Frequency Of Transfusion 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

Acute transfusion reactions in a district hospital: A 2-year retrospective review

Background: Blood transfusion is a life-saving intervention but carries numerous risks. It is therefore paramount to identify various adverse events associated with the procedure and to take stringent measures to reduce its occurrence. The aim of this study was to determine the incidence and analyse the type of acute transfusion reactions occurring in patients who required blood transfusion. Materials and Methods: This study was a retrospective review and analysis of all acute transfusion reactions reported to the blood bank of Methodist Hospital, Wenchi-Ghana from January 2021 to December 2022. Results: During the study period, a total of 5,857 units of blood were issued, out of which there was an incidence of 0.51% (n=30). Most acute transfusion reactions were observed in females and in patients between 26 – 45 years. The most common symptom was pruritus/itching (33.3%), followed by skin rash (23.3%) and urticaria (13.3%). Majority of the reactions were allergic (70%) followed by Febrile non-hemolytic transfusion reaction (20%). The frequency of transfusion reactions was significantly higher with packed red blood cell transfusion (50%). Conclusion: Sensitization of all health personnel involved in the transfusion chain and strict hemovigilance program enforcement will help in improving the safety of blood transfusion.

Characterization of pediatric transfusion-dependent thalassemia patients in a large academic center.

Transfusion-dependent thalassemia patients are at high risk of transfusion-related complications. Yet, there is scanty data on the frequency of transfusion reactions, particularity alloimmunization among pediatric transfusion-dependent thalassemia patients. In addition, there is no consensus on the prophylactic antigen matching for prevention of alloimmunization or the extent of antigen matching for alloimmunized thalassemia patients. We conducted a retrospective study to assess the frequency and specificity of alloimmunization among pediatric transfusion-dependent thalassemia patients receiving ABO, RhD, and K-matched red blood cell units. In addition, we studied the association between patients' characteristics and alloimmunization. The clinical and transfusion records of transfusion-dependent thalassemia patients followed up at our institution between July 2018 and June 2022 were reviewed. Ninety-two transfusion-dependent thalassemia patients having mean age of 13.37 years (SD, 5.56) were included in our study. Eight patients (9%) had developed clinically significant alloantibodies; six patients (6%) developed alloantibody against E antigen while two patients (2%) developed more than one alloantibody. Of alloimmunized patients, five patients had received transfusion outside Canada. Patients' sex, age, having a genotype variant, total number, and duration of transfusion received were not associated with the risk of alloimmunization. The transfusion-recipient's diagnosis of β-thalassemia, having developed autoantibody, and history of receiving transfusion outside Canada were associated with alloimmunization. Blood matching for ABO, RhD, and K antigens resulted in, although not eliminated, lower frequency of alloimmunization than that previously reported among pediatric thalassemia patients. Extending matching to include Rh antigens could further reduce the rate of alloimmunization.

Akut Dönem Transfüzyon Reaksiyonlarının Sıklığı: Tek Merkezli Çalışma

Amaç: Kan ve kan bileşenlerinin transfüzyonu sırasında ya da sonrasında basit reaksiyonlardan hayatı tehdit eden reaksiyonlara kadar geniş spektrumda klinik sonuçlara yol açan komplikasyonlar gelişebilmektedir. Bu çalışmanın amacı, akut dönemde gelişen transfüzyon reaksiyonlarının sıklığını saptayarak gelişebilecek komplikasyonların erken tanınması ve yönetilmesindeki farkındalığı artırmaktadır. Gereç ve Yöntemler: Araştırmamız Okmeydanı Eğitim ve Araştırma Hastanesi İç Hastalıkları ve Hematoloji Kliniğinde Kasım 2018 ile Temmuz 2019 tarihleri arasında tek merkezli olarak yürütülmüştür. Komplikasyonlar Türk Hematoloji Derneği güncel kılavuzlarına göre sınıflandırılmıştır. İç hastalıkları ve hematoloji kliniğine çeşitli nedenlerle yatışı yapılan ve transfüzyon yapılan 1.000 hasta çalışmaya dâhil edilmiştir. Bu hastaların yatış nedenleri, kan transfüzyonu endikasyonları, transfüzyon tarihi, verilen kan ürünü, cross match uyumu, kan ürünlerine ışınlama veya lökosit filtrasyonu gibi uygulanan işlemler, doğum, küretaj ve abortus öyküsü, önceki kan transfüzyonu ve komplikasyon öyküsü sorgulanarak kaydedildi. Hastalarda akut dönemde gelişen reaksiyonlar kaydedildi. Bulgular: Çalışmamızdaki hastaların 553'ü (%55,30) erkek, 447'si (%44,70) kadınlardan oluşmaktadır. Dokuz yüz elli sekiz (%95,80) hastada kan transfüzyon reaksiyonu gözlenmemiştir. Kırk iki hastada akut reaksiyon gözlenmiştir. Hastaların 29'unda (%2,9) febril reaksiyon, 8'inde (%0,8) alerjik reaksiyon, 1'inde (%0,1) alerjik reaksiyon + febril reaksiyon, 2'sinde (%0,2) hipertansiyon, 1'inde (%0,1) volüm yüklenmesi ve 1'inde (%0,1) akut hemolitik reaksiyon gözlendi. Sonuç: Çalışmamızda akut dönemdeki transfüzyon reaksiyon oranları literatüre göre daha yüksek oranda bulunmuştur. Komplikasyonların sıklığının bilinmesi, erken fark edilmesi ve uygun şekilde yönetilmesi hayati öneme sahiptir.

