National Haemovigilance System Research Articles

Role of disruptions in O RhD negative donations in Colombia on increasing maternal mortality ratio from haemorrhage.

The aim of this work was to evaluate the relationship of the maternal mortality ratio due to obstetric haemorrhage (MMROH) with the national blood donations, particularly O RhD negative (Oneg) before and during COVID-19 pandemic. The maternal mortality ratio is increasing in Colombia, yet little is known regarding the relationship between blood donations and maternal mortality due to obstetric haemorrhage. A retrospective cross-sectional study between January 1, 2018, and December 31, 2021, was performed, to assess MMROH compared to the blood donations notified to the Colombian National Haemovigilance System, through non-parametric methods. Because a relationship between blood donations and MMROH was identified, the analysis was expanded from 2009 to 2017. In 2020, Colombia increased the MMROH by 32% compared to 2019 which coincided with the lockdown period to contain COVID-19. An inversed relationship (SumD2 = 631.0; rs = -0.7335; p 0.01) between blood donations, particularly Oneg (SumD2 = 652.0; rs = -0.7912; p 0.002) and MMROH was identified. For the years 2015-2019 and 2021, the annual mean MMROH was 8.5 ± 0.5 per 100 000 live births when the annual mean blood donations was 18.2 ± 0.4 donations per 1000 people and the Oneg was 1.0 ± 0.0 donations per 1000 people. In contrast, the years 2009-2014 and 2020 displayed an annual MMROH of 12.6 ± 0.8, when the annual collection of blood was 16.4 ± 0.8 donations and the Oneg was 0.9 ± 0.0, p < 0.001. There was an inverse relationship between blood donation, mainly Oneg, and maternal mortality from obstetric haemorrhage. However, we recognise these deaths could be related to other reasons, especially when they occurred in rural areas with limited access to medical services.

Adverse reactions following transfusion of blood components, with a focus on some rare reactions: Reports to the International Haemovigilance Network Database (ISTARE) in 2012-2016.

The International Haemovigilance Network's (IHN) ISTARE database collects surveillance data on all adverse reactions (AR) associated with transfusion of blood and blood components, facilitating the sharing of best practice and benchmarking for improving blood safety and quality. Up to 2012, no publications discussed certain rare AR. The aim of this study is to examine ISTARE data on AR from 2012 to 2016, focusing on hypotensive reactions, post-transfusion purpura (PTP), transfusion-associated graft versus host disease (TA-GvHD), hyperkalemia and hypocalcemia. National Haemovigilance Systems (HVS), provided aggregate annual data on AR by type of reaction, severity, imputability to transfusion, and blood component implicated. Twenty-nine HVS provided 104 annual reports covering 107,778,290 blood units issued. Among AR reported, 25% were serious, including 368 deaths. The 284 transfusion-transmitted infections included 187 bacterial infections, 84 viral and 13 parasitic or fungal; nine deaths resulted. AR related to the respiratory system transfusion-associated circulatory overload, transfusion-related acute lung injury and transfusion-associated dyspnoea accounted for 8.3% of all AR, 20.1% of serious, and 52.2% of deaths. Of 1634 rare AR, 1565 were hypotensive, 38 PTP, 17 GvHD, 9 hyperkalemia and 5 hypercalcemia. Half were serious and 16 fatalities were recorded (13 hypotensive, 2 GvHD, one PTP). Among 14 countries that reported any hypotensive AR, incidences diverged widely. ARs in this group are frequently severe or life-threatening. Hypotensive AR are the most common, but may have been overlooked and counted under allergic and other AR presenting with hypotension. Compliance with the ISBT definition may be suboptimal, thus its real incidence may be higher. Data on GvHD may contribute to clarifying the role of leukodepletion with or without irradiation. ISTARE continues to be a useful surveillance tool for all transfusion AR and provides relevant insights into overlooked and rare AR, thus offering important contributions towards maximising transfusion safety.

The international experience of bacterial screen testing of platelet components with automated microbial detection systems: An update.

