Allergic Transfusion Reactions Research Articles

The impact of apheresis platelet manipulation on corrected count increment

Concentrating and washing apheresis platelets (APs) substantially reduce the number of allergic transfusion reactions likely due to removal of plasma. However, these processes may damage platelets (PLTs). This study evaluated whether concentrating or washing APs decrease the corrected count increment (CCI). This retrospective study evaluated individuals who initially received unmanipulated APs and subsequently received concentrated and/or washed APs at a large university hospital between 1998 and 2009. Concentrated units were prepared by reducing the plasma volume of APs by a goal of more than 67%. Washed units were prepared by washing the APs with 1 L of normal saline. The CCI (PLTs [×10(6)] × m(2)/L) for all transfusions was calculated. Hypothesis testing was performed with t tests for continuous variables and chi-square tests for dichotomous variables. We evaluated 121 individuals: 46 patients who received unmanipulated, concentrated, and then washed APs; 59 patients who received unmanipulated and then concentrated APs; and 16 patients who received unmanipulated and then washed APs. Patient demographics were similar among the three groups. The mean CCI for unmanipulated AP transfusions at 0 to 2 hours posttransfusion was significantly higher than concentrated and washed PLT transfusions (p<0.001). When accounting for PLT loss due to manipulation, concentrating APs did not impact the CCI. However, the CCI remained significantly lower for washed products at all time points after transfusion (40.7% mean reduction at 20-24 hr, p<0.001). Washing APs significantly reduces PLT count recovery and survival, as demonstrated by a significantly reduced CCI.

Providing ABO‐identical platelets and cryoprecipitate to (almost) all patients: approach, logistics, and associated decreases in transfusion reaction and red blood cell alloimmunization incidence

There are multiple benefits to transfusing only ABO-identical blood components. Historically our institution routinely transfused ABO-nonidentical platelets (PLTs) and cryoprecipitate to surgical patients. In April 2005, we implemented a policy of transfusing only ABO-identical components whenever feasible, regardless of outdating or logistic considerations. Technical staff closely monitored product usage and adjusted blood center orders based on recent utilization and planned transfusions. When unable to provide ABO-identical PLTs, ABO-compatible PLTs were washed to remove incompatible plasma. Data on outdating were collected for 18 months before and after implementation. We compared transfusion reaction and red blood cell (RBC) alloimmunization incidence for 4 years preceding (2001-2004) and subsequent (2006-2009) to implementation. In the year after implementation, only 11 of 410 surgical patients received ABO-nonidentical PLTs (2.7%). There was a 5.6% increase in outdating of PLTs. Transfusing ABO-identical components was associated with significant reductions in febrile (-46%; 8.0 to 4.3 per 10,000 components; p < 0.0001) and allergic transfusion reactions (-23%; from 7.0 to 5.4 per 10,000 components; p = 0.025). A progressive reduction in de novo RBC alloimmunization incidence also occurred (-50% by 2009; p = 0.03). Providing ABO-identical PLTs to almost all patients was feasible in our setting by changing ordering and inventorying procedures and making the ABO-identical policy a staff priority. Unexpected and striking reductions in febrile and allergic reactions and RBC alloimmunization were observed, of uncertain causal relationship to this ABO policy change, which will require further study.

Allergic agonists in apheresis platelet products are associated with allergic transfusion reactions

The mechanisms that underlie allergic transfusion reactions (ATRs) are not well characterized, but likely involve recipient, donor, and product factors. To assess product factors associated with ATRs, we investigated candidate mediators in apheresis platelet (PLT) products associated with ATRs and controls. Using bead-based and standard enzyme-linked immunosorbent assays, we tested supernatants from 20 consecutive apheresis PLT transfusions associated with ATRs and 30 control products for concentrations of mediators in three categories: acute inflammatory mediators, direct agonists of basophils and mast cells, and growth and/or priming factors of basophils and mast cells. Median concentrations of the direct allergic agonists C5a, brain-derived neurotrophic factor (BDNF), and CCL5 (RANTES) were 16.6, 41.8, and 13.9% higher, respectively, in the supernatant of apheresis PLT products that were most strongly associated with ATRs (p < 0.05 for each mediator). Other direct agonists (macrophage inflammatory protein-1α, monocyte chemotactic protein-1, eotaxin-1, interleukin-8) were similar between groups. Concentrations of acute inflammatory mediators and basophil growth and/or priming factors were also similar between groups (p > 0.2 for all associations). The allergic agonists C5a, BDNF, and CCL5 may be mediators of ATRs in apheresis PLT products. Acute inflammatory proteins and basophil and/or mast cell growth and priming factors do not appear to be associated with apheresis PLT products that cause ATRs.

