Use of Blood Components in the Management of Trauma,
NAVAL BLOOD RESEARCH LAB BOSTON MASS
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The major risk in transfusing blood products to treat acute hemorrhagic shock is the transmission of hepatitis, although testing for the hepatitis B surface antigen has reduced this risk considerably. Some investigators believe that the incidence of posttransfusion hepatitis can be reduced even further if the plasma is removed from the blood before transfusion. Red cell concentrates that are washed before transfusion are relatively free of plasma. Although red cell washing does reduce the dose of virus associated with the hepatitis, it does not eliminate the transmission of hepatitis. Testing of donor blood for alanine aminotransferase has been recommended as a method to reduce the transmission of non-A-non-B posttransfusion hepatitis. Blood products may also transmit malaria, cytomegalovirus, acquired immune deficiency syndrome AIDS, and other infectious diseases, and the risk of red cell incompatibility must always be considered. The transfusion of incompatible blood very likely produces a hemolytic transfusion reaction, resulting in renal insufficiency and disseminated intravascular coagulation. Red cell incompatibility rarely occurs as the result of failure to detect incompatible donor blood by the crossmatching procedure, but rather occurs during transfusion when, say, Group A, B, or AB blood is given erroneously to a Group O recipient.