Adverse Transfusion Reactions Research Articles

Transfusion-associated circulatory overload (TACO): Significance of appropriate pre-transfusion risk assessment to prevent fatal health outcomes.

Madam, Transfusion of blood products is a life rescuing medical intermediation; however, associated adverse transfusion reactions are major pitfalls. Transfusion-associated circulatory overload (TACO) is life-threatening pulmonary oedema that develops secondary to volume overload. Underlying precipitating factors include ages >60 years or <3 years, low body mass index (BMI), rapid transfusion rate and pre-existing volume overload conditions such as heart disease, renal failure, lung disease or low albumin levels. Sign and Symptoms include dyspnoea, tachypnoea, tachycardia, hypoxia, raised jugular venous pressure, broad pulse pressure and hypertension, that appears during or either six hours posttransfusion [1]. TACO should be discriminated from transfusion-related acute lung injury (TRALI) by high jugular venous pressure, pulmonary arterial pressure to >18mmHg, hypertension, brain natriuretic peptide levels (>1200pg/ml) and response to diuretics. Management of TACO includes immediate discontinuation of transfusion, diuretics, supplementary oxygen, and assisted ventilation if indicated [2]. Serious Hazards of Transfusion (SHOT) in 2018 reported TACO as the most typical reason for transfusion-related deaths. Over the period of 11 years (2007-2018), overall cases raised from six to one hundred and ten, including the increase in mortality from one to five and one significant morbidity from three to thirty-six cases [3]. Interestingly, timely and appropriate preventive actions can reduce this severe reaction to zero. A precise risk assessment before transfusion is recommended by SHOT for TACO elimination, especially if the patient has underlying risk factors. Preventive strategies in such predisposed patients include reviewing the need for transfusion, deferring the transfusion until issue can be resolved, transfuse according to body weight, measure fluid balance, consider prophylactic diuretic, slow transfusion rate and monitoring vital signs including oxygen saturation. Thus, TACO is a serious but avoidable transfusion reaction. Appropriate assessment prior to transfusion in every patient is important to ensure safe blood transfusion practice. Continuous...

Pragmatic, double-blind, randomised trial evaluating the impact of red blood cell donor sex on recipient mortality in an academic hospital population: the innovative Trial Assessing Donor Sex (iTADS) protocol

IntroductionWith over 1 million units of blood transfused each year in Canada, their use has a significant clinical and economic impact on our health system. Adequate screening of blood donors...

Bedside Allogeneic Erythrocyte Washing with a Cell Saver to Remove Cytokines, Chemokines, and Cell-derived Microvesicles.

Removal of cytokines, chemokines, and microvesicles from the supernatant of allogeneic erythrocytes may help mitigate adverse transfusion reactions. Blood bank-based washing procedures present logistical difficulties; therefore, we tested the hypothesis that on-demand bedside washing of allogeneic erythrocyte units is capable of removing soluble factors and is feasible in a clinical setting. There were in vitro and prospective, observation cohort components to this a priori planned substudy evaluating bedside allogeneic erythrocyte washing, with a cell saver, during cardiac surgery. Laboratory data were collected from the first 75 washed units given to a subset of patients nested in the intervention arm of a parent clinical trial. Paired pre- and postwash samples from the blood unit bags were centrifuged. The supernatant was aspirated and frozen at -70°C, then batch-tested for cell-derived microvesicles, soluble CD40 ligand, chemokine ligand 5, and neutral lipids (all previously associated with transfusion reactions) and cell-free hemoglobin (possibly increased by washing). From the entire cohort randomized to the intervention arm of the trial, bedside washing was defined as feasible if at least 75% of prescribed units were washed per protocol. Paired data were available for 74 units. Washing reduced soluble CD40 ligand (median [interquartile range]; from 143 [1 to 338] ng/ml to zero), chemokine ligand 5 (from 1,314 [715 to 2,551] to 305 [179 to 488] ng/ml), and microvesicle numbers (from 6.90 [4.10 to 20.0] to 0.83 [0.33 to 2.80] × 106), while cell-free hemoglobin concentration increased from 72.6 (53.6 to 171.6) mg/dl to 210.5 (126.6 to 479.6) mg/dl (P < 0.0001 for each). There was no effect on neutral lipids. Bedside washing was determined as feasible for 80 of 81 patients (99%); overall, 293 of 314 (93%) units were washed per protocol. Bedside erythrocyte washing was clinically feasible and greatly reduced concentrations of soluble factors thought to be associated with transfusion-related adverse reactions, increasing concentrations of cell-free hemoglobin while maintaining acceptable (less than 0.8%) hemolysis.

