Transfusion-related Adverse Reactions Research Articles

MiR-33a-5p in stored red blood cells regulates genes of innate immune response and promotes inflammation.

Blood transfusion is a common therapeutic procedure in hospitalized patients. Red blood cell (RBC) units undergo various biochemical and morphological changes during storage (storage lesion). miRNAs have been studied intensively regarding cellular metabolic processes, but the effect of miRNAs on blood storage is not well defined. We performed bioinformatics analysis on the public data set of miRNA expression of RBC based on R language, and performed the Kyoto encyclopedia of genes and genomes (KEGG) enrichment analysis on the target genes of differentially expressed miRNA. The expression of miRNA differential genes in blood samples stored at different times was verified by qRT-PCR. Next, we used ELISA and qRT-PCR to verify the expression of IL-1β, IL-6, IL-12 and TNF-α in blood at day 1 and day 42. In addition, in vitro, we transfected macrophages with overexpressed miRNA, and the effects of overexpressed miRNA on macrophage polarization and the release of inflammatory factors were verified by flow cytometry and qRT-PCR and ELISA. This study combined bioinformatics analysis and experiments to discover the differentially expressed miRNAs in long-term stored blood. The results showed that compared to fresh blood samples, the inflammatory factors were significantly doubled by ELISA, as well as the higher mRNA expression at 42 day. Experimentally verified that miR-33a-5p promoted the M1 type macrophage polarization and increased the release of related inflammatory factors through PPARα/ACC2/AMPK/CPT-1a axis regulation. This study elucidates a potential mechanism of inflammatory factor accumulation in long-term stored blood, providing a theoretical basis and a potential target to prevent transfusion-related adverse reactions.

Transfusion-related errors and associated adverse reactions and blood product wastage as reported to the National Healthcare Safety Network Hemovigilance Module, 2014-2022.

Transfusion-related errors are largely preventable but may lead to blood product wastage and adverse reactions, resulting in patient harm. In the United States, the incidence of transfusion-related errors is poorly understood nationally. We used data from the National Healthcare Safety Network (NHSN) Hemovigilance Module to describe and quantify transfusion-related errors, as well as associated transfusion-related adverse reactions and blood product wastage. During 2014-2022, data from the NHSN Hemovigilance Module were used to analyze errors, including near misses (errors with no transfusion), incidents (errors with transfusion), and associated serious adverse reactions (severe, life-threatening, or death). During 2014-2022, 80 acute care facilities (75 adult; 5 pediatric) reported 63,900 errors. Most errors occurred during patient blood sample collection (21,761, 34.1%) and blood sample handling (16,277, 25.5%). Less than one-fifth of reported errors (9822, 15.4%) had a completed incident form. Of those, 8780 (89.3%) were near misses and 1042 (10.7%) incidents. More than a third of near misses (3363, 38.3%) were associated with a discarded blood product, resulting in 4862 discarded components. Overall, 87 adverse reactions were associated with errors; six (7%) were serious. Over half of the transfusion-related errors reported to the Hemovigilance Module occurred during blood sample collection or sample handling. Some serious adverse reactions identified were associated with errors, suggesting that additional safety interventions may be beneficial. Increased participation in the Hemovigilance Module could enhance generalizability and further inform policy development regarding error prevention.

Current status of red blood cell manufacturing in 3D culture and bioreactors.

Owing to donor-related issues, blood shortages and transfusion-related adverse reactions have become global issues of grave concern. In vitro manufactured red blood cells (RBCs) are promising substitutes for blood donation. In the United Kingdom, a clinical trial for allogeneic mini transfusion of cultured RBCs derived from primary hematopoietic stem cells has recently begun. However, current production quantities are limited and need improved before clinical use. New methods to enhance manufacturing efficiencies have been explored, including different cell sources, bioreactors, and 3-dimensional (3D) materials; however, further research is required. In this review, we discuss various cell sources for blood cell production, recent advances in bioreactor manufacturing processes, and the clinical applications of cultured blood.

