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, 2006
| AGENT | RISK/UNIT TRANSFUSED | % TRANSMISSION |
|---|---|---|
| B19 erythrovirus | 1:3,300-40,000 | Low |
| Babesia & Malaria | <1:1 million | Unknown |
| Bacteria (platelets) | 1:3,000-5,000 untested <1:10,000 tested |
>40% |
| Bacteria (RBCs) | 1:1,000 | 1:10 million fatal |
| HAV | 1:1 million | 90 |
| HBV | 1:137,000 | 70 |
| HCV | 1:1-2 million | 90 |
| HIV | 1:2 million | 90 |
| HTLV | 1:641,000 | 30 |
| WNV | Seasonally & geographically variable | Variable |
K-A Nguyen, BCP, 1/4/0
Non-infectious Risks of Blood Transfusion, 2006
| ADVERSE OUTCOME | INCIDENCE | PRESENTATION |
|---|---|---|
| Acute Hemolytic | 1:38,000-70,000 | Chills, fever, pain at infusion site, hemoglobinemia, shock, acute renal failure, DIC |
| Allergic – Anaphylactic | 1:20,000-50,000 | Hypotension, wheezing, respiratory distress, local edema |
| Allergic – Non-anaphylactic |
1-3% | Urticaria, pruritis, flushing |
| Circulatory Overload | 0.1-1% | Dyspnea, hypertension, pulmonary edema |
| Delayed hemolytic | 15,000-11,000 | Drop in Hgb, new RBC antibodies, bilirubinemia |
| Febrile Non-hemolytic | 0.5-6% RBCs 1-38% platelets |
Fever, chills/rigors |
| GVHD | Rare | Rash, diarrhea, hepatitis, pancytopenia |
| Hypotension | Rare | Flushing, hypotension assoc. with ACE inhibitors & LR blood filters |
| Metabolic risk in neonates | ||
| TRALI | 1:5,000-190,000 | Hypoxemia, dyspnea, hypotension, pulmonary edema |
| Under-transfusion | 0.1-1% | Hypoxemia, bleeding (esp. due to dilutional coagulopathy) |
K-A Nguyen, BCP, 1/4/06
References
Busch MP, Glynn SA, Stramer S, 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.
Goodnough LT, Sander A, Brecher ME. Transfusion medicine: Looking to the future. Lancet (2003) 361:161-9.
“Infectious Risks of Blood Transfusion”, in Blood Bulletin (2001) 4(2). Washington, DC: America’s Blood Centers.
“Non-infectious Serious Hazards of Transfusion,” in Blood Bulletin (2002) 5(1). Washington, DC: America’s Blood Centers.
Prowse C, Ludlam CA, Yap PL. Human parvovirus B19 and blood products. Vox Sanguinis (1997) 72:1-10.
Schreiber GB, Busch MP, Kleinman SH, Korelitz JJ. The risk of transfusion-transmitted viral infections. NEJM (1996) 334:1685-1690.
Stramer SL, Glynn SA, Kleinman SH, et al. Detection of HIV-1 and HCV infections among antibody-negative blood donors by nucleic acid-amplification testing. NEJM (2004) 351:760-768.
Technical Manual, 15th edition. Bethesda, MD: AABB Press, 2005.
US General Accounting Office. Blood Supply: Transfusion-associated risks. GAO/PEMD-971. Washington, DC: US Government Printing Office, 1997.
Compiled by Kim-Anh Nguyen,
Blood Centers of the Pacific, Jan. 4, 2006
.