med 18

 

4. Volume overload to the neonate (delaying cord clamping)

Complications of Blood Transfusions

Transfusions are safer now than ever before, but they are not

risk-free.

1. Transmission of infectious diseases: The potential risk of

transfusion-transmitted infections in the United States

has been dramatically reduced by extensive donor

screening and laboratory testing. Current transfusiontransmitted disease testing for allogeneic blood donation include: Hepatitis B surface antigen (HBsAg) and

core antibody (anti-HBc); anti–hepatitis C (anti-HCV),

HIV-1/HIV-2 (anti-HIV-1/2), and HTLV-I/HTLV-II

syphilis (FTA-Abs) and Trypanosoma cruzi antibodies;

and nucleic acid testing (NAT) for HIV-1, HIV2, HCV,

and West Nile virus (47).

a. Viruses: Risk varies geographically (48–51)

(1) HIV: Estimated potential risk in United States

from a blood donor with negative serologic tests

is 1 in 2.3 million (49).

(2) HTLV I and II: Risk estimated at 1 in 2.9 million U transfused (51).

(3) Hepatitis B virus: Risk 1 in 220,000 U transfused

(50)

(4) Hepatitis C virus: Risk 1 in 1.8 million (49)

(5) Hepatitis A virus: Risk <1 in 1 million, asymptomatic in newborn, but may cause symptomatic infection in adults who are in contact with

infected neonates.

(6) CMV: Transmitted by cellular blood products,

(not FFP or cryoprecipitate). Risk factors for

neonatal transfusion-acquired CMV (TA-CMV)

include birthweight <1,200 g, exposure to

312 Section VIII ■ Transfusions

≥50 mL of blood, and maternal CMV seronegativity. Risk of TA-CMV from CMV-seronegative

or effectively leukoreduced components is <1%

to 4% (47,52).

(7) Hepatitis G, parvovirus B-19, EBV

b. Bacteria

(1) Platelet concentrates and RBCs most often

implicated