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Townsend M, Maryuningsih Soedarmono YS, Narayan S, Ashford P, Wood EM, Whitaker BI. Haemovigilance resources available for everyone: A report from the International Haemovigilance Tools Collaborative Project. Vox Sang 2024; 119:277-281. [PMID: 38126141 DOI: 10.1111/vox.13570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND AND OBJECTIVES Haemovigilance systems are intended to collect and analyse data, and report findings relating to transfusion complications, such as blood product safety, procedural incidents, and adverse reactions in donors and patients. A common problem among developing haemovigilance programs is the lack of resources and tools available to countries striving to establish or enhance their haemovigilance system. MATERIALS AND METHODS World Health Organization, in collaboration with International Society for Blood Transfusion (ISBT), International Haemovigilance Network and other haemovigilance experts embarked on a Haemovigilance Tools Project to collect and provide materials and resources to assist with the stepwise implementation of haemovigilance. RESULTS AND CONCLUSIONS Resources are housed as a virtual compendium on the ISBT website under the Haemovigilance Working Party. These are managed by a subcommittee of the Working Party and are freely available and downloadable to all without requiring ISBT membership.
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Affiliation(s)
| | | | - Shruthi Narayan
- NHS Blood and Transplant, Bristol, UK
- Manchester Blood Centre, Plymouth Grove, Manchester, UK
| | | | - Erica M Wood
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Haematology, Monash Health, Clayton, Victoria, Australia
| | - Barbee I Whitaker
- Division of Analytics and Benefit Risk Assessment, Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, Silver Spring, Maryland, USA
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Scuracchio P, Achkar R, Dias L, Oliveira M, Casella I, Presti C, Fachini R, Wendel S. A rare vascular injury in a blood donor after whole blood donation. Transfusion 2024; 64:546-549. [PMID: 38230511 DOI: 10.1111/trf.17725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/10/2023] [Accepted: 12/14/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Blood donation is a safe process though reactions may still occur. We describe a rare vascular complication in a frequent donor, with improvements in the collection process aimed at avoiding future events. METHODS A 63-year-old woman presented with local pain and an apparent collection in the left arm 8 days after donation. Duplex ultrasound identified a superficial liquid collection and signs of arteriovenous fistula (AVF) between the cubital vein and an arterial branch. A computed tomography (CT)-angio performed 1 day after ultrasound did not identify signs of AVF, followed by a new duplex which confirmed CT-angio findings. It was assumed that a traumatic AVF evolved with spontaneous thrombosis. In the early follow-up (18 days), a progressive regression of hematoma was observed without any sequelae. RESULTS Investigation showed a faster whole blood bag collection time (3 min; normal: 5-9 min), and the processed packed red blood cell had a brighter red color than usual. The donor reported local bleeding after needle withdrawal, not observed in previous donations and a bruise forming on the same day. No arterial puncture (AP) was noticed by the collection staff during the procedure. The staff was retrained and actions were taken focusing on more active surveillance of late reactions, highlighting the importance of post-donation information by the donors, regardless of any adverse reaction observed, to detect late complications. CONCLUSION We described an uncommon AP in a donor that was not identified, leading to an AVF that spontaneously thrombosed.
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Affiliation(s)
| | - Ruth Achkar
- Hospital Sírio-Libanês Blood Bank, São Paulo, Brazil
| | - Lara Dias
- Hospital Sírio-Libanês Blood Bank, São Paulo, Brazil
| | | | - Ivan Casella
- Universidade de São Paulo-Hospital das Clínicas, São Paulo, Brazil
| | - Calogero Presti
- Universidade de São Paulo-Hospital das Clínicas, São Paulo, Brazil
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3
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Espinosa A, Steinsvåg CT, Flesland Ø. Haemolytic transfusion reactions caused by non-ABO red cell antibodies reported to the Norwegian Haemovigilance System 2004-2020. Vox Sang 2024. [PMID: 38373854 DOI: 10.1111/vox.13605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/20/2023] [Accepted: 01/31/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to analyse the reports received in the Norwegian Haemovigilance System from 2004 to 2020 on acute and delayed haemolytic transfusion reactions caused by non-ABO red cell antibodies. MATERIALS AND METHODS Antibody specificity, clinical symptoms and outcomes were included when available. RESULTS After transfusion of 3.7 million red cell concentrates, reports on 78 cases of haemolytic transfusion reactions caused by non-ABO red cell antibodies were received, corresponding to an incidence of 1 in 47,000 transfused red cell concentrates. There were 30 acute and 48 delayed haemolytic transfusion reactions. A total of 113 red cell antibodies were found: 82 alloantibodies, 6 autoantibodies and 25 cases where the antibody specificity could not be determined. Two fatalities occurred: one caused by anti-Wra and one caused by an unidentified red cell antibody. The most frequently reported antibody specificities were those in the Rh and Kidd blood group systems, representing 24% and 14%, respectively, of all the antibodies identified. In six cases, errors occurred, leading to the issuing of blood units without the required phenotype match. CONCLUSIONS Despite the possible underreporting, the low number of serious haemolytic transfusion reactions reflects an adequate pre-transfusion practice by the Norwegian blood banks.
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Badami KG, McKellar M. Reactions to serum eye drops-New Zealand experience and review of the literature. Transfus Med 2024; 34:61-65. [PMID: 37947132 DOI: 10.1111/tme.13017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/09/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Serum eye drops (SED) are used to treat ocular surface disease. Reactions to SED are poorly documented. METHODS We present our experience of self-reported reactions in New Zealand to SED (25%; autologous, allogeneic, or both) between 2003 and 2023, and a focused review of the literature. RESULTS In total, 1067 patients received SED treatment (562 autologous, 318 allogeneic, and 187 both). Three (0.5% of those treated with allogeneic SED) reported reactions. All appeared to be allergic. All were associated with allogeneic SED. We have information on two patients: one had an eye reaction; in the other, the gastrointestinal tract was involved. The literature contains few reports of reactions to SED. They have involved both autologous and allogeneic SED, and various SED concentrations. None appears to have been severe. Notably, no eye or systemic infections have been reported. CONCLUSIONS Information on the types and frequencies of reactions to SED is poor. This may be due to: serum being less likely to cause reactions; eyes being resistant to reactions; reactions being rare, and insufficient use of SED having occurred; under-reporting related to SED use at home and reactions being mild. More robust monitoring for reactions to SED is needed.
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Laperche S, Sauvage C, Gallian P, Jbilou S, Pouchol E, Py JY, Chabli L, Richard P, Morel P, Lot F, Tiberghien P. Human immunodeficiency virus, hepatitis C virus and hepatitis B virus incidence in blood donors from 2000 to 2020 in France: Trends and lessons from haemovigilance surveillance. Vox Sang 2023; 118:843-853. [PMID: 37694766 DOI: 10.1111/vox.13514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/03/2023] [Accepted: 08/06/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Data from 21 years (2000-2020) of haemovigilance were used to assess human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) incidence rates in repeat blood donors and the occurrence of transfusion-transmitted (TT) viral infections. MATERIALS AND METHODS Blood donors who converted for HIV, HCV or HBV markers within serial three-year analysis periods were included. Epidemiological and virological data were retrieved from the national epidemiological donor database and were supplemented with information on blood components and the infection status of recipients of the previous negative donation (D.N-1) of donors who seroconverted. RESULTS Incidence rates declined from 1.27 to 0.35/100,000 person-years for HIV, from 0.59 to 0.19 for HCV and from 1.66 to 0.18 for HBV. Risk factors and lookback for 232 HIV, 90 HCV and 74 HBV seroconversions were investigated. The main risk factor identified at post-donation interview was having sex with men (47.8% of males) for HIV and a sexual risk for HCV (30.6%) and HBV (37.1%). The viral loads and sequences were retrospectively tested in 191 HIV, 74 HCV and 62 HBV D.N-1 archived samples. Six (five HBV and one HIV-1) were positive all low viral loads. Two recipients were infected by red blood cells from two HBV seroconverting donors before the introduction of HBV-nucleic acid testing. CONCLUSION HIV, HCV and HBV incidence rates in blood donors declined over the two past decades in France. There is a very small risk of a blood component that tests negative entering the blood supply resulting in TT infections, especially after introduction of molecular assays in donor screening.
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Affiliation(s)
- Syria Laperche
- Etablissement Français du Sang, La Plaine Saint-Denis, France
- National Reference Centre for infectious risks in transfusion, Institut National de la Transfusion Sanguine, Paris, France
| | | | - Pierre Gallian
- Etablissement Français du Sang, La Plaine Saint-Denis, France
| | - Saadia Jbilou
- Etablissement Français du Sang, La Plaine Saint-Denis, France
| | - Elodie Pouchol
- Etablissement Français du Sang, La Plaine Saint-Denis, France
| | - Jean Yves Py
- Etablissement Français du Sang, La Plaine Saint-Denis, France
| | - Lila Chabli
- Etablissement Français du Sang, La Plaine Saint-Denis, France
| | - Pascale Richard
- Etablissement Français du Sang, La Plaine Saint-Denis, France
| | - Pascal Morel
- Etablissement Français du Sang, La Plaine Saint-Denis, France
- UMR RIGHT 1098, Université de Franche-Comté INSERM, Etablissement Français du Sang, Besançon, France
| | | | - Pierre Tiberghien
- Etablissement Français du Sang, La Plaine Saint-Denis, France
- UMR RIGHT 1098, Université de Franche-Comté INSERM, Etablissement Français du Sang, Besançon, France
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Latour C, Gaussen A, Beaudoin J, Leiva-Torres GA, Rochette S, Robitaille N. Incidence of acute haemolytic transfusion reaction among ABO-incompatible recipients transfused with A 3 blood: A case series. Vox Sang 2023; 118:854-862. [PMID: 37589206 DOI: 10.1111/vox.13503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND AND OBJECTIVES ABO antigens are among the most immunogenic, but the haemolytic risks of ABO incompatibilities involving a donor with a weak ABO phenotype are little documented. MATERIALS AND METHODS This retrospective case series assessed the incidence of acute haemolytic transfusion reaction (AHTR) among ABO-incompatible recipients of A3 blood in Québec (Canada). Transfusion safety officers reported laboratory AHTR indicators measured ≤24 h pre- and post-transfusion. Because the AHTR case definition of Québec's Hemovigilance System (QHS) leaves significant room for clinical judgement, a two-step approach was used to assess potential cases: Step 1 consisted in a highly sensitive-but unspecific-initial screen that identified all candidate cases per QHS case definition, and Step 2 consisted in a detailed review of candidate cases by two haematologists. RESULTS Nine donors initially typed as Group B (N = 1) or O (N = 8) were subsequently found to display an A3 B or A3 O phenotype. Eighty-one recipients received ABO-incompatible blood, including 53 (65.4%) with interpretable data. Of these, 29 (54.7%) were classified as candidate cases after Step 1. Following Step 2, no conclusive evidence of AHTR was found: Abnormal pre- versus post-transfusion changes appeared modest, within normal range, insufficient to ascertain AHTR, or were consistent with a pre-existing condition unrelated to AHTR. Two candidate cases had a QHS-reported transfusion reaction; both were unrelated to AHTR. CONCLUSION In this case series, no conclusive evidence of serious AHTR was found among ABO-incompatible recipients who were inadvertently transfused with A3 blood.
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Affiliation(s)
| | - Amaury Gaussen
- Medical Affairs and Innovation, Héma-Québec, Québec City, Quebec, Canada
| | - Julie Beaudoin
- Quality Control and Development, Héma-Québec, Montréal, Quebec, Canada
| | | | - Samuel Rochette
- Medical Affairs and Innovation, Héma-Québec, Montréal, Quebec, Canada
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Batarfi K, Liu Y, Nixon J, Webert KE, John MS, Karunakaran M, Alhomsi N, Park JJ, Heddle NM. A retrospective analysis of haemolytic reactions to intravenous immunoglobulin using data from the Transfusion-Transmitted Injuries Surveillance System (Ontario). Vox Sang 2023; 118:753-762. [PMID: 37592865 DOI: 10.1111/vox.13501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/08/2023] [Accepted: 07/10/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Haemolysis can occur following intravenous immunoglobulin (IVIG) infusion. Haemovigilance data were analysed using a novel approach for including two control groups with no haemolysis to IVIG. Objectives included a summary of all reactions to IVIG, rate estimates and analysis of haemolytic reactions including risk factors. MATERIALS AND METHODS Canadian haemovigilance data from Ontario (2013-2021), IVIG distribution and transfusion data from the blood supplier, and data from a large local transfusion registry were used. An 'other-reactions' control group included patients with IVIG reactions that were not haemolytic, and registry patients with no-reaction were the 'no-reaction controls'. Descriptive analysis and two logistic regression models for the different control groups were performed. RESULTS One thousand one hundred and seventy reactions were included. Most common were febrile non haemolytic (26.1%), minor allergic (24.5%) and IVIG headache (15.3%) followed by haemolytic 10.9% (128/1170). Haemolytic reaction rates decreased over time: rates since 2020 estimated between 1.5 and 2.9/1000 kg IVIG used. The regression model for other-reaction controls identified two risk factors for haemolysis: non-O blood group recipients compared with group O recipients (p value = 0.0106) and IVIG dose per 10 g increase (OR 1.359; 95% CI 1.225-1.506). The model using no-reaction controls gave similar results and also showed no pre-medication was associated with a higher risk of haemolysis (OR 29.084; 95% CI 1.989-425.312). CONCLUSION The frequency of haemolytic reactions has decreased over time. We confirmed non-O blood group recipients and IVIG dose as risk factors for haemolysis and raise the hypothesis that no pre-medication may increase the risk of haemolysis.
