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Hmida MA, Mahjoub S, Ben Hamed L, Mojaat N, Bahloul A, Hmida S. Transfusion safety: Is there a difference between reported reactions in low-to-middle income and high-income countries? Transfus Apher Sci 2024; 63:103916. [PMID: 38553365 DOI: 10.1016/j.transci.2024.103916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND AND OBJECTIVES Transfusion safety may be becoming dependent on the financial resources made available for transfusion structures and may vary between high-income countries (HIC) and low-to-middle-income countries (LMIC). To assess whether there is a difference in the reported TR between these two groups of countries, we examined TR reported in Tunis the capital of Tunisia, a LMIC, and compared their frequency with reported TR in HIC. MATERIALS AND METHODS Data of TR were collected from transfusion incident report (TIR) forms declared by healthcare facilities in Tunis between 2015 and 2019. They were analysed and compared to reported TR in France (ANSM) and UK (SHOT). RESULTS The incidence of TR was 70.6/100 000 blood components (BP) issued. A third of TR (36.8%) occurred at night. Febrile non-hemolytic transfusion reactions (43.7%) and allergic reactions (35%) were the most reported TR respectively 22.4/100 000 BP and 17.9/100 000 BP. The rate of ABO incompatibilities was 1.96/100 000 red blood cell units (RBC): they were all caused by human error. The rates of TRALI, TACO and bacterial contaminations were respectively 1.26/100 000 BP, 1.4/100 000 RBC and 0.7/100 000 BP. CONCLUSION While advanced technologies applied to transfusion have improved transfusion safety, this study shows that their impact has been relatively minor, as reported TR in LMIC are still comparable to those in HIC. ABO-incompatibilities are still higher in LMIC: this should be addressed by reinforcing the training of all healthcare personnel involved in transfusion medicine.
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Affiliation(s)
- Mohamed Amine Hmida
- Faculty of Medicine of Tunis - University Tunis El Manar, Djebal Lakhdar Street, 1006 Tunis, Tunisia; Hematology Laboratory, La Rabta University Hospital, La Rabta, 1007 Tunis, Tunisia.
| | - Sonia Mahjoub
- Faculty of Medicine of Tunis - University Tunis El Manar, Djebal Lakhdar Street, 1006 Tunis, Tunisia; Hematology Laboratory, La Rabta University Hospital, La Rabta, 1007 Tunis, Tunisia
| | - Leila Ben Hamed
- National Blood Transfusion Center, 13 Djebel Lakhdhar Street, Bab Sabdoun, 1006 Tunis, Tunisia
| | - Najet Mojaat
- Central Unit of Blood Transfusion and Blood Banks, Djebel Lakhdhar Street, Bab Sabdoun, 1006 Tunis, Tunisia
| | - Abdessalem Bahloul
- Hematology Laboratory, Charles Nicolle University Hospital, 9 avril 1938 Street, Bab Saadoun, 1007 Tunis, Tunisia
| | - Slama Hmida
- National Blood transfusion Center, 13 Djebel Lakhdhar Street, Bab Sabdoun, 1006 Tunis, Tunisia
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Pitman JP, Payrat JM, Park MS, Liu K, Corash L, Benjamin RJ. Longitudinal analysis of annual national hemovigilance data to assess pathogen reduced platelet transfusion trends during conversion to routine universal clinical use and 7-day storage. Transfusion 2023; 63:711-723. [PMID: 36802055 DOI: 10.1111/trf.17285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/27/2023] [Accepted: 01/28/2023] [Indexed: 02/20/2023]
Abstract
BACKGROUND France converted to universal pathogen reduced (PR; amotosalen/UVA) platelets in 2017 and extended platelet component (PC) shelf-life from 5- to 7-days in 2018 and 2019. Annual national hemovigilance (HV) reports characterized longitudinal PC utilization and safety over 11 years, including several years prior to PR adoption as the national standard of care. METHODS Data were extracted from published annual HV reports. Apheresis and pooled buffy coat [BC] PC use was compared. Transfusion reactions (TRs) were stratified by type, severity, and causality. Trends were assessed for three periods: Baseline (2010-14; ~7% PR), Period 1 ([P1] 2015-17; 8%-21% PR), and Period 2 ([P2] 2018-20; 100% PR). RESULTS PC use increased by 19.1% between 2010 and 2020. Pooled BC PC production increased from 38.8% to 68.2% of total PCs. Annual changes in PCs issued averaged 2.4% per year at baseline, -0.02% (P1) and 2.8% (P2). The increase in P2 coincided with a reduction in the target platelet dose and extension to 7-day storage. Allergic reactions, alloimmunization, febrile non-hemolytic TRs, immunologic incompatibility, and ineffective transfusions accounted for >90% of TRs. Overall, TR incidence per 100,000 PCs issued declined from 527.9 (2010) to 345.7 (2020). Severe TR rates declined 34.8% between P1-P2. Forty-six transfusion-transmitted bacterial infections (TTBI) were associated with conventional PCs during baseline and P1. No TTBI were associated with amotosalen/UVA PCs. Infections with Hepatitis E (HEV) a non-enveloped virus resistant to PR, were reported in all periods. DISCUSSION Longitudinal HV analysis demonstrated stable PC utilization trends with reduced patient risk during conversion to universal 7-day amotosalen/UVA PCs.
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Affiliation(s)
- John P Pitman
- Scientific and Medical Affairs, Cerus Corporation, Concord, California, USA
| | | | - Min-Sun Park
- Biostatistics and Data Management, Cerus Corporation, Concord, California, USA
| | - Kathy Liu
- Biostatistics and Data Management, Cerus Corporation, Concord, California, USA
| | - Laurence Corash
- Scientific and Medical Affairs, Cerus Corporation, Concord, California, USA
| | - Richard J Benjamin
- Scientific and Medical Affairs, Cerus Corporation, Concord, California, USA
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How to improve issuing, transfusion and follow-up of blood components in Southern and Eastern Mediterranean countries? A benchmark assessment. Transfus Apher Sci 2022; 62:103616. [PMID: 36470725 DOI: 10.1016/j.transci.2022.103616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 11/12/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022]
Abstract
To determine the existence of guidelines regarding the appropriate clinical use of blood and blood components, transfusion requests, and blood issuing/reception documents and procedures. The different bedside transfusion organizations/processes and hemovigilance are also analyzed. The ultimate objective is to identify safe potential options in order to improve blood safety at the lowest cost. Data emanating from eight Arabic eastern/southern Mediterranean countries who responded to five surveys were collected and tabulated. National recommendations for the clinical use of blood components especially for hemoglobinopathies are lacking in some countries. In matter of good practices in the prescription, issuing and reception of BCs, efforts were made either on national or local basis. Procedures regarding patient information and ethical issues are still lacking. Almost all Mediterranean countries apply two blood testing procedures on each patient sample. Only Morocco, Tunisia and Algeria perform bed side blood group testing; Egypt and Lebanon perform antibody screen and antiglobulin cross matching universally. Automation for blood testing is insufficiently implemented in almost all countries and electronic release is almost absent. National hemovigilance policy is implemented in Tunisia, Morocco, and Lebanon but the reporting system remains inoperative. Insufficient resources severely hinders the implementation of expensive procedures and programs; however, the present work identifies safe procedures that might save resources to improve other parts in the transfusion process (e.g. electronic release to improve safety in issuing). Moreover, setting up regulations regarding ethics in transfusing recipients along with local transfusion committees are crucially needed to implement hemovigilance in transfusion practice.
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4
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Tacquard C, Andreu G, Meyer N, Carlier M, Py JY, Drouet C, Bienvenu J, Mertes PM, Boudjedir K. Hypersensitivity transfusion reactions to fresh frozen plasma: a retrospective analysis of the French hemovigilance network. Transfus Med Rev 2022; 36:77-81. [DOI: 10.1016/j.tmrv.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
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5
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Acharya D, Lewin A, Gaussen A, Lambert G, Renaud C, Nawej K, Poder TG. Study protocol of associated criteria used in investigating septic transfusion reactions (STRs): A scoping review about available evidence. PLoS One 2022; 17:e0262765. [PMID: 35051241 PMCID: PMC8775533 DOI: 10.1371/journal.pone.0262765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/03/2022] [Indexed: 12/02/2022] Open
Abstract
Background and objective Assessment criteria for septic transfusion reactions (STRs) are variable around the world. A scoping review will be carried out to find out, explore and map existing literature on STRs associated criteria. Methods This scoping review will include indexed and grey literatures available in English or French language from January 1, 2000, to December 31, 2021. Literature search will be conducted using four electronic databases (i.e., MEDLINE via PubMed, Web of Science, Science Direct, and Embase via Ovid), and grey literatures accompanying the research questions and objectives. Based on the inclusion criteria, studies will be independently screened by two reviewers for title, abstract, and full text. Extracted data will be presented in tabular form followed by a narrative description of inputs corresponding to research objectives and questions.
