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Chapter 177. Transfusion of Blood Components, Derivatives and Their Adverse Effects

Elianna Saidenberg, MD, FRCP(C); Morris A. Blajchman, MD, FRCP

  1. What are the indications for transfusion of blood products?

  2. What are the common complications of transfusion?

  3. What interventions minimize the need for transfusion?

The transfusion of blood products is a regular, daily occurrence in hospital practice. In 2006, in the United States, approximately 22.3 million transfusions of various blood products were carried out. Depending on the size of the hospital and the range of services offered, only a few patients a month or many patients each day may be transfused. Similarly, blood banks may carry as few as one or two to more than a dozen different types of blood products. Table 177-1 shows a list of most of the blood products provided to Canadian hospitals for patient use by Canadian Blood Services.

Table 177-1 Products Supplied in Canada by Canadian Blood Services
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Table 177-1 Products Supplied in Canada by Canadian Blood Services
  • Packed red blood cells (RBCs)*
  • Platelets*
    • Single donor apheresis
    • Pooled from multiple donors
  • Fresh frozen plasma (FFP)
  • Cryoprecipitate units
  • Prothrombin complex concentrates (PCCs)
  • Albumin
  • Antithrombin concentrates
  • C-1 esterase inhibitor concentrates
  • Recombinant human factor VIIa (rhFVIIa)
  • Factor VII concentrates
  • von Willebrand factor/factor VIII concentrates
  • Intravenous immune globulin (IVIg)
  • Recombinant factor VIII concentrates
  • Recombinant factor IX concentrates
  • Factor XI concentrates
  • Factor XIII concentrates
  • Fibrinogen concentrates
  • Immune globulins (Ig) preparations:
    • Anti-D Ig
    • Anti-CMV Ig
    • Anti-hepatitis B Ig
    • Anti-varicella Ig
  • Starch volume expanders
  • Protein C concentrates
  • Factor eight inhibitor bypassing activity agent (FEIBA)

*In Canada, cellular products are universally leukoreduced before storage. These products may also be provided irradiated, provided as CMV negative, concentrates, or as washed cells. Additionally, RBCs of rare blood types may be stored frozen for up to 10 years, and processed just prior to transfusion in the liquid state.

It is not necessary for physicians outside the field of transfusion medicine to have detailed information about each of these many products. However, clinicians should be able to explain the indications for transfusion of the most commonly used blood products and recognize transfusion reactions. Each of the five cases demonstrates how certain blood products might be used and the adverse outcomes that are potentially associated with their use.

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Case Information

  1. A 73-year-old male with a lower GI bleed.

  2. A 31-year-old woman undergoing therapy for AML with bruising, petechiae, and uncontrolled epistaxis.

  3. A 67-year-old man on oral anticoagulant therapy with a profusely bleeding scalp laceration.

  4. A 28-year-old female s/p recent pregnancy termination, now acutely unwell with a purpuric rash and heavy vaginal bleeding.

  5. A victim of a hit and run motor vehicle accident who has sustained multiple injuries, including a fractured pelvis.

Each of these patients would likely benefit from the transfusion of different products and at least one of them would probably benefit from the transfusion of multiple blood products.

Red Blood Cell Transfusions

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