Abstract
Background: Transfusion of blood components are vital therapeutic procedures in clinical medicine. However patients may still be at risk of adverse effects of transfusions. Analysis of all untoward effects of blood transfusion must be monitored in order to correct their cause and prevent recurrence. This study was designed to analyse the incidence and spectrum of adverse effects of blood transfusion so as to initiate measures to minimize risks and improve overall transfusion safety.
Methods: In the present study, we totally reviewed data over 12 years. All the acute transfusion reactions of blood components, that were reported to the hospital blood bank were included. Reactions due to Platelets and delayed transfusion reactions were excluded. The transfusion reaction workup done for these reported cases included; verification of patient identity and clinical records, examination of blood transfusion set and bag, ABO and Rh blood grouping, cross matching (pre & post transfusion samples)and urine analysis.
Results: Of the total 293023 transfusions during the study period, 417 (0.14%) acute transfusion reactions (ATR) were reported. The commonest type of reaction noted were of the allergic type (ANHTR) (n=303; 72.6%), followed by febrile non hemolytic transfusion reactions(FNHTR)(n=104;24.9%), 8 (1.9%)hemolytic transfusion reactions(HTR).2 cases of the NHTRs presented with clinical suspicion of TRALI. All the HTRs were due to packed red cell (PC) transfusions. 324 NHTRs were due to red cell transfusions, 85 due to infusion of plasma.
Conclusions: The NHTRs were far more in number (esp the ANHTRs),effective leucodepletion holds the key. HTRs were completely preventable but far more dangerous clinically. A strict protocol needs to be followed not only in the blood bank, but also in other relevant procedures like; pre transfusion sampling, storage outside blood banks, bed side patient identification and monitoring of transfusion to ensure blood safety and reduce such adverse effects
Keywords: Transfusion reactions, hemolytic, non-hemolytic.
References
- Aubuchnon JP, Kruskall MS. Transfusions safety: Realigning efforts with risks. Transfusion 1997;37:1211-6
- Kleinmman S. Chan P Robillard P. Risk associated with transfusion of cellular blood components in Canada. Transfus Med 2003:17120-62
- National Institute of Biologicals, Ministry of Health and Family Welfare, Government of India. [updated 2016 June 3; cited Dec 2012]. Haemovigilance Programme of India.National Institute of Biologicals & India Pharmacopoeia Commission Collaboration. (about 1 screen) Available from: http://www.nib.gov.in/haemovigilance1.html.
- Tutu EK. A review of international blood safety and quality regulations: Key implications for blood organizations and hospital blood transfusion practice. Can J Med Lab Sci 2011;73:6-12.
- Salmi R. Epidemiological support of hemovigilance. Transfus Clin Biol 1994;6:421-4.
- Jain A, Kaur R. Hemovigilance and blood safety. Asian J Transfus Sci 2012;6:137-8
- Robillard P, Nawej KI, Jochem K.The Quebec haemovigilance system: descry-ption and results from the first two years. Transfus Apher Sci. 2004;31:111-22.
- Moore S, Taswell HF, Pineda AA. Delayed hemolytic transfusion reactions: Evidence of the need for an improved pretransfusion compatibility test. Am J Clin Path 1980;74:94-7.
- Lichtiger B, Thornton E. Hemolytic transfusion reactions in oncology patients: Experience in a large cancer center. J Clin Oncol 1984;2:438-42.
- Khalid S, Usman M, Khurshid M. Acute transfusion reactions encountered in patients at a tertiary care center. J Pak Med Assoc. 2010;10:832-36
- Bhattacharya P, Marwaha N, Dhawan HK, Roy P and Sharma RR. Transfusion-related adverse events at the tertiary care center in North India: An institutional hemovigilance effort. Asian Journal of Transfusion science 2011;5:164-170
- Febrile, Allergic and Non immune Transfusion reactions. Stack G,Pomper GJ. In: (eds) Simon TL, Dzik WH, Snyder EL et al; Rossi’s Principles of Transfusion Medicine: 3rd edition .Philadelphia: Lippincott Williams and Wilkin;2002:831-851
- die Rie MA, van der Plas-van Dalen CM, Engelfriet CP,van dem Borne AEGKr . The serology of febrile transfusion reactions. Vox sang 1985;49: 126-134
- Brubaker DB. Clinical significance of white cell antibodies in febrile non hemolytic transfusion reactions. Transfusion 1990;30:733-37
- StackG, Snyder EL. Cytokine generation in stored platelet concentrates. Transfusion 1994;34:20-25
- Muyelle L, Joos M, Wouters E et al. Increased tumour necrosis factor, interl-eukin 1 and interleukin 6 levels in platelet concentrates: Relationship between TNF and IL-6 levels and febrile transfusion reactions. Transfusion 1993;33:195-99
- Heddle NM, Klama L, Singer J, Richards C, Fedak P, Walker I, Kelton JG. The role of plasma from platelet concentrates in transfusion reactions. N Eng J Med . 1994;331: 625-28
- Sharma AD, Grocott HP. Platelet transfusion reactions:febrile non hemolytic reaction or bacterial contamination? Diagnosis, detection and current preventive modalities. J Cardiothorac vasc Anesth.2000;14: 460-66
- NIH consensus conference: Perioperative red cell transfusion. JAMA 1988;260: 2700-3
- Ulhman EJ, Isgrigs E, Wallhermanfechtel M, Goodnough LT. Prestorage universal WBC reduction of RBC units does not affect the incidence of transfusion reactions. Transfusion 2001;41:997-1000
- Tyler VV, Benson K, Branch DR, Loni Calhoun MT, Dzik WH, Leparc GF et al. editors. Non infectious Complications of Blood transfusion . In; Technical manual of the American Association of Blood Banks. 12th Ed, Bethesda ,Maryland.1996 : 543-61
- Ezidiegwu, CN, Lauenstein KJ, Rosales LG, Kelly KC, Henry JB. Febrile Nonhemolytic Transfusion Reactions Management by Premedication and Cost Implications in Adult Patients. Arch Pathol lab med 2004;128:991-95
- Tanz WS, King KE, Ness PM. Re-evaluation of transfusion reaction rates associated with leukocyte-reduced red blood cells. Transfusion 2001;41:7s (abstr suppl).
- Domen RE, Heoltage GA, Allergic transfusion reactions. Arch Path Lab Med 2003;127:316-20
- Marwaha N, Singh S, Bisht A. ISBT Science Series. Vol. 9. Hoboken, NJ: Wiley Publishers. 2014. p. 178-83
- Global Consultation on Haemovigilance. 20-22 November 2012, Dubai, United Arab Emirates. Jointly Organized by WHO HQ/Geneva, Sharjah Blood Transfusion and Research Center and the Government of the United Arab Emirates, in Collaboration with the International Haemovigilance Network and the International Society of Blood Transfusion. 2012. [cited 2013].Available from: http://www.who.int/bloodsafety/haemovigilance/haemovigilance-report.pdf.
Corresponding Author
Dr Vanamala Alwar
Department of Transfusion Medicine and Immunohematology, St John’s Medical College Hospital
Sarjapur Road, Bangalore560034
Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mob-9480706112
DOI: https://dx.doi.org/10.18535/jmscr/v6i1.14
