Irradiated Blood

• On request red cells, platelets and granulocytes can be irradiated at Blood Bank.  This reduces the risk of graft versus host disease.
• There is a 24 hour shelf life as potassium levels rise in stored irradiated units of blood.

Graft Versus Host (GVH)

• Is a complication of transfusions and is due to the transfused white cells (lymphocytes) being immunocompetent and recognising the host cells as foreign tissue.

Hyperviscosity

• Hyperviscosity may occur in adults when the haemoglobin is greater than 180g/L or the haematocrit greater than 0.65.
• Hyperviscosity may result in poor circulation, thrombosis, tachypnoea, hypoglycaemia, heart failure, small cerebral thrombosis.  In the neonate the plasma protein concentration of blood is lower than in the adult and therefore normal whole blood viscosity is maintained, even with haemoglobins as high as 200g/L.  However if a neonate is transfused with adult plasma or blood, one should aim for a haematocrit of the transfused blood to be no greater than 0.65 and a haemoglobin no greater than 160g/L in order to reduce the risk of hyperviscosity problems.

Hyperosmotic Fluid

• 20mls of Albumex TM20 results in approximately 80ml increase in the circulating blood volume.  This can cause volume overload, particularly in the presence of renal failure.
• Diuretics may be required or the use of Albumex TM4.

Haemolysis

• Haemolysis is the disintegration of red blood cells.
• Can be caused by:

1. Infusing blood rapidly through small gauge needles.
2. Infusing through 0.22 micron filter.
3. Overheating blood.
4. Storage at incorrect temperature.
5. Mixing blood with other drugs.
6. Mixing dextrose with blood in the giving set (dextrose rapidly enters the red cells and water follows causing the red cells to swell and haemolyse).
7. Mixing with sterile water.

Haemolytic Reactions

Intravascular

• The red cells are haemolysed in the circulation with resultant:

1. Haemoglobinaemia ((the presence of haemoglobin in the blood plasma).
2. Haemoglobinuria (the presence of haemoglobin in the urine).

• If haemolytic reaction is confirmed, then fluid balance must be carefully controlled and all urine passed should be saved and tested for presence of blood.
• Intravascular haemolysis may trigger off disseminated intravascular coagulation (DIC) and the depletion of clotting factors or platelets may cause a transient bleeding tendency.
• The renal complications which commonly develop after an intravascular haemolytic reaction are serious and can be fatal.

Extravascular

• The cells are phagocytosed and are removed by the reticulo-endothelial system.
• This may cause a transient increase in serum bilirubin for some 12-36 hours, depending on the amount of red cells broken down.

Risks of Infection