Matched Cohort Study of Convalescent COVID-19 Plasma Treatment in Severely or Life Threateningly Ill COVID-19 Patients.

BackgroundThe utility of convalescent coronavirus disease 2019 (COVID-19) plasma (CCP) in the current pandemic is not well defined. We sought to evaluate the safety and efficacy of CCP in severely or life threateningly ill COVID-19 patients when matched with a contemporaneous cohort.MethodsPatients with severe or life-threatening COVID-19 were treated with CCP according to Food and Drug Administration criteria, prioritization by an interdisciplinary team, and based on CCP availability. Individual-level matched controls (1:1) were identified from patients admitted during the prior month when no CCP was available. The safety outcome was freedom from adverse transfusion reaction, and the efficacy outcome was a composite of death or worsening O2 support. Demographic, clinical, and laboratory data were analyzed by univariate and multivariable regression analyses accounting for matched design.ResultsStudy patients (n = 94, 47 matched pairs) were 62% male with a mean age of 58, and 98% (90/94) were minorities (53% Hispanic, 45% Black, non-Hispanic) in our inner-city population. Seven-day composite and mortality outcomes suggested a nonsignificant benefit in CCP-treated patients (adjusted hazard ratio [aHR], 0.70; 95% CI, 0.23–2.12; P = .52; aHR, 0.23; 95% CI, 0.04–1.51; P = .13, respectively). Stratification by pretransfusion mechanical ventilation status showed no differences between groups. No serious transfusion reactions occurred.ConclusionsIn this short-term matched cohort study, transfusion with CCP was safe and showed a nonsignificant association with study outcomes. Randomized and larger trials to identify appropriate timing and dosing of CCP in COVID-19 are warranted.Trial Registration ClinicalTrials.gov Identifier: NCT04420988.

The Relationship between Serum Leukotriene B4 and High-Sensitivity C-Reactive Protein Expression Levels and Adverse Reactions in Patients with Colon Cancer During Perioperative Blood Transfusion

To explore the predictive value of serum high-sensitivity C-reactive protein and leukotriene B4 in perioperative blood transfusion patients with colon cancer in patients with adverse blood transfusion reactions. 168 patients undergoing colon cancer surgery in a hospital from March 2018 to March 2020 were selected as the research objects and checked the levels of high-sensitivity C-reactive protein and leukotriene B4 in the venous blood of all patients. There were 73 cases in the adverse blood transfusion group (experimental group) and 95 cases in the non-transfusion reaction group (control group). The serum levels of high-sensitivity C-reactive protein and leukotriene B4 in the two groups were compared. Based on the analysis of the basic data of the two groups of patients, serum high-sensitivity C-reactive protein and leukotriene B4 are independent risk factors for perioperative adverse reactions in colon cancer patients. The levels of serum high-sensitivity C-reactive protein and leukotriene B4 in the experimental group are higher than those in the normal group and there are differences, both were statistically significant (p<0.05); receiver operating characteristic curve results showed that the area under the curve of high-sensitivity C-reactive protein and leukotriene B4 alone and in combination to predict adverse transfusion reactions were 0.733, 0.819 and 0.877, respectively. The area under the curve of combined factor diagnosis was greater than single diagnosis; serum high-sensitivity C-reactive protein≥14.64 mg/l and leukotriene B4≥18.86 pg/l are risk factors for adverse reactions in patients with colon cancer perioperative blood transfusion. Elevated serum high-sensitivity C-reactive protein and leukotriene B4 in patients with colon cancer during perioperative blood transfusion are risk factors for adverse blood transfusion reactions. High-sensitivity C-reactive protein≥14.64 mg/l and leukotriene B4≥18.86 pg/l suggest that adverse blood transfusion reactions may occur. The combination of the two can increase the incidence of adverse blood transfusion reactions.

