Transfusion Adverse Events Research Articles

Blood Donor Arm Cleaning–Another Step towards Preventing the Contamination of Blood Products for Transfusion Purposes

Blood Establishments strive to provide blood and blood derivatives that are safe for transfusion. A recurrent concern is providing blood components that are free from bacterial contamination. Bacterial and fungal contamination of blood products is nowadays a major apprehension when it comes to transfusion adverse events. Over the years, several disinfection products and protocols have been devised to mitigate the risks of such contaminants, nonetheless, sepsis is still the leading cause of transfusion reaction fatalities. This fact raises the question of whether disinfection on its own is sufficient for preventing such outcomes.

Adsorption and elution study detected misidentification of para-Bombay phenotype donor in an incompatible crossmatch with Bombay phenotype patient

Abstract Bombay and para-Bombay are rare phenotypes with H antigen-deficient red blood cells. A 54-year-old male patient suffering from suspected malignant pleural effusion was planned for thoracotomy. The patient’s blood group showed blood group discrepancy during pretransfusion testing due to ABO isoagglutinin. Further workup with anti-H lectin was negative with pan-reactive antibody screening and negative autocontrol, which suggested that the patient is Bombay RhD positive. A known Bombay phenotype donor was called for donation. That Bombay donor is a para-Bombay donor incorrectly labeled as Bombay in another hospital. During pretransfusion testing, there was an incompatible crossmatch. Hence, the adsorption of donor red cells with the patient’s serum was performed, followed by heat elution. The eluate was pan-reactive with an antibody screening panel indicating anti-H present. The Lewis phenotype of the donor is Leb positive, which reflects the secretor status of the individual. This case highlights the importance of reverse grouping, adsorption, Lewis phenotyping, and elution testing in detecting and differentiating Bombay and para-Bombay phenotypes to avoid fatal adverse transfusion events.

Costs and consequences of over-investigation of minor transfusion reactions.

Adverse transfusion events create a direct cost burden on the healthcare system through increased morbidity, mortality, extra investigations for diagnosis, patient treatment and increased use of hospital resources. Understanding the costs and impact minor transfusion reactions have on the healthcare system presents an opportunity for potential cost savings and improved clinical practice. To determine the cost associated with investigating minor transfusion reactions, to identify opportunities to improve the management of blood transfusion reactions and potential cost savings through the application of current national guidelines. A retrospective review of all suspected transfusion reactions reported to the laboratory over a 6-year period was performed. Reports were assessed for appropriateness of clinical management and associated investigations. Cost of inappropriate investigations and associated blood product discard was calculated using current national tariffs. Of the 274 reports, febrile non-haemolytic transfusion reactions were the most common reactions, with 96 (35%) cases. One hundred forty-eight patients were unnecessarily investigated for suspected transfusion reactions totalling AU$ 32 427.00. The initial total value of partially discarded blood products was AU$ 55 656.00. The study demonstrated that unnecessary investigation of minor transfusion reactions adds a significant financial burden to the healthcare system.

Adverse Blood Transfusion Reaction Reporting at a Tertiary Care Hospital, Bhutan

Background and Objectives: Even though Blood Transfusion Service is considered as life-saving intervention, it is associated with the occurrence of uneventful reactions from the transfusion of blood and blood units. Bhutan Blood Bank is fragmented with different levels of services provided which leads to varied levels of adverse blood transfusion reaction reported. Study on the hemovigilance system at tertiary care hospital is conducted so as to study the frequency and types of reactions over a period of three years from 1st January 2019 to 31st December 2021. Methods: All ATRs occurring within a period of 3 years were studied according to the Blood Bank standard operating procedure. Adverse transfusion events related to blood and blood units were analyzed and classified on the basis of their clinical features and laboratory tests. Descriptive statistics were used to represent the adverse transfusion reactions. Results: During this period, a total of 19,961 blood and blood components were issued and 120 adverse transfusion events were reported. Most reaction reported were febrile non-hemolytic transfusion reaction, FNHTR (59.2%) followed by allergic reaction (22.5%) occurring predominantly in females (93%). Packed red cells were the common component causing adverse events (83 %) with most observable in Group A (42.5%) blood units. Conclusion: Febrile and allergic reactions are the most common type of reaction reported. Although such reaction type is least harmful but fatal reaction can occur and preventive measures must be taken to avoid such reactions. This preliminary study indicates the importance of having continuous monitoring and quality assessment scheme in addressing the issues of adverse transfusion reaction. Furthermore, establishing a hospital transfusion committee is vital for delivery of safe and efficient blood transfusion services.

