Which of the following is the triad of complications of massive blood transfusion?

Acidosis, hypothermia, coagulopathy

Hypocalcemia, hypothermia, coagulopathy

Hyperkalemia, metabolic acidosis, and cardiac arrhythmias

Alkalosis, hyperthermia, coagulopathy

A CKD patient had to undergo dialysis. His Hb was 5.5. So two blood transfusions were to be given. First bag was completed in 2 hours. Second was started and midway between he developed shortness of breath, hypertension. Vitals: BP 180/120 mm Hg and pulse rate 110/min. What is the cause?

Transfusion related circulatory overload (TACO)

The following is not true of platelet transfusion -

Effects decrease with repeated usage

Which of the following is false regarding transfusion-associated anaphylactic reactions?

Seen in IgG deficient individuals

Epinephrine is the drug of choice

Washed blood products prevent it

Transfusion Medicine for NEET-PG: High-Yield Internal Medicine Lessons

Blood Groups & Compatibility - Mix 'n' Match Mayhem

ABO (Landsteiner's): Natural Abs to absent A/B Ags.
- O: Anti-A/B. A: Anti-B. B: Anti-A. AB: None.
- 📌 Univ. Donor: O Rh(D)-neg. Univ. Recipient: AB Rh(D)-pos.
- ABO Compatibility:
  Recipient Donor O Donor A Donor B Donor AB
  O ✅ ❌ ❌ ❌
  A ✅ ✅ ❌ ❌
  B ✅ ❌ ✅ ❌
  AB ✅ ✅ ✅ ✅
Rh System: D Ag key. Rh(D)-neg gets Rh(D)-neg blood.
- Weak D: Donor D+; Recipient D- (if sensitized).
- Rh Prophylaxis: Anti-D Ig (300 µg) for Rh(D)-neg mother/Rh(D)+ fetus.
Bombay (Oh): No H Ag. Anti-A, -B, -H. Needs Oh blood.
Testing: Typing (ABO/Rh), Screen (Abs), Crossmatch.

Recipient	Donor O	Donor A	Donor B	Donor AB
O	✅	❌	❌	❌
A	✅	✅	❌	❌
B	✅	❌	✅	❌
AB	✅	✅	✅	✅

⭐ Bombay (Oh) lacks H Ag; only Oh blood compatible due to anti-H.

Blood Components - The Life-Saving Lineup

Component	Key Contents	Storage (Temp, Life)	Vol.	Dose / Increment	Key Indications
PRBCs	RBCs, minimal plasma	2-6°C, 35-42d	~300mL	1U ↑Hb 1g/dL or Hct 3%	Anemia (Hb<7g/dL), acute loss >20%
Platelets	Platelets, plasma	20-24°C (agitate), 5d	50-200mL	RDP: ↑5-10k/µL; SDP: ↑30-50k/µL	Thrombocytopenia (<10k/µL), active bleeding
FFP	All clotting factors, albumin	≤-18°C, 1yr (Thawed: 24h, 1-6°C)	~225mL	10-15mL/kg; ↑factors 20-30%	Coagulopathy (INR>1.7), TTP, MTP
Cryo	Fibrinogen, F.VIII, vWF, F.XIII 📌	≤-18°C, 1yr (Thawed: 4-6h, 20-24°C)	~15mL/U	1U/10kg ↑Fibrinogen ~50mg/dL	Hypofibrinogenemia (<100mg/dL), vWD, F.XIII def.
Granulocytes	Neutrophils, some RBCs/PLTs	20-24°C, 24h (no agitate)	~250mL	Variable; clinical response	Severe neutropenia (<500/µL) + sepsis (unresponsive, rare)

Transfusion Reactions - When Good Blood Goes Bad

STOP TRANSFUSION! Maintain IV. Notify blood bank.

Acute Reactions (<24h)

Reaction	Onset	Features/Patho	Mgmt
AHTR	Mins-Hrs	ABO mismatch; Hemolysis, fever, shock	Supportive
FNHTR	<4h	Cytokines/WBC Abs; Temp ↑ ≥1°C	Antipyretics
Allergic/Anaphylactic	Mins-Hrs	IgE (urticaria); Anti-IgA (anaphylaxis)	Antihistamines/Epi
TRALI	<6h	Donor Abs; Non-cardiac pulm. edema, hypoxemia	O2, supportive
TACO	<6h	Volume overload; Cardiac pulm. edema, ↑BNP	Diuretics, O2
Bacterial Contam.	Mins-Hrs	Toxins; High fever, shock	IV Abx

Delayed Reactions (>24h)

DHTR (3-30d): Extravascular hemolysis (IgG); ↓Hb, jaundice. Supportive.
PTP (5-12d): Anti-platelet Abs (HPA-1a); Severe thrombocytopenia. IVIG.
TA-GVHD (1-6w): Donor T-cells attack host; Rash, pancytopenia. Irradiate to prevent.

Special Transfusions & Safety - Handle With Care

Massive Transfusion Protocol (MTP):
- Definition: Replacement of >1 blood volume in 24 hrs, >50% in 4 hrs, or >4 units in 1 hr.
- Ratio: 1:1:1 (PRBC:FFP:Platelets).
- Complications (📌 ACHE): Acidosis, Coagulopathy, Hypothermia, Electrolyte imbalance ($↑K^+$, $↓Ca^{2+}$).

Transfusion Transmitted Infections (TTIs):
- Mandatory Indian screening: HIV, HBV, HCV, Syphilis, Malaria.
- Window period risk remains.
⭐ HBV is the most common TTI in India despite screening.
Leucoreduction: Reduces febrile non-hemolytic reactions, CMV transmission. Indicated in immunocompromised, chronically transfused patients.
Irradiation: Prevents Transfusion-Associated Graft-Versus-Host Disease (TA-GVHD). Indicated for immunocompromised, directed donations from relatives, and intrauterine/neonatal transfusions.

High‑Yield Points - ⚡ Biggest Takeaways

O RhD negative is the universal RBC donor; AB RhD positive is the universal RBC recipient.

AB group is the universal plasma donor; O group is the universal plasma recipient.

FNHTR (Febrile Non-Hemolytic Transfusion Reaction) is the most common reaction, caused by cytokines from donor leukocytes.

TACO (Transfusion-Associated Circulatory Overload) presents with fluid overload; manage with diuretics and slow infusion.

TRALI (Transfusion-Related Acute Lung Injury) causes non-cardiogenic pulmonary edema due to donor antibodies.

Massive transfusion protocol often uses a 1:1:1 ratio of PRBCs:FFP:Platelets.

Irradiation of blood products prevents TA-GVHD in immunocompromised patients and directed donations from relatives.

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Transfusion Medicine