Febrile Nonhemolytic Transfusion Reactions Research Articles

Phenotyping and Genotyping of HNA: Prevalence, Risk of Alloimmunization, and HNA Incompatibilities in Indians

Background: Antibodies to human neutrophil alloantigens (HNA) are involved in the pathophysiology of several clinical conditions including transfusion-related acute lung injury (TRALI), alloimmune and autoimmune neutropenia, and febrile nonhemolytic transfusion reactions leading to neutropenia. The cognate antigens are polymorphic structures expressed on several glycoproteins on the neutrophils, i.e., antigens HNA-1a, -1b, -1c, and -1d on Fc-γ-receptor IIIb; HNA-2 on CD177; HNA-3a and -3b on choline transporter-like protein 2; HNA-4a and -4b on CD11b/αM subunit of the αMβ2-integrin (CD11b/CD18, Mac-1, CR3); and HNA-5a and -5b on αL-subunit (CD11a) of the αLβ2 integrin (CD11a/CD18), leukocyte function associated molecule (LFA)-1. Currently, there is a lacuna of diagnostic methods for detection of HNA in India. This study aimed to determine the HNA frequencies in Indians, estimate the risk of alloimmunization, and prepare typed neutrophil panels, which can be used to detect HNA antibodies in neutropenia cases. Material and Methods: EDTA blood samples were collected from random 1,054 blood donors. HNA-2 was phenotyped on fresh EDTA samples using FITC labelled monoclonal anti-CD177 by flowcytometry. HNA-1 (FCGR3B) genotyping was carried out by DNA sequencing and PCR-RFLP. Antigens of HNA-3 (SLC44A2) and HNA-5 (ITGAL) were genotyped by PCR-RFLP using TaqαI and Bsp1286I restriction enzymes, respectively, while HNA-4 (ITGAM) was genotyped by PCR-SSP. Results: Allele frequencies of FCGR3B*01, FCGR3B*02, and FCGR3B*03 were found to be 0.433, 0.444, and 0.087, respectively. FCGR3B*01+*02+*03− was the most common genotype (33.78%). Ten individuals showed deficiency of FCGR3B individuals, while 23 showed hyperexpression, i.e., FCGR3B*01+*02+*03+. FCGR3B*04and *05 occurred with a frequency of 0.002 and 0.024. HNA-2 was found to be a high frequency antigen occurring in 98.8% population. Four percent individuals showed atypical expression of CD177 on their neutrophils. Allele frequencies of SLC44A2*01 and SLC44A2*02were 0.812 and 0.188, respectively, and that of ITGAM*01, ITGAM*02, ITGAL*01, and ITGAL*02 were 0.9546, 0.0454, 0.2372, and 0.7628, respectively. Conclusion: This is the first study in India to report the frequencies of HNA among blood donors. Typed neutrophil panels identified in the present study will enable us to investigate suspected cases of immune neutropenia in future.

Incidence and Analysis of Acute Transfusion Reactions in a Hospital-Based Hemovigilance System at a Tertiary Care Center in Bangladesh

Background and Objectives: Blood transfusion is a life-saving intervention but may cause nonfatal to fatal untoward events. Therefore, for safe blood transfusion, various adverse reactions need to be identified and steps should be taken to reduce such events. The aim of this study was to determine the incidence and analyze the types of acute transfusion reactions (ATRs) with associated factors. Patients and Methods: All ATRs reported to the transfusion medicine department from January 2016 to December 2020 were retrospectively reviewed and analyzed. The incidence of ATRs and its associated factors were assessed. Results: During the study period, a total of 39,070 units of blood were issued, out of which there was an incidence of 0.24% (n = 95) ATRs mostly seen in females and older patients aged above 60 years. Most common ATR was febrile nonhemolytic transfusion reactions (51.6%, n = 49), followed by allergic reaction (35.8%, n = 34). The most common symptom was chills and rigor (41.1%). The frequency of reactions was significantly higher with packed red blood cell transfusion (62.1%). Patients with previous transfusion history (n = 63, % = 66.3, P = 0.711) had more ATRs. Conclusion: By this study, the authors want to create awareness among health personnel involved in the transfusion chain is necessary to establish a proper hemovigilance system.

