Incidence of transfusion reactions: a multicenter study utilizing systematic active surveillance and expert adjudication

Abstract

Background Prevalence estimates of serious hazards of transfusion vary widely. We hypothesized that the current reporting infrastructure in the United States fails to capture many transfusion reactions, and undertook a multi-center study utilizing active surveillance, data review, and adjudication to test this hypothesis. Study Design and Methods A retrospective record review was completed for a random sample of 17% of all inpatient transfusion episodes over 6 months at 4 academic tertiary care hospitals, with an episode defined as all blood products released to a patient in 6 hours. Data were recorded by trained clinical research nurses, and serious reactions were adjudicated by a panel of transfusion medicine experts. Results Of 4857 transfusion episodes investigated, 1.1% were associated with a serious reaction. Transfusion associated circulatory overload (TACO) was the most frequent serious reaction noted, being identified in 1% of transfusion episodes. Despite clinical notes describing a potential transfusion association in 59% of these cases, only 5.1% were reported to the transfusion service. Suspected transfusion related acute lung injury (TRALI/possible TRALI), anaphylactic, and hypotensive reactions were noted in 0.08%, 0.02%, and 0.02% of transfusion episodes. Minor reactions, including febrile non-hemolytic and allergic, were noted in 0.62% and 0.29% of transfusion episodes, with 30–50% reported to the transfusion service. Conclusion Underreporting of cardiopulmonary transfusion reactions is striking among academic, tertiary care hospitals. Complete and accurate reporting is essential to identify, define, establish pathogenesis, and mitigate/treat transfusion reactions. A better understanding of the failure to report may improve the accuracy of passive reporting systems.

The epidemiology of bacterial culture–positive and septic transfusion reactions at a large tertiary academic center: 2009 to 2016

“…Such was noted in our study: even serious clinical signs—such as hypotension—that have been reported to be associated with STRs, were encountered in only a minority of cases. This finding is consistent with previous studies, which reported that vital signs are of limited utility in the recognition (or exclusion) of transfusion reactions . Similarly, prophylactic antibiotic therapy could mask signs and symptoms of sepsis as well as impede growth in blood cultures that are undertaken as part of the investigation of STRs .…”

“…This finding is consistent with previous studies, which reported that vital signs are of limited utility in the recognition (or exclusion) of transfusion reactions. 18,21 Similarly, prophylactic antibiotic therapy could mask signs and symptoms of sepsis as well as impede growth in blood cultures that are undertaken as part of the investigation of STRs. 22 Collectively, the reported symptoms and signs were shown to be inconsistent predictors of STRs and failed to discriminate BCPTRs and STRs reliably from other reactions.…”

Prolonged platelet storage associated with increased frequency of transfusion‐related adverse events

“…Our present study has provided strong clinical evidence of storage-associated PLT AEs with careful statistical analysis of a large sample size. A recent study showed that the reporting rate of most transfusion reactions ranged from 5% to 30% except for allergic reactions which were 50% at four tertiary academic hospitals in the United States [30]. Another study showed a similar reporting rate of 24% of all transfusion reactions types [31], with the self-reported AE rate of PLT transfusion of 0Á4% (0Á5% overall), which is similar to the overall AE rate of PLT transfusion in our current study (0Á56%).…”

Cornerstones of patient blood management in surgery

“…In particular, severe cardiopulmonary complications, including transfusion‐related acute lung injury (TRALI) and transfusion‐associated circulatory overload (TACO), have been identified as the leading cause of transfusion‐associated death (Bolton‐Maggs et al, ). In a recent multicentre, retrospective analysis of almost 5000 transfusion episodes, 1·1% were associated with TACO and 0·08% with TRALI (Hendrickson et al, ). Other transfusion risks include anaphylaxis and hypotensive episodes and milder events, including febrile non‐haemolytic, minor allergic and delayed serological reactions.…”