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What Are the Most Common Complications in Blood Transfusions?

Written by Berkowitz

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A blood transfusion occurs when someone’s blood is supplemented by or replaced with the blood of someone else, or blood previously donated by the patient himself, typically through an intravenous line. Blood transfusions are common medical procedures.

Transfusions are most common when someone has lost blood during surgery, due to an accident, or as a result of a bleeding disorder such as hemophilia. They are also used during other circumstances, such as when blood is contaminated due to a liver malfunction.

Whole blood transfusions, which replace all four of the foregoing blood components, are relatively unusual. Most transfusions will replace or supplement one or more blood components – blood platelets, for example.

How Blood Transfusions Work

The most important preliminary step in performing a blood transfusion is to test the blood to determine its type. Since there is no such thing as synthetic blood, you will have to rely on the donated blood, and the donated blood must be compatible with your blood type. Transfusing the wrong blood type could result in serious consequences, including death.

It is important that you inform your doctor if you have ever had a blood transfusion before.

Before the Transfusion

If you know about the transfusion long enough in advance (for example, if you have surgery scheduled several weeks from now), you can donate your own blood for the transfusion. If not, then you will have to rely on blood donated by strangers. It is critical that your health care provider double check to make sure you are getting the right type of blood.

During the Procedure

The entire procedure should take one to four hours. An IV line will be inserted into one of your blood vessels, and the donated blood will be transferred from a plastic bag into the IV line into your blood vessel. The donated blood that’s been stored in a plastic bag enters your bloodstream through the IV. You will be sitting or lying down throughout the entire procedure.

Possible Side Effects during the Transfusion

A nurse will be supervising the entire procedure. Your heart rate, blood pressure, and body temperature will be monitored. Make sure to inform the nurse immediately if you experience any of the following symptoms:

  • Fever;
  • Shortness of breath or difficulty breathing;
  • Chills;
  • Itching;
  • Chest pain;
  • Back pain; or
  • A general sense of unease.

Immediately Afterwards

After the needle and IV line are removed, you may develop a bruise around the insertion site that causes a certain amount of soreness. This is normal, but it should only last for a few days. Some patients develop chest pain, back pain, or shortness of breath in the days following their transfusion; contact your doctor immediately if this happens to you.


Your doctor will probably conduct additional blood testing to make sure your body is responding appropriately to the donated blood. Depending on your condition, you may need more than one transfusion.

Risks Associated with Blood Transfusions

Blood transfusions are sometimes (but not always) dangerous. In some cases, the choices are stark – the patient will almost certainly die without a transfusion, but may very well die because of a transfusion. In some cases, death is unavoidable. In other cases, however, death or serious complications are the results of medical negligence.

Risk factors associated with blood transfusions include:

  • Transfusing contaminated blood;
  • Transfusing blood into the wrong patient,
  • Transfusing the wrong type of blood into a patient;
  • Mislabeling of blood;
  • Improper storage of blood; and
  • Insufficient or non-existent staff training.

Blood transfusion errors can cause grave consequences such as infections, including blood-borne diseases such as hepatitis and HIV. The transfusion of contaminated blood, however, is relatively rare, since blood samples are carefully screened before they are used.

Common Blood Transfusion Complications

Since 2005, it has been mandatory for health care providers to report any serious adverse reactions to blood transfusions that can be attributable to the quality or safety of blood. The most common cause of transfusion-related deaths is acute lung injury. The following are some of the most common transfusion-related complications:

  • Febrile Transfusion Reaction: This reaction, which occurs during a transfusion, includes fever, chills, shaking, a spike in blood pressure, heavy breathing, headache, and anxiety.
  • Acute Hemolytic Transfusion Reaction (AHTR): AHTR occurs when the doctor transfuses the wrong type of blood into the patient. It is a serious and often fatal error. The patient’s body rejects the new blood as a foreign substance and attacks the new red blood cells. Symptoms include back and chest pain, nausea, fever, chills, and sometimes death.
  • Delayed Hemolytic Transfusion Reaction (DHTR): DHTR is another reaction that occurs when the wrong type of blood is transfused into the patient. The effects are more gradual, however. Symptoms often do not occur for as long as four weeks after the transfusion. This could make it difficult for you to even realize that your condition was caused by malpractice.
  • Transfusion-Related Lung Injury (TRALI): This condition makes breathing difficult during the first one to six hours after the transfusion. In some cases, it can be fatal.
  • Hemochromatosis (iron overload): Multiple transfusions can result in iron overload, which can cause serious damage to your heart and lungs.
  • Graft-versus-host disease: This disease is characterized by transfused white blood cells attacking your bone marrow. When this occurs, it usually happens to people with weakened immune systems, such as people treated for leukemia. It is usually fatal.
  • Blood infections: Blood infections are caused by contaminated blood. The most common blood-borne infections are HIV, Hepatitis B and C, West Nile Virus, parasites, and various bacterial infections. Malpractice can be difficult to identify, because symptoms typically do not occur weeks or even months after the transfusion. When this condition does occur, however, it is almost always the result of malpractice.

