Febrile Reactions Research Articles

Acute generalized exanthematous pustulosis secondary to spider bites: Clinico-dermoscopic findings and review of literature

Acute generalized exanthematous pustulosis (AGEP) or toxic pustuloderma is a febrile adverse cutaneous reaction, characterized by small non-follicular sterile pustules. AGEP can occur in any age group and is found to be more common in women. A large proportion (>90%) of cases are triggered by medications, particularly macrolides and aminopenicillins. The occurrence of AGEP following spider bite has been rarely documented in the literature.We report two cases who presented to us with AGEP following spider bite along with dermoscopic findings and also present a brief review of literature on the same.

Trend towards reduction of transfusion reactions using prestorage leukocyte-reduced and pooled whole blood-derived platelets and cost savings compared with poststorage whole blood-derived random platelets as evidenced by real-time hemovigilance.

Due to chemotherapy-induced neutropenia or hematologic malignancies, immunocompromised cancer patients may have higher incidence of febrile nonhemolytic transfusion reactions compared with the general population and frequently require platelet transfusions. This quality improvement project compared the safety of transfusion using prestorage leukocyte-reduced and pooled whole blood-derived platelets (Acrodose/WBD) with conventionally produced poststorage WBD platelets (RDP) using an active hemovigilance system. Every patient receiving a blood product at the hospital was virtually monitored in real time by trained nurses from a remote hemovigilance unit. These nurses monitor a digital dashboard, which populates a watch list of patients from the time blood product administration is initiated until 12 hours posttransfusion. Over the course of 6 months, 371 patients receiving 792 RDP transfusions and 423 patients receiving 780 Acrodose/WBD platelets transfusions were monitored for transfusion reactions. We identified 26 transfusion reactions in RDP but only 12 transfusion reactions in the Acrodose/WBD platelet group. Acrodose platelet transfusion was associated with fewer transfusion reactions, which resulted in significant cost savings.

Review of haemovigilance at the Rabat Regional Blood Transfusion Centre in Morocco (2017-2021).

blood transfusion remains an essential therapeutic intervention, but the occurrence of transfusion reactions makes its administration even more complex. Vigilant reporting of such reactions by recipients of blood products is essential for effective haemovigilance. This study aimed to determine the frequency and nature of transfusion reactions. conducted over five years (2017-2021) at the Haemovigilance Department of the Rabat Regional Blood Transfusion Centre, this retrospective study exploited incident forms notified by health establishments and data from the regional blood transfusion centre's computer system. from 1 January 2017 and 31 December 2021, the Rabat Regional Blood Transfusion Centre distributed 435,651 labile blood products to various healthcare establishments, which reported 191 transfusion reactions involving 191 patients. The median age of the patients was 44.3 years, with an overall cumulative incidence of transfusion reactions of 0.44 per 1000 labile blood products delivered. The predominant reactions were non-haemolytic febrile and allergic reactions, accounting for 41.36% and 35.60% respectively. Grade 1 reactions accounted for 87% of all reactions recorded. During the study period, three deaths were recorded, with ABO incompatibility and transfusion-related acute lung injury (TRALI) accounting for two and one case respectively. Transfusion reactions involving erythrocyte components were significantly more frequent than those involving platelet and plasma components. this study revealed a relatively low incidence of transfusion reactions (0.44%), dominated by non-haemolytic febrile and allergic reactions. Several levels of failure were identified, in particular under-reporting of reactions and inadequate training in transfusion practices and haemovigilance, as well as the need for an effective electronic transfusion reaction reporting system to facilitate reporting and identification of underlying problems and risk factors to improve the quality of transfusion care provided to patients.

High mobility group box protein 1 sensitizes mononuclear cells to further contact with lipopolysaccharide.