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.

Inpatient Non-Hemolytic Delayed Serologic Transfusion Reactions and Hospital Length of Stay: Is There an Association?

Introduction Anti-erythroid antibodies are the classical marks of serologic and hemolytic transfusion reactions. These reactions can occur acutely or in a delayed timeframe, while the sensitizing antibody may derive from the host or be passively acquired. In those with concurrent hemolysis, the red blood cell (RBC) breakdown may be severe enough to command supportive care. However, in those with non-hemolytic delayed serologic transfusion reactions (NH-DSTRs), the threat applies more towards the future rather than the present time. Downstream hazards range from hemolytic disease of the newborn, to delays and difficulties sourcing antigen-negative blood (when the antibody is known), or an anamnestic response with higher odds of hemolysis on antigen re-exposure (when the antibody becomes unknown by evanescence and healthcare fragmentation). Data are lacking on inpatient outcomes associated with discovering a new NH-DSTR during a hospital admission. A review of NH-DSTRs was thus performed in a large academic hospital (34,000 RBC dispensations annually). Methods A retrospective review of a transfusion reaction database was undertaken at a large academic hospital in Toronto, Canada. Transfusion reactions (TRs) occurring during inpatient admissions (excluding emergency room and outpatient visits) from 1/1/2010-31/12/2015 were included. NH-DSTR was defined as the presence of a new antibody on repeat screen post transfusion with no evidence of hemolysis. Other anti-RBC antibody mediated TRs included acute hemolytic transfusion reactions (AHTR) (both host-derived and passively-acquired [from products such as intravenous immunoglobulin]), and delayed hemolytic transfusion reactions (DHTR) occurring with or without serologic findings. A comparison was also made against all inpatient TRs not due to RBC antibodies (non-anti-RBC TRs). Disturbances deemed unrelated to transfusion were excluded. Outcomes included length of stay (LOS), interval between TR recognition and discharge, severity of TR (as per the International Society of Blood Transfusion grading system), and death. Results A total of 783 inpatient TRs were reviewed. The distribution of TRs (Figure 1) included 562 (71.8%) non-anti-RBC TRs and 221 (28.2%) anti-RBC TRs. Within the anti-RBC TRs, 159 (71.9%) were classified as NH-DSTRs. The mean age of all patients was 57 (± 17) with 49.4% of reactions occurring in females. Compared with non-anti-RBC and other anti-RBC transfusion reactions, NH-DSTRs were significantly less frequently classified as severe (Table 1). The overall LOS and remaining days in hospital after TR were significantly longer in those with NH-DSTRs compared with the two other groups (Table 1). Post-reaction LOS was longer by a median of 5 or 7 days for NH-DSTR versus non-anti-RBC TRs and other anti-RBC TRs respectively. There was no significant difference between groups when evaluating inpatient mortality. Conclusions NH-DSTRs are associated with a longer LOS when compared with all other TRs. This relationship holds even in comparisons with other anti-RBC TRs. Causality is not established by this analysis, nor is there a biologic rationale for a NH-DSTR to directly impact LOS. However, the propensity to form a new anti-RBC antibody may reflect an underlying pro-inflammatory comorbid state that itself may be influencing LOS. Further studies are needed to confirm this association. Nevertheless, given any potential for additional/current impacts beyond future ramifications, the precautionary principle is strengthened for the value of curating the full extent of a recipient's antibody history, and prophylactically matching for minor antigens if resources permit. Table 1 Comparison of outcomes between NH-DSTRs versus non-anti-RBC TRs and other-anti-RBC TRs. Table 1. Comparison of outcomes between NH-DSTRs versus non-anti-RBC TRs and other-anti-RBC TRs. Figure 1 Frequency of transfusion reactions from January 1, 2010 to December 31, 2015. Abbreviations: allergic transfusion reaction (ATR), febrile non-hemolytic transfusion reaction (FNHTR), transfusion associated circulatory overload (TACO), transfusion associated dyspnea (TAD), bacterial contamination (BaCon), transfusion related acute lung injury (TRALI), inflammatory transfusion reaction (ITR), citrate reaction (CR), acute passive serologic/hemolytic transfusion reaction (APSHTR). Figure 1. Frequency of transfusion reactions from January 1, 2010 to December 31, 2015. Abbreviations: allergic transfusion reaction (ATR), febrile non-hemolytic transfusion reaction (FNHTR), transfusion associated circulatory overload (TACO), transfusion associated dyspnea (TAD), bacterial contamination (BaCon), transfusion related acute lung injury (TRALI), inflammatory transfusion reaction (ITR), citrate reaction (CR), acute passive serologic/hemolytic transfusion reaction (APSHTR). Disclosures No relevant conflicts of interest to declare.

