Transfusion-related Adverse Reactions Research Articles

Transfusion Related Acute Lung Injury after Cesarean Section in a Patient with HELLP Syndrome.

Transfusion-related acute lung injury (TRALI) is a serious adverse reaction of transfusion, and presents as hypoxemia and non-cardiogenic pulmonary edema within 6 hours of transfusion. A 14-year-old primigravida woman at 34 weeks of gestation presented with upper abdominal pain without dyspnea. Because she showed the syndrome of HELLP (hemolysis, elevated liver enzymes, and low platelet count), an emergency cesarean section delivery was performed, and blood was transfused. In the case of such patients, clinicians should closely observe the patient's condition at least during the 6 hours while the patient receives blood transfusion, and should suspect TRALI if the patient complains of respiratory symptoms such as dyspnea. Furthermore, echocardiography should be performed to distinguish between the different types of transfusion-related adverse reactions.

Heamovigilance for Safer Blood Transfusion Process

Heamovigilance is a surveillance programme aimed at identifying and preventing the occurrence and reoccurrence of transfusion related adverse reactions and events and to increase the safety and efficiency of transfusion process. It surveys a chain of events from the collection of blood and its products to the follow up of the recipient. It is a continuous process of data collection and analysis of the adverse events related to blood and its products transfusion. The blood and its product transfusion carry with it a risk of acute or late adverse reaction. The adverse events may range from fever, chills to delayed haemolytic reactions. Some may even develop transfusion induced acute lung injury, bacterial contamination etc. Blood transfusion is a complex process involving more than 70 steps and error may occur in any step and will lead to adverse events. The lack of a clear idea about the roles and responsibility of the individuals involved, the lack of proper tools or procedure for the data collection, the incomplete knowledge about blood transfusions, the lack of necessary data of the transfusion, the carelessness during blood transfusion are the factors that lead to increase in adverse events in blood transfusion process. The main aim of heamovigilance programme is to set guidelines for improving the quality of blood collection, testing, processing, storage and distribution and to follow up the recipient for providing better safety. Therefore it is important to have a standard protocol for guidance and to improve the safety and quality of blood transfusion process.

Evaluation of the in-hospital hemovigilance by introduction of the information technology-based system.

Hemovigilance is an important aspect of transfusion medicine. However, the frequency of the adverse reactions often varies using different reporters. Recently, we have employed a new information technology (IT)-based in-hospital hemovigilance system. Here, we evaluated changes in practice after implementation of an IT-based reporting system. We compared the rate of frequency and details of blood transfusion-related adverse reactions 3 years before and after introduction of the IT-based reporting system. Contents and severity of the adverse reactions were reported in a paper-based reporting system, but input by selecting items in an IT-based reporting system. The details of adverse reactions are immediately sent to the blood transfusion unit online. After we introduced the IT-based reporting system, the reported rate of transfusion-related adverse reactions increased approximately 10-fold from 0.20% to 2.18% (p < 0.001), and frequencies of urticaria, pruritus, rash, fever (p < 0.001), hypertension (p = 0.001), tachycardia (p = 0.003), and nausea and vomiting (p = 0.010) increased significantly. Although there was no error report in the paper-based reporting, incorrect reports were observed in 90 cases (0.52%) in the IT-based reporting (p < 0.001). The advantages of IT-based reporting were: 1) a significant increase in the frequency of adverse reaction reporting and 2) a significant decrease in underreporting, although the true frequency has yet to be clarified. The disadvantage of the IT-based reporting was an increased incidence of incorrect inputs, all of which was unnoticed by the reporters. Our results showed several important points in need of monitoring after introduction of an IT-based reporting system.

Prevalence and specificity of RBC alloantibodies in the general hospitalised population in Guangxi.

