Post-transfusion complications

Nature and clinical presentation of complications

Transfusion complications are classified by severity into mild, moderate, and severe. Pathological reactions develop shortly after the intervention.

General symptoms include:

• Elevated body temperature and marked chills.
• General malaise, weakness, and headache.
• Various allergic manifestations: pruritus, as well as edema (including dangerous angioedema).

In severe cases, a characteristic clinical presentation unfolds:

• Changes in the patient's behavior occur (restlessness appears).
• Skin coloration changes—pallor or cyanosis develops.
• The patient complains of retrosternal pain and acute lower back pain.
• Hemodynamics are impaired: increased heart rate (tachycardia) and a drop in blood pressure (hypotension) are recorded.
• Dyspnea appears.

If these symptoms appear, urgent measures must be taken. Early initiation of treatment significantly improves the prognosis.

Guidelines for patient monitoring after blood transfusion

The transfusion process does not end when the needle is removed—the patient requires rigorous monitoring for the timely management of post-transfusion reactions.

Regimen and monitoring:

1. Bed rest: the patient must remain in bed for the first 3–4 hours after the procedure ends.
2. Hourly monitoring: during the first 4 hours, medical staff measure the patient's body temperature and count the pulse every hour.
3. General observation: lasts for 24 hours. The physician assesses complaints, behavior, appearance, and skin color.
4. Laboratory monitoring: the day after the blood transfusion, the patient is mandatorily prescribed a complete blood count (CBC) and urinalysis (UA).

Criteria for the absence of a reaction: the procedure is considered uneventful if, within 4 hours after the transfusion with hourly thermometry, the temperature did not rise and the aforementioned pathological symptoms are completely absent.

Anamnesis collection and patient routing

In case of suspected severe consequences of blood transfusions (e.g., suspected AA), the patient workup algorithm is expanded and requires detailed anamnesis collection.

• Search for the cause: the physician investigates the connection between symptoms and exposure to toxic or medicinal agents, as well as the association of the disease with viral hepatitis B and C.
• Family history: necessary to rule out congenital anomalies. It is critically important to clarify the presence of siblings (brothers and/or sisters)—this is necessary to assess the feasibility of allogeneic hematopoietic stem cell transplantation (allo-HSCT).
• Infectious history: a mandatory description of all episodes of infectious complications, previous antibacterial therapy, and bacteriological culture data is performed.
• Transfusion history: a complete description of the frequency and need for transfusions is recorded, and data on all past post-transfusion complications are collected.

Patient routing: all patients with suspected similar blood pathologies are recommended to undergo an initial appointment (examination, consultation) with a hematologist to establish an accurate diagnosis.

Historical background: Period II (1628–1901)

Understanding the risks of blood transfusion took centuries to develop. In the second historical period of transfusiology development, the technique was primitive: the syringe method was used, as well as the "vein-to-vein" transfusion method using silver tubes.

The volume of transfused blood was often determined by weighing—based on the decreasing weight of the donor animal (e.g., a lamb).

• 1666 — French physician Jean-Denis performed the first human blood transfusion. The procedure turned out unsuccessfully.
• Empirical experience: it was during this period that the very first signs of post-transfusion complications were described. Physicians observed restlessness, skin hyperemia, chills, and shivering in patients.
• Statistics: by 1875, medicine had accumulated data, describing 347 cases of human blood transfusion and 129 cases of animal blood transfusion. This experience became the foundation for studying blood incompatibility.

Class and exam questions

What else to study on this topic

• Mechanisms of allergic reactions and angioedema development during blood transfusion
• Allogeneic hematopoietic stem cell transplantation (allo-HSCT)
• The impact of viral hepatitis B and C on the hematopoietic system
• Diagnosis and treatment of AA (aplastic anemia)
• Pathophysiology of lower back pain during incompatible blood transfusion

Other topics in the section "CHAPTER 6. BLOOD TRANSFUSION"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.