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Affiliation(s)
- Khalid Batarfi
- Transfusion Medicine Services, Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Yang Liu
- Michael DeGroote Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Joanne Nixon
- Michael DeGroote Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kathryn E Webert
- Michael DeGroote Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- Canadian Blood Services, Ottawa, Ontario, Canada
| | - Melanie St John
- Michael DeGroote Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Meera Karunakaran
- Michael DeGroote Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nour Alhomsi
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jane J Park
- Michael DeGroote Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nancy M Heddle
- Michael DeGroote Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Canadian Blood Services, Ottawa, Ontario, Canada
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Bisht A, Arora S, Patidar G, Marwaha N. Knowledge assessment of a donor adverse reaction severity grading tool by the National Blood Donor Vigilance Programme of India. Vox Sang 2023; 118:721-729. [PMID: 37533234 DOI: 10.1111/vox.13502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/17/2023] [Accepted: 07/11/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND AND OBJECTIVES The severity grading tool (SGT) was recently designed by the Association for Advancement of Blood and Biotherapies (AABB) to have more objectivity in severity assignment for an adverse donor reaction after blood donation. A study was performed in India to assess the knowledge (post-training) and determine the degree of agreement of the SGT between participating centres and the subject expert group. MATERIALS AND METHODS This prospective cross-sectional survey-based study was conducted by the National Coordinating Centre (NCC) of the National Blood Donor Vigilance Programme (NBDVP) of India. Thirty-five real-world case scenarios, validated by seven national and two international experts, were sent to the participating centres, and their responses received (diagnosis and severity grade) were compared and analysed. RESULTS A total of 50 blood centres participated in the study. The overall agreement between the participating centres and the expert group was 66.4%, with a fair Kendall's coefficient of concordance (W) of 0.271 (p-value < 0.05). The degree of agreement was observed to be more than 80% for 12 centres, 60%-80% for 27 centres and <60% for 11 centres. The overall degree/percentage of agreement for cases with single and multiple types of donor adverse reaction was 71.3% and 42.6%, respectively. CONCLUSION The SGT will be an efficient mode to have uniform objective reporting of the adverse donor reactions and may be implemented in the NBDVP of India. This study also highlights the need for training of the blood centres on the basic definitions and categorization of the donor's adverse reaction.
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Affiliation(s)
- Akanksha Bisht
- Haemovigilance Programme of India (HvPI), National Institute of Biologicals, Ministry of Health and Family Welfare, Government of India, Noida, Uttar Pradesh, India
| | - Satyam Arora
- Department of Transfusion Medicine, Post Graduate Institute of Child Health (PGICH), Noida, Uttar Pradesh, India
| | - Gopal Patidar
- Department of Transfusion Medicine, All India Institute of Medical Science, New Delhi, India
| | - Neelam Marwaha
- Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Ashford P, Butch S, Barhoush AO, Bolton W, Cusmai M, Espensen L, Geary J, Moniz K. International Society for Blood Transfusion Guidelines for Traceability of Medical Products of Human Origin. Vox Sang 2023; 118:587-597. [PMID: 37458170 DOI: 10.1111/vox.13473] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/03/2023] [Accepted: 05/07/2023] [Indexed: 07/20/2023]
Affiliation(s)
| | - Suzanne Butch
- Department of Pathology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Amjad Omar Barhoush
- Omar Freelance Quality and Accreditation Consultant, Rochester, Minnesota, USA
| | - Wayne Bolton
- Australian Red Cross Lifeblood, Information, and Communications Technology, Adelaide, South Australia, Australia
| | | | - Lone Espensen
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Josh Geary
- Cell Manipulation Core Facility, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Samukange WT, Lu TA, Souverein PC, Gardarsdottir H, Mantel-Teeuwisse AK. Suspected adverse reactions reported for blood, blood components, and blood products in VigiBase. Transfusion 2023; 63:982-992. [PMID: 36994873 DOI: 10.1111/trf.17336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION Since being designated as medicines by World Health Organization (WHO), blood components are subject to pharmacovigilance reporting. Using VigiBase, the WHO global database of individual case safety reports (ICSRs), we characterized reports of adverse reactions for all blood products. STUDY DESIGN AND METHODS ICSRs involving blood products as the suspected medicine in VigiBase between 1968 and 2021 were extracted. MedDRA preferred terms and the International Society of Blood Transfusion haemovigilance definitions were used to stratify adverse reactions. Descriptive statistics were used to characterize ICSR demographics. RESULTS A total of 111,033 ICSRs containing 577,577 suspected adverse reactions with 6152 MedDRA preferred terms were reported for 34 blood products. There were 12,153 (10.9%) reports for blood components, 98,135 (88.4%) reports for plasma-derived medicines, and 745 (0.7%) reports for recombinant products. The majority of reports (21.0% and 19.7%, respectively) were from patients aged 45-64 and over 65 years. The Americas contributed the most ICSRs (49.7%). Top reported suspected adverse reactions were for the following MedDRA preferred terms: headache (3.5%), pyrexia (2.8%), chills (2.8%), dyspnoea (1.8%), and nausea (1.8%). CONCLUSION VigiBase already has a large number of reports on blood products. When compared to other existing haemovigilance databases, our study found reports from a broader range of countries and reporters. This may provide us with new perspectives, but for VigiBase to reach its full potential in haemovigilance some alterations in what is captured in reports are required.
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Affiliation(s)
- Washington T Samukange
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, the Netherlands
- Major Policy and Coordination Division, Paul Ehrlich Institut, Langen, Germany
| | - Ting-An Lu
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Patrick C Souverein
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, the Netherlands
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland
| | - Aukje K Mantel-Teeuwisse
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, the Netherlands
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11
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Yang J, Fan D, Xie D, Guo X, Zhu W, He T, Huang X. First donor haemovigilance system at a national level in China: Establishment and improvement. Vox Sang 2023; 118:357-366. [PMID: 36896482 DOI: 10.1111/vox.13421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND AND OBJECTIVES No systematic study has measured the incidence of adverse reactions (ARs) to blood donation at the national level in China before 2019. The objective of this study was to establish an effective reporting system to collect information on ARs to blood donation in China. MATERIALS AND METHODS The status of donor haemovigilance (DHV) in blood collection facilities in China was evaluated, and an online DHV system was established to collect data on ARs to blood donation in July 2019. The definitions of ARs were based on the International Society of Blood Transfusion (ISBT) standards. The prevalence and data quality of ARs from 2019 to 2021 were analysed. RESULTS A standard online reporting system has been established for ARs to blood donation. In total, 61, 62 and 81 participating sites were included in this pilot study in 2019, 2020 and 2021, respectively. From July 2019 to December 2021, 21,502 cases of whole-blood-related ARs and 1114 cases of apheresis platelet-related ARs were reported, with an incidence of 3.8‰ and 2.2‰, respectively. Data completeness for key reporting elements improved from 41.7% (15/36) in 2019 to 74.4% (29/39) in 2020. Data quality analysis for the year 2021 yielded similar results as for 2020. CONCLUSION The construction and continuous improvement of the blood donor safety monitoring system prompted the establishment of the DHV system. Improvements have been made to the DHV system in China, with a significant increase in sentinels and higher data quality.
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Affiliation(s)
- Junhong Yang
- Chongqing Blood Center, Chongqing, China.,Working Party on Hemovigilance of the Chinese Society of Blood Transfusion, Chongqing, China
| | - Dinrong Fan
- School of Nursing, Chongqing Medical University, Chongqing, China.,Department of Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dongfu Xie
- Working Party on Hemovigilance of the Chinese Society of Blood Transfusion, Chongqing, China.,Shanghai Red Cross Blood Center, Shanghai, China
| | - Xiaojie Guo
- Working Party on Hemovigilance of the Chinese Society of Blood Transfusion, Chongqing, China.,Anhui Blood Center, Hefei, China
| | | | - Tao He
- Working Party on Hemovigilance of the Chinese Society of Blood Transfusion, Chongqing, China.,Chongqing Society of Blood Tranfusion, Chongqing, China
| | - Xia Huang
- Chongqing Blood Center, Chongqing, China.,Working Party on Hemovigilance of the Chinese Society of Blood Transfusion, Chongqing, China
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12
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Yuan Y, Dennington PM, Daly J, Baidya S, Tung JP. The impact of revised definitions for transfusion-associated circulatory overload and transfusion-related acute lung injury on haemovigilance reporting. Vox Sang 2023; 118:199-206. [PMID: 36654528 DOI: 10.1111/vox.13402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/09/2022] [Accepted: 12/26/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND OBJECTIVES Transfusion-associated circulatory overload (TACO) and transfusion-related acute lung injury (TRALI) are serious adverse transfusion reactions. Standardized surveillance definitions are important to ensure consistent reporting of cases. Recently, revised definitions have been developed for TACO and TRALI, the latter of which has not yet been widely implemented. This study aimed to assess the impact of the new TACO and TRALI definitions on haemovigilance reporting. MATERIALS AND METHODS The Australian Red Cross Lifeblood Adverse Transfusion Reaction database was accessed to identify all cases of suspected or confirmed TACO and TRALI referred from 1 July 2015 to 30 June 2019. Cases were assessed against both the former and new definitions and the results were compared. RESULTS A total of 73 cases were assessed. There were 48 TACO cases identified. Only 26 of 48 cases strictly met the former 2011 International Society of Blood Transfusion (ISBT) definition of TACO; 6 cases did not meet the definition and 16 cases lacked sufficient clinical details. In comparison, 46 cases met the revised 2018 ISBT definition, with only 2 cases having insufficient details. There were 24 cases of TRALI according to the existing 2004 Canadian Consensus Conference (CCC) definition compared with 25 cases according to the proposed 2019 revised definition. CONCLUSION The revised TACO definition captured more cases than the former definition. No significant differences were observed in the number of TRALI cases under the proposed new definition. This is the first study to provide validation data for the revised TRALI definition.
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Affiliation(s)
- Yin Yuan
- Clinical Services and Research, Australian Red Cross Lifeblood, Kelvin Grove, Australia.,WEHI, Melbourne, Australia
| | - Peta M Dennington
- Clinical Services and Research, Australian Red Cross Lifeblood, Kelvin Grove, Australia
| | - James Daly
- Clinical Services and Research, Australian Red Cross Lifeblood, Kelvin Grove, Australia
| | - Shoma Baidya
- Clinical Services and Research, Australian Red Cross Lifeblood, Kelvin Grove, Australia
| | - John-Paul Tung
- Clinical Services and Research, Australian Red Cross Lifeblood, Kelvin Grove, Australia.,Faculty of Health, Queensland University of Technology, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
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13
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Mikkelsen C, Paarup HM, Bruun MT, Pedersen LØ, Hasslund S, Larsen R, Aagaard B, Sørensen BS. A Danish national, multicentre evaluation of the new donor vigilance system among different staff groups. Vox Sang 2023; 118:121-127. [PMID: 36520050 DOI: 10.1111/vox.13392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/14/2022] [Accepted: 11/30/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Two years after implementing a new national donor vigilance system, the Danish Haemovigilance Committee conducted a nationwide survey to evaluate the implementation among different staff groups. We present the results here. MATERIALS AND METHODS The study was designed as an anonymous online survey to evaluate the satisfaction with the new registration, understanding of the parameters used and the user-friendliness. The REDCap platform was used. The questionnaire consisted of 22 questions. Ordinal variables were answered using five-point Likert scale (1 = strongly disagree to 5 = strongly agree). The data were analysed using descriptive statistics. Successful implementation was defined as mean overall satisfaction ≥4 and mean understanding of the individual components (adverse reaction category, severity and imputability) in the registration ≥4. RESULTS In all, 104 staff members (77.9% donation staff) participated. The mean (SD) overall satisfaction among all participants was 3.96 (0.94), highest among medical doctors (4.43 (0.78)) and lowest for administrative or other personnel (2.78 (1.09)). The mean scores for understanding the adverse reaction categories, severity and imputability were 3.92 (0.94), 3.92 (0.94) and 3.88 (1.00), respectively. Experience with a previous donor vigilance system was associated with lower scores. The most successful implementation programme included a medical doctor for introduction and a contact person. CONCLUSION The goal for successful implementation was not met. However, the overall attitude towards the new registration was positive and indicates that the system is suitable for different staff groups. Our results suggest that implementation could benefit from special attention to administrative staff and those accustomed to another donor vigilance system.
