Incidence Of Transfusion Reactions Research Articles

Is Preoperative Type and Screen High-value Care? A Cost-effectiveness Analysis of Performing Preoperative Type and Screen Prior to Urogynecological Surgery.

Routine preoperative type and screen (T&S) is often ordered prior to urogynecological surgery but is rarely used. We aimed to assess the cost effectiveness of routine preoperative T&S and determine transfusion and transfusion reaction rates that make universal preoperative T&S cost effective. A decision tree model from the health care sector perspective compared costs (2020 US dollars) and effectiveness (quality-adjusted life-years, QALYs) of universal preoperative T&S (cross-matched blood) vs no T&S (O negative blood). Our primary outcome was the incremental cost-effectiveness ratio (ICER). Input parameters included transfusion rates, transfusion reaction incidence, transfusion reaction severity rates, and costs of management. The base case included a transfusion probability of 1.26%; a transfusion reaction probability of 0.0013% with or 0.4% without T&S; and with a transfusion reaction, a 50% probability of inpatient management and 0.0042 annual disutility. Costs were estimated from Medicare national reimbursement schedules. The time horizon was surgery/admission. We assumed a willingness-to-pay threshold of $150,000/QALY. One- and two-way sensitivity analyses were performed. The base case and one-way sensitivity analyses demonstrated that routine preoperative T&S is not cost effective, with an ICER of $63,721,632/QALY. The optimal strategy did not change when base case cost, transfusion probability, or transfusion reaction disutility were varied. Threshold analysis revealed that if transfusion reaction probability without T&S is >12%, routine T&S becomes cost effective. Scenarios identified as cost effective in the threshold and sensitivity analyses fell outside reported rates for urogynecological surgery. Within broad ranges, preoperative T&S is not cost effective, which supports re-evaluating routine T&S prior to urogynecological surgery.

Futility of fresh frozen plasma in the correction of coagulopathy prior to image-guided drainage of infected collections: Results from a prospective case–control study

Abstract BACKGROUND: Fresh frozen plasma (FFP) is frequently used as prophylactic hemostatic therapy for correction of periprocedural coagulopathy. This practice is frequently based on the assumption that deranged international normalized ratio (INR) predicts the risk of periprocedural bleeding and that FFP transfusion is effective in mitigating the procedure-associated bleeding risks. There is limited evidence to support both these assumptions in the context of image-guided drainage of infected collections. AIMS: The study aimed to analyze the efficacy of weight-based standard FFP dose for correction of infection-associated coagulopathy in patients with clinicoradiologically diagnosed infected collections planned for image-guided drainage. MATERIALS AND METHODS: In this prospective case–control study, 229 patients with clinicoradiologically diagnosed infected abdominal collection(s) planned to undergo image-guided drainage were included. Cases and controls were defined as patients with baseline INR >1.2–3 (in the absence of any other bleeding diathesis) and INR ≤1.2, respectively. Cases received 10–15 mL/kg of FFP before drainage. Costs and time delays in drainage among the two groups, efficacy of plasma transfusion in the correction of coagulopathy, incidence of transfusion reactions, bleeding complications, and inhospital mortality were analyzed. RESULTS: There were 117 cases and 112 controls. A total of 445 FFP units were utilized. The median (interquartile range) time required from diagnosis of collection to the procedure was 25.3 (20.8–40.3) hours among cases and 16.4 (8.7–20.1) hours among controls (P < 0.001). FFP transfusion resulted in INR normalization (≤1.2) only in 7.9% of cases (n = 9). Among the 81 cases who had pretransfusion INR ≥1.5, INR improved to ≤1.5 in 49 (60.4%) patients. There was an average of 2.9% decrease in INR per unit of FFP transfused. No bleeding complications were noted in patients undergoing drainage despite a persistent deranged INR (>1.5) postplasma transfusion. Transfusion reactions occurred in 17/117 (14.5%) patients. There were no deaths among the controls while five patients died among the cases. CONCLUSION: Prophylactic FFP transfusion for infection-associated coagulopathy leads to a significant delay in lifesaving drainage procedures. Minority of patients attain normalization of INR with FFP transfusion.