Frequency and clinical characteristics of adverse transfusion reactions in hospitalized patients: A retrospective review of electronic medical records

Purpose: Adverse transfusion reactions (ATRs) are unfavorable reactions to the transfused unit, and the severity may be different among individuals, depending upon the type of reactions and the patient’s susceptibility. It is necessary to operate and manage a systematic monitoring system to minimize these ATRs and increase the safety. This study was conducted to evaluate clinical features of transfusion-related adverse events and morbidities. Methods: We retrospectively analyzed transfusion data from electronic medical records during the recent 3 years (April 2017 to April 2020) at Seoul National University Bundang Hospital. The electronic search strategy was applied to search for the type of blood prod-ucts prescribed and identify symptoms that occurred during transfusion as recorded in the nursing chart which is based on the In-ternational Classification for Nursing Practice. Results: A total of 18,772 people were transfused during the study period. A total of 524 people were reported as suspected ATRs, of whom 466 were finally confirmed. Red blood cell was the most frequent culprit blood product (59.9%), followed by apheresis plate-let (25.1%), fresh frozen plasma (10.1%), and platelet (4.9%). Clinical symptoms included fever (54.9%), urticaria and itching (34.7%), chillness and shivering (21.9%), and chest discomfort (6.0%), dyspnea (5.3%), cold sweating (3.8%), hypotension (2.1%), and palpita-tions (1.9%). The severity of ATRs were mild (91.8%), moderate (7.1%), and severe (1.1%). Conclusion: ATRs are mostly mild, but life-threatening reactions may occur. Physicians should be aware of various features of ATRs to appropriately recognize and treat such patients. (Allergy Asthma Respir Dis 2021;9:225-230)

Practical blood transfusion and adverse transfusion reactions

Blood transfusion, which has been conducted as a basic medical procedure since 17th century, is a supportive therapy to compensate loss of each blood component. All blood materials are donated, and alive and subject to decay, type-dependent for transfusion, vary in quality, may induce severe adverse reactions, such as anaphylaxis, and may transmit infectious agents. Therefore, not only the scientific and clinical decisions but also ethical considerations should be focused on for their use. All blood products are determined as "Products Derived from Specific Organism" by the Pharmaceutical and Medical Devices Law in Japan. Of note, blood management systems are different among countries; the Japanese Red Cross Society is a unique organization that collects and manufactures blood products under supervision of the Japanese Government. It establishes a hemovigilant system by which it collects all the information concerning transfusion-related adverse events and provides them to the responsible transfusion service staff of each hospital. Physicians should check all the information from the Japanese Red Cross and refer both the "Guidelines for Blood Transfusion" and "Guidelines for the Usage of Blood Products" by the Ministry of Health, Labor and Welfare for transfusion practice.

Incidence of Adverse Transfusion Reaction and Practices for its Prevention

Transfusion reactions are the untoward event towards blood products. Although majority of transfusion reactions are uneventful sometimes it may have life threatening events. This study was conducted to estimate the incidence and determine the nature of blood transfusion reactions in our hospital. It also aims to find practices which could prevention such reactions. All the Adverse transfusion reactions were investigated in detail in the blood bank for the clerical errors, immunohematology workup and classified according to their nature. A total of 38308 units of components were issued to various departments in the hospital. Total 61 transfusion reactions were reported to the blood bank following transfusion of components only (0.16%). The most common type of transfusion reaction among all the ATRs was febrile nonhemolytic transfusion reaction (44%), followed by allergic (39%). Fever and chills, rigors were the most common symptom. Other reactions were dyspnoea, rashes and tachycardia. Avoiding unnecessary transfusion, red cell modification like leukofitration for FNHTR, red cell washing for allergic reactions and anaphylactoid reactions and implementing Patient Blood Management are tools to decrease transfusion reactions.

Initiative for rare donor registry for A2/A2B subgroups with Rh phenotyping: A first of its kind

Aims: Aim of this study is to create donor registry of A2/A2B subgroup blood donors with Rh and Kell phenotype, to provide transfusion to multi-transfused A2/A2B subgroup patients and to prevent adverse transfusion reaction due to immunological stimulation by pre-existing anti-A1 antibodies having enhanced titer and thermal amplitude. Prevalence of A2/A2B subgroup in Indian population is rare with highest prevalence of “e” antigen among the five Rh antigens, phenotyped serologically, and “E” antigen being the lowest in prevalence. Anti-A1 antibodies appear as cold agglutinins in A2/A2B individuals and can be clinically significant when reactive at 37 °C, causing hemolysis of A1 RBCs. Methods: A retrospective data analysis was done in a tertiary care hospital-based blood center at capital city of India from January 2016 to December 2020. All donors were subjected to ABO Rh grouping, Rh and Kell phenotyping by solid phase method. Tube technique was used to distinguish A2/A2B by agglutination reaction with anti-A1 lectin. Results: Total 40,051 donors were analyzed during study period, of which, A and AB groups constituted 21.26% and 9.01% respectively; out of these, only 0.47% belonged to A2 subgroup while A2B subgroup was more frequent (1.06%). The rarest Rh phenotypes found were R1Rz, r”r, r’r” in A2/A2B blood donors. Conclusion: There is a need to create rare donor registry for A2/A2B subgroups and clinically significant blood group antigens and share at various levels. This is a first small step to create a rare donor registry of A2/A2B subgroups with Rh and Kell phenotype, to provide transfusion to A2/A2B patients to prevent adverse transfusion reaction due to immunological stimulation by pre-existing anti-A1 antibodies having enhanced titer and thermal amplitude and to ensure improved quality of transfusion therapy.

