Types Of Transfusion Reactions Research Articles

Adverse transfusion reactions following transfusion of blood and blood products in a tertiary care hospital: A step toward hemovigilance

Background: Transfusion of blood and blood products is a double-edged sword, so it should be used judiciously. The primary aim of the centralized hemovigilance program is to improve transfusion safety. Aims and Objectives: To determine the frequency, distribution, and types of transfusion reactions (TRs) occurring in patients, reported to the blood center in a tertiary care hospital in North East India. Materials and Methods: A retrospective study was conducted in State of The Art Model Blood Center, Assam Medical College and Hospital for 1 year from July 2022 to June 2023. Data were collected from TR records as per the hemovigilance reporting format and analyzed. Results: During the study, 38,165 blood products were issued. 41 (0.11%) TRs were recorded, out of which 25 (61%) occurred with packed red cell transfusion followed by whole blood transfusion (39%). The most common type was febrile non-hemolytic TR (51.2%) followed by allergic reactions (39%). Conclusion: The frequency of adverse TRs was low (0.11%), which may be due to the management of a few cases by the treating clinician itself. Most reactions occurred with packed red blood cells (PRBC) transfusion, the most common type being febrile non-hemolytic TR, which may be due to the presence of leukocytes, inflammatory mediators in leftover plasma during PRBC preparation, which can be standardized by the use of leukoreduced blood products. Hemovigilance will help to strengthen the quality and safety of blood transfusion.

Clinical and in vitro evaluation of red blood cells collected and stored in a non-DEHP plasticized bag system.

Di-ethyl-hexyl-phthalate (DEHP) is currently the main plasticizer used for whole blood collection systems. However, in Europe, after May 2025, DEHP may no longer be used above 0.1% (w/w) in medical devices. DEHP stabilizes red cell membranes, thereby suppressing haemolysis during storage. Here we compared in vitro quality parameters of red cell concentrates (RCCs) collected and stored in DEHP-, DINCH- or DINCH/BTHC-PVC hybrid blood bags with saline-adenine-glucose-mannitol (SAGM) or phosphate-adenine-glucose-guanosine-saline-mannitol (PAGGSM) storage solution. Last, we performed haemovigilance surveillance for RCC collected in DINCH-PVC and stored in PAGGSM/BTHC-PVC. In vitro quality parameters of RCC were determined during 42 days of storage. Haemovigilance surveillance was conducted to compare the frequency and type of transfusion reaction. Haemolysis levels were increased in SAGM/BTHC-PVC as compared to SAGM/DEHP-PVC (0.66% ± 0.18% vs. 0.36% ± 0.17%). PAGGSM storage solution was able to adequately suppress haemolysis to levels observed during storage in SAGM/DEHP-PVC, both in BTHC-PVC (0.38% ± 0.12%), and to a slightly lesser extent in DINCH-PVC (0.48% ± 0.17%). A total of 1650 PAGGSM/BTHC-PVC and 5662 SAGM/DEHP-PVC RCC were transfused yielding a transfusion reaction frequency of 0.24% (95% CI 0.0000-0.0048) and 0.44% (95% CI 0.0027-0.0061) respectively. The in vitro quality of RCC stored in PAGGSM/BTHC-PVC and SAGM/DEHP-PVC is comparable. There is no indication that transfusion of erythrocytes stored in PAGGSM/BTHC-PVC results in increased transfusion reaction frequency. These initial results provide a basis for further clinical evaluation to narrow down the confidence interval of transfusion reaction frequency.

Multinational Analysis of Children Transfused With Pathogen Inactivated Platelets.

Pathogen inactivated (PI) platelets are a technological advancement in blood safety; however, the pediatric experience is not well characterized. We studied pediatric patients who received transfusions of PI platelets across several centers and countries to determine if transfusion reaction rates differed when compared with conventional platelets. This is a retrospective multisite study conducted during 2 time periods. The study period started at the time each site began using PI platelets on a widespread basis, and the control period was a similar timespan before PI introduction. Suspected acute transfusion reactions were compared. The study included 3839 pediatric patients who were 0 to 18 years of age who received >7930 platelet transfusions, in total, across 4 centers in 3 countries between 2013 and 2019. The age distribution of patients in the study and control period was not significantly different (P = .190). There was not a difference in the percentage of patients who had any type of transfusion reaction between the time periods (1.0% and 1.1%, P = .803). There were fewer patients with mild allergic reactions in the study period compared with the control period (0.2% and 0.7% of patients with reactions, respectively, P = .018). Pediatric patients have the same rate of acutely suspected transfusion reactions when receiving PI or conventional platelet transfusions. Subgroup analysis found fewer mild allergic reactions in the study period, which was contemporaneous to the addition of using platelet additive solution more broadly. Future studies of PI platelets should include children to better assess transfusion efficacy and hemostatic outcomes.

