Metabolic, Hypotensive and Other Acute Reactions and Complications

This chapter discusses the metabolic, hypotensive and other acute reactions an complications of transfusion. Metabolic complications of blood transfusion are most often seen in neonates or in circumstances in which large volumes of blood products are transfused and this category of metabolic complications include acidosis, citrate toxicity, hyperkalemia, hyperammonemia and hypothermia. Hypocalcemia is a result of citrate in the anticoagulant solution, as citrate chelates calcium to prevent blood from clotting. Recipients are at risk of hypocalcemia if the amount of citrate is large, such as in massive transfusion or apheresis. Hypotensive reactions are sudden decrease in systolic or diastolic blood pressure of at least 30 mmHg occurring usually within 10 minutes of starting the transfusion. Hypotensive reactions are most commonly seen with the use of negatively-charged bedside leukoreduction filters for platelet transfusions in patients receiving ACE inhibitors. In addition, hypotensive reactions are seen in patients undergoing extracorporeal blood processing procedures such as hemodialysis and therapeutic apheresis. Other complications of transfusion described include red eye syndrome and back pain. © 2009 Elsevier Inc. All rights reserved.

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Author Beth H. Shaz Pathology