Fever is an adaptive host-defense response to infection and nowadays is rightly considered to be an expression of a healthy body and a well-functioning immune system. The condition is that it must be tightly regulated. Therefore, in individual cases, fever may be detrimental and should be treated. Specific excessive febrile reaction to pathogens which occurs after aseptic injuries is one among such cases. We previously found that among necrotic products, high mobility group box protein 1 (HMGB1) released from the site of aseptic injury affects immune effectors (cells) to mediate higher fever in response to further contact with bacterial lipopolysaccharide (LPS). Here we observed that intraperitoneal (i.p.) pre-injection of recombinant HMGB1 (5 µg/rat i.p.) provoked an increase in plasma levels of prostaglandin E2 (PGE2) in rats and augmented release of interleukin (IL)-1β and IL-6 after LPS administration at a dose of 50 µg/kg i.p. compared to rats pre-injected with saline or heat-denatured HMGB1. Furthermore, peripheral blood mononuclear cells (PBMCs) isolated from rats injected with HMGB1 were more sensitized to produce enhanced levels of IL-1β and PGE2 when stimulated with LPS in vitro (1 µg/ml/106 cells for 4 h) compared to control animals injected with saline or heat-denatured HMGB1. We also noted a significant increase in activation of nuclear factor κB (NF-κB) in cells isolated from rats injected with HMGB1. Altogether, the obtained results suggest that HMGB1 participates in priming of immune cells to further contact with pathogens.

Эффективность регидратирующей терапии при вирусных гастроэнтеритах у детей

Aim: to compare the efficacy of reduced osmolarity oral rehydration solution (ORS) with zinc and infusion therapy with salt and sugar-salt solutions in children suffering from viral gastroenteritis (VGE) complicated by dehydration syndrome of I-II stage and II stage. Patients and Methods: a prospective open-ended comparative randomized clinical trial was conducted The children were divided into two groups: the main group (n=45) with therapy used reduced osmolarity ORS (carbohydrates 2.84 g, glucose 2.82 g, chlorides 0.453 g, zink 0.003 g, osmolarity: 245 mOsm/L, per 1 sachet), and the comparison group (n=34), receiving standard infusion therapy with salt-sugar solutions. The severity of acute gastroenteritis was assessed using a modified Vesikari score. Comprehensive clinical and laboratory examination of children was performed before and after treatment Results: the mean severity of the patients' condition on the modified Vesikari score was 13.26±0.7 points for VGE, which corresponds to the moderate severity. In 42 (93.3±4.5%) patients of the main group, the condition stabilization and reduction of pathological losses were achieved during the first 6 hours, and therefore oral rehydration was continued. In this case, the active use of ORS was conducted for 24–48 hours with an assessment of the trend in general and topical symptoms, as well as laboratory parameters of the fluid and electrolyte balance and renal excretion of nitrogenous compounds. 3 patients (6.66±3.7%) who required further parenteral fluid administration were excluded from the study due to the lack of proper oral rehydration effect associated with the vomiting and the impossibility of further therapeutic manipulations. During oral rehydration in the main group, the febrile reaction duration was comparable in the lasting with the comparison group. Normalization of general well-being in the form of the fatigue disappearance was noted in the compared groups at the same time, while the vomiting cessation was recorded in a significantly shorter time in the main group. Exicosis and diarrhea were managed to be stopped in the main and comparison groups at almost comparable time. Conclusion: rehydration with low-osmolar ORS helps to avoid possible complications of parenteral fluid administration and a traumatic situation for a child KEYWORDS: exicosis, dehydration syndrome, viral gastroenteritis, acute intestinal infection, oral rehydration, oral rehydration therapy, oral rehydration solution, zinc, low-osmolar oral rehydration solution, children. FOR CITATION: Bekhtereva M.K., Komarova A.M. Rehydration therapy efficacy of viral gastroenteritis in children. Russian Journal of Woman and Child Health. 2024;7(2):177–183 (in Russ.). DOI: 10.32364/2618-8430-2024-7-2-14.

Evaluation of the bone marrow transplantat recipient patients regarding fever onset, fever permanence, risk factors, and underlying causes, during the pre-engraftment phase