Every one counts: A retrospective cohort study examining the safety of extending pre-transfusion compatibility testing from 72 hours to 7 days in hematology patients receiving red blood cell transfusions

Aims: To investigate the safety of extending the pretransfusion compatibility testing (PTCT) interval from 72 hours to 7 days in hematology patients receiving packed red blood cells (PRBC). Methods: We undertook a retrospective cohort study over two years when the local protocol for PTCT in recently transfused hematology patients was changed from 72 hours to 7 days. All transfusions from 12 months prior and post this date were exported from eBlood and analyzed. The primary outcome was the incidence of transfusion reactions. Subgroup analysis was conducted for the chronically transfused patient group and patients with PTCT > 72 hours. Results: A total of 2079 packs were analyzed from 227 patients. Only 37 transfusions that fulfilled the extended crossmatch. There were five (0.69%) transfusion reactions within the post-protocol change cohort and no transfusion reactions in the pre-protocol change cohort. All transfusion reactions occurred in the greater 72-hour subgroup of the post-protocol change cohort. At the time of reaction, there were no alloantibodies identified. No patients demonstrated new alloantibodies post-reaction. Conclusion: This study found no evidence for an increased risk of transfusion reactions associated with increasing the PTCT interval from 72 hours to 7 days in a subset of chronically transfused hematology patients. Extending the PTCT interval could decrease costs, decrease patient infection risk, improve comfort, and conserve public health resources. Further evaluation in a larger cohort is necessary.

Impact of buffy coat reduction on the severity of febrile nonhemolytic transfusion reactions with red cell components.

Febrile nonhemolytic transfusion reactions (FNHTRs) are the most common adverse reaction reported under the Haemovigilance Programme of India, and the use of leukodepleted blood products is recommended. The severity of the reaction may affect the morbidity associated with the reaction. This study aims to calculate the incidence of various transfusion reactions in our blood center and to evaluate the impact of buffy coat reduction on the severity of febrile reaction and other hospital resource-consuming activities. It was an observational retrospective study in which all reported FNHTRs were evaluated during the period July 1, 2018-July 31, 2019. Patient demographic details, component transfused, and clinical presentation were analyzed to identify factors affecting the severity of FNHTRs. The incidence of transfusion reaction in our study period was 0.11%. Out of total 76 reactions reported, 34 (44.7%) were febrile reactions. Other reactions included allergic reactions (36.8%), pulmonary reactions (9.2%), transfusion-associated hypotension (3.9%), and others (2.7%). The incidence of FNHTR in buffy coat-depleted packed red blood cells (PRBCs) and PRBCs is 0.03% and 0.05%, respectively. FNHTRs are seen more in females with prior history of transfusion (87.5%) as compared to males (66.67%) (P = 0.046). We also found that FNHTRs are less severe with buffy coat-depleted PRBC transfusion than PRBC transfusion as mean ± standard deviation temperature rise was less in buffy coat-depleted PRBC (1.3 ± 0.8) than PRBC (1.74 ± 1.129). The febrile response to buffy coat-depleted PRBC transfusion occurred at higher volume (145 ml) transfusion than PRBC transfusion (87.2 ml), and it was statistically significant (P = 0.047). Leukoreduction remains the main modality to prevent FNHTR, but in developing countries like India, the use of buffy coat-depleted PRBC over PRBC can reduce the incidence and severity of FNHTR.