Atopic predisposition of recipients in allergic transfusion reactions to apheresis platelets

The biologic mechanisms of allergic transfusion reactions (ATRs) are largely unknown. We sought to compare the atopic predisposition of platelet (PLT) recipients who experienced an ATR to nonreactive control recipients. We identified 37 consecutive apheresis PLT recipients who experienced an ATR and 26 matched controls. Total immunoglobulin (Ig)E and aero- and food allergen-specific IgE were quantified in plasma by a blood test for allergies (ImmunoCAP: Phadiatop and Fx5). IgE testing of apheresis PLT supernatants was also performed. Pruritus and urticaria were manifest in 91.9 and 83.8% of all ATRs, with more severe respiratory symptoms and angioedema occurring in less than 15% of cases. No subject had anaphylaxis. Sex, age, and primary diagnosis were balanced between the two groups. Total and aeroallergen-specific IgE was higher among subjects experiencing an ATR in comparison to control subjects (median total IgE, 55.5 kU/L vs. 8.3 kU/L, p = 0.002; and median aeroallergen-specific IgE, 0.57 kUa/L vs. 0.36 kUa/L, p = 0.046). IgE antibody levels in apheresis products associated with ATRs were similar to control products (p > 0.1 for all IgE tests). Recipient atopic predisposition, as defined by IgE sensitization, is a risk factor associated with ATRs.

Allergic transfusion reactions to platelets are associated more with recipient and donor factors than with product attributes

Mechanisms of allergic transfusion reactions (ATRs) are not well understood. The aim of this study was to distinguish recipient-, donor-, and product-specific factors associated with ATRs. We conducted a retrospective cohort study of apheresis platelet (AP) products transfused from April 2000 through March 2010. The concordance rate of ATRs when split AP products were transfused to at least two individuals was compared to the overall ATR rate among all AP products. Per-person ATR rates also were compared to the overall ATR rate. We observed 1616 ATRs among 93,737 transfusions, for an overall incidence of 1.72% (95% confidence interval [CI], 1.64%-1.81%). Of the 1616 ATRs, 630 occurred when split AP products were transfused to at least two recipients. Of these 630 AP products, ATRs were observed in at least two different recipients of the same AP collection only 6 of 630 times, for a concordant incidence of 0.95% (95% CI, 0.35%-2.06%), which is similar to the overall ATR rate (p = 0.17). On an individual level, 30.0% of recipients had ATR rates of more than 5%, and these 30.0% accounted for 62.1% of ATRs. Donors of AP products associated with concordant ATRs donated AP products that had an ATR rate of 5.8% (95% CI, 3.1%-9.7%), which is higher than the overall ATR rate (p < 0.001). An observed ATR does not predict an ATR in a different recipient of a split AP product. A minority of platelet recipients accounts for the majority of ATRs. Some donors are strongly associated with ATRs. Consequently, recipient and donor factors are implicated in the mechanism of ATRs.

Prevention of allergic transfusion reactions to platelets and red blood cells through plasma reduction

