Febrile Nonhemolytic Reactions Research Articles

A Survey of Acute Transfusion Reactions in Thalassemic Patients in Pakistan: A Single Centre Experience

Background: Blood transfusion reactions are characterized as adverse reactions linked to whole blood or any of its constituent parts, encompassing a spectrum of severity levels, from minor to potentially life-threatening. The administration of blood products is a common practice to enhance the hemodynamic status and overall clinical well-being of patients. However, it's important to note that transfusing blood components comes with potential complications, both infectious and non-infectious in nature. Objective: The current study aim to evaluate the type and frequency of transfusion reactions in thalassemic patients at Hamza Foundation Welfare Hospital and Blood Services, Peshawar. Method: The current study was a descriptive cross-sectional study. The data was collected from 152 participants through a self-generated questionnaire during the 4 months (from April to July 2022) study period. Results: The overall frequency of febrile non-hemolytic reactions (FNHTR), allergic transfusion reactions (ATR), and acute hemolytic transfusion reactions (AHTR) was 84%. Among the 152 participants, 91 (59.8%) were males, and 61 (40.2%) were females. Of the total males, 83 (55.6%) experienced transfusion reactions, while 46 (30%) of the females had transfusion reactions. Specifically, 56 males and 36 females experienced FNHTRs, 22 males and 4 females experienced ATRs, and 5 males and 6 females experienced AHTRs. Fever was observed predominant symptom 69.7% and 52.6% among FNHTR and AHTR, anxiety was predominantly observed in 34.8% in ATRs. Conclusion: Among the transfusion reaction types, FNHTRs emerged as the most common, followed by ATRs and AHTRs. Key words: Febrile Non-Hemolytic Reaction, Allergic Transfusion Reaction, Hemolytic Transfusion Reactions

Incidence of acute transfusion reactions and associated factors among adult blood-transfused patients at Jimma University Medical Center, southwest Ethiopia: A cross-sectional study.

Acute transfusion reaction is mainly related to the infusion of blood or blood products resulting at any time within a day of the intervention. It ranges from a non-specific febrile episode to a life-threatening intravascular hemolysis. The severity of the reaction and the degree of morbidity are usually related to the degree of ABO incompatibility and the volume of blood transfused. Therefore, this study aimed to determine the incidence of acute transfusion reactions and its associated factors in Jimma University Medical Center, southwest Ethiopia. Institution-based cross-sectional study was conducted from 1 October to December 30, 2020. A total of 384 transfused patients were followed in this study. Socio-demographic and clinical data were collected through a structured questionnaire. Baseline measurement and 24-hour periodic vital signs monitoring were conducted after each transfusion. Four milliliters of venous blood were drawn after transfusion intervention from each distrusted patient for complete blood count, blood group phenotype, direct antihuman globulin test (DAT), and crossmatching. Data were entered into Epi data version 3.1 and analyzed using Statistical Package for Social Science software (SPSS) version 20. Descriptive statistics, and bivariable and multivariable logistic regression were employed to test the association between independent and dependent variables. A P value ≤ .05 was considered to indicate statistical significance. Acute transfusion reactions were diagnosed in 5.7% of patients, with most of these reactions were febrile nonhemolytic reactions (63.6%) followed by allergic (36.4%) reactions with mild clinical manifestations (27.3%). Transfusion history, transfused blood that was kept for more than 13 days, abortion history, and number of transfused units (≥3 units of blood/blood component) have 3.3, 3.85, 4.2, and 3.9 times greater odds, respectively, besides their significant association with the incidence of acute transfusion reactions. Patients with a history of previous transfusion, abortion, multi-unit transfusion, and patients transfused with blood stored for ≥14 days should be closely monitored. Starting a hemovigilance system of monitoring, collecting, and evaluating data on adverse effects of blood transfusion locally and nationally will decrease the occurrence of acute transfusion reactions.

