Advertisement

Red blood cell transfusion, risks and limitations

  • Francesco Mercuriali
  • G. Inghilleri

Abstract

Allogeneic blood transfusion was traditionally considered a necessary support in surgery to treat or prevent imminent inadequate delivery of oxygen to tissues induced by surgical related anemia, but it is now perceived as a procedure to be avoided. The safety of blood supply has been in question since the first cases of transfusion transmitted AIDS in the early 1980. In response to this crisis blood collection centres implemented a successful multilayered safety net which has dramatically reduced infectious risk of allogeneic blood. However, although currently the blood supply is safer than it ever has been, it is unlikely that blood transfusion will ever be a risk free procedure. There would always remain the possibility of the emergence of new unknown agents and even in already known diseases there may always be a group of infectious donors who, at various phases of their infection, will be undetectable even with the most sensitive screening tests. Moreover it is necessary to define, together with the risk of transfusion transmitted infections, the nature and magnitude of all the other potential risk of blood transfusion such as the immunological risks and circulatory and metabolic complication. Accurate estimates of blood transfusion risks are important to enable physicians and patients to make informed decisions about whether to receive an allogeneic transfusion or to select other therapeutic options (Table 1).

Keywords

Blood Transfusion Bovine Spongiform Encephalopathy Allogeneic Blood Allogeneic Blood Transfusion Transfusion Reaction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Anderson KC, Weistein HJ (1990) Transfusion associated graft-versus-host disease. N Engl J Med 323: 315–321PubMedCrossRefGoogle Scholar
  2. 2.
    Blair SD, Janvrin SB (1985) Relation between cancer of the colon and blood transfusion. Br Med J 290: 1516–1517CrossRefGoogle Scholar
  3. 3.
    Blajchman MA (1994) Transfusion-associated bacterial sepsis: The phoenix rises yet again. Transfusion 34: 940–942PubMedCrossRefGoogle Scholar
  4. 4.
    Blajchman MA (1996) The clinical relevance of leukocytes present incellular components. In: Smith C Th, Das Sibinga PC, Snyder EL (eds) Trigger factors in transfusion medicine. Kluwer Academic Publishers, Dordrecht, pp 73–82CrossRefGoogle Scholar
  5. 5.
    Blajchman MA (1998) Immunomodulatory effects of allogeneic blood transfusio: clinical manifestations and mechanisms. Vox Sang 74 (Suppl 2): 315–319PubMedCrossRefGoogle Scholar
  6. 6.
    Bordin JO, Bardossy L, Blajchman MA (1994) Growth enhancement of established tumors by allogeneic blood transfusion in experimental animals and its amelioration by leukodepletion: The importance of the timing of leukodepletion. Blood 84: 344–348PubMedGoogle Scholar
  7. 7.
    Bordin JO, Heddle NM, Blajchman MA (1994) The biologic effects of leukocytes present in transfused blood products. Blood 84: 1703–1721PubMedGoogle Scholar
  8. 8.
    Braga M, Vignali A, Radaelli G et al (1992) Association between perioperative blood transfusion and postoperative infection in patients having elective operations for gastrointestinal cancer. Eur J Surg 158: 531–536PubMedGoogle Scholar
  9. 9.
    Brunson ME, Alexander JW (1990) Mechanisms of transfusion-induced immunosuppression. Transfusion 30: 651–658PubMedCrossRefGoogle Scholar
  10. 10.
    Busch ORC, Marquet RL, Jeekel J (1993) Allogeneic blood transfusions and prognosis in colorectal cancer. N Engl J Med 328: 1372–1376PubMedCrossRefGoogle Scholar
  11. 11.
    Creasy TS, Veitch PS, Bell PR (1987) A relationship between perioperative blood transfusion and recurrence of carcinoma of the sigmoid colon following potentially curative surgery. Ann R Coll Surg Engl 69: 100–103PubMedGoogle Scholar
  12. 12.
    De Schiver A, Meheus A (1990) Syphilis and blood transfusion: a global perspective. Transfusion 30: 844–848CrossRefGoogle Scholar
  13. 13.
    Dodd RY (1998) Transmission of parasites by blood transfusion. Vox Sang 74: 161–163PubMedCrossRefGoogle Scholar
  14. 14.
    Ferrara JL, Deeg HJ (1991) Graft versus host disease. N Engl J Med 324: 667–673PubMedCrossRefGoogle Scholar