Comparison of transfusion reactions in children and adults: A systematic review and meta-analysis.

There are no international standards or normalizations for diagnosing and treating complications from blood transfusions. We comprehensively compared the incidence of adverse blood transfusions in children and adults. Available literature on blood transfusion adverse reactions in children and adults prior to November 27, 2021 was collected from several electronic databases. This meta-analysis was performed using Revman 5.2 and Stata 15.1. The incidence of transfusion reactions is higher in children than in adults. Children transfused with red blood cells and platelets exhibited a higher incidence of transfusion reaction than that of adults. Moreover, the incidence of allergic and febrile non-hemolytic transfusion reactions was significantly higher in children than in adults. The incidence of some rare transfusion reactions was also significantly higher in children than in adults. The incidence of transfusion reactions in children and adults is varied. Guidelines for children are necessary.

Blood Transfusion Reactions-A Comprehensive Review of the Literature including a Swiss Perspective.

Blood transfusions have been the cornerstone of life support since the introduction of the ABO classification in the 20th century. The physiologic goal is to restore adequate tissue oxygenation when the demand exceeds the offer. Although it can be a life-saving therapy, blood transfusions can lead to serious adverse effects, and it is essential that physicians remain up to date with the current literature and are aware of the pathophysiology, initial management and risks of each type of transfusion reaction. We aim to provide a structured overview of the pathophysiology, clinical presentation, diagnostic approach and management of acute transfusion reactions based on the literature available in 2022. The numbers of blood transfusions, transfusion reactions and the reporting rate of transfusion reactions differ between countries in Europe. The most frequent transfusion reactions in 2020 were alloimmunizations, febrile non-hemolytic transfusion reactions and allergic transfusion reactions. Transfusion-related acute lung injury, transfusion-associated circulatory overload and septic transfusion reactions were less frequent. Furthermore, the COVID-19 pandemic has challenged the healthcare system with decreasing blood donations and blood supplies, as well as rising concerns within the medical community but also in patients about blood safety and transfusion reactions in COVID-19 patients. The best way to prevent transfusion reactions is to avoid unnecessary blood transfusions and maintain a transfusion-restrictive strategy. Any symptom occurring within 24 h of a blood transfusion should be considered a transfusion reaction and referred to the hemovigilance reporting system. The initial management of blood transfusion reactions requires early identification, immediate interruption of the transfusion, early consultation of the hematologic and ICU departments and fluid resuscitation.

Development of the Chinese Haemovigilance Network and reporting of adverse transfusion reactions from 2018 to 2020.

To advance blood transfusion safety, the Chinese Haemovigilance Network (CHN) was put into operation in 2018. This report describes the development of the CHN and evaluates its role by analysing reported adverse transfusion reactions (ATRs) from 2018 to 2020. All data in this study were obtained from the CHN online reporting platform. A timeline of CHN development is presented, and the activities of CHN-enrolled facilities are analysed by year. The reported ATRs were analysed in detail for ATR types, blood components involved and adherence to case definition, severity and imputability criteria. Incidence rates were calculated and compared with international examples. During 2018-2020, a total of 3061 ATRs were reported through the CHN online reporting system. The rate of reported ATRs in all facilities and the 10 highest reporting facilities was 0.7‰ and 1.8‰, respectively. When analysed by year, the incidence rate showed an increasing trend from 2018 to 2020. Allergic (68.2%) and febrile non-haemolytic transfusion reaction (27.1%) were the most common. The vast majority of ATRs (92.0%) were not serious, but serious cases of transfusion-associated circulatory overload, transfusion-associated dyspnoea and hypotensive reaction were common. Most (86.0%) of reported cases were definitely or probably associated with transfusion. Under-reporting of ATRs occurs in many Chinese hospitals, but the establishment of CHN has increased ATR recognition and management. More effort will be needed in the future to detect transfusion problems and improve transfusion practice in China.