Blood transfusion reactions and risk of acute kidney injury and major adverse kidney events

BackgroundBlood transfusion reactions may have a negative impact on organ function. It is unknown whether this association holds true for acute kidney injury (AKI). Therefore, we conducted a cohort study to assess the association between transfusion reactions and the incidence of AKI and major adverse kidney events.MethodsIn this retrospective cohort study, we included patients who received transfusion of blood products during hospitalization at the Hospital Civil of Guadalajara. We analyzed them according to the development of transfusion reactions, and the aim was to assess the association between transfusion reactions and AKI during long-term follow-up.ResultsFrom 2017 to 2021, 81,635 patients received a blood product transfusion, and 516 were included in our study. The most common transfusion was red blood cell packaging (50.4%), fresh frozen plasma (28.7%) and platelets (20.9%); of the 516 patients, 129 (25%) had transfusion reactions. Patients who had transfusion reactions were older and had more comorbidities. The most common type of transfusion reaction was allergic reaction (70.5%), followed by febrile nonhemolytic reaction (11.6%) and anaphylactoid reaction (8.5%). Most cases were considered mild. Acute kidney injury was more prevalent among those who had transfusion reactions (14.7%) than among those who did not (7.8%), p = < 0.01; those with AKI had a higher frequency of diabetes, vasopressors, and insulin use. Transfusion reactions were independently associated with the development of AKI (RR 2.1, p = < 0.02). Major adverse kidney events were more common in those with transfusion reactions. The mortality rate was similar between subgroups.ConclusionIn our retrospective cohort of patients who received blood product transfusions, 25% experienced transfusion reactions, and this event was associated with a twofold increase in the probability of developing AKI and some of the major adverse kidney events during long follow-up.Graphical abstract

Prevalence of Acute Complications of Transfusion in Children with β-thalassemia Major in Southeast Iran: A Prospective Study

Background: Acute complications of transfusion are among the leading causes of morbidity and mortality in chronically transfused patients. One of the main goals of blood transfusion is to reduce complications and improve blood safety and patient health care worldwide. The present study aimed to investigate the prevalence of acute complications of transfusion beta-thalassemia major (TM) patients in Southeast Iran. Methods: In a prospective study, 23882 transfusions were evaluated in TM patients of a thalassemia clinic for acute reactions during a two-year period. Data were collected by forms to record the information related to blood transfusion at the time of reaction occurrence. Results: The assessment of the data revealed that 228 TM patients (0.95%) had acute complications of transfusion. Among 23882 TM patients undergoing transfusion, 211 (0.87%) developed allergic reactions, 11 (0.04%) were diagnosed with febrile non-hemolytic reaction, and one patient (0.004%) had experienced acute hemolytic transfusion reaction. Conclusion: The results of the current study support preventive measures for the reduction of these complications to improve patients’ health. Acute complications occurred may be due to insufficient ability to perform blood bank tests, lack of standard operating instructions, and lack of necessary monitoring during the transfusion process. The best way to reduce the risk of blood transfusion reactions is to provide special care to the patients during the first 24 hours after transfusion. Creating a consistent and continuous education system with standard operating instructions and establishing an error reporting system leads to improve knowledge about transfusion guidelines and best practices.

Blood Transfusion Reactions and Institutional Hemovigilance Protocols

Background: Blood transfusion reactions contribute significantly to the morbidity and mortality of both in- and outpatients in hospitals globally. Developing adequate protocols for detecting and reporting this complication is key to attaining global blood transfusion safety. Objective: The objective of the study was to review the frequency of blood transfusion reactions and the adequacy of institutional hemovigilance efforts in a Nigerian hospital. Materials and Methods: Records of patients that had blood transfusion reactions (cases) and those that did not (controls) were analyzed over a 2-year period. Sociodemographic information, transfusion and admission histories, primary diagnoses, as well as transfusion reaction details (where applicable) were recorded. Data were analyzed using STATA 16.1 (StataCorp. 2019, Stata Statistical Software: Release 16, College Station, TX: StataCorp LLC). Sociodemographic characteristics were presented in frequency tables and charts, whereas relationships between study variables were compared using the Chi-square and the Person Correlation. P value less than 0.05 was considered to be statistically significant (confidence level = 95%). Results: One death was recorded among the cases during the study, whereas febrile nonhemolytic reactions constituted the most type of reaction (41.5%). Only 37.5% of reactions were investigated, and none was reported to the hospital blood transfusion/hemovigilance committee. There was no significant association between the study-related variables and the type of reaction or the likelihood of experiencing a new reaction with subsequent transfusions (P values all &gt; 0.05). Conclusion: Febrile reactions are the commonest complication of blood transfusion in our data set; institutional hemovigilance efforts remain suboptimal and should be further strengthened.