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Affiliation(s)
- Christina Mikkelsen
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark.,Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health Science, Copenhagen University, Copenhagen, Denmark
| | | | - Mie Topholm Bruun
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | | | - Sys Hasslund
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Rune Larsen
- Department of Clinical Immunology, Naestved Hospital, Naestved, Denmark
| | - Bitten Aagaard
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
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14
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Aarany Sivakaanthan, Fiona Swain, Gail Pahn, Kathryn Goodison, Naadir Gutta, Rhonda Holdsworth, Shoma Baidya, John-Paul Tung. Transfusion-related acute lung injury (TRALI): a retrospective review of reported cases in Queensland, Australia over 20 years. Blood Transfus 2022; 20. [PMID: 35969142 DOI: 10.2450/2022.0020-22] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/03/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Transfusion-related acute lung injury (TRALI) is a rare but potentially fatal transfusion reaction. An effective haemovigilance programme is important in implementing successful and targeted risk reduction strategies. We aim to provide a summary of TRALI cases referred for investigation in Queensland (QLD) Australia from 1999 to 2019, describing the epidemiological and laboratory features of local TRALI cases. MATERIALS AND METHODS A retrospective audit evaluated all cases reported to the QLD Australian Red Cross Lifeblood over the 20-year study period. Cases were categorised according to the 2004 Canadian consensus criteria. RESULTS Of the 91 cases referred for investigation, expert review confirmed 30 of TRALI and 18 of possible TRALI. A total of 238 donors and 110 blood products were assessed in confirmed cases. TRALI affected patients of all ages. Most patients had underlying haematological malignancies (25%), surgery (15%) or liver disease (13%). TRALI incidence was measured at 1 in 130,000 per issued product in QLD. Red cells were transfused in 32 cases, platelets in 18 and plasma products in 21, with 16 cases involving multiple products. Following laboratory assessment, 23% of cases had findings supportive of antibody mediated TRALI and 21% as likely non-antibody mediated. Possible TRALI was identified in 37.5% of cases of which 25% were antibody mediated and 12.5% non-antibody mediated. Nine (18.5%) cases were uncategorised due to insufficient immunologic investigations. DISCUSSION Rates of TRALI incidence measured are lower than those seen in many international studies. A reduction in confirmed cases has been noted over recent years, supporting the implementation of risk-reduction strategies. We report a relatively higher proportion of non-antibody mediated TRALI and possible TRALI cases in more recent years, suggesting the need to further understand the role of product age and biological risk modifiers.
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15
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Lægreid IJ, Wilson T, Næss KH, Ernstsen SL, Schou V, Arsenovic MG. Whole blood transfusion and paroxysmal nocturnal haemoglobinuria meet again: Minor incompatibility, major trouble. Vox Sang 2022; 117:1323-1326. [PMID: 36102159 PMCID: PMC9826352 DOI: 10.1111/vox.13354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/10/2022] [Accepted: 08/10/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND OBJECTIVES The field of transfusion medicine started out with whole blood transfusion to treat severe anaemia and other deficiencies, and then transitioned to component therapy, largely leaving the practice, and experiences, of whole blood transfusions behind. Currently, the field is circling back and whole blood is gaining ground as an alternative to massive transfusion protocols. MATERIALS AND METHODS Herein we describe a severely anaemic paroxysmal nocturnal haemoglobinuria (PNH) patient initially suspected of suffering from renal haemorrhage, receiving a standard low-titre group O whole blood transfusion during pre-hospital transportation. RESULTS Following the transfusion, the patient suffered a clinically unmistakable haemolytic transfusion reaction requiring supportive treatment in the intensive care unit. Clinical observations are consistent with an acute haemolytic reaction. The haemolysis was likely due to minor incompatibility between the plasma from the transfused whole blood and the patient's PNH red cells. Recovery was uneventful. CONCLUSION This revealed an unappreciated contraindication to minor incompatible whole blood transfusion, and prompted a discussion on the distinction between whole blood and erythrocyte concentrates, the different indications for use and the importance of emphasizing these differences. It also calls attention to patient groups where minor incompatibility can be of major importance.
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Affiliation(s)
- Ingvild Jenssen Lægreid
- Department of Laboratory Medicine, Division of Diagnostic servicesUniversity Hospital of North NorwayTromsøNorway
| | - Thomas Wilson
- Division of Prehospital servicesFinnmark Hospital TrustKirkenesNorway
| | | | - Siw Leiknes Ernstsen
- Department of Laboratory Medicine, Division of Diagnostic servicesUniversity Hospital of North NorwayTromsøNorway
| | - Vibeke Schou
- Department of Anesthesia and Intensive CareKirkenes Hospital, Finnmark Hospital TrustKirkenesNorway
| | - Mirjana Grujic Arsenovic
- Department of Laboratory Medicine, Division of Diagnostic servicesUniversity Hospital of North NorwayTromsøNorway
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16
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Vanessa Piccinini, Giuseppe Marano, Liviana Catalano, Ilaria Pati, Eva Veropalumbo, Chiara de Waure, Simonetta Pupella, Vincenzo De Angelis. Vasovagal reactions in whole blood and apheresis donors: a cross-sectional study on donor haemovigilance data from 2016 to 2019 in Italy. Blood Transfus 2022; 20. [PMID: 34694220 DOI: 10.2450/2021.0114-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/14/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Acute and delayed vasovagal reactions (VVR) are the most frequent adverse reactions (AR) associated with donations. The aim of this study was to provide the data of the Italian donor haemovigilance system and contextualise the VVR data within the international framework, as well as evaluating, among first-time donors, the association of gender and age and the prevalence of VVR compared to other AR. MATERIALS AND METHODS The prevalence analysis was performed on VVR and other AR notified to the Italian haemovigilance system from 2016 to 2019. The analysis on the association of gender and age group and VVR prevalence was performed on first-time donations. The definitions and severity of AR were as set out in the 2014 ISBT/IHN international standards. RESULTS From 2016 to 2019, 34,519 AR were notified, of which 87.1% were VVR. The overall VVR prevalence was 25.0/10,000 donations and the overall prevalence of other AR was 3.7/10,000 donations. All the estimated prevalences of AR were higher for first-time donations than for regular donations and lower for whole blood than for apheresis donations. No difference was noted between whole blood and apheresis donations for VVR with complications or injuries. The prevalence of AR among first-time donors was higher in females than in males. The prevalence of VVR decreased as donor age increased. DISCUSSION The prevalence of VVR related to blood donation was very low and similar to those calculated by other haemovigilance systems. Among first-time donors, the prevalence of AR was higher in females than in males. The higher prevalence of VVR in young donors and a significant decreasing trend by age group confirmed the results reported in the literature. Finally, no trend by age group in first-time donors was observed for other AR to donations.
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17
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Tian X, Kong Y, Wang J, He R, Li L, Liu Z. Development of the Chinese Haemovigilance Network and reporting of adverse transfusion reactions from 2018 to 2020. Vox Sang 2022; 117:1027-1034. [PMID: 35560059 DOI: 10.1111/vox.13291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/09/2022] [Accepted: 04/11/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVES To advance blood transfusion safety, the Chinese Haemovigilance Network (CHN) was put into operation in 2018. This report describes the development of the CHN and evaluates its role by analysing reported adverse transfusion reactions (ATRs) from 2018 to 2020. MATERIALS AND METHODS All data in this study were obtained from the CHN online reporting platform. A timeline of CHN development is presented, and the activities of CHN-enrolled facilities are analysed by year. The reported ATRs were analysed in detail for ATR types, blood components involved and adherence to case definition, severity and imputability criteria. Incidence rates were calculated and compared with international examples. RESULTS During 2018-2020, a total of 3061 ATRs were reported through the CHN online reporting system. The rate of reported ATRs in all facilities and the 10 highest reporting facilities was 0.7‰ and 1.8‰, respectively. When analysed by year, the incidence rate showed an increasing trend from 2018 to 2020. Allergic (68.2%) and febrile non-haemolytic transfusion reaction (27.1%) were the most common. The vast majority of ATRs (92.0%) were not serious, but serious cases of transfusion-associated circulatory overload, transfusion-associated dyspnoea and hypotensive reaction were common. Most (86.0%) of reported cases were definitely or probably associated with transfusion. CONCLUSION Under-reporting of ATRs occurs in many Chinese hospitals, but the establishment of CHN has increased ATR recognition and management. More effort will be needed in the future to detect transfusion problems and improve transfusion practice in China.
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Affiliation(s)
- Xue Tian
- Clinical Transfusion Research Center, Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, People's Republic of China.,Key Laboratory of Transfusion Adverse Reactions, CAMS, Chengdu, People's Republic of China
| | - Yujie Kong
- Clinical Transfusion Research Center, Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, People's Republic of China.,Key Laboratory of Transfusion Adverse Reactions, CAMS, Chengdu, People's Republic of China
| | - Jue Wang
- Clinical Transfusion Research Center, Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, People's Republic of China.,Key Laboratory of Transfusion Adverse Reactions, CAMS, Chengdu, People's Republic of China
| | - Rui He
- Clinical Transfusion Research Center, Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, People's Republic of China.,Key Laboratory of Transfusion Adverse Reactions, CAMS, Chengdu, People's Republic of China
| | - Ling Li
- Clinical Transfusion Research Center, Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, People's Republic of China.,Key Laboratory of Transfusion Adverse Reactions, CAMS, Chengdu, People's Republic of China
| | - Zhong Liu
- Clinical Transfusion Research Center, Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, People's Republic of China.,Key Laboratory of Transfusion Adverse Reactions, CAMS, Chengdu, People's Republic of China
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18
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Politis C, Wiersum-Osselton J, Richardson C, Grouzi E, Sandid I, Marano G, Goto N, Contego J, Boudjedir K, Asariotou M, Politi L, Land K. Adverse reactions following transfusion of blood components, with a focus on some rare reactions: reports to the International Haemovigilance Network Database (ISTARE) in 2012-2016. Transfus Clin Biol 2022; 29:243-249. [PMID: 35476961 DOI: 10.1016/j.tracli.2022.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The International Haemovigilance Network's (IHN) ISTARE database collects surveillance data on all adverse reactions (AR) associated with transfusion of blood and blood components, facilitating the sharing of best practice and benchmarking for improving blood safety and quality. Up to 2012 no publications discussed certain rare AR. The aim of this study is to examine ISTARE data on AR from 2012 to 2016, focusing on hypotensive reactions, post-transfusion purpura (PTP), transfusion-associated graft versus host disease (TA-GvHD), hyperkalemia and hypocalcemia. MATERIALS AND METHODS National Haemovigilance Systems (HVS), provided aggregate annual data on AR by type of reaction, severity, imputability to transfusion, and blood component implicated. Twenty-nine HVS provided 104 annual reports covering 107,778,290 blood units issued. RESULTS Among AR reported, 25% were serious, including 368 deaths. The 284 transfusion-transmitted infections included 187 bacterial infections, 84 viral and 13 parasitic or fungal; nine deaths resulted. AR related to the respiratory system transfusion-associated circulatory overload, transfusion-related acute lung injury and transfusion-associated dyspnoea accounted for 8.3% of all AR, 20.1% of serious, and 52.2% of deaths. Of 1634 rare AR, 1565 were hypotensive, 38 PTP, 17 GvHD, 9 hyperkalemia and 5 hypercalcemia. Half were serious and 16 fatalities were recorded (13 hypotensive, 2 GvHD, one PTP). Among 14 countries that reported any hypotensive AR, incidences diverged widely. CONCLUSIONS ARs in this group are frequently severe or life-threatening. Hypotensive AR are the most common, but may have been overlooked and counted under allergic and other AR presenting with hypotension. Compliance with the ISBT definition may be suboptimal, thus its real incidence may be higher. Data on GvHD may contribute to clarifying the role of leukodepletion with or without irradiation. ISTARE continues to be a useful surveillance tool for all transfusion AR and provides relevant insights into overlooked and rare AR, thus offering important contributions towards maximising transfusion safety.
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Affiliation(s)
- C Politis
- Coordinating Centre for Haemovigilance and Surveillance of Transfusion, Hellenic National Public Health Organization, Attika, Greece.
| | | | - C Richardson
- Panteion University of Social and Political Sciences, Athens, Greece
| | - E Grouzi
- Transfusion Service and Clinical Hemostasis, Saint Savvas Oncology Hospital of Athens, Greece
| | - I Sandid
- French National Agency for Medicines and Health Products Safety (ANSM), France
| | - G Marano
- National Blood Centre, Instituto Superiore di Sanita, Rome, Italy
| | - N Goto
- Safety Vigilance Division, Technical Department, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - J Contego
- Transplantacao, Instituto Portugues do Sangue e da Transplantacao, Port, Portugal
| | - K Boudjedir
- French National Agency for Medicines and Health Products Safety (ANSM), France
| | - M Asariotou
- Coordinating Centre for Haemovigilance and Surveillance of Transfusion, Hellenic National Public Health Organization, Attika, Greece
| | - L Politi
- Directorate of Surveillance and Prevention of Infectious Diseases, Hellenic National Public Health Organization, Greece
| | - K Land
- Clinical Services at Vitalant San Antonio, Texas, United States
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19
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Mikkelsen C, Paarup HM, Bruun MT, Pedersen LØ, Hasslund S, Larsen R, Aagaard B, Sørensen BS. The new donor vigilance system in Denmark reveals regional differences in adverse reactions supposedly caused by variation in the registration. Vox Sang 2021; 117:321-327. [PMID: 34523137 DOI: 10.1111/vox.13202] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/24/2021] [Accepted: 08/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES In recent years, there has been an increased focus among blood bank professionals on the health and safety of blood donors. In 2019, the Danish Haemovigilance Committee designed a national donor vigilance system to improve the registration of adverse reactions (AR) in blood donors. The new donor vigilance system was implemented on 1 January 2020 and we here present the results from the first year of registration. MATERIALS AND METHODS AR categories, severity level and imputability score were defined based on the definitions from the International Society of Blood Transfusion, AABB and the European Commission directive 2005/61/EC, respectively. RESULTS Across all severity levels, AR in Danish blood donors were found to be rare (1498 per 100,000 donations). Only 0.2% of the registered reactions were classified as serious (2.7 per 100,000 donations). Large regional differences were seen in the registration of citrate reactions and haematomas. CONCLUSION Significant differences across regions in what to categorize as an AR were persistent even when including a severity score in the reporting. The Danish Haemovigilance Committee will commence a national work to align the definitions but suggests that this matter is raised to an international level as part of the current work to agree upon definitions for assessment of donor AR.