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.

A Retrospective Analysis of Transfusion Reactions at a Tertiary Care Center: An Institutional Hemovigilance Study.

The goal of our study was to determine the frequency and type of transfusion reactions (TRs) as well as other hemovigilance activities reported at a tertiary care hospital in Turkey over a period of 3 years. In this retrospective study, the notification sheets of TRs reported to the institution's local hemovigilance system between December 2017 and December 2020 were analyzed. A total of 89,187 units of blood components were administered to patients during this period. A total of 197 TRs were reported to the hemovigilance system. The overall frequency of TRs was 0.22%. The most common TRs were allergic reactions (49.2%) and febrile nonhemolytic transfusion reactions (37.6%), respectively. Most of the adverse events were reported by clinical nurses. Our study showed that the frequency of TRs was low, and most were manageable reactions. We found that reporting of all TRs and continuous nursing education can help to strengthen the hemovigilance system. [J Contin Educ Nurs. 2021;52(12):581-588.].

Blood Utilization and Transfusion Reactions in Pediatric Patients Transfused with Conventional or Pathogen Reduced Platelets

To assess the safety and efficacy of a Food and Drug Administration-approved pathogen-reduced platelet (PLT) product in children, as ongoing questions regarding their use in this population remain. We report findings from a quality assurance review of PLT utilization, associated red blood cell transfusion trends, and short-term safety of conventional vs pathogen-reduced PLTs over a 21-month period while transitioning from conventional to pathogen-reduced PLTs at a large, tertiary care hospital. We assessed utilization in neonatal intensive care unit (NICU) patients, infants 0-1year not in the NICU, and children age 1-18years (PED). In the 48hours after an index conventional or pathogen-reduced platelet transfusion, respectively, NICU patients received 1.0±1.4 (n=91 transfusions) compared with 1.2±1.3 (n=145) additional platelet doses (P=.29); infants 0-1year not in the NICU received 2.8±3.0 (n=125) vs 2.6±2.6 (n=254) additional platelet doses (P=.57); and PEDs received 0.9±1.6 (n=644) vs 1.4±2.2 (n=673) additional doses (P< .001). Time to subsequent transfusion and red cell utilization were similar in every group (P> .05). The number and type of transfusion reactions did not significantly vary based on PLT type and no rashes were reported in NICU patients receiving phototherapy and pathogen-reduced PLTs. Conventional and pathogen-reduced PLTs had similar utilization patterns in our pediatric populations. A small, but statistically significant, increase in transfusions was noted following pathogen-reduced PLT transfusion in PED patients, but not in other groups. Red cell utilization and transfusion reactions were similar for both products in all age groups.

Direct costs of transfusion reactions - an expert judgement approach.

Despite increasingly meticulous haemovigilance reporting throughout the world, a systematic assessment of the cost of transfusion reactions is still lacking. This is partly caused by the fact that such an assessment requires a subjective expert assessment of the additional costs linked to the adverse reaction. Data on the cost of transfusion reactions could support decision-making regarding blood transfusion safety measures. Thirteen experts from nine hospitals were asked to estimate the additional care required following various types of transfusion reactions. Additional care was quantified as the proportion of reactions requiring care, and the amount of care required (e.g. hospitalization days, additional physician's time). Experts were also asked to provide, per type of transfusion reaction, an estimate of the proportion of transfusion reactions preventable. Structured quantitative expert elicitation methods were applied to obtain and combine expert estimates. The estimated annual in-hospital cost of transfusion reactions in the Netherlands is €933 356 per year (€1.52 per transfusion). Two-thirds (64%) of these are incurred by non-serious transfusion reactions. Circulatory overload, TRALI and anaphylaxis clearly dominate the costs of serious adverse transfusion reactions (66% in total); non-haemolytic transfusion reactions incur 46% of the cost of non-serious transfusion reactions. Additional safety measures targeting circulatory overload and new antibody formation potentially offer the highest cost reduction. In-hospital costs of transfusion reactions are substantial but contribute to less than 1% of the total cost of transfusion in the Netherlands. A considerable part of these costs (24%) might be preventable.