The incidence of allergic transfusion reactions (ATRs) ranges from 1% to 3% of all transfusions, and they are difficult to prevent. This study evaluated whether removing plasma from apheresis platelets (APs) or red blood cells (RBCs) by concentrating or washing transfusion products can decrease the incidence of ATRs. A retrospective cohort study of 179 individuals who received unmanipulated and subsequently concentrated and/or washed APs was conducted. Poisson regression with generalized estimating equations was used to estimate the incident rate ratios and 95% confidence intervals (CIs) of ATRs. The incidence of ATRs to unmanipulated APs was 5.5% (306 ATRs/5575 AP units). The incidence decreased to 1.7% (135 ATRs/4327 AP units) when individuals received concentrated APs (73% reduction; 95% CI, 65%-79%) and 0.5% (21 ATRs/4082 AP units) when individuals received washed APs (95% reduction; 95% CI, 91%-97%). Of the 39 individuals who received unmanipulated RBCs and subsequently washed RBCs, the incidence of ATRs decreased from 2.7% (33 ATRs/1236 RBC units) to 0.3% (2 ATRs/733 RBC units; 89.4% reduction; 95% CI, 55.5%-97.5%). The median number of AP transfusions to first ATR was six (interquartile range [IQR], 2-19) for unmanipulated APs and increased to 13 (IQR, 4-32) for concentrated APs and 40 (IQR, 29-73.5) for washed APs. Concentrating APs and washing APs and RBCs substantially reduces ATRs, suggesting that the plasma component of APs and RBCs has an essential role in the etiology of ATRs.

A comparison of washed and volume‐reduced platelets with respect to platelet activation, aggregation, and plasma protein removal

Washed or volume-reduced platelets (PLTs) are occasionally requested for patients with a history of allergic or anaphylactic transfusion reactions. However, conclusive data are not available as to which method is more suitable. A direct comparison of saline-washed and volume-reduced PLTs was performed by splitting 11 units of 6-day-old apheresis PLT units. PLT activation, aggregation, plasma protein, and PLT count were determined before and after each procedure. To assess whether washing using neutral, calcium-free Ringer's acetate (NRA) would better preserve PLT function, 8 additional units of apheresis PLTs were split and were washed in saline or NRA. Saline washing resulted in significantly increased number of activated, P-selectin-expressing PLTs compared to volume reduction (24.2% vs. 10.3%, p = 0.001). Aggregation was also significantly reduced (-40.6% vs. -0.8%, p = 0.004). Plasma protein removal was significantly better for saline-washed than volume-reduced PLTs (96% vs. 51.1%, p < 0.001). PLT recovery was not significantly different for saline-washed versus volume-reduced PLTs (70.5% vs. 80.7%, p = 0.079). There was no difference between washing in saline or NRA with regard to PLT activation and loss of aggregation. PLT washing with saline or NRA significantly increases PLT activation and decreases PLT aggregability. On the other hand, volume reduction does not adequately remove plasma proteins. Therefore, PLT washing should be reserved for patients with a history of severe allergic or anaphylactic transfusion reactions. We suggest that fresher PLTs be selected to improve the functionality of washed PLTs.

Transfusion premedication to prevent acute transfusion reactions: a retrospective observational study to assess current practices

The use of premedication to prevent acute transfusion reactions has been estimated to occur in 50% to 80% of transfusions. While this practice has some biologic rationale, few clinical studies have been performed to assess the efficacy of this practice, and the methodologic quality of these studies is variable. The primary objective of this study was to describe current practices regarding transfusion premedication to prevent febrile nonhemolytic transfusion reactions, mild allergic transfusion reactions, and transfusion-associated circulatory overload. We conducted an observational retrospective chart review of a stratified random sample of 324 transfusions that took place over a 6-month period. Data were abstracted from medical records and then scanned into a database for analysis. We calculated inter- and intraobserver agreement on key abstracted data to estimate assessment error. A two-phase adjudication process was used to determine whether or not medications given before the time of each transfusion were intended as premedications. Of the transfusions sampled, 1.6% (95% confidence interval, 0.4-3.9) were associated with premedication medications to prevent an acute transfusion reaction. Inter- and intraobserver reliability in the abstraction of key data points was good. Good agreement in adjudicator classification of outcomes was achieved only when adjudicators were provided with patient source documents. Premedication use was infrequent and much less common than previously reported. Improved methods of capturing transfusion premedication, which likely require prospective assessments, are needed for future research studies.

