Associated Factors With Acute Transfusion Reaction From Hospital Online Reporting Events: A Retrospective Cohort Study

Non-hemolytic acute transfusion reactions: the impact of patient and blood product characteristics

BACKGROUND

Non-hemolytic acute transfusion reactions (ATRs) are generally not fatal, but they can cause serious increases in workload and costs as a result of blood product wastage.

METHODS

A retrospective analysis was made of the data of the 7-year period between January 2016 and December 2022 to identify the possible associations between patient and product characteristics and the development of ATRs.

RESULTS

A total of 113,666 blood products were transfused during the study period. There were 146 ATRs with an estimated rate of 1.28 per 1000 blood products administered. The most common ATR was mild allergic reactions (n = 84, 57.6%). No statistically significant relationship was found in blood group distribution between patients who had and did not develop ATR (p = 0.797). Febrile Non-hemolytic Transfusion Reaction (FNHTR) was more common in patients receiving erythrocyte suspension (ES) transfusion, and Fresh Frozen Plasma (FFP) was mostly used in those with mild allergic reactions (p < 0.001). Patient age was determined as > 60 years in those who developed FNHTR or 'others,' and < 60 years in patients with mild allergic reactions (p = 0.046).

CONCLUSION

The results of the current study demonstrated that regardless of blood group, the probability of developing FNHTR is high when ES is transfused in elderly patients, and the probability of developing mild allergic reaction is high when FFP is used. While recognizing that ATRs are difficult to prevent, it can be emphasized that prediction and management may become easier if clinicians keep these possibilities in mind when making transfusion decisions.

Comparison of post-decompressive haematuria in rapid versus gradual bladder decompression in patients with chronic urinary retention

Background

Chronic urinary retention (CUR) is a common urological emergency. Initial management involves the drainage of the bladder by urethral catheterisation. Relief of CUR may be associated with post-decompressive haematuria. The two primary methods of emptying the obstructed bladder are rapid and gradual emptying. The method of relief of CUR to reduce this complication has been debated for decades.

Objective

To compare the risk of post-decompressive haematuria following rapid versus gradual urinary bladder decompression in patients with CUR.

Materials and Methods

This was a prospective, randomised study in which patients with CUR were randomised into two groups: group A and group B. Group A had rapid urinary decompression with an 18 Fr urethral catheter attached to a urine bag, whereas group B had gradual decompression using a urethral catheter attached to an intravenous fluid-giving set, which was then attached to the urine bag. Post-decompressive haematuria in each group was assessed at designated times and documented based on a research protocol.

Data Analysis and Result Presentation

Data were analysed using the Statistical Package for Social Sciences (IBM) SPSS version 21. Data were summarised by descriptive statistics. The two arms were compared for similarities in demographic variables. Continuous and categorical variables were compared using the Student's t test and Pearson's chi-square test, respectively. The results of the analysis were presented with the aid of bar charts and tables for clarity. Significant P value was ≤0.05.

Result

Sixty patients were recruited into the study and randomised into groups A (rapid urinary decompression) and B (gradual urinary decompression) with 30 patients in each arm of the study. The mean age was 70.92 ± 13.98 years (range 20-96 years). The mean age of the patients recruited into group A was 68.50 ± 14.77 years, whereas that of group B was 73.33 ± 13.19 years. The P value was 0.187. Fifteen patients (50%) developed gross haematuria in group A compared with 7 patients (23.3%) in group B with a statistically significant p value of 0.032. Four (26.7%) of the patients with gross haematuria had blood transfusions in group A, whereas only 1 (16.7%) of the patients with gross haematuria in group B had a blood transfusion. The P value was 0.920.

Conclusion

The rate of haematuria is significantly higher in group A with a higher rate of blood transfusion than that of group B. Though gradual urinary decompression is cumbersome, it is recommended to reduce the rate of haematuria and blood transfusion with its associated complications.

Recognition mechanisms of hemoglobin particles by monocytes - CD163 may just be one

Hemoglobin-based oxygen carriers (HBOCs) as blood substitutes are one of the great hopes of modern transfusion and emergency medicine. After the major safety-relevant challenges of the last decades seem to be largely overcome, current developments have in common that they are affected by degradation and excretion at an early stage in test organisms. Several possible mechanisms that may be responsible for this are discussed in the literature. One of them is CD163, the receptor of the complex of haptoglobin (Hp) and hemoglobin (Hb). The receptor has been shown in various studies to have a direct affinity for Hb in the absence of Hp. Thus, it seems reasonable that CD163 could possibly also bind Hb within HBOCs and cause phagocytosis of the particles. In this work we investigated the role of CD163 in the uptake of our hemoglobin sub-micron particles (HbMPs) in monocytes and additionally screened for alternative ways of particle recognition by monocytes. In our experiments, blockade of CD163 by specific monoclonal antibodies proved to partly inhibit HbMP uptake by monocytes. It appears, however, that several other phagocytosis pathways for HbMPs might exist, independent of CD163 and also Hb.