Improving Blood Product Transfusion Premedication Plan Documentation: A Single-institution Quality Improvement Effort.

Introduction:Premedication with acetaminophen and/or diphenhydramine to prevent febrile nonhemolytic transfusion reactions and minor allergic transfusion reactions is a common practice based on historical recommendations. However, recent small randomized-controlled trials showed no benefit of premedication. This inconsistency leads to practice variability, which results in the inefficiency of our institution’s blood product ordering process. This project aimed to improve the number of transfusion encounters with premedication plan documentation from a baseline of 19% to 80% in 12 months.Methods:A multidisciplinary quality improvement (QI) team used QI tools to design interventions to improve the efficiency of the ordering process for blood products. Measures were tracked monthly and analyzed using statistical process control.Results:From September 2018 to January 2021, 5,351 blood product transfusion visits were scheduled. At baseline, 34% of patients received premedication, and 19% had premedication plans documented. Interventions included a passive computerized provider order entry alert, clinical care pathway development, and clinician education. Postimplementation, the average number of encounters with a premedication plan increased from 19% to 87%, whereas encounters receiving premedication decreased from 34% to 25%. There was no change in the average number of transfusion reactions (1.8 per 100 transfusions).Conclusions:Using QI methods, our team successfully standardized the blood product premedication plan documentation despite unclear best practices regarding blood product transfusion premedication. The team added premedication plan documentation training to new employee orientation for sustainability.

The differences in the levels of interleukin 1 beta (IL-1ß) and tumor necrosis factor alpha (TNF-Α) based on the storage of thrombocyte concentrates

Thrombocyte concentrate (TC) transfusion plays an important role in preventing bleeding in patients with severe thrombocytopenia. Febrile non hemolytic transfusion reaction (FNHTR) may occur after TC administration. IL-1ß and TNF-α cytokines released by thrombocytes and leucocytes during TC storage play important roles in the occurrence of FNHTR after TC transfusion. The purpose of this study was to analyze changes in levels of IL-1ß and TNF-α on the duration of TC storage. This was an observational analytical research with time series design carried out at the Clinical Pathology Laboratory and Blood Bank of the Dr. Soetomo Hospital Surabaya in September - October 2019. IL-1ß and TNF -α levels in 20 bags of Thrombocyte Concentrate blood components derived from Platelet Rich Plasma during storage for day 1, day 3 and day 5 were measured using ELISA Sandwich method. The statistical analysis was performed using the Subject Same Variant Test or Friedman Test. The results showed no significant differences in the levels of IL-1ß and TNF-α based on the storage duration of TCs on day 1, 3 and 5, p = 0.262 and p = 0.534 respectively. There was a significant difference of IL-1ß levels between day 1 and day 3 (p=0.032).

Platelet concentrates in platelet additive solutions generate less complement activation products during storage than platelets stored in plasma.

Platelet transfusions can be associated with adverse reactions, such as febrile non-haemolytic transfusion reaction (FNHTR). It has been suggested that damage-associated molecular patterns (DAMP) and complement play a role in FNHTR. This study investigated the nature of DAMPs and complement activation products contained in platelet concentrates during storage, with a specific focus on different platelet storage solutions. Buffy coats (BC) from healthy donors were pooled (15 BC per pool) and divided into three groups of the same volume. After addition of different storage solutions (plasma, platelet additive solutions [PAS]-C or PAS-E; n=6 for each group), BC pools were processed to platelet concentrates (PC). Leukoreduced PCs were stored on a shaking bed at 20-24°C and sampled on days 1, 2, 6 and 8 after collection for selected quality parameters: platelet activation, DAMPs (High Mobility Group Box 1 [HMGB1], nucleosomes), and complement activation products. During storage, equal levels of free nucleosomes and increasing concentrations of HMGB1 were present in all groups. Complement activation was observed in all PC. However, by day 8, the use of PAS had reduced C3b/c levels by approximately 90% and C4b/c levels by approximately 65%. Nucleosomes and HMGB1 were present in PCs prepared in plasma and PAS. Complement was activated during storage of platelets in plasma and in PAS. The use of PAS is associated with a lower amount of complement activation products due to the dilution of plasma by PAS. Therefore, PC in PAS have less complement activation products than platelets stored in plasma. These proinflammatory mediators in PC might induce FNHTR.

