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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 32  |  Issue : 1  |  Page : 47-50

Acute transfusion reactions in a tertiary hospital: A 2-year retrospective study


Department of IHBT, RIMS, Imphal, Manipur, India

Date of Web Publication18-Jun-2018

Correspondence Address:
Dr. Pratima Khoyumthem
Department of IHBT, RIMS, Imphal- 795 004, Manipur
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jms.jms_41_17

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  Abstract 

Background: Modern day transfusion therapy, even though safe, is associated with noninfectious complication such as transfusion-related reactions. The study was undertaken to determine the incidence of the reactions as to correct their cause and prevent recurrences.
Materials and Methods: It was a retrospective review of all transfusion-related adverse events reported within 2014–2015. They were analyzed as per the protocol laid down by the department.
Results: A total of 31,074 units of blood components were issued during the study period and 28 patients developed transfusion reactions. Maximum cases were due to allergic reaction (n = 15, 53.57%) and were mostly females. Packed red blood cells were also the most common component associated with the transfusion reactions.
Conclusion: Allergic reaction was the most common acute transfusion reaction followed by febrile nonhemolytic transfusion reaction. Sensitization of all the health personnel involved in the transfusion chain and strict hemovigilance program enforcement will help in improving the safety of blood transfusion.

Keywords: Acute, adverse events, retrospective, transfusion reaction


How to cite this article:
Khoyumthem P, Rachandra K, Goswami S, Lyngdoh LN, Sharma AB, Singh AM. Acute transfusion reactions in a tertiary hospital: A 2-year retrospective study. J Med Soc 2018;32:47-50

How to cite this URL:
Khoyumthem P, Rachandra K, Goswami S, Lyngdoh LN, Sharma AB, Singh AM. Acute transfusion reactions in a tertiary hospital: A 2-year retrospective study. J Med Soc [serial online] 2018 [cited 2020 May 25];32:47-50. Available from: http://www.jmedsoc.org/text.asp?2018/32/1/47/234652


  Introduction Top


Transfusion of blood is often required to improve the clinical condition of patient. Modern day transfusion therapy has changed from a hazardous position to a relatively safe procedure with the advancement of technology. Nevertheless, the greatest risk to the patient lies in the noninfectious complications of blood transfusion. These noninfectious complications of transfusion can be broadly divided into:[1]

  1. Acute (manifesting within 24 h)
  2. Delayed (after 24 h).


Acute reactions can be further classified into:

  1. Hemolytic transfusion reaction (HTR) – immune and nonimmune
  2. Sepsis
  3. Transfusion-related acute lung injury
  4. Allergic reactions (including anaphylaxis)
  5. Transfusion-associated circulatory overload (TACO)
  6. Complications of massive transfusion
  7. Febrile non-HTR (FNHTR)
  8. Air embolism.


The study has been taken up to determine the frequency and type of acute transfusion reactions (ATRs) occurring in inpatients of our hospital that required blood transfusion, as no such study was reported from this part of our country till date. The study will also help to correct their cause and prevent recurrence.


  Materials and Methods Top


This study is a retrospective review of all the transfusion reactions that were reported to Immunohaematology and Blood Transfusion Department, in a tertiary care center, Imphal, from January 2014 to December 2015. After getting approval from the Institutional Ethical Committee, all transfusion reactions that were reported during the period were investigated and analyzed as per the departmental protocol which was prepared in accordance with the guidelines laid down by the Directorate General of Health Services.

The investigations done in our department for transfusion-related adverse events were as follows:

  1. Rechecking of all documents for possibility of clerical error
  2. Rechecking volume of blood left and any abnormality. Bacterial cultures are conducted on the blood sample from the returned blood bag and also from the patient (posttransfusion)
  3. Serological testing:


    1. Comparison of plasma between the pre- and post-transfusion patient's samples
    2. Retesting of blood groups of both patient and blood bag
    3. Direct Coombs test on the patient's sample
    4. Antibody screening tests on both pre- and post-transfusion samples (patient)
    5. Crossmatch (Coombs) was repeated between the blood bag and the pre- as well as post-transfusion samples
    6. Other posttransfusion investigations included serum bilirubin, hemoglobin, urine color, platelet count, and coagulation profile.


Based on the results obtained from the above investigations, a final conclusion on the type of transfusion reaction was given and the final report was made.