  15. 15.
    Firestone DT (1995) Adverse effects of blood transfusion. In: Rudmann SV (ed) Textbook of blood Banking and Transfusion Medicine. Harcourt Brace & Co Philadelphia, pp 406–463Google Scholar
  16. 16.
    Goodnough LT, Brecher ME, Kanter MH, AuBuchon JP (1999) Transfusion medicine. First of two parts. Blood Transfusion. N Engl J Med 340: 438–447PubMedCrossRefGoogle Scholar
  17. 17.
    Grass JA, Wafa T, Reames A et al (1999) Prevention of transfusion-associated graft-versus-host disease by photochemical treatment. Blood 93: 3140–3147PubMedGoogle Scholar
  18. 18.
    Heddle NM, Soutar RL, O’Hoski PL et al (1995) A prospective study to determine the frequency and clinical significance of alloimmunization post-transfusion. Br J Haematol 91: 1000–1005PubMedCrossRefGoogle Scholar
  19. 19.
    Heiss MM, Jauch KW, Delanoff C et al (1994) Blood transfusion modulated tumor recurrence: a randomized study of autologous versus allogeneic blood transfusion in colorectal cancer surgery. J Clin Oncol 12: 1859–1867PubMedGoogle Scholar
  20. 20.
    Heiss MM, Mempel W, Jauch K-W et al (1993) Beneficial effect of autologous blood transfusion on infectious complications after colorectal cancer surgery. Lancet 342: 1328–1333PubMedCrossRefGoogle Scholar
  21. 21.
    Hill AF, Butterworth RJ, Joiner S et al (1999) Investigation of variant CreutzfeldtJakob disease and other human prion diseases with tonsil biopsy samples. Lancet 353: 183–189PubMedCrossRefGoogle Scholar
  22. 22.
    Hillyer CD, Emmens RK, Zago-Novaretti M, Berkman EM (1994) Methods for reduction of transfusion-transmitted cytomegalovirus infection: filtration versus the use of seronegative donor units. Transfusion 34: 929–932PubMedCrossRefGoogle Scholar
  23. 23.
    Hilton DA, Fathers E, Edwards P et al (1998) Prion immunoreactivity in appendix before clinical onset of variant Creutzfeldt-Jakob disease. Lancet 352: 703–704PubMedCrossRefGoogle Scholar
  24. 24.
    Houbiers JGA, Brand A, van de Watering LMG et al (1994) Randomised controlled trial comparing transfusion of leucocyte-depleted or buffy-coat-depleted blood in surgery for colorectal cancer. Lancet 344: 573–578PubMedCrossRefGoogle Scholar
  25. 25.
    Houston F, Foster JD, Chong A, Hunter N, Bostock CJ (2000) Transmission of BSE by blood transfusion in sheep. Lancet 356: 999–1000PubMedCrossRefGoogle Scholar
  26. 26.
    Klein HG (2000) Will blood transfusion ever be safe enough? YAMA 284: 238–240CrossRefGoogle Scholar
  27. 27.
    Klein HG, Dodd RY, Ness PM, Fratantoni JA, Nemo GJ (1997) Current status of microbial contamination of blood components: Summary of a conference. Transfusion 37: 95–101PubMedCrossRefGoogle Scholar
  28. 28.
    Klein MA, Frigg R, Flechsig E et al (1997) A crucial role for B cells in neuroinvasive scrapie. Nature 390: 687–690PubMedGoogle Scholar
  29. 29.
    Kleinman S (1999) New variant Creutzfeldt-Jakob disease and white cell reduction: risk assesment and decision making in the absence of data. Transfusion 39: 920–924PubMedCrossRefGoogle Scholar
  30. 30.
    Kollef MH, Schuster DP (1995) The acute respiratory distress syndrome. N Engl J Med 332: 27–37PubMedCrossRefGoogle Scholar
  31. 31.
    Kopko PM, Holland PV (1999) Transfusion-related acute lung injury. Br J Haematol 105: 322–329PubMedCrossRefGoogle Scholar
  32. 32.
    Lackritz EM, Satten GA, Aberle-Grasse J et al (1995) Estimated risk of transmission of the human immunodeficiency virus by screened blood in the United States. N Engl J Med 333: 1721–1725PubMedCrossRefGoogle Scholar
  33. 33.
    Linden JV, Kaplan HS (1994) Transfusion errors: Causes and effects. Transfus Med Rev 8: 169–183PubMedCrossRefGoogle Scholar
  34. 34.
    Linden JV, Wagner K, Voytovich AE, Sheehan J (2000) Transfusion errors in the New York State: an analysis of 10 years’ experience Transfusion 40: 1207–1213PubMedCrossRefGoogle Scholar
  35. 35.
    Mc Farland JG (1996) Posttransfusion purpura. In: Popovsky MA (ed) Transfusion reactions. American Association of Blood Banks Press Bethesda, MD, pp 205–229Google Scholar
  36. 36.
    Menitove JE (1996) Transfusion-transmitted infections: update. Semin Hematol 33: 290–301PubMedGoogle Scholar
