Adverse transfusion reactions with neurological signs in transfused patients

OBJECTIVES

Many transfused patients present severe, sometimes critical, clinical conditions. The occurrence of adverse transfusion reactions may cause the clinical condition to deteriorate. A study was conducted aimed at establishing whether the presence of neurological signs during an adverse transfusion reaction increases its severity.

METHODS

From 1 January 2010 to 30 June 2019, adverse reactions with neurological signs were extracted from the French haemovigilance database system. Two signs observed at the time of the reaction were analysed: unconsciousness and convulsions. Stroke was excluded. The type of reaction, its severity, the blood product involved and its imputability were all studied.

RESULTS

During the study period, 10,670 reactions were reported, including 20 (0.19%) imputed to the transfusion with unconsciousness and/or convulsions. Unconsciousness without convulsions was frequently observed (14 reports, 70.0%). Convulsions were reported in 5 cases (25.0%), with 1 case being associated with unconsciousness. Unconsciousness and/or convulsions were present in 9 allergic reactions (45.0%) and 4 transfusion-associated circulatory overloads (20.0%). Nine reactions were severe (45.0%), 7 were life-threatening (35.0%) and 1 case resulted in the recipient's death (5.0%). A red blood cell and a platelet concentrate transfusion were involved in 8 reactions (40.0%) each, although the imputability of the blood product was certain in only 2 of the reactions.

CONCLUSION

Unconsciousness and/or convulsions were rarely observed in adverse reactions reported in transfused patients. Nevertheless, the presence of these signs highlights the severity of the adverse reactions (17 reactions, 85.0%).

Adverse transfusion reactions in transfused children

Transfusion in paediatrics requires specific guidelines, because child physiology and pathology differ significantly as compared to adults. Adverse transfusion reactions in transfused children also vary in type and frequency, but there is a better understanding of these reactions in adults than in children. However, for the most frequent adverse transfusion reactions, the overall prevalence is higher in children than in adults, with the exception of post-transfusion red blood cell alloimmunisation, which is lower, excluding patients with haemoglobinopathies. In several studies, allergic reactions were the most frequently reported adverse transfusion reaction in paediatrics, and the platelet concentrate the most frequently implicated blood product. Early diagnosis of certain adverse transfusion reactions such as haemosiderosis, is essential in order to initiate the best therapy and obtain a good clinical outcome. The prevention of adverse transfusion reactions in children is required, but needs further clinical studies in paediatrics. Lastly, changes in technology, policy and clinical practices will improve transfusion safety in children.

EFS Centre-Atlantique donor's biobank: Ten years of samples usage

INTRODUCTION

The French Establishment of Blood Centre Atlantique (EFSCA) is one of the French regional blood transfusion centers. Donor's biobank is a mandatory activity leading to the storage of biological samples taken from the blood donor. Samples of each blood donation are preserved for a 5-year period at Châteauroux in the form of two straws of 500microliters stored in liquid nitrogen. The aim of this study was to analyze the samples usage by studying quantitative, qualitative and economic criteria.

MATERIAL AND METHOD

We analyzed all the requests of stored blood samples from 2005 to 2014. They were coming either from the blood donor qualification laboratory (BDQL), in order to perform complementary tests, or from hemovigilance inquiry.

RESULTS

Among the blood donation samples, 2,144,636 (whole blood, plasma or platelets apheresis) were preserved during these ten years. During this period, 548 (0.025%) requests for samples were received; 78% were in relation with a request of the BDQL and 22% in relation with a request of hemovigilance. For the straws, the mean exit delay with regard to the blood donation date was 11.5 months (2-55). The cost of samples exit includes only working hours of a laboratory technician. On average, the annual working time dedicated to this activity was 23h. Also, the average price for one-year issuing activity was 620.31 euros.

CONCLUSION

In our study, the donor's biobank was little used. The part of hemovigilance was weak but essential for the blood safety.

[Adverse transfusion reactions in recipients with anti-vitamin K treatment]

PURPOSE OF THE STUDY

Vitamin K antagonist treated patients are exposed to a risk of haemorrhage in case of overdose leading to a need for transfusion. In order to determine the incidence of adverse transfusion reactions in these patients, the reports indicating a vitamin K antagonist treatment were analyzed.

PATIENTS AND METHODS

In the treated and transfused patient population, the diagnosis following the adverse transfusion reactions, the incidence, the degree of severity, the blood component involved and its imputability were evaluated.

RESULTS

From January 1st 2000 to December 31st 2014, 142 reports were notified in 141 patients. Haemorrhage was observed in 102 cases (71.8%). Overdose of anti-vitamin K was reported in 43 cases only (30.3%). The most frequent adverse transfusion reaction was the anti-erythrocyte alloimmunization (66 cases, 46.5%) followed by the febrile non-haemolytic reaction (37 cases, 26.1%). Most adverse reactions were non-severe (131 cases, 92.3%). The most involved blood component was the red blood cells concentrate (139 cases, 97.9%). The imputability of the blood product was certain in 39 cases only (27.5%).

CONCLUSION

In patients treated with vitamin K antagonists and transfused, the anti-erythrocyte alloimmunization was the most frequent adverse transfusion reaction. Overdose of the vitamin K antagonists was notified in approximately a third of cases.

[Association of red blood cell and platelet allo-antibodies in platelet alloimmunized patients]

PURPOSE OF THE STUDY

Use of matched red blood cell (RBC) concentrates is imperative in patients with RBC allo-antibodies (Abs) and when platelet (PLT) specific allo-Abs are present additional difficulties occur for PLT transfusions. In order to evaluate the prevalence of the PLT and RBC allo-Abs association, a study on patients with PLT specific allo-Acs was performed. This association is not a rare event.

PATIENTS AND METHODS

In the database of a PLT immunohaematology laboratory, patients with PLT specific allo-Abs were selected and the presence and specificity of RBC allo-Abs was evaluated.

RESULTS

Six hundred and eighty seven patients (673 females, 14 males) with PLT specific allo-Abs were found. Six hundred and seventy-five patients (98.3%) had PLT specific allo-Abs with only one specificity. Anti-HPA-5b was the most frequent (539 cases). Twenty-nine (4.2%) patients had also RBC allo-Abs, including 27 females (93.1%) and two males. Seventy (58.6%) had RBC allo-Abs with only one specificity, 10 several and two unknown. Among the first, RBC allo-Abs directed against Rhesus blood group antigens were predominant (11 cases [64.7%]). Among the 29 patients with associated PLT and RBC allo-Abs, 15 (51.7%) were 50 or more years old and 14 (48.3%) under 50.

CONCLUSION

In PLT specific alloimmunized patients, detection of RBC alloimmunization is not a rare event. When RBC and PLT transfusions are required, the supply of matched RBC and PLT concentrates is more difficult.