Pyrogenic and allergic reactions
These types of complications are the most common.
Pyrogenic reactions develop in response to the introduction of plasma protein breakdown products, leukocytes, or bacterial toxins. Depending on severity, three degrees are distinguished:
- Mild: temperature rises by 1 °C, accompanied by headache and muscle pain.
- Moderate: temperature rises by 1.5–2 °C, accompanied by chills, tachycardia, and tachypnea.
- Severe: temperature rises above 40 °C (more than 2 °C from baseline). Severe shaking chills, intense bone pain, dyspnea, and cyanosis of the lips occur.
Treatment of mild forms includes warming, hot drinks, and NSAIDs. In severe reactions, NSAIDs are administered by injection, supplemented with intravenous calcium chloride and dextrose infusion. For prevention, washed or thawed red blood cells are transfused in severe patients with anemia.
Allergic reactions are associated with the patient's sensitivity to donor immunoglobulins (Ig) and occur more frequently during repeated transfusions. They manifest as fever, urticaria, pruritus, as well as dyspnea, nausea, and vomiting. They are managed with antihistamines, calcium chloride, and glucocorticoids; vasopressors are used in case of a drop in blood pressure.
Transfusion shock
This life-threatening condition arises due to medical errors—the transfusion of blood incompatible by the AB0 system or Rh factor.
The pathogenesis is based on rapid intravascular hemolysis. Symptoms may appear after the administration of just 10–30 ml of blood. The clinical picture in a conscious patient develops very rapidly:
- Severe anxiety, chest tightness, lower back and muscle pain, and pronounced chills appear.
- The face first flushes, then rapidly turns pale or cyanotic.
- Dyspnea and nausea occur, and involuntary defecation and urination may happen.
- The pulse becomes weaker and more rapid, and blood pressure drops precipitously.
Severity of shock is assessed by systolic blood pressure (SBP): at grade I, it remains up to 90 mmHg; at grade II, it drops to 80–70; and at grade III, it falls below 70 mmHg.
If the patient is under anesthesia, the classic symptoms are masked. Shock can be suspected based on unexplained fluctuations in blood pressure and increased tissue bleeding in the wound. After awakening, hypotension, tachycardia and acute respiratory failure are noted. Shock due to Rh incompatibility usually develops with a delay — 30–40 minutes or even several hours after transfusion of a large volume, but it is always severe.
Acute renal failure
During the resuscitation of a patient from transfusion shock, acute kidney injury (AKI) frequently develops, caused by kidney damage from erythrocyte breakdown products.
The condition goes through several stages:
- Initial stage (period of oliguria and anuria): urine output drops sharply, and urine has low specific gravity. In severe cases, complete anuria occurs. Toxic nitrogenous products (urea) and bilirubin accumulate in the blood. This period lasts from 1.5 to 2 weeks.
- Diuresis recovery period: accompanied by polyuria (excessive urination) and a gradual decrease in blood toxin levels (lasts 2–3 weeks).
- Recovery period: takes from 1 to 3 months.
The entire cycle of AKI can last 8–15 days (up to a month). Without successful treatment, the risk of death from uremia is high, most commonly occurring on days 13–15.
Emergency Medicine
At the first signs of any transfusion complication, it is necessary to immediately stop the transfusion, leaving the needle in the vein to maintain venous access. Treatment is initiated immediately without waiting to determine the exact cause.
Action algorithm for shock:
- Antishock therapy: administer glucocorticoids (prednisolone or hydrocortisone) and antihistamines. If blood pressure drops, use norepinephrine; for cardiac support, use cardiac glycosides.
- Restoration of blood circulation: infusion of saline solutions and volume expanders (dextran).
- Combating intoxication: use electrolyte solutions with povidone, and correct acid-base balance with sodium lactate or sodium bicarbonate.
- Kidney protection: furosemide and mannitol are prescribed to maintain diuresis. Bilateral lumbar procaine blockade is performed to relieve vascular spasm.
- Respiratory support: oxygen inhalation, with mechanical ventilation if necessary.
If the complication is associated with thromboembolism, the algorithm includes stopping the transfusion, administering oxygen, cardiovascular medications, and giving fibrinolytic agents with heparin sodium.
Class and exam questions
What is the first thing to do when a complication is suspected during a transfusion?
The transfusion must be stopped immediately, but venous access must be preserved (do not remove the needle or catheter) for administering emergency medications.
What is the specific feature of shock if the patient is under anesthesia at that moment?
The patient cannot complain of pain or chills. The primary guides for the physician become sharp blood pressure fluctuations and sudden tissue bleeding in the surgical wound.
How is the severity of transfusion shock assessed?
Severity is determined by the level of systolic blood pressure: grade I — up to 90 mmHg, grade II — down to 70–80, grade III — below 70 mmHg.
What else to study on this topic
- Pathogenesis of intravascular hemolysis
- Drugs for correcting acid-base balance (ABB)
- Indications for the transfusion of washed red blood cells
- Technique for lumbar procaine blockade
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Other topics in the section "CHAPTER 6. BLOOD TRANSFUSION"
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