Platelet transfusion in adults: An update.

Many patients worldwide receive platelet components (PCs) through the transfusion of diverse types of blood components. PC transfusions are essential for the treatment of central thrombocytopenia of diverse causes, and such treatment is beneficial in patients at risk of severe bleeding. PC transfusions account for almost 10% of all the blood components supplied by blood services, but they are associated with about 3.25 times as many severe reactions (attributable to transfusion) than red blood cell transfusions after stringent in-process leukoreduction to less than 106 residual cells per blood component. PCs are not homogeneous, due to the considerable differences between donors. Furthermore, the modes of PC collection and preparation, the safety precautions taken to limit either the most common (allergic-type reactions and febrile non-hemolytic reactions) or the most severe (bacterial contamination, pulmonary lesions) adverse reactions, and storage and conservation methods can all result in so-called PC "storage lesions". Some storage lesions affect PC quality, with implications for patient outcome. Good transfusion practices should result in higher levels of platelet recovery and efficacy, and lower complication rates. These practices include a matching of tissue ABH antigens whenever possible, and of platelet HLA (and, to a lesser extent, HPA) antigens in immunization situations. This review provides an overview of all the available information relating to platelet transfusion, from donor and donation to bedside transfusion, and considers the impact of the measures applied to increase transfusion efficacy while improving safety and preventing transfusion inefficacy and refractoriness. It also considers alternatives to platelet component (PC) transfusion.

Implementation of technical supervision of the public blood management agencies of Federal District and its effects on hemovigilance activities

Objective: To analyze the impact of the implementation of technical supervision in the Transfusion Agencies (TAs) of the public blood network hospitals of Federal District (DF) on hemovigilance activities, from 2009 to 2019. Methods: Retrospective descriptive cross-sectional study with a quantitative approach. Two secondary databases were used: one with information on Transfusion Reactions (TRs) registered in the System of Notifications in Health Surveillance (Notivisa) and another with information on the number of transfusions performed, reported in the Hemotherapy Production Information System (Hemoprod). The information from each TA was separated into two periods: “without a supervisor” and “with a supervisor”. Results: 1,096 TRs were reported and 574,708 transfusions were performed. Considering only confirmed, probable and possible TRs, the number of TRs increased to 981, of which 85.43% were immediate, Allergic (37.92%) and Febrile non-hemolytic reaction (33.74%). More than 80% were mild, however, 2 deaths were attributed to transfusion (0.21%). They occurred predominantly in women (56.27%) and between 25 and 35 years (16.50%). The Transfusion Outpatient (22.43%) was the hospital sector with the highest occurrence of TRs, with Concentrated Red Blood Cells being the blood component most involved in these records (68.40%). In the “no supervisor” period, the notification rate was 0.220 and the underreporting was 92.666%, using the French parameter for comparison (3 TRs/1,000 transfusions). In the “with supervisor” period, the notification rate was 2.297 and the underreporting was 23.417%, showing that the inclusion of supervisors had an impact on the hemovigilance scenario in the TAs of the hospitals in the public blood network of the DF, reducing underreporting by 74.78%.

Solving problems in Blood transfusion with efficient technology

Blood transfusion is a life-sustaining procedure. But there are several hurdles in safe blood administration which can cause transfusion transmitted infections (TTI) and acute transfusion reactions and even death. Besides, human errors anywhere in the transfusion chain add fuel to the fire. Blood borne Infections like Hepatitis B and Hepatitis C are highly prevalent in Pakistan affecting about 7.4% of the general population. Among acute transfusion reactions, Febrile nonhemolytic reaction and the allergic reaction are the most common. Moreover, a variety of human errors and near-miss events in transfusion have been reported in the past. Technology has played an important contribution in upgrading the quality of life and healthcare. The main goal of this review is to point out the problems in blood transfusion and to hint at possible solutions with the use of Technology. In addition to following the WHO strategies for safe blood transfusion, blood safety can be ensured by incorporating haemovigilance systems, pathogen reduction technologies and certain approaches to reduce the risk of bacterial contamination. Human errors can be halted via a Management Information System called “Blood Bank Management Information System (BBMIS)” which can recognize and arrest such errors simultaneously.