Transfusion-related adverse reactions: An update from a district hospital in Ghana

Background: Transfusion therapy is indispensable for effective emergency medicine practice. However, in resource-poor settings transfusion therapy is suspected to be practiced in a manner that may be contributory to morbidity and mortality among blood recipients. Yet, there exists a wide information gap, with respect to incidence of transfusion-related adverse reactions secondary to inappropriate blood prescription.
 Objective: This study assessed incidence of transfusion-related adverse reactions in a district hospital in Ghana.
 Materials and Methods: A hospital-based cross-sectional study was conducted from December 2020 to January 2021. Patients attending a district hospital in Kumasi, Ghana who were prescribed blood transfusion were recruited into the study after oral/written consent. Patients’ demographic data, blood components and units of blood requested as well as the ward of patients were recorded. Records of patient’s full blood count (FBC), body temperature, blood pressure and transfusion-related adverse reactions were extracted from their medical folders.
 Results: Out of 200 patients, 169 were transfused with whole blood while 31 patients received packed red cells. Majority (48%) of the patients were transfused with ≤1 unit whereas 10% received 3 units of blood. Anaemia (Hb = 6.13 g/dl) and leukocytosis (WBC = 13.83 x 103/µL) were observed in the haematological parameters in which the MCV and lymphocyte count differed significantly in males compared to females. The overall incidence of transfusion-related adverse reactions was 47.5%. Of the 169 patients who received whole blood, more than half (53.8%) experienced more than one of the transfusion-related adverse reactions that were monitored. Finally, patients within the ages of 19-29 years had the highest incidence of transfusion reaction (30.5%) and overall, the number of units administered was significantly associated with the incidence of transfusion reaction (p<0.011). Conclusion: Transfusion-related adverse reaction was common at the study setting. This could be attributed to inappropriate administration of blood and blood products. Strict adherence to World Health Organization recommendations on transfusion therapy needs to be encouraged and supervised in the study setting>< 0.011)
 Conclusion: Transfusion-related adverse reaction was common at the study setting. This could be attributed to inappropriate administration of blood and blood products. Strict adherence to World Health Organization recommendations on transfusion therapy needs to be encouraged and supervised in the study setting.

Investigation of Transfusion Adverse Events Patterns in Fayoum University Hospitals, Egypt: Hemovigilance Initiative

Background and Objective: Hemovigilance is an adverse reaction surveillance and monitoring system to improve the safety and quality of blood transfusion in terms of corrective and preventive action. Identification of the adverse reactions and their risk factors will assist in taking appropriate steps to reduce their incidence and make blood transfusion safer. The aim of our study was to analyze the nature and incidence of transfusion related adverse events as a tool for implementation of hemovigilance system in Egypt.
 Study Design and Methods: Our study included all transfusion related adverse reactions from Fayoum University Hospital reported to the Blood Bank over a period of one year from August 2021 to July 2022. All patients receiving transfusion and all blood donors according to The National Blood Transfusion Guidelines were included. All reported reactions were analyzed, categorized and evaluated.
 Results: 28, 253 blood and blood components units were issued to 13, 544 patients. 273 (0.967%) transfusion related adverse reactions were reported to the blood bank. The most common reaction observed in recipients was allergic reaction 129 (47.25 %) followed by febrile non hemolytic transfusion reaction (FNHTR) 108 (39.56 %).
 Conclusion: Data related to transfusion related adverse reactions in developing countries are rare in literature. A strict quality assurance measures are required to build a hemovigilance system including, appropriate use of blood, maintain blood cold chain, monitoring, documenting and reporting transfusion reactions so that, the proper hemovigilance system can be attained.

ABO discrepancy in pediatric lymphomas and solid organ tumors.

Objective: To determine the frequency of ABO discrepancies in pediatric patients of lymphoma and solid organ tumors and to categorize these discrepancies and their resolution. Study Design: Cross-sectional study. Setting: Department of Hematology & Transfusion Medicine, The University of Child Health Sciences & The Children’s Hospital, Lahore. Period: November 2020 to September 2021. Material & Methods: ABO blood group discrepancies were assessed by tube method of blood grouping, using antisera A, B, AB & D for forward grouping and A, B, and O cells for reverse grouping. Auto control was also run. The resolution techniques were used accordingly. The collected data was checked for its completeness, consistency and accuracy before analysis which was done on SPSS version 26. Results: In this study, a total of 105 subjects were included with mean age of 5.64 ±2.1 years. Among them 72(68.6%) were male and 33(31.4%) were female. Out of total samples processed, three (2.9%) discrepancies found, 1 in female and 2 in male patients. There were two cases of Group I ABO discrepancies, one of which was resolved by elution, antibody screening and identification and other by incubation at 37oC and correlation with previous transfusion history. One case of Group II ABO discrepancy which was resolved by incubation at 40C for 30 minutes. Conclusion: This shows that ABO discrepancies occur in pediatric patients of lymphoma and solid organ tumors. So, the interpretation of forward and reverse ABO blood grouping, identification and resolution of ABO discrepancies in these patients should be done very carefully to avoid any transfusion related adverse reactions.

