The Bleeding Complications of Blood Transfusion

Various urgent symptoms usually draw attention to a mismatched transfusion. but unexplained bleeding may be the first sign in an anesthetized patient.'* The bleeding syndrome may follow the administration of as little as 200 to 500 ml. oi incompatible blood. Local bleeding, e.g., at an operation site, may be more severe than would have been expected; generalized bleeding may include epistaxis, bruising and purpura. Renewed bleeding at sites of venipunctures and injections made several hours previously is a characteristic sign of the sudden onset of the defibrination syndrome. Afibrinogenemia was noted by Moore22 in a fatal case, and in the two instances studied by Krevans and others18 there was a rapid fall in plasma fibrinogen concentration without evidence of fibrinolysis. It has been well shown in dogslltzo that intravascular hemolysis leads to coagulation in vim. Clotting by this mechanism does not depend on foreign surface contact and so can readily be initiated in the circulating blood. However, abnormal bleeding may be seen in half to one-third of patients developing major hemolytic transfusion reactions. Treatment. The appearance of abnormal bleeding following an incompatible transfusion should be investigated and treated along the lines appropriate for the acute defibrination syndrome. When blood is taken for immunological studies, at the onset of the reaction, it would be reasonable to carry out simple screening tests for hemostatic depletion even if overt bleeding has not appeared. A platelet count, and the fibrinogen titer test as described by A. A. Sharp121 31 are useful both as screening tests and-the second especially-for rapid evaluation of overt cases. The addition of the thrombin clotting time test,*2.14 a rapid fibrinogen determination based on clottable protein,l6 and a screening test for thromboplastic factorsl3 will provide a broad assessment of the hemostatic reserve (note that