The Screening and Identification of Atypical Red Cell Antibodies by Simultaneous LISS/Coombs and NaCl/Enzyme Gel Methods Prior to Blood Transfusion

Background: In this retrospective study, we measured the frequency of unexpected antibodies in the blood by Nacl/enzyme gel method or LISS/Coombs method and compared the result and frequency of identification in patients with a history of gestation or blood transfusion. Aims and Objectives: To detect unexpected/atypical red cell antibodies by simultaneous LISS/Coombs and NacL/enzyme gel methods prior to blood transfusion. Materials and Methods: Atypical antibody screening has done in all patients with the history of recurrent blood transfusion or history of gestation by commercially available red cell panel (ID–Dia panel, Diamed–ID Micro Typing System). Results: A total of 30 patients were screened for the presence of atypical antibody. Out of 30 patients, 1 (3.33%) patient showed the presence of alloantibody in the serum. The alloantibody identified was of anti-Lewis system. Conclusion: Screening for the presence of alloantibodies in patients is important to provide compatible blood and avoid adverse transfusion reactions.

Hipokalcemija novorođenčeta usled transfuzije eritrocita - prikaz slučaja

Introduction: Hypocalcemia in preterm infants could occurs as early or late. Causes of late onset of hypocalcaemia: maternal vitamin D deficiency, metabolic syndromes, congenital abnormalities, iatrogenic (transfusion, bicarbonate therapy, phototherapy, antibiotics). Case report: The authors describe the occurrence of late hypocalcemia following transfusion of erythrocytes to the second newborn from a twin pregnancy born prematurely in the 32/33 week of gestation. Mother is diabetic and has hypertension, edema, hypothyroidism, and preeclampsia during pregnancy. Due to the detected pyelectasis in newborn, prophylactic use of cephalexin was introduced. At the end of the first month of life, anemia appear indicating a transfusion. The infant received 50 ml an O+ leukodepleted RBC transfusion. Immediately after transfusion was completed, there is a short-term deterioration of the general condition. Cyanosis, stiffness, trismus, and bradycardia appear within a few seconds. DAT was negative, bilirubin in the reference range. After transfusion, laboratory, echosonographic examination, neurological examination, EEG and ECG showed normal results. It was concluded that the adverse reaction was probably caused by transfusion. Conclusion: In preterm infants, hypocalcaemia may occur during transfusion due to citrate overload. Children of diabetic mothers, on antibiotic and photo therapy are at higher risk of developing hypocalcemia. Future studies should evaluate incidence rate of adverse transfusion reactions in newborns.

A Study of Frequency and Pattern of Adverse Transfusion Reactions at a Blood Bank in a Tertiary Care Hospital: Towards Hemovigilance

Background: Adequate and safe transfusion facility of blood and its components is necessary as blood transfusions are a part of life saving measures in medical and surgical emergencies. However, transfusion practice could result in non-fatal to fatal adverse transfusion reactions (ATR). Therefore, it is important to identify various adverse reactions so that steps can be taken to minimize such reactions and ensure safer transfusion being carried out.&#x0D; Methods: All ATRs reported to the blood bank from January 2013 to December 2016 were reviewed and analysed. The frequency of ATRs and its association with various component types were assessed.&#x0D; Result: During the study period, a total of 199106 units of blood were issued from the blood bank out of which there was an incidence of 77 (0.12%) transfusion reactions. Chills/rigors was the most common symptom (27.3%) of the symptomatic cases followed by pruritis (23.4%)&#x0D; Majority of the transfusion reaction were non haemolytic, 76 (98.7%) cases. One case was of haemolytic transfusion reaction. Among the non-haemolytic transfusion reactions, febrile non haemolytic transfusion reaction (FNHTR) constituted 28 (36.4%) and allergic reactions constituted 41(53.2%). Other transfusion reactions including hypotensive transfusion reaction (HTR), 1 (1.3%) case and transfusion associated dyspnoea (TAD), 6 (7.8%) cases were also seen. The frequency of ATRs was highest with packed red cells (PC) being 75.3% and least with platelet concentrate (PLTC) being 11.7%.&#x0D; Conclusion: The frequency of ATRs in our blood bank was found to be on a lower scale when compared to that of most of the similar studies. Allergic reactions and FNHTR were the most common ATRs seen, introduction of leukoreduction filters would help reduce FNHTRs.

