Analysis of clinical presentations of allergic transfusion reactions and febrile non‐haemolytic transfusion reactions in paediatric patients

Abstract

Background and objectives Like adults, children can have allergic transfusion reactions (ATRs) and febrile non-haemolytic transfusion reactions (FNHTRs). But published information about the incidence of paediatric ATR and FNHTR is scarce.Materials and methods This retrospective study was conducted from April 2002 to June 2018 on children who had ATRs and/or FNHTRs to platelet (PLT), red blood cell (RBC) or washed PLT/RBC concentrate transfusions. We analysed ATR/ FNHTR clinical presentations, such as severity, time of occurrence and other features when they occurred.Results During the study, 2742 children received 23 444 bags of PLT and RBC concentrate (including washed products). ATRs occurred in 100 cases (3Á6% of total patients), caused by 201 products (0Á9% of total products). In contrast, 28 patients (1Á0% of total patients) had 42 FNHTRs caused by 42 products (0Á2% of total products). Upon analysis of cases with detailed clinical information, the median onset time for ATRs and FNHTRs was 2Á0 h after the start of transfusion. Of the 40% of ATRs that necessitated the discontinuation of blood transfusions, 10% escalated to anaphylaxis. Compared with minor ATRs, anaphylaxis tended to develop quickly. Moreover, 96% of patients with FNHTRs had a fever less than 39°C. There were no associations between blood product types and numbers or occurrence patterns of these reactions. ConclusionThe occurrence of ATRs and FNHTRs in children was variable, although there are common features such as severity and time of occurrence.

Preventing adverse reactions in pediatric transfusions using washed platelet concentrate

“…Although most of the ATRs were minor ATRs such that blood transfusions could be completed, 40% of the transfusions were discontinued. 27 Although this study did not include fatal cases, about 10% of ATRs involved anaphylaxis symptoms. Because this study is a retrospective analysis, it is possible that resumption of blood transfusions may not have been attempted in all cases.…”

“…In pediatric cases, the same patient may suffer FNHTR many times, and most patients who had FNHTRs also had hematological disease and/or malignant disease. 27 Addas-Carvalho et al investigated FNHTR and cytokine gene polymorphism and reported a relationship with IL1RN*2Á2. 77 This allele and genotype have been related to higher serum levels of IL-1b.…”

“…By contrast, in FNHTR, about 96% had a fever of less than 39°C. 27 It has been reported that there is a certain percentage of FNHTR cases that involve high temperature in adults. 80 Although the incidence of fever in pediatric FNHTR is not yet fully understood, in pediatric hematology and oncology practices, FNHTR require differential diagnosis from infectious diseases such as febrile neutropenia or neoplastic fever.…”

“…81,82 In one study, severity of ATR and FNHTR did not change depending on the occurrence time of ATR or FNHTR, and there was no difference in severity depending on the causative blood products. 27 It may not therefore be easy to predict the severity of ATR and FNHTR based only the clinical situation in which actual blood transfusions are performed.…”

“…[1][2][3][4][5][6]13 Generally, TARs are likely caused by platelet (PLT) products that are particularly prone to cause mild ATR. 5,6,15,27 Nevertheless, it can be seen that the details and frequency of pediatric TARs differ greatly depending on the report. There are several possible reasons for this.…”