Other Adverse Effects of Blood Transfusion

Transfusion-Associated Graft-Versus-Host Disease

Transfusion-associated graft-versus-host disease occurs when donor lymphocytes from transfused blood products engraft in the recipient, initiating an immune reaction against host tissue. A generalized rash, leukopenia, and thrombocytopenia occur. Sepsis and death usually result. Irradiation of blood can prevent transfusion-associated graft-versus-host disease from occurring, although there is a report of one case occurring despite leukocyte filtering.^[125]

Transfusion-Related Acute Lung Injury

TRALI is fatal in 5% to 10% of cases and is the second or third leading cause of transfusion-related mortality^[126] (see Table 47-7 ), although TRALI probably is under-diagnosed and under-reported.^[124] This injury manifests as noncardiogenic pulmonary edema resulting from immune reactivity of certain leukocyte antibodies a few hours after transfusion. Specifically, it involves an antigen-antibody mechanism involving human leukocyte antigen and granulocyte antigens. Clinically, symptoms and signs appear 1 to 2 hours after transfusion and are in force within 6 hours. Fever, dyspnea, fluid in the endotracheal tube, and severe hypoxia are typical. During anesthesia, a persistent decrease in blood oxygen saturation can be the presenting sign. All blood components, especially FFP, are implicated as caustic factors. There is no specific therapy other than stopping the transfusion and instituting critical care supportive measures. Most patients recover in 96 hours.^[127] However, TRALI remains one of the top three most common causes of transfusion-related deaths.

Adverse Ocular Reaction

In 1997, 112 cases of bilateral conjunctival erythema were reported to have occurred within 24 hours of transfusion. The Centers for Disease Control and Prevention studied 49 other cases in 1997 and 1998 and concluded that they were toxic reactions to a chemical or material used in the blood collection filtration system, most likely a leukocyte-reducing filter system.^[128]

Transfusion-Related Immunomodulation

Homologous (allogeneic) blood transfusion exerts a non-specific immunosuppressive action on the recipient. Landers and associates^[129] summarized all of the down-regulated immune functions after administration of allogeneic blood transfusions (see Table 47-14 ). More than 150 clinical studies have tried to relate allogeneic blood transfusions to recurrence of resected cancers, postoperative infections, and virus activation, with the conclusion that adverse effects may be caused by transfusion-related immunomodulation. Although the conclusions of these studies are contradictory and inconclusive, universal

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If more research is conducted on this topic, Vamvakus^[130] has recommended that "the association between allogeneic blood and postoperative infection should consider two outcomes (postoperative organ failure in addition to infection), as well as three exposures: immunologically active allogeneic leukocytes, soluble mediators originating in white blood cell granules or membranes, and soluble HLA proteins circulating in allogeneic plasma."