  Results Top


A total of 31,074 units of blood components were issued to inpatients during the 2-year study period [Table 1]. Twenty-eight patients developed transfusion-related adverse effects where the maximum cases are due to allergic reaction [Table 2]. Female patients in the age group of 21–30 years were the maximum associated with the transfusion reactions than their male counterparts [Table 3]. Packed red blood cells (PRBCs) were more commonly involved with the transfusion reactions with no incidence reported with platelet concentrate and whole blood [Table 4].
Table 1: The distribution of blood units to inpatients of our hospital during the study period

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Table 2: The distribution of different transfusion reactions during the study period

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Table 3: The distribution of age and gender in the transfusion reaction patients

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Table 4: The distribution of blood components in different types of acute reactions

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Allergic reactions

These were noted in 15 patients (male = 3, female = 12). PRBC was implicated in 14 cases, and fresh frozen plasma (FFP) was implicated in one case. Rash was the only presenting symptom in 9 cases, pruritus in 3 cases, and rash with pruritus in 3 cases.

Febrile nonhemolytic transfusion reaction

Ten patients developed FNHTR (male = 5, female = 5). Clinical signs and symptoms were fever (n = 10), chill (n = 5), rigors (n = 4), tachycardia (n = 2), hypotension (n = 1), and vomiting (n = 1). All cases were recorded during PRBC transfusion.

Hemolytic transfusion reaction (immune)

AB+ PRBC was transfused to an 84-year-old female with A+ blood group. It was a case of the patient misidentification at the bedside (the last part in the transfusion chain). The patient developed fever and the transfusion was immediately stopped. Appropriate measures were taken and the patient did not suffer from any serious consequences.

Transfusion-associated circulatory overload

Found in a 62-year-old female suffering from chronic anemia. She presented with shortness of breath with wheeze after PRBC transfusion. It was relieved on stopping of transfusion and administration of diuretics.

Unspecified

A 7-year-old male presented with tachycardia and hypotension after PRBC transfusion.


  Discussion Top


Incidence of allergic reactions varies in different studies (0.2%–3%).[2],[3],[4],[5] Higher incidence of allergic reaction (3%–4.8%) is reported in study with platelet transfusion in hematooncologic patients.[2],[6] In this study, it is 0.59/1000 recipient of PRBC and 0.24/1000 FFP transfusion.

With the concept of universal leukoreduction, there is a dramatic reduction in the risk for FNHTR. The most common quoted rate for FNHTR is 0.5%–1%[7] for the general populations of the patients with red cell transfusion. A comparative study on incidence of FNHTR in leukoreduced versus nonleukoreduced blood components showed that the incidence is 0.12% in nonleukoreduced and 0.08% in prestorage leukoreduced blood.[3] In our study, it is 0.42/1000 PRBC transfusion which is lower than the above quoted rate. This can be due to underreporting.

TACO observed in this study which was due to RBC transfusion. Our patient belonged to elderly group with preexisting hyperdynamic circulation (due to chronic anemia). Studies estimating the risks of hypervolemia due to transfusion reported 0.31–0.42/1000 recipients of transfusion.[2],[8],[9] In the present study, it is 0.04/1000 PRBC transfusion.

Hemolytic transfusion reaction

Overall risks for acute hemolytic reactions which were observed in different studies ranges from 0.02–0.07/1000 red cell.[10],[11],[12] Our study had 0.04/1000 red cell transfusion.

Incidence rates of transfusion reactions are reported by various hemovigilance systems. Puerto Rico medical services administration reported 0.2% of ATRs after labile blood product transfusion.[12] The hemovigilance network in France reported a rate of 0.25 incidents/100 blood components between 1994 and 1998.[13] According to 2001 report of a hemovigilance system of the Canadian province of Quebec, the incidence of ATR was 0.35% for labile blood components.[2] A university hospital in Switzerland documented a global incidence of 4.2 for 1000 blood products distributed.[14]

The incidence rate of ATR in our study is 0.09%. This rate is lower than the rates mentioned in other studies. There is a factor of underreporting in our center. Majority of the reaction are reported to our department only when the reaction occurred during transfusion. Those less obvious reactions occurring after transfusion but within 24 h could have been omitted. Low incidence rate of ATR has also been reported by Khalid et al. in 2010. They found 0.082% of ATR in their center in Pakistan.[15]

The study is not without any limitations. Dependence on the awareness of physicians and other healthcare workers to look for adverse effects may lead to underreporting of the cases in our setup.


