Some Complications Associated with the Administration of Blood and Blood Products

A low prime extracorporeal system for small patients: a primate model

In the course of developing a technique for heart and lung transplantation a 6 kg Rhesus monkey model was used. We required a low prime circuit, because it was difficult to obtain donor blood for these animals, which was also capable of supporting the circulation for up to two hours. We describe a system incorporating a semidisposable bubble oxygenator, run under controlled negative pressure with very short blood lines. This arrangement allows for a priming volume of 110 ml with good venous drainage control. The principle could be exploited for use with paediatric extracorporeal systems.

Routine cross-matching is not necessary for a transurethral resection of the prostate

Two hundred and fifty-five consecutive patients undergoing transurethral prostatectomy were studied prospectively to test a policy of not routinely cross-matching blood. Blood was ordered only for patients with anaemia, a major medical risk factor, a prostate gland estimated to be greater than 60 g, or the presence of red cell alloantibodies. Of the 203 patients who were "grouped and saved" only, 30 (12%) were subsequently cross-matched and 22 (8.5%) transfused. There were no significant problems as a result of the operation of this policy. The value of these pre-operative criteria for cross-matching was confirmed, apart from the clinical estimation of prostatic size. The use of such a policy could be of significant value to the hospital blood transfusion services.

Clinical presentation of haemolytic transfusion reactions

Haemolytic transfusion reactions can be defined as the occurrence after transfusion of measurably increased destruction of red cells, of donor or recipient, by alloantibodies. They may be acute (occurring within 24 hours of transfusion) or delayed (when signs of red cell destruction do not occur until 4 to 10 days after transfusion). The severest signs and symptoms of acute reactions follow intravascular red cell lysis and progress to anaemia, fever, haemoglobinuria and jaundice. The subjective responses of pain, restlessness, nausea, skin flushing, dyspnoea and shock are mediated by cleavage products of complement (C3a, C5a) activated by red cell antigen-antibody reaction. The bleeding and renal failure complications that follow are multi-factoral in aetiology but also stem from the activation of intravascular clotting and from the vasomotor disturbances following histamine and kinin release.

Clinical presentation of nonhaemolytic transfusion reactions

Due to the sophistication of red cell compatibility testing, the majority of transfusion reactions are non-haemolytic in origin. This paper reviews the clinical presentation of these reactions, emphasising that blood transfusion reaction must always be considered in the differential diagnosis when a patient develops unexpected complications during his hospital stay. Fever, allergic reactions, respiratory distress, hypotension and jaundice may all be manifestations of a transfusion reaction.

Incidence of allo-immunization and allergic reactions to cryoprecipitate in haemophilia

38 haemophiliacs who had received frequent cryoprecipitate infusions, were investigated for the presence of antibodies directed against red cell, HLA, Gm, Inv and platelet-specific antigens. 15 had detectable antibodies against one or more antigen systems. 11 experienced allergic reactions following infusions of cryoprecipitate. There was no correlation between allergic reactions and the presence of detectable antibodies.