Allergic transfusion reactions from blood components donated by IgA‐deficient donors with and without anti‐IgA: a comparative retrospective study

IgA deficiency is common (1/500) and up to 40% of affected individuals will develop anti-IgA. A few studies suggested that passive transfusion of anti-IgA was not associated with an increased risk of allergic reactions. This study was designed to assess the safety of transfusing blood components containing anti-IgA. IgA-deficient blood donors with and without anti-IgA were identified from Héma-Québec's (HQ) computerized database. IgA deficiency was confirmed by an ELISA method and the presence of anti-IgA by a passive hemagglutination assay. Blood donations from IgA-deficient donors issued to hospitals between March 1999 and December 2004 were retrieved. Medical charts of recipients were reviewed for the occurrence of a suspected transfusion reaction. Presence and nature of transfusion reactions were assessed blindly by an adjudicating committee. A total of 323 IgA-deficient blood products were issued by HQ to 55 hospitals. Of these, 48 agreed to participate [315 blood products (97.5%)]. A total of 272 products were transfused: 174 contained anti-IgA, and 98 did not. Only two minor allergic reactions occurred in each group. Incidence of allergic reactions was 1.15% in the anti-IgA group and 2.04% in the group without anti-IgA (P = 0.91). There was no anaphylactic reaction in either group. This study indicates that the proportion of allergic reactions does not appear to be greater in recipients of blood components containing anti-IgA compared to recipients of non-anti-IgA-containing components. Allowing donations from IgA-deficient donors with anti-IgA may therefore be contemplated.

Pharmacological interventions for the prevention of allergic and febrile non-haemolytic transfusion reactions

Allergic and febrile non-haemolytic transfusion reactions (NHTRs) are the two most common forms of transfusion reaction. Pretransfusion medication with anti-inflammatory drugs is used in NHTR prevention, however its efficacy and safety remains unclear. To assess the clinical effects and safety of pharmacological interventions for preventing NHTR in patients with and without a history of transfusion reactions. The search strategy included The Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (Issue 4, 2008), Cochrane Injuries Group's Specialised Register (December 17, 2008), MEDLINE (1950 to November (week 3) 2008), EMBASE (1988 to November (week 3) 2008), LILACS (1982 to January 12, 2009), CINAHL (1982 to December 2008), ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED): 1970 to December 2008). There was no language restriction. Randomised controlled trials (RCTs) assessing the effectiveness of interventions for the prevention of NHTR. Authors independently selected studies, assessed the risks of bias and extracted data. Relative risks (RR) were estimated in RCTs with parallel design (PD). Odds ratio (OR) was estimated for one RCT with crossover design (CD). No meta-analysis was attempted due to differences in the pharmacotherapy of pre-transfusion medication and methodology between the studies; a per-protocol analysis was used. This review includes three RCTs (two PD and one CD). The PD-RCTs employed disparate units of randomisation (UofR); patient or transfusion, while the CD-RCT applied the patient as the UofR. The PD-RCTs administered leukodepleted blood products. Both PD-RCTs compared acetaminophen plus diphenhydramine (ApD) at different regimens with placebo, while the CD-RCT contrasted hydrocortisone pharmacotherapy with diphenhydramine. Both PD-RCTs found no statistically significant difference in allergic reactions (RR 0.13, 95% confidence interval (CI) 0.01 to 2.39, RR 1.46, 95% CI 0.78 to 2.73) and febrile reactions (RR 0.52, 95% CI 0.22 to 1.26). The CD-RCT found a statistically significant difference in the odds of febrile reactions (OR 2.38, 95% CI 1.07 to 5.27). The trials did not report anaphylactic reactions, deaths related to transfusion reactions or other adverse events. None of the three studies found that medication prior to transfusion reduces NHTR. This applied regardless of the patient's history of NHTR and the use of leukodepleted blood products in the transfusion. However, this conclusion is based on three trials of moderate to low quality. A better-powered RCT is necessary to evaluate the role of pretransfusion medication in the prevention of NHTR. Inclusion criteria should be restricted to patients at high risk of developing NHTR, with no restriction by age, history of transfusion reactions and type of blood products (leukodepleted or not).

