SPECTRUM OF BLOOD TRANSFUSION-ASSOCIATED KIDNEY INJURY

7 Feb 2025 12 a.m. 12 a.m.

WCN25-AB-2308, Poster Board= FRI-044

Introduction:

Blood transfusions result in various complications, and rarely, they result in organ failure. We present a series of 3 cases of acute kidney injury developing as a complication of blood transfusion.

Methods:

Results:

CASE-1: A 40-year-old female with a history of one unit packed red blood cell (PRBC) transfusion one day prior presented to us with fever, jaundice, and anuria. She was found to have coombs-negative hemolytic anemia with positive urine hemoglobin, suggestive of non-immune intra-vascular hemolysis. She had anuric Acute Kidney Injury (AKI) with a creatinine of 8.6 mg/dl (Table 1). Renal biopsy showed Pigment cast nephropathy (hemoglobin) with acute tubular injury (Figure 1). She underwent multiple sessions of hemodialysis and had complete renal recovery in 3 weeks.

CASE-2: A 64-year-old male patient with stable chronic kidney disease V (CKD) and compensated heart failure (EF-45%) and severe anemia developed sudden onset dyspnoea after receiving three units of blood transfusion. He was diagnosed with severe anemia with acute pulmonary edema with a reduction in cardiac ejection fraction to 25% post-transfusion (Table 1). A diagnosis of Transfusion-associated cardiac overload (TACO) with AKI on CKD was made, and he was managed with ultrafiltration and fluid restriction. His cardiac function improved to baseline status in two weeks, but he remained dialysis dependent.

CASE-3: A 52-year-old male presented with fever, jaundice, and decreased urine output one day after receiving a blood transfusion. On evaluation, he had severe hyperbilirubinemia with oliguric AKI (Table 1). Blood cultures from the blood bag and patient both revealed growth of the same organism (Escherichia coli). He was diagnosed as blood transfusion related sepsis with multiorgan dysfunction. He underwent multiple sessions of dialysis and had complete renal and liver recovery in 2 weeks.

Figure 1: Renal biopsy showing the presence of hemoglobin casts within tubular lumen with acute tubular injury and interstitial inflammation Table 1: AKI-Acute kidney injury, CAD-coronary artery disease, CKD-chronic kidney disease, DM-diabetes mellitus, HTN- hypertension

Conclusions:

Blood transfusion is a common procedure but can rarely have organ and life-threatening complications. Appropriate transfusion care and knowledge of the complications can help prevent and manage these complications.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.