have anxious regarding transfusion as they consider it unsafe. Such people tend to refuse even a clinically important transfusion. In some cases, patients who have undergone transfusion are not able to recall the consent given for the same. The main reason behind both instances was found to be poor communication. It is evident that patients, as well as the general public, are cautious of the transfusion-related risks and complications. But if they are well informed, their willingness to participate will increase and will engage in safe transfusion practices. In recent years the UK has witnessed such patient engagement awareness campaigns and initiatives to improve the safe transfusion knowledge in the general public.^[4]

Pre-transfusion testing standards are important to maintain the quality and safety of blood transfusions. These guidelines are laid down based on the expert opinion and the recommendations of various transfusion quality regulation as well as pathology accreditation bodies. A summary of the key recommendations are as follows:

• All the important serological studies should be done with the collected blood sample within three days. The tests should be before actual transfusion to avoid post-transfusion risks
• The ABO group testing of the pre-transfusion sample should be done and retained to prevent acute hemolytic reaction or repeat the test if such reaction happens after few days if transfusion
• The laboratory test units should be fully automatic to minimize the errors during interpretation and transcription of serological results
• A full risk assessment must be done where any abbreviation related to the ABO blood group is present
• If the patient tends to form a red cell alloantibody, it is important that before each transfusion the blood sample should be properly examined to ensure that no alloantibody is present in it
• When the test unit faces any electronic issue, the default technique of the Indirect Antiglobulin Test crossmatch should be done to validate results
• All the test and transfusion laboratories should practice the habit of keeping written protocols in a place where the responsibilities of all the staffs dealing with emergency patient needs are highlighted

Apart from these standard storage guidelines and quality management of the collected blood products should also be followed to facilitate a safe and good practice if blood transfusion. Standard protocols are mentioning the number of platelets or red blood cells that should be transfused to adults, neonates, and children.^[5]

The greatest risk perceived by the blood transfusion candidates throughout the world is due to human errors that lead to transfusion of incorrect blood groups or components. After observing this result of hemovigilance programs, the healthcare industry has come up with some new technologies that have shown promising results to reduce manual errors and improve blood transfusion safety.

Some of the common technologies in use are as follows:

Improvement in Sample Labeling: This involves the use of handheld scanning devices to facilitate patient identification and improved sample labeling with the help of a barcode. The printer attached to the bed of the patient scans data directly from their wristband and transfers information through a cable to the connected hospital network

Standards for National Performance and Charts for Statistical Process Control: The SPC control charts are used to track the performance of blood sample collection as well as to keep a check on their quality. The data collected through Statistical Process Control charts are used to set an upper control limit for the expected performance. SPC monitoring can easily incorporate a national standard for performance to help all the hospitals guide for expected performance and proper sampling

Administration of Nanosensors Or Tissue Oxygen Probes: Generally, the transfusion of red blood cells is to increase the oxygen levels in the tissues, and the current practice of transfusion is based on the amount of hemoglobin present in the blood. The recent advancements are aiming to make use of nanotechnology in the form of tissue oxygen sensors to evaluate the demand for transfusion based on the oxygen content of the blood. This oxygen probe will be implanted in organ beds to give real to data, and I set to make the notion of transfusion based on hemoglobin level obsolete

Barcode Technology: It is a stable and inexpensive method of machine reading identification for patient identification and transfusion safety. Patients are given a wristband with barcode and eye readable identification that acts as an identification slip and helps the nurses to verify the accuracy of bedside check

Although all these technological advancements are promising a great future for blood transfusion safety, there are certain obstacles in the path of deploying these technologies. The most common hindrance being the natural tendency to resist change, confusion, or dilemma to choose the best technology, and uncertainty regarding the investment they made and the return they would get. But the integration of these technologies will significantly improve patient care related to blood transfusion.^[6]

Blood transfusion safety has been a pressing issue in the healthcare sector. Due to the risk of transmitted infections and complications related to massive transfusion, the public has been reluctant regarding blood transfusion. With new technological advancement and initiatives like patient awareness programs, it will be quite easy for patients to accept transfusion options as well as ensure their safety throughout the process.

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Also Read:

• What is Blood Transfusion & When Do We Need It?
• Blood Groups and Matching: Under What Conditions Is Blood Transfusion Done & the Needed Precautions