diarrhea, septic shock

even years later). They range from mild urticarial reactions that may be treated easily to fatal hemolytic reactions. It is important to note that almost all fatal hemolytic reactions are attributable to human error. Blood transfusion reactions can be mediated by the immune system or by nonimmune factors (Table 1).

The immune system recognizes red blood cells, platelets, white blood cells, or immunoglobulins as "non-self' because the donor's blood carries foreign proteins that are incompatible with the recipient's antibodies. Typing, screening, and matching of blood units before administration eliminates most incompatibilities, but all potential incompatibilities cannot be screened out in the matching process.

One hemolytic transfusion reaction occurs per 40,000 transfused units of packed red blood cells, whereas nonhemolytic febrile reactions and minor allergic reactions occur in 3% to 4% of all transfusions. One anaphylactic reaction occurs per 20,000 transfused units. The risk of transfusion-related hepatitis B is 1 per 50,000 units transfused, the risk for hepatitis C is 1 per 3000 to 4000 units transfused, and the risk of transfusion-related HIV infection is 1 per 150,000 units transfused.

Nonimmune factors are usually related to improper storage. Complications to transfusion reactions include acute bronchospasm, respiratory failure, acute tubular necrosis, and acute renal failure. The most severe reactions can cause anaphylactic shock, vascular collapse, or disseminated intravascular coagulation. Also, current research shows that patients who receive transfusions have an increased risk of infection because the transfusion depresses the immune system for weeks and even months afterward.

132 Blood Transfusion Reaction

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