The aim of this work was to investigate the prevalence and specificities of red blood cell (RBC) alloantibodies in the general hospitalised population in Guangxi, China. Alloimmunisation to RBC antigens is a major complication of transfusion therapy, and alloantibodies pose many clinical problems such as blood transfusion-related adverse reactions. The frequency and specificity of erythrocyte alloantibodies were different in populations from different geographic areas and races. However, the data on alloantibodies in the Guangxi population are limited; thus, we aimed to investigate them in this study. Erythrocyte request records of Guangxi patients were retrospectively reviewed from January 2013 to February 2014. Data from antibody screening tests for 20,283 patients were retrieved for analysis. Clinical data, including gender, age, medical history, transfusion history, pregnancy history and alloantibody specificity were collected. Data from 20,283 patients were analysed, and a total of 166 alloantibodies were identified in 150 patients (0.74%). The most frequent alloantibodies were anti-E (39.76%), anti-Mi(a)/Mur (11.45%), anti-c (10.84 %), anti-Le(a) (8.43%) and anti-M (6.63%). Three cases of anti-D (1.81%) and two rare cases of anti-H (1.20%) were also detected. The frequency and specificities of erythrocyte alloantibodies among hospitalised patients in Guangxi were different from those in other Chinese populations and Caucasians, although the alloantibodies against the antigens of the Rh system are still common. Anti-E and anti-Mi(a)/Mur were more common in Guangxi patients, but anti-K and anti-D, which are prone to develop in Caucasians, were less likely to develop in our patients.

A summary of the Transfusion Transmitted Injuries Surveillance System: 2006 - 2012.

The Transfusion Transmitted Injuries Surveillance System (TTISS) is a pan-Canadian surveillance system established by the Public Health Agency of Canada (the Agency) in partnership with the provinces and territories to capture non-nominal data on adverse transfusion reactions in Canadian hospitals providing transfusion services with the overarching goal of improving patient safety. To summarize transfusion-related adverse reactions reported to the TTISS between 2006 and 2012. Hospitals from 10 provinces and two territories participated in the TTISS by collecting and submitting data on all transfusion-related reactions or injuries to the provincial / territorial blood coordinating offices. This data was sent to the Agency where it was consolidated, cleaned, validated and analyzed by type of reactions or outcome. Corresponding rates were also calculated using the total number of units of blood components transfused as a denominator. From 2006 to 2012, a total of 3,957 adverse reactions were reported to the TTISS, excluding minor allergic reactions. Of these, 2,920 (73.8%) were related to transfusion of blood components and 1,036 (26.2%) were from the transfusion of blood products. Among reactions related to the transfusion of blood components, the most common were: transfusion-associated circulatory overload (n = 1,242, 42.5%), severe allergic / anaphylactic / anaphylactoid reactions (n=411; 14.1%) and hypotensive reactions (n=298; 10.2%). Among those related to transfusion of blood products, close to one-half were intravenous immunoglobulin (IVIG) headache (n=295; 28.5%) or delayed hemolytic reaction (n=175; 16.9%). Death definitely attributable to transfusion was extremely rare: only one case diagnosed with transfusion-related acute lung injury was identified between 2006 and 2012. The majority of reactions attributable to transfusion resulted in minor or no sequelae. Strengthening the TTISS will improve the monitoring of adverse transfusion reactions which is one of the key components of an overall patient safety strategy. Current initiatives to improve data quality include the development of transfusion-associated circulatory overload / transfusion-related acute lung injury recognition algorithm and the collection of appropriate denominators for the calculation of the rates of adverse reactions from the transfusion of blood products.

Transfusion-related adverse reactions reported to the National Healthcare Safety Network Hemovigilance Module, United States, 2010 to 2012.

In 2010, health care facilities in the United States began voluntary enrollment in the National Healthcare Safety Network (NHSN) Hemovigilance Module. Participants report transfusion practices; red blood cell, platelet (PLT), plasma, and cryoprecipitate units transfused; and transfusion-related adverse reactions and process errors to the Centers for Disease Control and Prevention through a secure, Internet-accessible surveillance application available to transfusing facilities. Facilities submitting at least 1 month of transfused components data and adverse reactions from January 1, 2010, to December 31, 2012, were included in this analysis. Adverse reaction rates for transfused components, stratified by component type and collection and modification methods, were calculated. In 2010 to 2012, a total of 77 facilities reported 5136 adverse reactions among 2,144,723 components transfused (239.5/100,000). Allergic (46.8%) and febrile nonhemolytic (36.1%) reactions were most frequent; 7.2% of all reactions were severe or life-threatening and 0.1% were fatal. PLT transfusions (421.7/100,000) had the highest adverse reaction rate. Adverse transfusion reaction rates from the NHSN Hemovigilance Module in the United States are comparable to early hemovigilance reporting from other countries. Although severe reactions are infrequent, the numbers of transfusion reactions in US hospitals suggest that interventions to prevent these reactions are important for patient safety. Further investigation is needed to understand the apparent increased risk of reactions from apheresis-derived blood components. Comprehensive evaluation, including data validation, is important to continued refinement of the module.