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Affiliation(s)
- Dilaram Acharya
- School of Public Health, Université de Montréal, Montréal, Québec, Canada
- Medical Affairs and Innovation, Héma-Québec, Montréal, Québec, Canada
| | - Antoine Lewin
- Medical Affairs and Innovation, Héma-Québec, Montréal, Québec, Canada
- Faculty of Medicine and Health Science, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Amaury Gaussen
- Medical Affairs and Innovation, Héma-Québec, Montréal, Québec, Canada
| | - Gilles Lambert
- Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l’Île-de-Montréal du Québec, Montréal, Québec, Canada
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Montréal, Québec, Canada
| | - Christian Renaud
- Medical Affairs and Innovation, Héma-Québec, Montréal, Québec, Canada
| | - Karlitaj Nawej
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Montréal, Québec, Canada
| | - Thomas G. Poder
- School of Public Health, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, CIUSSS de l’Est-de-l’île-de-Montréal, Montréal, Canada
- * E-mail:
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Hasan M, Lal J, Ali N. Frequency and types of transfusion reactions in pediatric population: A report from a tertiary care center in Pakistan. IRAQI JOURNAL OF HEMATOLOGY 2022. [DOI: 10.4103/ijh.ijh_47_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Braathen H, Sivertsen J, Lunde THF, Strandenes G, Lindemann PC, Assmus J, Hervig TA, Apelseth TO. Effect of leukoreduction and temperature on risk of bacterial growth in CPDA-1 whole blood: A study of Escherichia coli. Transfusion 2021; 61 Suppl 1:S80-S89. [PMID: 34269444 DOI: 10.1111/trf.16499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Collection of non-leukoreduced citrate-phosphate-dextrose-adenine (CPDA-1) whole blood is performed in walking blood banks. Blood collected under field conditions may have increased risk of bacterial contamination. This study was conducted to examine the effects of WBC reduction and storage temperature on growth of Escherichia coli (ATCC® 25922™) in CPDA-1 whole blood. METHODS CPDA-1 whole blood of 450 ml from 10 group O donors was inoculated with E. coli. Two hours after inoculation, the test bags were leukoreduced with a platelet-sparing filter. The control bags remained unfiltered. Each whole blood bag was then split into three smaller bags for further storage at 2-6°C, 20-24°C, or 33-37°C. Bacterial growth was quantified immediately, 2 and 3 h after inoculation, on days 1, 3, 7, and 14 for all storage temperatures, and on days 21 and 35 for storage at 2-6°C. RESULTS Whole blood was inoculated with a median of 19.5 (range 12.0-32.0) colony-forming units per ml (CFU/ml) E. coli. After leukoreduction, a median of 3.3 CFU/ml (range 0.0-33.3) E. coli remained. In the control arm, the WBCs phagocytized E. coli within 24 h at 20-24°C and 33-37°C in 9 of 10 bags. During storage at 2-6°C, a slow self-sterilization occurred over time with and without leukoreduction. CONCLUSIONS Storage at 20-24°C and 33-37°C for up to 24 h before leukoreduction reduces the risk of E. coli-contamination in CPDA-1 whole blood. Subsequent storage at 2-6°C will further reduce the growth of E. coli.
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Affiliation(s)
- Hanne Braathen
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Joar Sivertsen
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Turid Helen Felli Lunde
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | - Geir Strandenes
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway.,Department of War Surgery and Emergency Medicine, Norwegian Armed Forces Medical Services, Oslo, Norway
| | | | - Jörg Assmus
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Tor Audun Hervig
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Sciences, University of Bergen, Bergen, Norway.,Department of Immunology and Transfusion Medicine, Haugesund Hospital, Haugesund, Norway
| | - Torunn Oveland Apelseth
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway.,Department of War Surgery and Emergency Medicine, Norwegian Armed Forces Medical Services, Oslo, Norway
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Musumari PM, Mbikayi SM, Srithanaviboonchai K, Techasrivichien T, Tangmunkongvorakul A, Tshilolo L. Symptoms of acute transfusion reactions at a general referral hospital in Kinshasa, Democratic Republic of Congo: a cross-sectional study. BMJ Open 2021; 11:e045081. [PMID: 34290061 PMCID: PMC8296776 DOI: 10.1136/bmjopen-2020-045081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Blood transfusion is a life-saving procedure and is also associated with a range of risks including the occurrence of symptoms of acute transfusion reactions (ATRs). Very few studies in sub-Saharan Africa have reported on ATRs. The present study addresses this gap in the literature by documenting the prevalence of and factors associated with ATRs in the Democratic Republic of Congo (DRC). DESIGN This is a cross-sectional descriptive and analytical study using blood bank data from a general referral hospital. SETTING Centre Hospitalier Mère-Enfant (CHME) Monkole, a general referral hospital in Kinshasa, DRC. PARTICIPANTS General population who have received blood transfusion in CHME Monkole between 2014 and 2019. RESULTS The data set included a total of 7166 patients; 3153 (44%) men and 4013 (56%) women. The overall prevalence of symptoms of ATRs was 2.6%; the lowest prevalence was in 2017 (2.34%) and highest in 2018 (2.95%) and 2019 (2.94%). The documented symptoms included 74 (39.6%) cases of dyspnoea/respiratory distress, 60 (32.1%) cases of fever, 36 (19.2%) cases of pruritus/urticaria and 17 (9.1%) cases of vomiting. None of the studied factors was associated with symptoms of ATRs. CONCLUSION Symptoms of ATRs were not uncommon in the studied population. Dyspnoea and respiratory distress, fever and pruritus/urticaria were the most common symptoms of ATRs. This study highlights the need for a clinical and biological surveillance to detect, prevent and manage ATRs in the context of the DRC.
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Affiliation(s)
- Patou Masika Musumari
- Global Health Interdisciplinary Unit, Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan
- Chiang Mai University Research Institute for Health Sciences, Chiang Mai, Thailand
| | - Samclide Mutindu Mbikayi
- Department of Hematology, Centre Hospitalier Mère-Enfant Monkole, Kinshasa, Democratic Republic of Congo
| | - Kriengkrai Srithanaviboonchai
- Chiang Mai University Research Institute for Health Sciences, Chiang Mai, Thailand
- Department of Community Medicine, Chiang Mai University Faculty of Medicine, Chiang Mai, Thailand
| | - Teeranee Techasrivichien
- Global Health Interdisciplinary Unit, Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan
- International Institute of Socio-Epidemiology, Kyoto, Japan
| | | | - Léon Tshilolo
- Department of Hematology, Centre Hospitalier Mère-Enfant Monkole, Kinshasa, Democratic Republic of Congo
- Centre de Formation et Appui Sanitaire (CEFA), Kinshasa, Democratic Republic of Congo
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9
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Kracalik I, Mowla S, Basavaraju SV, Sapiano MRP. Transfusion-related adverse reactions: Data from the National Healthcare Safety Network Hemovigilance Module - United States, 2013-2018. Transfusion 2021; 61:1424-1434. [PMID: 33880771 DOI: 10.1111/trf.16362] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/03/2021] [Accepted: 01/23/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Ian Kracalik
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sanjida Mowla
- Oak Ridge Institute for Science and Education (ORISE), Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sridhar V Basavaraju
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mathew R P Sapiano
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Lantana Consulting Group, Inc., East Thetford, Vermont, USA
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Sahli SD, Rössler J, Tscholl DW, Studt JD, Spahn DR, Kaserer A. Point-of-Care Diagnostics in Coagulation Management. SENSORS (BASEL, SWITZERLAND) 2020; 20:E4254. [PMID: 32751629 PMCID: PMC7435714 DOI: 10.3390/s20154254] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/17/2020] [Accepted: 07/28/2020] [Indexed: 12/15/2022]
Abstract
This review provides a comprehensive and up-to-date overview of point-of-care (POC) devices most commonly used for coagulation analyses in the acute settings. Fast and reliable assessment of hemostasis is essential for the management of trauma and other bleeding patients. Routine coagulation assays are not designed to visualize the process of clot formation, and their results are obtained only after 30-90 m due to the requirements of sample preparation and the analytical process. POC devices such as viscoelastic coagulation tests, platelet function tests, blood gas analysis and other coagulometers provide new options for the assessment of hemostasis, and are important tools for an individualized, goal-directed, and factor-based substitution therapy. We give a detailed overview of the related tests, their characteristics and clinical implications. This review emphasizes the evident advantages of the speed and predictive power of POC clot measurement in the context of a goal-directed and algorithm-based therapy to improve the patient's outcome. Interpretation of viscoelastic tests is facilitated by a new visualization technology.
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Affiliation(s)
- Sebastian D. Sahli
- Institute of Anesthesiology, University and University Hospital Zurich, 8091 Zurich, Switzerland; (S.D.S.); (J.R.); (D.W.T.); (D.R.S.)
| | - Julian Rössler
- Institute of Anesthesiology, University and University Hospital Zurich, 8091 Zurich, Switzerland; (S.D.S.); (J.R.); (D.W.T.); (D.R.S.)
| | - David W. Tscholl
- Institute of Anesthesiology, University and University Hospital Zurich, 8091 Zurich, Switzerland; (S.D.S.); (J.R.); (D.W.T.); (D.R.S.)
| | - Jan-Dirk Studt
- Division of Hematology, University and University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Donat R. Spahn
- Institute of Anesthesiology, University and University Hospital Zurich, 8091 Zurich, Switzerland; (S.D.S.); (J.R.); (D.W.T.); (D.R.S.)
| | - Alexander Kaserer
- Institute of Anesthesiology, University and University Hospital Zurich, 8091 Zurich, Switzerland; (S.D.S.); (J.R.); (D.W.T.); (D.R.S.)
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Mardani A, Balali MR. Transfusion reactions: A retrospective analysis of the Iranian national haemovigilance system (INHS) data. Transfus Apher Sci 2020; 59:102767. [PMID: 32280036 DOI: 10.1016/j.transci.2020.102767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 03/03/2020] [Accepted: 03/11/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The 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. METHODS This 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. RESULTS A 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). CONCLUSIONS In 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.
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Affiliation(s)
- Ahmad Mardani
- Department of Microbiology, Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran; Central Haemovigilance Office (CHO), Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran.
| | - Mohammad Reza Balali
- Central Haemovigilance Office (CHO), Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
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12
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Moncharmont P, Barday G, Benamara H. Adverse transfusion reactions with neurological signs in transfused patients. Transfus Clin Biol 2020; 27:87-90. [PMID: 32122763 DOI: 10.1016/j.tracli.2020.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/25/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Many transfused patients present severe, sometimes critical, clinical conditions. The occurrence of adverse transfusion reactions may cause the clinical condition to deteriorate. A study was conducted aimed at establishing whether the presence of neurological signs during an adverse transfusion reaction increases its severity. METHODS From 1 January 2010 to 30 June 2019, adverse reactions with neurological signs were extracted from the French haemovigilance database system. Two signs observed at the time of the reaction were analysed: unconsciousness and convulsions. Stroke was excluded. The type of reaction, its severity, the blood product involved and its imputability were all studied. RESULTS During the study period, 10,670 reactions were reported, including 20 (0.19%) imputed to the transfusion with unconsciousness and/or convulsions. Unconsciousness without convulsions was frequently observed (14 reports, 70.0%). Convulsions were reported in 5 cases (25.0%), with 1 case being associated with unconsciousness. Unconsciousness and/or convulsions were present in 9 allergic reactions (45.0%) and 4 transfusion-associated circulatory overloads (20.0%). Nine reactions were severe (45.0%), 7 were life-threatening (35.0%) and 1 case resulted in the recipient's death (5.0%). A red blood cell and a platelet concentrate transfusion were involved in 8 reactions (40.0%) each, although the imputability of the blood product was certain in only 2 of the reactions. CONCLUSION Unconsciousness and/or convulsions were rarely observed in adverse reactions reported in transfused patients. Nevertheless, the presence of these signs highlights the severity of the adverse reactions (17 reactions, 85.0%).