Background: Patients undergoing bone marrow transplantation (BMT) are at higher risk of immune system deficiency. The immunosuppression, followed by pre-transplant chemotherapy makes patients vulnerable to a variety of infections, and fever is one of the first symptoms, which could develop as a result of infectious or non-infectious diseases. In the present study, the features of the fever during the pre-engraftment stage in BMT-receiving patients have been investigated.
 Materials and Methods: Sixty-four patients receiving BMT were prospectively evaluated during the pre-engraftment phase to evaluate the evidence of the febrile reaction. Data concerning the cause of fever, microbiological tests, the treatments and fever onset pattern, and treatment outcomes were recorded and analyzed.
 Results: 73.4% of the patients had autologous transplants, and the others received allogeneic. After transplantation, 75% of patients encountered fever during the pre-engraftment period. Of the 48 patients, 47.9% of the patients suffered from fever of unknown origin (FUO). Age, gender, underlying malignancy, type of transplantation, and acute phase reactants levels before transplantation were not associated with fever development. Among febrile patients, patients with autologous transplantation were significantly more likely to develop FUO (p-value = 0.036) There was also no significant difference in the onset of fever between patients with infectious fever and who suffered FUO
 Conclusions: During BMT, half of the patients developed a fever of unknown origin; nevertheless, it seems that patients undergoing autologous transplantation are at higher risk of FUO compared to patients who received an allogeneic transplant.

Rate of Acute Complications of Blood and Blood Products Transfusion among Children at Jafar Ibn Ouf Hospital, Khartoum, Sudan,2022

Blood transfusion is the process of transferring blood or blood products into one`s circulation intravenously. transfusions are used for various medical conditions to replace lost components of the blood. early transfusions used whole blood, but modern medical practice commonly uses only components of the blood, such as red blood cells, white blood cells, plasma, clotting factors, and platelets. Objectives: To assess the Rate of Acute Complications of Blood and Blood products Transfusion among Children at Jaffar Ibn Ouf Hospital, Khartoum, Sudan,2021. Methodology: It was a cross-sectional, Observational, descriptive hospital-based study. Data were collected using a checklist including brief clinical history and examination and laboratory investigation, type of blood transfusion, and short-term complications. Data were cleaned and entered into a Microsoft Excel data sheet and were analyzed using SPSS latest version software. Result: A total of 130 pediatric patients participated in this study their ages ranged from 1-17 years, most of them; 56 (43.1%) were aged less than 5 years. Of most patients, 89 (68.5%) had blood transfusions based on both clinical conditions and lab results, and 24 (18.5%) patients had blood transfusions based on their clinical conditions. In most patients, 124 (95.4%) had a complete transfusion. Only 15 (11.5%) patients developed blood reactions among them 8 (53.3%) patients developed febrile non-hemolytic transfusion reaction, 6 (40%) patients developed an allergic reaction, and 1 (6.7%) patient developed transfusion-related acute lung injury. According to patients’ outcomes; most of them 123 (94.6%) were discharged, and 2 (1.5%) cases of death. Conclusion: The main limitation of this study was that it was conducted in only one hospital,and the results may differ in other hospitals. Although our hospital serves a large geographical catchment area with numerous referrals, we do not know if current data accurately reflect the overall transfusion pattern in other similar health facilities or the country as a whole due to a lack of local comparable data. A multicenter survey is advised because it can provide more data and more solid conclusions.

Impact of Premedication Prior to Platelet Transfusion on Platelet Increment Among Hemato-Oncological Patients

