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Year : 2021  |  Volume : 5  |  Issue : 2  |  Page : 147-148

Blood transfusion set: A possible cause for blood clotting during transfusion?

Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, India

Date of Submission14-Dec-2020
Date of Decision07-Feb-2021
Date of Acceptance09-Feb-2021
Date of Web Publication16-Apr-2021

Correspondence Address:
Dr. Priyanka Gupta
Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/bjoa.bjoa_264_20

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How to cite this article:
Pathak S, Gupta P, Andleeb R, Perween R. Blood transfusion set: A possible cause for blood clotting during transfusion?. Bali J Anaesthesiol 2021;5:147-8

How to cite this URL:
Pathak S, Gupta P, Andleeb R, Perween R. Blood transfusion set: A possible cause for blood clotting during transfusion?. Bali J Anaesthesiol [serial online] 2021 [cited 2021 Jun 23];5:147-8. Available from: https://www.bjoaonline.com/text.asp?2021/5/2/147/313897


Blood transfusion (BT) is a highly meticulous process. Careful practice guidelines need to be followed to prevent transfusion-related adverse reactions.[1],[2] Blood components require filtration during the transfusion to remove the small clots and clumps of platelets and white blood cells that form during collection and storage. The needle size through which the blood is transfused should also be carefully selected. A broad-gauge cannula is recommended to avoid hemolysis and clotting.[3] We present a case of clotting of blood in the BT set during administration.

A 35-year-old male with a history of a traffic accident and loss of consciousness was brought to our institute. Radiological imaging revealed, large subdural hematoma in the left frontotemporal region. He was scheduled for emergency decompressive craniectomy and evacuation of the hematoma. During the surgery, the patient lost 1200 ml of blood following the elevation of the cranium. We decided to transfuse packed red blood cells. The blood bag received in the operating theater was cross-checked by the anesthesia team, and the transfusion was started through a fresh BT set via a 16G cannula.

After few minutes, we noticed that blood was not flowing through the set as expected. At this point, we flushed the cannula, which was working properly, and then we tried to aspirate the blood into a syringe through the three-way extension line attached ahead of the BT set but failed to do so. We then inspected the blood bag for any clots but noticed no visible clot. We decided to change the BT set, and when we removed the BT set, a large clot was seen blocking the piercing spike of the BT set, which prevented the entry of blood into the filter part of the set [Figure 1]. A new BT set was connected, and the transfusion resumed for a few minutes, but then we were faced with the same problem. The blood bag was inspected for any clots and was clear.
Figure 1: Blood clot blocking the piercing spike of blood transfusion set

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We reviewed the BT set again, and we noticed a clot blocking the set's piercing spike. We had kept the blood bag on the trolley for changing for both the previous scenarios, so this time, we replaced the whole set while keeping the blood bag above the heart level at all points. The transfusion resumed successfully without any more problems. The rest of the procedure was uneventful, and the patient was shifted to intensive care unit for postoperative ventilation and further management.

A case report reported that mixing the patient's blood with the blood in the blood bag may result in clotting.[4] The information helped to bring the above fact to light. They ran DNA analysis on the blood bags, which were returned due to clotting, and the results revealed mixing of patient's own blood resulting in clotting. The development of blood clots on the BT-set spike in our case can also be explained by the same mechanism. While connecting the BT set, the blood bag was kept on the trolley, which was lower than the heart level, which may have resulted in the patient's blood traveling up. This is a common practice whenever changing bags. It can even result in the clotting of blood in the blood bag. Fortunately, in our case, the blood clot could be identified at an early stage. We could prevent catastrophic complications related to blood clot embolisms like pulmonary embolism, stroke, or even cardiac arrest in the patient by strict vigilance.[5]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Robinson S, Harris A, Atkinson S, Atterbury C, Bolton-Maggs P, Elliott C, et al. The administration of blood components: A British Society for Haematology Guideline. Transfus Med 2018;28:3-21.  Back to cited text no. 1
Carson JL, Guyatt G, Heddle NM, Grossman BJ, Cohn CS, Fung MK, et al. Clinical practice guidelines from the AABB: Red blood cell transfusion thresholds and storage. JAMA 2016;316:2025-35.  Back to cited text no. 2
Mayr WR. Guide to the Preparation, Use and Quality Assurance of Blood Components. 13th and 9th ed., Vol. 93. Vox Sanguinis: Council of Europe Publishing; 2007. p. 279.  Back to cited text no. 3
Aelst BV, Coene J, Feys HB, Emonds MP, Poucke KV, Moerman J, et al. Massive clotting in red cell concentrates during transfusion caused by backflow of patient blood. Belg J Hematol 2017;8:195-7.  Back to cited text no. 4
Oklu R. Thrombosis. Cardiovasc Diagn Ther 2017;7 Suppl 3:S131-3.  Back to cited text no. 5


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