Frequency and Nature of Transfusion Related Adverse Reactions in Patients Admitted in A Tertiary Care Hospital

Background:Transfusion of blood and blood products if employed safely, with intensive care can save manyvaluable lives. But a number of transfusion reactions may develop that are sometimesmore serious and life threatening.So this study was done to find out the most frequent and life threatening reactions that develop during transfusion. Methods: A Cross sectional descriptive observational study was performed at a tertiary care centre. Patients of 18 years and older irrespective of sexes who received blood and blood products due to different reasons between April 2020 to September 2020 were included in this study. A total of 96 patients were included in the study. Results:In thisstudy 11(11.5%) out of 96 patients had transfusion reactions of different types .Febrile non haemolytic reaction was the highest with 8 patients (8.33%),followed by Allergic reaction in 2 patients(2.08%) and Acute haemolytic transfusion reaction in 1 patient (1.04%).Among them 7(63.6%) reactions occurred with whole blood , 2(18.2%) reactions occurred with red cell concentrate and 1 reaction occurred with Apheresis platelet (9.1%) and fresh frozen plasma(9.1%).Statistically significant association was found between duration of storage of blood and transfusion reaction. Conclusion: Febrile non haemolytic reaction was the commonest type of transfusion reaction found in this study and there was also statistically significant association between duration of storage of blood and transfusion reaction. Bangladesh J Medicine July 2022; 33(1) : 27-33

Is the whole greater than the sum of its parts? The implementation and outcomes of a whole blood program in Ecuador

BackgroundHemorrhagic shock is a major cause of mortality in low-income and middle-income countries (LMICs). Many institutions in LMICs lack the resources to adequately prescribe balanced resuscitation. This study aims to describe the implementation of a whole blood (WB) program in Latin America and to discuss the outcomes of the patients who received WB.MethodsWe conducted a retrospective review of patients resuscitated with WB from 2013 to 2019. Five units of O+ WB were made available on a consistent basis for patients presenting in hemorrhagic shock. Variables collected included gender, age, service treating the patient, units of WB administered, units of components administered, admission vital signs, admission hemoglobin, shock index, Revised Trauma Score in trauma patients, intraoperative crystalloid (lactated Ringer’s or normal saline) and colloid (5% human albumin) administration, symptoms of transfusion reaction, length of stay, and in-hospital mortality.ResultsThe sample includes a total of 101 patients, 57 of which were trauma and acute care surgery patients and 44 of which were obstetrics and gynecology patients. No patients developed symptoms consistent with a transfusion reaction. The average shock index was 1.16 (±0.55). On average, patients received 1.66 (±0.80) units of WB. Overall mortality was 13.86% (14 of 101) in the first 24 hours and 5.94% (6 of 101) after 24 hours.DiscussionImplementing a WB protocol is achievable in LMICs. WB allows for more efficient delivery of hemostatic resuscitation and is ideal for resource-restrained settings. To our knowledge, this is the first description of a WB program implemented in a civilian hospital in Latin America.Level of evidenceLevel IV.

Patient ABO blood type is a major predictor of a positive DAT following a transfusion reaction

Background: A direct antiglobulin test (DAT) checks for antibody or complement on the surface of RBCs and is often done following a transfusion reaction. While passive anti-A and anti-B antibodies are known to cause positive DATs, the extent this occurs following transfusion is unknown. Study Design and methods: DAT results, ABO type and blood product information was recorded on 1097 transfusion reactions at a large academic hospital over 8 years. The effect of patient blood type, product type and plasma compatibility of blood product transfused on DAT results were determined. Statistical significance was determined using Chi-squared testing. Results: Plasma compatibility of the product was a strong predictor of a positive DAT with plasma compatible transfusions having a 9.4% positive rate while plasma incompatible transfusions were positive 44% of the time (P<0.0001). Patient ABO blood type was a strong predictor of a positive DAT with Type O patients having 6.6% positive rate and non-O patients having a positive rate of 20.6% (P <0.0001). These results were significant for individual blood types as well. Type A, B or AB patients had higher DAT positive rates even when plasma incompatible transfusions were excluded from the analysis (P<0.0001). Platelets were significantly more likely to be associated with a positive DAT when compared to RBC transfusions. Conclusions: These results show plasma compatibility and ABO types are strong predictors of positive DAT results following a transfusion reaction. Anti-A and anti-B antibodies are estimated to account for about 50% of positive DATs in this study.

A case study of a patient with anti-Yta alloantibodies against the high-prevalence antigen of red blood cells qualified for heart transplantation

The Yta antigen from the Cartwright blood group system is a high-prevalence antigen found in 99.8% of the population. The literature data shows that antibodies anti-Yta demonstrate the variable clinical significance and are rarely the cause of a hemolytic post-transfusion reaction. The study aims to present the difficulties related to the selection and sustainable supply of blood for transfusion for the patient of the Silesian Centre for Heart Diseases with anti-Yta alloantibodies, qualified for a heart transplant. If Yt(a-) blood is not available Institute of Hematology and Transfusion Medicine in Warsaw, referring to reports in the publications, allowed transfusion of the least incompatible red blood cells in indirect antiglobulin test. One hour after transfusion of leucocyte-depleted concentrate of red blood cells (RBCs), issued in accordance with the above recommendations by Regional Blood Donation Center in Katowice as the least incompatible, the patient was observed to experience symptoms of an adverse post-transfusion reaction. For subsequent transfusions, RBCs from Yt(a-) donors were selected, of which only eight were registered in Poland at that time. Medical decisions on RBCs transfusion in patients for whom no compatible blood can be selected is very difficult, and the benefits of incompatible transfusion should be weighed against the risk of possible complications. To avoid this, it should be remembered that the early identification of antibodies increases the chance of finding serologically compatible blood and in many cases allows to supply blood for a patient with autologous donations.