  37. 37.
    National Blood Donor Resource Center (1999) Report on blood donation and transfusion in the United States in 1997 Bethesda, MD. National Blood Donor Resource CenterGoogle Scholar
  38. 38.
    Ness PM, Shirey RS, Thoman SK, Buck SA (1990) The differentation of delayed serologic and delayed hemolytic transfusion reactions: Incidence, long-term serologic findings, and clinical significance. Transfusion 30: 688–693PubMedCrossRefGoogle Scholar
  39. 39.
    Ohto H, Anderson KC (1996) Survey of transfusion-associated graft-versus-host disease in immunocompetent recipients. Transfus Med Rev 10: 31–43PubMedCrossRefGoogle Scholar
  40. 40.
    Opelz G, Sengar DP, Mickey MR, Terasaki PI (1973) Effect of blood transfusion on subsequent transplants. Transplant Proc 5: 253–259PubMedGoogle Scholar
  41. 41.
    Pineda AA, Brzica Jr SM, Taswell HF (1978) Hemolytic transfusion reaction. Recent experience in a large blood bank. Mayo Clinic Proceedings 53: 378–390PubMedGoogle Scholar
  42. 42.
    Pinkerton PH (1989) Frequency of hemolytic transfusion reaction. Ann Intern Med 110: 847 (Letter)Google Scholar
  43. 43.
    Popovsky MA, Chaplin Jr HC, Moore SB (1992) Transfusion-related acute lung injury: A neglected, serious complication of hemotherapy. Transfusion 32: 589–592PubMedCrossRefGoogle Scholar
  44. 44.
    Preiksaitis JK (1991) Indications for the use of cytomegalovirus-seronegative blood products. Transf Med Rev 1: 1–17CrossRefGoogle Scholar
  45. 45.
    Rosen NR, Weidner JG, Boldt HD, Rosen DS (1993) Prevention of transfusion-associated graft-versus-host disease: selection of an adequate dose of gamma radiation. Transfusion 33: 125–131PubMedCrossRefGoogle Scholar
  46. 46.
    Sandler SG, Mallory D, Malamut D, Eckrich R (1995) IgA anaphylactic transfusion reactions. Transfus Med Rev 9: 1–8PubMedCrossRefGoogle Scholar
  47. 47.
    Sazama K (1994) Bacteria in blood for transfusion. Arch Pathol Lab Med 118: 350–364PubMedGoogle Scholar
  48. 48.
    Schmunis GA (1991) Trypanosoma cruzi, the etiologic agent of Chagas’ disease: status in the blood supply in endemic and nonendemic countries. Transfusion 31: 547–557PubMedCrossRefGoogle Scholar
  49. 49.
    Schreiber GB, Busch MP, Kleinman SH, Korelitz JJ (1996) The risk of transfusion-transmitted viral infections. The Retrovirus Epidemiology Donor Study. N Engl J Med 334: 1685–1690Google Scholar
  50. 50.
    Silliman CC, Paterson AJ, Dickey WO et al (1997) The association of biologically active lipids with the development of transfusion-related acute lung injury: A retrospective study. Transfusion 37: 719–726PubMedCrossRefGoogle Scholar
  51. 51.
    Silliman CC, Voelkel NF, Allard JD et al (1998) Plasma and lipids from stored packed red cells cause acute lung injury in an animal model. J Clin Invest 101: 1458–1467PubMedCrossRefGoogle Scholar
  52. 52.
    Smith K, Cobain T, Dunstan R (1993) Removal of cytomegalovirus-DNA from donor blood by filtration. Br J Haematolol 30: 49–50Google Scholar
  53. 53.
    Turner ML, Ludlam CA (2000) Variant Creutzfeldt-Jacob disease. Trans Med Rev 14: 216–222CrossRefGoogle Scholar
  54. 54.
    Vamvakas EC, Pineda AA (1996). Allergic and Anaphylactic Reactions. In: Popovsky MA (ed) Transfusion Reactions. American Association of Blood Banks Press, Bethesda, MD, pp 81–123Google Scholar
  55. 55.
    Vamvakas EC, Pineda AA, Reisner R, Santrach PJ, Moore SB (1995) The differentiation of delayed hemolytic and delayed serologic transfusion reactions: Incidence and predictors of hemolysis. Transfusion 35: 26–32Google Scholar
  56. 56.
    Wagner SJ, Friedman LI, Dodd RY (1994) Transfusion-associated bacterial sepsis. Clin Microbiol Rev 7: 290–302PubMedGoogle Scholar
  57. 57.
    Walker RH (1987) Special report: Transfusion risks. Am J Clin Pathol 88: 374–378PubMedGoogle Scholar
  58. 58.
    Williamson LM (1999) Systems contributing to the assurance of transfusion safety in the United Kingdom. Vox Sang 77: 82–87PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag/Wien 2002

Authors and Affiliations

  • Francesco Mercuriali
    • 1
  • G. Inghilleri
    • 1
  1. 1.Immunohematology and Transfusion ServiceIstituto Ortopedico Gaetano PiniMilanoItaly

Personalised recommendations