Bewertung der Maßnahmen zur Reduktion schwerwiegender Transfusionsreaktionen (Hämovigilanzdaten von 1997 bis 2008)

On the basis of reports of serious transfusion reactions, measures aimed to improve the safety standard of the manufacturing process of blood components were evaluated from 1997-2008. Measures of the Paul-Ehrlich-Institut (PEI) as well as recommendations of the Advisory Committee "Blood" were considered. Reporting frequencies before and after the implementation of measures were compared. After the implementation of NAT pool testing, a reduction of virus transmission was seen for red blood cell concentrates (RBC) from 1.0/10(6) to 0.5/10(6) units and for platelet concentrates (PC) from 3.0/10(6) to 0.0/10(6) units. After the implementation of a pre-donation sampling, however, no reduction of bacterial infections associated with PC administration (>9.0/10(6)) was identified. To reduce the frequency of TRALI associated with FFP administration (11.2/10(6) units), the use of plasma from male donors or female donors without a history of pregnancy was established in September 2009. Without specific measures of risk reduction, the reporting frequency of severe allergic transfusion reaction increased for all blood components during the investigation period (from 0.8/10(6) to 6.2/10(6) RBC units). The benefit of measures to improve safety standards should be evaluated repeatedly by collecting precise hemovigilance data.

Clinical Analysis of 159 Times Acute Transfusion Reaction in Single Center.

Abstract 4196 ObjectiveRetrospective analysis of acute transfusion reactions occurred in our hospital in recent years. MethodsInvestigate all hospitalized patients who transfused various blood components from November 2006 to July 2009. ResultsDuring study period, there were 27,672 times transfusion with 80,112 units various blood components, mainly red blood cells(RBCs), frozen plasma(FP) and leukocyte-depleted platelets(PLTs). Acute transfusion reactions occured in 143 patients of 159 times transfusion, including febrile nonhemolytic transfusion reactions(FNHTR), allergic transfusion reactions(ATR), transfusion-related acute lung injury(TRALI), transfusion-associated circulatory overload(TACO) and hemorrhagic tendency. The 143 enrolled patients, 87male and 56female, were between the age of 16 and 94. The incidence rate of acute transfusion reaction was 0.57%, FNHTR and ATR accounted for 96.23%. Of all blood components, the incidence rates of acute reaction were 0.35%, 0.50% and 1.82% respectively in RBCs, FP and PLTs transfusions. In 159 times of acute transfusion reactions, the constituent ratios of 0∼3 times and more than 3 times transfusion were 23.27%, 18.87%, 7.55%, 4.40% and 45.91%, respectively. ConclusionMost of acute transfusion reactions were FNHTR and ATR. The highest incidence rate was in platelets transfusion, and the most constituent ratio was in patients who have received more than 3 times transfusion. Disclosures:No relevant conflicts of interest to declare.

Application of the basophil activation test in the analysis of allergic transfusion reactions