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Affiliation(s)
- P Moncharmont
- Department of Vigilance, Haemovigilance, établissement français du sang Auvergne Rhône-Alpes, site de Lyon Décines, 111, rue Elisée-Reclus CS 20617, 69153 Décines-Charpieu cedex, France.
| | - G Barday
- Department of Vigilance, Haemovigilance, établissement français du sang Auvergne Rhône-Alpes, site de Lyon Décines, 111, rue Elisée-Reclus CS 20617, 69153 Décines-Charpieu cedex, France
| | - H Benamara
- Department of Vigilance, Haemovigilance, établissement français du sang Auvergne Rhône-Alpes, site de Lyon Décines, 111, rue Elisée-Reclus CS 20617, 69153 Décines-Charpieu cedex, France
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Sahu A, Bajpai M. Determining the true incidence of acute transfusion reactions: Active surveillance at a specialized liver center. Hematol Transfus Cell Ther 2019; 42:326-332. [PMID: 31838025 PMCID: PMC7599260 DOI: 10.1016/j.htct.2019.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/08/2019] [Accepted: 09/13/2019] [Indexed: 11/16/2022] Open
Abstract
Background Blood transfusion is a life-saving procedure, but may cause adverse transfusion reactions (TRs). The reporting of TRs is often missed due to various reasons. The aim of this study was to determine the incidence of unreported acute TRs through active surveillance and to compare it with the incidence of passively reported TRs. Methods This prospective observational study was done over a period of four months at a tertiary care hospital. A total of 500 consecutive transfusion episodes (TEs) in patients who had received blood component transfusions in the intensive care units were included in the study. Comprehensive data were collected from the blood bank records, patient records and through interviews with the attending clinical staff. The TEs were defined as all blood components issued to a single patient in 24 h. Results The overall incidence of TRs was 1.8 % (9 cases), with 0.4 % (2 cases) being reported passively, while 1.4 % (7 cases) were identified during active surveillance. The transfusion-associated cardiac overload (TACO) had the highest incidence of 1.2 % (6 cases) in active surveillance. A single case of acute hemolytic transfusion reaction was also observed during active surveillance. The passively reported TRs were one allergic reaction and one febrile non-hemolytic transfusion reaction. Conclusion Active surveillance of TRs provided an insight into the true incidence of TRs, which is higher when compared with the passively reported TRs. The TACO was found to have the highest incidence and not a single case was reported. There is a need to improve awareness regarding TR reporting.
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Affiliation(s)
- Ansuman Sahu
- Institute of Liver and Biliary Sciences, New Delhi, India
| | - Meenu Bajpai
- Institute of Liver and Biliary Sciences, New Delhi, India.
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Ddungu H, Krantz EM, Phipps W, Naluzze S, Orem J, Kiwanuka N, Wald A, Kajja I. Survey to Assess Knowledge and Reported Practices Regarding Blood Transfusion Among Cancer Physicians in Uganda. J Glob Oncol 2019; 4:1-12. [PMID: 30307805 PMCID: PMC6818296 DOI: 10.1200/jgo.18.00143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose Optimal decision making regarding blood transfusion for patients with cancer
requires appropriate knowledge of transfusion medicine among physicians. We
assessed blood transfusion knowledge, attitudes, and reported practices
among physicians working at Uganda Cancer Institute (UCI). Materials and Methods A cross-sectional self-administered survey of UCI physicians on their
knowledge, attitudes, and practices regarding blood transfusion was
conducted from June to September 2014. In consultation with transfusion
medicine experts, 30 questions were developed, including 10 questions for
each of the following three domains: knowledge, attitudes, and practices.
For the knowledge domain, we created a knowledge score equal to the number
of questions correctly answered out of 10. Results Of 31 physicians approached, 90% participated. The mean knowledge score was
5.3 (median, 5.5), and 32% correctly answered at least seven of 10
questions. Almost all (96%) understood the importance of proper patient
identification before transfusion and indicated identification error as the
most common cause of fatal transfusion reactions. More than 60% of
physicians acknowledged they lacked knowledge and needed training in
transfusion medicine. Most physicians reported sometimes changing their mind
about whether to provide a patient with a transfusion on the basis of
opinion of colleagues and sometimes administering unnecessary transfusions
because of influence from others. Conclusion Although UCI physicians have some basic knowledge in transfusion, most
reported gaps in their knowledge, and all expressed a need for additional
education in the basics of blood transfusion. Transfusion training and
evidence-based guidelines are needed to reduce inappropriate transfusions
and improve patient care. Greater understanding of peer influence in
transfusion decision making is required.
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Affiliation(s)
- Henry Ddungu
- Henry Ddungu, Sandra Naluzze, and Jackson Orem, Uganda Cancer Institute; Noah Kiwanuka and Isaac Kajja, Makerere University, Kampala, Uganda; Elizabeth M. Krantz, Warren Phipps, and Anna Wald, Fred Hutchinson Cancer Research Center; and Warren Phipps and Anna Wald, University of Washington, Seattle, WA
| | - Elizabeth M Krantz
- Henry Ddungu, Sandra Naluzze, and Jackson Orem, Uganda Cancer Institute; Noah Kiwanuka and Isaac Kajja, Makerere University, Kampala, Uganda; Elizabeth M. Krantz, Warren Phipps, and Anna Wald, Fred Hutchinson Cancer Research Center; and Warren Phipps and Anna Wald, University of Washington, Seattle, WA
| | - Warren Phipps
- Henry Ddungu, Sandra Naluzze, and Jackson Orem, Uganda Cancer Institute; Noah Kiwanuka and Isaac Kajja, Makerere University, Kampala, Uganda; Elizabeth M. Krantz, Warren Phipps, and Anna Wald, Fred Hutchinson Cancer Research Center; and Warren Phipps and Anna Wald, University of Washington, Seattle, WA
| | - Sandra Naluzze
- Henry Ddungu, Sandra Naluzze, and Jackson Orem, Uganda Cancer Institute; Noah Kiwanuka and Isaac Kajja, Makerere University, Kampala, Uganda; Elizabeth M. Krantz, Warren Phipps, and Anna Wald, Fred Hutchinson Cancer Research Center; and Warren Phipps and Anna Wald, University of Washington, Seattle, WA
| | - Jackson Orem
- Henry Ddungu, Sandra Naluzze, and Jackson Orem, Uganda Cancer Institute; Noah Kiwanuka and Isaac Kajja, Makerere University, Kampala, Uganda; Elizabeth M. Krantz, Warren Phipps, and Anna Wald, Fred Hutchinson Cancer Research Center; and Warren Phipps and Anna Wald, University of Washington, Seattle, WA
| | - Noah Kiwanuka
- Henry Ddungu, Sandra Naluzze, and Jackson Orem, Uganda Cancer Institute; Noah Kiwanuka and Isaac Kajja, Makerere University, Kampala, Uganda; Elizabeth M. Krantz, Warren Phipps, and Anna Wald, Fred Hutchinson Cancer Research Center; and Warren Phipps and Anna Wald, University of Washington, Seattle, WA
| | - Anna Wald
- Henry Ddungu, Sandra Naluzze, and Jackson Orem, Uganda Cancer Institute; Noah Kiwanuka and Isaac Kajja, Makerere University, Kampala, Uganda; Elizabeth M. Krantz, Warren Phipps, and Anna Wald, Fred Hutchinson Cancer Research Center; and Warren Phipps and Anna Wald, University of Washington, Seattle, WA
| | - Isaac Kajja
- Henry Ddungu, Sandra Naluzze, and Jackson Orem, Uganda Cancer Institute; Noah Kiwanuka and Isaac Kajja, Makerere University, Kampala, Uganda; Elizabeth M. Krantz, Warren Phipps, and Anna Wald, Fred Hutchinson Cancer Research Center; and Warren Phipps and Anna Wald, University of Washington, Seattle, WA
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15
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Saha S, Krishna D, Prasath R, Sachan D. Incidence and Analysis of 7 Years Adverse Transfusion Reaction: A Retrospective Analysis. Indian J Hematol Blood Transfus 2019; 36:149-155. [PMID: 32158098 DOI: 10.1007/s12288-019-01174-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 08/17/2019] [Indexed: 12/11/2022] Open
Abstract
Safe blood transfusion is the primary need of all the health care delivery system. Though with the advances of transfusion medicine, the incidences of transfusion risk is gradually reduced, but the adverse transfusion reaction (ATR) of non hemolytic type still prevails. The purpose of this study was to estimate the incidence and pattern of transfusion-related adverse events at our centre. The present retrospective observational study was conducted in the Department of Transfusion Medicine from April 2011 to April 2018, at a multi-organ transplant centre in South India. All the Adverse transfusion reactions were investigated in detail in the blood bank for the clerical errors, immunohematology workup and classified according to their nature with imputability assessment. A total of 140 ATR were reported out of 100,569 blood components distributed during the study period. After the analysis and workup of the reported reactions, majority of the reactions were observed in males (71%, n = 99). Most common symptom presented was Itching/Rashes in 43.6% (n = 61) ATR. Allergic reactions (51.4%, n = 72), were the most commonly encountered ATR followed by FNHTR (25.7%, n = 36). FFP transfusions (0.2%) contributed to the majority of the reactions followed by Red cell transfusion (0.15%). ATR were observed maximum in Hepato-biliary disease and liver transplantation patients (62%) followed by oncology patients (15%). The overall incidence of ATR in our study is 0.14% which is comparatively low compared to other studies due to well established hemovigilance systems. Adoption of more equipped methods & sensitive technology in various areas of blood banking will help to bring down the unwanted adverse transfusion reactions.