Analysis of Incidence of Adverse Events of Neonatal Blood Transfusion in Sharqia Governorate

Analysis of Incidence of Adverse Events of Neonatal Blood Transfusion in Sharqia Governorate

Investigation of Transfusion Adverse Events Patterns in Fayoum University Hospitals, Egypt: Hemovigilance Initiative

Background and Objective: Hemovigilance is an adverse reaction surveillance and monitoring system to improve the safety and quality of blood transfusion in terms of corrective and preventive action. Identification of the adverse reactions and their risk factors will assist in taking appropriate steps to reduce their incidence and make blood transfusion safer. The aim of our study was to analyze the nature and incidence of transfusion related adverse events as a tool for implementation of hemovigilance system in Egypt.
 Study Design and Methods: Our study included all transfusion related adverse reactions from Fayoum University Hospital reported to the Blood Bank over a period of one year from August 2021 to July 2022. All patients receiving transfusion and all blood donors according to The National Blood Transfusion Guidelines were included. All reported reactions were analyzed, categorized and evaluated.
 Results: 28, 253 blood and blood components units were issued to 13, 544 patients. 273 (0.967%) transfusion related adverse reactions were reported to the blood bank. The most common reaction observed in recipients was allergic reaction 129 (47.25 %) followed by febrile non hemolytic transfusion reaction (FNHTR) 108 (39.56 %).
 Conclusion: Data related to transfusion related adverse reactions in developing countries are rare in literature. A strict quality assurance measures are required to build a hemovigilance system including, appropriate use of blood, maintain blood cold chain, monitoring, documenting and reporting transfusion reactions so that, the proper hemovigilance system can be attained.

Frequency of Indirect Hyperbilirubinemia Requiring Exchange Transfusion, Etiology and its Immediate Outcome in Term Neonates in Neonatal ICU of National Institute of Child Health, Karachi

Objectives: The present study assessed the frequency of causes of indirect hyperbilirubinemia (IH) requiring exchange transfusion and its immediate adverse events of exchange transfusion in term neonates. Methods: A prospective, observational study was undertaken at the Neonatal ICU of National Institute of Child Health, Karachi between July 2021 and December 2021. Term neonates arriving at the newborn unit of NICH with indirect hyperbilirubinemia were included in this study. All enrolled neonates were monitored for clinical, biochemical, and hematological adverse events for 7 days following exchange transfusion, and a predesigned performa was used to document observations. Results: Among 730 neonates with indirect hyperbilirubinemia, a total of 63 term neonates underwent exchange transfusion. The most common causes of hyperbilirubinemia were sepsis in 19 (30.2%) patients and ABO incompatibility in 13 (20.6%) patients. The most common adverse events noted were hypokalemia, which occurred in 10 (15.9%) and thrombocytopenia, which occurred in 10 (15.9%) cases. In six patients, sepsis developed. In total, five neonates died while four developed bilirubin encephalopathy. The total serum bilirubin and direct bilirubin among patients were significantly lowered after exchange transfusion (p<0.0001). There were no umbilical catheter-related complications. Bilirubin encephalopathy was present in 4 patients. There were five deaths, but not due to the procedure. Practical implication Conclusion: We highlighted the main causes of indirect hyperbilirubinemia as sepsis and ABO incompatibility in our setting. Furthermore, we also identified the immediate and short-term outcomes of exchange transfusion with a mortality rate of 7.9%. The overall outcome was favorable after the exchange transfusion. Keywords: Hyperbilirubinemia, kernicterus, exchange transfusion, indirect bilirubin, neonates , jaundice

Analyzing real world data of blood transfusion adverse events: Opportunities and challenges.

