Risks associated with transfusion of cellular blood components in canada*,☆☆,,★★

https://doi.org/10.1053/tmrv.2003.50009Get rights and content

Abstract

We provide a comprehensive review of risks associated with allogeneic red blood cell and platelet transfusions in Canada. The review focuses on clinically symptomatic noninfectious transfusion risks (acute and delayed hemolytic, febrile nonhemolytic [FNHTR], allergic, volume overload, transfusion-related acute lung injury, graft-versus-host disease, and posttransfusion purpura) and the risk of clinically significant disease from transfusion-transmitted infections. Data sources include information from Canadian Blood Services, Héma-Québec, Health Canada, and the Québec Hemovigilance System as well as published information from research studies and international hemovigilance systems. We estimate that in 2000 the aggregate risk of potentially severe reactions (excluding FNHTR and minor allergic reactions) was 43.2 per 100,000 red cell units (95% confidence interval [CI]: 38.7-48.1), affecting 337 recipients, and 125.7 per 100,000 platelet pools of 5 units (95% CI: 100.8-154.9), affecting 88 recipients. The most frequent potentially severe outcomes for red cell transfusion were hemolytic reactions and volume overload and for platelet transfusion were major allergic reactions and bacterial contamination. The current risk of human immunodeficiency virus and hepatitis C virus transmission is approximately 1 in 4 million and 1 in 3 million units, respectively. These estimates are useful for decisions concerning transfusion therapy, the informed consent process, and for evaluating efficacy of interventions to reduce risk. Copyright 2003, Elsevier Inc. All rights reserved.

Section snippets

Measurement of risk

The simplest means of determining risk is by clinical case reporting of adverse reactions or effects*after transfusion. Unfortunately, clinical case reporting has several

Literature review

The Medline database was searched using the following general and specific key terms: transfusion reaction, transfusion error, adverse transfusion event, transfusion complication, febrile nonhemolytic transfusion reaction, transfusion allergic reaction, transfusion anaphylactic reaction, hemolytic transfusion reaction, ABO errors, transfusion and volume/circulatory overload, transfusion-related acute lung injury, transfusion-associated graft versus host disease, posttransfusion purpura,

Infectious risks

An important aspect of assessing the infectious risks of transfusion is the distinction between the risk of transmission of the agent and that of clinically significant disease, which generally occurs only in a percentage of those who become infected. Many agents (eg, HIV, HCV, and human T-cell lymphotropic virus [HTLV]) produce clinical disease only many years after the initial infection. It is obvious that the deleterious effects of these agents will occur in fewer patients than would be

Hemolytic transfusion reactions

A hemolytic transfusion reaction consists of an accelerated destruction of red blood cells because of incompatibility between the donor and the recipient. Red cell hemolysis can also occur because of nonimmunological causes like overheating of the blood unit and mechanical damage to the cells because of extracorporeal circulation devices or aging of red cell units during storage. These rare events can also cause reactions, but they are not included in this review. Hemolytic transfusion

Summary of risks of transfusion in Canada

The risks of clinically symptomatic noninfectious and infectious adverse reactions in Canada are summarized in Tables 9 (non-infectious risks) and 10 (infectious risks).The far right-hand columns of these tables project the annual number of cases of each reaction that are expected to occur in Canada assuming 780,000 red cell units and 350,000 platelets (70,000 platelet pools) are transfused annually.

The noninfectious risk estimates in this review were taken either from the published literature

Acknowledgements

The authors thank Dr Graham Sher, Canadian Blood Services; Dr Francine Décary, Héma-Québec; and Julia Hill, Health Canada for approving release of data from their respective organizations for purposes of this review. We• would also like to thank Dr Heather Hume, Dr Vito Scalia, Dr Joanne Chiavetta, Dr Shelley Deeks, Tom Walker, and Pina Guidoccio from Canadian Blood Services; Dr Mindy Goldman and Dr Marc Germain from Héma-Québec; and Dr Peter Ganz and Dr Farid Hindieh from Health Canada who

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    This document represents the work of individuals and is not an official document of the National Blood Safety Council or the Quebec Public Health Institute.

    ☆☆

    Funded by an unrestricted educational grant from the Hemosol Corporation.

    Address reprint requests to Steven Kleinman, MD, 1281 Rockcrest Avenue, Victoria, BC, V9A-4W4 Canada.

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