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Affiliation(s)
- Christina Mikkelsen
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark.,Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health Science, Copenhagen University, Copenhagen, Denmark
| | | | - Mie Topholm Bruun
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | | | - Sys Hasslund
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Rune Larsen
- Department of Clinical Immunology, Naestved Hospital, Naestved, Denmark
| | - Bitten Aagaard
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
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20
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Drews SJ, Van Caeseele P, Bullard J, Lindsay LR, Gaziano T, Zeller MP, Lane D, Ndao M, Allen VG, Boggild AK, O'Brien SF, Marko D, Musuka C, Almiski M, Bigham M. Babesia microti in a Canadian blood donor and lookback in a red blood cell recipient. Vox Sang 2021; 117:438-441. [PMID: 34462920 DOI: 10.1111/vox.13198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/09/2021] [Accepted: 08/09/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVES We describe the third documented case of autochthonous human babesiosis in Canada and the second in a Canadian blood donor. MATERIALS AND METHODS Multiple laboratory investigations were carried out on the donor and the immunocompromised recipient of an associated, potentially infectious red blood cell product. RESULTS The donor had not travelled except for outdoor exposure in south-eastern Manitoba, followed by illness and hospital admission. The donor had a notable parasitaemia, positive for Babesia microti using whole blood nucleic acid testing (NAT). The recipient was negative for B. microti by both serology and NAT. CONCLUSION There was no evidence of transfusion-transmitted babesiosis.
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Affiliation(s)
- Steven J Drews
- Microbiology, Donation Policy and Studies, Canadian Blood Services, Edmonton, Alberta, Canada.,Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Jared Bullard
- Cadham Provincial Laboratory, Winnipeg, Manitoba, Canada
| | - L Robbin Lindsay
- Zoonotic Diseases and Special Pathogens Section, National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - Teresa Gaziano
- Medical Laboratory and Stem Cell Services, Canadian Blood Services, Brampton, Ontario, Canada
| | - Michelle P Zeller
- Medical Laboratory and Stem Cell Services, Canadian Blood Services, Ancaster, Ontario, Canada.,McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Debra Lane
- Medical Laboratory and Stem Cell Services, Canadian Blood Services, Winnipeg, Manitoba, Canada
| | - Momar Ndao
- National Reference Centre for Parasitology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Vanessa G Allen
- Public Health Ontario, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Andrea K Boggild
- Tropical Disease Unit, Division of Infectious Diseases, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sheila F O'Brien
- Epidemiology and Surveillance, Donation Policy and Studies, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Daniel Marko
- Department of Pathology, University of Manitoba, Winnipeg, Manitoba, Canada.,Shared Health, Winnipeg, Manitoba, Canada
| | - Charles Musuka
- Department of Pathology, University of Manitoba, Winnipeg, Manitoba, Canada.,Shared Health, Winnipeg, Manitoba, Canada
| | - Muhamad Almiski
- Department of Pathology, University of Manitoba, Winnipeg, Manitoba, Canada.,Shared Health, Winnipeg, Manitoba, Canada
| | - Mark Bigham
- Medical Laboratory and Stem Cell Services, Canadian Blood Services, Vancouver, British Columbia, Canada
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21
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Tanaka A, Yokohama A, Fujiwara SI, Fujii Y, Kaneko M, Ueda Y, Abe T, Kato Y, Hasegawa Y, Ikeda K, Fujino K, Matsumoto M, Makino S, Kino S, Takeshita A, Muroi K. Transfusion-associated circulatory overload and high blood pressure: A multicentre retrospective study in Japan. Vox Sang 2021; 116:785-792. [PMID: 33529383 DOI: 10.1111/vox.13063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 11/23/2020] [Accepted: 12/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transfusion-associated circulatory overload (TACO) is an adverse reaction associated with a high risk of mortality. The actual incidence of TACO and hypertension associated with transfusion in Japan is unknown. METHODS A multicentre retrospective observational study was conducted across 23 institutions during the 1-year period of 2016. Patients were included if they developed TACO or their blood pressure (either systolic or diastolic) increased by at least 30 mmHg during the transfusion. TACO was confirmed by the primary physicians and transfusion medicine teams and recorded in the data on passive surveillance, and additional data were extracted from electronic medical records. RESULTS In our patient cohort of 31 384 patients who underwent transfusion, the incidence of TACO and hypertension was 0·03% and 0·2%, respectively. However, 43% of the participating institutions didn't report any cases. When comparing risk factors between the TACO and hypertension groups, there were significant differences in comorbidities, such as abnormal findings on chest x-ray. Significant differences between the two groups were observed post-transfusion pulse rate, body temperature and oxygen saturation (P < 0·01). In the group of patients with hypertension, the level of BNP increased significantly after transfusion in 45% (5/11) of the patients. We identified 4 patients in the hypertension group who met the new ISBT's TACO criteria. CONCLUSION Our study suggests that more attention should be given to TACO in Japan, particularly in terms of improving surveillance systems. For the early diagnosis of TACO, it is crucial to carefully monitor vital signs including blood pressure.
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Affiliation(s)
- Asashi Tanaka
- Department of Clinical Laboratory Medicine and Department of Transfusion Medicine, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Akihiko Yokohama
- Division of Blood Transfusion Service, Gunma University Hospital, Gunma, Japan
| | - Shin-Ichiro Fujiwara
- Division of Cell Transplantation and Transfusion, Jichi Medical University Hospital, Tochigi, Japan
| | - Yasuhiko Fujii
- Department of Transfusion Medicine, Yamaguchi University Hospital, Yamaguchi, Japan
| | - Makoto Kaneko
- Division of Cell Transplantation and Transfusion, University of Yamanashi Hospital, Yamanashi, Japan
| | - Yasunori Ueda
- Department of Hematology and Oncology, Kurashiki Central Hospital, Okayama, Japan
| | - Takashi Abe
- Department of Hematology, Niigata City General Hospital, Niigata, Japan
| | - Yoko Kato
- Division of Transfusion and Cell Therapy, The Jikei University Hospital, Tokyo, Japan
| | - Yuichi Hasegawa
- Department of Transfusion Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Kazuhiko Ikeda
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Keizo Fujino
- Department of Transfusion Medicine, Osaka City University Hospital, Osaka, Japan
| | | | - Shigeyoshi Makino
- Department of Transfusion Medicine, Toranomon Hospital, Tokyo, Japan
| | - Shuichi Kino
- Hokkaido Block Blood Center Japanese Red Cross, Hokkaido, Japan
| | - Akihiro Takeshita
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Shizuokoa, Japan
| | - Kazuo Muroi
- Division of Cell Transplantation and Transfusion, Jichi Medical University Hospital, Tochigi, Japan
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22
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Skagerlind L, Toss F. Prevention of hypokalaemia and hypomagnesaemia following peripheral stem cell collection - a prospective cohort study. Vox Sang 2021; 116:916-923. [PMID: 33491787 DOI: 10.1111/vox.13075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/16/2020] [Accepted: 12/28/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Citrate-based anticoagulation reduces plasma potassium and free magnesium in patients undergoing peripheral stem cell collections. Whether the effects may be mitigated by pre-procedure oral electrolyte supplements has not been previously assessed. MATERIALS AND METHODS Results from a historic cohort (2010-2013) guided a systematic prospective intervention in subjects deemed at risk for clinically meaningful hypokalaemia and hypomagnesaemia. From 2015 to 2019, 136 patients were enrolled in the study. Pre- and post-apheresis electrolyte levels were measured, and oral potassium and magnesium supplements were systematically administered based on the pre- electrolyte levels. RESULTS We saw a 37% absolute reduction in severe hypokalaemia and 39% absolute reduction in hypomagnesaemia in the prospective intervention cohort when compared to the historic cohort. Multivariate analyses indicated that part of the effect was due to the electrolyte intervention, while part of the effect likely stemmed from other procedure-related changes implemented during the study period. CONCLUSION Oral potassium and magnesium prophylaxis appear to reduce hypokalaemia and hypomagnesaemia following peripheral stem cell collection. Whether the effect size is sufficient to motivate the intervention warrants further investigation, preferably in a prospective randomized trial setting.
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Affiliation(s)
- Lars Skagerlind
- Department of Haematology, Umeå University Hospital, Umeå, Sweden
| | - Fredrik Toss
- Department of Clinical Microbiology, Division of Clinical Immunology, Umeå University, Umeå, Sweden.,Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
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23
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Yin Y, Tian X, Li L, Kong Y, Wang J, Lin F, Song N, Chen Q, Gan J, Peng T, Li X, Wu Y, Ge H, Wang H, Jiang J, Bai L, Ji H, Zhao G, Huang Y, Liu Z. First annual report of Chinese haemovigilance network. Vox Sang 2021; 116:718-724. [PMID: 33423307 DOI: 10.1111/vox.13059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/25/2020] [Accepted: 12/02/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Haemovigilance involves surveillance of the whole chain of blood transfusion with the aim of identifying adverse events and errors and improving outcomes for patients. The Chinese Haemovigilance Network, founded in August 2017, has witnessed a rapid development in the last three years. MATERIALS AND METHODS Based on the 1,022 cases in 2019, we analysed the adverse reactions (ARs) by blood component, clinical outcome severity and demography of recipients in an effort to publish the first annual Chinese haemovigilance report. RESULTS The AR rate associated with blood transfusion in 2019 was 0·2% in China. Allergic reactions and FNHTR were the two most common adverse symptoms, accounting for 97·7% of the reports. Two-thirds of the TAD, AHTR and TACO and all of the HTR and DHTR resulted in hospitalization or prolongation of hospitalization. Plasma and AP were usually associated with allergic reaction (81·1%), whereas red cells more commonly cause FNHTR (68·8%) and all the AHTR, HTR, DSTR and DHTR. 84·1% of patients were aged 16 years or over, and the majority of the TAD, AHTR, TACO and HTR involved patients aged 60 and above. The ratio of serious adverse reactions (SARs) was 8·2%. Allergic reaction and FNHTR were top two (85·7%) SARs. The first case related to anti-D immunoglobulin was detected in a DHTR report. CONCLUSION This report provides the world's first overview of transfusion-related adverse reactions in China. This report is useful for better understanding transfusion risks in China.
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Affiliation(s)
- Yonghua Yin
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, China.,Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, Chengdu, China
| | - Xue Tian
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, China.,Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, Chengdu, China
| | - Ling Li
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, China.,Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, Chengdu, China
| | - Yujie Kong
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, China.,Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, Chengdu, China
| | - Jue Wang
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, China.,Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, Chengdu, China
| | - Feng Lin
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, China.,Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, Chengdu, China
| | - Ning Song
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, China.,Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, Chengdu, China
| | - Qiang Chen
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, China.,Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, Chengdu, China
| | - Jia Gan
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Tao Peng
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiying Li
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | | | - Hongwei Ge
- Beijing Red Cross Blood Center, Beijing, China
| | | | - Jingmei Jiang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Lianjun Bai
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hongwen Ji
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Guohua Zhao
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuguang Huang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhong Liu
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, China.,Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, Chengdu, China
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24
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Wiersum-Osselton JC, Politis C, Richardson C, Goto N, Grouzi E, Marano G, Land KJ. Complications of blood donation reported to haemovigilance systems: analysis of eleven years of international surveillance. Vox Sang 2020; 116:628-636. [PMID: 33278040 DOI: 10.1111/vox.13048] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/19/2020] [Accepted: 11/19/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND OBJECTIVES The International Haemovigilance Network collects aggregate data on complications of blood donation from member haemovigilance systems (HVS). We analysed the data collected in 2006-2016 in order to learn from it and consider future improvements. MATERIALS AND METHODS National HVS entered annual data on donation complications and on annual whole blood and apheresis donations in the 'ISTARE' (International Surveillance of Transfusion Adverse Reactions and Events) online database. We calculated national and aggregate donation complication rates. RESULTS Twenty-four HVS provided data for 138 country years (CY; median 7 CY, IQR 2-8), covering 155 M donations. The overall complication rate was 6·3/1000 donations and the median country rate 3·2/1000 (IQR 1·1-10·1). Overall and severe complication rates varied considerably between HVS. Vasovagal reactions (VVR) were most commonly reported: 4·6/1000 donations, median country rate 3·1/1000 donations (IQR 0·6-7·7). Rare complications included generalized allergic reaction (0·10/100 000) and major blood vessel injury (category available since 2015; 0·12/100 000). Eighteen HVS reported complications of whole blood donation (WBD) and apheresis separately (89 CY, 101·6 M WBD and 26·3 M apheresis donations). The median country VVR rate was 3·4/1000 WBD (IQR 1·0-9·1) and 1·5/1000 apheresis donations (1·0-4·2). Rates of venepuncture-related complications tended to be higher for apheresis: the median country rate of reported haematomas was 0·39/1000 WBD (IQR 0·31-1·2) vs. 4·2/1000 apheresis donations (0·69-5·6). CONCLUSION International reporting allows HVS to study rates of blood donation complications and capture information about very rare events. The present variability of reporting and severity assessment hampers comparisons between HVS and requires further work.
