IMMUNE REACTIONS AND/OR SUPPRESSION

1. Immune System Suppression - A condition of decreased immunity seen after blood transfusions.  Such immune suppression increases incidence of cancer recurrence and increases morbidity and mortality.

2. Allergic Reaction to Transfused Blood - Hypersensitivity to antigens found in blood or to certain blood proteins.  Reactions can include swelling, red patches, low blood pressure, heart palpitations, and difficulty in breathing.  In extreme cases it may lead to anaphylaxis and death.

3. Intravascular and Extravascular Hemolysis - A very rapid red cell destruction caused by incompatibility within the ABO system and from anti-Le, anti-Jk, and anti-Fy antibodies.  Reactions can include anxiety, flushing, chest pain, rapid breathing and rapid heart rate.  In extreme cases it may have the appearance of shock and renal failure.  Extravascular hemolysis is normally caused by Rh incompatibility and in acute state is less severe but may cause complete rapid destruction of all transfused cells within one week.

4. Graft-Versus-Host (GVH) Disease - An immune reaction caused by the presence of T cell lymphocytes from transfused blood.  May present anorexia, vomiting, skin eruptions, watery or bloody diarrhea, hyperbilirubinemia, and decrease in the number of all types of blood cells.  The majority of reported cases have been fatal despite immunosuppressive therapy.

CHEMICAL/METABOLIC IMBALANCE

1. Circulatory Overload - A condition in which the body's circulatory system is not capable of meeting the demands placed on it.  Transfusions can cause an elevated about of fluid to accumulate, compromising the heart and other vital organs.  The blood may also become viscous and decrease oxygen delivery to parts of the body.

2. Iron Overload - Increased red cell destruction of transfused blood can increase the amount of iron in the body resulting in loss of cell function, cell death, and organ failure.  Normal body excretion of excess iron can take many years.

3. Post-transfusion Thrombocytopenia - A condition of decreased platelet counts after the transfusion of blood.  The transfusion blood may have specific antibodies to the recipient's platelets, thus destroying these platelets.  This condition may cause purple areas on the skin and increased bleeding and it may increase the risk of life-threatening massive hemorrhage.

4. 2,3-Diphosphoglycerate (2,3-DPG) Deficiency - A chemical compound of red blood cells that changes their ability to carry oxygen.  The 2,3-DPG levels of blood decrease rapidly when stored.  Such transfused blood has a decreased ability to release oxygen to the cells, thus causing oxygen starvation at the cell level.  Cell oxygen starvation occurs in spite of normal hemoglobin levels and apparent color of the patient.

5. Electrolyte Imbalance - Electrolytes such as sodium, potassium, and carbonate are maintained in balance by the body for its proper operation.  Transfusions may introduce into this closed circuit an imbalance of these elements.  Such imbalance may alter body metabolism and lead to shock, coma, or heart failure.

VIRAL INFECTIONS

1. HIV (AIDS) - human immunodeficiency virus.  A viral infection that suppresses human immunity, transmitted primarily through venereal routes or by exposure to contaminated blood or blood products.

2. Hepatitis - Inflammation of the liver caused by infectious or toxic agents resulting in swelling of the liver and impaired liver function.  The types A, B, C, D and NANBH refer to the particular variety of hepatitis, each having a different level of severity.  Hepatitis can cause jaundice, vomiting, fever, weight loss, and weakness.  In severe cases it can cause encephalopathy, internal bleeding, heart failure, and death.

3. Herpetovirus - A group of double-stranded DNA viruses that cause various infections in humans.  Most notable is Herpes Simplex and Epstein-Barr.  Epstein-Barr has been found in cultures of Burkitt's lymphoma, a malignant and deadly disease, and is also associated with infectious mononucleosis.

4. Cytomegalovirus - A group of herpetoviruses that can infect the visceral or internal organs.  Once infected the virus can cause widespread damage and death.  These infections are most commonly seen in newborn children or those with suppressed immune systems.

BACTERIAL INFECTIONS

1. Malaria - A parasitic infection that invades red blood cells and begins reproducing within the host cells.  After maturation, these new parasites are released into the bloodstream by rupturing the host cell.  This activity can cause blood to be restricted in certain areas of the body, including vital organs such as the brain and heart.

2. Typhus - An infection caused by various rickettsias.  Such a parasitic invasion of the body causes cell destruction.  Severity ranges from mild headache and fever to renal and circulatory failure and death.

3. Salmonellosis and Typhoid Fever - A gram-negative bacilli infection.  The bacilli cause the formation of large mononuclear cells in tissue of the lymph, liver, spleen, intestine, bone marrow, and lung.  Cell death in areas of the intestinal tract can cause massive hemorrhage or perforation of the intestines.  Other manifestations include inflammation of the brain, bone linings, joints and kidneys, pneumonia, deafness, loss of hair, hemolytic anemia.

4. Chagas Disease and South African Trypanosomiasis - A parasitic infection that in its acute phase can invade heart muscle, skeletal muscle, smooth muscle and nervous tissue, resulting in heart failure and meningitis.

5. Toxoplasmosis - A parasitic infection that causes inflammation of the joints, heart muscle, heart lining, lungs and brain.

6. Syphilis - A chronic bacterial infection caused by Treponema pallidum.  In its primary state it causes skin lesions; in the secondary state it may cause skin lesions, hair loss, fever, weakness and inflammation of the brain, liver and joints.  Untreated cases may cause irreversible damage to the kidneys, brain, and heart which can lead to early death.