Associations between alloantibodies and multiple red blood cell transfusions in patients with sickle cell anemia

Alloantibodies are popularly transfusion-related and can be formed against many blood components including the red blood cells, white blood cells, and platelets. The formation of alloantibodies which is a common a sequence for repeated red blood cell transfusion has been reported and are clinically crucial in pregnancies, and to identify risk of future transfusion-related adverse hemolytic reactions. The present study was focused at studying the background clinical factors around red blood cell (RBC) transfusion with respect to alloimmunization, effect of Rh-Kell antigen matching units and its impact on sickle cell anemia (SCA) patients to decrease the incidence of alloantibody development. Methodology – Our retrospective study involved data analysis from SCA patients including pregnant women who had undergone antibody screening from Riyadh, Saudi Arabia. Data from the year 2010 up until 2020 was collected from the King Saud Medical City, the regional laboratory and central blood bank in Riyadh and included a total of 246 patients who matched our criteria. Data from indirect antiglobulin test (IAT) done on each patient at two separate time periods was analysed by appropriate statistical tools in SPSS® software platform. Results – A total of 246 SCA patients with a mean age of 11.9 ± 6.7 years were identified to have obtained blood donation in the study period, and 52.4% transfusion recipients were recorded to have undergone phenotype match: Rh-K. Our study also found 17.9% of the alloimmunized patients to have a record of blood transfusions before alloimmunization. Anti-E (40.9%), anti-Kell (34.1%), anti-D (4.5%) were the most popular specificities of alloantibodies defined. No association was found between gender and production of antibodies, and the backward step binary logistic regression analysis predicted recipients of blood transfusions (>7 units) was 3.66 times more exposed to risk of developing alloantibodies (1.23 – 10.85, 95% CI). While among those in the matching phenotype (Rh-K) group was less likely [OR = 0.012 (0.001–0.11, 95% CI)] to develop alloantibodies. The current study showed that advancing age, and multiple transfusion episodes to increase the risk of developing alloantibodies following blood transfusion among SCA patients.

Understanding the nursing practices and perspectives of transfusion reaction reporting.

The aim of this study was to investigate nurse perspectives on transfusion-related adverse reaction reporting practices. Transfusion-related adverse reaction reporting is an essential component of hemovigilance in Canada, but reporting rates vary and under-reporting of minor transfusion-related adverse reactions exists. To our knowledge, this is the first report of nursing transfusion-related adverse reaction reporting attitudes. This qualitative descriptive study explored the nursing practices and perspectives of transfusion-related adverse reaction reporting by conducting one-on-one interviews with nurses (n=25) working in adult oncology inpatient and outpatient units. Data were thematically analysed; data collection ended when saturation was reached. The COREQ checklist was used to guide this study. The study revealed that the nursing practices of transfusion-related adverse reaction reporting are not standardised to meet the institutional reporting guidelines. Under-reporting of febrile reactions exists at this institution. Major concepts uncovered included the factors impacting nurses' transfusion-related reporting practices, as well as barriers and facilitators to transfusion reporting. A practice change in transfusion-related adverse reaction reporting is needed to achieve optimal hemovigilance at this institution. Using the barriers and facilitators identified in this study, institutions can better inform future interventions by employing strategies like TR reporting education in order to improve reporting of transfusion-related adverse reactions in this hospital and other similar institutions. This study informs clinical practice and decision-making for nurses and nursing educators who manage blood transfusion administration procedures.

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

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

Whole blood transfusion in common marmosets: a clinical evaluation.

