Incidence of transfusion reactions: a multicenter study utilizing systematic active surveillance and expert adjudication

Abstract

Background: Prevalence estimates of the serious hazards of transfusion vary widely. We hypothesized that the current reporting infrastructure in the United States fails to capture many transfusion reactions and undertook a multicenter study using active surveillance, data review, and adjudication to test this hypothesis.

Study design and methods: A retrospective record review was completed for a random sample of 17% of all inpatient transfusion episodes over 6 months at four academic tertiary care hospitals, with an episode defined as all blood products released to a patient in 6 hours. Data were recorded by trained clinical research nurses, and serious reactions were adjudicated by a panel of transfusion medicine experts.

Results: Of 4857 transfusion episodes investigated, 1.1% were associated with a serious reaction. Transfusion-associated circulatory overload was the most frequent serious reaction noted, being identified in 1% of transfusion episodes. Despite clinical notes describing a potential transfusion association in 59% of these cases, only 5.1% were reported to the transfusion service. Suspected transfusion-related acute lung injury/possible transfusion-related acute lung injury, anaphylactic, and hypotensive reactions were noted in 0.08, 0.02, and 0.02% of transfusion episodes, respectively. Minor reactions, including febrile nonhemolytic and allergic, were noted in 0.62 and 0.29% of transfusion episodes, respectively, with 30 and 50% reported to the transfusion service.

Conclusion: Underreporting of cardiopulmonary transfusion reactions is striking among academic, tertiary care hospitals. Complete and accurate reporting is essential to identify, define, establish pathogenesis, and mitigate/treat transfusion reactions. A better understanding of the failure to report may improve the accuracy of passive reporting systems.

Figure 1

Schematic of study design with identification of serious and minor transfusion reactions

Figure 2. Adjudication and imputability of serious transfusion reactions

(A) 102 cases were identified by nurse study coordinators as having potential serious transfusion reactions. (B) Consensus in diagnosis and imputability among the transfusion medicine expert panel members.

Figure 3. Information on cases adjudicated to be TACO

(A) Co-morbidities associated with the 39 cases adjudicated to be definite or probable TACO. (B) CXR findings for these 39 TACO cases.

Figure 4. Blood components released for transfusion for TACO cases and all screened cases

(A) Distribution of blood components released for transfusion in the 6-hour episode for the 39 TACO cases (black bars) and for the >4800 other screened cases that did not have TACO (grey bars). (B) Number of total products released for transfusion in the 6-hour episode for TACO cases (black bars) and other screened cases (grey bars).

Figure 5. Serious and minor transfusion reaction reporting

(A) Serious transfusion reactions determined to be definitely or probably associated with transfusion, in comparison to those with notes in the chart potentially implicating the transfusion and in comparison to those reported to the transfusion service. (B) Minor transfusion reactions identified by the study nurse coordinators, in comparison to those reported to the transfusion service.