Practice Parameter for the Recognition, Management, and Prevention of Adverse Consequences of Blood Transfusion

Sazama, Kathleen; DeChristopher, Phillip J.; Dodd, Roger Y.; Harrison, Christopher; Shulman, Ira A.; Cooper, E. Shannon; Labotka, Richard; Oberman, Harold A.; Zahn, Christopher M.; Greenburg, A. Gerson; Stehling, Linda C.; Lauenstein, Karla J.; Price, Thomas H.; Williams, Lee K.

doi:10.5858/2000-124-0061-ppftrm

Cited by 20 publications

(4 citation statements)

References 30 publications

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“…Patients who are followed-up by emergency services and whose blood and products are transfused various rates of hospitalization, referral to a better-equipped hospital, and discharge. In some studies, 1.6% of patients who underwent blood and product transfusions in the emergency department were referred to another health institution, discharged, or died in the emergency department [29,30]. In our study, 204 patients (55.4%) were discharged, 134 (36.4%) were transferred to the service, 18 to the intensive care unit, and 10 (2.7%) underwent emergency surgery.…”

Section: Discussionmentioning

confidence: 57%

Comprehensive Evaluation of Blood Product Transfusions Administered in the Emergency Department

Seçkin¹,

Coşkun²,

Demirci³

et al. 2023

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Objective: It was aimed to evaluate the clinical and laboratory findings, the frequency and distribution of post-transfusion complications of patients who presented to the emergency department with a transfusion indication. Materials and Methods:In our study, patients aged 18 years and over who applied to the emergency medicine clinic between January 01, 2019 and March 31, 2019, who had blood and blood product transfusions, were retrospectively analyzed. The demographic and clinical characteristics of the patients, the reason for transfusion, the number of transfused blood products, the presence and type of complications were analyzed.Results: Three hundred and sixty-eight patients who received blood and blood product transfusions were included in the study. The mean age of the patients was 62.5±19.3 years (range 18-96 years), 193 (52.4%) were female and 175 (47.6%) were male. The most common causes of transfusion were symptomatic anemia in 110 patients (29.9%), oncological diseases in 71 patients (19.3%), gastrointestinal bleeding in 65 patients (17.7%), and chronic renal failure patients in 59 (16%) patients. No post-transfusion complication was observed in 358 (97.3%) patients for all blood products. Multiple erythrocyte suspension (ES) data revealed significant variation in hemoglobin and hematocrit levels among patients (p=0.001). Additionally, a significant difference was found in the international normalized ratio because of administering more than one unit of fresh frozen plasma (FFP) (p=0.002). Complications were observed in 2.9% of patients given ES and 1.9% of patients given FFP, whereas none of the patients given thrombocyte suspension developed. Conclusion:The appropriate use of blood and blood products in the emergency department plays a critical role in preventing patient morbidity and mortality. Performing the transfusion procedure in the correct indication is important in preventing the risk of infection in the emergency department.

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Section: Discussionmentioning

confidence: 57%

Comprehensive Evaluation of Blood Product Transfusions Administered in the Emergency Department

Seçkin¹,

Coşkun²,

Demirci³

et al. 2023

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“…While pRBC and platelets can help acutely bleeding and surgical patients with tissue perfusion and coagulation, respectively, there are risks associated with transfusions including acute hemolysis, anaphylaxis, TRALI, TACO, sepsis, febrile non-hemolytic reaction, and allergic transfusion reaction. 23 When predicting bleeding risk, clinicians should consider factor levels, the site and type of surgery, previous bleeding episodes, and combined hemostatic defects. Unfortunately, there are no standardized scores or algorithms to guide physicians.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with factor VII or factor XI deficiency, transfusion of pRBC and platelets should be guided by normal transfusion goals. While pRBC and platelets can help acutely bleeding and surgical patients with tissue perfusion and coagulation, respectively, there are risks associated with transfusions including acute hemolysis, anaphylaxis, TRALI, TACO, sepsis, febrile non‐hemolytic reaction, and allergic transfusion reaction 23 …”

Section: Discussionmentioning

confidence: 99%

Case of concurrent factor VII and factor XI deficiencies manifesting as spontaneous lower extremity compartment syndrome

Marshalek

Yashar

Huynh

et al. 2022

Clinical Case Reports

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“…AHTR is characterized clinically by fever, chills, hypotension, back pain, and disseminated intravascular hemolysis (DIC). Laboratory findings most commonly include hemoglobinemia, hemoglobinuria, a positive direct antiglobulin test (which may be negative if all offending cells have hemolyzed), findings of coagulopathy (prolonged Prothrombin Time (PT), prolonged activated Partial Thromboplastin Time (aPTT), low fibrinogen, thrombocytopenia), elevated creatinine, decreased haptoglobin and increased bilirubin 6 . However, provided the body can compensate, the hemolysis generally clears and thus is a self‐limiting event once the offending RBCs are destroyed.…”

Section: Introductionmentioning

confidence: 99%

A case of mistaken MELD (model for end stage liver disease) score—How an acute hemolytic transfusion reaction falsely altered a patient's transplant status

et al. 2023

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Background An acute hemolytic transfusion reaction (AHTR) caused by intravascular hemolysis features a decrease in hemoglobin/hematocrit, reduced haptoglobin, and increases in creatinine, and bilirubin. Acute intravascular hemolysis carries its own morbidity and mortality, especially in the setting of a patient liver disease related pre‐existing alterations in hemostasis. Additionally, AHTR significantly impacts the laboratory values used in calculating the Model for End Stage Liver Disease (MELD) score and thus liver transplant status. Case Report Herein, we present a case of a patient with hepatorenal syndrome due to ESLD on the transplant list who developed an AHTR due to an evolving anti‐Jka that initially presented as non‐specific reactivity in solid phase adherence testing. This evolving antibody caused intravascular hemolysis and a significant increase in bilirubin from 4.7 to 17.1 mg/dl, thus, raising the MELD score, increasing the predicted short‐term mortality risk, and affecting the patient's transplant status. Results Acute hemolysis caused significant elevation of bilirubin raising the MELD score which increased both the predicted mortality to 70 percent and the perceived urgency of transplant. The MELD score improved after resolution of the AHTR and clearing of the offending Jka‐positive RBCs. Conclusion This case highlights the effect of AHTR on parameters used in the determination of MELD score which significantly increases the perceived short‐term mortality and urgency of liver transplant. Therefore, any nonspecific reactivity in initial workup could be due to developing antibodies, and put the patient at higher risk for an acute hemolytic transfusion reaction.

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Practice Parameter for the Recognition, Management, and Prevention of Adverse Consequences of Blood Transfusion

Abstract: No Abstract Available

Cited by 20 publications

References 30 publications

Comprehensive Evaluation of Blood Product Transfusions Administered in the Emergency Department

Comprehensive Evaluation of Blood Product Transfusions Administered in the Emergency Department

Case of concurrent factor VII and factor XI deficiencies manifesting as spontaneous lower extremity compartment syndrome

A case of mistaken MELD (model for end stage liver disease) score—How an acute hemolytic transfusion reaction falsely altered a patient's transplant status

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