Adverse Effects of Blood Transfusions - Research Paper Example

? Adverse Effects of Blood Transfusions (Add (Add (Add Adverse Effects of Blood Transfusions Medical dictionaries define blood transfusion as the process of transferring blood or blood based products from an individual to the circulatory system of another. “Blood transfusion is the transfer of blood from the vein of one person (donor) to the vein of another (recipient); and this includes collection of blood from the donor and administration of blood to the recipient” (Thresyamma, 2005). Generally, blood transfusion is conducted to replace the blood lost from a person’s body due to a surgery or a serious injury. This technique is also used when an individual’s body is not capable of producing blood due to illness. A small needle is used to connect an IV line to one of the blood vessels of the recipient, through which the person receives healthy blood. This process may take 1 to 4 hours to complete depending on the volume of the blood the recipient needs. As Fasano and Luban (2008) point out, in olden days, whole blood required was transferred through the blood transfusion process whereas modern medical science uses only some of the components of the blood including red and white blood cells, plasma, and platelets. Blood donation, processing of the donated blood, compatibility testing, and neonatal transfusion are the major pre-transfusion procedures. Statistical data show that nearly 5 million Americans require a blood transfusion each year. This paper will critically analyze the adverse effects of blood transfusions. Adverse Effects of Blood Transfusions There is a wide range of complications associated with the transfusion of blood and other blood products. High level of quality degradation of blood during storage becomes one of the most adverse impacts of this method and this trouble raises a series of direct and indirect complications. As per reports, side effects associated with blood transfusion in the United States cost nearly $17 billion; and this situation forces the economy to spend more on healthcare sector. Evidently, some complications may depend on the physical status of the patient whereas some others would develop due to the particular transfusion quantity involved. However, the level of baseline complication risks associated with blood transfusion is directly proportional to the frequency and amount of transfusion. The adverse impacts of blood transfusion are mainly categorized into two such as immunologic and infectious which are described below. Immunologic effects Sometimes the blood recipient’s antibodies may destroy donor erythrocytes and this condition may lead to the occurrence of acute hemolytic reactions during the transfusion of red blood cells. Such a situation is fatal although it occurs very rarely. Clerical errors and improper cross matching are the major causes of such reactions, and symptoms may include fever, chest pain, increased heart rate, breathing troubles, hemorrhage, and hypotension. Researches indicate the fact that the effects of hemolytic reaction may sometimes result in a kidney injury too. It is observed that delayed hemolytic reactions occur more frequently than acute hemolytic reactions even though both of these troubles are occurred due to the same mechanism. However, effects of delayed hemolytic reactions are placid and generally they do not cause patients to develop symptoms. At the same time, hemolysis and declining hemoglobin level would still occur in patients. Although any treatment is not required for this condition, the presence of recipient antibodies would badly affect future compatibility. Febrile nonhemolytic reactions occur nearly in 7% of blood transfusions and such a condition can be attributed to the reaction of recipient antibodies to the white blood cells of the donor. This difficulty may also arise as a result of exposure occurred during the previous blood transfusions. “Fever is generally short lived and is treated with antipyretics, and transfusions may be finished as long as an acute hemolytic reaction is excluded”; hence, the process of leukoreduction is widely used to filtrate white cells of the donor from red cell product units (World News Inc, 2012). Likewise, allergic reactions are more likely to occur during blood transfusion if recipient antibodies react to some specific chemical in the donor blood. Symptoms of these allergic reactions may include urticaria, pruritus, and sometimes it may lead to anaphylactic shock. The treatment used for type 1 hypersensitivity reactions can be applied in the case of allergic reactions too (RxFind, 2011). It is noted that nearly 0.13% of patients are immunoglobin lgA. Such patients are more likely to develop an anaphylactic reaction when they get exposed to lgA contained blood. Murphy and Wallis (2007) state that a complication called posttransfusion purpura may rarely develop in patients after transfusion of blood platelets having a surface protein HPA-1a (p.25). Individuals with the absence of this protein would be highly sensitive to it as a result of prior transfusions and therefore they may develop thrombocytopenia around 7-10 days after following transfusions. Under such circumstances, recipients must be given HPA-1a negative cells during future transfusions. In the words of Kleinman & Kakaiya (2009), transfusion associated acute lung injury (TRALI) is one of the increasingly recognized difficulties related with blood transfusion. It is directly linked with respiratory distress and often occurs along with other problems such as fever and hypotension. The TRALI may happen 1 in every 2000 transfusions. Although its symptoms can be life threatening, death caused from this condition is rated less than 10%. This condition is often associated with anti-HLA antibodies, which are commonly