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8 out of 10

Which of the following are major complications of massive transfusion: (AIPG 2009)

A Hypokalemia
B Hypothermia

C Hypomagnesemia
D All of the above

Ans. D

All of the above

Anti-D is not a naturally occurring antibody….cryoprecipitate contains only ---VWF, Fibrinogen, VIII, XIII

Extra Edge.

Anti –D is not a naturally occurring antibody

Cryoprecipitate does not contain all coagulation factors.

Table - Risks of Transfusion Complications (Ref. Hari- 18th ed., Pg. 951)

1. Reactions

a. Febrile (FNHTR) b. Allergic c. Delayed hemolytic

d. TRALI e. Acute hemolytic f. Fatal hemolytic

g. Anaphylactic

2. Infections

a. Hepatitis B b. Hepatitis C c. Hepatitis G virus d. HIV e. Malaria f. Cytomegalovirus g. Parvovirus B-19

3. C. Other complications

a. RBC allosensitization b. HLA allosensitization c. Graft-versus-host disease


1. Fluid Overload

2. Hypothermia

3. Electrolyte Toxicity


a. Hyperkalemia or Hypokalemia b. Hypocalcemia c. Hypomagnesemia

d. Acidosis or alkalosis (Metabolic alkalosis can occur with massive blood transfusions due to the breakdown of citrate stored in blood into bicarbonate)

d. Iron overload

Impaired oxygen capacity of hemoglobin ( 2, 3 DPG)

e. Hypotensive reactions.

f. Immunomodulation

Extra Edge:

1. Massive transfusion (MT) is a lifesaving treatment of hemorrhagic shock, but can be associated with significant complications.

2. The lethal triad of acidosis, hypothermia, and coagulopathy associated with MT is associated with a high mortality rate.

3. Other complications include hypothermia, acid/base derangements, electrolyte abnormalities (hypocalcemia, hypomagnesemia, hypokalemia, hyperkalemia), citrate toxicity, and transfusion-associated acute lung injury.

4. Now lets see K+ changes: Hyperkalemia or Hypokalemia

a. Potassium release from red cells increases during storage, and after irradiation. Levels of up to 80 mmol/L may be reached in a unit of red blood cells.

b. Massive transfusion may lead to hyperkalemia, which can cause cardiac arrhythmias or myocardial depression. Young infants are the most susceptible patients, particularly if stored blood is transfused rapidly into a central line.

c. Paradoxically, hypokalemia has also been described with massive transfusion. Possible causes include metabolic alkalosis secondary to citrate metabolism and re-accumulation of potassium in transfused potassium-depleted RBCs.

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