Blood Transfusion: Indications and Complications for PLAB 1
This module covers the essential indications for blood transfusion and the potential complications that can arise, focusing on knowledge relevant to the PLAB 1 exam and UK guidelines. Understanding these aspects is crucial for safe and effective patient care.
Indications for Blood Transfusion
Blood transfusions are life-saving interventions but should only be administered when clinically indicated. The decision to transfuse is based on a combination of the patient's clinical condition, haemoglobin level, and the presence of symptoms or signs of anaemia.
Generally below 70 g/L.
Complications of Blood Transfusion
While blood transfusions are generally safe, a range of complications can occur, from mild and transient to severe and life-threatening. These are broadly categorized as acute and delayed.
| Complication Type | Description | Management |
|---|---|---|
| Acute Haemolytic Transfusion Reaction (AHTR) | Immune response to ABO-incompatible red blood cells. Rapid onset, often within minutes. Symptoms: fever, chills, back pain, hypotension, haemoglobinuria. | STOP TRANSFUSION IMMEDIATELY. Maintain IV access. Monitor vital signs. Hydration. Diuretics if indicated. Investigate cause. |
| Febrile Non-Haemolytic Transfusion Reaction (FNHTR) | Most common reaction. Immune response to donor white blood cells or cytokines. Symptoms: fever, chills, headache. Usually mild and self-limiting. | STOP TRANSFUSION. Antipyretics (e.g., paracetamol). Restart transfusion if mild and symptoms resolve, or consider alternative products. |
| Allergic Reactions | Mild: Urticaria, itching. Severe (anaphylaxis): bronchospasm, stridor, hypotension. Immune response to plasma proteins. | Mild: Antihistamines. Severe: Adrenaline, oxygen, IV fluids, corticosteroids. STOP TRANSFUSION. |
| Transfusion-Associated Circulatory Overload (TACO) | Fluid overload, especially in elderly or cardiac patients. Symptoms: dyspnoea, cough, hypertension, pulmonary oedema. | STOP TRANSFUSION. Sit patient upright. Administer diuretics (e.g., furosemide). Oxygen therapy. |
| Transfusion-Related Acute Lung Injury (TRALI) | Non-cardiogenic pulmonary oedema. Immune-mediated (donor antibodies against recipient leukocytes) or non-immune. Symptoms: acute dyspnoea, hypoxaemia, fever. | STOP TRANSFUSION. Supportive care: oxygen, mechanical ventilation if needed. Usually resolves within 48-96 hours. |
| Delayed Haemolytic Transfusion Reaction (DHTR) | Occurs days to weeks after transfusion. Extravascular haemolysis. Often asymptomatic or mild jaundice, anaemia. | Monitor haemoglobin. May require further transfusion if symptomatic. Usually self-limiting. |
| Infectious Complications | Transmission of bacteria, viruses (e.g., HIV, Hepatitis B/C), parasites. Risk significantly reduced by screening. | Prevention through rigorous donor screening and component processing. Treat specific infections if they occur. |
| Graft-versus-Host Disease (GvHD) | Rare but severe. Donor lymphocytes engraft in immunocompromised recipient. Symptoms: fever, rash, diarrhoea, liver dysfunction. | Irradiation of blood products for at-risk patients (e.g., immunocompromised, neonates). Supportive care. |
The 'STOP TRANSFUSION IMMEDIATELY' instruction is critical for any suspected acute transfusion reaction. Prompt action can significantly mitigate harm.
UK Guidelines and Best Practices
In the UK, blood transfusion practice is governed by national guidelines, primarily from the Serious Hazards of Transfusion (SHOT) scheme and the British Committee for Standards in Haematology (BCSH). These guidelines emphasize:
To optimize a patient's own blood volume and minimize the need for transfusion.
Key Takeaways for PLAB 1
For the PLAB 1 exam, focus on understanding:
- The clinical scenarios that warrant blood transfusion.
- The common and critical acute transfusion reactions, their symptoms, and immediate management.
- The role of UK guidelines (SHOT, BCSH) in ensuring safe transfusion practice.
- The concept of restrictive transfusion thresholds and Patient Blood Management.
Learning Resources
The Serious Hazards of Transfusion (SHOT) scheme publishes annual reports detailing transfusion incidents and providing recommendations for improving safety in the UK.
The British Committee for Standards in Haematology (BCSH) provides comprehensive guidelines on various aspects of transfusion medicine, including indications and complications.
Official information from NHS Blood and Transplant on blood transfusion services, safety, and best practices in the UK.
The World Health Organization's resources on Patient Blood Management, outlining its principles and benefits globally.
A detailed overview of transfusion reactions, including their pathophysiology, clinical presentation, and management, from a reputable medical resource.
A learning module from BMJ covering the essential aspects of blood transfusion, including when to transfuse and potential adverse events.
An introductory video from NHS Blood and Transplant explaining the basics of blood transfusion and its importance.
An article from the Royal College of Pathologists discussing the scientific principles behind blood transfusion and its safety.
While not a single article, this journal publishes peer-reviewed research on all aspects of transfusion medicine, offering in-depth knowledge.
A comprehensive overview of blood transfusion, its history, procedures, indications, and risks, providing a broad context.