Novel Home-Based Transfusion Model of Palliative Care in Malignant Hematology

Background: Patients with hematologic malignancies often receive aggressive care at the end of life (EOL) and utilize hospice services less frequently than patients with solid tumors1. Hospice utilization rates are low, and patients enroll late in the disease, spending an average of 3 days on hospice2, thereby limiting the potential benefit of hospice care1,3. Access to transfusions has been identified as a major barrier to hospice enrollment in hematologic malignancies despite representing an important strategy that can help improve quality of life (QOL) and symptoms for these individuals4,5. Therefore, we hypothesized that the creation of a home-based transfusion system that allows patients to receive blood and platelet transfusions while enrolled in hospice would improve their QOL and symptom burden. Furthermore, we created a program with symptom-based triggers for transfusion, rather than the standard transfusion practices with complete blood count (CBC) triggers. In this interim analysis of our novel home-based transfusion pilot study, we sought to investigate feasibility, transfusion reaction incidence, QOL and symptom improvement, and hospice outcomes. Methods: Patients enrolled in hospice and participated in the home-based transfusion system from 8/17/2020 to 2/16/2022 (n=12 out of a planned 20). Eligibility criteria included: age ≥18 years, primary hematologic malignancy, transfusion dependence and an absence of previous blood transfusion reactions or difficulty with blood typing. Evaluable patients received one unit of packed red blood cells (RBCs) and/or platelet transfusions weekly based on trigger symptoms (Common Terminology Criteria for Adverse Events [CTCAE] defined grade 2+ symptoms secondary to anemia and/or thrombocytopenia) continued until unacceptable toxicities or death. Patients were assessed by study personnel via a phone call at the start of every week. All patients who received transfusions, received follow-up phone calls 48-72 hours after transfusion to assess for post-transfusion reactions, symptoms, and QOL via the EORTC QLQ C30 questionnaire. The primary end point was feasibility of home based transfusion system with secondary endpoints assessing QOL and symptoms, transfusion rate and reaction incidence, length of time on hospice, incidence of revocation of hospice, hospitalization while on hospice and site of death. Weekly CBC data was collected throughout the course of this study and CBC data was blinded to the study personnel until study completion. Results: 12 patients were enrolled. Median patient age was 66 (range 31-83) years. Patients’ diseases included Acute Myeloid Leukemia (9 [75%]), Non-Hodgkin Lymphoma (2 [16.7%]), and Myelodysplastic Syndrome (1 [8.3%]). The average number of transfusions per patient was 2.91 (n=11) with no reported transfusion reactions. The average number of reported grade 2+ symptoms decreased from 2.93 to 1.97, pre- and post-infusion respectively. Patients reported that pre-transfusion dyspnea and fatigue were the most common symptoms, both of which improved after transfusions by 55% (patients reported dyspnea 66.67% of the time pre-transfusion vs 30% post transfusion) and 22% (patients reported fatigue 90% of the time pre-transfusion and 70% post transfusion), respectively. Median time on hospice was 11.5 days. The mean number of transfusions per patient while on hospice was 2.67 (n=11) packed RBCs and 1.50 (n=10) platelets. The mean EORTC QOL score pre-transfusion was 50.49 and post transfusion 51.95 with a mean difference of 1.46. There was one hospitalization (for fever and severe thrombocytopenia), no ICU admissions and no hospice revocations. All 12 patients died at home. Conclusion: In this interim analysis, we described the potential feasibility of a novel home-based transfusion system, with high enrollment rates and no transfusion reactions. Notably, the number of transfusions required was quite small, and we found that patients’ most common symptoms improved following transfusion. In our small pilot study, the time on hospice increased from a standard 3 days to 11.5 days. No transfusion reactions were noted, and transfusions improved QOL. Future work is needed in a larger demonstration project to evaluate if home-based transfusion system could improve hospice utilization and quality of hospice care in patients with hematologic malignancies.

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.

Changes in the incidence of transfusion reactions in hematological patients over the past 30 years.

Patients with hematological diseases are polytransfused and often immunocompromised, therefore susceptible to transfusion reactions (TR). This study aims to document the incidence of TRs in adult hematological patients and assess the effect of changes in the production of blood components and transfusion practice on their occurrence. Retrospective observational analysis of TRs reported from 1993 to 2019 was performed. For the analysis of the effect of changes on the incidence of TRs, the evaluated time was divided into two periods: the 1st period before the introduction of changes in production, when leukoreduced blood components were used only selectively, and the 2nd period, when semi-automated method of production and universal leukoreduction was introduced. The decrease in the incidence of TRs was observed for both red blood cell (RBC) and platelet concentrate (PC) transfusions in the 2nd period. Since platelet additive solution has been used, a further decrease in the incidence was reported. The decrease in incidence was also observed for delayed hemolytic/serological transfusion reactions and for transfusion-transmitted bacterial infections. Four cases of incorrect blood transfusions were uniquely related to the hematological patients, caused by antigen loss and transfusion ordering after ABO-incompatible hematopoietic stem cell transplantation. Our results provided evidence that the introduction of tools offered by modern transfusion medicine: universal leukodepletion, plasma replacement with additive solutions, sensitive laboratory techniques, prophylactic antigen matching policy, informatization, and automatization, decreased the incidence of TRs and improved transfusion safety.