Transfusion reaction and hemovigilance: An imperative discussion in Brazilian hemotherapy services

Transfusion of blood components is considered safer, but it took years to reach this level. One of the most effective ways to make blood transfusion a safer practice is hemovigilance, which provides important data, including the history of feared transfusion reactions. In recent years in Brazil, there has been an improvement in the reporting of transfusion reactions, however due to the great diversity of hematology services, there are still transfusion reactions. The aims of this study were described the main types of transfusion reactions, as well as to evaluate the underreporting importance of transfusion occurrences of hemotherapy services in Brazil.

Transfusion Reactions as an Indicator of Service Quality of Blood Transfusion in Sanglah General Hospital Denpasar Bali-Indonesia

Background: One of the fatal side effects of transfusion is transfusion reactions. The incidence of transfusion reaction in Sanglah Hospital is still relatively high and far from national target which is 0.01%. To achieve the target of quality, it is necessary to set up an active program so that the number of incidence of transfusion reactions can be decreased. Methods: Pre and post test interventional study was conducted for 6 months in Sanglah Hospital Bali. All nurses in wards which is blood product frequently used was involved in this study. The intervention in this study was in the form of education and training programs on the application of the closed system and cold chain in the distribution of blood products as well as improved service system. Results: The results showed a decline in the incidence of transfusion reactions occurred every month during the study. The incidence of transfusion reactions occurred each month was 0.77%, 0.56%, 0.5%, 0.49%, 0.45% and 0.38% respectively. The average reduction in the incidence of transfusion reactions was 0.08% every month. The type of transfusion reaction that occurred was 59% urticaria, 29% fever, 7% shortness of breath, 4% fever and chills, and 1% shock. Conclusion: Education and training programs on the application of the cold chain system and closed system in the distribution of blood products as well as the improvement of service system helped reduce the number of the incidence of transfusion reactions in Sanglah Hospital Bali.

Gaps in Research on Adverse Events to Transfusion in Pediatrics.

Adverse consequences of blood transfusion in children are not completely understood. Much remains to be learned about defining their mechanisms, learning how they can be avoided, and improving our understanding how to minimize the morbidity of their consequences. All types of transfusion reactions can occur in children. This article focuses on four adverse consequences that have particular relevance for pediatric populations: cytomegalovirus transmission, red blood cell alloimmunization, immune altering consequences of transfusion, and necrotizing enterocolitis.

Transfusion-related Acute Lung Injury in Obstetrics and Gynecology

ABSTRACT Transfusion-related acute lung injury (TRALI), a type of noncardiogenic pulmonary edema related to blood transfusion, is gaining prominence as a common adverse event related to blood transfusions in hospitals. It is typified by dyspnea, cough, hypoxemia and pulmonary edema within 6 hours of transfusion. Without any ‘gold standard’, the diagnosis of TRALI relies on a high index of suspicion and on excluding other types of transfusion reactions. As our understanding of TRALI deepens, risk reduction or prevention may become possible. The management of TRALI is early diagnosis and good supportive care with, occasionally ventilator support. With the increasing use of blood products in obstetrics and gynecology, awareness of this complication is desirable to prevent one of the commonest and most frequently under-recognized transfusion related adverse event of the present day. How to cite this article Kakade A, Kulkarni Y, Shukla H. Transfusion-related Acute Lung Injury in Obstetrics and Gynecology. J South Asian Feder Obst Gynae 2015;7(1)26-29.

Monitoring and reporting transfusion reactions as a quality indicator – a clinical audit

Background and ObjectiveThis audit was conducted as a part of a quality assurance activity to assess the frequency of receiving completely filled out blood transfusion reaction forms which were accompanied by the required samples. Once this information is known, we will elevate the bar each year to achieve 100% compliance. The sub-aim was to evaluate the frequency of the reported transfusion reactions. Materials and MethodsThe study was conducted from 1st April 2010 to 30th April 2011. The information was evaluated and the frequency of receiving completely filled blood transfusion reaction forms was assessed. The variables identified were the type of transfusion reaction, the blood component transfused, the health care personnel filling the form, and whether there was legible handwriting and a completely filled form. Transfusion reactions were reported as a percentage of the total number of units transfused. ResultsDuring the study period, 17,880 packed red cells, 13,200 platelets, 13,620 fresh frozen plasma and 2256 cryoprecipitate were transfused and 106 transfusion reactions (0.23%) were reported. Of these, febrile non hemolytic transfusion reaction was the most common (47%), the majority caused by packed red cells. ConclusionEighty-four percent of the transfusion reaction forms were completely filled as per our criteria. Febrile non hemolytic transfusion reactions were the most common reactions reported.

