Addressing Blood Transfusion-Related Complications: A Literature Review

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Addressing Blood Transfusion-Related Complications: A Literature Review

Blood transfusion is recognized as a lifesaving procedure that is quite effective and indispensable. While this therapy is helpful and is associated with many benefits, it presents a likelihood of complications that need to be addressed or reduced through evidence-based practices. This paper presents a literature review on the reduction of blood transfusion-related complications.

Clifford et al. (2017) conducted a study in which they sought to characterize the risk factors for perioperative transfusion-associated circulatory overload and better comprehend how it affects patient-important outcomes. Choosing a case-control approach, the researchers employed multivariate and univariate logistic regression analyses to evaluate the potential risk factors for circulatory overload following blood transfusion. They uncovered chronic kidney disease, emergency surgery, left ventricular dysfunction, isolated erythrocyte transfusion, and previous β-adrenergic receptor antagonist use as the main predictors of the aforesaid circulatory overload. The authors found out that perioperative transfusion-associated circulatory overload has a strong association with not only protracted hospital course but also increased mortality. They emphasize the need for efforts to minimize these impacts by using intra-operative blood transfusion as well as nonsanguineous fluid therapies.

Also focusing on transfusion-associated circulatory overload was a study by Gosmann et al. (2018) that sought to investigate the complication’s incidence and contextual haemovigilance system reporting. They found out that the incidence of this complication in acute emergency settings was the same as has been shown in similar clinical research. The authors report the failure to recognize and report vital signs of the complication early enough as a major missing link that ought to be addressed within the transfusion chain. They point out the need to boost nurses’ competencies a regards the implied monitoring and reporting, more particularly by paying attention to the TACO checklist provided by SHOT (Serious Hazards of Transfusion). The findings, inferences, and recommendations by Gosmann et al. (2018) are congruent with those of Roubinian and Murphy (2015) who go further to suggest the conduction of randomized clinical trials to test the strategies thought to effectively address blood transfusion-related complications, particularly TACO. The strategies they suggest include using documented risk factors, modified transfusion, prophylactic diuretic therapy, and more robust and heightened diagnostic measures.

Equally important in the current conversation is a case-study by Asil et al. (2017) that focused on transfusion-related acute lung injury. Emphasizing the need for awareness of transfusion-related complications and how to effectively manage them, the authors identify TRALI as one of the complications with the highest incidence reported in literature, yet it remains underdiagnosed. From their case study, they were able to identify acute lung cancer’s differential diagnosis as including TACO, bacteremia/sepsis, anaphylactic and/or allergic reactions, and cardiogenic edema. They emphasize that treatment for this complication is largely supportive and upon diagnosis transfusion ought to be stopped immediately. While they illuminate different treatment options for the complication, they emphasize the significance of mitigation strategies such as the ‘preferential use of plasma from male donors or female donors without a history of pregnancy” (Asil et al., 2017: p.14). They also recommend the use of pooled plasma treated with solvent detergent as another useful strategy.

Last yet important in this literature review is the work of Clevenger and Kelleher (2014), authors who also explore the hazards of blood transfusion in both adults and children. Pointing out the age (of product) plays a role in transfusion-related complications, the authors draw attention to the functional and structural changes in red cells and how such imply increased risk of complications in older blood. They explore an array of complications including TACO, TRALI, post-transfusion purpura, iron overload, haemolytic transfusion reactions and acute transfusion reactions. They recommend several strategies for addressing these complications, some of which include universal leucodepletion, use of pooled plasma (to dilute antibodies present), recurrent venesection, careful monitoring and reporting, and adequate training and education on blood transfusion.

In conclusion, blood transfusion related complications are of significant interest in health circles, a fact that becomes clear when considering the voluminous literature that focuses in this subject. Notably, a greater percentage of the literature encountered focuses on TACO and TRALI, an observation that is suggestive of the high incidence of these complications. There is need to consider implementing the recommended strategies namely using documented risk factors, modified transfusion, universal leucodepletion, use of pooled plasma, prophylactic diuretic therapy, nonsanguineous fluid therapies, adequate education and training, and robust and heightened diagnostic measures.