Frequency and types of transfusion reactions in pediatric population: A report from a tertiary care center in Pakistan

Background: A transfusion reaction is an untoward reaction following blood transfusion. It can be immediate or delayed and further sub-classified into immune and nonimmune. The role of physicians and paramedical staff is important in recognition of reaction and notifying transfusion services by sending relevant material for workup. Objective: The aim of the current study is to see frequency and types of transfusion reactions in pediatric population in a tertiary care center. We also assessed the compliance of clinical staff to send the proper transfusion reaction workup in required time. Materials And Methods: This retrospective cross-sectional study was conducted in the section of hematology and transfusion medicine of a tertiary care hospital in Karachi, from January 2020 to December 2021 after the approval from Ethical Review Committee. The data were analyzed using SPSS version 20. Results: Of the 21,230 units dispensed and transfused, 36 (0.17%) transfusion reactions were noted. Allergic was the most frequent type 21 (58.3%). Red cells accounted for 28 (77.8%) of the reactions. In all cases, reaction forms were completely filled. Blood bags, posttransfusion ethylenediaminetetraacetic acid samples and urine samples in only 8 (22.2%) cases were received at blood bank within 2 h of reaction. Conclusion: Incidence of transfusion reactions was 1 in 590 units transfused. Allergic reactions were most common. No acute hemolytic or septic reaction noted. Practices regarding submission of transfusion reaction form along with required workup to the blood bank need improvement.

Effect of washing units of canine red blood cells on storage lesions.

BackgroundIn humans, washing stored blood products before transfusion reduces storage lesions and incidence of transfusion reactions, but the effectiveness of washing canine blood is unknown.ObjectivesThe objective was to determine if manually washing units of stored blood would reduce storage lesions without adversely affecting erythrocytes. We hypothesized that washing stored units would reduce concentrations of storage lesions and cause minimal erythrocyte damage.AnimalsEight healthy research dogs.MethodsRepeated measure cohort study. Units of whole blood were stored for 28 days and washed 3 times with 0.9% NaCl. Blood samples were collected before and after storage, after each wash, and after being held at a simulated transfusion temperature. Variables measured included CBC variables, blood gas analysis, erythrocyte morphology, mean corpuscular fragility (MCF), and eicosanoid concentrations. A Friedman's test was used to evaluate changes in variables (P < .05 was considered significant).ResultsAfter the first wash, compared to values after storage, there was a significant decrease in potassium (4.3 mmol/L [4.0‐4.7] to 1.2 mmol/L [1‐1.6]; P < .0001, median [range]), lactate (1.45 mmol/L [1.07‐1.79] to 0.69 mmol/L [0.39‐0.93]; P = .002), and partial pressure carbon dioxide (102 mm Hg [80.2‐119.2] to 33.7 mm Hg [24.5‐44.5]; P < .0001), and increase in MCV (69.3 fL [65.7‐72.3] to 74 fL [69.6‐79.5]; P = .0003), and MCF (0.444 fL [0.279‐0.527] to 0.491 fL [0.43‐0.616]; P = .0006).Conclusions and Clinical ImportanceA single wash of stored whole blood significantly reduces most extracellular storage lesions, and additional washing might cause hemolysis.

Active surveillance of serious adverse events following transfusion of COVID-19 convalescent plasma.

BackgroundThe reported incidence of adverse reactions following Coronavirus disease 2019 (COVID‐19) convalescent plasma (CCP) transfusion has generally been lower than expected based on the incidence of transfusion reactions that have been observed in studies of conventional plasma transfusion. This raises the concern for under‐reporting of adverse events in studies of CCP that rely on passive surveillance strategies.Materials and MethodsOur institution implemented a protocol to actively identify possible adverse reactions to CCP transfusion. In addition, we retrospectively reviewed the charts of inpatients who received CCP at Stanford Hospital between May 13, 2020 and January 31, 2021. We determined the incidence of adverse events following CCP transfusion.ResultsA total of 49 patients received CCP. Seven patients (14%) had an increased supplemental oxygen requirement within 4 h of transfusion completion, including one patient who was intubated during the transfusion. An additional 11 patients (total of 18, 37%) had increased oxygen requirements within 24 h of transfusion, including 3 patients who were intubated. Six patients (12%) fulfilled criteria for transfusion‐associated circulatory overload (TACO).ConclusionUsing an active surveillance strategy, we commonly observed adverse events following the transfusion of CCP to hospitalized patients. It was not possible to definitively determine whether or not these adverse events are related to CCP transfusion. TACO was likely over‐diagnosed given overlap with the manifestations of COVID‐19. Nevertheless, these results suggest that the potential adverse effects of CCP transfusion may be underestimated by reports from passive surveillance studies.

