Transfusion reactions caused by chemical and physical agents
- Arthur J Silvergleid, MD
Arthur J Silvergleid, MD
- Section Editor — Transfusion Medicine
- Affiliate Associate Professor, Department of Pathology and Cell Biology
- University of South Florida, College of Medicine
- Medical Director, OneBlood, Inc.
Reactions to the transfusion of blood products are unfortunately not rare, and may be fatal. Chemical and physical causes of untoward reactions to transfusion of blood products will be reviewed here. Other reactions to blood products are discussed separately. (See "Immunologic blood transfusion reactions" and "Transfusion-related acute lung injury (TRALI)" and "Transfusion-associated graft-versus-host disease".)
TRANSFUSIONAL VOLUME OVERLOAD (TACO)
Clinical presentation — Pulmonary edema secondary to congestive failure can occur with transfusion-associated volume/circulatory overload (TACO), especially in elderly patients, small children, and/or those with compromised cardiac function and may occur more frequently in association with surgical or intensive care settings, where large fluid volumes and some blood are administered . Symptoms include dyspnea, orthopnea, tachycardia and a wide pulse pressure, often with hypertension and hypoxemia, and may begin near the end of the transfusion, or within six hours. Headache is common and seizures have been reported. (See "Use of blood products in the critically ill".)
In 2013, TACO was the second most common cause of transfusion-related mortality as reported to the United States FDA; these episodes are likely to be underreported. This was shown in a combined retrospective/prospective analysis of TACO events caused by plasma at a tertiary care hospital. Results included the following :
●In the retrospective seven-year analysis period, using the blood bank’s records, the prevalence rate of TACO was 1 in 1566 transfused plasma units.
●In the one-month prospective analysis period, using active surveillance of plasma recipients, there were four TACO reactions, for a prevalence rate of 1 in 68 transfused plasma units. None of these reactions were reported to the blood bank.
- Stack G, Judge JV, Snyder EL. Febrile and non-immune transfusion reactions. In: Principles of Transfusion Medicine, Rossi EC, Simon TL, Moss GS, Gould SA (Eds), Williams and Wilkins, Philadelphia 1996. p.778.
- Narick C, Triulzi DJ, Yazer MH. Transfusion-associated circulatory overload after plasma transfusion. Transfusion 2012; 52:160.
- Li G, Rachmale S, Kojicic M, et al. Incidence and transfusion risk factors for transfusion-associated circulatory overload among medical intensive care unit patients. Transfusion 2011; 51:338.
- Popovsky MA, Audet AM, Andrzejewski C Jr. Transfusion-associated circulatory overload in orthopedic surgery patients: a multi-institutional study. Immunohematology 1996; 12:87.
- Bierbaum BE, Callaghan JJ, Galante JO, et al. An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surg Am 1999; 81:2.
- McLeod BC, Reed S, Viernes A, Valentino L. Rapid red cell transfusion by apheresis. J Clin Apher 1994; 9:142.
- Kruskall MS, Pacini DG, Malynn ER, Button LN. Evaluation of a blood warmer that utilizes a 40 degrees C heat exchanger. Transfusion 1990; 30:7.
- Linko K, Hynynen K. Erythrocyte damage caused by the Haemotherm microwave blood warmer. Acta Anaesthesiol Scand 1979; 23:320.
- Huestis DW, Bove JR, Busch S. Practical Blood Transfusion, 3rd ed, Little Brown, Boston 1981. p.352.
- Linden JV, Kaplan HS, Murphy MT. Fatal air embolism due to perioperative blood recovery. Anesth Analg 1997; 84:422.
- Engelhardt W, Blumenberg D. [Risks and side effects of intraoperative autotransfusion]. Beitr Infusionsther 1991; 28:317.
- Delva E, Sadoul N, Chandon M, et al. Air embolism during liver resection: an unusual mechanism of entry from a peristaltic pump. Can Anaesth Soc J 1986; 33:488.
- TRANSFUSIONAL VOLUME OVERLOAD (TACO)
- Clinical presentation
- ADDITION OF DRUGS AND DILUENTS TO BLOOD PRODUCTS
- THERMAL HEMOLYSIS
- Blood warmers
- COAGULATION DEFECTS
- CITRATE TOXICITY
- HYPERKALEMIA, HYPOKALEMIA, AND METABOLIC ALKALOSIS
- Hyperkalemia and potassium leakage
- Metabolic alkalosis
- IRON OVERLOAD
- AIR EMBOLISM
- GENERAL RULES CONCERNING ADVERSE REACTIONS
- SUMMARY AND RECOMMENDATIONS