Transfusion therapy adverse effects

Other important adverse effects of methyldopa are development of a positive Coombs test (occurring in 10-20% of patients undergoing therapy for longer than 12 months), which sometimes makes cross-matching blood for transfusion difficult and rarely is associated with hemolytic anemia, as well as hepatitis and drug fever. Discontinuation of the drug usually results in prompt reversal of these abnormalities. 

Adverse effects. Bleeding is the most important complication and usually occurs at a vascular lesion, e.g. the site of injection, for fibrinolytic therapy does not distinguish between an imdesired thrombus and a useful haemostatic plug. If the contraindications are followed, the incidence of bleeding severe enough to require transfusion is < 1%. Nausea and vomiting may occur. 

Adverse effects. Haemorrhage occurs but is less of a problem with low doses of heparin it remains a particular risk in patients treated after failed fibrinol5 c therapy for acute myocardial infarction. Platelet transfusion after cessation of abciximab is necessary for refractory or life threatening bleeding. After transfusion, the antibody redistributes to the transfused platelets, reduces the mean level of receptor blockade and improves platelet function. Thrombocytopenia may occur from 1 hour to days after commencing treatment in up to 1% of patients. This necessitates platelet counts at 2-4 hours and then daily if severe, therapy must be stopped and, if necessary, platelets transfused. EDTA-induced pseudothrombocytopenia has been reported and a low platelet count should prompt examination of a blood film for agglutination before therapy is stopped. 

Treatment of anemia of critical illness has nonspecific goals of therapy. The role of monitoring RBCs, Hgb, Hcfi EPO levels, and reticulocyte counts remains to be determined. Outcomes used in EPO studies are transfusion requirements and transfusion independence. Morbidity, mortality, and length of stay are also assessed. Adverse effects such as risk of thrombotic events must be monitored. More research is needed to determine whether reduction in RBC transfusions and increases in Hgb will result in improved clinical outcomes. 

Stiehm ER. Adverse effects of human immrmoglobulin therapy. Transfus Med Rev July 2013 27(3) 171-8. 

A number of reports have appeared on the adverse effects of rifampicin on the kidney. Courtois and de Coninck reported a case of acute renal failure requiring several transfusions and multiple periods of haemodialysis. Nephrotoxicity in this case developed when rifampicin was re-introduced into the treatment schedule after a gap of several weeks (25 ). A similar case was reported by Hanzl et at. from Germany (26 ) and a further case in which the nephrotoxicity became manifest during a course of twice weekly therapy was described by Nessi et al. (27 ). These authors also reviewed the cases reported to date in the literature, showing that interruptions of treatment or treatment on an intermittent basis are a common feature to most of the reported cases. Eventual renal failure may or may not be preceded by a flu-like illness. Renal biopsy has been carried out in approximately a third of the reported cases and a picture of tubular interstitial necrosis has been seen. The results of immunological tests have not been consistent, and antibodies to rifampicin have not been demonstrated in every case. It is perhaps worthy of note that renal failure has only, so far, been reported in patients who have had a fairly long course of treatment. 

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