Transfusion and coagulation management in liver transplantation

Table 1 Risks of transfusion

General risks
Transfusion related immunomodulation	Accumulation of immune mediators in stored blood
Transfusion associated circulatory overload	Acute left ventricular failure or congestive cardiac failure
Transfusion related acute lung injury	Capillary leak and neutrophil extravasation and activation caused by: Immune mediated: Donor antibodies react with recipient white blood cells, forming leukoagglutinate that become trapped in the lung Non-immune mediated: Endothelium suffers initial insult (e.g., sepsis, surgery or trauma), attracting neutrophils that are activated by biologically active compounds in stored blood
Haemolytic transfusion reactions	Immediate: Donor membrane antigens react with antibodies against these present in recipient plasma
	Delayed: Alloimmunised recipient with specific antibodies respond to re-exposure to antigen positive red blood cells
Acute non haemolytic transfusion reactions	Febrile: Donor leucocyte antigens react with recipient white cell antibodies
	Allergic: Soluble donor antigens react in an already sensitised recipient
Post-transfusion purpura	Previous sensitisation produces antibodies which attach donor platelet antigens and additionally destroy their own platelets
Transfusion associated graft vs host disease	Donor lymphocytes proliferate within immunocompromised recipient, attacking host cells as ‘‘foreign’’
Infection	Bacterial 1:2000-1:500000
	Viral: hepatitis B 1:450000; hepatitis C 1:32000000; HIV 1:5000000; human T-cell leukaemia virus 1:12500000

HIV: Human immunodeficiency virus; RBC: Red blood cells.