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Affiliation(s)
- Johanna C Wiersum-Osselton
- TRIP National Hemovigilance and Biovigilance Office, Leiden, The Netherlands.,Sanquin, Amsterdam, The Netherlands
| | - Constantina Politis
- Coordinating Centre for Haemovigilance and Surveillance of Transfusion (SKAEM), Hellenic National Public Health Organisation, Athens, Greece
| | - Clive Richardson
- Panteion University of Social and Political Sciences, Athens, Greece
| | - Naoko Goto
- Safety Vigilance Division, Technical Department, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Elisavet Grouzi
- Transfusion Service and Clinical Hemostasis of Saint Savvas, Oncology Hospital of Athens, Athens, Greece
| | | | - Kevin J Land
- Vitalant, Phoenix, AZ, USA.,Department of Pathology, UT Health San Antonio, San Antonio, TX, USA
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25
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O'Brien KL, Chen Y, Uhl L. Assessing inpatient platelet ordering practice: evaluation of computer provider order entry overrides. Vox Sang 2020; 116:702-712. [PMID: 33615489 DOI: 10.1111/vox.13050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Judicious utilization of platelet products protects a limited resource and mitigates risks of transfusion. At many institutions, computer physician order entry systems provide prompts to guide transfusion decisions; many capture the indication for transfusion, and generate metadata when orders are dissonant with guidelines. We conducted a retrospective review to examine adherence to and overrides of hospital guidelines for platelet transfusion to identify opportunities for improved transfusion practice. MATERIALS AND METHODS Physician override reports (1/1/2018-3/31/2019) were examined and physician-entered justification comments accompanying override orders were extracted, in addition to patient-specific data (clinical service, age, sex, and pretransfusion platelet count). Two transfusion medicine physicians independently assessed comments in context of patient data and institutional guidelines and categorized as: indicated, protocol driven, or not indicated. Following adjudication, consensus was reached between the two reviewers. Override keyword frequencies were also determined. RESULTS Over 15-months, 1373 override orders were placed for 558 unique patients (25% of all adult inpatient platelet transfusions). haematology/oncology providers placed 573 (42%) override orders (261 unique patients), 46% of which were categorized as "not indicated", based on consensus review. Overall, 470 (34%) override orders were categorized as "not indicated". Examples of recurring key words included "bleeding/risk of bleeding", "falling platelet count", "platelet goal of XX". CONCLUSIONS A large percentage of override orders for platelet transfusions were determined to be "not indicated" and out of compliance with institutional guidelines. The metadata captured identified concerns regarding clinical transfusion practice and opportunities for revised indications (e.g. threshold for retinal haemorrhage).
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Affiliation(s)
- Kerry L O'Brien
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Yigu Chen
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Lynne Uhl
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
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26
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Kumukova I, Trakhtman P, Starostin N, Borsakova D, Ignatova A, Bayzyanova Y. Quality assessment of red blood cell suspensions derived from pathogen-reduced whole blood. Vox Sang 2020; 116:547-556. [PMID: 33222171 DOI: 10.1111/vox.13039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND We used laboratory indicators to evaluate the quality of pathogen-reduced red blood cell suspension (RBCS) compared with gamma-irradiated RBCS. MATERIALS AND METHODS To determine biochemical and metabolic parameters of RBCS, we obtained 50 whole blood units from healthy volunteers and randomized them into 2 groups: 25 were pathogen-reduced, and then, RBCS prepared from them. RBCS from the other 25 was gamma-irradiated. Sampling was carried out on day zero before and after treatment and at 7, 14, 21 and 28 days. To determine lymphocyte inactivation, we collected another 35 whole blood units. Each was sampled to form 3 study groups: untreated, gamma-irradiated and pathogen-reduced. Daily sampling was carried out during 3 days of storage. RESULTS The quality of RBCS from both groups was largely the same, except for haemolysis and red blood cell fragility, which were more pronounced in the pathogen-reduced group. This finding limited the shelf life of pathogen-reduced RBCS to 14 days. Lymphocyte viability was significantly reduced after both treatments. Proliferation of lymphocytes after pathogen reduction was reduced to the detection limit, while low-level proliferation was observed in gamma-irradiated samples. CONCLUSION Pathogen-reduced red blood cells have acceptable quality and can be used for transfusion within 14 days. Results of inactivation of lymphocytes demonstrate that pathogen reduction technology, applied on WB, can serve as an alternative to irradiation.
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Affiliation(s)
- Irina Kumukova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology Oncology and Immunology, Moscow, Russia
| | - Pavel Trakhtman
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology Oncology and Immunology, Moscow, Russia
| | - Nicolay Starostin
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology Oncology and Immunology, Moscow, Russia
| | - Daria Borsakova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology Oncology and Immunology, Moscow, Russia.,Laboratory of Physiology and Biophysics of the Cell, Center for Theoretical Problems of Physicochemical Pharmacology, Russian Academy of Sciences, Moscow, Russia
| | - Anastasia Ignatova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology Oncology and Immunology, Moscow, Russia
| | - Yana Bayzyanova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology Oncology and Immunology, Moscow, Russia
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27
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Mikkelsen C, Mori G, van Walraven SM, Castrén J, Zahra S, MacLennan S, Seidel K, Fontana S, Veropalumbo E, Cannata L, Pupella S, Kvist M, Happel M, Korkalainen P, Chandrasekar A, Paulus U, Bokhorst A, Wulff B, Fernandez-Sojo J, Eguizabal C, Urbano F, Vesga MA, van Kraaij M, Merz EM, van den Hurk K, Hansen MB, Slot E, Ullum H. How donor selection criteria can be evaluated with limited scientific evidence: lessons learned from the TRANSPOSE project. Vox Sang 2020; 116:342-350. [PMID: 33191514 DOI: 10.1111/vox.13028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Donor selection criteria (DSC) are a vital link in the chain of supply of Substances of Human Origin (SoHO) but are also subject to controversy and differences of opinion. Traditionally, DSC have been based on application of the precautionary principle. MATERIALS AND METHODS From 2017 to 2020, TRANSPOSE (TRANSfusion and transplantation PrOtection and SElection of donors), a European research project, aimed to identify discrepancies between current DSC by proposing a standardized risk assessment method for all SoHO (solid organs excluded) and all levels of evidence. RESULTS The current DSC were assessed using a modified risk assessment method based on the Alliance of Blood Operators' Risk-based decision-making framework for blood safety. It was found that with limited or diverging scientific evidence, it was difficult to reach consensus and an international standardized method for decision-making was lacking. Furthermore, participants found it hard to disregard their local guidelines when providing expert opinion, which resulted in substantial influence on the consensus-based decision-making process. CONCLUSIONS While the field of donation-safety research is expanding rapidly, there is an urgent need to formalize the decision-making process regarding DSC. This includes the need for standardized methods to increase transparency in the international decision-making process and to ensure that this is performed consistently. Our framework provides an easy-to-implement approach for standardizing risk assessments, especially in the context of limited scientific evidence.
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Affiliation(s)
- Christina Mikkelsen
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gaia Mori
- Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
| | | | | | - Sharon Zahra
- Scottish National Blood Transfusion Service, Edinburgh, Scotland
| | | | | | - Stefano Fontana
- Interregional Blood Transfusion Service SRC, University of Lausanne, Berne, Switzerland
| | - Eva Veropalumbo
- Centro Nazionale Sangue, Istituto Superiore di Sanità, Rome, Italy
| | - Livia Cannata
- Centro Nazionale Sangue, Istituto Superiore di Sanità, Rome, Italy
| | | | - Maria Kvist
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Solna, Sweden
| | - Marjan Happel
- TRIP Hemovigilance and Biovigilance Office, Leiden, the Netherlands
| | | | | | | | - Arlinke Bokhorst
- TRIP Hemovigilance and Biovigilance Office, Leiden, the Netherlands
| | - Birgit Wulff
- Institute of Legal Medicine, University Medical Center Hamburg, Hamburg, Germany
| | | | - Cristina Eguizabal
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | - Fernando Urbano
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | - Miguel Angel Vesga
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | | | - Eva-Maria Merz
- Sanquin Research, Department of Donor Medicine Research - Donor Studies, Amsterdam, the Netherlands.,Department of Sociology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Katja van den Hurk
- Sanquin Research, Department of Donor Medicine Research - Donor Studies, Amsterdam, the Netherlands
| | - Morten Bagge Hansen
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ed Slot
- Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
| | - Henrik Ullum
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
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28
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Grey S, Bolton-Maggs P. Pulmonary complications of transfusion: Changes, challenges, and future directions. Transfus Med 2020; 30:442-449. [PMID: 32924216 DOI: 10.1111/tme.12709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 11/27/2022]
Abstract
The pulmonary complications of transfusion (TACO, TRALI and TAD) are the leading cause of transfusion-related mortality and major morbidity. Advance in this area is essential in improving transfusion safety. This review describes the drivers for change in haemovigilance practice, the influence of recent key publications and future directions.
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Affiliation(s)
- Sharran Grey
- Lancashire Haematology Centre, Blackpool Teaching Hospitals NHS Foundation Trust, North Lancashire, UK.,Serious Hazards of Transfusion, Manchester Blood Centre, Manchester, UK
| | - Paula Bolton-Maggs
- Serious Hazards of Transfusion, Manchester Blood Centre, Manchester, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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29
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Dhesi AS, Moss R, Deelen R, O'Reilly C, Bielby L. A survey of transfusion practitioners in international society of blood transfusion member countries. Vox Sang 2020; 115:200-210. [PMID: 31944334 DOI: 10.1111/vox.12882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 12/05/2019] [Accepted: 12/05/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Transfusion Practitioner (TP) is a term that describes activities undertaken by a variety of healthcare professionals who play a key role in supporting safe and appropriate blood management/transfusion care for patients. There is significant variation in staff specialty filling the role. To understand which countries have the TP role, and the variations that exist, an international survey was undertaken in 2017. METHODS A survey was developed by the TP Forum Steering Committee (TPFSC) with input from the International Society of Blood Transfusion (ISBT) Clinical Transfusion Working Party. The survey was distributed by the ISBT Office to all ISBT members and promoted via newsletters and social media. RESULTS/DISCUSSION Five hundred and eighty-two responses received from 84 different countries. The TP role exists in 67 countries, 10 countries do not have the TP role, one was unaware of the role, and respondents from six other countries did not answer this question. The most prevalent TP activities reported were policy and procedure development, education, participation in Transfusion Committees and audit activities. Eighty-eight respondents indicated they did not have a TP role, with the main barrier being financial, followed by lack of support for the role. Eight respondents indicated they previously had a TP, and this role was no longer in place due to lack of support for the role, cutbacks and other priorities. CONCLUSION This survey provides insights as to where and how the TP functions and provides the TPFSC with valuable information to develop tools to support further development of the role.
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Affiliation(s)
| | - Rachel Moss
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Clare O'Reilly
- BC Children's Hospital and BC Women's Hospital & Health Centre, Vancouver, Canada
| | - Linley Bielby
- Department of Health and Human Services, Victoria and the Australian Red Cross Blood Service, Melbourne, Australia
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30
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Abstract
Pre-term infants have one of the highest transfusion requirements within the hospital-setting. The vast majority of blood transfusions performed in Neonatal Intensive Care Units (NICUs) are for medically stable pre-term infants with anaemia of prematurity, with the aim of improving oxygen delivery to the vital organs during the crucial phase of growth and development. However, despite the frequency of transfusion in this population, the potential benefits and harms of 'top up' transfusion are not fully understood, leading to practice variation between clinicians, institutions and countries. Significant advances have been made in the prevention of anaemia of prematurity, with recent emphasis on optimising infants' circulatory volume at birth via placental transfusion and preserving infants' own blood volume through innovative minimal sampling techniques. More research is urgently needed to establish optimal transfusion thresholds for these high-risk pre-term infants, for whom benefits as well as adverse outcomes may have consequences that extend for decades throughout the recipients' life-course. In this review, we will discuss some of the consensus and controversies regarding optimal management of anaemia in pre-term infants and highlight potential areas for future research.
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Affiliation(s)
- Maria Saito-Benz
- Neonatal Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand.,Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | | | - Mary J Berry
- Neonatal Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand.,Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand.,Centre for Translational Physiology, University of Otago, Wellington, New Zealand
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31
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Abstract
Virtual reality is an innovative solution in simulation when it is used to reinforce caregivers' skills. A health facility has set up a continuing professional development programme using this technique. It has enabled caregivers to reinforce their skills in the area of blood transfusion safety.