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Affiliation(s)
- Suryatapa Saha
- 1Present Address: Department of Transfusion Medicine, Apollo Gleneagles Hospital, Calcutta, India.,2Department of Transfusion Medicine, Gleneagles Global Health City, Chennai, 600100 India
| | - Deepthi Krishna
- 2Department of Transfusion Medicine, Gleneagles Global Health City, Chennai, 600100 India
| | - Raghuram Prasath
- 2Department of Transfusion Medicine, Gleneagles Global Health City, Chennai, 600100 India
| | - Deepti Sachan
- 2Department of Transfusion Medicine, Gleneagles Global Health City, Chennai, 600100 India.,Present Address: Department of Transfusion Medicine, Dr. Rela Institute and Medical Centre, No. 7, CLC Works Road, Chromepet, Chennai, Tamil Nadu 600044 India
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16
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Schulz WL, McPadden J, Gehrie EA, Bahar B, Gokhale A, Ross R, Price N, Spencer BR, Snyder E. Blood Utilization and Transfusion Reactions in Pediatric Patients Transfused with Conventional or Pathogen Reduced Platelets. J Pediatr 2019; 209:220-225. [PMID: 30885645 DOI: 10.1016/j.jpeds.2019.01.046] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/15/2019] [Accepted: 01/29/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVES 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. STUDY DESIGN 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 0-1 year not in the NICU, and children age 1-18 years (PED). RESULTS In the 48 hours 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 0-1 year 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. CONCLUSIONS 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.
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Affiliation(s)
- Wade L Schulz
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
| | - Jacob McPadden
- Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Eric A Gehrie
- Department of Pathology and Surgery, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Burak Bahar
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT
| | - Amit Gokhale
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT; Department of Pathology, Stony Brook School of Medicine
| | - Rebecca Ross
- Blood Bank, Yale New Haven Hospital, New Haven, CT
| | - Nathaniel Price
- Information Technology Services, Yale New Haven Health, New Haven, CT
| | | | - Edward Snyder
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT.
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Mertes PM, Tacquard C, Andreu G, Kientz D, Gross S, Malard L, Drouet C, Carlier M, Gachet C, Sandid I, Boudjedir K. Hypersensitivity transfusion reactions to platelet concentrate: a retrospective analysis of the French hemovigilance network. Transfusion 2019; 60:507-512. [DOI: 10.1111/trf.15275] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 02/19/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Paul M. Mertes
- Department of Anesthesia and Intensive CareNouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg Strasbourg France
| | - Charles Tacquard
- Department of Anesthesia and Intensive CareNouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg Strasbourg France
| | | | - Daniel Kientz
- Etablissement Français du Sang Grand Est Strasbourg France
| | - Sylvie Gross
- Etablissement Français du Sang La Plaine Saint‐Denis France
| | - Lucile Malard
- Etablissement Français du Sang La Plaine Saint‐Denis France
| | - Christian Drouet
- INSERM U1016, CNRS UMR8104, Institut CochinUniversité Paris‐Descartes Paris France
| | - Monique Carlier
- Agence Régionale de Santé Grand Est Châlons en Champagne France
| | | | - Imad Sandid
- French National Agency for Medicines and Health Products Safety (ANSM) Saint Denis France
| | - Karim Boudjedir
- French National Agency for Medicines and Health Products Safety (ANSM) Saint Denis France
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18
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TOPAL G, ŞAHİN İ, ÇALIŞKAN E, KILINÇEL Ö. Kan Transfüzyonu ve Reaksiyonları İle İlgili Sağlık Çalışanlarının Bilgi Düzeylerinin Araştırılması. DÜZCE ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2019. [DOI: 10.33631/duzcesbed.461050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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19
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Andreu G, Boudjedir K, Muller JY, Pouchol E, Ozier Y, Fevre G, Gautreau C, Quaranta JF, Drouet C, Rieux C, Mertes PM, Clavier B, Carlier M, Sandid I. Analysis of Transfusion-Related Acute Lung Injury and Possible Transfusion-Related Acute Lung Injury Reported to the French Hemovigilance Network From 2007 to 2013. Transfus Med Rev 2018; 32:16-27. [DOI: 10.1016/j.tmrv.2017.07.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/13/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022]
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Pathogen reduction through additive-free short-wave UV light irradiation retains the optimal efficacy of human platelet lysate for the expansion of human bone marrow mesenchymal stem cells. PLoS One 2017; 12:e0181406. [PMID: 28763452 PMCID: PMC5538655 DOI: 10.1371/journal.pone.0181406] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 06/30/2017] [Indexed: 12/17/2022] Open
Abstract
Background We recently developed and characterized a standardized and clinical grade human Platelet Lysate (hPL) that constitutes an advantageous substitute for fetal bovine serum (FBS) for human mesenchymal stem cell (hMSC) expansion required in cell therapy procedures, avoiding xenogenic risks (virological and immunological) and ethical issues. Because of the progressive use of pathogen-reduced (PR) labile blood components, and the requirement of ensuring the viral safety of raw materials for cell therapy products, we evaluated the impact of the novel procedure known as THERAFLEX UV-Platelets for pathogen reduction on hPL quality (growth factors content) and efficacy (as a medium supplement for hMSC expansion). This technology is based on short-wave ultraviolet light (UV-C) that induces non-reversible damages in DNA and RNA of pathogens while preserving protein structures and functions, and has the main advantage of not needing the addition of any photosensitizing additives (that might secondarily interfere with hMSCs). Methodology / Principal findings We applied the THERAFLEX UV-Platelets procedure on fresh platelet concentrates (PCs) suspended in platelet additive solution and prepared hPL from these treated PCs. We compared the quality and efficacy of PR-hPL with the corresponding non-PR ones. We found no impact on the content of five cytokines tested (EGF, bFGF, PDGF-AB, VEGF and IGF-1) but a significant decrease in TGF-ß1 (-21%, n = 11, p<0.01). We performed large-scale culture of hMSCs from bone marrow (BM) during three passages and showed that hPL or PR-hPL at 8% triggered comparable BM-hMSC proliferation as FBS at 10% plus bFGF. Moreover, after proliferation of hMSCs in an hPL- or PR-hPL-containing medium, their profile of membrane marker expression, their clonogenic potential and immunosuppressive properties were maintained, in comparison with BM-hMSCs cultured under FBS conditions. The potential to differentiate towards the adipogenic and osteogenic lineages of hMSCs cultured in parallel in the three conditions also remained identical. Conclusion / Significance We demonstrated the feasibility of using UV-C-treated platelets to subsequently obtain pathogen-reduced hPL, while preserving its optimal quality and efficacy for hMSC expansion in cell therapy applications.
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21
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Py JY, Cabezon B, Sapey T, Jutant T. Unacknowledged adverse transfusion reactions: Are they a mine to dig? Transfus Clin Biol 2017; 25:63-72. [PMID: 28690037 DOI: 10.1016/j.tracli.2017.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 06/12/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Haemovigilance has long tried to characterize and understand transfusion reactions in order to prevent them. Unacknowledged ones are now a minority but they question us. Are they the result of incomplete clinical setting and/or insufficient medical reasoning, or can they contain real new entities we have not yet understood? MATERIAL AND METHODS Ten volunteer experts reviewed 30 recent unacknowledged cases. Their diagnostic propositions were compared with data issued from a five-year repository we have analysed in terms of statistical links between clinical signs and diagnoses. RESULTS Experts' opinions are only quite unanimous in 60% of the cases, and the proposed diagnosis remains unacknowledged in 53%. Repository comparison shows that signs like pain or digestive symptoms are far more frequent in unknown reactions. However, it is more the absence of some other signs which drives to that conclusion, in a default diagnosis mechanism. CONCLUSION Errors in transfusion reactions medical analysis are rare. Unacknowledged cases are more often linked to poor or unspecific clinical setting. But a particular attention must be paid with infrequent diagnoses which are far less characterised, like metabolic complications. Pain high occurrence in unknown cases also commands us to go further in the characterisation of acute pain transfusion reaction diagnosis, which is suggested by some authors.
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Affiliation(s)
- J-Y Py
- EFS Centre-Atlantique Orléans, 190, rue Léon-Foucault, 45140 Saint-Jean-de-la-Ruelle, France.
| | - B Cabezon
- EFS Centre-Atlantique Saintes, 33, chemin des Carrières-de-la-Croix, 17100 Saintes, France
| | - T Sapey
- ARS Centre Val-de-Loire, 131, rue du Faubourg-Bannier, 45000 Orléans, France
| | - T Jutant
- EFS Centre-Atlantique Poitiers, 350, avenue Jacques-Cœur, 86000 Poitiers, France
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23
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Kwon JR, Won EJ, Jo HJ, Choi SR, Lee K, Kim S, Ahn HS, Choi YS, Cho D, Lee DH. Serious Adverse Transfusion Reactions Reported in the National Recipient-Triggered Trace Back System in Korea (2006-2014). Ann Lab Med 2017; 36:335-41. [PMID: 27139606 PMCID: PMC4855053 DOI: 10.3343/alm.2016.36.4.335] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/02/2015] [Accepted: 02/16/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Adverse transfusion reactions (ATRs) are clinically relevant to patients with significant morbidity and mortality. This study aimed to review the cases of ATR reported in the recipient-triggered trace back system for a recent nine-year period in Korea. METHODS Nine-year data obtained from 2006 to 2014 by the trace back system at the Division of Human Blood Safety Surveillance of the Korean Centers for Disease Control (KCDC) were reviewed. The suspected cases were assessed according to six categories: (i) related to, (ii) probably related to, (iii) probably not related to, (iv) not related to transfusion, (v) unable to investigate, and (vi) under investigation. RESULTS Since 2006, 199 suspected serious ATRs were reported in hospitals and medical institutions in Korea, and these ATRs were reassessed by the division of Human Blood Safety Surveillance of the KCDC. Among the reported 193 cases as transfusion related infections, hepatitis C virus (HCV) infection (135, 67.8%) was reported most frequently, followed by hepatitis B virus (HBV) infection (27, 13.6%), HIV infection (13, 6.5%), syphilis (9, 4.5%), malarial infection (4, 2.0%), other bacterial infections (3, 1.5%), HTLV infection (1, 0.5%), and scrub typhus infection (1, 0.5%), respectively. Of the 199 cases, 13 (6.5%) cases were confirmed as transfusion-related (3 HCV infections, 3 malarial infections, 1 HBV infection, 2 Staphylococcus aureus sepsis, 3 transfusion-related acute lung injuries, and 1 hemolytic transfusion reaction). CONCLUSIONS This is the first nationwide data regarding serious ATRs in Korea and could contribute to the implementation of an effective hemovigilance system.