Prevalence of Adverse Transfusion Reactions in Hospitalized Patients in Tertiary Heart Center of Sari, Iran in 2014-2020

Introduction: Our study aimed to determine the prevalence of adverse transfusion reactions (ATRs), unexpected or undesirable effects resulting from the therapeutic use of blood products. Material and Methods: In this cross-sectional study, we assessed the medical records of ATR patients who were referred to Mazandaran Heart Center from March 2014 until July 2020. Patients needed blood transfusions during the operation for various reasons; complications related to blood administration were considered ATR. Age, sex, associated clinical signs, symptoms, and adverse response were composed of a patient's file checklist with ethical points. SPSS 16.0 was used for statistical analysis. Results: In this study, 23,206 blood products were used in hospitals as treatment, and there were 96 reactions (4%) because of transfusion, and 10 patients had a history of recent reactions. There was not any specific connection between the age of patients and the existence of complications. Most reactions were allergic (44%) and non-hemolytic febrile reactions (42%). It is essential to state that 91% of adverse reactions were slight ones, and only 5% led to the injury. Out of 96 patients with complications, 79 patients received blood products as pack cells; 6 patients received Fresh Frozen Plasma; 3 patients received autologous blood products, while this number was one for Blood Low Leukocytes and platelets (PLT). Conclusion: Based on this investigation, the risk of adverse transfusion reactions (ATRs) is 4%, and universally 85 million units of blood products are transfused every year. Consequently, investigation to reduce this number is required.

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.

Analysis of Adverse Reactions of Blood Transfusion and Discussion of Influencing Factors in Linyi Area from 2013 To 2020.

Background:We aimed to explore the influencing factors of clinical adverse blood transfusion reactions, to provide theoretical basis and support for clinical safe blood transfusion, and to minimize the occurrence of adverse blood transfusion reactions.Methods:The method was to retrospectively analyze the report of adverse blood transfusion reports from 6 hospitals in Linyi area, Shandong, China to the blood station in Linyi City center from 2013 to 2020. We aimed to classify factors, analyze the occurrence of adverse transfusion reactions, and discuss the correlation between the occurrence of adverse transfusion reactions and the above factors.Results:Overall, 248 patients (77.98%) had a history of blood transfusion. The difference between this group and the group with no history was statistically significant (P<0.05). The incidence of adverse transfusion reactions in middle-aged and elderly patients was relatively high, especially for those over 50 yr old, with an adverse reaction of 135, for example, the proportion reached 42.45%. In addition, a retrospective analysis found that the occurrence of adverse transfusion reactions was mostly concentrated from Mar to Sep, a total of 228 cases, accounting for 71.69% of all adverse reactions, which was the highest incidence of adverse transfusion reactions.Conclusion:The main adverse reactions of transfusion were allergic reactions, followed by non-hemolytic febrile reactions, mainly caused by transfusion of suspended red blood cells.

Evaluation of Blood Transfusion Complications in Patients Undergoing Surgery

Introduction: Patients undergoing surgery may need transfusion of blood products for a variety of reasons. Therefore, this study aimed to determine the incidence of blood transfusion complications in patients undergoing surgery. Methods: The present study was performed as a cross-sectional study in 2020 at Shohadaye Tajrish Hospital in Tehran, Iran. A total of 1132 patients who had complications during surgery upon transfusion of blood and blood products from 2015 to 2020 were included in the census. To collect information, a checklist, including patients’ information, the type of product, and types of complications was used. SPSS software version 21 was used for data analysis. Results: In this study, 99.7% of the complications were acute, and in 91.1% of the cases, the severity of complications was mild. Of the confirmed complications, 46.4% were allergic reactions, and 43.8% were reported as non-hemolytic febrile reactions. A total of 91.1% of patients completely recovered after the onset of the complication, 6.2% had a partial disability, 0.4% had severe disability, and 0.3% died. Conclusion: The results showed that most patients had acute complications in terms of the type of complication and mild in terms of the severity, thus a completely regular program is recommended to control side effects related to blood and blood products transfusion.

