Question

Describe the mechanisms and prevention of transfusion hemosiderosis, citrate toxicity, and
posttransfusion purpura.

Answer 1

Transfusional hemosiderosis is the accumulation of iron in the liver and heart but also endocrine organs, in patients who receive frequent blood transfusions.

It can be prevented by

1. Avoid iron supplements and multivitamins containing iron. These can increase your iron levels even more.
2. Avoid vitamin C supplements.
3. Avoid alcohol
4. Avoid eating raw fish and shellfish.

Citrate toxicity results when the citrate in the transfused blood begins to bind calcium in the patient's body.

It can be prevented by

1. stop citrate administration.
2. treat life-threatening hypocalcemia with IV calcium
3. optimise cardiac output and liver function to enhance citrate clearance.
4. consider RRT to correct metabolic derangement and enhance citrate clearance.

Post-transfusion purpura (PTP) is a delayed adverse reaction to a blood transfusion or platelet transfusion that occurs when the body has produced alloantibodies to the allogeneic transfused platelets antigens. PTP usually presents 5–12 days after transfusion and is a potentially fatal condition in rare cases.

Patient with known history of post-transfusion purpura should receive washed RBCs. Platelet transfusions should be crossmatched, HPA matched products.