Blood Transfusion Complications and Associated Factors Among Blood-Transfused Adult Patients at Debre Markos Comprehensive Specialized Hospital, Ethiopia: A Cross Sectional Study

Background

Blood transfusion is the infusion of whole blood or its components into the veins of the patient to improve tissue oxygenation and maintain hemostasis. Besides its clinical use, it can pose a risk of transfusion complications with different factors.

Purpose

The aim of this study was to assess blood transfusion complications, and associated factors among transfused adult patients at Debre Markos Comprehensive Specialized Hospital, North West Ethiopia, 2022.

Materials and Methods

An institution-based cross-sectional study design was conducted on a total of 182 patients from March 20 to June 15, 2022. Patients were enrolled in the study using consecutive sampling method. The socio-demographic and clinical data were collected using a structured questionnaire and data extraction sheet, respectively. About 3 ml of anti-coagulated blood and 30 ml of urine samples were collected to assess transfusion complications. CBC and Coombs test were performed from blood and urinalysis from urine, respectively. Chi-square, Fisher's exact test, and binary logistic regression were done using SPSS version 25. P-values less than 0.05 are declared as statistically significant.

Results

An acute transfusion reaction (ATR) was encountered in 12 (6.6%) patients. It was 4.13, 7.78 and 3.96 times more likely to occur among patients with a previous history of transfusion, abortion, and transfused blood stored for more than 20 days compared to their counterparts, respectively. In addition, the odds of developing ATR increase by 2.07 as the number of transfused blood units increases by 1 unit.

Conclusion

The incidence of acute transfusion reactions was high. During transfusion, clinicians should closely monitor patients who had history of transfusion, abortion, transfused old blood and more than 1 unit.

Association between Anemia Severity and Ischemic Stroke Incidence: A Retrospective Cohort Study

Stroke patients presenting with anemia at the time of stroke onset had a higher risk of mortality and development of other cardiovascular diseases and comorbidities. The association between the severity of anemia and the risk of developing a stroke is still uncertain. This retrospective study aimed to evaluate the association between stroke incidence and anemia severity (by WHO criteria). A total of 71,787 patients were included, of whom 16,708 (23.27%) were identified as anemic and 55,079 patients were anemia-free. Female patients (62.98%) were more likely to have anemia than males (37.02%). The likelihood of having a stroke within eight years after anemia diagnosis was calculated using Cox proportional hazard regression. Patients with moderate anemia had a significant increase in stroke risk compared to the non-anemia group in univariate analyses (hazard ratios [HR] = 2.31, 95% confidence interval [CI], 1.97-2.71, p < 0.001) and in adjusted HRs (adj-HR = 1.20, 95% CI, 1.02-1.43, p = 0.032). The data reveal that patients with severe anemia received more anemia treatment, such as blood transfusion and nutritional supplementation, and maintaining blood homeostasis may be important to preventing stroke. Anemia is an important risk factor, but other risk factors, including diabetes and hyperlipidemia, also affect stroke development. There is a heightened awareness of anemia's severity and the increasing risk of stroke development.

Applying Healthcare Failure Mode and Effect Analysis and the Development of a Real-Time Mobile Application for Modified Early Warning Score Notification to Improve Patient Safety During Hemodialysis

OBJECTIVE

Patients undergoing hemodialysis are a high-risk population. This study identified possible errors by using a healthcare failure mode and effect analysis system to improve patient safety during hemodialysis.

METHODS

A multidisciplinary collaborative team, including physicians, nurses, information technicians, and medical staff members, was assembled. A flow diagram was used to indicate each process of the hemodialysis procedure from evaluating patient condition to transporting the patient back to the ward from the hemodialysis center. We scored all possible failure modes using the hazard scoring method as a combination of the occurrence frequency and severity. These potential failure modes were used to identify and evaluate possible risks by using a risk scoring matrix.

RESULTS

Thirty failure modes were identified across 6 processes, and their potential causes were explored. Four major strategies for addressing most of the failure modes were implemented: establishment of a mobile application that sends real-time automated alerts to the medical team based on the Modified Early Warning Score, design of a modified dialysis Identify-Situation-Background-Assessment-Recommendation checklist for dialysis, technician education and training, and internal auditing and monitoring of the implementation of the entire process. After the implementation of the strategies, the hazard scores of patients during dialysis dropped by 71.2% from 170 points to 49 points.

CONCLUSIONS

The healthcare failure mode and effect analysis system was useful for evaluating potential risk during dialysis. Using the mobile application reduced the occurrence of emergency resuscitation during hemodialysis and significantly improved the communication between medical personnel.