Introduction: Platelet transfusions have reduced the incidence of major hemorrhagic complications among hemato-oncological patients, however they are associated with potential complications, including transfusion reactions. The efficacy of premedication with steroids and/or antihistamines prior to platelet transfusion in preventing transfusion reactions has been studied. However, to the best of our knowledge, the effect of premedication on platelet increment has not been previously addressed. We aimed to assess the impact of premedication on platelet increment after platelet transfusion. Methods: We conducted a prospective study among adult patients admitted to the hemato-oncology and bone marrow transplantation (BMT) units in a tertiary medical center. Enrolled patients, who received a platelet transfusion during their admission, had a complete blood count taken 1-hour post platelet transfusion completion. The decision whether to administer premedication and the specific medications were left to the discretion of the attending physician. Single donor platelets or 5 pooled random donor platelets were provided by the blood bank interchangeably according to inventory level. The primary outcome was platelet recovery, defined as the difference between the 1-hour post- and pre- transfusion platelet counts. Adequate platelet recovery was considered >10,000/µL. Secondary outcome was platelet survival, defined as the difference between platelet count 18- to 24-hours post- and pre- transfusion. Rates of post-transfusion reactions and premedication complications were recorded. Association of other clinical variables with outcomes of interest was evaluated and variables significantly associated with adequate platelet recovery response (p<0.05) were entered into a multivariable analysis. Results: Overall, 68 patients were enrolled, with a median age of 58 years (interquartile range [IQR] 45-67) and 43 (63%) were males. The most common diagnoses were AML (n=24, 35%) and multiple myeloma (n=23, 34%). Most patients (72%) were admitted for a BMT (autologous 47%, allogeneic 25%). Outcomes were recorded in response to 217 platelet transfusions, with a median number of platelet transfusion per patient of 4 (IQR 3-5). Premedication was given prior to 64 transfusions (29%), consisting of steroids in 17 (27%), antihistamines in 4 (6%), or both in 43 (67%) platelet transfusions. In 153 (71%) platelet transfusions, no premedication was given. Patients who received premedication were younger, more often had a diagnosis of acute leukemia and were mostly admitted for non-transplant admissions. ( Table 1). Median platelet recovery and survival for all platelet transfusions were 15,000/µL (IQR 10,0000-22,500/µL) and 8,000/µL (IQR 4000-14,000/µL), respectively. There was no significant difference in median platelet recovery and survival between patients who received premedication and those who did not (15,000/µL in both cohorts, p=0.36 and 6,500 vs. 9,000/µL, p=0.69, respectively). The number of platelet transfusions leading to adequate platelet recovery was 150/213 (70.4%) overall, with no significant difference between patients who received premedication and those who did not [45/64 (70.3%) vs.105/153 (70.5%), p=1.0]. Female gender was associated with a higher rate of adequate platelet response in univariate analysis (81.7% vs. 63.4%, p=0.006), while splenomegaly was associated with a trend towards lower rates of adequate platelet recovery (55.2% vs. 71.4%, p=0.086). None of these variables was associated with adequate platelet recovery in multivariate analysis. Febrile non-hemolytic transfusion reaction (FNHTR) was significantly more common after platelet transfusions without premedication compared to platelet transfusions with premedication (7.8% vs. 0%, respectively, p=0.02). Among patients who received premedication, only one patient developed grade 2 asymptomatic hyperglycemia. Conclusions: To the best of our knowledge, this is the first prospective study to assess the impact of premedication prior to platelet transfusion on platelet recovery and survival. We did not observe an effect of premedication on various parameters of platelet increment, while use of premedication did reduce FNHTR. Our results suggest that premedication with steroids and/or antihistamines can be given prior to platelet transfusion without compromising platelet increment.

Evaluation of Blood Transfusion-Related Reactions of Blood Recipients in Hamadan Besat Hospital Patients during 2020- 2022

Background: Blood transfusion has some complications known as transfusion-related reactions. Accurate identification and recording of these reactions is more important for their management and prevention. This study aimed to evaluate blood transfusion-related reactions in blood recipients in patients in Hamadan Besat hospital during 2020-2022. Methods: In this cross-sectional study, the data of 400 patients who had complications after receiving blood and blood components were collected in terms of hemolytic and non-hemolytic blood transfusion reactions. Data were collected from patients’ medical records and standard blood transfusion checklists and analyzed by SPSS version 26 software using the chi-square test and Fisher’s exact test. Results: Red blood cell (RBC), 70.25%, random donor platelet (RDP), 10.3%, and fresh frozen plasma (FFP), 9.5%, were the most transfused blood components. Blood transfusion reactions were allergic reactions (53.5%), febrile non-hemolytic transfusion reaction (FNHTR) (24%), dyspnea (10.25%), hemolytic reactions (HR) (4.5%), hypotension (4.25%), transfusion-associated cardiovascular overload (TACO) (1.75%), and other reactions (2.75%). A significant relationship was also observed between receiving components containing RBC, including whole blood (WB0), RBC concentrate, and leukoreduced RBC, and the incidence of FNHTR (P=0.001). Conclusion: Based on the findings of the present study, allergic reaction and FNHTR were the most common complications after blood transfusions. Blood transfusion-related reactions could be predicted, managed, and possibly prevented by considering the relationship between the type of reaction and the type of transfused blood components.