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Affiliation(s)
- Jeong Ran Kwon
- Division of Human Blood Safety Surveillance, Korea Centers for Disease Control & Prevention, Cheongju, Korea
| | - Eun Jeong Won
- Department of Laboratory Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun Jung Jo
- Division of Human Blood Safety Surveillance, Korea Centers for Disease Control & Prevention, Cheongju, Korea
| | - Sae Rom Choi
- Division of Human Blood Safety Surveillance, Korea Centers for Disease Control & Prevention, Cheongju, Korea
| | - Kyoungyul Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sinyoung Kim
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Young Sill Choi
- Division of Human Blood Safety Surveillance, Korea Centers for Disease Control & Prevention, Cheongju, Korea
| | - Duck Cho
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunwan University School of Medicine, Seoul, Korea.
| | - Dong Han Lee
- Division of Infectious Disease Surveillance, Korea Centers for Disease Control & Prevention, Cheongju, Korea.
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Cumming M, Osinski A, O'Hearn L, Waksmonski P, Herman M, Gordon D, Griffiths E, Knox K, McHale E, Quillen K, Rios J, Pisciotto P, Uhl L, DeMaria A, Andrzejewski C. Hemovigilance in Massachusetts and the adoption of statewide hospital blood bank reporting using the National Healthcare Safety Network. Transfusion 2017; 57:478-483. [PMID: 27774608 DOI: 10.1111/trf.13872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 08/26/2016] [Indexed: 11/29/2022]
Abstract
A collaboration that grew over time between local hemovigilance stakeholders and the Massachusetts Department of Public Health (MDPH) resulted in the change from a paper-based method of reporting adverse reactions and monthly transfusion activity for regulatory compliance purposes to statewide adoption of electronic reporting via the National Healthcare Safety Network (NHSN). The NHSN is a web-based surveillance system that offers the capacity to capture transfusion-related adverse events, incidents, and monthly transfusion statistics from participating facilities. Massachusetts' hospital blood banks share the data they enter into NHSN with the MDPH to satisfy reporting requirements. Users of the NHSN Hemovigilance Module adhere to specified data entry guidelines, resulting in data that are comparable and standardized. Keys to successful statewide adoption of this reporting method include the fostering of strong partnerships with local hemovigilance champions and experts, engagement of regulatory and epidemiology divisions at the state health department, the leveraging of existing relationships with hospital NHSN administrators, and the existence of a regulatory deadline for implementation. Although limitations exist, successful implementation of statewide use of the NHSN Hemovigilance Module for hospital blood bank reporting is possible. The result is standardized, actionable data at both the hospital and state level that can facilitate interfacility comparisons, benchmarking, and opportunities for practice improvement.
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Affiliation(s)
- Melissa Cumming
- Bureau of Infectious Disease and Laboratory Sciences, Division of Epidemiology and Immunization, Massachusetts Department of Public Health, Jamaica Plain, Massachusetts
| | - Anthony Osinski
- Bureau of Infectious Disease and Laboratory Sciences, Division of Epidemiology and Immunization, Massachusetts Department of Public Health, Jamaica Plain, Massachusetts
| | - Lynne O'Hearn
- Department of Transfusion Medicine and Pathology, Baystate Medical Center
| | - Pamela Waksmonski
- Division of Health Care Facility Licensure and Certification, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Michele Herman
- Department of Pathology, Division of Laboratory and Transfusion Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Deborah Gordon
- Department of Pathology, Heywood Hospital, Gardner, Massachusetts
- Department of Pathology, Athol Memorial Hospital, Athol, Massachusetts
| | - Elzbieta Griffiths
- Department of Pathology, Mount Auburn Hospital, Cambridge, Massachusetts
- Tufts University School of Medicine, Boston, Massachusetts
| | - Kim Knox
- Infection Prevention and Control Department, Milford Regional Medical Center, Milford, Massachusetts
| | - Eileen McHale
- Bureau of Healthcare Safety and Quality, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Karen Quillen
- Department of Pathology & Laboratory Medicine, Boston University Medical Center, Boston, Massachusetts
| | - Jorge Rios
- New England Region American Red Cross Blood Services, Dedham, Massachusetts
| | - Patricia Pisciotto
- New England Region American Red Cross Blood Services, Dedham, Massachusetts
| | - Lynne Uhl
- Department of Pathology, Division of Laboratory and Transfusion Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Alfred DeMaria
- Bureau of Infectious Disease and Laboratory Sciences, Division of Epidemiology and Immunization, Massachusetts Department of Public Health, Jamaica Plain, Massachusetts
| | - Chester Andrzejewski
- Department of Transfusion Medicine and Pathology, Baystate Medical Center
- Tufts University School of Medicine, Boston, Massachusetts
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25
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Hourani L, Weingart C, Kohn B. Alloimmunisation in transfused patients: serial cross-matching in a population of hospitalised cats. J Feline Med Surg 2017; 19:1231-1237. [DOI: 10.1177/1098612x16688574] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Cross-matching is currently recommended as part of pre-transfusion testing for repeat transfusions in cats 4 days after having received an initial transfusion. This prospective study determined when and if cats developed positive cross-match (CM) results after having been transfused with AB-compatible blood. Methods Donors were selected according to standard transfusion safety protocols. Twenty-one hospitalised anaemic recipients (blood type A: n = 20; blood type B: n = 1) received 1–4 (median 2) whole blood transfusions (WBTs) over 1–6 days (median 2) in 33 transfusion instances. The tube CM method, including major, minor and recipient control, was employed. Macroscopic and microscopic agglutination reactions were evaluated according to a predetermined scale. CM tests with a positive recipient control could not be evaluated. Results No signs of an acute transfusion reaction were observed. A total of 63 CMs were performed. In one cat with immune-mediated haemolytic anaemia the CM could not be evaluated (positive recipient control). The minor CM was negative in all cases. Fifteen of 20 cats had a negative major CM (MCM) 1–12 days (median 5) after their first transfusion. A positive MCM was observed in five cases after 2–10 days (median 5) post-first WBT. These five cats had received a total of 1–4 (median 2) WBTs. Cats with a negative MCM had received 1–3 (median 2) WBTs. In 51.5% (17/33) of transfusion instances, the cat’s haematocrit increased as expected, with cats with a positive MCM at 40% (4/10) vs 56.5% (13/23) if MCM was negative. Conclusions and relevance Twenty-five percent (5/20) of the feline recipients likely developed alloantibodies against erythrocyte antigens outside of the AB system as early as 2 days post-first WBT. This adds data to the recommendation to include cross-matching in pre-transfusion screening tests.
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Affiliation(s)
- Layla Hourani
- Small Animal Clinic, Faculty of Veterinary Medicine, Free University of Berlin, Germany
| | - Christiane Weingart
- Small Animal Clinic, Faculty of Veterinary Medicine, Free University of Berlin, Germany
| | - Barbara Kohn
- Small Animal Clinic, Faculty of Veterinary Medicine, Free University of Berlin, Germany
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Ghataliya KJ, Kapadia JD, Desai MK, Mehariya KM, Rathod GH, Bhatnagar N, Gajjar MD. Transfusion-related adverse reactions in pediatric and surgical patients at a tertiary care teaching hospital in India. Asian J Transfus Sci 2017; 11:180-187. [PMID: 28970688 PMCID: PMC5613427 DOI: 10.4103/0973-6247.214348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Use of blood and its components is lifesaving. However, their use is often associated with adverse events. OBJECTIVE: To analyze the pattern of adverse reactions associated with transfusion of blood and its components in pediatric and surgical patients at a tertiary care teaching hospital. MATERIALS AND METHODS: Patients receiving transfusion of blood or its components in a randomly selected unit each from Departments of Pediatrics, including thalassemia OPD and surgery, were monitored intensively for a period of 6 months. Clinical course, management, outcome, causality, severity, seriousness, and preventability of observed transfusion reactions (TRs) were analyzed. RESULTS: A total of 411 pediatric and 433 surgical patients received 594 and 745 transfusions respectively during the study period. Of these, TRs were observed in 69 (11.6%) children and 63 (8.4%) surgical patients. Majority of reactions in children (48, 69.5%) and surgical patients (51, 80.9%) were acute, developing within 24 h of transfusion. TRs were observed with packed cells (13.2%), cryoprecipitate (10%), platelet concentrate (14.3%) and fresh frozen plasma (1.3%) in pediatric patients and with packed cells (7.2%), whole blood (25%) and platelet concentrate (62.5%) in surgical patients. Most common TRs included febrile nonhemolytic TRs (FNHTRs) and allergic reactions. Reactions were more frequent in patients with a previous history of transfusion or those receiving more than one transfusion and in children, when transfusion was initiated after 30 min of issue of blood component. Majority of reactions were managed with symptomatic treatment, were nonserious, moderately severe, probably preventable and probably associated with the suspect blood component in both populations. CONCLUSION: Transfusion reactions in children and surgical patients are commonly observed with cellular blood components. Majority of reactions are acute and nonserious. FNHTRs and allergic reactions are the most common transfusion reactions. Risk of transfusion reactions is more in patients receiving multiple transfusions.
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Affiliation(s)
- Kunal J Ghataliya
- Department of Pharmacology, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Jigar D Kapadia
- Department of Pharmacology, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Mira K Desai
- Department of Pharmacology, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - K M Mehariya
- Department of Paediatrics, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - G H Rathod
- Department of Surgery, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Nidhi Bhatnagar
- Department of Immunohematology and Blood Transfusion, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - M D Gajjar
- Department of Immunohematology and Blood Transfusion, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
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Pahuja S, Puri V, Mahajan G, Gupta P, Jain M. Reporting adverse transfusion reactions: A retrospective study from tertiary care hospital from New Delhi, India. Asian J Transfus Sci 2017; 11:6-12. [PMID: 28316433 PMCID: PMC5345284 DOI: 10.4103/0973-6247.200779] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
CONTEXT: Blood transfusion services have achieved newer heights in the last decade, with developments in cellular techniques, component separation, and integration of molecular methods. However, the system of recording and reporting of the adverse events related to blood transfusion is developing countries like India is grossly inadequate and voluntary in nature. AIMS: This study was undertaken to analyze the retrospective data on adverse events related to blood transfusions in our hospital. SUBJECTS AND METHODS: This retrospective study was done to examine all the transfusion related adverse events reported in a Regional Blood Bank Transfusion Centre of North India over a period of 9 years. Adverse transfusion events related to whole blood, red cell concentrates (RCCs), and all other components were analyzed and classified on the basis of their clinical features and laboratory tests. Average rate of transfusion reactions with the components was also assessed. STATISTICAL ANALYSIS USED: Categorical variables were analyzed using the Chi-square test. P < 0.05 was taken to indicate a significant difference. RESULTS: During this period, a total of 1,60,973 blood/blood component units were issued by our blood bank to various departments of the hospital and 314 immediate transfusion events were reported. The rate of immediate transfusion reactions during the study was 0.19%. Average transfusion reaction rate with RCC was 0.25% with febrile nonhemolytic reactions being the most common type of adverse event (37.2%). CONCLUSIONS: Awareness should be increased among clinicians to correctly prevent, identify, and report transfusion-related adverse events. These measures should be implemented to increase blood transfusion quality and safety.
