From the Guidelines
The most common complication of blood transfusion is actually volume overload, specifically Transfusion-associated circulatory overload (TACO), as it is now the most common cause of transfusion-related mortality and major morbidity. According to the association of anaesthetists guidelines: the use of blood components and their alternatives 1, TACO is broadly defined as acute or worsening respiratory compromise and/or acute or worsening pulmonary oedema during or up to 12 h after transfusion, cardiovascular changes (tachycardia, hypertension) not explained by the patient’s underlying condition, evidence of fluid overload and supportive result of a relevant biomarker (e.g. brain natriuretic peptide). Some key points to consider:
- 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 1.
- Patient monitoring is essential to identify and manage adverse reactions, with dyspnoea and tachypnoea being typical early symptoms of serious transfusion reactions 1.
- Other complications such as hemolytic reactions, allergic reactions, HIV transmission, and coagulopathy are also important but are not as common as TACO in terms of morbidity and mortality.
- Allergic reactions, which were previously considered the most common complication, typically manifest as urticaria, pruritus, flushing, and occasionally mild fever, occurring in approximately 1-3% of all transfusions, but are generally less severe than TACO 1.
From the Research
Common Complications of Blood Transfusions
The most common complications of blood transfusions can be categorized into several types, including:
- Febrile nonhemolytic transfusion reactions
- Allergic transfusion reactions
- Transfusion-associated circulatory overload
- Transfusion-related acute lung injury
- Acute and delayed hemolytic transfusion reactions
Incidence of Complications
According to the studies, the incidence of complications after blood transfusions is as follows:
- Febrile nonhemolytic and allergic reactions constitute 36.8% and 30.5% of all complications, respectively 2
- Allergic reactions occur most frequently 3
- The overall incidence of adverse transfusion reactions is 0.16% of all donations 2
Types of Complications
The types of complications that can occur after blood transfusions include:
- Hemolytic reactions
- Allergic reactions
- Transfusion-associated circulatory overload
- Transfusion-related acute lung injury
- Coagulopathy
- It is worth noting that the most common complication of blood transfusions is not explicitly stated in the options, but based on the studies, allergic reactions and febrile nonhemolytic transfusion reactions are among the most common 4, 3, 2
Answer to the Question
Based on the studies, the most common complication of blood transfusions is likely to be an allergic reaction, which is option (c) 4, 3, 2