Division of Hematology & Thromboembolism
Blood Product Information for Physicians
Blood transfusions carries serious potential risks—thus, carefully consider risk benefit tradeoff when ordering and blood product.
Canadian Risks per Unit According to References Listed
Non-Infectious
| Acute Hemolytic | 1 in 40,000 |
| Fatal Hemolytic | 1 in 1 million |
| Delayed Hemolytic | 1 in 9,200 |
| Allergic | 1 in 100 |
| Anaphylaxis | 1 in 40,000 |
| Transfusion Associated Circulatory Overload (TACO) | 1 in 100 |
| Transfusion Related Acute Lung Injury (TRALI) | 1 in 5,000 to 1 in 100,000 |
| Transfusion Related Immunomodulation (TRIM) | Risk Unknown |
Infectious
| HIV | 1 in 7.8 million |
Human T-Cell Lymphotropic Virus (HTLV) |
1 in 5 million |
| Hepatitis A | Very rare |
| Hepatitis B | 1 in 153,000 |
| Hepatitis C | 1 in 2.3 million |
| Creutzfeldt-Jacob Disease (variant) | Theoretical risk in Canada Four probable cases in U.K. |
| Syphilis | Virtually nonexistent |
| Sepsis | 1 in 50,000 serious
reaction from platelets: 1 in 500,000 serious reaction from red blood cells |
| West Nile Virus | Risk unknown |
| Cytomegolovirus (CMV) | Up to 1 to 2 % in certain high risk patients |
Blood Uses and Risks
BLOOD PRODUCTS |
COMMON INDICATIONS |
COMMON RISKS(Usually not life-threatening) |
RARE IMPORTANT RISKS(may be life-threatening) |
| Red Cell Concentrate | Hb < 70 g/L , Hb 70 to 100 g/L grey area • Symptomatic anemia • Bleeding • Neonatal exchange transfusion (reconstituted with FFP) |
• Volume overload (TACO) • Allergic (hives) • Febrile reaction |
• Acute respiratory failure (eg, TRALI) •Infection (acute bacterial or chronic viral) • Acute or delayed hemolysis • Anaphylaxis due to IgA deficiency |
Plasma Fresh Frozen Plasma (FFP) |
• FFP / FP • Cryosupernatant |
• Volume overload (TACO) • Allergic (hives) |
• Acute respiratory failure (eg, TRALI) • Anaphylaxis due to IgA deficiency • Infection (acute bacterial or chronic viral) • Passive alloimmune thrombocytopenia |
| Cryoprecipitate | Usually for fibrinogen <0.8-1.0 g/L • Hypofibrinogenemia • Rarely von Willebrand Disease or factor VIII deficiency (if concentrates unavailable) |
• Allergic (hives) | • Infection (chronic viral) |
Platelets Buffy Coat- 4 donors pooled at CBS |
Platelets < 10-20 or < 50 for invasive procedure or < 75-100 for CNS/pericardial surgery • Bleeding from thrombocytopenia or platelet function defect |
• Febrile reaction • Allergic (hives) |
• Acute respiratory failure (eg, TRALI) • Infection (acute bacterial or chronic viral) • Anaphylaxis due to IgA deficiency |
| Albumin | • Volume expansion | • Volume overload (TACO) | • Allergic • Infection (theoretical) |
| Intravenous Gammaglobulin (Human) | • Replacement therapy for immunodeficiency states • Immune thrombocytopenia • Neurologic disorders (eg, Guillian Barré Syndrome • Rheumatologic disorders (eg, Kawasaki disease • Invasive group A strep infection with shock (off label) |
• Hypertension • Headache • Fever/chills • Volume overload (TACO) |
• Thrombosis (MI, CVA) • Infection (theoretical) • Anaphylaxis • Hemolysis • Acute renal failure |
| Rho (D) Immune Globulin | • Prevention of Rh-immunization in antenatal, postnatal Rh-negative obstetrical patients or Rh-negative patients receiving Rh-positive blood products • Immune thrombocytopenia (only for Rh-positive, non-splenectomized patient) |
• None | • Headache • Fever/chills • Hemolysis (only in Rh-positive recipient) • Viral infection (theoretical) |
| Manufactured Factor Concentrates | • Refer to Hematologist • Refer to Thrombosis/Hematology service for urgent warfarin reversal |
• None | • Viral infection (theoretical) • Thrombosis (MI, CVA) |
References
Vamvakas EC et al. Transfusion-related mortality: the ongoing risks of allogeneic blood transfusion and the available strategies for their prevention. Blood 2009; 113: 3406-3417
O’Brien et al. Current incidence and estimated residual risk of transfusion-transmitted infections in donations made to CBS, Transfusion 2007;47: 316-325
Canadian Blood Services
Clinical Guidelines to Transfusion, Canadian Blood Services, 2006
Kleinman S. et al. Risks associated with transfusion of cellular blood components in Canada. Transfusion Medicine Reviews 2003; 17: 120-162
Laupacis A. et al. Prevention of posttransfusion CMV in the era of universal WBC reduction:
A consensus statement. Transfusion, 2001;41:560-569