Perioperative transfusion of red cell products in patients operated at general surgical units of National Hospital of Sri Lanka

Indications for red cell transfusion among general surgical patients have changed over time. Despite a scarcity in evidence, many international guidelines advocate a restrictive transfusion protocol.Objectives: To describe the red cell transfusion practices including transfusion thresholds in general surgical wards of a tertiary hospital in Sri Lanka.Methods: A descriptive cross-sectional study was done in all general surgical units of the National Hospital of Sri Lanka, Colombo. All patients transfused with red cell products for a 3-month period from 1/5/2017-1/8/2017 were included in the study. Indications for transfusion, haemoglobin at transfusion and the number of units transfused was the primary data recorded.Results: A total of 196 patients were included in the study. Most transfusions 79.08% (n=155) were for elective reasons. Most elective transfusions were to facilitate chronic extremity wound healing (52.2%, n=81). Most emergency transfusions were for intraoperative bleeding (31.7%, n=13). The majority (73.5%, n=114) of elective transfusions occurred at a Hb of 7-10 g/dL. The mean number of RBC units transfused in elective circumstances for a Hb of 7-10 g/dL was 1.59. A pre-transfusion blood picture was not available in over 85% (n=132) of elective transfusions. Only a single febrile non-haemolytic transfusion reaction was reported.Conclusions: The study revealed substantial divergence of red cell transfusion thresholds in perioperative practice when compared with international guidelines, nonadherence to rational practice such as obtaining a blood picture prior to elective transfusion and therefore the need to formulate local guidelines. It also highlighted the transfusion burden of diabetic foot disease.

Febrile Reactions Associated with High IgG Antibody Titers after the Second and Third BNT162b2 Vaccinations in Japan.

Adverse events are potentially associated with an IgG response after BNT162b2 vaccination for severe acute respiratory syndrome coronavirus 2. In this study, we investigated the side effects of the BNT162b2 vaccine using a health questionnaire and examined its relationship with IgG antibody titers. Serum samples were collected from participants 3 months after the second vaccination, immediately before the third vaccination, and 1 and 3 months after the third vaccination. A total of 505 participants who received three doses of vaccine were eligible for inclusion in the analysis. The results showed that post-vaccination body temperature correlated with anti-spike-receptor-binding domain (anti-S-RBD) antibody titers measured 3 months after the second (r = 0.30, P < 0.001) and third (r = 0.14, P < 0.001) vaccinations. Multivariate linear regression analysis revealed that age and severe swelling were negatively associated, whereas female sex, body temperature, and heat sensation were positively associated with log-transformed anti-S-RBD antibody levels after the second vaccination. After the third vaccination, body temperature and fatigue were positively associated, and female sex was negatively associated, with the log-transformed anti-S-RBD antibody levels. These results suggest that post-vaccination fever may be a marker of a high antibody titer.

Evaluation of leukocyte depletion of packed red blood cell units and impact on clinically observed transfusion reactions.

The aim of this retrospective study was to determine whether there is an association between leukoreduction of packed red blood cell (pRBC) units and reduction of clinically observed transfusion reactions (TR), particularly febrile non-haemolytic transfusion reactions (FNHTR), and better outcomes in dogs. Secondary aims were to evaluate the effects of other factors suspected to influence transfusion reaction frequency or survival, including crossmatching, use of immunosuppressive drugs, and age and number of the blood products being administered. Medical data on dogs transfused with leukocyte-reduced (LR) and non-leukocyte-reduced (N-LR) pRBC units at the Animal Hospital Zürich, University of Zürich, Switzerland between January 1, 2007, and December 17, 2018 were searched. Before 2014, only N-LR blood were transfused. After 2014, both LR and N-LR blood were available. A total of 339 canine patients were transfused with 413 pRBC units; 30.5% (126/413) were LR units and 69.5% (287/413) were N-LR. Data collected from medical records was analyzed using univariate and multivariate logistic regression. In the present study, TR occurred in 19.8% of pRBC units (25/126) with LR and in 17.7% (51/287) of pRBC with N-LR; p > 0.05. FNHTR occurred in 6.3% of pRBC units (8/126) with LR and in 4.5% (13/287) of those with N-LR; p > 0.05. There was no correlation between the occurrence of TR and discharge from hospital (p > 0.05). Crossmatching, immunosuppressive therapy, and age of the blood product were not associated with the frequency of TR; p > 0.05 for all. The duration of survival days was not related to the number of transfusions dogs received. In the present study, the leukocyte-depletion of transfused pRBC units was not associated with fewer TR nor to fewer FNHTR compared to N-LR units. Discharge of dogs from hospital was not dependent on the occurrence of TR.