In veterinary medicine, blood transfusion is commonly performed on companion animals. The common marmoset is a small nonhuman primate with increasing popularity as an animal model in biomedical research. Because of its small whole blood volume, the marmoset is at high risk of exsanguination, and blood transfusion is required to care for life-threatening bleeding. However, few clinical evaluations exist on transfusions for marmosets. This study performed whole blood transfusion with cross-matching on nine marmosets and surveyed the therapeutic effects. Recipients included clinical cases with persistent bleeding, anemia, and coma, as well as animals subjected to postoperative bleeding prophylaxis. Donors were selected from healthy marmosets, including littermates. Cross-match assay before transfusion were all negative, and recipients showed no visible signs of transfusion-related adverse reactions. Whole blood transfusions caused hemostasis and successful recovery in bleeding marmosets, including long-term improvement of anemia cases. Our results indicated that blood transfusion is effective for marmosets with severe anemia and persistent hemorrhage from both non-experimental and surgical causes. Furthermore, DNA sequencing for blood-group classification revealed that all subject marmosets were type A, suggesting that the risk of blood type mismatch may be low in this species.

Stratégie transfusionnelle restrictive : unique choix en Afrique subsaharienne, une revue générale

Transfusion of red cell concentrates (RMCs) is the administration of red blood cells from a donor to a recipient to correct anemia. Despite improvements in blood preservation and treatment techniques in developed countries, the risk of transfusion-related adverse reactions remains significant. In Sub-Saharan Africa (SSA), while haemovigilance is not well organized and the majority of health institutions do not always screen for irregular agglutinins before each blood transfusion. Therefore, the restrictive transfusion policy defined by a transfusion threshold of blood haemoglobin concentration between 7 and 8 g/dl should be in place. Received: March 10th, 2021 Accepted: July 21st, 2021

Supplemental findings of the 2019 National Blood Collection and Utilization Survey.

Supplemental data from the 2019 National Blood Collection and Utilization Survey (NBCUS) are presented and include findings on donor characteristics, autologous and directed donations and transfusions, platelets (PLTs), plasma and granulocyte transfusions, pediatric transfusions, transfusion-associated adverse events, cost of blood units, hospital policies and practices, and implementation of blood safety measures, including pathogen reduction technology (PRT). National estimates were produced using weighting and imputation methods for a number of donors, donations, donor deferrals, autologous and directed donations and transfusions, PLT and plasma collections and transfusions, a number of crossmatch procedures, a number of units irradiated and leukoreduced, pediatric transfusions, and transfusion-associated adverse events. Between 2017 and 2019, there was a slight decrease in successful donations by 1.1%. Donations by persons aged 16-18 decreased by 10.1% while donations among donors >65 years increased by 10.5%. From 2017 to 2019, the median price paid for blood components by hospitals for leukoreduced red blood cell units, leukoreduced apheresis PLT units, and for fresh frozen plasma units continued to decrease. The rate of life-threatening transfusion-related adverse reactions continued to decrease. Most whole blood/red blood cell units (97%) and PLT units (97%) were leukoreduced. Blood donations decreased between 2017 and 2019. Donations from younger donors continued to decline while donations among older donors have steadily increased. Prices paid for blood products by hospitals decreased. Implementation of PRT among blood centers and hospitals is slowly expanding.

Exosomes From Packed Red Cells Induce Human Mast Cell Activation and the Production of Multiple Inflammatory Mediators.

Most blood transfusion-related adverse reactions involve the immunologic responses of recipients to exogenous blood components. Extracellular vesicles isolated from packed red cells can affect the recipient’s immune system. Mast cells are traditionally known as effector cells for allergic transfusion reactions. However, growing evidence supports the notion that activated mast cells might disturb host innate immunologic responses. Exosomes are a type of extracellular vesicle. To determine the effect of exosomes on mast cells, we enriched exosomes derived from volunteer plasma (EXs-nor) and packed red cells (EXs-RBCs) using ultracentrifugation and incubated them with a human mast cell line (HMC-1). We found that EXs-RBC exposure increased the expression of tryptase-1 and prostaglandin D2, the production of multiple inflammatory mediators, and the levels of Toll-like receptor-3 (TLR-3) and phospho-mitogen-activated protein kinase (MAPK) in HMC-1 cells. MAPK inhibitors (SB203580, PD98059, and SP600125) and a TLR-3/dsRNA complex inhibitor reduced the EXs-RBC-stimulated production of inflammatory mediators in HMC-1 cells, whereas the TLR-3 agonist [poly (A:U)] elevated the production of these mediators. These results indicate that EXs-RBCs activate HMC-1 cells and elicit the production of multiple inflammatory mediators, partly via the TLR-3 and MAPK pathways. Mast cells activated by EXs-RBCs exhibit complex inflammatory properties and might play a potential role in transfusion-related adverse reactions.

