RISKS ASSOCIATED WITH TRANSFUSION

While blood transfusion is, in many respects, safer than it has ever been, the risks associated with transfusion are still present and must be evaluated against the benefit provided by transfusion.

The following information has been compiled to provide both current infectious risks and non-infectious risks of blood transfusion. References to support this information are given at the bottom.

Infectious Risks of Blood Transfusion, 2007 to 2012

AGENT RISK PER UNIT TRANSFUSED
Parvovirus B19 (erythrovirus) Unknown; about 12 cases reported in the literature
Babesia 1:20,000
Bacteria (platelets) 1: 5,000 (tested)
Bacteria (RBCs) 1:500,000
Hepatitis A virus 1:1 million
Hepatitis B virus 1:850,000 to 1:2 million
Hepatitis C virus 1:1,150,000
HIV (Human Immunodeficiency virus) 1:2 million
Human T-lymphotrophic virus 1:200,000 to 1:500,000
Malaria 1:1,000,000
West Nile virus Unknown but varies by season; about 11 cases reported in the literature since 2003


Non-infectious Risks of Blood Transfusion, 2007 to 2012

Adverse Outcome Risk Per Unit Transfused Clinical Signs & Symptoms
Acute hemolytic 1:40,000 to 1:70,000 Chills, fever, pain at infusion site, hemoglobinuria, shock, acute renal failure, flank pain, DIC
Allergic - simple 1:100 to 3:100 Flushing, hives, itching
Allergic  - severe 1:20,000 to 1:50,000 Hypotension, respiratory distress, wheezing, local edema
Transfusion associated circulatory overload (TACO) 1:100 to 11:100 Dyspnea, hypertension, pulmonary edema
Delayed hemolytic 1:5,000 to 1:11,000 Drop in hemoglobin, increased indirect bilirubin, new RBC antibodies
Febrile non-hemolytic 1:100 (prestorage leukoreduced products) Fever with greater than 1°C change, chills, rigors
Graft versus host disease Rare Rash, diarrhea, hepatitis, pancytopenia
Transfusion-related acute lung injury (TRALI) 8:100,000 Hypoxemia, dyspnea, hypotension, non-cardiogenic pulmonary edema

 

 


References

Busch MP, et al. A new strategy for estimating risks of transfusion-transmitted viral infections based on rates of detection of recently infected donors. Transfusion. 2005;45:254-264.

Carson JL, et al. Red blood cell transfusion: A clinical practice guideline from the AABB. Ann Int Med. 2012;157:49-58.

Cullen KA, et al. Malaria surveillance – United States, 2011. MMWR Surveill Summ. 2013 Nov;1;62 Suppl 5:1-17.

Goodnough LT, et al. Transfusion medicine: Looking to the future. Lancet. 2003;361:161-9.

Land K. The Bloody Truth Medical Blog; The Truth About Blood Transfusions. http://thebloodytruth.com/risky-business-the-relative-infectious-risks-of-blood-transfusion. Aug 2012.

Li G, et al. Incidence and transfusion risk factors for transfusion-associated circulatory overload among medical intensive care unit patients. Transfusion. 2011 Feb;51(2):338-43.

Infectious Risks of Blood Transfusion. Blood Bulletin. Washington, DC. America’s Blood Centers. 2001;4(2).

Fatal West Nile Virus Infection After Probable Transfusion-Associated Transmission – Colorado 2012. MMWR. Aug 2013;62(31);622-24.

Non-infectious Serious Hazards of Transfusion. Blood Bulletin. Washington, DC: America’s Blood Centers. 2002; 5(1).

Prowse C, et al. Human parvovirus B19 and blood products. Vox Sanguinis. 1997;72:1-10.

Schreiber GB, et al. The risk of transfusion-transmitted viral infections. NEJM. 1996;334:1685-1690.

Stramer SL, et al. Detection of HIV-1 and HCV infections among antibody-negative blood donors by nucleic acid-amplification testing. NEJM. 2004;351:760-768.

Stramer SL. Current risks of transfusion-transmitted agents: a review. Arch Pathol Lab Med. 2007 May;131(5):702-7.

Technical Manual, 17th edition. Bethesda, MD: AABB Press. 2011.

Toy P, et al. Transfusion-related acute lung injury: incidence and risk factors. Blood. 2012 Feb;119(7):1757-67.

Update to Transfusion. AABB Resources. 2009;49(Suppl):107-09S.

US General Accounting Office. Blood Supply: Transfusion-associated risks. GAO/PEMD-971. Washington, DC: US Government Printing Office, 1997.

Young C. Preventing transfusion-transmitted babesiosis: Preliminary experience of the first laboratory-based blood donor screening program. Transfusion. 2012 Jul;52(7):1523-9.