The Risk of Blood-Borne Infections

The following are the risks of contracting certain blood-borne illnesses as a result of a transfusion:

  • HIV: 1 in 2 million chance. You are more likely to be eaten by a shark while swimming in the ocean.
  • Hepatitis B and C: 1 in 300,000.
  • Hepatitis C: 1 in 1.5 million.
  • West Nile Virus: 1 in 350,000.

Sharing unsterilized needles with other users, as recreational drug users do, lowers these odds by several orders of magnitude.

Inappropriate Delays in Blood Transfusions

One of the most overlooked delays in blood transfusions is not inappropriately administered blood transfusions, but inappropriately delayed blood transfusions, which can often be fatal. If you are an average-sized adult, your body contains about six quarts of blood. If you lose enough of it, you will sicken and die without a blood transfusion.

The following symptoms occur, in order, when you lose a lot of blood:

  1. A decrease in blood pressure;
  2. A narrowing of pulse pressure;
  3. An increase in your breathing rate;
  4. A change in the mental state to anxious, confused, lethargic, or in serious cases, unresponsive.

If these symptoms are not quickly identified by a healthcare professional, you may experience multiple organ failure. This type of crisis often occurs during childbirth, accidents, and among people with blood clotting disorders

Prior to performing a blood transfusion, fluids other than blood are typically inserted into your bloodstream to keep your heart pumping and to prevent it from collapsing. These are stopgap measures. A transfusion must occur soon afterwards to keep you alive since oxygenated blood must reach the tissues to keep them from dying or you from suffering severe brain damage.

To order a blood transfusion at the appropriate time and in the appropriate amount, a healthcare provider must::

  • Maintain a sufficient inventory of blood products;
  • Estimate the total amount of blood loss;
  • Order blood testing ASAP to learn your blood type;
  • Recognized the seriousness of any hemorrhagic shock that occurs, and deal with it accordingly;
  • Keep you well-supplied with fluid and/or blood volume;
  • Obtain the necessary blood products in a timely manner (time is critical); and
  • Transfuse the necessary blood products.

Religious Complications Involving Blood Transfusions

Certain religious groups, such as the Jehovah’s Witnesses, object to blood transfusions on religious grounds. What should a doctor do if his patient, who may die without a blood transfusion, refuses to consent to one on religious grounds?

The general rule is that, at least if a written advance directive exists that specifically excludes blood transfusions, a doctor has no right to impose a blood transfusion upon a mentally competent adult patient – even if failure to perform the transfusion will result in the death of the patient. Failure to honor the patient’s wishes can lead to criminal charges against the doctor.

Decisions Involving Children

A parent has no right to refuse a blood transfusion on behalf of his child, even for religious reasons. This means that a doctor is free, even duty-bound, to perform a transfusion upon a child, even over his parent’s objections and over the objections of the child himself.

The Doctor’s Religious Objections

What if the doctor himself is a Jehovah’s Witness or otherwise objects to blood transfusions or religious grounds? Except in emergency situations, a doctor has the right to refuse to perform a blood transfusion based on his own religious objections, as long as he can find a colleague to perform the procedure in his stead. If he cannot, and if the situation is a life or death emergency, he might be duty-bound to perform the transfusion despite his religious objections.

Every Day You Delay Pursuing Your Claim, It Gets Weaker

If you believe that you have been harmed by a blood transfusion, you need to retain an experienced malpractice attorney before you are even certain that malpractice occurred at all. After all, it may take an investigation to determine whether or not malpractice was the culprit.

Contact us Berkowitz Hanna today by calling one of our offices in Stamford, Danbury, Bridgeport, or Shelton. Otherwise, simply contact us online. Either way, we can provide you with a free case consultation. Remember this much: We won’t charge you a dime unless we win your case.