In 2014, the bacterial subgroup of the Transfusion-Transmitted Infectious Diseases working party of ISBT published a review on the International Experience of Bacterial Screen Testing of Platelet Components (PCs) with an Automated Microbial Detection System. The purpose of this review, which is focused on publications on or after 2014, is to summarize recent experiences related to bacterial contamination of PCs and the use of an automated culture method to safeguard the blood supply. We first reviewed septic transfusion reactions after PC transfusion as reported in national haemovigilance systems along with a few reports from various countries on bacterial contamination of blood products. Next, we reviewed PC automated culture protocols employed by national blood services in the United Kingdom, Australia, Canada and large blood collection organization and hospital transfusion services in the United States. Then, we acknowledged the limitations of currently available culture methodologies in abating the risks of transfusion-transmitted bacterial infection, through a review of case reports. This review was neither meant to be critical of the literature reviewed nor meant to identify or recommend a best practice. We concluded that significant risk reduction can be achieved by one or a combination of more than one strategy. No one approach is feasible for all institutions worldwide. In selecting strategies, institutions should consider the possible impact on platelet components availability and entertain a risk-based decision-making approach that accounts for operational, logistical and financial factors.

Effect of the first year of COVID-19 pandemic on the collection and use of blood components in Colombia monitored through the national haemovigilance system.

ObjectiveThis work aimed to establish the effects of the COVID‐19 pandemic on blood collection and blood product usage at the end of the first year.BackgroundThe arrival of SARS‐CoV‐2 to Colombia on March 6, 2020, triggered closure of borders and mandatory lockdown from March 23, 2020.Methods/MaterialsThe Colombian National Institute of Health administers the National database of confirmed cases of SARS‐CoV‐2 and the National Haemovigilance System. We examined positive SARS‐CoV‐2 cases identified between March 6, 2020, and March 6, 2021, using positive RT‐PCR testing (72.8%) or reactive antigen (27.2%). We also analysed accepted and deferred donors' information provided by 100% of blood banks and transfused patients notified by 83% of health care facilities nationwide, between March 1, 2019, to February 28, 2021.ResultsColombia registered 2 273 245 SARS‐CoV‐2 cases. From these, 60 412 people died from COVID‐19 (2.7%) and 2 172 418 individuals recovered (95.6%). There were 11 659 216 SARS‐CoV‐2 processed samples nationwide. People between the ages of 20 and 39 years concentrated 44.4% of the SARS‐CoV‐2 cases. There were 773 569 blood donations, mainly from a 20‐39‐year‐old population (60.5%). The pandemic caused a reduction of 155 393 blood donations (16.7%) and 51 823 total deferrals (33.7%).An 18.4% drop in volunteer donors and a 37.3% increase in donations from family/replacements members were observed. There were 399 453 transfused patients and 1 179 895 blood components administered (−8.7% and − 13.9% compared to March 2019–February 2020).ConclusionMandatory lockdowns in Colombia decreased blood collection and usage, resulting in a reduction of blood components transfused to individual patients.

HaemoKBS: A knowledge-based system for real-time, continuous categorisation of adverse reactions in blood recipients

This work introduces HaemoKBS, a novel Haemovigilance decision support system for adverse reactions in blood recipients. Machine learning inference and rule-based reasoning were applied to build the underlying decision support models, namely to automatically extract evidence from different types of data included in hospital notifications and incorporate a priori expert knowledge. The ultimate aim is to dynamically learn and improve the reasoning abilities of the system and thus, be able to provide educated recommendations to hospital notifiers along with understandable explanations on the acquired knowledge. Experiments over the records of the Portuguese National Haemovigilance System from the last 10 years demonstrate the practical usefulness of HaemoKBS, which will contribute to a better depiction of the adverse reactions and to flag any incomplete notification enforcing data quality.

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

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

Experience of haemovigilance in Japan

A haemovigilance system was established in Japan in 1993 by the Japanese Red Cross (JRC) headquarters, with the initial purpose of collecting reports of adverse transfusion reactions from medical facilities. Although this is a voluntary reporting system, the JRC, in co‐operation with medical facilities, collects almost all serious adverse reactions caused by blood transfusion. Non‐haemolytic transfusion reactions account for &gt;90% of all reported events and transfusion‐transmitted infection (TTI) account for 5–6%. The JRC haemovigilance system is supported by laboratory analyses conducted in the JRC Central Blood Institute and other laboratories. The JRC collects pre‐ and post‐transfusion blood samples from patients who have experienced adverse reactions. These samples together with repository blood samples obtained from corresponding blood donations are analysed to investigate the pathogenesis of adverse events. Data obtained using these samples are helpful in increasing our understanding of transfusion‐related events such as TTI, transfusion‐related anaphylaxis and transfusion‐related acute lung injury (TRALI). Each country has its own history of establishing blood programmes. The relationship between government, blood facilities, transfusion societies and physicians or clinical fields may differ greatly between countries, and the structure of national haemovigilance systems will differ according to these relationships. Whatever haemovigilance system is established, extensive collaboration and adequate information exchange are essential among stakeholders. Strong leadership by a national transfusion society in addition to legislative measures is required if a comprehensive national haemovigilance system is to be established.

