Chapter 468 Risks of Blood Transfusions
Although the risks of allogeneic blood transfusions are low, transfusions must be given judiciously. Taking nucleic acid amplification testing (NAT) and all other donor-screening activities (antibody and epidemiology screening) into account, a current estimate of the risk of transfusion-associated HIV is approximately one per every 2,000,000 donor exposures. Similarly, with NAT, the risk of viral hepatitis C is one per every 1,500,000 to 2,000,000 donor exposures (Table 468-1). NAT identifies circulating viral material in the window period before antibodies develop and is used to detect HIV, hepatitis C, and West Nile virus. NAT is also available for hepatitis B, but its use for this purpose is variable and controversial.
Table 468-1 ESTIMATED RISKS IN TRANSFUSION PER UNIT TRANSFUSED IN THE USA
| ESTIMATED RISK | |
| Febrile reaction | 1/300 |
| Urticaria or other cutaneous reaction | 1/50-100 |
| Red blood cell alloimmunization | 1/100 |
| Mistranfusion | 1/14,000-19,000 |
| Hemolytic reaction | 1/6,000 |
| Fatal hemolysis | 1/1,000,000 |
| Transfusion-associated lung injury | 1/5,000 |
| HIV1 and HIV2 | 1/2,000,000-3,000,000 |
| Hepatitis B | 1/100,000-200,000 |
| Hepatitis C | 1/1,000,000-2,000,000 |
| Human T-cell lymphotrophic virus (HTLV) I and II | 1/641,000 |
| Bacterial contamination | 1/5,000,000 |
| Malaria | 1/4,000,000 |
| Anaphylaxis | 1/20,000-50,000 |
| Graft versus host disease | Uncommon |