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.

Educational and Electronic-Based Tools to Mitigate the Risk of Transfusion Adverse Events.

The transfusion of blood products is a widely used practice but comes with the risk of transfusion-associated adverse events and fatalities. The primary aim of this study was to evaluate if strict adherence to transfusion guidelines would lead to a decrease in the rate of transfusion reactions that occurred when blood products were given outside of established indications. Hospital-wide educational programs and dedicated electronic transfusion order sets were used to encourage adherence to guidelines. A secondary aim of this study was to evaluate if a decrease in the incidence of transfusion reactions also lead to a decrease in associated healthcare costs.

An audit of transfusion reaction monitoring and reporting at a cancer hospital in Pakistan - a step towards haemovigilance.

To monitor the frequencies of different adverse transfusion reactions and to assess the compliance of clinical staff with the process of sending proper transfusion reaction workup within the specified time. The retrospective audit was conducted at the blood bank of Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised all transfusion reaction forms received from July 1, 2017, to June 30, 2018. The forms were analysed for type of blood component, time in which it was received by the blood bank, whether or not the form was completely filled, whether or not all required samples were provided, and the type of reaction. Of the 12,787 units dispensed and transfused, 50(0.39%) transfusion reactions were noted. Allergic was the most frequent type 24(48%). Red cells accounted for 38(76%) of the reactions. In 58(95%) cases, reaction forms were completely filled. Blood bags in 36(59%) and post-transfusion ethylenediaminetetra acetic acid samples in 35(57.3%) cases were received at blood bank within 2 hours of reaction. Incidence of transfusion reactions was found to be low as there was good compliance with procedures on the part of the clinical staff.

Transfusion reactions in pediatric and adolescent young adult haematology oncology and immune effector cell patients.

BackgroundActive surveillance for transfusion reactions is critically important among pediatric patients undergoing chemotherapy. Among pediatric-adolescent-young-adult (AYA) hematology/oncology patients, who have been typically excluded from transfusion reaction studies, this profile remains poorly characterized.MethodsWe assessed the incidence and clinical characteristics of transfusion reactions (n = 3246 transfusions) in this population (n = 201 patients) at our center.FindingsThe incidence of adjudicated transfusion reactions was 2·04%. The incidence was higher for platelet (2·78%) compared to packed red blood cell transfusions (1·49%) (p = 0·0149). The majority (61·4%) of all reactions were classified as febrile non-haemolytic transfusion, while 35·7% were considered allergic, and 2·9% were classified as transfusion-associated circulatory overload. The incidence of transfusion reactions in patients who were pre-medicated was higher (2·51%) than in patients who were not (1·52%) (p = 0·0406). Sub-set analysis revealed a 3·95% incidence of adjudicated transfusion reactions among recipients of immune effector cells (IECs) (n = 3), all of which occurred during the potential window for cytokine release syndrome; two-thirds of these reactions were severe/potentially life-threatening.InterpretationThe incidence of transfusion reactions among pediatric-AYA hematology/oncology patients may be lower than the general pediatric population. Patients with a prior history of transfusion reactions and those receiving platelet transfusions may be at higher risk for reaction. From our limited sample, IEC recipients may be at risk for severe transfusion reactions. Large multi-center prospective studies are needed to characterize transfusion reactions in this population. Appropriate characterization of reactions in this population may inform risk stratification and mitigate missed opportunities for prompt recognition and appropriate management.FundingNone.

AML-192: Transfusion Reactions in Children with Acute Myeloid Leukemia in Armenia: Analysis of 20 Years of Data