Relationship between allergic sensitisation-associated single-nucleotide polymorphisms and allergic transfusion reactions and febrile non-haemolytic transfusion reactions in paediatric cases.

Allergic transfusion reactions (ATR) and febrile non-haemolytic transfusion reactions (FNHTR) are common transfusion-related adverse reactions; however, their pathogenesis remains unclear and it is difficult to predict their occurrence. Single-nucleotide polymorphisms (SNP) are related to the onset of various diseases and therapy-related adverse events; therefore, identification of SNP related to transfusion-related adverse reactions may help to elucidate the underlying mechanism and predict the onset of these reactions. We retrospectively analysed the association between the onset of ATR or FNHTR and 22 allergic sensitisation-related SNP in 219 children (aged ≤20 years) who had haematological and oncological diseases and who had received transfusions of platelets and/or red blood cell concentrates. Among the 219 children, 105 had developed an ATR and/or FNHTR at least once. The patients who developed ATR frequently had a risk allele in rs6473223, while the patients who developed FNHTR frequently had a risk allele in rs10893845. Furthermore, patients who developed ATR accompanied by febrile symptoms also frequently had a risk allele in rs10893845, similar to patients who developed FNHTR. The results suggested that allergic sensitisation is associated with the onset of ATR and/or FNHTR in some patients. Although further prospective evaluation is necessary, analysis of these SNP might help to provide safer transfusion therapy by predicting patients at higher risk of transfusion-related adverse reactions and further clarifying the pathogenic mechanism underlying such reactions.

The influence of leukoreduction on the acute transfusion‐related complication rate in 455 dogs receiving 730 packed RBCs: 2014–2017

To investigate the influence of prestorage leukoreduction of packed RBCs (pRBCs) on acute transfusion-related complication rate in dogs. Two private referral hospitals. Retrospective case study. Four hundred and fifty-five dogs receiving nonleukoreduced (nLR) or leukoreduced (LR) pRBC between January 1, 2014 and July 31, 2017. Transfusions were retrospectively reviewed to record data about the patient, donor, unit, transfusion event, acute complications, hospital discharge, and cause of death. Of 730 transfusion events in 455 dogs, 288 used LR pRBC and 442 used nLR pRBC. There was a 18.9% (138/730) overall complication rate. Seven (0.96%) complications were life-threatening. The most common complications were pyrexia (5.6%), gastrointestinal signs (4.9%), and hemolysis with no other signs (4.1%). Pyrexia with no other clinical signs, consistent with a febrile nonhemolytic transfusion reaction (FNHTR), occurred in 3.2% of transfusion events. There was a significant (P=0.03) decrease in the rate of FNHTR with LR pRBC (1%) versus nLR pRBC (4.5%). Use of LR pRBC did not decrease in-hospital mortality. The odds of any complication, hemolysis only, FNHTR, and more severe complications increased with pRBC age. Leukoreduction did not decrease the impact of pRBC age on these complications. Use of older pRBC did not increase the incidence of life-threatening complications or mortality. Dogs receiving pRBC for blood loss were more likely to have gastrointestinal and more severe complications than those dogs that had hemolysis. The effect of pRBC unit age on complications was not influenced by the underlying reason for transfusion. Dogs that received a previous transfusion were more likely to have respiratory complications. In this study, the use of LR pRBC was associated with a decreased rate of FNHTR but no other complications. Unit age was associated with the incidence of hemolysis, FNHTR, and complication severity but not the rate of life-threatening complications or mortality.

Development and implementation of a hemovigilance program at a university veterinary teaching hospital.

