Risk of RBC Tx

• Citrate Intoxication
o CPDA→ citrate→↓ionized calcium.
o Signs hypotension, narrow pulse pressure, ↑VEDP, and CVP
o ECG changes: prolonged Q-T interval, widened QRS, and flattened T waves.
o The hypocalcemia is directly related to the rate and volume of blood Tx.
o Citrate is metabolized efficiently by the liver, Impaired liver function or
perfusion will lower the rate threshold for developing citrate intoxication.
o Treatment: CaCl
• Acid–Base Changes → ? metabolic acidosis
• ↓2,3-DPG→ left shift of the O2–Hgb dissociation curve
• Hyperkalemia→ with rapid Tx → ↑ by acidosis, hypovolemia, and hypothermia
o ECG → peaked T waves, a prolonged PR interval, and a widened QRS.
o If ECG changes are observed→ the transfusion should be stopped and
intravenous calcium should be administered. Bicarbonate, dextrose, and
insulin may also be appropriate according to the severity of the episode
• Volume Overload
• Hypothermia → ↓ CO, left shift of O2-Hgb, acidosis, coags
• Microaggregate Delivery
• Dilutional Coagulopathy → mainly PLT and labile factors II, VI, VIII, and
fibrinogen