Transfusion risks and what to do?

Blood transfusions save millions of lives each year, but they aren’t without risks. In addition to life-threatening reactions, they can also cause infectious diseases. This article explores the hidden dangers associated with blood transfusions and underscores the importance of rigorous screening, Nucleic Acid Testing (NAT), and Leucocyte reduction to enhance blood safety.

The Risks:

While blood transfusions are critical in many medical treatments, they carry several risks, including:

1. Transfusion-Transmitted Infections (TTIs): Diseases passed from donor to recipient through infected blood.

2. Transfusion-Associated Circulatory Overload (TACO): A condition where the transfusion overloads the circulatory system, leading to heart failure.

3. Transfusion-Related Acute Lung Injury (TRALI): A severe lung condition that can occur following transfusion.

4. Haemolytic Reactions: Occurs when the immune system attacks transfused red blood cells.

5. Febrile Non-Haemolytic Transfusion Reactions (FNHTR): Common, mild reactions characterized by fever and chills.

6. Allergic Reactions: Ranging from mild to severe, these reactions occur due to allergens present in the transfused blood. Allergic reactions includes itching and rashes.

7. Graft-Versus-Host Disease (GVHD): A rare but serious condition where transfused white blood cells attack the recipient’s tissues.

8. Diseases Transmitted Through Blood Transfusions: Despite rigorous testing, blood transfusions can transmit various infectious diseases, including:

• HIV (Human Immunodeficiency Virus)

• HBV (Hepatitis B Virus)

• HCV (Hepatitis C Virus)

• Syphilis

• Plasmodium (Malaria)

9. Iron Overload: The most important consequence of life-saving transfusions in thalassemia is the accumulation of iron within tissues, causing progressive organ dysfunction that is fatal without chelation therapy.

10. Developing Antibodies due to frequent blood transfusions: When someone receives a blood transfusion, their immune system may recognize the donor’s blood as foreign and produce antibodies against it, a process called alloimmunization. This happens when the antigens on the donor’s blood cells differ from the recipient’s. If the immune system identifies these antigens as foreign, it creates antibodies that can attack the donor blood cells, potentially causing a transfusion reaction. Future transfusions with similar foreign antigens can trigger a stronger immune response.

What should patients on regular blood transfusions do?

Enquire about the blood testing in your centre: Check what level of testing teh blood bank is doing. The safest is NAT, if NAT is not available then at least Elisa fourth-generation screening should be doned.
1. The Importance of Screening and NAT Testing: Comprehensive donor screening and Nucleic Acid Testing (NAT) have significantly reduced the risk of disease transmission through blood transfusions. NAT test helps to detect the virus at very early stages. NAT (Nucleic Acid Test) testing is a highly sensitive method that detects the genetic material (RNA or DNA) of a virus, such as HIV, Hepatitis B, or Hepatitis C, in the blood. For HIV detection, NAT can typically detect the virus as soon as 7 to 10 days after exposure
2. Fourth-generation ELISA (Enzyme-Linked Immunosorbent Assay) test: It is a type of blood test, more accurate after the NAT test. As NAT test is yet not available in all the cities so fourth-generation ELISA should be preferred. A fourth-generation ELISA test is a diagnostic tool used to detect both HIV antibodies and the p24 antigen, which is a protein found in the HIV virus. This test can identify an HIV infection earlier than previous generations of tests because it detects both the body’s immune response to the virus (antibodies) and the virus itself (p24 antigen). Typically, a fourth-generation ELISA test can detect HIV as soon as 2 to 4 weeks after exposure.
Use leuco reduced blood or bed-side leucocyte blood filters: Leucocyte reduction/Leucocyte filter White blood cells also known as leucocytes when get transfused even in small amounts, causes allergic reactions and risks of certain infections. Removing white blood cells from blood products further minimizes the risk of transfusion-related complications, including the transmission of infectious diseases. This process occurs at multiple stages:
1. During Collection: Initial removal of excess white blood cells at the time of blood collection or blood donation from blood donors.
2. In the Laboratory: Reduction of WBCs during blood processing in the laboratory.
3. At the Bed-side: Final filtration before transfusion, especially critical for high-risk patients. It is done with the help of bed-side blood filters that helps remove leucocytes during blood transfusions to the patients.
Ask the blood bank to do antibody testing: An antibody test for phenotype and genotype matching in blood is used to determine how compatible a donor’s blood is with a recipient’s.
1. Phenotype matching: The test checks the visible traits of blood, like blood type (A, B, AB, or O) and Rh factor (positive or negative). This is what you see directly in the blood and is determined by the proteins on the surface of blood cells.
2. Genotype matching: The test looks deeper at the genetic makeup, or DNA, of the blood to understand which specific genes are present. This helps ensure an even closer match between donor and recipient beyond what you can see with just phenotype testing. Together, these tests help find the best blood match for a transfusion to reduce the risk of rejection or complications.
Transfusion speed: Consider administrating blood transfusions at a slower rate with minimal required quantity to avoid overloading the circulatory system.

Conclusion:

Blood transfusions are vital, but they must be safe. By taking NAT-tested and Leucocyte-reduced blood components, we can reduce the risks associated with transfusions. Let’s work together to ensure that life-saving transfusions are as safe as possible. Share your thoughts on this critical issue and help raise awareness about the importance of blood safety.

Staying connected with a haematologist is crucial, especially for thalassemics on regular blood transfusions. A haematologist can provide personalized advice, monitor your condition, and ensure you receive the most suitable care.

In case of any medical emergency, reaching out to a healthcare professional immediately is essential. Quick consultation can make a significant difference in managing your health and preventing complications.

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