Quality of freeze‐dried (lyophilized) quarantined single‐donor plasma

Transfusion of plasma is a basic treatment for complex coagulopathies as well as in major blood loss. Early transfusion of plasma after trauma with major hemorrhage has been recommended by retrospective studies. However, the use of plasma is often hampered by the need to maintain a cold chain and the time needed for thawing fresh-frozen plasma (FFP). With freeze-dried (lyophilized) plasma (FDP) both difficulties can be avoided. Here, we describe the production, quality characteristics, and our experiences with FDP. Quarantine plasma samples were freeze-dried. The clotting factors fibrinogen, Factor (F)V, FVIII, FXI, von Willebrand factor (vWF), protein S, antithrombin, plasminogen, and plasmin inhibitor were determined after manufacturing and after storage at room temperature and refrigeration. Reported adverse transfusion events were evaluated and compared to that of FFP. Clinical effectiveness was estimated by inquiry among experienced users. Lyophilization resulted in a loss of coagulation factor activity between 0% and up to 20% to 25% (FVIII, vWF). When stored refrigerated, coagulation factors did not lose more than 10% of their activities. Storage at room temperature for 24 months mainly affected vWF/ristocetin cofactor activity and fibrinogen activity. From 2007 to 2011 more than 230,000 units of FDP were delivered. There were no reports about clinical ineffectiveness. The frequency of transfusion reactions was not different from that of FFP. Lyophilized plasma showed characteristics similar to FFP. Since FDP requires neither complex logistics nor time-consuming thawing, it allows rapid treatment of coagulopathies.

Cytokines in platelet concentrates: A comparison of apheresis platelet (haemonetics) and filtered and unfiltered pooled buffy-coat derived platelet concentrates

Variable degrees of platelet activation, shape changes, microvesiculation and fragmentation may occur during collection, processing and storage of platelet concentrates (PCs), contributing to different rate of platelet storage lesion. Leukocytes contribute to both the frequency of transfusion reactions and the acceleration of the rate of platelet storage lesion hence leukocyte removal of platelet concentrates has been introduced to overcome these problems. However transfusion reaction can still occur with the use of leukoreduced products and it is not fully elucidated that the rate of storage lesion is equivalent for filtered and unfiltered counter parts. This issue has been addressed in this manuscript comparing the generation of cytokines during storage in PCs derived from pooled buffy coat with the standard apheresis products, with a similar level of leukocyte contamination. The EDTA-induced shape change in platelet was used as an index of platelet functional integrity. In addition IL-8 and TGFβ were used as indicators of filtration process-inducing stimulation of cytokines. Our results clearly indicate that a rapid disc/spheric conversion occurs during storage of buffy-coat derived PC, and while prestorage filtration reduces both IL-8 content immediately after filtration and at the end of platelet shelf life but such a process may lead to slight enhancement of the rate of TGFβ generation indicating that any additional process may have some bearing in stimulation of TGFβ release.