The immune potential of ex vivo stored platelets: a review.

Platelets are now acknowledged as key regulators of the immune system, as they are capable of mediating inflammation, leucocyte recruitment and activation. This activity is facilitated through platelet activation, which induces significant changes in the surface receptor profile and triggers the release of a range of soluble biological response modifiers (BRMs). In the field of transfusion medicine, the immune function of platelets has gained considerable attention as this may be linked to the development of adverse transfusion reactions. Further, component manufacturing and storage methodologies may impact the immunoregulatory role of platelets, and an understanding of this impact is crucial and should be considered alongside their haemostatic characteristics. This review highlights the key interactions between platelets and traditional immune modulators. Further, the potential impact of current and novel component storage methodologies, such as refrigeration and cryopreservation, on this functional capacity is examined, highlighting why further knowledge in this area would be of benefit.

National blood system: current status and prospects. Organization of transfusion care in a medical institution

Background. Blood safety is a system of measures to organize equal and timely access of citizens to high-quality and safe components of donated blood in the required quantity, their safe and proper use, as well as the safety of donors and patients.&#x0D; Objective. To describe the state and prospects of the development of national blood system.&#x0D; Materials and methods. Analysis of available regulatory documents and literature sources.&#x0D; Results and discussion. In Ukraine, there is a need to create a sustainable self-sufficient national blood system, which could include both the provision of services by medical institutions and the supervision of their provision. This system should be based on voluntary gratuitous donation. It is also necessary to coordinate and standardize such processes as blood procurement, processing, testing for transfusion-transmission infections, determination of blood group and rhesus, storage, distribution, transportation of blood and its components, monitoring of adverse reactions. The hospital transfusion committee (HTC), the hospital blood bank (HBB) and the transfusion immunological laboratory should be the part of the transfusion service of health care facilities. The functions of HTC are to determine the algorithms for the organization of transfusion care, to establish the rules for the appointment of blood and its components, and to assist in education and training of personnel and more. In turn, the functions of HBB include centralized receiving, accounting, storage and dispensing of blood or its components, control of transportation and storage of blood, introduction of alternative therapeutic transfusion methods, control of clinical efficacy assessment, hemovigilance, control of the records and documents of transfusion assistance. It is recommended to allocate four rooms for HBB: for receiving, storage and distributing blood; for collecting and processing applications; for immunohematological examinations and for the staff. Requirements for the provision of blood transfusion services in a health care facility include the organization of the listed above units, inventory management, guidance on the proper use of blood components, quality management, reporting system, and staff training. The blood centre and health care facility must work together to manage blood supplies. When transporting blood, it is extremely important to adhere to the cold chain from the moment the blood is received from the donor to the transfusion of its components to the recipient. Blood and erythrocyte-containing blood components should be stored at 2-6 °C to prevent hemolysis and microbial contamination. Plasma blood components need to be stored frozen (-30 °C), and platelet-containing – in a thermoshaker at a temperature of 20-24 °C. Depending on the type of preparation, plasma, erythrocyte and platelet preparations may have different clinical efficacy. Before transfusion, the doctor must perform a macroscopic assessment of the suitability of the blood product, determine the blood group and rhesus of the recipient, compare the result with the patient’s medical record, determine the blood group and rhesus of the donor, compare the result with plastic container label, perform blood compatibility tests, perform clinical and biological test. Reports on the serious hazards of transfusion (SHOT) indicate that there are adverse transfusion reactions that cannot be prevented, as well as reactions that can be avoided by improving practice and control, and human-related reactions. An important role in the functioning of the blood system is played by hemovigilance. The advantages of hemovigilance are to identify trends in adverse reactions, to reveal the areas for improvement in transfusion medicine, to stimulate research, to raise awareness of risk factors, and to increase the safety of transfusions for patients.&#x0D; Conclusions. 1. In Ukraine there is a need to create a stable self-sufficient national blood system. 2. It is necessary to coordinate and standardize such processes as procurement, processing, testing for transfusion-transmission infections, determination of blood group and rhesus, storage, distribution, transportation of blood and its components, monitoring of adverse reactions. 3. Hemovigilance plays an important role in the functioning of the blood system.