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.

Retrospective evaluation of indications, transfusion protocols, and acute transfusion reactions associated with the administration of lyophilized canine albumin: 53 cases (2009-2020).

To describe the administration of lyophilized canine albumin (LCA) and determine the increase in serum albumin concentrations post-LCA transfusion. To describe the incidence and types of acute transfusion reactions (TRs) and associated outcome in dogs presenting to a veterinary teaching hospital. Retrospective and descriptive study from 2009 to 2020. University teaching hospital. Fifty-three client-owned dogs included in the study if they received an LCA transfusion and had vital sign monitoring recorded for at least for 4hours after starting the LCA transfusion. None. The 53 dogs available for study inclusion received 64 LCA transfusions. Signalment; underlying disease; indications for LCA transfusion; pre- and posttransfusion serum albumin concentration; volume, concentration, and dose of LCA; duration of transfusion; administration of other blood products or synthetic colloids; occurrence, timing, and type of TR; length of hospitalization; and outcome were recorded. Serum albumin concentrations increased post-LCA transfusion, with a median dose of 0.56g/kg and a median posttransfusion serum albumin increase of 3g/L (0.3g/dL) (P=0.008). TRs occurred in 13 of 64 (20.3%) transfusion events. Volume per kilogram, dose (g/kg), concentration, duration of transfusion, and additional administration of synthetic colloids were not associated with TRs. Three (23%) TRs were classified as febrile nonhemolytic transfusion reaction, 5 (38.5%) as transfusion-associated dyspnea (development of respiratory distress and limited diagnostics), and 5 (38.5%) had clinical signs that could not be defined by any 1 TR category. Six (46.1%) of 13 events were nonsevere, 5 (38.5%) were severe, and 2 (15.4%) were life-threatening. Administration of LCA can be used to increase serum albumin concentrations, although the clinical implications of this increase are unknown. Acute TRs associated with LCA are relatively frequent and can be life-threatening. Careful monitoring is vital.

Study of the incidence and profile of acute transfusion reactions in children

Background: Blood is a vital human tissue and a precious health resource. Use of these components may be associated with adverse events, which compromise the efficiency and safety of blood transfusion. The incidence of adverse transfusion reactions has declined with modern facilities like improved screening and transfusion practices, but some are still observed due to alloimmunization, bacterial contamination, immunomodulation, etc. Aims and Objectives: To study the incidence and profile of acute blood transfusion reactions (ATR) in pediatric patients at our center. Materials and Methods: We monitored ATRs in patients receiving blood components among the age group of 1 month–18 years, during September 2021–August 2022. A detailed proforma was used to collect data from patients developing ATR. Results: ATRs were observed among 329 patients (3.9%) out of 9501 transfusions. In decreasing order of frequency, febrile nonhemolytic transfusion reactions (3.3%), allergies (0.5%), hemolytic reactions (0.1%) were observed. ATRs were most commonly observed with red cell concentrate transfusions (90.6%) followed by platelets (7%) and then plasma (2.2%) (P=0.059). Most of the reactions occurred within 1st 2 h (82.4%) of transfusion and the most common symptom recorded was fever (61.5%) followed by chills and rigors (20.9%). We found a significant association between ATRs and previous history of blood transfusion (81.8%) (P&lt;0.00001) and also with storage of blood components for more than 3 days (88.8%) (P=0.019). Conclusion: The prevalence of ATR was 3.9% among pediatric patients in our setup. Knowledge of risk factors associated with transfusion reaction will help in improving transfusion practices.

