a. Circulatory Overload. Sudden increases in circulating blood volume are not
well tolerated by certain patients, for example, infants and individuals with chronic
anemia. Whole-blood transfusion or volume expanders, Iike 25 percent albumin, may
precipitate congestive heart failure manifested by coughing, cyanosis, and difficulty in
breathing. Congestive heart failure because of circulatory overload may be the most
preventable adverse effect of transfusion therapy, although it is infrequently reported to
the laboratory. Patients susceptible to circulatory overload should be transfused with
concentrated RBCs at a rate no faster than one ml per kilogram of body weight per
b. Febrile Nonhemoiytic Reactions.
(1) Febrile reactions, often preceded by chills, constitute the bulk of
transfusion reactions investigated by the blood bank. These reactions are generally
considered to be a result of cytotoxlc or agglutinating antibodies in either donor or
recipient plasma directed against antigens present on lymphocyte, granulocyte, or
platelet cell membranes. While reactions are usually mild and result principally in
recipient anxiety and discomfort, in rare instances pulmonary infiltrates, leukopenia and
shock, or even death has been reported. Leukocyte-poor (or frozen, thawed, washed)
RBCs blood cells should probably be given to recipients who display repeated chill/fever
reactions to transfused RBCs.
(2) Chills and fever, primarily a result of the leukocytes contaminating
platelet concentrate preparations, may be seen in patients who receive repeated
platelet transfusions. Removal of leukocytes from platelet concentrates may diminish
febrile responses in immunized recipients and improve post transfusion platelet
recovery and survival. The use of HLA-compatible or identical donors may also be
effective in preventing reactions and in improving post-transfusion platelet recovery and
survival in immunized recipients. Chill/fever reactions are frequently seen during
transfusion of granulocytes collected by filtration leukapheresis, and to a lesser extent,
those prepared by differential centrifugation.
c. Allergic Reactions.
(1) Allergic reactions following blood or plasma transfusions occur less
frequently than leukocyte chill/fever reactions and are usually relatively mild. Most
consist of local erythema, hives, and itching which develop during transfusion and that
can be easily treated with, or prevented by, administration of antihistamines.
(2) More severe reactions characterized by flushing, nausea and vomiting,
diarrhea, changes in blood pressure, and frank anaphylaxis have been reported in
persons without immunoglobulin A (lgA). These patients have developed IgG
antibodies against lgA and react to all blood products containing lgA, for example,
plasma. Patients with known anti-lgA antibody should be transfused only with blood or
plasma obtained from themselves or from other lgA-deficient donors or with extensively