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Affiliation(s)
- Sangeeta Pahuja
- Department of Pathology, Lady Hardinge Medical College, New Delhi, India
| | - Vandana Puri
- Department of Pathology, Lady Hardinge Medical College, New Delhi, India
| | - Gunjan Mahajan
- Department of Pathology, Lady Hardinge Medical College, New Delhi, India
| | - Prajwala Gupta
- Department of Pathology, Lady Hardinge Medical College, New Delhi, India
| | - Manjula Jain
- Department of Pathology, Lady Hardinge Medical College, New Delhi, India
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Mukherjee S, Maiti R. Haemovigilance: A Current Update in Indian Perspective. J Clin Diagn Res 2016; 10:EE05-EE09. [PMID: 28050389 PMCID: PMC5198342 DOI: 10.7860/jcdr/2016/21029.8868] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 09/02/2016] [Indexed: 11/24/2022]
Abstract
Haemovigilance is an organised scheme of monitoring, identifying, reporting, investigating and analysing adverse events and reactions pertinent to transfusion and manufacturing blood products. This system is also an elemental part of quality control in a blood system, bringing about corrective and preventive measures, and for the perpetual advancement of the quality and safety of blood products and the transfusion process. Nowadays haemovigilance setups have been enforced throughout the globe in most developed countries, to monitor the adverse reactions and episodes associated with blood donations and transfusions. Indian Pharmacopoeia Commission has started a Haemovigilance Program of India (HvPI) in 2012 under its Pharmacovigilance Program of India (PvPI) in collaboration with National Institute of Biologicals, Noida, Uttar Pradesh, under Ministry of Health and Family welfare, Government of India with a primary objective to track adverse reactions/events and incidences associated with blood transfusion and blood product administration and to identify trends, recommend best practices and interventions required to improve patient care and safety. This review article is a detail update of current scenario of haemovigilance in India.
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Affiliation(s)
- Somnath Mukherjee
- Associate Professor, Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Rituparna Maiti
- Associate Professor, Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Corash L, Benjamin RJ. The role of hemovigilance and postmarketing studies when introducing innovation into transfusion medicine practice: the amotosalen-ultraviolet A pathogen reduction treatment model. Transfusion 2016; 56 Suppl 1:S29-38. [PMID: 27001358 DOI: 10.1111/trf.13530] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Innovations in transfusion medicine require randomized controlled clinical trials (RCTs) to demonstrate safety and efficacy before approval; however, these studies are costly and limited in scope and may be underpowered to detect rare adverse events (AEs). Regulatory agencies, such as the Food and Drug Administration, require postmarketing surveillance, hemovigilance (HV), and controlled Phase IV studies to monitor performance and confirm safety. STUDY DESIGN AND METHODS The INTERCEPT Blood System (IBS) is an illustrative model for implementation of a transformative technology for which sponsored active HV, regulatory authority HV, and Phase IV studies were used to extend preapproval efficacy and safety information. RESULTS After CE mark registration in Europe, 13,644 patients received 76,346 IBS components prepared largely without gamma irradiation or bacterial screening in sponsored active HV studies documenting no increased incidence of AEs compared to historical controls and no increased component utilization. National HV systems in France and Switzerland specifically demonstrated no transfusion-associated graft-versus-host disease or increased incidence of transfusion-associated acute lung injury, after transfusion of 317,669 IBS platelet (PLT) components, and significant reduction of transfusion-transmitted bacterial infection as well as acute transfusion reactions. Cumulatively, these studies provide new information about safety and efficacy of IBS PLT and plasma components not obtainable from RCTs. CONCLUSION Although inherently different from RCTs, properly designed postmarketing studies are informative regarding the safety and efficacy of innovative transfusion technologies in large patient populations under conditions of routine use.
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Sharma DK, Datta S, Gupta A. Study of acute transfusion reactions in a teaching hospital of Sikkim: A hemovigilance initiative. Indian J Pharmacol 2016; 47:370-4. [PMID: 26285707 PMCID: PMC4527056 DOI: 10.4103/0253-7613.161257] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 04/08/2015] [Accepted: 06/26/2015] [Indexed: 11/06/2022] Open
Abstract
Objective: Blood transfusions are inherently associated with risks ranging in severity from minor to life-threatening. Continuous monitoring of transfusion related complications can promote understanding of factors contributing to transfusion reactions and help to formulate necessary remedial measures. This study was designed to analyze the frequency and nature of transfusion reactions reported to the blood bank of a remote North East Indian teaching hospital. Materials and Methods: All acute transfusion reactions (ATRs) reported to the blood bank over a period of 20 months (May 2013 to January 2015) were reviewed and analyzed. The risk of transfusion reactions associated with each individual component was assessed. Results: A total of 3455 units of whole blood and component transfusions were carried out of which a total of 32 (0.92%) ATRs were encountered. Packed red blood cells (PRBCs) (n = 15, P = 0.06) and whole blood (WB) (n = 13, P = 0.83) were most commonly implicated. Allergic reaction was the most frequent transfusion reaction encountered (65.6%), seen most commonly with PRBC (risk of 0.76%, P = 0.42), and WB (risk of 0.68%, P = 0.63) transfusions. This was followed by febrile reactions (28.1%), which were seen more commonly with PRBCs (risk of 0.57%, P = 0.016). No reactions were observed with platelet transfusions. Conclusion: The overall incidence of transfusion reactions in this hospital is slightly higher than those having more advanced transfusion facilities in India. The lack of leukoreduction facilities in our hospital could be a likely cause for the same. The use of leukoreduced WB and PRBCs could possibly reduce the overall incidence of ATRs in general and febrile nonhemolytic transfusion reactions in particular.
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Affiliation(s)
- Dhruva Kumar Sharma
- Department of Pharmacology, Sikkim Manipal University, Sikkim Manipal Institute of Medical Sciences, Tadong, Gangtok, East Sikkim, Sikkim, India
| | - Supratim Datta
- Department of Pharmacology, Sikkim Manipal University, Sikkim Manipal Institute of Medical Sciences, Tadong, Gangtok, East Sikkim, Sikkim, India
| | - Amlan Gupta
- Department of Pathology and Blood Bank, Sikkim Manipal University, Sikkim Manipal Institute of Medical Sciences, Tadong, Gangtok, East Sikkim, Sikkim, India
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Sidhu M, Meenia R, Akhter N, Sawhney V, Irm Y. Report on errors in pretransfusion testing from a tertiary care center: A step toward transfusion safety. Asian J Transfus Sci 2016; 10:48-52. [PMID: 27011670 PMCID: PMC4782493 DOI: 10.4103/0973-6247.175402] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Errors in the process of pretransfusion testing for blood transfusion can occur at any stage from collection of the sample to administration of the blood component. The present study was conducted to analyze the errors that threaten patients' transfusion safety and actual harm/serious adverse events that occurred to the patients due to these errors. MATERIALS AND METHODS The prospective study was conducted in the Department Of Transfusion Medicine, Shri Maharaja Gulab Singh Hospital, Government Medical College, Jammu, India from January 2014 to December 2014 for a period of 1 year. Errors were defined as any deviation from established policies and standard operating procedures. A near-miss event was defined as those errors, which did not reach the patient. Location and time of occurrence of the events/errors were also noted. RESULTS A total of 32,672 requisitions for the transfusion of blood and blood components were received for typing and cross-matching. Out of these, 26,683 products were issued to the various clinical departments. A total of 2,229 errors were detected over a period of 1 year. Near-miss events constituted 53% of the errors and actual harmful events due to errors occurred in 0.26% of the patients. Sample labeling errors were 2.4%, inappropriate request for blood components 2%, and information on requisition forms not matching with that on the sample 1.5% of all the requisitions received were the most frequent errors in clinical services. In transfusion services, the most common event was accepting sample in error with the frequency of 0.5% of all requisitions. ABO incompatible hemolytic reactions were the most frequent harmful event with the frequency of 2.2/10,000 transfusions. CONCLUSION Sample labeling, inappropriate request, and sample received in error were the most frequent high-risk errors.
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Affiliation(s)
- Meena Sidhu
- Department of Transfusion Medicine, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Renu Meenia
- Department of Transfusion Medicine, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Naveen Akhter
- Department of Transfusion Medicine, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Vijay Sawhney
- Department of Transfusion Medicine, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Yasmeen Irm
- Department of Transfusion Medicine, Government Medical College, Jammu, Jammu and Kashmir, India
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Leucoreduction of blood components: an effective way to increase blood safety? BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 14:214-27. [PMID: 26710353 DOI: 10.2450/2015.0154-15] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/31/2015] [Indexed: 02/08/2023]
Abstract
Over the past 30 years, it has been demonstrated that removal of white blood cells from blood components is effective in preventing some adverse reactions such as febrile non-haemolytic transfusion reactions, immunisation against human leucocyte antigens and human platelet antigens, and transmission of cytomegalovirus. In this review we discuss indications for leucoreduction and classify them into three categories: evidence-based indications for which the clinical efficacy is proven, indications based on the analysis of observational clinical studies with very consistent results and indications for which the clinical efficacy is partial or unproven.