Haemovigilance in China: experiences, challenges and strategies

Haemovigilance (HV) plays an essential role in ensuring the safety of donors and recipients with regard to blood transfusions. China now has annually survey on blood collection and supply, but no national reporting system of AR/AE related to blood transfusion. By 2013, the first guideline on HV in China was released by the Blood Quality Management Committee of Chinese Society of Blood Transfusion (CSBT) and revised in 2015. For blood establishments and hospitals looking for help with setting up new plans or further improving blood transfusion safety, the guideline provides ample information on definitions, methodology and documentation protocols. Based on the guideline, a series of education and promoting programmes was developed in Shanghai and other regions. With the integration of HV into the existing expert symposiums and education courses in the past few years, hundreds and thousands of clinicians and blood bank practitioners got training and the importance of HV were recognized widely, and the principles of nonpunitive principle and learning from errors. In 2017, the working party on haemovigilance of CSBT was set up, which is a milestone for the progress of HV in China. Through the working party, we can study the practices of antecedence countries and learning their experiences, by formulating policies, evaluating modes and mechanisms, compiling standards and guidelines, improving information management and standardization from one region to the other, to establish a national HV systems step by step in China.

The haemovigilance: the best quality management system of the transfusion chain?

Background and ObjectivesHaemovigilance is an integral part of blood safety worldwide. Many haemovigilance systems are already in place or are developing, and national or regional haemovigilance systems have been implemented in several countries. In 2016, the WHO Global Database on Blood Safety reported that national haemovigilance system had been established in 70 countries, among which 38 countries were members of the International Haemovigilance Network by the end of August 2017. In this review, we retrospect the development and current status of haemovigilance to outline its function in transfusion chain.Materials and MethodsThrough contrasting the evolution of haemovigilance definition in different periods, by analysing its scope and breadth, and with the illustrating its achievements and challenges, we retrospect the development and current status of haemovigilance to outline its function in transfusion chain.ResultsHaemovigilance is becoming an important aspect of transfusion medicine,could be used as quality indicator for monitoring the blood transfusion safety, contribute significantly to evidence‐based transfusion medicine and results in improved policies, procedures and practices in the blood transfusion chain.ConclusionsThe scope of haemovigilance may cover the whole transfusion chain, from collection of blood and its components to follow‐up of recipients. Haemovigilance is an essential component of quality management in a blood system and haemovigilance is the best quality management system of the transfusion chain.

Frequência dos incidentes transfusionais imediatos em receptores de hemocomponentes

Objectives: To identify the frequency and gravity of the most common Adverse Reactions (ARs) related to acute transfusions reactions. Methods: A retrospective cross-sectional study ARs notified to the National Hemovigilance System from May 2002 to May 2016 was carried out in a Teaching Hospital of high complexity with 862 beds. The study was preceded by approval of the Ethics Committee of the institution, on 26 October 2016. Results: We analyzed 1.462 notification forms reporting transfusion reactions. The profile found was mostly of acute events associated to transfusion of Red Blood Cells, being Febrile Nonhemolytic Transfusion and Allergic Reaction the most frequent ARs; as for the gravity, the ARs were considered as mildAmong the cases considered as serious, these two types of ARs occurred in 13 (62%) of the cases. Conclusions: The study allowed a better evaluation and understanding of transfusion reactions, which allows improvement in the quality of the blood cycle and greater safety of patients undergoing transfusion therapy.

Haemovigilance of reactions associated with red blood cell transfusion: comparison across 17 Countries.