Context The incidence and severity of transfusion reactions in children with AML differ from those in adults. Published data on this problem is limited, especially from the developing world. Objective The aim of our nationwide study was to evaluate the necessity of blood products transfusions and the incidence of transfusion reactions among children with acute myeloid leukemia (AML) during their hospitalization in Armenia between 1995 and 2014. Design The medical records of all children with different types of AML receiving treatment in 2 main hospitals (Hematology Center after Prof. R.H.Yeolyan and Muratsan Hospital Complex of Yerevan State Medical University) of Armenia within 20 years (1995-2014) were retrospectively reviewed and analyzed. Results Data of 91 pediatric patients with AML with a median age of 12 y and mean age of 10.7 y were collected. Fifty-six (61.5%) patients were male. From the entire cohort, 61 (67%) patients received RBC transfusions overall 423 times (on average 7 transfusions per patient). Information about pretransfusion Hb level was available in 132 cases: in 102 (77.3%) cases, it was below 70 g/L, in 24 (18.2%) cases, between 70 and 80 g/L, and in 6 (4.5%) cases, it was above 80 g/L. Only one transfusion reaction (chills) was documented. Platelets (PLT) were transfused to 36 (39.6%) patients: 522 (14.5 units per patient) units of whole blood platelets (WBT) were administered overall 292 times (1.8 unit per transfusion). In 149 (51%) transfusions, the pretransfusion PLT levels were below 10 × 109/L. In the entire group, WBT transfusion-related reactions were documented 2 times (1 urticaria and 1 febrile reaction with chills). Twelve packs of apheresis platelets were used and only 1 case of urticaria was reported. 286 packs (6 packs per patient) of fresh-frozen plasma (FFP) were administered to 48 (52.75%) patients. In this subgroup 10 cases of urticaria, 1 case of vomiting, and 1 febrile reaction were documented. Whole blood was transfused to 2 (2.2%) patients 4 times. Conclusions In our study cohort, no life-threatening transfusion reactions were reported for any blood product transfusion, which proves that blood transfusions are quite safe in children with AML. Larger studies need to explore these findings.

Effect of cross-match on packed cell volume after transfusion of packed red blood cells in transfusion-naïve anemic cats.

BackgroundNovel feline RBC antigens might contribute to decreased efficacy of RBC transfusion and increased incidence of acute transfusion reactions (ATR).ObjectivesTo examine the effect of major cross‐match in transfusion‐naïve anemic cats on the incidence of acute immunologic transfusion reaction and transfusion efficacy for up to 24 hours after transfusion.AnimalsForty‐eight client owned transfusion‐naïve anemic cats.MethodsProspective, randomized, controlled study. All transfusion‐naïve cats receiving packed red blood cells (pRBC) transfusions from January 2016 to August 2017 were eligible for inclusion. Cats in the study group received cross‐match and blood type compatible pRBCs and cats in the control group received noncross‐matched blood type compatible pRBCs. Incidence of ATR and change in PCV after transfusion was recorded.ResultsNo significant difference in incidence of transfusion reactions between cross‐matched and noncross‐matched groups (CM+ 4/24; 17%, CM– 7/24; 29%, P = .16). No significant difference between groups in mean change in PCV after transfusion scaled to dose of pRBCs administered at any time point after transfusion (immediate: CM+ 0.62 ± 0.59, CM– 0.75 ± 0.48, P = .41; 1 hour: CM+ 0.60 ± 0.66, CM– 0.74 ± 0.53, P = .43; 12 hours: CM+ 0.70 ± 0.55, CM– 0.66 ± 0.60, P = .81; 24 hours: CM+ 0.64 ± 0.71, CM– 0.55 ± 0.48, P = .70).Conclusions and Clinical ImportanceOur results do not support use of the major cross‐match test to increase efficacy of, and to decrease adverse events associated with, RBC transfusion in AB blood typed transfusion‐naïve cats.

Retrospective analysis of all patients undergoing blood transfusion in obstetrics at a Tertiary Care Hospital, Belgaum: A cross-sectional study

OBJECTIVES: This study was conducted to know the various indications of blood transfusion (blood and blood products) in obstetrics and to know transfusion reactions if any. METHODOLOGY: This study was done from September 2014 to September 2015 in the Department of Obstetrics and Gynaecology, KLE Dr. Prabhakar Kore Charitable Hospital and Medical Research Centre, Belagavi. All women who received blood and blood product transfusion for any obstetric cause during this period were analyzed to know the indications for transfusion and to know transfusion reactions. RESULTS: A total of 204 women received blood and blood products transfusion in this study. The indications for blood and blood product transfusion observed in our study were anemia, obstetric hemorrhage, hemolysis, elevation of liver enzymes and low platelets, thrombocytopenia, disseminated intravascular coagulopathy, ruptured ectopic, ruptured uterus, and others (incomplete abortion, complete abortion, hydatidiform mole, and persistent trophoblastic disease). Anemia in pregnancy was the most common indication and was observed in 121 cases (58.45%) followed by Obstetric hemorrhage, which was seen in 40 cases (19.32%). The incidence of transfusion reactions was 4.41% in our study. CONCLUSION: A proper knowledge for blood and blood product transfusion is needed to make it available for people who are actually in need and also to decrease the economic burden. The appropriateness of utilization of blood and blood products lies with the physicians' compliance with blood transfusion guidelines. Anemia followed by obstetric hemorrhage still persists to be a major cause for blood and blood product transfusion. Measures to prevent anemia should be implemented. Obstetric hemorrhage is an emergency situation and cannot always be avoided or prevented. The development of various strategies to avoid transfusion reactions is needed.