Retrospective evaluation of adverse transfusion reactions following blood product transfusion from a tertiary care hospital: A preliminary step towards hemovigilance

Background:The goal of hemovigilance is to increase the safety and quality of blood transfusion. Identification of the adverse reactions will help in taking appropriate steps to reduce their incidence and make blood transfusion process as safe as possible.Aims:To determine the frequency and type of transfusion reactions (TRs) occurring in patients, reported to the blood bank at our institute.Materials and Methods:A retrospective review of all TRs reported to the blood bank at the All India Institute of Medical Sciences, between December 2007 and April 2012 was done. All the TRs were evaluated in the blood bank and classified using standard definitions.Results:During the study period a total of 380,658 bloods and blood components were issued by our blood bank. Out of the total 196 adverse reactions reported under the hemovigilance system, the most common type of reaction observed was allergic 55.1% (n = 108), followed by febrile non-hemolytic transfusion reaction (FNHTR) 35.7% (n = 70). Other less frequently observed reactions were Anaphylactoid reactions 5.1% (n = 10), Acute non-immune HTRs 2.6% (n = 5), Circulatory overload 0.5% (n = 1), Transfusion related acute lung injury 0.5% (n = 1), Delayed HTRs 0.5% (n = 1). Not a single case of bacterial contamination was observed.Conclusion:The frequency of TRs in our patients was found to be 0.05% (196 out of 380,658). This can be an underestimation of the true incidence because of under reporting. It should be the responsibility of the blood transfusion consultant to create awareness amongst their clinical counterpart about safe transfusion practices so that proper hemovigilance system can be achieved to provide better patient care.

Blood transfusions in dogs and cats: blood typing and cross matching

The blood transfusion (administration of blood) is a resource of veterinary medicine with several indications. Point-of-care blood-typing methods, including both typing cards and rapid gel agglutination, are readily available. Following blood typing, cross matching is performed on one or more donor units of appropriate blood type. Cross matching reduces the risk of transfusion reactions but does not completely eliminate the risk of other types of transfusion reactions in veterinary patients. All transfusion reactions should be appropriately documented and investigated. It is, therefore, important to have in-depth technical knowledge about concepts and procedures involved in clinical blood transfusion, so that the entire procedure can be performed in the most appropriate way and with a high success rate.

L’hypotension artérielle dans les effets indésirables receveurs : du signe clinique associé à la réaction transfusionnelle hypotensive

Objective The first aim of this study was to confirm the presence of hypotension blood transfusion reactions and to assess the part of hypotension as a principal event, as defined by the literature but not characterized in French haemovigilance data. As well, recent series of several cases led us to consider a possible incidence increase. Study design Using a retrospective observation, the haemovigilance data from 2000 to the end of 2007 of two French regions were reviewed. During this period, 1 159 657 blood units were transfused by nearly 100 hospitals and 3727 adverse reactions observed. Results One hundred and sixty-eight adverse reactions with hypotension were noticed and analyzed, representing 4.5% of all transfusion reactions and revealing an incidence of 14.5 for 100 000 blood units transfused. It turned out to be mostly male recipients, severe reactions and appearing rather in the beginning of transfusions. Although platelets having greater incidence, all types of blood products may be involved. The clinical diagnosis was the following: 40 to 47% were classified as febrile reactions, 13 to 17% were allergic reactions, 8 to 9% were due to immunologic and/or haemolytic reactions, 5 to 7% resulted of cardiologic disorders, 5% resulted of hypovolemic contexts and 22% were unexplained hypotensive transfusion reactions. Conclusion In about three cases out of four, transfusion-induced hypotension was associated with other clinical reactions. Indeed, hypotensive transfusion reactions were identified, having an incidence of 3.2 for 100 000 blood units transfused. Furthermore, there was no explanation found for the incidence increase in our region during 2007. A national study was suggested to analyse the national data as well as a prospective study to clear out this type of transfusion reactions.