Cytokines in platelet concentrates: A comparison of apheresis platelet (haemonetics) and filtered and unfiltered pooled buffy-coat derived platelet concentrates

Variable degrees of platelet activation, shape changes, microvesiculation and fragmentation may occur during collection, processing and storage of platelet concentrates (PCs), contributing to different rate of platelet storage lesion. Leukocytes contribute to both the frequency of transfusion reactions and the acceleration of the rate of platelet storage lesion hence leukocyte removal of platelet concentrates has been introduced to overcome these problems. However transfusion reaction can still occur with the use of leukoreduced products and it is not fully elucidated that the rate of storage lesion is equivalent for filtered and unfiltered counter parts. This issue has been addressed in this manuscript comparing the generation of cytokines during storage in PCs derived from pooled buffy coat with the standard apheresis products, with a similar level of leukocyte contamination. The EDTA-induced shape change in platelet was used as an index of platelet functional integrity. In addition IL-8 and TGFβ were used as indicators of filtration process-inducing stimulation of cytokines. Our results clearly indicate that a rapid disc/spheric conversion occurs during storage of buffy-coat derived PC, and while prestorage filtration reduces both IL-8 content immediately after filtration and at the end of platelet shelf life but such a process may lead to slight enhancement of the rate of TGFβ generation indicating that any additional process may have some bearing in stimulation of TGFβ release.

Failure to kill Yersinia enterocolitica by plasma diluted to the concentration found in red cell units.

The possibility that the use of additive solutions for red cell storage might impair the ability of plasma to kill Yersinia enterocolitica was investigated by studying killing of Y enterocolitica by neat and diluted plasma. The ability of neat citrated plasma to kill complement sensitive organisms was lost at around 26%, the dilution typically found in red cell units. These results should be considered in the light of evidence that killing in plasma is important in the protection of donated blood against growth of Y enterocolitica, and the observation that the increase in frequency of transfusion reactions caused by Y enterocolitica coincided with the widespread introduction of additive solutions. Taken together, these points support the suggestion that the introduction of additive solutions may have precipitated the problem of growth of Y enterocolitica in stored blood.

Transfusion of blood components to persons infected with human immunodeficiency virus type 1: relationship to opportunistic infection.

Although a recent study reported shorter survivals in human immunodeficiency virus type 1 (HIV-1)-infected patients who received transfusions, no study has analyzed the relationship in such patients between the frequency of opportunistic infection and transfusion. Records of 196 HIV-1-infected subjects with CD4 lymphocyte counts below 250 cells per mm3 were reviewed to determine if there were more opportunistic infections in patients who previously received transfusions than in those who received no transfusions. The decline in CD4 cells was also compared, and the frequency of transfusion reactions and red cell alloantibodies was assessed. The frequency of cytomegalovirus (CMV), wasting, and bacterial infections (p < 0.01), but not the frequency of Pneumocystis carinii pneumonia (PCP) (p > 0.2), was significantly increased in the patients who had previously received transfusions, and this effect was independent of CD4 count, race, or risk factor. The frequency of CMV infection, but not of PCP, was also related to the number of units of blood received (p < 0.01). Significant bacterial infections occurred primarily in persons with CMV infection, of whom there were more in the transfusion cohort. When analyzed separately in the group of patients without CMV infection, the frequency of bacterial infection was unrelated to transfusion. The death rate in those who received transfusions was also greater than that in patients who had never received a transfusion. None of the 130 patients who received red cell transfusions developed red cell alloantibodies. The higher incidence of certain infectious complications in HIV-1-infected patients who received transfusions indicates that the relationship of transfusion to virus activation in patients with acquired immunodeficiency syndrome and the potential benefits of modifying the preparation of blood components should be investigated further.

A clinical evaluation of citrate-phosphate-dextrose-adenine blood.

(1) Blood was stored in polyvinyl-chloride bags containing citrate-phosphate-dextrose (CPD) with adenine in a final concentration of 0.25 mM. (2) Red cell ATP was well maintained (greater than 70% of original) for 4 weeks in whole blood as well as in red cell concentrate (PCV 85 plus or minus 2%). After 5 weeks the ATP level was about 70% in whole blood and about 40% in red cell concentrate. (3) Red cell 2,3-diphosphoglycerate (DPG) was about 60% of the original after 2 weeks and about 30% after 3 weeks of storage when stored both as whole blood and as red cell concentrate. (4) The red cell 24-hour post-transfusion viability was about 80% after 4 weeks of storage both as whole blood and as red cell concentrate. After 5 weeks of storage the 24-hour viability was 78.7 plus or minus 3.5% in whole blood and 76.5 plus or minus 6.7% in red cell concentrate. (5) 820 patients received 3,238 units of CPD-adenine blood, and 761 patients serving as controls received 2,807 units of acid-citrate-dextrose (ACD) blood. The frequency of transfusion reactions was 3.5% for patients receiving CPD-adenine blood and 4.1% for the control group. (6) The maximum storage time was set at 5 weeks for the CPD-adenine blood and 3 weeks for the ACD blood. The longer preservation time decreased out-dating by at least 50%.