Transfusion-related adverse reactions: Data from the National Healthcare Safety Network Hemovigilance Module - United States, 2013-2018.

Despite current blood safety measures, transfusion recipients can experience transfusion-related adverse reactions. Monitoring these reactions can aid in understanding the effectiveness of current transfusion safety measures. Data from the National Healthcare Safety Network Hemovigilance Module were used to quantify adverse reaction risk. Facilities reporting at least one month of transfused blood components and transfusion-related adverse reactions during January 2013-December 2018 were included. Adverse reaction rates (number per 100,000 components transfused) were calculated for transfused components stratified by component type, collection, and modification methods. During 2013-2018, 201 facilities reported 18,308 transfusion-related adverse reactions among 8.34 million blood components transfused (220/100,000). Adverse reactions were higher among apheresis (486/100,000) and pathogen-reduced platelets (579/100,000) than apheresis red blood cells (197/100,000). Allergic reactions (41%) were most common. There were 23 fatalities and 9% of all adverse reactions were serious (severe, life-threatening, or fatal). Reactions involving pulmonary complications (transfusion-associated circulatory overload, transfusion-related acute lung injury and transfusion-associated dyspnea) accounted for 35% of serious reactions but 65% of fatalities. Most (76%) of the 37 transfusion-transmitted infections were serious; none involved pathogen-reduced components. One in 455 blood components transfused was associated with an adverse reaction although the risk of serious reactions (1 in 6224) or transfusion-transmitted infections (1 in 225,440) was lower. Some serious reactions identified were preventable, suggesting additional safety measures may be beneficial. Higher reaction rates identified among pathogen-reduced platelets require further study. These findings highlight the importance of monitoring reactions through national hemovigilance to inform current safety measures and the need for strategies to increase healthcare facility participation.

A Comparison of Transfusion-Related Adverse Reactions Among Apheresis Platelets, Whole Blood-Derived Platelets, and Platelets Subjected to Pathogen Reduction Technology as Reported to the National Healthcare Safety Network Hemovigilance Module.

Despite advances in transfusion safety, concerns with safety of platelet transfusions remain including platelet-related sepsis and higher reaction rates observed among patients receiving apheresis platelets (APLTs). National Healthcare Safety Network (NHSN) Hemovigilance Module (HM) data were analyzed to quantify the burden and severity of adverse reactions occurring from APLTs and whole blood-derived platelets (WBD-PLTs). Facilities participating in NHSN HM during 2010-2018 were included. Adverse reaction rates (number per 100,000 components transfused) were calculated for APLTs and WBD-PLTs stratified by severity, use of platelet additive solution (PAS), and pathogen reduction technology (PRT). Chi-square tests were used to compare rates. During the study interval, 2,000,589 platelets were transfused: 1,435,154 APLTs; 525,902 WBD-PLTs; and among APLTs, 39,533 PRT-APLTs. APLT adverse reaction rates were higher (478 vs 70/ 100,000, P< .01) and more often serious (34 vs 6/100,000; P< .01) compared with WBD-PLTs. Adverse reactions were higher among PRT-APLTs (572/100,000) and were less often serious (18/100,000) compared with non-PRT-APLTs (35/100,000) although this association was not statistically significant. Among components implicated in adverse reactions, 92% of APLTs were suspended in plasma. Compared with PRT-APLTs stored in PAS, rates were higher among units stored in plasma (760 vs 525/100,000). Most serious reactions (75%) were allergic. No transfusion-transmitted infections were reported among PRT-APLTs. APLTs were associated with a 6-fold and 2-fold higher serious adverse reaction risks compared with WBD-PLTs and PRT-APLTs, respectively. These findings demonstrate the importance of monitoring transfusion-related adverse reactions to track the safety of platelet transfusions and quantify the impact of mitigation strategies through national hemovigilance systems.