Incidence of Transfusion-Related Adverse Reactions per Patient Reflects the Potential Risk of Transfusion Therapy in Japan

To describe the frequency of adverse reactions (ARs) after transfusion on both per transfused patient and per transfused unit bases. We performed a retrospective analysis of data available from records of 6 hospitals on the total number of transfusions and documented ARs between January 2008 and December 2009 for RBCs, fresh-frozen plasma (FFP), and platelet concentrates (PCs). The incidence of ARs to RBCs, FFP, and PCs per transfused unit was 0.6%, 1.3%, and 3.8%, respectively. The incidence of ARs to RBCs, FFP, and PCs per patient was 2.6%, 4.3%, and 13.2%, respectively-almost 3-fold higher. Most RBC-ARs were febrile nonhemolytic transfusion reactions and allergic reactions, whereas most FFP-ARs and PC-ARs were allergic reactions. The incidence of ARs per transfused patient may reflect better the potential risk of transfusion with blood components, taking into account the characteristics of the transfused patient.

Online reporting system for transfusion-related adverse events to enhance recipient haemovigilance in Japan: A pilot study

BackgroundA surveillance system for transfusion-related adverse reactions and infectious diseases in Japan was started at a national level in 1993, but current reporting of events in recipients is performed on a voluntary basis. A reporting system which can collect information on all transfusion-related events in recipients is required in Japan. MethodsWe have developed an online reporting system for transfusion-related events and performed a pilot study in 12 hospitals from 2007 to 2010. ResultsThe overall incidence of adverse events per transfusion bag was 1.47%. Platelet concentrates gave rise to statistically more adverse events (4.16%) than red blood cells (0.66%) and fresh-frozen plasma (0.93%). In addition, we found that the incidence of adverse events varied between hospitals according to their size and patient characteristics. ConclusionThis online reporting system is useful for collection and analysis of actual adverse events in recipients of blood transfusions and may contribute to enhancement of the existing surveillance system for recipients in Japan.

Surface modification of PBT nonwoven fabrics used for blood filtration and their blood compatibility study

It is necessary to remove residual leukocytes to prevent the blood transfusion-related adverse reactions. This paper describes a facile approach for the surface modification of commercial PBT nonwoven fabrics (PBTNF), used for blood filtration, followed by immobilizing polyvinylpyrrolidone (PVP). The whole blood filtration results revealed that the five types of PBTNF-PVPs' leucocytes retention rates and erythrocyte recovery rates increased to 96% and 92% compared with the untreated PBTNF. The blood compatibilities results indicated that PVP modified PBTNFs have good blood compatibility, suggesting that PVP-modified PBTNF is a very promising blood filter for selective removal of leukocytes.

Transfusion‐associated graft‐versus‐host disease

Transfusion‐associated graft‐versus‐host disease

Preparation of surface‐modified poly(butylene terephthalate) nonwovens and their application as leukocyte removal filters

