Why are mismatched blood transfusions dangerous

Treatment consists primarily of antihistamines. Anaphylactic reactions are IgA mediated and begin within seconds to minutes of the start of transfusion. These reactions occur primarily in patients with selective IgA deficiency but can also occur in patients with antibodies to other donor plasma proteins. Treatment includes immediately stopping the transfusion, securing the airway including intubation, if needed , and giving epinephrine, corticosteroids, and antihistamines [ 6 ].

Transfusion-associated acute lung injury TRALI is an immune-mediated transfusion reaction, which manifests as an inflammatory lung injury within the first 6 hours of transfusion. It is due to donor granulocyte-induced acute respiratory distress syndrome ARDS.

The chest X-ray findings are the same as in other causes of ARDS, namely, diffuse bilateral pulmonary infiltrates, and the treatment is the same lung protective ventilation strategies and supportive care. Graft-versus-host disease can be seen in severely immunocompromised patients who receive blood products.

It is an immune-mediated transfusion reaction caused by donor T lymphocytes, which attack patient human leukocyte antigen HLA antigens. Signs and symptoms include rash, elevated liver function test LFTs , diarrhea, and bone marrow suppression and typically develop a week or more after transfusion.

Treatment consists of supportive care, and prevention can be accomplished by giving irradiated PRBC or platelet transfusions to at-risk patients [ 8 ]. FFP and cryoprecipitate do not have to be irradiated; however, as this is a lymphocyte-mediated reaction and these products do not contain lymphocytes. In addition to immune-mediated transfusion reactions, there are a number of nonimmune transfusion reactions which can occur, including transfusion-associated circulatory overload TACO , nonimmune hemolysis, hypothermia, electrolyte abnormalities, and infectious diseases.

Patients with a history of heart failure, kidney insufficiency or failure, poor nutrition leading to decreased intravascular oncotic pressure due to low albumin , and patients at extremes of age pediatric and elderly patients are at an increased risk of TACO [ 9 ].

Treatment consists of supportive care and diuresis, and prevention includes slower rates of infusion or infusing blood products in aliquots rather than whole units. Nonimmune hemolytic transfusion reactions are due to red cell destruction by transfusing PRBCs at the same time as hypertonic or hypotonic IV fluids or medications, by thermal damage from warmers or freezers or mechanical damage from cardiopulmonary bypass pumps, extra-corporeal membranous oxygenation pumps, or continuous renal replacement therapy [ 9 ].

Other considerations regarding adverse blood transfusion reactions include hypothermia, electrolyte abnormalities, and infectious diseases. Trauma patients or patients who are already hypothermic prior to transfusion should ideally receive blood via a warmer. Patients with renal disease or preexisting electrolyte abnormalities should be closely monitored for signs of hyperkalemia or hypocalcemia, including cardiac monitoring during and after transfusion.

Although rare, bacterial, or viral contamination of blood products can occur. Proper collection, storage, and administration of blood products are keys in limiting bacterial contamination. All blood products undergo vigorous screening for viral diseases including hepatitis B and C, cytomegalovirus CMV and human T-cell lymphotropic virus type 1 HTLV-1 prior to administration.

The overall incidence of blood-borne pathogen transmission during transfusion is low [ 9 ]. Once an adverse reaction has been identified, the following actions should be performed:. Transfer blood product s and tubing back to the blood bank for analysis.

Attach new IV tubing that has been primed with saline. Notify the blood bank immediately. Other tests that may be considered include a complete blood count, peripheral blood smear, bilirubin, serum haptoglobin, and lactate dehydrogenase LDH , all of which can indicate hemolysis. Specific therapies geared toward each type of transfusion reaction diuretics, antihistamines, etc. Inform the patient of the error. Hemoglobin spills into the plasma of the blood and is excreted in the urine, turning the urine a dark brown color.

Red blood cells also contain bilirubin, a component in bile. This usually gets spilled in the liver, which breaks down red blood cells, and excreted. Bilirubin is yellow-brown, and gives your poop its brown color. When the red blood cells is split while still in the bloodstream, the bilirubin turns a person's whole body yellow. The yellowing skin and brown urine can be managed, but they're signs of a very dangerous situation. The red blood cell debris careening through the blood vessels can set off any number of chain reactions.