Increasing patient safety in veterinary transfusion medicine: an overview of pretransfusion testing

To review the principles and available technology for pretransfusion testing in veterinary medicine and discuss the indications and importance of test performance before RBC transfusion. Current human and veterinary medical literature: original research articles and scientific reviews. Indications for RBC transfusion in veterinary medicine include severe anemia or tissue hypoxia resulting from blood loss, decreased erythrocyte production, and hemolyzing conditions such as immune-mediated anemia and neonatal isoerythrolysis. Proper blood sample collection, handling, and identification are imperative for high-quality pretransfusion testing. Point-of-care blood typing methods including both typing cards and rapid gel agglutination are readily available for some species. Following blood typing, crossmatching is performed on one or more donor units of appropriate blood type. As an alternative to technically demanding tube crossmatching methods, a point-of-care gel agglutination method has recently become available for use in dogs and cats. Crossmatching reduces the risk of hemolytic transfusion reactions but does not completely eliminate the risk of other types of transfusion reactions in veterinary patients, and for this reason, all transfusion reactions should be appropriately documented and investigated. The administration of blood products is a resource-intensive function of veterinary medicine and optimizing patient safety in transfusion medicine is multifaceted. Adverse reactions can be life threatening. Appropriate donor screening and collection combined with pretransfusion testing decreases the occurrence of incompatible transfusion reactions.

Transfusion related acute lung injury

Transfusion related acute lung injury (TRALI) is an uncommon but potentially fatal adverse reaction to transfusion of plasma containing blood components. We describe a case of 10-year-old male child with aplastic anemia, platelet count of 7800/l, B positive blood group who developed fever (39.2C), difficulty in breathing and cyanosis within 2 hrs after transfusion of a random platelet concentrate. Despite the best resuscitative efforts, the child died within next 24 hrs. The present case highlights the fact that TRALI should be kept as a differential diagnosis in all patients developing acute respiratory discomfort within 6 hrs of transfusion. Without a 'gold standard' the diagnosis of TRALI relies on a high index of suspicion and on excluding other types of transfusion reactions. Notification to transfusion services is crucial to ensure that a proper investigation is carried out and at-risk donor and recipients can be identified, and risk reduction measures can be adopted.

Transfusion-Related Acute Lung Injury

Noncardiogenic pulmonary edema caused by transfusion has been observed for almost 60 years. Today, we know this entity as transfusion-related acute lung injury (TRALI). TRALI is an uncommon but potentially fatal adverse reaction to transfusion of plasma-containing blood components. It is typified by dyspnea, cough, hypoxemia, and pulmonary edema within 6 hours of transfusion. Most commonly, it is caused by donor HLA antibodies that react with recipient antigens. It may also be caused by biologically active compounds accumulated during storage of blood products, which are capable of priming neutrophils. Without a "gold standard," the diagnosis of TRALI relies on a high index of suspicion and on excluding other types of transfusion reactions. Although current definitions of TRALI depend on symptoms, laboratory parameters can aid in the diagnosis and frequently identify the causative donor unit. As our understanding of TRALI deepens, risk reduction or prevention may become possible.

Vasoactive mediators and hypotensive transfusion reactions

Vasoactive mediators and hypotensive transfusion reactions

Mechanisms and new approaches for the allogeneic blood transfusion-induced immunomodulatory effects

ELLULAR BLOOD components such as red cells, platelets, and granulocytes are routinely used for clinical conditions associated with deficits of these respective cells in patients. Because different alloantigens are present on donor blood cells, elicitation of humoral and cellular immune responses to these foreign antigens is expected. These immune responses could lead to various types of transfusion reactions, such as hemolysis, fever, lung injury, refractoriness to random donor platelets, and so forth. ~ In addition to these well-recognized immunologic reactions, a number of unintended and subtle immunologic consequences associated with transfusions of allogeneic blood components have also been reported. The best-documented consequence is the prolonged survival of renal allografts in patients who had blood transfusions before transplantation. 2,3 This finding indicates that allogeneic blood transfusion could enhance the acceptance of allografts and has prompted extensive investigation on the possible immunologic mechanisms for this intriguing phenomenon. 4 This finding also prompted a close examination of other possible clinical consequences that might have resulted from potential nonspecific immunosuppressive effect of allogeneic blood transfusion. The reported clinical consequences include increased risk of postoperative infection, 5,6 increased growth and dissemination of tumor cells] activation of latent viral infection, 8-1~ amelioration of immune inflammatory diseases,11 and prevention of recurrent spontaneous abortions. ~2,13 However, the causal association between these immunologic effects and allogeneic blood transfusion remains controversial, and the mechanisms for these effects are poorly defined. 13-15 Recent advances in the