The complications of blood transfusion
Résumé
Since the highly advertised ``contaminated blood'' case in France, a set of specific regulations and procedures have been established to improve transfusion safety. Improved techniques for the preparation of labile blood products also contributed to this. The establishment of a haemovigilance organisation (created in 1993) made it possible to identify and define the incidence of various adverse effects of blood transfusion. The risks involved in a blood transfusion, even if they are not very frequent, are sufficiently serious to justify a preliminary evaluation of the benefit-risk ratio by the doctors. The complications of the transfusion are directly related to the genetic capital of the transfused patient, and the quality of the labile blood products administered. They have changed over the years. Currently, viral risk has declined sharply and febrile non-haemolytic reactions and allergies are now the main complications of transfusion. Immunological risk now clearly outpaces the infectious risk. Vascular surcharge is still the leading cause of post-transfusion mortality in France. This work was written to provide the participants in the transfusion with a synthesis on the complications of blood transfusion. They are not comparable across countries because of the heterogeneity of preparations of labile blood products, the different prevention policies in the selection of donors and the diversity of functioning of haemovigilance systems (systematic or selective). In this general review, we will study the complications of transfusion according to the pathophysiological mechanism. We will emphasise the serious complications that threaten the vital prognosis. The first part is devoted to immunological complications, the second to infectious complications, and the third to overload accidents. The last part will focus on massive transfusion.