Transfusion MedicineVolume 19, Issue 5 p. 274-277 Application of the basophil activation test in the analysis of allergic transfusion reactions N. Matsuyama, N. Matsuyama Japanese Red Cross Osaka Blood Center, 2-4-43, Morinomiya, Joto-ku, Osaka, 536-8505 JapanSearch for more papers by this authorF. Hirayama, Corresponding Author F. Hirayama Japanese Red Cross Osaka Blood Center, 2-4-43, Morinomiya, Joto-ku, Osaka, 536-8505 JapanFumiya Hirayama MD, Ph.D., Japanese Red Cross Osaka Blood Center, 2-4-43, Morinomiya, Joto-ku, Osaka, 536-8505 Japan.Tel.: +81-6-6962-7066; fax: +81-6-6962-7029;e-mail: hirayama@osaka.bc.jrc.or.jpSearch for more papers by this authorS. Wakamoto, S. Wakamoto Japanese Red Cross Hokkaido Blood Center, 2-2, Yamanote, Nishi-ku, Sapporo, 063-0002 JapanSearch for more papers by this authorK. Yasui, K. Yasui Japanese Red Cross Osaka Blood Center, 2-4-43, Morinomiya, Joto-ku, Osaka, 536-8505 JapanSearch for more papers by this authorR. A. Furuta, R. A. Furuta Japanese Red Cross Osaka Blood Center, 2-4-43, Morinomiya, Joto-ku, Osaka, 536-8505 JapanSearch for more papers by this authorT. Kimura, T. Kimura Japanese Red Cross Osaka Blood Center, 2-4-43, Morinomiya, Joto-ku, Osaka, 536-8505 JapanSearch for more papers by this authorA. Taniue, A. Taniue Japanese Red Cross Osaka Blood Center, 2-4-43, Morinomiya, Joto-ku, Osaka, 536-8505 JapanSearch for more papers by this authorY. Fukumori, Y. Fukumori Japanese Red Cross Osaka Blood Center, 2-4-43, Morinomiya, Joto-ku, Osaka, 536-8505 JapanSearch for more papers by this authorM. Fujihara, M. Fujihara Japanese Red Cross Hokkaido Blood Center, 2-2, Yamanote, Nishi-ku, Sapporo, 063-0002 JapanSearch for more papers by this authorH. Azuma, H. Azuma Japanese Red Cross Hokkaido Blood Center, 2-2, Yamanote, Nishi-ku, Sapporo, 063-0002 JapanSearch for more papers by this authorH. Ikeda, H. Ikeda Japanese Red Cross Hokkaido Blood Center, 2-2, Yamanote, Nishi-ku, Sapporo, 063-0002 JapanSearch for more papers by this authorY. Tani, Y. Tani Japanese Red Cross Osaka Blood Center, 2-4-43, Morinomiya, Joto-ku, Osaka, 536-8505 JapanSearch for more papers by this authorH. Shibata, H. Shibata Japanese Red Cross Osaka Blood Center, 2-4-43, Morinomiya, Joto-ku, Osaka, 536-8505 JapanSearch for more papers by this author N. Matsuyama, N. Matsuyama Japanese Red Cross Osaka Blood Center, 2-4-43, Morinomiya, Joto-ku, Osaka, 536-8505 JapanSearch for more papers by this authorF. Hirayama, Corresponding Author F. Hirayama Japanese Red Cross Osaka Blood Center, 2-4-43, Morinomiya, Joto-ku, Osaka, 536-8505 JapanFumiya Hirayama MD, Ph.D., Japanese Red Cross Osaka Blood Center, 2-4-43, Morinomiya, Joto-ku, Osaka, 536-8505 Japan.Tel.: +81-6-6962-7066; fax: +81-6-6962-7029;e-mail: hirayama@osaka.bc.jrc.or.jpSearch for more papers by this authorS. Wakamoto, S. Wakamoto Japanese Red Cross Hokkaido Blood Center, 2-2, Yamanote, Nishi-ku, Sapporo, 063-0002 JapanSearch for more papers by this authorK. Yasui, K. Yasui Japanese Red Cross Osaka Blood Center, 2-4-43, Morinomiya, Joto-ku, Osaka, 536-8505 JapanSearch for more papers by this authorR. A. Furuta, R. A. Furuta Japanese Red Cross Osaka Blood Center, 2-4-43, Morinomiya, Joto-ku, Osaka, 536-8505 JapanSearch for more papers by this authorT. Kimura, T. Kimura Japanese Red Cross Osaka Blood Center, 2-4-43, Morinomiya, Joto-ku, Osaka, 536-8505 JapanSearch for more papers by this authorA. Taniue, A. Taniue Japanese Red Cross Osaka Blood Center, 2-4-43, Morinomiya, Joto-ku, Osaka, 536-8505 JapanSearch for more papers by this authorY. Fukumori, Y. Fukumori Japanese Red Cross Osaka Blood Center, 2-4-43, Morinomiya, Joto-ku, Osaka, 536-8505 JapanSearch for more papers by this authorM. Fujihara, M. Fujihara Japanese Red Cross Hokkaido Blood Center, 2-2, Yamanote, Nishi-ku, Sapporo, 063-0002 JapanSearch for more papers by this authorH. Azuma, H. Azuma Japanese Red Cross Hokkaido Blood Center, 2-2, Yamanote, Nishi-ku, Sapporo, 063-0002 JapanSearch for more papers by this authorH. Ikeda, H. Ikeda Japanese Red Cross Hokkaido Blood Center, 2-2, Yamanote, Nishi-ku, Sapporo, 063-0002 JapanSearch for more papers by this authorY. Tani, Y. Tani Japanese Red Cross Osaka Blood Center, 2-4-43, Morinomiya, Joto-ku, Osaka, 536-8505 JapanSearch for more papers by this authorH. Shibata, H. Shibata Japanese Red Cross Osaka Blood Center, 2-4-43, Morinomiya, Joto-ku, Osaka, 536-8505 JapanSearch for more papers by this author First published: 04 September 2009 https://doi.org/10.1111/j.1365-3148.2009.00939.xCitations: 20Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume19, Issue5October 2009Pages 274-277 RelatedInformation

