Adverse reactions to blood product administration
Although by classifying donated blood and performing a cross-match test between the donor and the recipient, we reduce the likelihood of allergic and hemolytic phenomena, they do not completely prevent these types of reactions from occurring. There is still the possibility of an unwanted reaction early or late after (or during) the transfusion of the blood product. It should be remembered that reactions can occur as a result of blood groups present in the donor and not in the recipient, for which a perfect match cannot be created. The recipient can also react in response to groups of antigens found on the white blood cells that find their way (even if in very small quantities) from the donor to the recipient, similar to platelets from the donor's blood and other elements that come from the donor and are an integral part of the various blood products.
In an attempt to group the types of reactions, two lists of reactions can be created. Immunological versus non-immunological reactions, as well as short-term versus long-term reactions (Late responses).
Immediate Immunological reactions
Hemolytic reaction (destruction of the red blood cells of the donor's blood) -
This is the most severe and dangerous reaction of all the other possible reactions. This is a donor who has apparently already received a blood or product containing red blood cells in the past that was not matched to his blood type, hence his body contains antibodies against foreign blood types. As a result, an acute hemolytic reaction is immediately created within the blood vessels.
Clinical signs such as - high fever, rapid heart rate (tachycardia), very slow heart rate (bradycardia), low blood pressure, respiratory distress, cyanosis, vomiting, convulsions, hemoglobinemia/hemoglobinuria (at a slightly later stage) up to a state of hemorrhagic shock. Treatment of this condition must be immediate by stopping the blood product, administering oxygen, heparin (anticoagulant), and high doses of intravenous steroids.
Mild allergic reaction - This is again a reaction of the donor's immune system against the donor's blood, but now directed towards the white blood cells and platelets found as part of the blood product. This is the most common reaction when administering a blood product and usually results in an increase in the donor's body temperature (a degree or two) and slight weakness. This reaction usually goes away on its own without any external treatment but can be helped by giving an injection containing antihistamines or NSAIDs.
Urticaria (hives) - Again, this is an immunological reaction involving mast cells and basophils in response to donor blood. The reaction is characterized by skin symptoms and itching. Rarely, this type of reaction can progress to anaphylactic shock. Proper treatment will include the use of an antihistamine, slowing the rate of blood product administration, and monitoring.
Non-immediate immunological reactions
These reactions often involve the process of "taking" the blood, its storage, and the method of administering the blood product to the patient (the work environment).
Sepsis - a reaction to infection of the blood product itself, which can cause high fever, low blood pressure, hypoglycemia, and even DIC-type systemic failure in the donor. Proper treatment involves stopping the blood product and treating the symptoms as well as the infection. Performing a culture of the blood product can be very helpful in accurately administering the correct antibiotic if necessary. To prevent contamination when administering the blood product, ensure a clean environment (treatment room, hospitalization room), and ensure that the venous access area is clean and well shaved (a radius of at least 3 cm must be left around the venous access area). The blood product must be administered using the kit provided, thus maintaining the principle of a closed system (do not "draw" blood from the product bag, using an external syringe, thus creating an open system that is exposed to infections). The administration of the entire blood product (or the calculated amount) must be completed within 4 hours and no more (after 4 hours the product is more susceptible to bacterial populations). The blood product must be checked for colour changes, sediment.
Circulatory overload - If the volume of fluids administered exceeds the donor's ability to receive or the rate of administration of the product is too high, which may manifest as respiratory distress, increased respiratory rate, and persistent coughing, proper treatment will include stopping or slowing the rate of administration of the blood product and proper use of a diuretic (furosemide).
Citrate Toxicity - As a reaction to the administration of a blood product containing citrate as an anticoagulant which may lead to a hypocalcemic state, especially in dogs that suffer from various liver diseases that make it difficult to cope with the citrate. Clinical signs such as vomiting, tremors, convulsions and spasms, tetany, and abnormal heart rate. Proper treatment will include stopping the administration of the blood product and monitoring the animal. If the symptoms continue, 10% calcium gluconate can be administered intravenously at a slow rate, while it is advisable to monitor the heart activity on an ECG device until stabilization of normal heart activity.
Hemolysis - As a result of overheating the product, storage at too high a temperature, or destruction of red blood cells during administration of the product, clinical signs such as hemoglobinemia and hemoglobinuria without the expected signs of hemolysis, which is expected as a result of an autoimmune reaction. Treatment is not required and an additional dose of blood product should be given for treatment.
Hyperammonemia - As a result of a large amount of ammonia that is created during the blood storage process (using blood after its expiration date), especially in dogs suffering from various liver diseases. Clinical signs indicate impaired activity of the central nervous system similar to the symptoms that occur during hepatic encephalopathy. Proper treatment includes treatment similar to hepatic encephalopathy, stopping the product and giving fresh product.
Delayed immunological reactions
Delayed immunological reactions between the donor's antibodies and antigens found in the donor's blood can occur from 3 days to 2 weeks after donation. The reaction is accompanied by the destruction of red blood cells in the extravascular space, so signs such as hemoglobinuria will not be seen. Clinical signs will be rare and will show a steady decrease in the PCV level. Proper treatment will consist of administering an additional dose of blood product when necessary.
Infectious diseases - transmission of infectious diseases through the administration of blood products. Diseases such as, Beza, Ehrlichia, Leishmania and heartworms in dogs. Proper treatment involves the geographic area and a screening system for donor dogs which includes serological or PCR tests as well as a review of the donor's medical record to detect diseases in the past.