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32
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Simpson JD, Hopkins A, Amil A, Ross B, Enjeti AK. Transfusion-associated circulatory overload in ambulatory patients. Vox Sang 2019; 114:216-222. [PMID: 30734301 DOI: 10.1111/vox.12753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/28/2018] [Accepted: 12/24/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Transfusion-associated circulatory overload is a leading cause of transfusion-related adverse events. The frequency and risks for transfusion-associated circulatory overload in ambulatory haematology patients are not known. MATERIALS AND METHODS A retrospective cohort analysis of ambulatory patients transfused in a tertiary haematology centre, using medical records and an electronic transfusion database, was undertaken between January and December 2014. Variables studied included age, gender, diagnosis, heart failure, kidney disease and details of transfusions. Transfusion-associated circulatory overload was defined according to proposed International Society of Blood Transfusion criteria. Patients with clinical evidence of hypervolaemia, not meeting the TACO definition and/or who were prescribed otherwise unscheduled diuretic agent, were collectively deemed to be at 'risk of clinically significant hypervolaemia' (ROCSH). RESULTS In the study period, 93 ambulatory patients (male = 49, female = 44, mean age = 75·89 ± 11·37 years) attended 715 transfusion encounters, totalling 1536 packed red cell units. No cases of TACO occurred whilst 'ROCSH' events occurred in 57/715 (8%) of transfusion encounters. In a univariate model, age was significantly associated with 'ROCSH', odds ratio = 1·05 (P = 0·017 95%, CI 1·01-1·09) and no factors were significant on multivariate analysis. CONCLUSIONS Transfusion-associated circulatory overload occurs infrequently haematology patients receiving ambulatory blood transfusions. To our knowledge, this is the first study to report on occurrence and risk factors for circulatory overload in ambulatory transfusions. This study provides vital baseline data for future prospective studies on this important aspect of haemovigilance.
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Affiliation(s)
- Jock D Simpson
- Haematology Department, Calvary Mater Newcastle, Waratah, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Adam Hopkins
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Adilah Amil
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Bryony Ross
- Haematology Department, Calvary Mater Newcastle, Waratah, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,NSW Health Pathology - Hunter, New Lambton Heights, NSW, Australia
| | - Anoop K Enjeti
- Haematology Department, Calvary Mater Newcastle, Waratah, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,NSW Health Pathology - Hunter, New Lambton Heights, NSW, Australia.,Hunter Medical Research Institute, New Lambton, NSW, Australia.,Hunter Cancer Research Alliance, Callaghan, NSW, Australia
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33
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Wood EM, Ang AL, Bisht A, Bolton-Maggs PH, Bokhorst AG, Flesland O, Land K, Wiersum-Osselton JC, Schipperus MR, Tiberghien P, Whitaker BI. International haemovigilance: what have we learned and what do we need to do next? Transfus Med 2019; 29:221-230. [PMID: 30729612 DOI: 10.1111/tme.12582] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 11/05/2018] [Accepted: 01/12/2019] [Indexed: 02/06/2023]
Abstract
The International Haemovigilance Network (IHN) defines haemovigilance as 'a set of surveillance procedures covering the whole transfusion chain (from the collection of blood and its components to the follow-up of recipients), intended to collect and assess information on unexpected or undesirable effects resulting from the therapeutic use of labile blood products, and to prevent their occurrence or recurrence'. IHN, the International Society of Blood Transfusion and World Health Organization work together to support both developing and established haemovigilance systems. Haemovigilance systems provide valuable data on a range of adverse events related to blood donation and clinical transfusion, from donor syncopal events to transfusion-transmitted infections, immunological complications and the impact of human errors. Harmonised definitions for most adverse reactions have been developed and validated internationally. Definitions of pulmonary complications are again under review. Haemovigilance data have resulted in changes in policy, products and practice, and can complement and inform clinical audit and research, leading to improved blood donor safety, optimised product use and better clinical outcomes after transfusion. However, more work is needed. Not all countries have haemovigilance systems in place. More robust data and careful analysis are required to improve the understanding of the causes, occurrence and clinical outcomes of these events. Wider dissemination of results will facilitate health policy development internationally, and implementation of haemovigilance recommendations will support further important progress in blood safety.
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Affiliation(s)
- E M Wood
- Transfusion Research Unit, Monash University, Melbourne, Victoria, Australia.,Department of Clinical Haematology, Monash Health, Melbourne, Victoria, Australia
| | - A L Ang
- Blood Services Group, Health Sciences Authority, Singapore.,Department of Haematology, Singapore General Hospital, Singapore
| | - A Bisht
- Haemovigilance Programme of India, National Institute of Biologicals, Ministry of Health & Family Welfare, Noida, India
| | - P H Bolton-Maggs
- Serious Hazards of Transfusion, Manchester, UK.,University of Manchester, Manchester, UK
| | - A G Bokhorst
- Transfusion and Transplantation Reactions in Patients (TRIP), National Haemovigilance and Biovigilance Office, Leiden, The Netherlands
| | - O Flesland
- Norwegian Directorate of Health, Oslo, Norway
| | - K Land
- Blood Systems Inc., Tempe, Arizona, USA.,Department of Pathology, University of Texas Health Science Center, San Antonio, Texas, USA
| | - J C Wiersum-Osselton
- Transfusion and Transplantation Reactions in Patients (TRIP), National Haemovigilance and Biovigilance Office, Leiden, The Netherlands
| | - M R Schipperus
- Transfusion and Transplantation Reactions in Patients (TRIP), National Haemovigilance and Biovigilance Office, Leiden, The Netherlands.,Department of Haematology, Haga Teaching Hospital, The Hague, The Netherlands
| | - P Tiberghien
- Etablissement Français du Sang, La Plaine St Denis, France.,Université de Franche-Comté, Inserm, EFS, UMR 1098, Besançon, France
| | - B I Whitaker
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Review US Food & Drug Administration, Silver Spring, Maryland, USA
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Folléa G. [Transfusion practice: what's new?]. Rev Prat 2018; 68:1025-1028. [PMID: 30869365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Transfusion practice: what's new? Among many novelties in the field of transfusion, three are particularly noteworthy, as they significantly impact clinical practice of blood components transfusion and patients' safety. Patient blood management, evidence based and multidisciplinary, aims to optimize the management of each patient who may require transfusion. A medical and rational application of restrictive transfusion policies combined with alternatives to transfusion will lead to both better patient management and a reduction in exposure to blood components and related risks. Multidisciplinary training on prescribing and transfusion counseling, a suitable haemovigilance and a developed clinical research will support the development of patient blood management. The application of mitigation methods for infectious agents is now widespread for platelets and therapeutic plasma. And the concomitant transfusion of plasma, platelets and red blood cells has become a therapeutic standard for patients with severe haemorrhagic shock.
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Affiliation(s)
- Gilles Folléa
- Société française de transfusion sanguine, Paris, France
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Bolton-Maggs PHB. Serious hazards of transfusion - conference report: celebration of 20 years of UK haemovigilance. Transfus Med 2018; 27:393-400. [PMID: 29282809 DOI: 10.1111/tme.12502] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/16/2017] [Accepted: 12/04/2017] [Indexed: 11/29/2022]
Abstract
The Annual SHOT Report for incidents in 2016 was published on July 12 and celebrated of 20 years of UK haemovigilance. Components are very safe, related in part to risk-reduction measures triggered by SHOT reporting. Transfusion-related acute lung injury is now very rare (all plasma components are provided from male donors), and infection transmission is also uncommon - a single transmission of hepatitis E in 2016 and no bacterial transmissions. Human factors (errors) account for 87% of all reports. Deaths and major morbidity most often result from transfusion-associated circulatory overload. Wrong transfusions and deaths from ABO-incompatible transfusion can be reduced by correct bedside checks. It is notable that information technology systems may not be safe. Standardisation is required for flags and alerts. SHOT key recommendations include: assess patients for transfusion-associated circulatory overload prior to transfusion. Be like a pilot - use a bedside checklist when setting up the transfusion.
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Affiliation(s)
- P H B Bolton-Maggs
- Serious Hazards of Transfusion, SHOT Office, Manchester Blood Centre, Manchester, UK
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36
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Akers C, Savoia H, Kane S, Crispin P, Keegan A, Wood E, Glazebrook B, Bielby L, Davis AK. Misinterpretation of blood group and antibody screen leading to serious errors in RhD immunoglobulin administration: A report on first two years of data from Serious Transfusion Incident Reporting program. Aust N Z J Obstet Gynaecol 2018; 59:161-164. [PMID: 30187454 DOI: 10.1111/ajo.12889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 07/29/2018] [Indexed: 11/26/2022]
Abstract
The Serious Transfusion Incident Reporting program (STIR) commenced haemovigilance in relation to RhD immunoglobulin (Ig) administration in 2015. During two years of reporting, 21 reports relating to RhD Ig administration were received. Thirty-three percent (7/21) were related to omission of RhD Ig, putting women at risk of RhD alloimmunisation and adverse consequences in future pregnancies. A recent case reported to STIR highlights poor communication and misinterpretation of pathology results leading to significant morbidity from haemolysis in the fetus. STIR makes recommendations related to education of staff and communication between clinical and laboratory staff to improve the safety of patient care.
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Affiliation(s)
- Christine Akers
- Blood Matters, Department of Health and Human Services, Serious Transfusion Incident Reporting Program, Melbourne, Victoria, Australia.,Blood Matters Program, Melbourne, Victoria, Australia
| | - Helen Savoia
- Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Stefan Kane
- Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Philip Crispin
- Blood Matters, Department of Health and Human Services, Serious Transfusion Incident Reporting Program, Melbourne, Victoria, Australia.,The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Anastazia Keegan
- Blood Matters, Department of Health and Human Services, Serious Transfusion Incident Reporting Program, Melbourne, Victoria, Australia.,Australian Red Cross Blood Service, Melbourne, Victoria, Australia
| | - Erica Wood
- Blood Matters, Department of Health and Human Services, Serious Transfusion Incident Reporting Program, Melbourne, Victoria, Australia.,School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bridget Glazebrook
- Blood Matters, Department of Health and Human Services, Serious Transfusion Incident Reporting Program, Melbourne, Victoria, Australia.,Blood Matters Program, Melbourne, Victoria, Australia
| | - Linley Bielby
- Blood Matters, Department of Health and Human Services, Serious Transfusion Incident Reporting Program, Melbourne, Victoria, Australia.,Blood Matters Program, Melbourne, Victoria, Australia
| | - Amanda K Davis
- Blood Matters, Department of Health and Human Services, Serious Transfusion Incident Reporting Program, Melbourne, Victoria, Australia.,Alfred Hospital, Melbourne, Victoria, Australia
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Bielby L, Moss RL. Patient blood management and the importance of the Transfusion Practitioner role to embed this into practice. Transfus Med 2018; 28:98-106. [PMID: 29660827 DOI: 10.1111/tme.12526] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/12/2018] [Accepted: 03/18/2018] [Indexed: 11/28/2022]
Abstract
Patient blood management (PBM) is a widely established international initiative, with a multidisciplinary approach to reduce transfusion. The Transfusion Practitioner1 (TP) role is well embedded in the United Kingdom (UK) and Australia. The value of the TP in changing both culture and practice to implement an all-inclusive PBM approach to care will be discussed. The TP role was born from both a safety and haemovigilance culture, where the greatest identified risk to the patient undergoing a transfusion was human error. From this initial trigger for improved safety, the TP role has evolved to a multifaceted, highly specialised role, involved in both PBM and transfusion processes. As the transfusion paradigm shifted from product to patient, the TP role evolved to include PBM, with an emphasis on the patients and the impact transfusion has on them. A multidisciplinary team is required to drive both PBM and transfusion; the TP is recognised as a critical link in the multidisciplinary team. They are seen as a driving force for change, bridging the gap between the laboratory and clinical arenas. The TP plays a vital role in helping establish and embed PBM that improves patient and safety outcomes.
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Affiliation(s)
- L Bielby
- Department of Health and Human Services, Victoria and the Australian Red Cross Blood Service, Melbourne, Australia
| | - R L Moss
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Bosboom JJ, Klanderman RB, Peters AL, van de Weerdt EK, Goudswaard EJ, Binnekade JM, Zwaginga JJ, Beckers EAM, Geerts BF, Hollmann MW, Zeerleder SS, van Kraaij M, Vlaar AP. The practice of diagnosing and reporting transfusion-associated circulatory overload: a national survey among physicians and haemovigilance officers. Transfus Med 2017; 28:363-370. [PMID: 29058354 DOI: 10.1111/tme.12480] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/25/2017] [Accepted: 09/16/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aims at identifying factors that disciplines consider when diagnosing and reporting transfusion-associated circulatory overload ('TACO'). BACKGROUND TACO is a clinical diagnosis based mainly on subjective factors. Therefore, TACO could be an underreported complication of blood transfusion. METHODS A survey was conducted among critical care physicians, anaesthesiologists, haematologists, transfusion medicine physicians and haemovigilance officers using case vignettes and a questionnaire. Factors that may affect diagnosing TACO were investigated using conjoint analysis. A positive B-coefficient indicates a positive preference for diagnosing TACO. Participants rated factors influencing reporting TACO on a 0- to 100-point scale. RESULTS One hundred and seven surveys were returned (62%). Vignettes showed preferences in favour of diagnosing TACO with the onset of symptoms within 2 h [β 0·4(-0·1-1·0)], positive fluid balance [β 0·9(0·4-1·5)] and history of renal failure [β 0·6(0·1-1·2)]. Compared with transfusion of a single unit of red blood cells (RBC), respondents showed a preference for diagnosing TACO following a single unit of solvent/detergent (S/D) plasma or pooled platelet concentrate (PPC) [β 0·3(-0·2-0·7) resp. 0·5(-0·1-1·2)]. Multiple transfusion (6 RBC + 4 S/D plasma) was a strong preference for diagnosing TACO compared to 1 RBC and 1 S/D plasma [β 0·3(-0·8-1·3)]. Respondents did not fully take into account new hypertension and tachycardia when reporting TACO [median 70 (IQR 50-80) resp. 60 (IQR 50-80)]. No differences were observed between disciplines involved. CONCLUSION When diagnosing and reporting TACO, physicians and haemovigilance officers do consider known risk factors for TACO. Reporting could be improved by increasing the awareness of haemodynamic variables in future education programmes.