Allergic transfusion reactions in a tertiary hospital in southwest Nigeria

Allergic transfusion reactions in a tertiary hospital in southwest Nigeria

Analysis of transfusion reactions associated with prestorage‐pooled platelet components

The goal of this study was to assess transfusion reactions arising from prestorage-pooled platelet (PSPP) infusions compared with apheresis single-donor platelets (SDPs) and poststorage-pooled, whole blood-derived random-donor platelets (RDPs). Over a span of 18 months, transfusion reaction records of patients receiving platelet (PLT) infusions were retrospectively reviewed at two academic, tertiary care hospitals. Chi-square analysis was used for statistical comparisons; significance was a p value of less than 0.05. For the two sites, 10,251 prestorage-leukoreduced PLT products were infused including 4731 PSPPs, 3999 SDPs, and 1521 RDPs. Of the total infusions, 0.91% (93/10,251) were associated with a transfusion reaction. The aggregate transfusion reaction rate was 0.89% (42/4731) for PSPPs, 0.75% (30/3999) for SDPs, and 1.38% (21/1521) for RDPs. There were no significant differences in total reaction rate between PSPPs and the other PLT products (p > 0.05). Allergic transfusion reactions were the most common adverse event for PLT products evaluated (63/10,251; 0.61%) and febrile reactions were second most common (27/10,251; 0.26%). There were 2 suspected cases of sepsis (1 associated with PSPP and 1 associated with RDP; both culture negative) and 1 case of volume overload associated with RDP infusion. There were no significant differences in aggregate allergic or febrile reaction rates among the 93 PLT products evaluated (p > 0.05). No reports of transfusion-related acute lung injury or hemolysis were noted. No difference in reactions rates was observed among PSPPs and the other PLT products. The transfusion reactions occurring in this population were not dependent on the type of PLT product infused.

Evaluation of White Blood Cell- and Platelet-Derived Cytokine Accumulation in MIRASOL-PRT-Treated Platelets

Background: Soluble mediators in platelet concentrates (PCs) released from contaminating white blood cells (WBCs) and platelets (PLTs) themselves are supposed to promote allergic and non-hemolytic febrile transfusion reactions in the recipient. Pathogen reduction technologies (PRTs) prevent replication and proliferation of pathogens as well as of WBCs, and may reduce cytokine accumulation in PCs during storage and prevent adverse events after PLT transfusion. On the other hand, such treatments may also lead to increased cytokine production by stimulation of WBCs or PLTs due to the photochemical or photodynamical process itself. Material and Methods: 12 triple-dose PLT apheresis collections were leukoreduced by the process-controlled leukoreduction system of the Trima Accel machine and split into 3 units undergoing Mirasol-PRT treatment (M) or gamma irradiation (X) or remaining untreated (C). During storage for up to 7 days, PLT activation, WBC-derived Th-1/2, and inflammatory as well as PLT-derived cytokines were measured by cytometric bead array and enzymelinked immunosorbent assay, respectively. Results: Independent of treatment, all PLT products exhibited low levels of WBC-associated cytokines near or below assay detection limits. WBC-associated cytokines were not elevated by Mirasol-PRT treatment. PLT-derived cytokines were detected at higher levels and increased significantly during storage in all units. Most likely due to higher PLT activation, M units showed significantly higher levels of PLT-derived cytokines compared to untreated and gamma-irradiated units on day 5 of storage. Conclusion: In all PCs, PLTs themselves were the main source of cytokine release. Mirasol-PRT treatment was associated with a significantly increased PLT activation and accumulation of PLT-derived cytokines during storage, without affecting WBC-derived cytokines relative to controls.

Prevention of febrile nonhemolytic and allergic transfusion reactions with pretransfusion medication: is this evidence‐based medicine?

Prevention of febrile nonhemolytic and allergic transfusion reactions with pretransfusion medication: is this evidence‐based medicine?