Background and ObjectivesThe recent establishment of the National Healthcare Safety Network Hemovigilance Module in the United States affords an opportunity to compare results with those of other developed nations.Materials and MethodsUsing data from national haemovigilance systems, reactions associated with red blood cell (RBC) transfusion and residual risks of transfusion‐transmitted infectious diseases were assembled from 17 nations. Country‐specific rates of adverse events were pooled using random‐effects Poisson regression.ResultsFebrile non‐haemolytic and delayed serologic transfusion reactions were the most frequent adverse events reported after RBC transfusion, occurring in 26 patients per 100 000 RBC units and 25 patients per 100 000 RBC units administered, respectively. Rates of allergic, febrile non‐haemolytic and delayed haemolytic transfusion reactions in the United States were significantly greater than the pooled rates from other countries. Frequencies of adverse events generated from the national haemovigilance programme in the United States were considerably lower than when obtained through active surveillance.ConclusionHaemovigilance reports of adverse events in the United States are comparable to, or greater than, reports from other developed countries. Rates generated from haemovigilance programmes are lower than those obtained through active surveillance. The lack of universal leucoreduction of RBC units may be a contributing factor to the higher rate of some adverse events in the United States.

How is national recipient hemovigilance conducted in the United States?

A national recipient hemovigilance system was introduced in the United States in 2010, when voluntary enrollment began as part of the National Healthcare Safety Network (NHSN) Hemovigilance Module. NHSN is a secure, Web-based surveillance system operated by the Centers for Disease Control and Prevention and used by US health care facilities to report a variety of patient safety information. The Hemovigilance Module is used for comprehensive monitoring of transfusion-related adverse events. Participating facilities can utilize analytic tools available within the module to identify opportunities for enhancing transfusion safety, evaluate the effectiveness of interventions, and compare facility specific transfusion-related data to aggregate national estimates. Data may be voluntarily shared by facilities with external partners for patient safety improvement initiatives and to fulfill reporting mandates. We describe the key characteristics of the Hemovigilance Module, highlight the benefits for participating facilities, and discuss the use of reported data for establishing national estimates of transfusion-associated adverse events to identify gaps in transfusion safety and opportunities for interventions. National hemovigilance systems are essential to recognize gaps in transfusion safety and identify opportunities for interventions to improve patient safety and outcomes.

Estimation of the prevalence and rate of acute transfusion reactions occurring in Windhoek, Namibia.

Acute transfusion reactions are probably common in sub-Saharan Africa, but transfusion reaction surveillance systems have not been widely established. In 2008, the Blood Transfusion Service of Namibia implemented a national acute transfusion reaction surveillance system, but substantial under-reporting was suspected. We estimated the actual prevalence and rate of acute transfusion reactions occurring in Windhoek, Namibia. The percentage of transfusion events resulting in a reported acute transfusion reaction was calculated. Actual percentage and rates of acute transfusion reactions per 1,000 transfused units were estimated by reviewing patients' records from six hospitals, which transfuse >99% of all blood in Windhoek. Patients' records for 1,162 transfusion events occurring between 1(st) January - 31(st) December 2011 were randomly selected. Clinical and demographic information were abstracted and Centers for Disease Control and Prevention National Healthcare Safety Network criteria were applied to categorize acute transfusion reactions. From January 1 - December 31, 2011, there were 3,697 transfusion events (involving 10,338 blood units) in the selected hospitals. Eight (0.2%) acute transfusion reactions were reported to the surveillance system. Of the 1,162 transfusion events selected, medical records for 785 transfusion events were analysed, and 28 acute transfusion reactions were detected, of which only one had also been reported to the surveillance system. An estimated 3.4% (95% confidence interval [CI]: 2.3-4.4) of transfusion events in Windhoek resulted in an acute transfusion reaction, with an estimated rate of 11.5 (95% CI: 7.6-14.5) acute transfusion reactions per 1,000 transfused units. The estimated actual rate of acute transfusion reactions is higher than the rate reported to the national haemovigilance system. Improved surveillance and interventions to reduce transfusion-related morbidity and mortality are required in Namibia.

Knowledge and barriers related to reporting of acute transfusion reactions among healthcare workers in Namibia

Knowledge and barriers related to reporting of acute transfusion reactions among healthcare workers in Namibia

Quality validation of data in national haemovigilance systems in Europe: report of a survey on current state of practice

European Union member states must have national haemovigilance reporting of serious adverse reactions and events. We sent national competent authorities an email questionnaire about data validation. Responses were received from 23/27 countries. Nine previously had no national haemovigilance system. In 13 (57%), the serious adverse reactions and events can be verified. Coverage of blood establishments is documented in 20 systems (87%) and of hospitals in 15 systems (65%). Although all member states have implemented haemovigilance systems, there are currently wide variations in data quality assurance, not allowing comparisons between countries.