To describe the development and implementation of a small animal hemovigilance program at a university veterinary teaching hospital. Retrospective observational descriptive study performed between October 2014 and March 2019. University teaching hospital. Dogs and cats receiving blood product transfusions . None. A hemovigilance working group composed of veterinary specialists in clinical pathology, internal medicine, and emergency and critical care was established. This group developed evidence-based definitions of transfusion reactions, reaction classification systems, and a transfusion reaction reporting form. The reporting form contained sections for patient information, transfusion information, administration details, and reaction details. Reaction events were classified by reaction type, severity grade, and imputability to the transfusion. Following implementation of the hemovigilance program, transfusion reaction data were collected and examined for the period spanning October 2014 and March 2019. During the study period, 718 canine transfusions (4 whole blood, 400 packed RBC [pRBC], 300 fresh frozen plasma [FFP], 7 platelet rich plasma, and 7 cryoprecipitate) and 124 feline transfusions (5 whole blood, 95 pRBC, and 24 FFP) were administered. There were 32 total reactions (27 canine and 5 feline), with the most common reaction being febrile nonhemolytic transfusion reactions (19/32; 59%). The incidence rate of transfusion reactions was found to be 3.8% in dogs and 4.0% in cats. For the confirmed reactions, classification criteria for case definition, reaction severity grade, and imputability were able to be determined and recorded. This allowed targeted interventions to be implemented in order to potentially reduce future reactions. A hemovigilance program can be instituted successfully in a veterinary hospital setting and once developed, standardized reporting tools could be utilized by multiple hospitals and provide the basis for more widespread reaction reporting in veterinary medicine.

Acute Transfusion Reactions in a Tertiary Care Hospital: The Saudi Context

Although blood transfusion is a life-saving procedure, it can be associated with complications in rare cases. An acute transfusion reaction (ATR) is a complication where recipients exhibit an adverse reaction within 24 hours of a blood transfusion. This study aimed to determine the incidence of ATRs. This retrospective study reviewed the ATRs for all patients who received blood products over three years (2018, 2019, 2020). Of 81,498 transfusion episodes investigated, 132 (0.16%) were associated with ATRs. The most frequent adverse reactions were allergic reactions (62.9%, n = 83), followed by febrile non-haemolytic transfusion reactions (FNHTR) (32.6%, n = 43). Among blood products, it was found that allergic reactions were associated with platelet transfusions (40.9%, n = 34) and FNHTR with packed red blood cell transfusions (79.0%, n = 34). Serious complications such as acute haemolytic transfusion reaction and transfusion-related lung injury were not reported. The low percentage of recorded ATRs may indicate an underestimation of the true incidence due to under-reporting. Accurate reporting of ATRs is a crucial element of the haemovigilance system and would improve blood transfusion safety and enhance patient management. KEYWORDS FNHTR; allergic reactions; TACO; haemovigilance; urticarial rash

Adverse Reactions to Blood Components- A Twelve-Year Retrospective Study- A Step towards Prevention

Introduction: The transfusion of blood and blood components is a life-saving procedure in clinical practice. However, it is associated with risks that can range from trivial self-limited Allergic Reactions (AR) to life endangering anaphylactic or haemolytic transfusion reactions. Aim: To analyse the pattern and incidence of transfusion related adverse events and to develop preventive strategies. Materials and Methods: This was a retrospective, observational study conducted at Department of Pathology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India, on data of Adverse Transfusion Reactions (ATR) reported to the blood bank over a period of 12 years from January 2006 to December 2018. The ATRs were analysed with respect to gender, type of blood component, and nature of the reaction. The data collected were tabulated and the analysis was done using percentages. Results: A total of 1,60,914 units of Whole Blood (WB) and blood components were issued during the study period. A 271 adverse reactions (129 reactions in females and 142 reactions in males) were documented constituting 0.168% of the total products issued, majority were due to packed red cells (0.29%). The incidence of AR was the maximum, accounting for 63.1% of the reactions (n=171, 75 in females and 96 in males) followed by Febrile Non Haemolytic Transfusion Reactions (FNHTR) which were 33.57% (n=91, 42 in males and 49 in females). There were four cases of Transfusion Associated Acute Lung Injury (TRALI), all in males, accounting for 1.48% of the reactions, three cases of anaphylactoid reactions (2 in females and 1 in male) accounting for 1.11% of the total reactions and two cases of haemolytic transfusion reaction (0.73%). Conclusion: The frequency of adverse reactions in the present study is 0.168% (271 out of 1, 60,914 units), majority were due to packed red cells (0.29%). No adverse reactions due to bacterial contamination occurred during the study period. It is important to ensure education of nursing staff, interns, and residents regarding the correct procedure of blood transfusion, identification of adverse reactions and appropriate remedial measures for the same.

