Passive reporting greatly underestimates the rate of transfusion‐associated circulatory overload after platelet transfusion

Raval, Jay S.; Mazepa, Marshall A.; Russell, Sara; Immel, Caroline C.; Whinna, Herbert C.; Park, Y. A.

doi:10.1111/vox.12234

Cited by 53 publications

(42 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This study, which retrospectively surveyed 4857 transfusion episodes of adult inpatients aged >18 years over a 6‐month period at four academic tertiary care hospitals in the United States, found that serious cardiopulmonary transfusion reactions occurred in approximately 1% of all transfusion episodes. TACO was the most common reaction noted in this study, consistent with the relatively high incidence rates reported by active surveillance studies . The incidence of other serious transfusion reactions was difficult to accurately estimate due to their low levels of apparent occurrence, which was not unexpected given our moderate sample size.…”

Section: Discussionsupporting

confidence: 73%

“…Although 27 of 43 (63%) adjudicated TACO or TRALI/possible TRALI cases had documentation in clinical notes suggesting the possibility that a transfusion was associated with cardiopulmonary symptoms, only three reactions (two TACO, one TRALI/possible TRALI) were reported to the transfusion medicine service/hospital blood bank. Under‐reporting of transfusion reactions has been described in prior studies, and one study found that only 14% of TRALI/possible TRALI cases and 11% of TACO cases were reported to the transfusion service . A better understanding of why cardiopulmonary transfusion reactions are less likely to be reported to the transfusion service than febrile or allergic reactions is an important step in improving such reporting.…”

Section: Discussionmentioning

confidence: 99%

“…A national recipient hemovigilance system that relies on passive reporting was initiated in the United States in 2010, and similar reporting systems have been in place in other countries for many years. Active reporting systems uniformly report higher rates of transfusion reactions than passive systems, both in the United States and abroad . This trend exists not only for cardiopulmonary complications but also for other noninfectious transfusion reactions.…”

Section: Introductionmentioning

confidence: 96%

See 2 more Smart Citations

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

et al. 2016

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

See 1 more Smart Citation

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

et al. 2016

View full text Add to dashboard Cite

show abstract

“…A recent report on transfusion-associated circulatory overload showed considerable underreporting, with a 36-fold difference in detection between active and passive surveillance: 1:5997 cases reported by passive surveillance vs 1:167 by active surveillance. 21 Furthermore, there is considerable variation in the reported incidence of transfusion reactions to platelets, with recent reports ranging from 0.01% to 10.0%, with considerable variation in reaction severity definitions and surveillance methods likely accounting for this wide range. [22][23][24] Platelet components are particularly vulnerable to bacterial contamination, mainly due to their storage at room temperature, which allows growth of small inocula to very high titers and limits the shelflife of these products.…”

Section: Discussionmentioning

confidence: 99%

Detection of septic transfusion reactions to platelet transfusions by active and passive surveillance

Hong

Xiao

Lazarus

et al. 2016

Blood

174

230

View full text Add to dashboard Cite

• Bacterial sepsis from contaminated platelet transfusions continues to occur despite recent interventions; additional measures are needed.• STR to platelet transfusion is frequently not recognized or reported; use of recent AABB criteria showed highest diagnostic sensitivity.Septic transfusion reactions (STRs) resulting from transfusion of bacterially contaminated platelets are a major hazard of platelet transfusion despite recent interventions. Active and passive surveillance for bacterially contaminated platelets was performed over 7 years (2007)(2008)(2009)(2010)(2011)(2012)(2013) by culture of platelet aliquots at time of transfusion and review of reported transfusion reactions. All platelet units had been cultured 24 hours after collection and released as negative. Five sets of STR criteria were evaluated, including recent AABB criteria; sensitivity and specificity of these criteria, as well as detection by active and passive surveillance, were determined. Twenty of 51 440 platelet units transfused (0.004%; 389 per million) were bacterially contaminated by active surveillance and resulted in 5 STRs occurring 9 to 24 hours posttransfusion; none of these STRs had been reported by passive surveillance. STR occurred only in neutropenic patients transfused with high bacterial loads. A total of 284 transfusion reactions (0.55%) were reported by passive surveillance. None of these patients had received contaminated platelets. However, 6 to 93 (2.1%-32.7%) of these 284 reactions met 1 or more STR criteria, and sensitivity of STR criteria varied from 5.1% to 45.5%. These results document the continued occurrence of bacterial contamination of platelets resulting in STR in neutropenic patients, failure of passive surveillance to detect STR, and lack of specificity of STR criteria. These findings highlight the limitations of reported national STR data based on passive surveillance and the need to implement further measures to address this problem such as secondary testing or use of pathogen reduction technologies. (Blood. 2016;127(4):496-502)

show abstract

“…While national haemovigilance systems are valuable and contribute to our understanding of transfusion reactions, a significant limitation is that reactions are captured by a passive reporting system, thereby underestimating true incidence . Active surveillance for severe transfusion reactions may offer a more accurate assessment of the incidence and characterization of severe transfusion‐related acute adverse events and provide insight on how to refine haemovigilance criteria to be more sensitive and specific .…”

Section: Introductionmentioning

confidence: 99%

Incidence and clinical characteristics of transfusion‐associated circulatory overload using an active surveillance algorithm

et al. 2016

View full text Add to dashboard Cite

Background The concordance of hemovigilance criteria developed for surveillance of transfusion-associated circulatory overload (TACO) with its clinical diagnosis has not been assessed. In a pilot study to evaluate an electronic screening algorithm, we sought to examine TACO incidence and application of hemovigilance criteria in patients with post-transfusion pulmonary edema. Study Design and Methods From June to September 2014, all transfused adult inpatients at four academic hospitals were screened with an algorithm identifying chest radiographs ordered within 12 hours of blood component release. Patients with post-transfusion pulmonary edema underwent case adjudication by an expert panel. TACO incidence was calculated and clinical characteristics were compared with other causes of post-transfusion pulmonary edema. Results Among 4,932 transfused patients, there were 3,412 algorithm alerts, 50 cases of TACO and 47 other causes of pulmonary edema. TACO incidence was 1 case per 100 patients transfused. TACO classification based on two sets of hemovigilance criteria (National Healthcare Safety Network and proposed revised International Society for Blood Transfusion) was concordant with expert panel diagnosis in 57% and 54% of reviewed cases, respectively. Although, the majority of clinical parameters did not differentiate expert-panel adjudicated TACO from other cases, improved oxygenation within 24 hours of transfusion did (p=.01). Conclusions The incidence of TACO was similar to that observed in prior studies utilizing active surveillance. Case classification by hemovigilance criteria was frequently discordant with clinical diagnoses of TACO in patients with post-transfusion pulmonary edema. Improvements in oxygenation within 24 hours of transfusion merit further evaluation in the diagnosis of TACO.

show abstract

Passive reporting greatly underestimates the rate of transfusion‐associated circulatory overload after platelet transfusion

Abstract: Platelet-associated TACO is greatly underestimated by passive reporting in the adult patient population.

Cited by 53 publications

References 13 publications

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

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

Detection of septic transfusion reactions to platelet transfusions by active and passive surveillance

Incidence and clinical characteristics of transfusion‐associated circulatory overload using an active surveillance algorithm

Contact Info

Product

Resources

About