Blood transfusions are a vital component of modern healthcare, yet adverse reactions to blood product transfusions can cause morbidity, and rarely result in mortality. Therefore, accurate reporting of transfusion related adverse events (TRAEs) is paramount to improved transfusion practice. This study aims to investigate real-world data (RWD) on TRAEs by evaluating differences between ICD 9/10-based electronic health records (EHR) and blood bank-specific reporting. TRAE data were retrospectively collected from a blood bank-specific database between Jan 2015 and June 2019 as the reference data source and compared it to ICD 9/10 diagnostic codes corresponding to various TRAEs. Seven reactions that have corresponding ICD 9/10 diagnostic codes were evaluated: Transfusion related circulatory overload (TACO), transfusion related acute lung injury (TRALI), febrile non-hemolytic reaction (FNHTR), transfusion-related anaphylactic reaction (TRA), acute hemolytic transfusion reaction (AHTR), delayed hemolytic transfusion reaction (DHTR), and delayed serologic reaction (DSTR). These accounted for 33% of the TRAEs at an academic institution during the study period. Among 18637 adult blood transfusion recipients, there were 229 unique patients with 263 TRAE related ICD codes in the EHR, while there were 191 unique patients with 287 TRAEs identified in the blood bank database. None of the categories of reaction we investigated had perfect alignment between ICD 9/10 codes and blood bank specific diagnoses. Multiple systemic challenges were identified that hinder effective reporting of TRAEs. Identifying factors causing inconsistent reporting between blood banks and EHRs is paramount to developing effective workability between these electronic systems, as well as across clinical and laboratory teams.

Use of Diagnosis Codes to Find Blood Transfusion Adverse Events in Electronic Health Records.

Electronic health records (EHRs) and big data tools offer the opportunity for surveillance of adverse events (patient harm associated with medical care). We used International Classification of Diseases, Ninth Revision, codes in electronic records to identify known, and potentially novel, adverse reactions to blood transfusion. We used 49,331 adult admissions involving critical care at a major teaching hospital, 2001-2012, in the Medical Information Mart for Intensive Care III EHRs database. We formed a T (defined as packed red blood cells, platelets, or plasma) group of 21,443 admissions versus 25,468 comparison (C) admissions. The International Classification of Diseases, Ninth Revision, Clinical Modification , diagnosis codes were compared for T versus C, described, and tested with statistical tools. Transfusion adverse events (TAEs) such as transfusion-associated circulatory overload (TACO; 12 T cases; rate ratio [RR], 15.61; 95% confidence interval [CI], 2.49-98) were found. There were also potential TAEs similar to TAEs, such as fluid overload disorder (361 T admissions; RR, 2.24; 95% CI, 1.88-2.65), similar to TACO. Some diagnoses could have been sequelae of TAEs, including nontraumatic compartment syndrome of abdomen (52 T cases; RR, 6.76; 95% CI, 3.40-14.9) possibly being a consequence of TACO. Surveillance for diagnosis codes that could be TAE sequelae or unrecognized TAE might be useful supplements to existing medical product adverse event programs.

The 4-Year Experience with Implementation and Routine Use of Pathogen Reduction in a Brazilian Hospital.

(1) Background: We reviewed the logistics of the implementation of pathogen reduction (PR) using the INTERCEPT Blood System™ for platelets and the experience with routine use and clinical outcomes in the patient population at the Sírio-Libanês Hospital of São Paulo, Brazil. (2) Methods: Platelet concentrate (PC), including pathogen reduced (PR-PC) production, inventory management, discard rates, blood utilization, and clinical outcomes were analyzed over the 40 months before and after PR implementation. Age distribution and wastage rates were compared over the 10 months before and after approval for PR-PC to be stored for up to seven days. (3) Results: A 100% PR-PC inventory was achieved by increasing double apheresis collections and production of double doses using pools of two single apheresis units. Discard rates decreased from 6% to 3% after PR implementation and further decreased to 1.2% after seven-day storage extension for PR-PCs. The blood utilization remained stable, with no increase in component utilization. A significant decrease in adverse transfusion events was observed after the PR implementation. (4) Conclusion: Our experience demonstrates the feasibility for Brazilian blood centers to achieve a 100% PR-PC inventory. All patients at our hospital received PR-PC and showed no increase in blood component utilization and decreased rates of adverse transfusion reactions.

Development and validation of a novel predictive model and web calculator for evaluating transfusion risk after spinal fusion for spinal tuberculosis: a retrospective cohort study

ObjectivesThe incidence and adverse events of postoperative blood transfusion in spinal tuberculosis (TB) have attracted increasing attention. Our purpose was to develop a prediction model to evaluate blood transfusion risk after spinal fusion (SF) for spinal TB.MethodsNomogram and machine learning algorithms, support vector machine (SVM), decision tree (DT), multilayer perceptron (MLP), Naive Bayesian (NB), k-nearest neighbors (K-NN) and random forest (RF), were constructed to identified predictors of blood transfusion from all spinal TB cases treated by SF in our department between May 2010 and April 2020. The prediction performance of the models was evaluated by 10-fold cross-validation. We calculated the average AUC and the maximum AUC, then demonstrated the ROC curve with maximum AUC.ResultsThe collected cohort ultimately was consisted of 152 patients, where 56 required allogeneic blood transfusions. The predictors were surgical duration, preoperative Hb, preoperative ABL, preoperative MCHC, number of fused vertebrae, IBL, and anticoagulant history. We obtained the average AUC of nomogram (0.75), SVM (0.62), k-NM (0.65), DT (0.56), NB (0.74), MLP (0.56) and RF (0.72). An interactive web calculator based on this model has been provided (https://drwenleli.shinyapps.io/STTapp/).ConclusionsWe confirmed seven independent risk factors affecting blood transfusion and diagramed them with the nomogram and web calculator.

