Blood Transfusion: Mismatched Blood Transfusion May Cause Death

Blood transfusion is the procedure where whole blood or formed-elements of blood is transferred from the circulatory system of one person to another. Blood transfusion is needed when the blood inside someone’s body becomes qualitatively or quantitatively insufficient to maintain normal internal environment or homeostasis. It may be due to insufficient blood volume, inadequate red blood cell count or any other deficiencies of formed elements of blood. Before blood transfusion there are some points to ponder. We should know when and where blood transfusion is required and when it is contraindicated. We must have a clear idea about the hazards of massive or mismatched blood transfusion.

Mismatched blood transfusion causes intravascular coagulation of blood and some other allergic reactions. But some clinical conditions still tend to happen though the blood transfused is apparently of same group. A clear idea about those conditions is very helpful in saving a life.

Blood Transfusion is needed in case of:

• Thalassaemia.
• Severe anaemia.
• Bleeding disorder: Haemophilia, Disseminated Intravascular Coagulation (DIC) and Liver Disease.
• Severe blood loss due to any cause or accident.
• Severe burn where there is excessive haemolysis and dehydration.
• Major operative/ surgical procedures.
• Patient who are getting Chemotherapy & Radiotherapy.

Blood Transfusion Hazards:

• Febrile reaction: Reaction due to Pyrogen, Leukoagglutinate.
• Allergic reaction: Urticaria, Anaphylaxis.
• Hemolytic Transfusion Reaction.
• Circulatory overload.
• Embolism.
• Potassium toxicity.
• Citrate toxicity.
• Reaction due to infected Blood.

• Thrombophlebitis
• Thrombocytopenia
• Transfusion Transmitted Disease
• Immunological sensitization.
• Transfusion haemosiderosis.
• Post transfusion purpura.
• Delayed hemolytic transfusion reaction.
• Graft vs. Host disease.
• Complication of massive transfusion.

• Collapse due to cold blood.
• Excess citrate (exaggerates bleeding tendency).
• Excess ammonia from stored blood (exaggerates pre-coma in cirrhosis).
• Excess potassium (exaggerates hyper-kalaemia in uraemic patient).
• Loss of 2, 3 DPG.
• Hypothermia.
• Hypocalcaemia.
• Defective haemostasis – thrombocytopenia & bleeding.

• Viral Hepatitis (Hepatitis B & Hepatitis C).
• AIDS.
• Herpes.
• Infectious mononucleosis.
• Syphilis.
• Malaria.
• Toxoplasmosis.
• Brucellosis etc.

• Plasma-borne
  • Hepatitis B and its variants.
  • Hepatitis C
  • Other unidentified Hepatitis Viruses
  • HIV-1 & HIV-2
  • Hepatitis A (rarely)
• Cell-associated:
  • Cytomegalovirus.
  • Epstein-Barr virus
  • HTLV-1 & HTLV-2

In some cases blood transfusion is contra-indicated. These are:

• Cardiac Insufficiency.
• Congestive cardiac failure.
• Renal failure.
• Hypertension.
• Polycythemia.

(AB blood grouping system)

• Blood grouping – both ABO & Rh group.
• Cross matching with the patient.
• Test for Hepatitis & Syphilis.
• Test for AIDS.

Mismatched blood transfusion causes hazards and risks life too. There are at least 16 different types of blood grouping system. So it is not possible to match all the groups; especially in case of emergency or in case of rare groups like O negative. Precautionary measures should be available during blood transfusion and close monitoring is a must to ensure safety to the recipien