When to suspect this adverse reaction?
Complications of massive transfusion include metabolic and haemostatic abnormalities, immune haemolysis and air embolism (1) which can result in a patient presenting with cardiac arrhythmia or cardiac arrest.
Massive transfusion is an independent risk factor for developing multi-organ failure.(2)
The complications associated with massive transfusion are dependent on the following factors:(2)
- Number of units transfused
- Rate of transfusion
- Patient factors
Some of the complications of massive transfusion include:(1,2)
- Dilutional coagulopathy
- Hypocalcaemia, hypomagnesaemia, citrate toxicity
- Metabolic acidosis
- Air embolism
These complications are rarely seen outside the massive transfusion setting and the incidence rate is variable depending on the clinical situation.(1)
Monitor core temperature and keep above 36°C.
Monitor electrolytes including potassium, ionized calcium and acid base status.
Watch for dilutional coagulopathy by measuring platelets, INR/APPT and fibrinogen often.
Consider thromboelastography where appropriate and cardiac monitoring.
What to do?
Massive transfusion should follow the national Patient Blood Management Guidelines: Module 1 Critical Bleeding/Massive Transfusion(3) and your institutional protocols.
Use blood warmers where appropriate for all blood components and IV fluid.
Consider calcium replacement and tranexamic acid infusions.
- Fung MK, Grossman BJ, Hillyer CD, Westhoff CM (ed). Non-infectious complications of blood transfusion. Chapter 27, AABB Technical Manual, 18th edition. AABB, Bethesda, 2014.
- Callum JL, Pinkerton PH, Lima A, Lin Y, Karkouti K, Lieberman, L, et al. Chapter 5, Transfusion Reactions. Bloody Easy 4: Blood Transfusions, Blood Alternatives and Transfusion Reactions: A Guide to Transfusion Medicine, 4rd edition. Canada: Ontario Regional Blood Coordinating Network, 2016.http://transfusionontario.org/en/download/bloody-easy-4-blood-transfusio...
- National Blood Authority. Patient Blood Management Guidelines: Module 1 – Critical Bleeding/Massive Transfusion. [cited 2013 May 29]. Available from: http://blood.gov.au.