From the Guidelines
Blood transfusions can cause significant early and late side effects, including transfusion-associated circulatory overload (TACO), which is now the most common cause of transfusion-related mortality and major morbidity, as reported in the most recent guidelines from the Association of Anaesthetists 1.
Early Side Effects
Early side effects of blood transfusions typically occur during or within 24 hours of transfusion and include:
- Acute hemolytic reactions
- Febrile non-hemolytic reactions
- Allergic reactions ranging from mild urticaria to severe anaphylaxis
- Transfusion-associated circulatory overload (TACO)
- Transfusion-related acute lung injury (TRALI) Patients may experience fever, chills, back pain, shortness of breath, hives, or hypotension.
Late Side Effects
Late side effects, occurring days to years after transfusion, include:
- Delayed hemolytic reactions
- Transfusion-associated graft-versus-host disease
- Iron overload (particularly in chronically transfused patients)
- Alloimmunization (development of antibodies against donor antigens)
- Potential transmission of infectious diseases (though rare with modern screening) Management includes immediate cessation of transfusion for severe reactions, diphenhydramine for allergic reactions, diuretics for volume overload, and supportive care.
Risk Factors for TACO
Risk factors for developing TACO include older, non-bleeding patients (age >70 years), comorbidities (heart failure, renal failure and hypoalbuminaemia), low body weight and rapid transfusion, as highlighted in the guidelines from the Association of Anaesthetists 1.
Monitoring and Prevention
Patient monitoring is essential to identify and manage adverse reactions, with respiratory rate, pulse, blood pressure, and temperature being monitored throughout transfusion, as recommended by the National Institute for Health and Care Excellence (NICE) 1. The use of blood components and their alternatives should be guided by the most recent and highest quality evidence, prioritizing patient safety and minimizing the risk of adverse reactions, as emphasized in the guidelines from the Association of Anaesthetists 1.
From the Research
Late and Early Side Effects of Blood Transfusions
- The provided studies do not directly address the late and early side effects of blood transfusions, but rather focus on the management of iron overload resulting from frequent blood transfusions 2, 3, 4, 5, 6.
- Iron overload can lead to various complications, including cardiac and liver damage, and the studies discuss the use of iron chelators such as desferrioxamine, deferiprone, and deferasirox to manage this condition 3, 4, 5, 6.
- Adverse events associated with these iron chelators include gastrointestinal disturbances, skin rash, joint pain, and increases in liver enzymes and renal impairment 3, 4, 5.
- The studies suggest that desferrioxamine and the oral iron chelators deferiprone and deferasirox produce significant reductions in iron stores in transfusion-dependent, iron-overloaded patients, but the long-term efficacy and safety of these treatments remain to be established 3, 4, 5, 6.
- Regular monitoring of patients receiving iron chelation therapy is recommended to minimize the risk of adverse events and optimize treatment outcomes 3, 5, 6.