Code development of the national hemovigilance system and expansion strategies for hospital blood banks

Objectives:The aims of this study were to develop reportable event codes that are applicable to the national hemovigilance systems for hospital blood banks, and to present expansion strategies for the blood banks.Materials and Methods:The data were obtained from a literature review and expert consultation, followed by adding to and revising the established hemovigilance code system and guidelines to develop reportable event codes for hospital blood banks. The Medical Error Reporting System-Transfusion Medicine developed in the US and other codes of reportable events were added to the Korean version of the Biologic Products Deviation Report (BPDR) developed by the Korean Red Cross Blood Safety Administration, then using these codes, mapping work was conducted. We deduced outcomes suitable for practice, referred to the results of the advisory councils, and conducted a survey with experts and blood banks practitioners.Results:We developed reportable event codes that were applicable to hospital blood banks and could cover blood safety - from blood product safety to blood transfusion safety - and also presented expansion strategies for hospital blood banks.Conclusion:It was necessary to add 10 major categories to the blood transfusion safety stage and 97 reportable event codes to the blood safety stage. Contextualized solutions were presented on 9 categories of expansion strategies of hemovigilance system for the hospital blood banks.

Risks of Transfusion

Each year, more than 4 million patients receive a blood transfusion in the United States to control symptoms associated with anemia, coagulopathy, thrombocytopenia, or some combination thereof. In each of these cases, the physician and the patient must weigh the potential benefits of the transfusion along with the associated risks. To assess accurately the risk:benefit ratio and to discuss this with the patient, the physician must be familiar with the range of adverse transfusion outcomes and the current estimates of their frequency. Most important, during the past decade the risk profile of transfusion has changed significantly. Transfusion-transmitted disease, although still a rare outcome of transfusion, is no longer an overriding concern in transfusion safety considerations; however, risks such as hemolysis, transfusion-related lung injury, and anaphylaxis continue to represent significant concerns and are relatively more common than the transmission of infectious diseases after transfusion. Against this background, the development of a national hemovigilance system, designed to evaluate more accurately transfusion adverse outcomes in the United States, will require greater precision and reliability in the assessment of adverse transfusion outcomes by clinicians if the proposed benefits of this system are to be realized.

TRALI‐risk‐reduction strategies: Japanese approach

Transfusion‐related acute lung injury (TRALI) is one of the most serious complications of blood transfusion. We have been gathering information about TRALl in Japan since 1997 through our national haemovigilance system. Recently, we have 20–40 TRALI cases per year (five million bags issued per year). Although TRALI is a rare complication of transfusion, it may become severe and may sometimes be fatal. A substantial number of TRALI cases have been caused by donor HLA or HNA antibodies, which were generated in alloimmunized, i.e. parous females. Considering this mechanism, TRALI mitigation strategies such as the use of male‐only‐plasma have been implemented in many blood centres or countries. Because of the availability of male plasma and the time limit for the production of fresh frozen plasma (FFP), we first tried to prepare FFP‐LR2 derived from 400 ml whole blood only from male donors. FFP‐LR2 accounts for 75% of FFP in Japan. (Six per cent of FFP products are from 200 ml whole blood and 19% from apheresis plasma.) A preliminary project on male‐predominant plasma was started at several core blood centres. To minimize the burden on nurses regarding marking bags collected from males or females, which might lead to serious errors in collection sites, we updated the computer system that allows the staff members in the production department to sort male and female blood automatically. In a month after the system implementation nationwide, we successfully increased the production rate of male plasma for FFP‐LR2 product by up to more than 98%. Regarding FFP‐LR1 derived from 200 ml whole blood, the percentage of female donors is approximately 75%. One of the core blood centres has successfully implemented the same strategy for producing FFP‐LR1, but others have not done so yet. Although male‐only‐plasma strategies achieved good results without any expensive screening tests to reduce TRALI incidence in some countries, the standard measures for other plasma rich blood products such as platelet concentrates or apheresis plasma have not been established yet. There are some measures to consider reducing the risk of TRALI caused by other plasma‐rich products – recruiting only males as apheresis platelet donors, testing a certain number of donors for HLA antibodies, replacing the supernatant of a platelet pool with male plasma and excluding female donors from apheresis donations. Some blood centres adopted some of these measures, but so far there is little evidence for the efficacy of these measures for reducing the risk of TRALI. We have recently conducted research about the relationship between strength of HLA antibodies and TRALI development. On the basis of the results of the research, we can set the cut‐off level in HLA antibody tests, which can reduce the risk of TRALI by eliminating strong HLA antibodies that presumably cause TRALI development if the specificity of an antibody matches the patient’s antigen. Preliminary screening for donor HLA antibodies is ongoing in three core blood centres in Japan, results of which enable us to establish effective and feasible screening strategies for HLA antibodies in the near future.