Preoperative autologous blood donation and transfusion in dogs undergoing elective surgical oncology procedures with high risk of hemorrhage.

To describe preoperative autologous blood donation (PABD) and transfusion in dogs undergoing elective surgical oncology procedures with a high risk of intraoperative hemorrhage. Prospective study. Twelve dogs. Dogs undergoing surgical oncology procedures associated with a high risk of hemorrhage were enrolled. Blood was collected a minimum of 6 days before surgery and separated into fresh frozen plasma (FFP) and packed red blood cells (pRBC). Dogs received FFP at the start of surgery and pRBC intraoperatively when hemorrhage ensued. The mean packed cell volume/total solids (PCV/TS) were calculated on the day of PABD preoperatively, immediately postoperatively, and 24 hours after transfusion. The dogs were monitored for transfusion-related adverse reactions, including hyperthermia, hypotension, tachycardia, bradycardia, pale mucous membranes, prolonged capillary refill time, or tachypnea/dyspnea. Dogs enrolled in the study underwent mandibulectomy, maxillectomy, chest wall resection, and liver lobectomy. Ten of the 12 dogs that underwent PABD received autologous transfusion at first signs of hemorrhage intraoperatively. Iatrogenic anemia was noted in two dogs (PCV 30% and 31%). The mean PCV/TS levels on the day of blood collection, preoperatively, immediately postoperatively (after transfusion), and 24 hours posttransfusion were 45.1%/7.1 g/dL, 42.2%/6.73 g/dL, 33.2%/5.42 g/dL, and 36.5%/5.65 g/dL, respectively. No dog developed transfusion-related complications. Preoperative autologous blood donation was well tolerated and led to uneventful autologous transfusion in 10 of 12 dogs. Preoperative autologous blood donation and autologous transfusion are feasible for dogs undergoing elective surgical procedures with a high risk of hemorrhage.

Bedside Allogeneic Erythrocyte Washing with a Cell Saver to Remove Cytokines, Chemokines, and Cell-derived Microvesicles.

Removal of cytokines, chemokines, and microvesicles from the supernatant of allogeneic erythrocytes may help mitigate adverse transfusion reactions. Blood bank-based washing procedures present logistical difficulties; therefore, we tested the hypothesis that on-demand bedside washing of allogeneic erythrocyte units is capable of removing soluble factors and is feasible in a clinical setting. There were in vitro and prospective, observation cohort components to this a priori planned substudy evaluating bedside allogeneic erythrocyte washing, with a cell saver, during cardiac surgery. Laboratory data were collected from the first 75 washed units given to a subset of patients nested in the intervention arm of a parent clinical trial. Paired pre- and postwash samples from the blood unit bags were centrifuged. The supernatant was aspirated and frozen at -70°C, then batch-tested for cell-derived microvesicles, soluble CD40 ligand, chemokine ligand 5, and neutral lipids (all previously associated with transfusion reactions) and cell-free hemoglobin (possibly increased by washing). From the entire cohort randomized to the intervention arm of the trial, bedside washing was defined as feasible if at least 75% of prescribed units were washed per protocol. Paired data were available for 74 units. Washing reduced soluble CD40 ligand (median [interquartile range]; from 143 [1 to 338] ng/ml to zero), chemokine ligand 5 (from 1,314 [715 to 2,551] to 305 [179 to 488] ng/ml), and microvesicle numbers (from 6.90 [4.10 to 20.0] to 0.83 [0.33 to 2.80] × 106), while cell-free hemoglobin concentration increased from 72.6 (53.6 to 171.6) mg/dl to 210.5 (126.6 to 479.6) mg/dl (P < 0.0001 for each). There was no effect on neutral lipids. Bedside washing was determined as feasible for 80 of 81 patients (99%); overall, 293 of 314 (93%) units were washed per protocol. Bedside erythrocyte washing was clinically feasible and greatly reduced concentrations of soluble factors thought to be associated with transfusion-related adverse reactions, increasing concentrations of cell-free hemoglobin while maintaining acceptable (less than 0.8%) hemolysis.

First annual report of Chinese haemovigilance network.