Prediction of Packed Cell Volume after Whole Blood Transfusion inSmall Ruminants and South American Camelids: 80 Cases (2006-2016).

BackgroundCalculation of desired whole blood transfusion volume relies on an estimate of an animal's circulating blood volume, generally accepted to be 0.08 L/kg or 8% of the animal's body weight in kilograms.ObjectiveTo use packed cell volume before and after whole blood transfusion to evaluate the accuracy of a commonly used equation to predict packed cell volume after transfusion in small ruminants and South American camelids; to determine the nature and frequency of adverse transfusion reactions in small ruminants and camelids after whole blood transfusion.AnimalsFifty‐eight small ruminants and 22 alpacas that received whole blood transfusions for anemia.MethodsRetrospective case series; medical record review for small ruminants and camelids that received whole blood transfusions during hospitalization.ResultsMean volume of distribution of blood as a fraction of body weight in sheep (0.075 L/kg, 7.5% BW) and goats (0.076 L/kg, 7.6% BW) differed significantly (P < 0.01) from alpacas (0.103 L/kg, 10.3% BW). Mild transfusion reactions were noted in 16% of transfusions.Conclusions and Clinical RelevanceThe generally accepted value of 8% for circulating blood volume (volume of distribution of blood) is adequate for calculation of transfusion volumes; however, use of the species‐specific circulating blood volume can improve calculation of transfusion volume to predict and achieve desired packed cell volume. The incidence of transfusion reactions in small ruminants and camelids is low.

Evaluation of eicosanoid concentrations in stored units of canine packed red blood cells

OBJECTIVE To evaluate eicosanoid concentrations in freshly prepared canine packed RBCs (PRBCs) and to assess changes in eicosanoid concentrations in PRBC units over time during storage and under transfusion conditions. DESIGN Prospective study. SAMPLE 25 plasma samples from 14 healthy Greyhounds. PROCEDURES Plasma samples were obtained during PRBC preparation (donation samples), and the PRBC units were then stored at 4°C until used for transfusion (≤ 21 days later; n = 17) or mock transfusion if expired (22 to 24 days later; 8). Immediately prior to use, 100 mL of saline (0.9% NaCl) solution was added to each unit and a pretransfusion sample was collected. A posttransfusion sample was collected after transfusion or mock transfusion. Concentrations of arachidonic acid, prostaglandin (PG) F2α, PGE2, PGD2, thromboxane B2, 6-keto-PGF1α, and leukotriene B4 were measured by liquid chromatography-mass spectrometry and analyzed statistically. RESULTS Median arachidonic acid concentration was significantly decreased in posttransfusion samples, compared with the concentration in donation samples. Median PGF2α, 6-keto-PGF1α, and leukotriene B4 concentrations were significantly increased in pretransfusion samples, compared with those in donation samples. Median PGF2α, thromboxane B2, and 6-keto-PGF1α concentrations were significantly increased in posttransfusion samples, compared with those in pretransfusion samples. Duration of PRBC storage had significant associations with pretransfusion and posttransfusion arachidonic acid and thromboxane B2 concentrations. CONCLUSIONS AND CLINICAL RELEVANCE Concentrations of several proinflammatory eicosanoids increased in PRBC units during storage, transfusion, or both. Accumulation of these products could potentially contribute to adverse transfusion reactions, and investigation of the potential association between eicosanoid concentrations in PRBCs and the incidence of transfusion reactions in dogs is warranted.

Alternative agents to prophylactic platelet transfusion for preventing bleeding in people with thrombocytopenia due to chronic bone marrow failure: a meta-analysis and systematic review.

Alternative agents to prophylactic platelet transfusion for preventing bleeding in people with thrombocytopenia due to chronic bone marrow failure: a meta-analysis and systematic review.