Blood transfusion-related adverse reactions have been reported to be caused by leukocytes in blood products. It is now generally accepted that it would be highly desirable to reduce leukocytes level as low as possible. In this study, melt-blown poly(butylene terephthalate) nonwoven (PBT-NW) was treated with a hydroxyapatite (HA) surface-modification method for removal of leukocytes from blood components. Acrylic acid was graft-polymerized onto the surface of the PBT-NW after oxygen plasma glow discharge treatment. The PBT-NW surface was covered with a thin layer of HA produced by immersing the polymer surface in an aqueous solution containing high concentrations of PO(4) (3-) and Ca(2+) after graft-polymerization of acrylic acid, which provided the nucleus for HA crystallization. The surface was characterized using water contact angles, attenuated total reflection-Fourier transform infrared (ATR-FT-IR), and electron spectroscopy for chemical analysis. When filtration was performed with a unit of red blood cell concentrates, HA-deposited PBT-NW (PBT-HA) removed 98.5% of the leukocytes and recovered 99.5% of the erythrocytes, suggesting that HA-deposited PBT-NW is a very promising blood filter for selective removal of leukocytes.

Reduction of the Platelet Transfusion Dose and Its Effects

In Korea, a platelet transfusion dose (TD) of 8 units of platelet concentrates (PC) is usually used. To minimize the shortage of blood products and transfusion-related adverse reactions, the TD has been changed from 8 to 6 units in 2006 in our hospital. Here, we analyzed the dose reduction effect on patients' platelet counts and transfusion frequency. We compared the amount of issued PC, platelet counts before and after transfusion, post-transfusion platelet increments, and transfusion frequencies in patients who were transfused with 8 PC in 2006 and 6 PC in 2008. Despite an increase in the number of admitted patients by 20% in 2008 with a disease distribution similar to that in 2006, the number of issued PC in 2008 was decreased by 26.6% compared to that in 2006. In 2008, post-transfusion platelet counts, pre-transfusion platelet counts in patients transfused with 320 mL whole blood-derived PC, and platelet increments in patients transfused with 400 mL whole blood-derived PC were significantly decreased. However, the mean transfusion frequency per one month was not significantly different, 4.3 times in 2006 and 4.7 in 2008. By implementing a policy of platelet TD restriction, the amount of total issued PC was markedly decreased. Although post-transfusion platelet counts were decreased, the transfusion frequency in a month was not significantly increased. The restriction of platelet TD was helpful for increasing physicians' recognition of blood shortage while achieving similar transfusion effects. We conclude that 6 units of PC would be a better guideline for the platelet TD.

Virus-inactivated plasma - Plasmasafe: a one-year experience.

Fresh-frozen plasma (FFP) is a widely used blood transfusion product. The transfusion safety of this product is ensured by legally obligatory tests, but can be further improved by using some technical procedures, such as methylene blue (MB) and solvent-detergent (SD) viral inactivation methods. Mainly organisational criteria led us to introduce the SD viral inactivation technique as a service activity. In this report we describe our first year of experience, following the introduction of the SD technique, and thus the use of SD-virally inactivated plasma (PlasmaSafe). IN ORDER TO EVALUATE THE APPROPRIATE USE AND THE THERAPEUTIC EFFICACY OF PLASMASAFE IN OUR BLOOD TRANSFUSION UNIT, THE FOLLOWING PROGRAMME WAS PLANNED: quality control [prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen] of the FFP units (N=312); evaluation of the clinical effectiveness on 490 patients (879 transfusion events); pre- and post-treatment monitoring of indicators of coagulation (PT, aPTT, fibrinogen, proteins S and C, factor VIII) on 15 patients; treatment of three patients with thrombotic thrombocytopenic purpura (TTP) undergoing plasma-exchange; haemovigilance of adverse reactions provoked by SD-plasma. THE INDICATORS OF COAGULATION IN THE FFP UNITS VARIED GREATLY: the PT ranged from 50-120%, the aPTT from 24-41 seconds and the fibrinogen concentration from 1.42-6.84 g/L. Seventy-six percent of the patients responded to the plasma administration; moreover, two of 15 patients in whom protein S was assayed, showed no increase of this haemostatic protein. The TTP patients responded to plasma exchange treatment following four sessions of apheresis. During the observation period 8,422 PlasmaSafe units were transfused and no adverse reactions were recorded. PlasmaSafe, a pharmaceutical-like product with a standardised content of coagulation factors, was found to be effective at correcting coagulation defects and for treating TTP. No thrombotic complications or transfusion-related adverse reactions were recorded.