A Comparative Study of Transfusion Reactions in the Thalassemia Patients before and after Implementation of the Hemovigilance System in Yazd Province, Iran

Background: Patients with thalassemia major require frequent blood transfusions. Blood transfusion can lead to the adverse reactions. Reporting and evaluating the transfusion reactions are among the goals of implementing the hemovigilance system to improve blood recipients’ safety. This study aimed to compare the transfusion reactions in the thalassemia patients before and after implementation of the hemovigilance system in the Shahid Sadoughi Hospital in Yazd (Iran). Materials and Methods: In this historical cohort study conducted in 2018, the data of 87 patients with thalassemia major including age, sex, the total number of blood transfusions before and after the implementation of hemovigilance system, information about the occurrence of blood transfusion reactions, type, and severity of each reaction were recorded in the questionnaire. Paired-Samples T-test and Chi-Square test were used for data analysis. Results: The mean age of the participants was equal to 19.69±8.41 years old and 52% of them were male. The age of onset of transfusion was 14.3±16.62 months with a range of 2 - 96 months. The relative frequency of transfusion reactions in the thalassemia patients was 0.74% and 0.81%, respectively before and after implementation of the hemovigilance system. Allergic (54%) and non-hemolytic febrile reactions (23%) were the most frequent transfusion reactions. Severe and life-threatening reactions were reported more frequently after implementation of the hemovigilance system compared to pre-implementation (p=0.007). Totally, 8% of the reactions were hemolytic reactions and 7.5% of the patients had unexpected alloantibodies identified after implementation of the hemovigilance system. Conclusion: Documentation and reporting of the transfusion reactions after implementation of the hemovigilance system have resulted in reporting of more severe reactions and determination of the clinically significant alloantibodies. Therefore, prevention of the subsequent reactions and increasing the safety of the blood transfusion for the thalassemia patients could be provided, emphasizing the continuation of the system.

A Study on Day Care Transfusion Services in Transfusion Medicine Department of a Tertiary Care Hospital

Background: Transfusion of blood components and derivatives in day care unit is an eminent part of management of transfusion dependent patients. Day care transfusion service is an alternative to hospital admission and beneficial for those patients who receive blood more frequently for their survival. Objective: The aim of present study is to assess Transfusion Services provided in a Day Care Unit (DCU) of a tertiary care hospital. Methodology: This study was carried out in DCU of Transfusion Medicine Department, Bangabandhu Sheikh Mujib Medical University, (BSMMU) at Dhaka during January 2014 to December 2014. Data were collected from record registers. Recorded retrospective data were analyzed as percentage and proportion. Results: Total recipients were 718. Among those 424 (59.05%) were male and 294 (40.95%) were female and 562 (78.27%) were between 10 to 40 years. A total of 8587 units of blood components were used during this period. Red Cell Concentrate was most commonly utilized product 6388 (74.39%) followed by Fresh Frozen Plasma (FFP) 1360 (15.83%), Platelet Concentrate 544 (6.33%), Whole blood 260 (3.05%)&#x0D; and Cryoprecipitate 35 (0.40%). Transfusion was required more frequently in thalassaemic 365(50.88%) patients. Haemophilia 77(10.72%) and aplastic anaemia patients 49 (6.82%) were next high. The main transfusion reaction observed during transfusion was febrile non-haemolytic reactions. Conclusion: For increasing use of specific blood product and hassle-free transfusion services this kind of day care unit services should be strengthened. Long term study of this kind will help us to develop safe clinical transfusion practice.

Transfusion reactions: A retrospective analysis of the Iranian national haemovigilance system (INHS) data