The debris can activate the complement system, a part of the immune system consisting of cell signaling proteins that activate more cell signaling proteins. The end result of this mass of signals is activation of the membrane attack complex, which rips cells apart. Meanwhile, spilled platelets from the blood cells can trigger an "uncontrollable clotting cascade," causing blood to clot in the veins.

If your transfusion uses the wrong blood type, it could be the result of mislabeled blood, incorrectly completed forms, or a failure to check donated blood before the transfusion.

These may include:. Medical staff will stop the blood transfusion if they suspect you might be having an incompatibility reaction. Learn more: Transfusion reactions ». Your doctor will test samples of your blood for evidence of destruction of your red blood cells.

While these procedures are performed, your doctor or nurse will monitor your vital signs, including your:. You may need to enter the intensive care unit. After stopping your blood transfusion, the medical staff will attach a saline drip to the line to keep it open. You may receive oxygen and intravenous fluids. You may also receive a drug to increase your urine output. However, most hospitals and blood banks have systems in place to reduce the chance that such a reaction will occur. These include:.

During an ABO incompatibility reaction, the red blood cells inside your circulatory system break down. At no time, a clinically perceptible intravascular hemolysis occurred. In addition, the serum parameters and the anti-A titers rose only slowly.

However the hemoglobin dropped slowly to the transfusion limit, without further blood loss. This must be probably regarded as indication of an extravascular hemolysis [ Table 1 ]. After 3 days an acute intermittent porphyria was found as a secondary finding; this was probably the cause of the unclear abdominal complaints. The therapy was therefore adjusted to trigger-free medication.

The further intensive therapy process was first characterized by repeated generalized convulsions and later by a progressive multi-organ failure MOF , which most probably can be explained by the initially inappropriate therapy of the porphyria.

The patient deceased 4 weeks after the event because of a multi-organ failure MOF without ever showing signs of severe intravascular hemolysis. Most recipients of ABO incompatible blood have blood group O[ 17 ] as in our case.

Thus, it seems that the present case study is very typical for a transfusion of incompatible blood. We believe that the safety of blood with regard to infections makes the user think that all aspects of blood transfusions are safe. Since infectious complications have been reduced, the main reason of fatal transfusion complications is the transfusion of mismatched blood. A bedside test carried out prior to administration would have prevented the mismatched transfusion.

Situations that do not allow bedside testing are difficult to imagine, because there should be enough time to do the test while the packed RBC are delivered from the blood bank. If blood-group-unequal blood has already been given, it is very hard to determine the correct blood group. In the aforementioned case the blood group in the bedside test was determined incorrectly, since first only the agglutination became evident.

It can not be determined afterward, but it is to be assumed with large probability that a mixing field reaction did take place. Recognition of a mixing field reaction in the bedside test is nearly impossible for doctors, who do not have cross sample laboratory experience [ Figure 1 ]. This practice can be adhered to even in the case of supply. In the present case it could have been advantageous if the patient had not received further A-antibodies.

In the majority of cases the immune hematological determination of the blood group is sufficient and safe. However, after mass transfusions and polytransfusions e. The molecular-genetic blood group determination offers a solution in such a case. Here it would have otherwise been impossible to determine the real blood group of the patient, since even the old test result of blood group could have been based on a mix-up of samples.

The authors have already been involved in the treatment of several ABO incompatible transfusions. However, these cases involved transfusions of up to2 units.

Without exception severe circulatory reactions and indications of an intravascular hemolysis occurred. Among them were also acutely lethal processes. Initially, it appears to be rather amazing that the mismatched transfusion of 8 units should lead to obviously substantial milder reactions.

As a consequence of this extraordinary case, we contacted several German transfusion centers and heard about several similar cases with up to 20 mismatched units, which remained without any acute effects just like the case described above.

After literature research, it seems obvious that there is no correlation between the number of the transfused units and the type and severity of the reaction. Fatal outcomes are described after 1, 4, and 30 units. Linden et al. Yang et al.