Blood transfusion is an emergency and life-saving therapeutic measure. But the therapy involves certain risks and hazardous complications.
Keeping the hazards of blood transfusion in view, it should not be given to a patient who does not consent for the same. Instead, the patient may be treated by other best available means and a record of refusal of transfusion signed by the patient, should be kept to counter any subsequent charge of negligence against the doctor.
The hazards of blood transfusion are:
1. Serological – arising from mismatched transfusion.
2. Transfusion of infected blood.
3. Infection due to wrong technique.
4. Transfusion of excess volume.
5. Air embolism.
6. Transfusion of haemolysed blood.
1. Serological Problem:
Due to mismatched blood transfusion there may be haemolysis and clumping of blood cells. Mismatching occurs when there is incorrect grouping of the donor’s or recipient’s blood, or when under compulsion, blood from ‘O’ group donor is transfused to ‘A’, ‘B’ or ‘AB’ group recipient. Apart from signs and symptoms of mismatching in the form of rigor and compression over chest, proper investigations will reveal the mismatched transfusion.
i) There will be free haemoglobin in the blood of the transfused patient.
ii) Haematin, methaemalbumin and bilirubin in more than normal ranges in the blood of the patient or the deceased, who was given transfusion, if he had no such thing in his blood before transfusion, are also indicative of mismatched transfusion.
iii) Blood, subjected to microscopical examination may show clumping of the donor’s cells.
iv) If no clumps are observed, coomb’s test may show clumping, suggesting sensitization of donor’s cells by recipient’s serum factor, which in spite of mismatching, failed to agglutinate the cells due to some reasons. However, it should be remembered in this context that, a living body will try to remove clumped cells very rapidly.
The serum and cells of pre-transfused and post transfused blood of the patient and the serum and cells of the donor’s blood should be subjected to re-testing by various methods.
In the recipient’s blood, the responsible antibody may not be detected due to wrong preservation or due to neutralization of the antibody by the donor’s cells. Sometime high titre antibody in donor’s blood may agglutinate recipient’s cells. This is possible in case of transfusion of ‘O’ group donor’s blood in ‘A’ ‘B’ or ‘AB’ group recipient, without proper cross matching.
v) There will be Haemoglobinurea, and hence, test for urobilin and urobilinogen will also be very much suggestive.
2&3.Transfusion of infected blood and infection due to wrong technique:
Infection may occur in 2 ways : 1. From transfused blood and 2. From a contaminated transfusion set.
This will cause corresponding infection in the recipient, particular danger being for Hepatitis, AIDS virus, Malaria, Syphilis and in other cases bacterimia. Even if the blood did not contain living pathogenic bacteria, there may be complicated pyogenic reactions, like rigor, pyrexia, severe shock. In the event of death due to pyogenic reaction there will be subendocardial haemorrhage in the septum of heart and straining of non-pathogenic bacteria in the Kidney network.
4. Transfusion of excess volume may cause two hazards:
a) Overloading of heart
b) Pulmonary oedema.
5. Air Embolism:
During transfusion, air embolism may occur under positive pressure. Entrance of minimum 60 to 100 ml. of air may be serious. The effects are noticeable near the end parts of vessels. In case of septal defects of heart chambers, much less amount of air may be dangerous.
6. Transfusion of haemolysed blood:
The effects are more or less the same as in case of transfusion of mismatched blood. The danger of transfusion of haemolysed blood originates : (a) due to transfusion of old blood, (b) badly preserved blood, (c) when haemolysis occurs due to over cooling or over heating. Biochemical tests for blood and urine of the transfused patient as recommended in case of transfusion of mismatched blood are also recommended for investigation of these cases.