A prospective, randomized, double‐blind controlled trial of acetaminophen and diphenhydramine pretransfusion medication versus placebo for the prevention of transfusion reactions

Acetaminophen and diphenhydramine are commonly used as pretransfusion medications to prevent transfusion reactions. The purpose of this study was to prospectively compare the risk of transfusion reactions in hematology/oncology patients who receive acetaminophen with diphenhydramine or placebo before transfusion. A randomized, double-blind, placebo-controlled transfusion reaction study of 315 eligible patients was performed. Inclusion criteria were patients aged 18 to 65 years admitted to the leukemia or bone marrow transplant (BMT) services. Patients were excluded if they had a known allergy to either acetaminophen or diphenhydramine or had a documented history of a febrile or allergic transfusion reaction. All blood products were administered using a leukofilter. Study medications were given 30 minutes before transfusions and no other acetaminophen or diphenhydramine was given within 4 hours of administration of the study medications. Patients were monitored for the development of reaction symptoms within 4 hours after the transfusion. A total of 154 active drug patients were compared to 161 placebo patients. There was no significant difference in the overall risk of transfusion reactions between the two groups. However, analysis of specific reaction types revealed a significant decrease in the risk of febrile reactions when pretransfusion medication is used in addition to bedside leukoreduction. Pretransfusion medication of leukemia or BMT patients without a history of transfusion reaction does not decrease the overall risk of transfusion reactions. However, pretransfusion medication may decrease the risk of febrile nonhemolytic transfusion reactions to leukoreduced blood products.

L’introduction de solutions de conservation dans les concentrés plaquettaires : vers une diminution des réactions transfusionnelles

Platelet concentrates (PC) are used in thrombocytopenia for curative or preventive treatment for hemorrhagic risk. Since five years, additive solutions have been added in PCs for several reasons; one of them is to present an interest in the intolerance in plasma reactions. The literature data have shown that these solutions entail fewer allergic reactions than PCs kept in plasma. This study was reviewed on three years of transfusion in France. The main objective of this study was to see if there was a difference in frequency when these PCs were in solution or not. All adverse reactions in recipients (ARR) occurring among PCs recipients (with and without additive solution) were analysed. The categories of ARR specifically studied were: allergies, febril non haemolytic reactions (FNHR) and the category “unknown”. This study shows that there is significantly lower incidence of allergies by introducing solution. For all ARRs, there is also a decrease in their frequency when PCs are in additive solution, it is significant except for the apheresis platelet concentrates. For categories FNHR and “unknown”, the results are opposed and/or not significant. This study confirms that introduction of additive solutions in PCs is able to reduce some allergic transfusion reactions.

Blood transfusion practices in Orthopaedic and Trauma Department in a tertiary health institution in Nigeria: a two year retrospective review

Aim: The aim of this study is to review blood and blood products use in the Orthopaedics and Trauma department of Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife. Subjects and methods: Records of patients seen at the Orthopaedic and Trauma Unit of the OAUTHC, Ile-Ife, between July 2004 and June 2006, were retrospectively studied. Clinical and laboratory parameters extracted from their case files included age, gender, diagnosis, blood group, indication for transfusion and number of units received, and complications, if any. Results: A total of 85 patients were managed during the study period. Their ages ranged between 1.5 and 94 years with a median of 30 years. There were 52 males and 33 females with a M: F ratio of 1.6:1. All the patients had allogeneic whole or packed red cells. No patient received autologous blood, and none received platelet concentrate, fresh frozen plasma or any other blood products. Forty-eight of the eighty-five patients (56.5%) were blood group O Rhesus D positive. Major indications for blood transfusion included traumatic fractures (39/85 or 45.9%), osteomyelitis (13/85 or 15.3%), gangrene (11/85 or 12.9%), malunion and non-union (13/85 or 15.3%). The highest numbers of transfusion were seen in multiply injured patients, extremity gangrene, gunshot injuries and sarcomas. Mild febrile and allergic blood transfusion reactions were encountered in 6 (7.1%) of our patients. Conclusion: Fractures and its complications were the most common indications for blood transfusion in orthopaedics and trauma patients in our hospital. Keywords: Blood transfusion, Indications, Orthopaedics, Trauma.Nigerian Journal of Orthopaedics and Trauma Vol. 6 (2) 2007: pp. 55-57