RISKS ASSOCIATED WITH TRANSFUSION
While blood transfusion is, in many respects, safer than it has ever been, the risks associated with transfusion are still present and must be evaluated against the benefit provided by transfusion.
The following information has been compiled to provide both current infectious risks and non-infectious risks of blood transfusion. References to support this information are given at the bottom.
Infectious Risks of Blood Transfusion, 2007 to 2012
| AGENT |
RISK PER UNIT TRANSFUSED |
| Parvovirus B19 (erythrovirus) |
Unknown; about 12 cases reported in the literature |
| Babesia |
1:20,000 |
| Bacteria (platelets) |
1: 5,000 (tested) |
| Bacteria (RBCs) |
1:500,000 |
| Hepatitis A virus |
1:1 million |
| Hepatitis B virus |
1:850,000 to 1:2 million |
| Hepatitis C virus |
1:1,150,000 |
| HIV (Human Immunodeficiency virus) |
1:2 million |
| Human T-lymphotrophic virus |
1:200,000 to 1:500,000 |
| Malaria |
1:1,000,000 |
| West Nile virus |
Unknown but varies by season; about 11 cases reported in the literature since 2003 |
Non-infectious Risks of Blood Transfusion, 2007 to 2012
| Adverse Outcome |
Risk Per Unit Transfused |
Clinical Signs & Symptoms |
| Acute hemolytic |
1:40,000 to 1:70,000 |
Chills, fever, pain at infusion site, hemoglobinuria, shock, acute renal failure, flank pain, DIC |
| Allergic - simple |
1:100 to 3:100 |
Flushing, hives, itching |
| Allergic - severe |
1:20,000 to 1:50,000 |
Hypotension, respiratory distress, wheezing, local edema |
| Transfusion associated circulatory overload (TACO) |
1:100 to 11:100 |
Dyspnea, hypertension, pulmonary edema |
| Delayed hemolytic |
1:5,000 to 1:11,000 |
Drop in hemoglobin, increased indirect bilirubin, new RBC antibodies |
| Febrile non-hemolytic |
1:100 (prestorage leukoreduced products) |
Fever with greater than 1°C change, chills, rigors |
| Graft versus host disease |
Rare |
Rash, diarrhea, hepatitis, pancytopenia |
| Transfusion-related acute lung injury (TRALI) |
8:100,000 |
Hypoxemia, dyspnea, hypotension, non-cardiogenic pulmonary edema |
References
- Busch MP, et al. A new strategy for estimating risks of transfusion-transmitted viral infections based on rates of detection of recently infected donors. Transfusion. 2005;45:254-264.
- Carson JL, et al. Red blood cell transfusion: A clinical practice guideline from the AABB. Ann Int Med. 2012;157:49-58.
- Cullen KA, et al. Malaria surveillance – United States, 2011. MMWR Surveill Summ. 2013 Nov;1;62 Suppl 5:1-17.
- Goodnough LT, et al. Transfusion medicine: Looking to the future. Lancet. 2003;361:161-9.
- Land K. The Bloody Truth Medical Blog; The Truth About Blood Transfusions. http://thebloodytruth.com/risky-business-the-relative-infectious-risks-of-blood-transfusion. Aug 2012.
- Li G, et al. Incidence and transfusion risk factors for transfusion-associated circulatory overload among medical intensive care unit patients. Transfusion. 2011 Feb;51(2):338-43.
- Infectious Risks of Blood Transfusion. Blood Bulletin. Washington, DC. America’s Blood Centers. 2001;4(2).
- Fatal West Nile Virus Infection After Probable Transfusion-Associated Transmission – Colorado 2012. MMWR. Aug 2013;62(31);622-24.
- Non-infectious Serious Hazards of Transfusion. Blood Bulletin. Washington, DC: America’s Blood Centers. 2002; 5(1).
- Prowse C, et al. Human parvovirus B19 and blood products. Vox Sanguinis. 1997;72:1-10.
- Schreiber GB, et al. The risk of transfusion-transmitted viral infections. NEJM. 1996;334:1685-1690.
- Stramer SL, et al. Detection of HIV-1 and HCV infections among antibody-negative blood donors by nucleic acid-amplification testing. NEJM. 2004;351:760-768.
- Stramer SL. Current risks of transfusion-transmitted agents: a review. Arch Pathol Lab Med. 2007 May;131(5):702-7.
- Technical Manual, 17th edition. Bethesda, MD: AABB Press. 2011.
- Toy P, et al. Transfusion-related acute lung injury: incidence and risk factors. Blood. 2012 Feb;119(7):1757-67.
- Update to Transfusion. AABB Resources. 2009;49(Suppl):107-09S.
- US General Accounting Office. Blood Supply: Transfusion-associated risks. GAO/PEMD-971. Washington, DC: US Government Printing Office, 1997.
- Young C. Preventing transfusion-transmitted babesiosis: Preliminary experience of the first laboratory-based blood donor screening program. Transfusion. 2012 Jul;52(7):1523-9.