developed during pregnancy (pp. 90-96). Infectious Effects In rare occasions, bacterial actions may contaminate blood products and this issue would subsequently cause life threatening infection; and this condition is called transfusion transmitted bacterial infection. As Blajchman (2002) points out, severe bacterial infection may occur approximately 1 in every 50,000 transfusions and 1 in every 500,000 blood cell transfusions. Although blood product contamination is less likely to happen, its occurrence is relatively higher than actual infection. Similarly, the rate of contamination of platelets is higher than other blood products since they are stored up at room temperature for a short span of time. It is observed that the possibility of contamination increases with duration of the blood storage and contaminants sources may include donor’s blood and donor’s skin whereas skin flora, gut flora, and other some other environmental organisms represent contaminating organisms. In addition, HIV transmission during blood transfusion remains to be a threatening complication even though HIV testing of donor blood has been started since 1980s. Even though a more reliable nucleic acid test has been developed for HIV, the risk of HIV transmission still exists in transfusions. As Cutler (2009) points, the process of blood transfusion poses a high degree threat of hepatitis C transmission and this issue currently occurs at an approximate rate of 1 in 2 million units. Syphilis, Chagas disease, HLTV, and cytomegalovirus infections are other transmissible infections during blood transmissions. Other Effects It has been evidently identified that a set of biochemical and biomechanical transformations occurring during blood storage (the process is called storage lesion) and this changes directly lead to inefficiency in blood transfusion. Transfusion inefficiency may cause a series of other complications, especially to subsequent transfusions. Transfusion inefficiency dreadfully affects critical care patients who are badly in need of quick restoration of effective oxygen delivery. Inefficient transfusion of red blood cells can minimize the viability of tissue oxygenation. Sometimes, volume overload occurs during blood transmissions as each blood product has its own distinct volume. Such issues are more likely to happen in recipients suffering from cardiac or kidney disease. The transfusion process needs to be repeated under certain situations where an inefficient transfusion of red blood cells occurs; and such a situation may sometimes lead to volume overload. Plasma transfusion is more likely to cause volume overload as a result of the effect of hypertonicity. Kahan & Smith (2004) indicates that transfusions of huge amount of blood products, which are kept at cold temperatures, would rarely lead to a condition called Hypothermia. This condition will lower an individual’s body temperature as low as 32o C and has the potential to develop physiologic disturbances (p.93). In order to prevent this issue, medical practitioners often suggest proper warming of blood prior to transfusions. Evidences indicate that transfusion of large quantities of red blood cells often results in an inclination for bleeding. “The mechanism is thought to be due to disseminated intravascular coagulation, along with dilution of recipient platelets and coagulation factors” (Regularity.org, 2012). Massive blood transfusion and associated breakdown of citrate into bicarbonate leads to metabolic alkalosis while the complex of citrate with serum calcium formed as a result of large amount of blood transfusion can leads to a condition called hypocalcemia. Conclusions In total, blood transfusion has a range of adverse effects even though highly improved technologies are being applied in this area. Acute hemolytic reactions, delayed hemolytic reactions, febrile nonhemolytic reactions, allergic reactions, and posttransfusion purpura, transfusion associated acute lung injury are the major immunologic complications of blood transfusion whereas contamination of blood products and transmission of diseases are the adverse effects of this process. In addition, this process has a range of other issues such as volume overload, hypothermia, metabolic alkalosis, and hypocalcemia, which are associated with blood transfusion. References Blajchman, M. A. (2002). Incidence and significance of the bacterial contamination of blood components. Developments in Biologicals, 108, 59-67. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12220143 Cutler, N. (2009). An overview of the HCV Drug development process. Hepatitis Central. Retrieved from http://www.hepatitis-central.com/mt/archives/general_hepatitis_c_newsupdates/ Fasano, R & Luban, N. L. C. (2008). Blood component therapy. Pediatric Clinics of North America, 55, 421-445. Retrieved from http://www.sld.cu/galerias/pdf/sitios/hematologia/transfusion_pediatrica.pdf Kleinman, S. H & Kakaiya, R. (2009). Transfusion related acute lung injury. In M. F. Murphy & D. H. Pamphilon (eds). Practical Transfusion Medicine. USA: Wiley- Blackwell. Kahan, S & Smith, E. G. (2004). Signs & Symptoms. USA: Blackwell Publishing. Murphy, M & Wallis. (2007). Red cell transfusion. In M Contreras (ed). ABC of Transfusion. (pp. 15-26). USA: Wiley-Blackwell. Regulatory. Org. (2012).  Blood transfusion: Encyclopedia. Retrieved from http://www.regularity.org/blood_transfusion/encyclopedia.htm RxFind. (2011). Donor set bulk packed misc. Retrieved from http://www.rxfind.net/drugs/41203-Donor-Set-Bulk-Packed-Misc Thresyamma, C. P. (2005). Fundamentals of Nursing: Procedure Manual for General Nursing and Midwifery Course. New Delhi: Jaypee Brothers Publishers. World News Inc. (2012). Blood transfusion and nitric oxide depletion. Retrieved from http://wn.com/Blood_Transfusions_and_Nitric_Oxide_Depletion Read More