Transfusion‐associated adverse events and implementation of blood safety measures ‐ findings from the 2017 National Blood Collection and Utilization Survey

Abstract

BACKGROUND Serious transfusion‐associated adverse events are rare in the United States. To enhance blood safety, various measures have been developed. With use of data from the 2017 National Blood Collection and Utilization Survey (NBCUS), we describe the rate of transfusion‐associated adverse events and the implementation of specific blood safety measures. STUDY DESIGN AND METHODS Data from the 2017 NBCUS were used with comparison to already published estimates from 2015. Survey weighting and imputation were used to obtain national estimates of transfusion‐associated adverse events, and the number of units treated with pathogen reduction technology (PRT), screened for Babesia, and leukoreduced. RESULTS The rate of transfusion‐associated adverse events requiring any diagnostic or therapeutic interventions was stable (275 reactions per 100,000 transfusions in 2015 and 282 reactions per 100,000 transfusions in 2017). In 2017 among US blood collection centers, 16 of 141 (11.3%) reported screening units for Babesia and 28 of 144 (19.4%) reported PRT implementation; 138 of 2279 (6.1%) hospitals reported transfusing PRT‐treated platelets. In 2017, 134 of 2336 (5.7%) hospitals reported performing secondary bacterial testing of platelets (50,922 culture‐based and 63,220 rapid immunoassay tests); in 2015, 71 of 1877 (3.8%) hospitals performed secondary testing (87,155 culture‐based and 21,779 rapid immunoassay tests). Nearly all whole blood/red blood cell units and platelet units were leukoreduced. CONCLUSIONS Besides leukoreduction, implementation of most blood safety measures reported in this study remains low. Nationally, hospitals might be shifting from culture‐based secondary bacterial testing to rapid immunoassays.

Supplemental findings of the 2017 National Blood Collection and Utilization Survey

“…This article supplements the findings reported by Jones et al 2 on collection, use, and cost of whole blood, red blood cells (RBCs), platelets (PLTs), and plasma, and by Savinkina et al 3 on topics related to implementation of safety measures in the blood industry, including transfusion-associated adverse reactions. The remaining results from the 2017 NBCUS are presented herein with comparison to the 2015 findings.…”

“…This increase in the proportion of PLT units transfused 4‐5 days after collection was not associated with the number of reported transfusion‐transmitted bacterial infections. Fewer transfusion‐transmitted bacterial infections were reported in the 2017 NBCUS compared to the 2015 NBCUS . Changes in the age of transfused PLT units might be associated with changes in testing for bacterial contamination of PLTs.…”

“…Fewer transfusion-transmitted bacterial infections were reported in the 2017 NBCUS compared to the 2015 NBCUS. 3 Changes in the age of transfused PLT units might be associated with changes in testing for bacterial contamination of PLTs. PLT units can be stored beyond 5 days if additional safety testing is performed 49 but, during 2017, only 2% of transfused apheresis PLTs were transfused 6-7 days after collection.…”

Evidence-Based Minireview: The use of premedications for platelet transfusions in pediatric patients

“…2,3 The most commonly occurring reactions are febrile nonhemolytic transfusion reactions (FNHTRs) and allergic reactions. 4 FNHTRs are identified by fever (>38°C and a change in temperature of >1°C) during or shortly following transfusion and can be associated with additional symptoms such as chills, headache, nausea, or vomiting. 5 Allergic reactions occur in 1% to 2% of platelet transfusions and are typically mild or moderate, with cutaneous symptoms of erythema, urticaria, and pruritus.…”

Hypothermic storage of leukoreduced red blood cells for greater than 21 days is a safe alternative to irradiation

“…TA-GVHD occurs when viable donor T lymphocytes are transfused into either an immunocompromised patient or where a close human leukocyte antigen (HLA) match exists allowing the T cells to proliferate and attack the recipient's cells. [1][2][3][4] In routine blood banking practice, prevention of some transfusion adverse events can be accomplished by reducing viable white blood cells (WBCs) from products destined for transfusion 5,6 ; however, this remains insufficient for preventing TA-GVHD. Canadian Blood Services (CBS), like many other blood suppliers, leukoreduce red blood cell (RBC) products during production.…”