Modeling global transfusion medicine education.

Modeling global transfusion medicine education.

Improvement in Blood Transfusion Safety: Using Root Cause Analysis

Objectives: This research aimed at analyzing the adverse events reported related to blood transfusion in one of the large vice-chancellorships of Iran University of Medical Sciences in spring 2018. Methods: This descriptive study was performed based on the eight stages of the root cause analysis (RCA) of healthcare events by the National Authority for Health. For classification of the considered concerns, the “classifying nursing errors in clinical management (NECM)” model, failure classification, approved by the UK National Health System, and also a creative problem-solving technique were used for determining the improvement solutions. Results: Based on the results, 70% of states of blood transfusion error and blood products were placed in the category of care errors, 10% in the communication category, 20% in the category of implementation errors, and 0% in the category of knowledge and skill errors. A total of 38 influencing factors were identified for adverse events of blood transfusion, the most cause of the error was associated with organizational factors (18.4%), and the least reasons for failure were equipment and resource factors (5.3%). Conclusions: The establishment of advanced systems for the automatic transmission of blood and blood products, due to the lack of proper infrastructure in Iran, is not economically feasible. Therefore, at the level of this deputy, the guideline for managing blood transfusion and blood products in the two areas of "measures required before, during, and after blood transfusion and blood products" and "hemovigilance for physicians" were developed.

Transfusion-Associated Circulatory Overload and Transfusion-Related Acute Lung Injury.

To review the new current diagnostic criteria of transfusion-associated circulatory overload (TACO) and transfusion-related acute lung injury (TRALI) from the literature while highlighting distinguishing features. We provide comprehensive understanding of the importance of hemovigilance and its role in appropriately identifying and reporting these potentially fatal transfusion reactions. A review of the English language literature was performed to analyze TACO and TRALI while providing further understanding of the rationale behind the historical underrecognition and underreporting. Our review demonstrates the new 2018 and 2019 case definitions for TACO and TRALI, respectively. With more comprehensive diagnostic strategies, adverse transfusion events can be better recognized from mimicking events and underlying disease. In addition, there are mitigation strategies in place to help prevent complications of blood product transfusion, with emphasis on the prevention of TACO and TRALI. TACO and TRALI are potentially fatal adverse complications of blood transfusion. Both have been historically underrecognized and underreported due to poor defining criteria and overlapping symptomatology. Developing a thorough clinical understanding between these two entities can improve hemovigilance reporting and can contribute to risk factor identification and preventative measures.

220 Risk of RBC Transfusion and Volume-Related Adverse Events in Patients With Dialysis-Dependent Chronic Kidney Disease: Pooled Results From Roxadustat Phase 3 Studies

220 Risk of RBC Transfusion and Volume-Related Adverse Events in Patients With Dialysis-Dependent Chronic Kidney Disease: Pooled Results From Roxadustat Phase 3 Studies

63 Risk of RBC Transfusion and Volume-Related Adverse Events in Patients With Nondialysis-Dependent Chronic Kidney Disease: Pooled Results From Roxadustat Phase 3 Studies

63 Risk of RBC Transfusion and Volume-Related Adverse Events in Patients With Nondialysis-Dependent Chronic Kidney Disease: Pooled Results From Roxadustat Phase 3 Studies

Transfusion medicine and blood banking education and training for blood establishment laboratory staff: A review of selected countries in Africa.