  Conclusion Top


In this study, allergic reaction was the most common transfusion reaction followed by FNHTR. These are mild reactions with no serious consequences in the recipient. However, the serious transfusion reaction such as HTR was also noted which could have been fatal but fortunately detected and timely intervention done.

Haemovigilance Programme of India was launched on December 10, 2012. Our department has also enrolled in this program since July 2014. Since then, we have been submitting our reports. However, there is a need to sensitize all the health personnel involved in the transfusion chain for more thorough reporting. This will help in improving the safety of blood transfusion.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
AABB Technical Manual, Sheth S. Transfusional iron overload. In: Simon TL, Snyder EL, Solheim BG, Strauss RG, Petrides M, editors. Rossi's Principles of Transfusion Medicine. 4th ed. West Sussex: Blackwell Publishing Ltd.; 2009. p. 858-69.  Back to cited text no. 1
    
2.
Robillard P, Karl Itaj N. Incidence of adverse transfusion reactions in the Quebec Hemovigilance System. Vox Sang 2002;83:120.  Back to cited text no. 2
    
3.
Uhlmann EJ, Isgriggs E, Wallhermfechtel M, Goodnough LT. Prestorage universal WBC reduction of RBC units does not affect the incidence of transfusion reactions. Transfusion 2001;41:997-1000.  Back to cited text no. 3
[PUBMED]    
4.
Kleinman S, Chan P, Robillard P. Risks associated with transfusion of cellular blood components in Canada. Transfus Med Rev 2003;17:120-62.  Back to cited text no. 4
[PUBMED]    
5.
Tanz WS, King KE, Ness PM. Re-evaluation of transfusion reaction rates associated with leukocyte-reduced red blood cells. Transfusion 2011;41:7.  Back to cited text no. 5
    
6.
Heddle NM, Klama LN, Griffith L, Roberts R, Shukla G, Kelton JG, et al. Aprospective study to identify the risk factors associated with acute reactions to platelet and red cell transfusions. Transfusion 1993;33:794-7.  Back to cited text no. 6
    
7.
NHI Consensus conference. Perioperative red blood cell transfusion. JAMA 1988;260:2700-3.  Back to cited text no. 7
    
8.
Domen RE, Hoeltge GA. Allergic transfusion reactions: An evaluation of 273 consecutive reactions. Arch Pathol Lab Med 2003;127:316-20.  Back to cited text no. 8
[PUBMED]    
9.
Popovsky MA, Taswell RF. Circulatory overload: An undiagnosed consequence of transfusion. Vox Sang 2002;83:469.  Back to cited text no. 9
    
10.
Moore SB, Taswell HF, Pineda AA, Sonnenberg CL. Delayed hemolytic transfusion reactions. Evidence of the need for an improved pretransfusion compatibility test. Am J Clin Pathol 1980;74:94-7.  Back to cited text no. 10
[PUBMED]    
11.
Lichtiger B, Perry-Thornton E. Hemolytic transfusion reactions in oncology patients: Experience in a large cancer center. J Clin Oncol 1984;2:438-42.  Back to cited text no. 11
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12.
Climent-Peris C, Vélez-Rosario R. Immediate transfusion reactions.P R Health Sci J 2001;20:229-35.  Back to cited text no. 12
    
13.
Andreu G, Morel P, Forestier F, Debeir J, Rebibo D, Janvier G, et al. Hemovigilance network in France: Organization and analysis of immediate transfusion incident reports from 1994 to 1998. Transfusion 2002;42:1356-64.  Back to cited text no. 13
[PUBMED]    
14.
Michlig C, Vu DH, Wasserfallen JB, Spahn DR, Schneider P, Tissot JD, et al. Three years of haemovigilance in a general university hospital. Transfus Med 2003;13:63-72.  Back to cited text no. 14
    
15.
Khalid S, Usman M, Khurshid M. Acute transfusion reactions encountered in patients at a tertiary care center. J Pak Med Assoc 2010;60:832-6.  Back to cited text no. 15
[PUBMED]    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


This article has been cited by
1 Transfusion reactions: A retrospective analysis of the Iranian national haemovigilance system (INHS) data
Ahmad Mardani,Mohammad Reza Balali
Transfusion and Apheresis Science. 2020; : 102767
[Pubmed] | [DOI]



 

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