Study of the Impact of Leucocyte Reduction on the Coagulation Factors in Fresh Frozen Plasma

Introduction:Plasma transfusion is required to arrest or prevent bleeding, for various congenital and acquired cases of coagulopathies such as inherited factor deficiencies, disseminated intravascular coagulation, liver disease, post major trauma, etc. Leukocyte reduced blood components are indicated to prevent the febrile nonhemolytic transfusion reactions, Human Leukocyte Antigen (HLA) alloimmunization, transmission of infections such as cytomegalovirus (CMV), and adverse transfusion reactions due to storage lesion. In the present study, the effect of plasma filtration on eight coagulation factors viz. fibrinogen, factors II, V, VII, VIII, IX, X and XI has been studied.Materials and Methods:The plasma separated from the whole blood donation from each of 25 donors was separated into two aliquots. Group-1 included unfiltered fresh frozen plasma; group-2 included fresh frozen plasma which was subjected to pre-storage leukocytereductionbyfiltration.ThelevelsofthecoagulationfactorsFibrinogen,II,V, VII, VIII, IX, X, XI were estimated in each sample in both the groups.Results:There was no statistically significant difference in the levels of any of the coagulation factors included in this study, between the unfiltered and the leukocyte reduced plasma. Group O positive individuals were found to have higher levels of all the coagulation factors. Conclusion:Filtration of plasma has no effect on the coagulation factors. This is the first study where the effect of plasma filtration on eight coagulation factors has been studied. Blood group O positive individuals were found to have higher levels of all the eight coagulation factors.

A Retrospective Analysis of Transfusion Reactions at a Tertiary Care Center: An Institutional Hemovigilance Study.

The goal of our study was to determine the frequency and type of transfusion reactions (TRs) as well as other hemovigilance activities reported at a tertiary care hospital in Turkey over a period of 3 years. In this retrospective study, the notification sheets of TRs reported to the institution's local hemovigilance system between December 2017 and December 2020 were analyzed. A total of 89,187 units of blood components were administered to patients during this period. A total of 197 TRs were reported to the hemovigilance system. The overall frequency of TRs was 0.22%. The most common TRs were allergic reactions (49.2%) and febrile nonhemolytic transfusion reactions (37.6%), respectively. Most of the adverse events were reported by clinical nurses. Our study showed that the frequency of TRs was low, and most were manageable reactions. We found that reporting of all TRs and continuous nursing education can help to strengthen the hemovigilance system. [J Contin Educ Nurs. 2021;52(12):581-588.].

Perbandingan Proporsi Antibodi Ireguler pada Pasien Multitransfusi dan Pasien Non Multitransfusi di UTD RSUP Dr. Mohammad Hoesin Palembang

Irregular antibodies or "unexpected antibodies" are antibodies other than antibody A and antibody B that can occur due to pregnancy and blood transfusions. Patients who frequently perform transfusions (multitransfusions) are more at risk of forming irregular antibodies because the frequency of exposure to donor red blood cell antigens is more frequent. Irregular antibodies are clinically significant because they can cause hemolysis (erythrocyte alloantibodies), febrile non-hemolytic transfusion reactions (leukocyte alloantibodies), or refractory platelet transfusions (platelet alloantibodies). This research aims to compare the proportion of irregular antibodies in multitransfusion patients and non-multi transfused patients at UTD Dr. Mohammad Hoesin Palembang. This research is an analytic observational study with a cross-sectional design conducted on 2 groups of subjects, 45 each sample. Antibody identification in each group was carried out. Chi-Square analyzed the proportion of irregular antibodies. An analysis of the types of antibodies found and the accompanying clinical diagnoses were carried out. This study showed a significant difference in the proportion of irregular antibodies between the multitransfusion and non-multitransfusion groups with a p-value of 0.001. The types of irregular antibodies found anti-c, Fya, Lea, M, Kpa, LubkKpb, and the clinical diagnoses that found irregular antibodies were anemia, thalassemia, and AIHA.