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.

An audit of transfusion reaction monitoring and reporting at a cancer hospital in Pakistan - a step towards haemovigilance.

To monitor the frequencies of different adverse transfusion reactions and to assess the compliance of clinical staff with the process of sending proper transfusion reaction workup within the specified time. The retrospective audit was conducted at the blood bank of Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised all transfusion reaction forms received from July 1, 2017, to June 30, 2018. The forms were analysed for type of blood component, time in which it was received by the blood bank, whether or not the form was completely filled, whether or not all required samples were provided, and the type of reaction. Of the 12,787 units dispensed and transfused, 50(0.39%) transfusion reactions were noted. Allergic was the most frequent type 24(48%). Red cells accounted for 38(76%) of the reactions. In 58(95%) cases, reaction forms were completely filled. Blood bags in 36(59%) and post-transfusion ethylenediaminetetra acetic acid samples in 35(57.3%) cases were received at blood bank within 2 hours of reaction. Incidence of transfusion reactions was found to be low as there was good compliance with procedures on the part of the clinical staff.

Retrospective Analysis of the Efficacy of Solvent/Detergent Treated Pooled Plasma As Compared to Fresh Frozen Plasma in Thrombotic Thrombocytopenic Purpura: A Single Center Experience

Background : Plasma exchange is the primary treatment for acute episodes of Thrombotic Thrombocytopenic Purpura (TTP), a rare condition characterized by the formation of thromboses in small blood vessels, resulting in thrombocytopenia, hemolytic anemia and multi-organ failure. Plasma exchange replacement fluids in TTP include Fresh Frozen Plasma (FFP) and solvent/detergent treated pooled plasma (SDP), such as Octaplas. SDP is a virus-inactivated, pooled human plasma product with standardized plasma protein content, including ADAMTS13, that has been used in the treatment of TTP. This study evaluates the effectiveness of SDP as compared to FFP in the treatment of acute TTP episodes. Study Design and Methods : A retrospective analysis was conducted comparing SDP- to FFP-treated patients with suspected acute TTP episodes as a primary admitting diagnosis between December 2014 and December 2019. A total of 16 patients were included in this study. The FFP group consisted of 9 patients (6M/3F, median age 44 years), three of whom had relapsed TTP. The SDP cohort had 7 patients (2M/5F, median age 38 years), one of whom had relapsed TTP. The primary outcomes measured included reported thromboembolic and major bleeding events. Secondary outcomes included number of plasma exchange procedures, adverse effects including neurological changes, transfusion of other blood products, ICU and hospital length of stay (LOS), and changes in laboratory values. Results : There were no adverse transfusion reactions reported in either group. 12 bleeding events were reported from 6 patients in the FFP group and 8 bleeding events from 4 patients in the SDP group (p=0.397). No significant differences were detected in ICU stay, hospital LOS, number of plasma units transfused, daily percentage of change of laboratory values, or changes in neurological status. Conclusions:These data confirm the previously reported efficacy of SDP for treating suspected/confirmed TTP.There were no significant differences in thromboembolic or bleeding events between patients who received FFP as compared to SDP. The non-significant differences observed in laboratory values throughout the duration of plasma exchange procedures as well as adverse reactions and clinical outcomes between both groups confirm the safety of SDP when used interchangeably with FFP for the treatment of TTP. Table Disclosures Blumberg: CSL Behring: Consultancy. Refaai:CSL Behring: Consultancy; Octapharma: Research Funding; Instrumentation Laboratory: Research Funding; iLine Microsystems: Research Funding; Diagnostica Stago: Consultancy.