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Affiliation(s)
- J J Bosboom
- Department of Anaesthesiology, Academic Medical Centre, Amsterdam, the Netherlands
| | - R B Klanderman
- Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam, the Netherlands.,Laboratory of Experimental Intensive Care and Anaesthesiology (L.E.I.C.A.), Academic Medical Centre, Amsterdam, the Netherlands
| | - A L Peters
- Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam, the Netherlands.,Laboratory of Experimental Intensive Care and Anaesthesiology (L.E.I.C.A.), Academic Medical Centre, Amsterdam, the Netherlands
| | - E K van de Weerdt
- Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam, the Netherlands
| | - E J Goudswaard
- Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam, the Netherlands
| | - J M Binnekade
- Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam, the Netherlands
| | - J J Zwaginga
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Centre, Leiden, the Netherlands.,Centre for Clinical Transfusion Research, Sanquin Blood Supply, Sanquin Research, Leiden, the Netherlands
| | - E A M Beckers
- Department of Internal Medicine - Haematology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - B F Geerts
- Department of Anaesthesiology, Academic Medical Centre, Amsterdam, the Netherlands
| | - M W Hollmann
- Department of Anaesthesiology, Academic Medical Centre, Amsterdam, the Netherlands.,Laboratory of Experimental Intensive Care and Anaesthesiology (L.E.I.C.A.), Academic Medical Centre, Amsterdam, the Netherlands
| | - S S Zeerleder
- Department of Internal Medicine - Haematology, Academic Medical Centre, Amsterdam, the Netherlands
| | - M van Kraaij
- Centre for Clinical Transfusion Research, Sanquin Blood Supply, Sanquin Research, Leiden, the Netherlands
| | - A P Vlaar
- Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam, the Netherlands.,Laboratory of Experimental Intensive Care and Anaesthesiology (L.E.I.C.A.), Academic Medical Centre, Amsterdam, the Netherlands
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Noens L, Vilariño MD, Megalou A, Qureshi H. International, prospective haemovigilance study on methylene blue-treated plasma. Vox Sang 2017; 112:352-359. [PMID: 28345172 DOI: 10.1111/vox.12510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 12/27/2016] [Accepted: 02/11/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Methylene blue is a phenothiazine dye, which in combination with visible light has virucidal and bactericidal properties, disrupting the replication of a broad range of enveloped viruses and some non-enveloped viruses. The study objective was to collect data on adverse reactions occurring with methylene blue plasma administered in a routine clinical practice environment and document their characteristics and severity. MATERIALS AND METHODS This was an open label, multicentre, non-controlled, non-randomized, non-interventional study. Patients who receive a methylene blue plasma transfusion were observed for any signs and symptoms (adverse reactions) within 24 h safter the start of the transfusion, in different hospitals for a study duration of at least 1 year. RESULTS A total of 19 315 methylene blue plasma units were transfused. There were eight patients with adverse reactions recorded during the study, one of them serious. Two had more than one reaction (two and four, respectively). Three patients had previous transfusions with methylene blue plasma only. CONCLUSION Methylene blue plasma has a very acceptable safety profile with a rate of serious adverse reactions of 0·5/10 000 units.
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Affiliation(s)
- L Noens
- Universitair Ziekenhuis, Gent, Belgium
| | - Ma D Vilariño
- Complejo Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - A Megalou
- Evaggelismos General Hospital of Athens, Athens, Greece
| | - H Qureshi
- University Hospitals of Leicester NHS Trust, Leicester, UK
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Shih AW, Jamula E, Diep C, Lin Y, Armali C, Heddle NM, Traore A, Doherty J, Shah N, Hillis CM. Audit of provincial IVIG Request Forms and efficacy documentation in four Ontario tertiary care centres. Transfus Med 2017; 27:122-131. [PMID: 28144996 DOI: 10.1111/tme.12391] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/29/2016] [Accepted: 12/30/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Retrospective audit of IVIG Request Forms in four Ontario tertiary care centres: to determine the case mix of new IVIG requests, to authenticate information provided, and to determine documentation of clinical efficacy. AIMS To understand contributors to increases in IVIG utilisation and to determine whether IVIG is being used and monitored appropriately. INTRODUCTION Intravenous immunoglobulin (IVIG) use in Canada is high compared with other developed countries. We performed a retrospective audit of new IVIG Request Forms across four tertiary care centres in Ontario, one with an active surveillance programme, to determine the case mix, authenticate information provided and assess documentation of efficacy. METHODS Consecutive adult patients with a first-time IVIG request in 2014 were included. The ordering physician specialty, form completeness, documentation of diagnostic criteria for the medical condition and indication for IVIG use and documentation of efficacy were assessed by form and chart review. RESULTS Of 178 patients, the most common indications for IVIG were immune thrombocytopenia (24.2%) and secondary immune deficiency (20.2%). The most frequent prescribers were haematologists (37.6%) and neurologists (10.7%). Other conditions not listed on the form represented 24.2% of cases, with most not indicated in current guidelines. A total of 32.6% of cases overall lacked verification of diagnostic criteria and 51.7% lacked verification for IVIG utilisation criteria, with the number of cases meeting criteria based on documentation being higher at the active surveillance site (P = 0.005). A total of 19.1% of cases had a discrepancy between the indication written on the form and the documented clinical diagnosis. A total of 18.7% of clinic notes following IVIG had no mention of efficacy. CONCLUSION Our audit demonstrates a lack of compliance with IVIG Request Form requirements, a lack of documentation of diagnostic criteria and efficacy, and suggests inappropriate use of IVIG. Current implementation of the form may not be sufficient as a strategy for improving appropriate IVIG use.
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Affiliation(s)
- A W Shih
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - E Jamula
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - C Diep
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Y Lin
- Department of Clinical Pathology, Sunnybrook Health Sciences Centre and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - C Armali
- Department of Clinical Pathology, Sunnybrook Health Sciences Centre and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - N M Heddle
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada.,Centre for Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - A Traore
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - J Doherty
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - N Shah
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - C M Hillis
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada.,Department of Oncology, McMaster University, Hamilton, Ontario, Canada
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Owusu-Ofori AK, Owusu-Ofori SP, Bates I. Detection of adverse events of transfusion in a teaching hospital in Ghana. Transfus Med 2017; 27:175-180. [PMID: 28139022 DOI: 10.1111/tme.12392] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 12/30/2016] [Accepted: 01/04/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Monitoring the whole chain of events from the blood donors to recipients, documenting any undesirable or untoward effects and introducing measures to prevent their recurrence if possible are components of haemovigilance systems. Only few sub-Saharan African countries have haemovigilance systems, and there are very little data on adverse events of transfusion. Adverse events monitoring is an integral part of a haemovigilance system. Our study aimed to establish the incidence and types of adverse events of transfusions in Ghana and to identify interventions to improve effectiveness. MATERIALS AND METHODS This prospective observational 1-year study enrolled 372 recipients of 432 transfusions in a Ghanaian teaching hospital. Vital signs were monitored at 15, 30 and 60 min intervals during the transfusion, then 8 h until 24 h post-transfusion. Three investigators independently classified any new signs and symptoms according to Serious Hazards of Transfusion definitions. RESULTS The adverse events incidence was 21·3% (92/432), predominantly mild acute transfusion reactions (84%). A total of 20 transfusions (4·6%) were stopped before completion, 60% of them for mild febrile reactions, which could have been managed with transfusion in situ. CONCLUSION This prospective study indicates a high incidence of adverse events of transfusion in Kumasi, Ghana. The significant numbers of discontinued transfusions suggest that guidelines on how to manage transfusion reactions would help preserve scarce blood stocks. Gradual implementation of a haemovigilance system, starting with monitoring adverse transfusion events, is a pragmatic approach in resource-limited settings.
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Affiliation(s)
- A K Owusu-Ofori
- Department of Clinical Microbiology, Kwame Nkrumah University of Science of Technology, Kumasi, Ghana.,University of Kwazulu-Natal, Westville, South Africa
| | - S P Owusu-Ofori
- Transfusion Medicine Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - I Bates
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Amato M, Schennach H, Astl M, Chen CY, Lin JS, Benjamin RJ, Nussbaumer W. Impact of platelet pathogen inactivation on blood component utilization and patient safety in a large Austrian Regional Medical Centre. Vox Sang 2016; 112:47-55. [PMID: 28001297 DOI: 10.1111/vox.12456] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/06/2016] [Accepted: 09/07/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND In clinical studies, pathogen inactivation (PI) of platelet concentrates (PC) with amotosalen and UVA light did not impact patient risk for haemorrhage but may affect transfusion frequency and component utilization. We evaluated the influence of platelet PI on PC, red cell concentrate (RCC) and plasma use and safety in routine practice in a large regional hospital. STUDY DESIGN AND METHODS Comparative effectiveness of conventional vs. PI-treated PC was analysed during two 21-month periods, before and after PI implementation. RESULTS Similar numbers of patients were transfused in the pre-PI (control, 1797) and post-PI (test, 1694) periods with comparable numbers of PC (8611 and 7705, respectively). The mean numbers of PC per patient transfused (4·8 vs. 4·5, P = 0·43) were not different but days of PC support (5·9 vs. 5·0, P < 0·01) decreased. Most patients received RCC (86·8% control vs. 84·8% test, P = 0·90) with similar mean numbers transfused (10·8 vs. 10·2 RCC, P = 0·22), and fewer patients (55·4% control vs. 44·7% test, P < 0·01) received less plasma units (mean 9·9 vs. 7·8, respectively, P < 0·01) in the test period. The frequencies of transfusion-related adverse events (AE) were comparable (1·3% vs. 1·4%, P = 0·95). Analysis of haematology-oncology (522 control, 452 test), cardiac surgery (739 control, 711 test), paediatric (157 control, 130 test) and neonate (23 control, 20 test) patients revealed no increase in PC, plasma and RCC utilization, or AE. CONCLUSION Component utilization and patient safety were not impacted by adoption of PI for PC. RCC use per patient was comparable, suggestive of no increase in significant bleeding.
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Affiliation(s)
- M Amato
- Central Institute for Blood Transfusion and Immunology, Medical University Hospital Innsbruck, Innsbruck, Austria
| | - H Schennach
- Central Institute for Blood Transfusion and Immunology, Medical University Hospital Innsbruck, Innsbruck, Austria
| | - M Astl
- Central Institute for Blood Transfusion and Immunology, Medical University Hospital Innsbruck, Innsbruck, Austria
| | - C Y Chen
- Cerus Corporation, Concord, CA, USA
| | - J-S Lin
- Cerus Corporation, Concord, CA, USA
| | | | - W Nussbaumer
- Central Institute for Blood Transfusion and Immunology, Medical University Hospital Innsbruck, Innsbruck, Austria
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Politis C, Wiersum JC, Richardson C, Robillard P, Jorgensen J, Renaudier P, Faber JC, Wood EM. The International Haemovigilance Network Database for the Surveillance of Adverse Reactions and Events in Donors and Recipients of Blood Components: technical issues and results. Vox Sang 2016; 111:409-417. [PMID: 27658188 DOI: 10.1111/vox.12447] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 08/03/2016] [Accepted: 08/09/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES The International Haemovigilance Network's ISTARE is an online database for surveillance of all adverse reactions (ARs) and adverse events (AEs) associated with donation of blood and transfusion of blood components, irrespective of severity or the harm caused. ISTARE aims to unify the collection and sharing of information with a view to harmonizing best practices for haemovigilance systems around the world. MATERIALS AND METHODS Adverse reactionss and adverse events are recorded by blood component, type of reaction, severity and imputability to transfusion, using internationally agreed standard definitions. RESULTS From 2006 to 2012, 125 national sets of annual aggregated data were received from 25 countries, covering 132.8 million blood components issued. The incidence of all ARs was 77.5 per 100 000 components issued, of which 25% were severe (19.1 per 100 000). Of 349 deaths (0.26 per 100 000), 58% were due to the three ARs related to the respiratory system: transfusion-associated circulatory overload (TACO, 27%), transfusion-associated acute lung injury (TRALI, 19%) and transfusion-associated dyspnoea (TAD, 12%). Cumulatively, 594 477 donor complications were reported (rate 660 per 100 000), of which 2.9% were severe. CONCLUSIONS ISTARE is a well-established surveillance tool offering important contributions to international efforts to maximize transfusion safety.