BackgroundThe use of blood and blood components is an essential and effective treatment for many patients, but the transmission of infectious agents via transfusion and the occurrence of non-infectious transfusion reactions (TRs) are unavoidable. The objective of our study was to determine the frequency and type of transfusion-related reactions reported in Iran between 2014 and 2018. MethodsThis retrospective study was carried out in the Iranian blood transfusion organization (IBTO) during a period of five years (2014–2018). All TRs reported to the Iranian national haemovigilance system (INHS) were analyzed using SPSS software. ResultsA total of 20,062 TRs were reported to the INHS from 2014 to 2018. The overall frequency of TRs was 0.14 %. The most common TRs were allergic (42.51 %) and febrile non-hemolytic reactions (37.17 %), respectively. The frequency of TRs to red blood cell (RBC) components was significantly higher than those to the components of platelet (PLT) and plasma (P < 0.05). ConclusionsIn the present study, the frequency of TRs was relatively low (0.14 %) and the majority of them were allergic and febrile non-hemolytic reactions. The recording and reporting of all occurred TRs, the implementation of INHS in all hospitals and the continuity of specific educational courses to physicians, nurses and blood banking staff, as well as the use of an online reporting system will help to improve the haemovigilance in Iran.

ABO-incompatible platelets are associated with increased transfusion reaction rates.

ABO compatibility can affect platelet transfusion safety and efficacy, and ABO-incompatible (ABOi) platelets likely increases the risks of transfusion reactions though the magnitude of this risk is unclear. Data collected on all platelet transfusions administered over 36+ months were classified based on patient and product ABO blood group type and merged with a data set that included all transfusion reactions reported during that period. The transfusion reaction rates among various subsets was calculated. In patients greater than 1 year of age, the transfusion reaction rate in the ABO-compatible (ABO-identical) platelet group was 1.0%, while the ABOi platelet group had an elevated reaction rate of 1.7%. The increased reaction rate for ABOi platelets held true even if the analysis were limited to Centers for Disease Control and Prevention/National Healthcare Safety Network qualifying reactions or just allergic or febrile nonhemolytic reactions. The increased reaction rate with ABOi platelets was independent of unit age. Surprisingly, major-incompatible transfusions (A/B antigen incompatible) had the highest rate of reactions, at 2.0%. During the study period, three acute hemolytic reactions were reported out of 2522 plasma-incompatible platelet transfusions (0.12%). Our results find that compatible platelet transfusions have the lowest rate of transfusion reactions. While hemolytic reactions were observed with plasma-incompatible transfusions, the rate was low. Transfusion of ABO antigen-incompatible platelets had the highest rate of transfusion reactions and resulted in a transfusion reaction rate 1.5 to 2 times that of ABO compatible transfusions.

Study on Day Care Transfusion Services in Transfusion Medicine Department of a Tertiary Care Hospital

Transfusion of blood components and derivatives in day care unit is an eminent part of management of transfusion dependent patients. Day care transfusion service is an alternative to hospital admission and beneficial for those patients who receive blood more frequently for their survival. The aim of present study is to assess Transfusion Services provided in a Day Care Unit (DCU) of a tertiary care hospital. This study was carried out in DCU of Transfusion Medicine Department, Bangabandhu Sheikh Mujib Medical University, (BSMMU), in Dhaka during January to December 2014. Data were collected from record registers. Recorded retrospective data were analyzed as percentage and proportion. Total recipients were 718. Among those 424 (59.05%) were male and 294 (40.95%) were female and 562 (78.27%) were between 10 to 40 years. A total of 8587 units of blood components were used during this period. Red Cell Concentrate was most commonly utilized product 6388 (74.39%) followed by FFP 1360 (15.83%), Platelet Concentrate 544 (6.33%), Whole blood 260 (3.05%) and Cryoprecipitate 35(0.40%). Transfusion was required more frequently in thalassaemic 365(50.88%) patients. Haemophilia 77(10.72%) and aplastic anaemia patients 49 (6.82%) were next high. The main transfusion reaction observed during transfusion was febrile non-haemolytic reactions. For increasing use of specific blood product and hassle free transfusion services this kind of day care unit services should be strengthened. Long term study of this kind will help us to develop safe clinical transfusion practice.&#x0D; Bangladesh Med J. 2019 May; 48 (2): 28-31

Leucorreducción Universal en Costa Rica: ¿Es realmente urgente?