Haemovigilance involves surveillance of the whole chain of blood transfusion with the aim of identifying adverse events and errors and improving outcomes for patients. The Chinese Haemovigilance Network, founded in August 2017, has witnessed a rapid development in the last three years. Based on the 1,022 cases in 2019, we analysed the adverse reactions (ARs) by blood component, clinical outcome severity and demography of recipients in an effort to publish the first annual Chinese haemovigilance report. The AR rate associated with blood transfusion in 2019 was 0·2% in China. Allergic reactions and FNHTR were the two most common adverse symptoms, accounting for 97·7% of the reports. Two-thirds of the TAD, AHTR and TACO and all of the HTR and DHTR resulted in hospitalization or prolongation of hospitalization. Plasma and AP were usually associated with allergic reaction (81·1%), whereas red cells more commonly cause FNHTR (68·8%) and all the AHTR, HTR, DSTR and DHTR. 84·1% of patients were aged 16years or over, and the majority of the TAD, AHTR, TACO and HTR involved patients aged 60 and above. The ratio of serious adverse reactions (SARs) was 8·2%. Allergic reaction and FNHTR were top two (85·7%) SARs. The first case related to anti-D immunoglobulin was detected in a DHTR report. This report provides the world's first overview of transfusion-related adverse reactions in China. This report is useful for better understanding transfusion risks in China.

Reduced volume of red blood cell priming is safe for pediatric patients undergoing therapeutic plasma exchange

RationalTherapeutic Plasma Exchange (TPE) procedures in pediatric patients are challenging due to the large extracorporeal volume of the cell separators, which were designed for adults. Red blood cell (RBC) priming is an alternative for overpassing the risks of hypovolemia, but data referring to the volume of packed RBCs to be infused are yet incomplete. Restricting the volume of RBC priming may potentially be associated with less transfusion reactions. GoalTo determine the safety of administering a reduced volume of RBC priming for pediatric patients undergoing TPE, in comparison to the standard volume recommended by the cell separators’ manufacturers. MethodsThis was a case-control study which enrolled 15 pediatric patients undergoing TPE and weighting more than 10Kg. The TPE procedures (n = 406) were divided in two groups: 1) Group1: TPE with ≤150 mL of packed RBC priming and 2) Group2: TPE with 150-250 mL of RBC priming. Groups were compared in terms of hemoglobin / hematocrit and occurrence of adverse reactions. ResultsGroup1 and Group2 did not differ significantly in relation to pre- and post-TPE hemoglobin (Hb) levels (p = 0.19 and p = 0.18, respectively). The Δ Hb (Hb pre-TPE – Hb post-TPE) was also not statistically different between the groups. The number of adverse reactions was significantly higher in Group 2 in relation to Group 1 (p = 0.01). The number of allergic reactions was also higher in Group 2 (p = 0.06). ConclusionsRestricting the volume of RBC priming to less than 150 mL is safe for pediatric patients weighting more than 10Kg and associated with lower rates of transfusion-related adverse reactions.

Surveillance of Transfusion Related Adverse Reactions in a Tertiary Care Centre in Bangalore: A 4-Year Hemovigilance Initiative.

Even though blood transfusion is a life saving measure, it is nonetheless associated with a number of risks and hazards. The adverse reactions that can be potentially expected range anywhere in severity from mild to life threatening. The hemovigilance program deals with the systematic surveillance of these reactions as and when they occur in a hospital setting with an explicit aim of improving the quality and safety standards of the entire transfusion process. The current study was undertakenin the blood bank of a tertiary care centre in Bangalore to ascertain frequency of the blood transfusion related adverse reactions and to make a systematic profile assessment. Data was collected over a period of 4years and 3months. All adverse reactions caused by transfusion of blood and its products during the study period were included in the study. A total of 6910 units of blood and its components were issued to patients during the study period. Transfusion reactions accounted for 0.5% of transfusions. Febrile non-hemolytic transfusion reactions were the most common reactions (51.4%) followed by allergic reactions (40%), fluid overload (5.7%) and anaphylactic reactions (2.9%). Majority of these reactions were seen with PRBC transfusions (74.3%) followed by platelet transfusions (25.7%).The use of leukoreduced PRBCs will help in reducing the frequency of these reactions. The hemovigilance program of our institution helps in assessing the diversity of adverse reactions associated with transfusion of blood and its various components. It is also an efficient scheme for minimizing their occurrence by ensuring safety standards.