Potential complications of transfusions.

Photo © GARO / PHANIE / agefotostock

If your patient develops mild jaundice or thrombocytopenia two weeks after a blood transfusion, would you consider their transfusion history an important part of your assessment?

When I think of monitoring a patient who is receiving a blood transfusion, I think primarily about watching for a hemolytic transfusion reaction or circulatory overload. To me, that means keeping a close watch during the transfusion and for about 24 hours afterwards. Yet “classic” hemolytic reactions and volume overload are not the only potential complications of blood therapy. Delayed reactions can occur days or even weeks after you’ve run through your saline flush and disposed of the blood bag.

Update of current transfusion practices.

In this month’s AJN, Margaret Carman and colleagues provide readers with an update of current practices in transfusion therapy. In “A Review of Current Practice in Transfusion Therapy,” the authors survey the benefits and risks of fresh whole blood (used today primarily in military or disaster settings) and blood components—red blood cells, plasma, cryoprecipitate, and platelets.

The authors point out that blood components (as compared with whole blood) can be safely stored for longer periods, allow for the targeting of specific patient needs, and present a lower risk for infection and other complications. A handy table (perfect for posting on the unit) offers a quick summary of potential acute and delayed transfusion reactions, delineating when they tend to occur and describing their signs and symptoms. The article also discusses research examining different hemoglobin thresholds for red blood cell transfusion (7 g/dL vs. 10 g/dL.).

Update your clinical practice with the information in this month’s issues. What reactions have you seen to blood transfusions?