Identification of Risk Factors Characteristics of Transfusion Reaction

Blood transfusion is an important part of health care. A blood transfusion can be carried out after careful consideration of its risks and benefits. One of the important considerations for blood transfusion is adverse transfusion reaction. Several risk factors for a transfusion reaction are age, gender, repeated transfusion, disease diagnosis, type of blood component, and blood incompatibility. This research is a descriptive study performed at Blood Bank Dr. Wahidin Sudirohusodo Hospital, Makassar, from January to December 2017. The subjects were all patients reported to have an acute transfusion, totaling 104 subjects. The descriptive method was carried out by the calculation of frequency distribution. From January to December 2017, 104 patients with transfusion reactions were obtained, predominantly were male (53.8%), with the lowest age range of ≥ 60 years (27.9%), packed red cell as the most found blood components (82.4%), a history of previous transfusion reactions (72.1%), and a diagnosis of malignancy (53.9%). The history of repeated transfusions is the most common risk factor compared to age, gender, blood component, and patient diagnosis.

The use of whole blood in traumatic bleeding: a systematic review.

Hemostatic resuscitation is currently considered a standard of care for the management of life-threatening hemorrhage, but in some critical settings the access to high quantities of blood components is problematic. Whole blood (WB) transfusion has been proposed as an alternative modality for hemostatic resuscitation of traumatic major bleeding. To assess the efficacy and safety of WB in trauma-associated massive bleeding, we performed a systematic review of the literature. We selected studies comparing WB transfusions to transfusion of blood components (COMP) in massive trauma bleeding; both randomized clinical trial (RCT) and observational studies were considered. The outcomes were mortality (30-day/in-hospital and 24-h mortality) and adverse events/transfusion reactions. The effect sizes were crude odds ratio (OR), adjusted OR and hazard ratio (HR). The methodological quality of studies was assessed using the Cochrane Risk of Bias tool for RCTs, and the ROBIN-1 tool for observational studies. The overall quality of the available evidence was assessed with the GRADE system. One RCT (2 reports) and 6 cohort studies were included (3642 adult patients; 675 receiving WB, 2967 receiving COMP). Three studies were conducted in military setting, and 4 in civilian setting. In the overall analysis, 30-day/in-hospital and 24-h mortality did not differ significantly between groups (very low quality of the evidence due to high risk of bias, imprecision and inconsistency). After adjustment for baseline covariates in three cohort studies, the OR for mortality was significantly lower in WB recipients compared to COMP (OR 0.22; 95% CIs 0.10/0.45) (moderate grade of evidence). Adverse events and transfusion reactions were overlooked and not consistently reported. The available evidence does not allow to draw definite conclusions on the short-term and long-term efficacy and safety of WB transfusion compared to COMP transfusion. Further well designed research is needed.

Analysis of Patterns of Adverse Transfusion Reactions and Management: A Novel Initiative toward Hemovigilance in a Teaching Hospital of South India.

Objective Blood transfusion being a major lifesaving frontline procedure in majority of clinical wards, has a high potential with risk for adverse events ranging in severity, thus warranting optimal usage of blood. Continuous monitoring of adverse transfusion reaction (ATR) and analysis of the reactions can promote better comprehension of various contributing risk factors. Hemovigilance being a quality indicator with data system assists in ensuring quality and safe blood transfusion. The present study was designed to analyze the incidence and nature of adverse transfusion-associated events reported to the blood bank from our teaching hospital located in the remote part of South-East Coastal region with emphasis on corrective and preventive actions. Materials and Methods The prospective study included all the ATR reported to our hospital blood bank over a period of 42 months. The transfusion reactions report forms filled by the clinicians were analyzed and the reactions were categorized into patterns. The associated risk factors for the reaction are evaluated with substantial laboratory and clinical parameters in reference to hemovigilance. Results Among 19,800 transfusions, 189 transfusion reactions were encountered with a ratio of 10:0.9 with age ranging from 12 to 80, with female preponderance. Reactions associated with whole blood (WB) transfusion were common (50%, p = 0.002) followed by packed red blood cells transfusion (PRBC) (1.4%, p = 0.006) and platelets (0.8%, p = 0.1). Febrile nonhemolytic transfusion reactions were predominant patterns noted in 122 cases followed by allergic reactions in 43 cases with more commonly associated PRBC transfusion whereas hemolytic reactions showed association with WB transfusion. No delayed reactions or mortalities were encountered. Conclusion The present study concludes with novelty showing the overall incidence of transfusion-associated reactions in the study domain is slightly higher than more advanced centers in India owing to lack of leukodepletion units which could enable to substantially retard the incidence of adverse events of transfusion as a general measure and febrile reactions in particular. Hemovigilance and pattern analysis of ATR provide scope for corrective and preventive action and give referral guidelines to prevent future recurrence.