Avoidable human error is a significant cause of transfusion adverse events. Adequately trained, laboratory staff in blood establishments and blood banks, collectively blood facilities, are key in ensuring high-quality transfusion medicine (TM) services. Gaps in TM education and training of laboratory staff exist in most African countries. We assessed the status of the training and education of laboratory staff working in blood facilities in Africa. A cross-sectional study using a self-administered pilot-tested questionnaire was performed. The questionnaire comprised 26 questions targeting six themes. Blood facilities from 16 countries were invited to participate. Individually completed questionnaires were grouped by country and descriptive analysis performed. Ten blood establishments and two blood banks from eight African countries confirmed the availability of a host of training programs for laboratory staff; the majority of which were syllabus or curriculum-guided and focused on both theoretical and practical laboratory skills development. Training was usually preplanned, dependent on student and trainer availability and delivered through lecture-based classroom training as well as formal and informal on the job training. There were minimal online didactic and self-directed learning. Teaching of humanistic values appeared to be lacking. We confirmed the availability of diverse training programs across a variety of African countries. Incorporation of virtual learning platforms, rather than complete reliance on didactic, in-person training programs may improve the education reach of the existing programs. Digitalization driven by the coronavirus disease 2019 pandemic may provide an opportunity to narrow the knowledge gap in low- and middle-income countries (LMICs).

Safe Blood Transfusion Practices among Nurses in a Major Referral Center in Ghana.

Errors in transfusion of blood and blood products can lead to preventable morbidity and mortality. Nurses constitute a significant aspect of the transfusion process as they are the last in the chain of getting blood directly to the patient. They must, therefore, be conversant with the current standard of national and international guidelines on blood transfusion and appropriate management of adverse transfusion events. This study assesses the knowledge and practices of blood transfusion safety among nurses at Komfo Anokye Teaching Hospital. A descriptive cross-sectional design was employed, and structured questionnaire (Routine Blood Transfusion Knowledge Questionnaire) was used to collect data from 279 nurses from seven clinical directorates of the hospital. The data were processed with Stata version 14.0. Variables were analyzed using descriptive statistics, and relationships were drawn using inferential statistics. Over 90% of the respondents had a minimum of a diploma in nursing or midwifery, 63% had performed blood transfusion at least 5 times, and 46% had never received any training on blood transfusion. The mean score obtained in all four categories of blood transfusion knowledge assessed was 29, with 54% of the respondents scoring below the mean. The highest overall score on knowledge was 53%. This indicates that nurses had poor knowledge regarding safe blood transfusion practices as stipulated in the clinical guidelines for blood transfusion by Ghana's National Blood Service. There was no statistically significant relationship between training/experience and knowledge of safe blood transfusion practices. Regular and continuous update training and audit are needed to safeguard patient safety during blood transfusion.

Educational and Electronic-Based Tools to Mitigate the Risk of Transfusion Adverse Events.

The transfusion of blood products is a widely used practice but comes with the risk of transfusion-associated adverse events and fatalities. The primary aim of this study was to evaluate if strict adherence to transfusion guidelines would lead to a decrease in the rate of transfusion reactions that occurred when blood products were given outside of established indications. Hospital-wide educational programs and dedicated electronic transfusion order sets were used to encourage adherence to guidelines. A secondary aim of this study was to evaluate if a decrease in the incidence of transfusion reactions also lead to a decrease in associated healthcare costs.

Complications of blood donation reported to haemovigilance systems: analysis of eleven years of international surveillance.

The International Haemovigilance Network collects aggregate data on complications of blood donation from member haemovigilance systems (HVS). We analysed the data collected in 2006-2016 in order to learn from it and consider future improvements. National HVS entered annual data on donation complications and on annual whole blood and apheresis donations in the 'ISTARE' (International Surveillance of Transfusion Adverse Reactions and Events) online database. We calculated national and aggregate donation complication rates. Twenty-four HVS provided data for 138 country years (CY; median 7 CY, IQR 2-8), covering 155 M donations. The overall complication rate was 6·3/1000 donations and the median country rate 3·2/1000 (IQR 1·1-10·1). Overall and severe complication rates varied considerably between HVS. Vasovagal reactions (VVR) were most commonly reported: 4·6/1000 donations, median country rate 3·1/1000 donations (IQR 0·6-7·7). Rare complications included generalized allergic reaction (0·10/100000) and major blood vessel injury (category available since 2015; 0·12/100000). Eighteen HVS reported complications of whole blood donation (WBD) and apheresis separately (89 CY, 101·6 M WBD and 26·3 M apheresis donations). The median country VVR rate was 3·4/1000 WBD (IQR 1·0-9·1) and 1·5/1000 apheresis donations (1·0-4·2). Rates of venepuncture-related complications tended to be higher for apheresis: the median country rate of reported haematomas was 0·39/1000 WBD (IQR 0·31-1·2) vs. 4·2/1000 apheresis donations (0·69-5·6). International reporting allows HVS to study rates of blood donation complications and capture information about very rare events. The present variability of reporting and severity assessment hampers comparisons between HVS and requires further work.