The New Zealand national haemovigilance programme: the first step is the hardest

Blood transfusion is an important component of modern day medicine. As doctors our first consideration must always be the interests and safety of our patients. Haemovigilance programmes collect and analyse data on untoward events associated with transfusion. The information collated should be shared with health professionals who prescribe and administer blood products so that they can continue to deliver the good without unintended negative consequences.The European Directorate for the Quality of Medicines and Healthcare (EQDM) defines the standards for haemovigilance and acknowledges that it is a shared responsibility of the professionals in the field and the competent national authorities for blood safety. It includes the surveillance of donor‐related events, epidemiological assessment of infections in donors, full traceability of blood components, device defects and reporting of post‐transfusion infections.Implementation of a national haemovigilance system is a complex task and usually takes months of planning. Apart from the multiple resources it requires, a number of issues need to be considered: what is to be reported, how will it be reported and who will do the reporting. In addition, information and training needs to be provided to the key stakeholders.In order for a haemovigilance programme to be effective the data need to be collated, analysed and relayed back to the hospitals. Comprehensive annual haemovigilance reports that are readily accessible can include recommendations to promote strategies to reduce transfusion‐related risks.In New Zealand the National Haemovigilance Programme was established in 2005. The population of New Zealand is 4·1 million. Reporting is voluntary and usually mediated via the hospital blood banks. The larger hospitals have Transfusion Nurse Specialists (TNSs) who provide education and assist with reporting adverse events. New Zealand is a country member of the Internal Haemovigilance Network (IHN) and utilizes the definitions of reporting categories agreed upon by the IHN. The majority of reports involve reactions that are mild. The overall rate of an adverse event is approximately 1 in 300 units transfused. Platelet concentrates are more frequently associated with reactions compared with other blood components and reactions are predominantly of the allergic type.The Haemovigilance Programme has demonstrated a reduction in the reported rate of transfusion‐related acute lung injury (TRALI) since the introduction of male donor fresh frozen plasma (FFP) 3 years ago. The programme has also identified that bacterial contamination of blood components, incorrect blood component transfused (IBCT), wrong blood in tube (WBIT) and acute haemolytic transfusion reactions due to transfusion of passive haemolysin are risks that require further attention.Complications associated with blood donation are also included in the annual haemovigilance reports. Vasovagal reactions are the most frequently occurring donation‐associated event and are higher in donors under the age of 20 years.Ongoing surveillance and review of untoward events associated with transfusion is vital so that we can continue to minimize risks related to blood products.

Guidelines on the use of irradiated blood components prepared by the British Committee for Standards in Haematology blood transfusion task force

Search terms included: Transfusion-associated graft-versus-host disease, Transfusion-associated graft-versus-host, TA-GvHD. The last guideline covering this topic was published in 1996 (British Committee for Standards in Haematology (BCSH) Blood Transfusion Task Force, 1996. The writing group produced the new draft guideline, which was subsequently revised by consensus by members of the Haemato-oncology and Blood Transfusion Task Forces of the BCSH. The guideline was then reviewed by a sounding board of approximately 100 UK haematologists, the BCSH and the committee of the British Society for Haematology and amended, again by consensus. Criteria used to quote levels and grades of evidence are according to the GRADE system (Guyatt et al, 2006). Strong recommendations (grade 1, ‘recommended’) are made when there is confidence that the benefits either do or do not outweigh the harm and burden and costs of treatment. Where the magnitude of benefit or not is less certain a weaker grade 2 recommendation (‘suggested’) is made. Grade 1 recommendations can be applied uniformly to most patients whereas grade 2 recommendations require judicious application. The quality of evidence is graded as A (high quality randomized clinical trials), moderate (B) or low (C). This publication reports the key recommendations of the Writing Group. It is also accessible at http://www.bcshguide lines.com.