tailieunhanh - Chapter 107. Transfusion Biology and Therapy (Part 8)

Nonimmunologic Reactions Fluid Overload Blood components are excellent volume expanders, and transfusion may quickly lead to volume overload. Monitoring the rate and volume of the transfusion and using a diuretic can minimize this problem. Hypothermia Refrigerated (4°C) or frozen (–18°C or below) blood components can result in hypothermia when rapidly infused. Cardiac dysrhythmias can result from exposing the sinoatrial node to cold fluid. Use of an in-line warmer will prevent this complication. Electrolyte Toxicity RBC leakage during storage increases the concentration of potassium in the unit. Neonates and patients in renal failure are at risk for hyperkalemia. Preventive measures, such as using fresh or washed RBCs,. | Chapter 107. Transfusion Biology and Therapy Part 8 Nonimmunologic Reactions Fluid Overload Blood components are excellent volume expanders and transfusion may quickly lead to volume overload. Monitoring the rate and volume of the transfusion and using a diuretic can minimize this problem. Hypothermia Refrigerated 4 C or frozen -18 C or below blood components can result in hypothermia when rapidly infused. Cardiac dysrhythmias can result from exposing the sinoatrial node to cold fluid. Use of an in-line warmer will prevent this complication. Electrolyte Toxicity RBC leakage during storage increases the concentration of potassium in the unit. Neonates and patients in renal failure are at risk for hyperkalemia. Preventive measures such as using fresh or washed RBCs are warranted for neonatal transfusions because this complication can be fatal. Citrate commonly used to anticoagulate blood components chelates calcium and thereby inhibits the coagulation cascade. Hypocalcemia manifested by circumoral numbness and or tingling sensation of the fingers and toes may result from multiple rapid transfusions. Because citrate is quickly metabolized to bicarbonate calcium infusion is seldom required in this setting. If calcium or any other intravenous infusion is necessary it must be given through a separate line. Iron Overload Each unit of RBCs contains 200-250 mg of iron. Symptoms and signs of iron overload affecting endocrine hepatic and cardiac function are common after 100 units of RBCs have been transfused total-body iron load of 20 g . Preventing this complication by using alternative therapies . erythropoietin and judicious transfusion is preferable and cost effective. Deferoxamine and other chelating agents are available but the response is often suboptimal. Hypotensive Reactions Transient hypotension may be noted among transfused patients who take angiotensin-converting enzyme ACE inhibitors. Since blood products contain bradykinin that is normally degraded by ACE .

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• Transfusion Biology and Therapy
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• Harrisons Internal Medicine
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• Preventing Morbidity
• Multidisciplinary Care