La transfusión sanguínea confiere beneficios clínicos evidentes; sin embargo, posee algunos riesgos y resultados adversos si no se realiza bajo los controles estrictos que garanticen la seguridad de la donación, almacenamiento y transfusión adecuados. La leucorreducción es el proceso mediante el cual los leucocitos se eliminan de la sangre donada, y los estándares actuales de la Asociación Americana de Bancos de Sangre establece un valor residual de glóbulos blancos &lt;5 × 106 por unidad. El beneficio clínico de la aplicación selectiva se traduce en pacientes sometidos a múltiples transfusiones, inmunocomprometidos e internados en las Unidades de Cuidados Intensivos. La leucorreducción universal consiste en realizar este procedimiento en todas las transfusiones a cualquier tipo de paciente y los beneficios comprobados van dirigidos a disminuir las reacciones febriles no hemolíticas, las aloinmunizaciones HLA y las transmisiones virales. Desde el punto de vista médico, la leucorreducción universal parece estar justificada, pero el costo de implementación es significativo. Al estimar los costos en Costa Rica con base en las unidades colectadas en el 2017, la implementación universal sobrepasaría los $2 millones, una inversión significativa para un país de ingresos medios.

Donor Lymphocyte Infusion from G-CSF-Primed, Unmanipulated Whole Blood Is Safe and Improves Chimerism in HLA-Matched and Haploidentical Transplantation

Introduction Donor lymphocyte infusion (DLI) is a useful therapy for mixed chimerism (MC) and measurable residual disease (MRD) after allogeneic transplantation (HSCT). Multiple DLI products can be obtained through apheresis and cryopreservation, but their costs can be prohibitive in developing countries. T-cells in whole blood units can reach ≥1 × 106/kg in healthy donors and are increased after G-CSF exposure. The ideal CD3+ cell dose remains undefined. Objectives We aim to assess the safety and efficacy of G-CSF-primed whole blood units (WB-DLI) in peripheral blood HLA-matched sibling (MSD) and haploidentical (Haplo) transplant recipients. Methods Adults who received WB-DLI at any time after HSCT due to relapse, MRD, MC or poor graft function were included. Patients with active graft-versus-host disease (GVHD) were excluded. Donors received filgrastim 5 μg/kg QD (days 1-3) followed by a 450 mL whole blood draw on day 4 with crossmatching and lymphocyte quantification. For patients with major/bidirectional ABO mismatch without group switch or a mixed field reaction, a reactive major crossmatch was an absolute contraindication. WB-DLI was infused fresh and unmanipulated in an outpatient basis. Concurrent chemotherapy was allowed. Disease and chimerism were assessed on day 30 and 60, respectively. GVHD prophylaxis included oral cyclosporine/tacrolimus tapered in 60 days. Results Fourteen patients received a single WB-DLI, median age was 32 years (range, 16-67), 50% were women. Most common diagnoses were ALL, (n=5) and AML (n=5), followed by MDS (n=2), NHL (n=1) and CML (n=1). Nine had were Haplo grafts, while 4 were MSD. Indication for WB-DLI was relapse in 6 patients, 3 had MRD, 4 MC and 1 had poor graft function. Median chimerism pre-WB-DLI was 72% (range, 38-100%). Median mononuclear cell count obtained was 32 × 10x6/kg (range, 9-74), while median CD3+ cell count was 6.7 × 106/Kg (range, 5.2-19). No immediate severe adverse effects were observed. Febrile non-hemolytic reaction occurred in n=4. No complications were observed in n=4 ABO mismatch cases. Overall 50% responded; chimerism improved in 50%, with a median increase of 28% (range, 9-53%). Median post-DLI chimerism was 92.5% (range, 20-100). Regarding patients treated for relapse or MRD 4/9 responded (33%). Overall 8/14 patients relapsed (57%) with 12-month progression free survival of 27.5% which was significantly lower in relapsed/MRD patients (log rank test p=0.042). Overall survival at 12 months was estimated at 61.2%. Three developed aGVHD, 2 grade III/IV in a median of 13 days (range, 7-38). Four died due to relapse. Median follow-up was 5 months (0.6-20.1 months). The cost of performing WB-DLI was $350 USD per unit. Conclusions DLI obtained from GCSF-primed whole-blood is safe and affordable. It improves mixed chimerism, while it is less effective for overt relapse, similarly to DLI obtained through standard methods.

Transfusion of red blood cells stored for shorter versus longer duration for all conditions.

Transfusion of red blood cells stored for shorter versus longer duration for all conditions.