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

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

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

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

EVALUATION OF POSSIBLE COMPLICATIONS OF IRRADIATION OF BLOOD PRODUCTS ON PATIENTS

Background: Blood transfusion is a life-saving but high-risk procedure in various medical conditions as it is not a simple fluid infusion but an organ transplant. Although blood transfusions save lives, they may cause serious, life-threatening reactions. Nowadays, the number of reactions has decreased significantly with the reduction of leucocyte content of blood products or their irradiation. &#x0D; Materials and Method: A total of 5582 patients who received irradiated blood products in our hospital between 14/08/2020 and 17/02/2023 were included in the present study. Erythrocyte suspension, platelet apheresis, and pooled platelet suspension were irradiated at doses of 25–30 Gy.&#x0D; Results: A total of 5582 blood products including 4990 erythrocyte suspensions, 282 pooled platelet suspensions, and 310 platelet apheresis were irradiated in the present study. No transfusion-associated Graft Versus Host Disease was identified in any patient included in the present study and there were only mild allergic reactions and febrile non-hemolytic transfusion reactions. &#x0D; Conclusions: Based on the data obtained here from, it was concluded that irradiation of blood products can prevent the highly fatal transfusion-related Graft Versus Host Disease.

Complications of Therapeutic Plasma Exchange in pediatric patients: An experience at a tertiary care hospital.

To find the incidence of various complications of therapeutic plasma exchange (TPE) in ICU admitted children and to determine their association with age, gender, blood group and diagnosis of the patients. In this observational study, data of 24 patients who underwent 125 sessions of TPE was collected from the Pediatric Intensive care unit (PICU) and Hematology department of The Children's Hospital, Lahore from December 2020 to November 2021. Age, gender, blood group, indications and complications observed during and after the TPE procedure were documented on a pre-designed proforma. The data was analyzed by using SPSS version 23. Quantitative variables were presented in the form of mean and standard deviation. Qualitative variables like gender, blood groups, indications and complications of plasmapheresis were presented as frequency and percentage. Chi square test was applied for comparison of variables. Among the 24 patients, 45.8% were of age group five to ten years with mean age of 7.58 years± 2.04 years and male to female ratio of 0.84:1. Guillain-Barré syndrome (GBS) and Neuromyelitis Optica spectrum disorder (NMO-SD) were the most prevalent among the patients who underwent TPE. Most common complication was hypotension (44.9%), others were febrile reactions (11.6%), unstable vital signs (14.5%) and allergic reactions (24.6%). Blood group, clinical condition and diagnosis of the patient showed significant association with the incidence of TPE related complications. The majority of problems caused by TPE are considered to be minor. Sudden fall in blood pressure, pruritus, urticarial rash and fever are the common adverse consequences among pediatric patients. Blood group and diagnosis of the patient can determine the development of such complications during plasmapheresis procedure.

Major histocompatibility complex (MHC) antigens polymorphism and alloimmunization study in thalassemia patients with febrile non-hemolytic transfusion reaction (FNHTR).

HLA alloimmunization is one of the most troublesome consequence of regular transfusion which is itself a mainstay measure to provide longevity to the thalassemia patients. Febrile non-hemolytic transfusion reaction (FNHTR) is one of the most common complication which might be related to the HLA alloimmunization. Here, we studied the HLA antigenic system and alloimmunization rate in the Iranian β-thalassemia patients who suffered from FNHTR compare to the β-thalassemia patients without FNHTR. Total of 60 β-thalassemia patients with FNHTR (case group) and 20 β-thalassemia patients without FNHTR (control group) randomly have been selected and enrolled in the study. All were tested for HLA-A and -B loci by PCR-SSP method and also for the presence of anti-lymphocyte antibodies by LIFT method. Comparisons between two groups were performed by Pearson's χ2 test. Totally, a significant predominance was noted for two HLA alleles, HLA-A*24 (P=0.029) and B*55 (P=0.034) which have higher prevalence in control group. Although no significant association was found between the presence of anti-leukocyte antibodies and the development of FNHTR, the HLA-A*32 (P=0.047) allele was considered as possible genetic markers in the susceptibility to the development of anti-leukocyte antibodies. Here some evidences about the possible role of HLA polymorphism in susceptibility to FNHTR are provided. Those results indicated that HLA-A*24 and HLA-B*55 might play protective role on inducing FNHTR in β-thalassemia patients. Further studies which investigate the allele level of HLA-I alongside with specific reactivity of HLA-I antibodies might reveal more deep data about these phenomena.