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Knutson F, Osselaer J, Pierelli L, Lozano M, Cid J, Tardivel R, Garraud O, Hervig T, Domanovic D, Cukjati M, Gudmundson S, Hjalmarsdottir IB, Castrillo A, Gonzalez R, Brihante D, Santos M, Schlenke P, Elliott A, Lin JS, Tappe D, Stassinopoulos A, Green J, Corash L. A prospective, active haemovigilance study with combined cohort analysis of 19,175 transfusions of platelet components prepared with amotosalen-UVA photochemical treatment. Vox Sang 2015; 109:343-52. [PMID: 25981525 PMCID: PMC4690512 DOI: 10.1111/vox.12287] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 03/24/2015] [Accepted: 03/27/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES A photochemical treatment process (PCT) utilizing amotosalen and UVA light (INTERCEPT(™) Blood System) has been developed for inactivation of viruses, bacteria, parasites and leucocytes that can contaminate blood components intended for transfusion. The objective of this study was to further characterize the safety profile of INTERCEPT-treated platelet components (PCT-PLT) administered across a broad patient population. MATERIALS AND METHODS This open-label, observational haemovigilance programme of PCT-PLT transfusions was conducted in 21 centres in 11 countries. All transfusions were monitored for adverse events within 24 h post-transfusion and for serious adverse events (SAEs) up to 7 days post-transfusion. All adverse events were assessed for severity (Grade 0-4), and causal relationship to PCT-PLT transfusion. RESULTS Over the course of 7 years in the study centres, 4067 patients received 19,175 PCT-PLT transfusions. Adverse events were infrequent, and most were of Grade 1 severity. On a per-transfusion basis, 123 (0.6%) were classified an acute transfusion reaction (ATR) defined as an adverse event related to the transfusion. Among these ATRs, the most common were chills (77, 0.4%) and urticaria (41, 0.2%). Fourteen SAEs were reported, of which 2 were attributed to platelet transfusion (<0.1%). No case of transfusion-related acute lung injury, transfusion-associated graft-versus-host disease, transfusion-transmitted infection or death was attributed to the transfusion of PCT-PLT. CONCLUSION This longitudinal haemovigilance safety programme to monitor PCT-PLT transfusions demonstrated a low rate of ATRs, and a safety profile consistent with that previously reported for conventional platelet components.
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Affiliation(s)
- F Knutson
- Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden
| | - J Osselaer
- Cliniques Universitaires de Mont Godinne, Universite Catholique de Louvain, Yvoir, Belgium
| | - L Pierelli
- Department of Experimental Medicine, Sapienza University of Roma, Rome, Italy
| | - M Lozano
- Department of Hemotherapy and Hemostasis, CDB, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | - J Cid
- Department of Hemotherapy and Hemostasis, CDB, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | | | - O Garraud
- EFS Auvergne Loire, St. Etienne, France
| | - T Hervig
- Department of Immunology and Transfusion Medicine, University of Bergen, Bergen, Norway
| | - D Domanovic
- Blood Transfusion Centre of Slovenia, Ljubljana, Slovenia
| | - M Cukjati
- Blood Transfusion Centre of Slovenia, Ljubljana, Slovenia
| | - S Gudmundson
- Blood Bank, National University Hospital, Reykjavik, Iceland
| | | | - A Castrillo
- Transfusion Centre of Galicia, Santiago de Compostela, Spain
| | - R Gonzalez
- Transfusion Centre of Galicia, Santiago de Compostela, Spain
| | - D Brihante
- Servico de Imuno-Hemoterapia, Instituto Portugues de Oncologia de Lisboa, Lisbon, Portugal
| | - M Santos
- Servico de Imuno-Hemoterapia, Instituto Portugues de Oncologia de Lisboa, Lisbon, Portugal
| | - P Schlenke
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | | | - J-S Lin
- Cerus Corporation, Concord, CA, USA
| | - D Tappe
- Cerus Corporation, Concord, CA, USA
| | | | - J Green
- Cerus Corporation, Concord, CA, USA
| | - L Corash
- Cerus Corporation, Concord, CA, USA
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El Kenz H, Corazza F. Automated point-of-care testing for ABO agglutination test: proof of concept and validation. Vox Sang 2015; 109:79-85. [PMID: 25766458 DOI: 10.1111/vox.12248] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 12/12/2014] [Accepted: 12/15/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES ABO-incompatible red blood cell transfusions still represent an important hazard in transfusion medicine. Therefore, some countries have introduced a systematic bedside ABO agglutination test checking that the right blood is given to the right patient. However, this strategy requires an extremely time-consuming learning programme and relies on a subjective interpretation of ABO test cards agglutination. We developed a prototype of a fully automated device performing the bedside agglutination test that could be completed by reading of a barcoded wristband. This POCT checks the ABO compatibility between the patient and the blood bag. MATERIALS AND METHODS Proof of concept and analytical validation of the prototype has been completed on 451 blood samples: 238 donor packed red blood cells, 137 consecutive unselected patients for whom a blood group determination had been ordered and on 76 patient samples selected with pathology that could possibly interfere with or impair performances of the assay. RESULTS We observed 100% concordance for ABO blood groups between the POCT and the laboratory instrument. CONCLUSION These preliminary results demonstrate the feasibility of ABO determination with a simple POCT device eliminating manipulation and subjective interpretation responsible for transfusion errors. This device should be linked to the blood bank system allowing all cross-check of the results.
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Affiliation(s)
- H El Kenz
- Brugmann University Hospital Center and Queen Fabiola University Children Hospital blood bank, Brussels, Belgium
| | - F Corazza
- Brugmann University Hospital Center immunology laboratory, Brussels, Belgium
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Hussain S, Moiz B, Ausat FA, Khurshid M. Monitoring and reporting transfusion reactions as a quality indicator – a clinical audit. Transfus Apher Sci 2015; 52:122-7. [DOI: 10.1016/j.transci.2014.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 11/26/2013] [Accepted: 03/11/2014] [Indexed: 10/24/2022]
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Chung KW, Harvey A, Basavaraju SV, Kuehnert MJ. How is national recipient hemovigilance conducted in the United States? Transfusion 2015; 55:703-7. [PMID: 25565577 DOI: 10.1111/trf.12980] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 11/10/2014] [Accepted: 11/10/2014] [Indexed: 12/01/2022]
Abstract
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.
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Affiliation(s)
- Koo-Whang Chung
- Office of Blood, Organ and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alexis Harvey
- Office of Blood, Organ and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sridhar V Basavaraju
- Office of Blood, Organ and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew J Kuehnert
- Office of Blood, Organ and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
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Kato H, Nakayama T, Uruma M, Okuyama Y, Handa M, Tomiyama Y, Shimodaira S, Takamoto S. A retrospective observational study to assess adverse transfusion reactions of patients with and without prior transfusion history. Vox Sang 2014; 108:243-50. [PMID: 25536173 DOI: 10.1111/vox.12208] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 09/16/2014] [Accepted: 09/16/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND OBJECTIVES This study compares the frequency of adverse transfusion reactions (ATRs) after first transfusions with the frequency of ATRs for subsequent (non-first) transfusions. MATERIALS AND METHODS Five hospitals agreed to systematically collect and share 2 years of data. This was a retrospective observational analysis of data including the number of transfusion episodes and ATRs for red blood cells (RBCs), fresh frozen plasma (FFP) and platelet concentrates (PCs) given to first-time transfusion recipients and to those previously transfused. RESULTS First transfusion ATRs to RBCs, FFP and PCs were 1.08%, 2.84% and 3.34%, respectively. These are higher than ATR incidences to RBCs (0.69%), FFP (1.91%) and PCs (2.75%) on subsequent transfusions. Specifically, first transfusion incidences of febrile non-haemolytic transfusion reactions (FNHTRs) to RBCs (0.43%) and allergic reactions to FFP (2.51%) were higher than on subsequent transfusions (RBCs: 0.23%, FFP: 1.65%). CONCLUSION There are risks of ATRs on the first transfusion as well as transfusions of patients with transfusion history.
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Affiliation(s)
- H Kato
- Department of Transfusion Medicine, Aichi Medical University, Nagakute, Japan
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Harvey AR, Basavaraju SV, Chung KW, Kuehnert MJ. Transfusion-related adverse reactions reported to the National Healthcare Safety Network Hemovigilance Module, United States, 2010 to 2012. Transfusion 2014; 55:709-18. [PMID: 25371300 DOI: 10.1111/trf.12918] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 09/11/2014] [Accepted: 09/12/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND 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. STUDY DESIGN AND METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Alexis R Harvey
- Office of Blood, Organ and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging, Zoonotic, and Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sridhar V Basavaraju
- Office of Blood, Organ and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging, Zoonotic, and Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Koo-Whang Chung
- Office of Blood, Organ and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging, Zoonotic, and Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew J Kuehnert
- Office of Blood, Organ and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging, Zoonotic, and Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
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Bolton-Maggs PHB, Wood EM, Wiersum-Osselton JC. Wrong blood in tube - potential for serious outcomes: can it be prevented? Br J Haematol 2014; 168:3-13. [PMID: 25284036 DOI: 10.1111/bjh.13137] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
'Wrong blood in tube' (WBIT) errors, where the blood in the tube is not that of the patient identified on the label, may lead to catastrophic outcomes, such as death from ABO-incompatible red cell transfusion. Transfusion is a multistep, multidisciplinary process in which the human error rate has remained unchanged despite multiple interventions (education, training, competency testing and guidelines). The most effective interventions are probably the introduction of end-to-end electronic systems and a group-check sample for patients about to receive their first transfusion, but neither of these eradicates all errors. Further longer term studies are required with assessment before and after introduction of the intervention. Although most focus has been on WBIT in relation to blood transfusion, all pathology samples should be identified and linked to the correct patient with the same degree of care. Human factors education and training could help to increase awareness of human vulnerability to error, particularly in the medical setting where there are many risk factors.