A Study on Adverse Transfusion Reactions in a Secondary Care Hospital of Rural India

Aims: The study aims to assess the incidence, causality, and severity of adverse transfusion reactions in patients transfused with blood or blood components at a secondary care referral hospital.
 Study Design: A prospective observational study was conducted in the secondary care referral hospital located in rural settings of Anantapur district, Andhra Pradesh, India. The study was conducted for a period of six months from May 2019 to October 2019
 Methodology: All the patients transfused with blood or blood components in the hospital located in Andhra Pradesh during those six months study period were included. The transfusion reactions were reported to the blood bank in the Adverse Transfusion Reaction Report Form (ATRRF). Descriptive statistics were used to represent the adverse transfusion reactions.
 Results: From 2549 transfusions, 30 adverse transfusion reactions were reported (1.17%).Most of the reactions reported were febrile non-hemolytic transfusion reactions FNHTRs (73.3%) followed by allergic reactions (20.0%). Transfusion reactions were predominant in females 21 (70.0%) than males 9 (30.0%). Most of the reactions were confirmed/definite (46.6%) in causality assessment and moderate (63.3%) in severity assessment. The incidence of adverse transfusion reactions was found to be 1.17%.
 Conclusion: The study concludes that there was a low incidence of adverse transfusion reactions indicating probably underreporting in the healthcare system. This would be due to lack of knowledge regarding importance of surveillance and reporting of adverse transfusion reactions by blood or blood components. There was a need to conduct continuous educational programs (CEP) on hemovigilance system towards healthcare providers to improve the reporting practice. The study provides insights about type of adverse transfusion reactions and their causality and severity. This data helps in motivating the healthcare staff to report ATRs and also to develop strategies to handle preventable ATRs.

Transfusion Reactions in Pediatric Patients: An Analysis of 5 Years of Hemovigilance Data From a National Center for Children's Health in China.

Objective: This study aimed to describe transfusion reactions of pediatric patients from a National Center for Children's Health in China and to examine reaction incidents, reaction types by blood transfusion, and the associated blood products resulting in transfusion reactions.Methods: We compared transfusion reaction rates, among platelets, plasma, and red blood cells (RBCs) using a retrospective analysis of pediatric patients treated with blood transfusion based on data from the National Center for Children's Health (Beijing, China) by a hemovigilance reporting system from January 2015 to December 2019.Results: Over the past 5 years, 165 reactions were reported, and the overall incidence was 1.35‰ (95% CI: 1.14–1.55‰; 165/122,652); for each separate year, the incidences were 1.25‰ (95% CI: 0.76–1.74‰; 25/20,035; 2015), 1.09‰ (95% CI: 0.65–1.52‰; 24/22,084; 2016), 1.66‰ (95% CI: 1.14–2.18‰; 39/23,483; 2017), 1.36‰ (95% CI: 0.92–1.81‰; 36/26,440; 2018) and 1.34‰ (95% CI: 0.93–1.75‰; 41/30,610; 2019). Transfusion reaction incidents by person included 0.37‰ (95% CI: 0.21–0.53‰; 21/56,815) RBCs, 2.98‰ (95% CI: 2.33–3.64‰; 79/26,496) platelets and 1.65‰ (95% CI: 1.25–2.05‰; 65/39,341) frozen plasma. According to the analysis by blood products, the incidence of transfusion was 0.34‰ (95% CI: 0.20–0.48‰; 23/66,958) for RBCs, 3.21‰ (95% CI: 2.50–3.92‰; 78/24,318.5) for platelets, and 0.94‰ (95% CI: 0.71–1.17‰; 64/67,912) for frozen plasma. Transfusion reactions were most commonly associated with platelets, followed by plasma and RBC transfusions. The types of blood transfusion reactions were mainly allergic reactions (86.67%) and febrile non-hemolytic transfusion reactions (FNHTRs, 4.24%). The disease types of pediatric patients with transfusion reactions were concentrated among those with blood system diseases. A total of 80.61% of children with transfusion reactions had a previous blood transfusion history.Conclusions: Transfusion reactions are still relatively common in pediatric patients, and additional studies are necessary to address the differences in reaction rates, especially allergic and FNHTRs. Robust hemovigilance systems do include a special section dedicated to children will further the understanding of these reactions and trends, and prospective randomized clinical controlled trials may need to be conducted to perform preventive and corrective measures.

