(4) Hemolytic reactions. These are often difficult to detect. Initial hemolytic
reactions can be flushing, a feeling of apprehension, chest or back pain, chills, fever
and nausea, or vomiting. During anesthesia, diffuse bleeding may be the only
evidence. Severe reactions include excessive hemoglobin in the blood plasma,
hemoglobin in the urine, abnormally low blood pressure, coagulation in the blood
vessels, renal failure, and death.
(5) Bacterial contamination. This rarely occurs. When it does occur, a life-
threatening reaction is likely. Signs and symptoms of bacterial contamination include
the rapid onset of chills, high fever, vomiting, diarrhea, very low blood pressure, and
acute renal tubular necrosis.
(6) Hypothermia. If blood is not warmed before a massive transfusion,
hypothermia can cause ventricular arrhythmia and cardiac arrest.
(7) Hyperkalemia. Certain patients can react to the potassium that slowly
leaks into the blood plasma during storage. The patient may exhibit neuromuscular
problems such as muscular weakness and paralysis. Heartbeat may be irregular
(usually slowed), and death could result from cardiac arrest.
(8) Microemboli. Transfusion of large volumes of banked blood may require
filtering to remove debris accumulated from the breakdown of platelets, fibrin, and
leukocytes during storage. This can lead to impaired oxygen transport ability in some
patients who are administered large amounts of banked blood. The patient will exhibit
breathing difficulties and pain in the extremities.
b. Delayed Effects. Adverse reactions can sometimes take weeks to show up.
These are generally beyond the capability of the medical NCO to correct.
(1) Hemolytic. Delayed hemolytic reactions occur and usually result in
extravascular removal of transfused cells from the circulation. This effect may take
days or even weeks after the transfusion.
(2) Viral Hepatitis. The occasional occurrence of post-transfusion hepatitis
remains a serious consequence of blood transfusion. Albumin, plasma protein fraction,
and immunoglobulin preparations are regarded as safe derivatives since hepatitis virus
is usually inactivated or removed during preparation.
(3) Others. Diseases such as malaria, acquired immune-deficiency
syndrome (AIDS), hepatitis, and syphilis can be transmitted. Adequate donor screening
is the only effective protection against these diseases presently.