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Affiliation(s)
- C Politis
- Coordinating Haemovigilance Centre (SKAE), Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - J C Wiersum
- TRIP National Hemovigilance and Biovigilance Office, Leiden, The Netherlands
| | - C Richardson
- Panteion University of Social and Political Sciences, Athens, Greece
| | | | - J Jorgensen
- Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | | | - J-C Faber
- LuxConsulTrans®, Banglamung, Thailand
| | - E M Wood
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic., Australia
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Abstract
Background: With the implementation of NAT in countries around the world, there is a growing pressure on the transfusion services in India to adopt NAT testing. India has about 2545 licensed Blood Centres. The Transfusion Services in India are fragmented, poorly regulated and the quality standards are poorly implemented. Blood Centres are still dependent on replacement/family donors and in most places laboratory testing for Transfusion transmitted infections is not quality assured, laboratory equipment are not calibrated and maintained, and validation of results is not carried out. Against the current scenario introducing NAT for screening of blood donors in India would pose a challenge. Aim: To study the prudence of universal NAT testing in India. Materials and Methods: A retrospective study of 5 years from 2008-2012 was undertaken to study the true reactivity of donors using WHO strategy II and III and therefore the true seroprevalence of TTI infections in the donor populations. Results: The true reactivity of the donors was much less as compared to the initially reactive donors due to the use of a well designed testing algorithm. In addition having a total voluntary blood collection along with good pre-donation counseling program also reduces the transmission of infections. Conclusions: What India essentially needs to do is religiously implement the strategies outlined in the WHO Aide-memoire. The blood should be collected only from voluntary non remunerative and repeat donors, there should be stringent donor selection with pre-donation counseling instituted. Strict implementation of quality management system, development of well defined testing startegies and strong haemovigilance system could take us a step in the right direction.
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Affiliation(s)
- N K Naidu
- Medical Director, Indian Red Cross Society, Bombay City Branch Blood Centre, Mumbai, India
| | - Z S Bharucha
- Chairperson, Indian Red Cross Society, Bombay City Branch Blood Centre, Mumbai, India
| | - Vandana Sonawane
- Technical Supervisor, Indian Red Cross Society, Bombay City Branch Blood Centre, Mumbai, India
| | - Imran Ahmed
- Technologist, Indian Red Cross Society, Bombay City Branch Blood Centre, Mumbai, India
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Rogers MAM, Rohde JM, Blumberg N. Haemovigilance of reactions associated with red blood cell transfusion: comparison across 17 Countries. Vox Sang 2015; 110:266-77. [PMID: 26689441 PMCID: PMC7169273 DOI: 10.1111/vox.12367] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/05/2015] [Accepted: 10/30/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES The recent establishment of the National Healthcare Safety Network Hemovigilance Module in the United States affords an opportunity to compare results with those of other developed nations. MATERIALS AND METHODS Using data from national haemovigilance systems, reactions associated with red blood cell (RBC) transfusion and residual risks of transfusion-transmitted infectious diseases were assembled from 17 nations. Country-specific rates of adverse events were pooled using random-effects Poisson regression. RESULTS Febrile non-haemolytic and delayed serologic transfusion reactions were the most frequent adverse events reported after RBC transfusion, occurring in 26 patients per 100 000 RBC units and 25 patients per 100 000 RBC units administered, respectively. Rates of allergic, febrile non-haemolytic and delayed haemolytic transfusion reactions in the United States were significantly greater than the pooled rates from other countries. Frequencies of adverse events generated from the national haemovigilance programme in the United States were considerably lower than when obtained through active surveillance. CONCLUSION Haemovigilance reports of adverse events in the United States are comparable to, or greater than, reports from other developed countries. Rates generated from haemovigilance programmes are lower than those obtained through active surveillance. The lack of universal leucoreduction of RBC units may be a contributing factor to the higher rate of some adverse events in the United States.
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Affiliation(s)
- M A M Rogers
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Patient Safety Enhancement Program, Veterans Administration Ann Arbor Medical Center, University of Michigan, Ann Arbor, Michigan, USA
| | - J M Rohde
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - N Blumberg
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, New York, USA
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Knutson F, Osselaer J, Pierelli L, Lozano M, Cid J, Tardivel R, Garraud O, Hervig T, Domanovic D, Cukjati M, Gudmundson S, Hjalmarsdottir IB, Castrillo A, Gonzalez R, Brihante D, Santos M, Schlenke P, Elliott A, Lin JS, Tappe D, Stassinopoulos A, Green J, Corash L. A prospective, active haemovigilance study with combined cohort analysis of 19,175 transfusions of platelet components prepared with amotosalen-UVA photochemical treatment. Vox Sang 2015; 109:343-52. [PMID: 25981525 PMCID: PMC4690512 DOI: 10.1111/vox.12287] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 03/24/2015] [Accepted: 03/27/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES A photochemical treatment process (PCT) utilizing amotosalen and UVA light (INTERCEPT(™) Blood System) has been developed for inactivation of viruses, bacteria, parasites and leucocytes that can contaminate blood components intended for transfusion. The objective of this study was to further characterize the safety profile of INTERCEPT-treated platelet components (PCT-PLT) administered across a broad patient population. MATERIALS AND METHODS This open-label, observational haemovigilance programme of PCT-PLT transfusions was conducted in 21 centres in 11 countries. All transfusions were monitored for adverse events within 24 h post-transfusion and for serious adverse events (SAEs) up to 7 days post-transfusion. All adverse events were assessed for severity (Grade 0-4), and causal relationship to PCT-PLT transfusion. RESULTS Over the course of 7 years in the study centres, 4067 patients received 19,175 PCT-PLT transfusions. Adverse events were infrequent, and most were of Grade 1 severity. On a per-transfusion basis, 123 (0.6%) were classified an acute transfusion reaction (ATR) defined as an adverse event related to the transfusion. Among these ATRs, the most common were chills (77, 0.4%) and urticaria (41, 0.2%). Fourteen SAEs were reported, of which 2 were attributed to platelet transfusion (<0.1%). No case of transfusion-related acute lung injury, transfusion-associated graft-versus-host disease, transfusion-transmitted infection or death was attributed to the transfusion of PCT-PLT. CONCLUSION This longitudinal haemovigilance safety programme to monitor PCT-PLT transfusions demonstrated a low rate of ATRs, and a safety profile consistent with that previously reported for conventional platelet components.
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Affiliation(s)
- F Knutson
- Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden
| | - J Osselaer
- Cliniques Universitaires de Mont Godinne, Universite Catholique de Louvain, Yvoir, Belgium
| | - L Pierelli
- Department of Experimental Medicine, Sapienza University of Roma, Rome, Italy
| | - M Lozano
- Department of Hemotherapy and Hemostasis, CDB, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | - J Cid
- Department of Hemotherapy and Hemostasis, CDB, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | | | - O Garraud
- EFS Auvergne Loire, St. Etienne, France
| | - T Hervig
- Department of Immunology and Transfusion Medicine, University of Bergen, Bergen, Norway
| | - D Domanovic
- Blood Transfusion Centre of Slovenia, Ljubljana, Slovenia
| | - M Cukjati
- Blood Transfusion Centre of Slovenia, Ljubljana, Slovenia
| | - S Gudmundson
- Blood Bank, National University Hospital, Reykjavik, Iceland
| | | | - A Castrillo
- Transfusion Centre of Galicia, Santiago de Compostela, Spain
| | - R Gonzalez
- Transfusion Centre of Galicia, Santiago de Compostela, Spain
| | - D Brihante
- Servico de Imuno-Hemoterapia, Instituto Portugues de Oncologia de Lisboa, Lisbon, Portugal
| | - M Santos
- Servico de Imuno-Hemoterapia, Instituto Portugues de Oncologia de Lisboa, Lisbon, Portugal
| | - P Schlenke
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | | | - J-S Lin
- Cerus Corporation, Concord, CA, USA
| | - D Tappe
- Cerus Corporation, Concord, CA, USA
| | | | - J Green
- Cerus Corporation, Concord, CA, USA
| | - L Corash
- Cerus Corporation, Concord, CA, USA
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47
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Bolton-Maggs PHB. Conference report: the 2015 SHOT symposium and report--what's new? Transfus Med 2015; 25:295-8. [PMID: 26498582 DOI: 10.1111/tme.12257] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/26/2015] [Accepted: 09/28/2015] [Indexed: 12/13/2022]
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48
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Goldman M, Land K, Robillard P, Wiersum-Osselton J. Development of standard definitions for surveillance of complications related to blood donation. Vox Sang 2015; 110:185-8. [PMID: 26361365 DOI: 10.1111/vox.12323] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/20/2015] [Accepted: 07/21/2015] [Indexed: 11/28/2022]
Abstract
Standard definitions of donor reactions allow each blood establishment to monitor donor adverse events and compare with other organizations to develop best practices. The ISBT Haemovigilance Working Party leads a multi-organizational effort to update the 2008 ISBT standard for surveillance of complications related to blood donation. Revised definitions have been developed and endorsed by the ISBT, AABB, International Haemovigilance Network (IHN) and other international organizations.
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Affiliation(s)
- M Goldman
- Canadian Blood Services, Ottawa, ON, Canada
| | - K Land
- Blood Systems Inc., Scottsdale, AZ, USA
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49
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Bost V, Chavarin P, Boussoulade F, Fabrigli P, Chabre C, Benamara H, Odent-Malaure H, Legrand D, Cognasse F, Garraud O. Independent evaluation of tolerance of therapeutic plasma inactivated by amotosalen-HCl-UVA (Intercept ™) over a 5-year period of extensive delivery. Vox Sang 2015; 109:414-6. [PMID: 26031441 DOI: 10.1111/vox.12300] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 04/22/2015] [Accepted: 04/23/2015] [Indexed: 11/29/2022]
Abstract
Amotosalen-HCl-UVA (AI) is a process to inactivate pathogens in therapeutic plasma (FFP). Tolerance is the main residual issue in FFP transfusion, and only large series observations are powered enough to identify significantly elevated levels of hazards. We report here on 15,133 new transfusions of AI-FFP, over the previously published 36,035, which in all represents one of the largest series observed by means of a highly standardized surveillance (51.168 observations). There is no noticeable difference in terms of tolerance of AI-FFP compared to 5875 transfusions of Quarantine (Q)-FFP. There was no significant difference in terms of advance events, between the two types of FFP (P = 0.98); further, no difference was recorded either when the total number of AI-FFP (51,168) was compared to the corresponding number of Q-FFP (5875; P = 0.62).
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Affiliation(s)
- V Bost
- Etablissement Français du Sang Auvergne-Loire, Saint-Etienne, France
| | - P Chavarin
- Etablissement Français du Sang Auvergne-Loire, Saint-Etienne, France
| | - F Boussoulade
- Etablissement Français du Sang Auvergne-Loire, Saint-Etienne, France
| | - P Fabrigli
- Etablissement Français du Sang Auvergne-Loire, Saint-Etienne, France
| | - C Chabre
- Etablissement Français du Sang Auvergne-Loire, Saint-Etienne, France
| | - H Benamara
- Etablissement Français du Sang Auvergne-Loire, Saint-Etienne, France
| | - H Odent-Malaure
- Etablissement Français du Sang Auvergne-Loire, Saint-Etienne, France
| | - D Legrand
- Etablissement Français du Sang Auvergne-Loire, Saint-Etienne, France
| | - F Cognasse
- Etablissement Français du Sang Auvergne-Loire, Saint-Etienne, France.,GIMAP-EA3064, Université de Lyon, Saint Etienne, France
| | - O Garraud
- GIMAP-EA3064, Université de Lyon, Saint Etienne, France.,Institut National de la Transfusion Sanguine, Paris, France
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50
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El Kenz H, Corazza F. Automated point-of-care testing for ABO agglutination test: proof of concept and validation. Vox Sang 2015; 109:79-85. [PMID: 25766458 DOI: 10.1111/vox.12248] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 12/12/2014] [Accepted: 12/15/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES ABO-incompatible red blood cell transfusions still represent an important hazard in transfusion medicine. Therefore, some countries have introduced a systematic bedside ABO agglutination test checking that the right blood is given to the right patient. However, this strategy requires an extremely time-consuming learning programme and relies on a subjective interpretation of ABO test cards agglutination. We developed a prototype of a fully automated device performing the bedside agglutination test that could be completed by reading of a barcoded wristband. This POCT checks the ABO compatibility between the patient and the blood bag. MATERIALS AND METHODS Proof of concept and analytical validation of the prototype has been completed on 451 blood samples: 238 donor packed red blood cells, 137 consecutive unselected patients for whom a blood group determination had been ordered and on 76 patient samples selected with pathology that could possibly interfere with or impair performances of the assay. RESULTS We observed 100% concordance for ABO blood groups between the POCT and the laboratory instrument. CONCLUSION These preliminary results demonstrate the feasibility of ABO determination with a simple POCT device eliminating manipulation and subjective interpretation responsible for transfusion errors. This device should be linked to the blood bank system allowing all cross-check of the results.
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Affiliation(s)
- H El Kenz
- Brugmann University Hospital Center and Queen Fabiola University Children Hospital blood bank, Brussels, Belgium
| | - F Corazza
- Brugmann University Hospital Center immunology laboratory, Brussels, Belgium
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