Randomized double-blinded clinical trial on acute transfusion reactions in dogs receiving leukoreduced versus nonleukoreduced packed red blood cells.

BackgroundLeukoreduction of blood products is commonly performed in human medicine, but its effect on outcome or incidence of transfusion reactions (TRs) in dogs is unknown.ObjectivesTo prospectively evaluate the incidence of acute TRs in, and the outcome of, dogs receiving either leukoreduced (LR) or nonleukoreduced (N‐LR) packed red blood cells (PRBC).AnimalsDogs (n = 194) administered PRBC between August 2017 and June 2020.MethodsProspective randomized double‐blinded clinical trial. Dogs were randomized to receive either LR or N‐LR PRBC and clinicians, nurses and investigators were blinded to the group allocations. The incidence of TRs, change in PCV, hospitalization duration, and survival to discharge were recorded.ResultsOut of the 194 dogs, 96 received LR and 98 received N‐LR PRBCs. The mean 12‐hour change in PCV value was +9.22% (SD 5.27%) for dogs that received N‐LR and +10.69% (SD 6.44%) for dogs that received LR PRBC (effect size 0.26, 95% confidence interval [CI] −0.02 to 0.55), which was not significantly different (P = .08). TRs were documented in 16/194 (8.24%) dogs, with 1/194 (0.51%) being a mild allergic reaction, while 15/194 (7.73%) had suspected febrile nonhemolytic TRs (FNHTRs). FNHTR incidence was not significantly different between the LR (6/96, 6.25%, 95% CI 2.8‐13.56) and N‐LR (9/98, 9.18%, 95% CI 4.92‐17.11) groups (P = .81). Of the 156 dogs that survived to discharge, 80/156 received N‐LR PRBC and 76/156 received LR PRBC which was not significantly different (P = .66).Conclusions and Clinical ImportanceA clinical advantage of using LR over N‐LR PRBC in terms of TRs and increase in PCV after transfusion was not detected.

Preventing adverse reactions in pediatric transfusions using washed platelet concentrate

Blood transfusion is an important form of supportive care in children; however, transfusion-associated adverse reactions (TARs) are a problem. As with adults, allergic transfusion reactions (ATRs) and febrile non-hemolytic transfusion reactions (FNHTRs) are major TARs, and the frequency of ATRs caused by platelet concentrate (PC) tends to be particularly high. The plasma component of the blood product is thought to be a major factor in the onset of TARs such as ATR and FNHTR. By contrast, in children, age, underlying disease, and number of blood transfusions may be relevant patient-related factors. Although acetaminophen or diphenhydramine may be used prophylactically to prevent TARs, there is no clear evidence of their effectiveness. Volume-reduced PC is used to prevent TARs; however, it may be difficult to maintain the quality of platelets. Plasma-replaced PC stored with platelet additive solution raises the concern that TARs cannot be completely prevented by residual plasma. Washed PC removes most of the plasma, so it can effectively prevent ATR and FNHTR. The recent development of platelet additive solution [M-sol, bicarbonate Ringer's solution supplemented with acid-citrate-dextrose formula A (BRS-A)] in Japan has enabled the maintenance of the quality of platelets for long periods. The clinical use of washed PC in Japan has therefore progressed. Washed PC with M-sol or BRS-A for pediatric patients can effectively prevent TARs without diminishing the transfusion effect. The supply of washed PC has begun from the Japanese Red Cross Society, and it has become possible to use washed PC at all medical institutions in Japan.