Transfusions complications

Leukocyte-depleted blood products, particularly red blood cell concentrates, are clinically used to avoid negative side effects in recipients after transfusion. Possible leukocyte-associated post-transfusion complications include human leukocyte antigen alloimmunization, graft-versus-host disease, platelet refractoriness, and transmission of viruses. Amongst the various existing techniques for the selective removal of leukocytes from blood, filtration has become a popular method, because of its convenience and lowcosts. Leukocyte filters have been specially developed for the purpose they generally consist of fibrous materials made of Nylon, PAN, cotton wool, cellulose acetate,or polyester. Currendy available filters... 

Transfusion-induced autoimmune disease has been a significant complication in the treatment of patients who require multiple platelet transfusions. Platelets and lymphocytes carry their own blood group system, ie, the human leukocyte antigen (HLA) system, and it can be difficult to find an HLA matched donor. A mismatched platelet transfusion does not induce immediate adverse reactions, but may cause the patient to become refractory to the HLA type of the transfused platelets. The next time platelets with an HLA type similar to that of the transfused platelets are transfused, they are rejected by the patient and thus have no clinical efficacy. Exposure to platelets originating from different donors is minimized by the use of apheresis platelets. One transfusable dose (unit) of apheresis platelets contains 3-5 x 10 platelets. An equal dose of platelets from whole blood donation requires platelets from six to eight units of whole blood. Furthermore, platelets can be donated every 10 days, versus 10 weeks for whole blood donations. 

Filtration Filtration (qv) is appHed in blood cell separation to remove leukocytes from ted blood cell (RBC) and platelet concentrates. Centtifugational blood cell separators do not reduce white blood cells (WBC) in red cell and platelet products sufficiently to avoid clinical complications such as GvHD and alloimmunization. A post-apheresis filtration step is needed to further reduce the WBC load. Modem filters are capable of a 3-log reduction in white cell contamination of the blood product, eg, apheresis single-donor platelet units having a typical white cell contamination of 5 x 10 white cells in 4 x 10 platelets can be reduced to a 5 x 10 white cell contamination, a sufficiently low number to avoid severe transfusion reactions. 

Chronic transfusion therapy is warranted to prevent serious complications from SCD, including stroke and recurrence. Especially in children, chronic transfusions have been shown to decrease stroke recurrence from approximately 50% to 10% over 3 years. Without chronic transfusions, approximately 70% of ischemic stroke patients will have another stroke. Chronic transfusion therapy also may be used to prevent vaso-occlusive pain and ACS, as well as prevent progression of... 

HU significantly reduced the number of vasoocclusive crisis, hospitalization, rate of transfusion and, most importantly, the incidence of one of the deadly complications of this disease, called Acute chest syndrome [19]. 

Serious Gl adverse events, some fatal, have been reported with the use of alosetron. These events, including ischemic colitis and serious complications of constipation, have resulted in hospitalization, blood transfusion, surgery, and death. 

In complicated falciparum malaria exchange transfusion can be considered if high parasitemia s (>5%) is present, although the benefit has not been proven with a randomised controlled trial. In these severe cases i.v. quinine (with loading dose) is gradually being replaced by artesunate, wich has proven less mortality and less side effects than good old ... 

Epoetin alfa Agonist of erythropoietin receptors expressed by red cell progenitors Stimulates erythroid proliferation and differentiation, and induces the release of reticulocytes from the bone marrow Treatment of anemia, especially anemia associated with chronic renal failure, HIV infection, cancer, and prematurity prevention of the need for transfusion in patients undergoing certain types of elective surgery IV or SC administration 1-3 times per week Toxicity Hypertension, thrombotic complications, and, very rarely, pure red cell aplasia to reduce the risk of serious CV events, hemoglobin levels should be maintained < 12 g/dL... 

There are isolated reports of thromboembolic complications in recipients of desmopressin most occurred in patients with pre-existing vascular disease. However, in nine trials of the hemostatic efficacy of desmopressin in reducing blood and transfusion requirements in 763 patients, there were no significant differences between the frequencies of thromboembolism in subjects treated with desmopressin and controls (33). An analysis of 31 clinical trials of desmopressin in patients undergoing cardiac, vascular, orthopedic, or other major surgery showed that desmopressin did not increase the incidence of thrombosis (34). 

Long-term complications such as cardiomyopathy (e.g., doxorubicin), leukemia (i.e., mechlorethamine), and infertility (alkylating agents) can also occur. Amelioration of certain side effects can be achieved with the judicious use of antiemetics and blood transfusions (or erythropoietin). 

The high affinity for oxidized iron makes the siderophores ideal candidates for chelation therapy where the body is becoming overwhelmed by iron(III) either through acute poisoning or conditions like haemochromatosis that can occur when patients receive frequent blood transfusions. While enterobactin would seem to be the primary choice it has two major drawbacks its synthesis is complicated and, although both isomers bind iron(III) to the same extent, only the L-isomer has activity in vivo. Consequently desferrioxamine B is the agent of choice. 

Therapy for sickle cell disease has changed dramatically since the mid-1990s. Prior to the 1980s therapeutic interventions for sickle cell disease consisted of supportive care during acute illness, opioids for pain management, and occasional transfusions for severe anemia or life-threatening complications. At that time, sickle cell disease was considered a pediatric disease as there were few children who survived into adulthood. In 1986, the Penicillin Prophylaxis Study was conducted, providing evidence that early intervention with penicillin prevented... 

For many years, blood transfusion has been a therapy for children and adults with sickle cell disease. Prior to the 1980s, due to the lack of availability of blood products and the standard of care at that time, transfusion was used infrequently and generally only for catastrophic complications of this disease. During the 1980s, the risk of infection through transfusion was so high that transfusion continued to be used infrequently. When reliable testing for infectious diseases (e.g., HTV and hepatitis) in blood products became available, the use of red cell transfusion became standard of care for complications of sickle cell disease. 

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