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Affiliation(s)
- Paula H B Bolton-Maggs
- Serious Hazards of Transfusion UK National Haemovigilance Scheme, Manchester Blood Centre and the University of Manchester, Manchester, UK
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Oakley FD, Woods M, Arnold S, Young PP. Transfusion reactions in pediatric compared with adult patients: a look at rate, reaction type, and associated products. Transfusion 2014; 55:563-70. [PMID: 25145580 DOI: 10.1111/trf.12827] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 07/14/2014] [Accepted: 07/14/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND The majority of reports on transfusion reactions address adult patients. Less is known about the types, incidence, and other clinical details of transfusion reactions in pediatric populations. Furthermore, to our knowledge, there have been no previous reports directly comparing these aspects between adults and pediatric patient populations to assess if there are differences. STUDY DESIGN AND METHODS Between the period of January 1, 2011, and February 1, 2013, all reported adult and pediatric transfusion reactions at Vanderbilt University Medical Center (VUMC) were evaluated by transfusion medicine clinical service. The information was subsequently shared with the hemovigilance database. Data provided to hemovigilance included age, sex, blood product associated with the reaction, severity of the reaction, and the type of transfusion reactions. These were collated with hospital and blood bank information system-acquired data on overall admission and product transfusion. RESULTS A total of 133,671 transfusions were performed at VUMC during the study period including 20,179 platelet (PLT) transfusions, 31,605 plasma transfusions, 79,933 red blood cell (RBC) transfusions, and 2154 cryoprecipitate transfusions. Over the same period, 108 pediatric and 277 adult transfusion reactions were recorded. This corresponds to an incidence of 6.2 reactions per 1000 transfusions within the pediatric (age < 21) population and an incidence of 2.4 reactions per 1000 transfusions within the adult population. In both adult and pediatric populations, transfusion reactions were most commonly associated with PLT, followed by RBC, and then plasma transfusions. Within the pediatric population, subset analysis identified multiple differences when compared to the adult population, including an increased incidence of allergic transfusion reactions (2.7/1000 vs. 1.1/1000, p < 0.001), febrile nonhemolytic transfusion reactions (1.9/1000 vs. 0.47/1000, p < 0.001), and hypotensive transfusion reactions (0.29/1000 vs. 0.078/1000, p < 0.05). Interestingly, while the reaction incidence was the same between sexes in adults, in pediatric patients, reactions were more common in male patients (7.9/1000 pediatric males vs. 4.3/1000 pediatric females, p < 0.01). CONCLUSION To our knowledge this is the first study to provide detailed comparisons of acute transfusion reactions to all blood products between pediatric and adult populations at a single institution and supported by a single transfusion service and culture. Collectively these data provide insight into pediatric transfusion reactions and demonstrate a general increase in the incidence of transfusion reactions within the pediatric compared to adult population.
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Affiliation(s)
- Fredrick D Oakley
- Department of Pathology, Microbiology and Immunology, Nashville, Tennessee
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Mafirakureva N, Khoza S, Mvere DA, Chitiyo ME, Postma MJ, van Hulst M. Incidence and pattern of 12 years of reported transfusion adverse events in Zimbabwe: a retrospective analysis. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2014; 12:362-7. [PMID: 24887217 PMCID: PMC4111818 DOI: 10.2450/2014.0156-13] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 10/24/2013] [Indexed: 01/30/2023]
Abstract
BACKGROUND Haemovigilance hinges on a systematically structured reporting system, which unfortunately does not always exist in resource-limited settings. We determined the incidence and pattern of transfusion-related adverse events reported to the National Blood Service Zimbabwe. MATERIALS AND METHODS A retrospective review of the transfusion-event records of the National Blood Service Zimbabwe was conducted covering the period from 1 January 1999 to 31 December 2011. All transfusion-related event reports received during the period were analysed. RESULTS A total of 308 transfusion adverse events (0.046%) were reported for 670,625 blood components distributed. The majority (61.6%) of the patients who experienced an adverse event were female. The median age was 36 years (range, 1-89 years). The majority (68.8%) of the adverse events were acute transfusion reactions consisting of febrile non-haemolytic transfusion reactions (58.5%), minor allergies (31.6%), haemolytic reactions (5.2%), severe allergic reactions (2.4%), anaphylaxis (1.4%) and hypotension (0.9%). Two-thirds (66.6%) of the adverse events occurred following administration of whole blood, although only 10.6% of the blood was distributed as whole blood. Packed cells, which accounted for 75% of blood components distributed, were associated with 20.1% of the events. DISCUSSION The incidence of suspected transfusion adverse events was generally lower than the incidences reported globally in countries with well-established haemovigilance systems. The administration of whole blood was disproportionately associated with transfusion adverse events. The pattern of the transfusion adverse events reported here highlights the probable differences in practice between different settings. Under-reporting of transfusion events is rife in passive reporting systems.
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Affiliation(s)
- Nyashadzaishe Mafirakureva
- Unit of Pharmaco-Epidemiology & Pharmaco-Economics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
- National Blood Service Zimbabwe, Harare, Zimbabwe
| | - Star Khoza
- Department of Clinical Pharmacology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | | | - Maarten J. Postma
- Unit of Pharmaco-Epidemiology & Pharmaco-Economics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Marinus van Hulst
- Unit of Pharmaco-Epidemiology & Pharmaco-Economics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Martini Hospital, Groningen, The Netherlands
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Karim F, Moiz B, Shamsuddin N, Naz S, Khurshid M. Root cause analysis of non-infectious transfusion complications and the lessons learnt. Transfus Apher Sci 2014; 50:111-7. [DOI: 10.1016/j.transci.2013.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 09/27/2013] [Accepted: 10/22/2013] [Indexed: 10/26/2022]
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Corash L. Bacterial contamination of platelet components: potential solutions to prevent transfusion-related sepsis. Expert Rev Hematol 2014; 4:509-25. [DOI: 10.1586/ehm.11.53] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Estimation of the prevalence and rate of acute transfusion reactions occurring in Windhoek, Namibia. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 12:352-61. [PMID: 24333079 DOI: 10.2450/2013.0143-13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 08/01/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Kato H, Uruma M, Okuyama Y, Fujita H, Handa M, Tomiyama Y, Shimodaira S, Kurata Y, Takamoto S. Incidence of transfusion-related adverse reactions per patient reflects the potential risk of transfusion therapy in Japan. Am J Clin Pathol 2013; 140:219-24. [PMID: 23897258 DOI: 10.1309/ajcp6sbpox0uwhek] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES To describe the frequency of adverse reactions (ARs) after transfusion on both per transfused patient and per transfused unit bases. METHODS 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). RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Hidefumi Kato
- Department of Transfusion Medicine, Aichi Medical University, Nagakute, Aichi, Japan
| | - Motoaki Uruma
- Department of Transfusion Medicine, Aichi Medical University, Nagakute, Aichi, Japan
| | - Yoshiki Okuyama
- Division of Transfusion and Cell Therapy, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Hiroshi Fujita
- Department of Transfusion Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Makoto Handa
- Department of Transfusion Medicine & Cell Therapy, Keio University, Tokyo, Japan
| | - Yoshiaki Tomiyama
- Department of Blood Transfusion, Osaka University Hospital, Osaka, Japan
| | - Shigetaka Shimodaira
- Division of Transfusion Medicine, Shinshu University Hospital, Matsumoto-shi, Nagano-ken, Japan
| | - Yoshiyuki Kurata
- Department of Human Welfare, Shitennoji University, Habikino, Japan
| | - Shigeru Takamoto
- Department of Transfusion Medicine, Aichi Medical University, Nagakute, Aichi, Japan
- Japanese Red Cross Hokkaido Block Blood Center, Sapporo, Japan
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Morel P, Naegelen C, Deschaseaux M, Bardiaux L. [Prevention of bacterial risk: pathogen inactivation/detection of bacteria]. Transfus Clin Biol 2013; 20:109-14. [PMID: 23622837 DOI: 10.1016/j.tracli.2013.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 03/27/2013] [Indexed: 11/30/2022]
Abstract
Bacterial contamination of blood products remains the most important infectious risk of blood transfusion in 2013. Platelet concentrates (PC) are in cause in the majority of the transfusion reaction due to bacterial contaminations. A lot of prevention methods have been developed over the last 10 years (pre-donation interview, skin decontamination, diversion of the first 30 mL of the donation, leuko-reduction...), they have focused on limiting the contamination of the donations and prevent the bacterial growth in donations and/or in the blood products. These measures were effective and led to significantly reducing the risk of adverse effects associated with bacterial growth. However, every year there are about six accidents (with a high level of imputability) and one death. The reduction of the bacterial risk remains a priority for the French Blood Establishment (EFS). The procedure for skin disinfection is going to be improved in order to further strengthen this crucial step to avoid the contamination of donation. Methods of pathogen inactivation applied to plasma and PC are available in France and their effectiveness is demonstrated on the bacterial risk. Methods for bacterial detection of PC are used in many countries now. Automated culture is the most common. Alternatives are now available in the form of rapid tests able to analyze the PC just before the delivery and avoid false negatives observed with automated culture. Assessments are under way to confirm these benefits in 2013.
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Affiliation(s)
- P Morel
- Établissement français du sang (EFS) Bourgogne-Franche-Comté, BP 1937, 1, boulevard Alexander-Fleming, 25020 Besançon cedex, France.
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Odaka C, Kato H, Otsubo H, Takamoto S, Okada Y, Taneichi M, Okuma K, Sagawa K, Hoshi Y, Tasaki T, Fujii Y, Yonemura Y, Iwao N, Tanaka A, Okazaki H, Momose SY, Kitazawa J, Mori H, Matsushita A, Nomura H, Yasoshima H, Ohkusa Y, Yamaguchi K, Hamaguchi I. Online reporting system for transfusion-related adverse events to enhance recipient haemovigilance in Japan: A pilot study. Transfus Apher Sci 2013; 48:95-102. [DOI: 10.1016/j.transci.2012.07.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 07/30/2012] [Indexed: 11/16/2022]
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Berger K, Bauer M, Schopohl D, Henschler R, Ostermann H. Model Calculations to Quantify Clinical and Economic Effects of Pathogen Inactivation in Platelet Concentrates. ACTA ACUST UNITED AC 2013; 36:53-9. [DOI: 10.1159/000346309] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Falzone E, Auroy Y, Hoffmann C, Sandid I, Carlier M, Benhamou D, Andreu G, Lienhart A. Erreurs de destinataire de concentrés de globules rouges : méthode d’analyse à partir de déclarations d’incidents de la chaîne transfusionnelle en 2009. Transfus Clin Biol 2012; 19:338-44. [DOI: 10.1016/j.tracli.2012.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 06/16/2012] [Indexed: 11/28/2022]
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Kleinman S, Reed W, Stassinopoulos A. A patient-oriented risk-benefit analysis of pathogen-inactivated blood components: application to apheresis platelets in the United States. Transfusion 2012; 53:1603-18. [DOI: 10.1111/j.1537-2995.2012.03928.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 08/24/2012] [Accepted: 08/25/2012] [Indexed: 12/21/2022]
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