· immunological complications: red cells white cells febrile reaction trali ta-gvhd

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COMPLICATIONS:COMPLICATIONS:ImmunologicalImmunologicalNonNon--immunologicalimmunologicalInfectiousInfectious

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Immunological Complications:Immunological Complications:Red cellsRed cells

Haemolytic transfusion reactionHaemolytic transfusion reactionAcuteAcuteDelayedDelayed

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Immunological Complications:Immunological Complications:Red cellsRed cellsWhite cellsWhite cells

Febrile reactionFebrile reactionTRALITRALITATA--GvHDGvHD

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Immunological Complications:Immunological Complications:Red cellsRed cellsWhite cellsWhite cellsPlateletsPlatelets

Post transfusion purpuraPost transfusion purpura

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Other antigensOther antigensUrticariaUrticaria �� Anaphylactic shockAnaphylactic shock

Plasma proteins:Plasma proteins: IgIg AAAtopensAtopens:: PenicillinPenicillin

NickelNickel

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Other antigensOther antigens

Other InteractionOther InteractionChangeChange of the immune responseof the immune responseImproved survival of transplanted kidneysImproved survival of transplanted kidneysPostoperative infections ?Postoperative infections ?Cancer recurrence ?Cancer recurrence ?

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NonNon--immunological complications:immunological complications:Vasoactive substancesVasoactive substances

PrekallicreinPrekallicrein substancessubstancesHypotension, vasodilatation, nauseaHypotension, vasodilatation, nausea

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NonNon--immunological complications:immunological complications:Vasoactive substancesVasoactive substancesPyrogensPyrogens

Bacterial contaminationBacterial contaminationEndogenous Endogenous pyrogenspyrogens

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NonNon--immunological complications:immunological complications:Vasoactive substancesVasoactive substancesPyrogensPyrogensCold bloodCold blood

Cardiac arrestCardiac arrest

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NonNon--immunological complications:immunological complications:Vasoactive substancesVasoactive substancesPyrogensPyrogensCold bloodCold bloodCitrate toxicityCitrate toxicity

Muscle tremorMuscle tremorCardiac output decreaseCardiac output decreaseHypotensionHypotension

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NonNon--immunological complications:immunological complications:Vasoactive substancesVasoactive substancesPyrogensPyrogensCold bloodCold bloodCitrate toxicityCitrate toxicityPotassium toxicityPotassium toxicity

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NonNon--immunological complications:immunological complications:Vasoactive substancesVasoactive substancesPyrogensPyrogensCold bloodCold bloodCitrate toxicityCitrate toxicityPotassium toxicityPotassium toxicityAir embolismAir embolism

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NonNon--immunological complications:immunological complications:Vasoactive substancesVasoactive substancesPyrogensPyrogensCold bloodCold bloodCitrate toxicityCitrate toxicityPotassium toxicityPotassium toxicityAir embolismAir embolismMicro embolismMicro embolism

Cell aggregatesCell aggregates

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NonNon--immunological complications:immunological complications:Vasoactive substancesVasoactive substancesPyrogensPyrogensCold bloodCold bloodCitrate toxicityCitrate toxicityPotassium toxicityPotassium toxicityAir embolismAir embolismMicro embolismMicro embolismSeptic thrombophlebitisSeptic thrombophlebitis

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NonNon--immunological complications:immunological complications:Vasoactive substancesVasoactive substancesPyrogensPyrogensCold bloodCold bloodCitrate toxicityCitrate toxicityPotassium toxicityPotassium toxicityAir embolismAir embolismMicro embolismMicro embolismSeptic thrombophlebitisSeptic thrombophlebitisOverloadOverload

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NonNon--immunological complications:immunological complications:Vasoactive substancesVasoactive substancesPyrogensPyrogensCold bloodCold bloodCitrate toxicityCitrate toxicityPotassium toxicityPotassium toxicityAir embolismAir embolismMicro embolismMicro embolismSeptic thrombophlebitisSeptic thrombophlebitisOverloadOverloadHaemosiderosisHaemosiderosis

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Infectious Complications:Infectious Complications:BacteriaBacteriaVirusVirusProtozoesProtozoesParasitesParasites

PrionsPrions::CJD, CJD, vCJDvCJD ??

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SHOT and DARTSHOT and DART

SHOT: SHOT: ““Severe Hazards of TransfusionSevere Hazards of Transfusion”” UK 1996UK 1996

DART: DART: ““Danish Registration of Transfusion RisksDanish Registration of Transfusion Risks”” DK 1999DK 1999

Voluntary and confidential collecting of data about transfusion Voluntary and confidential collecting of data about transfusion risks, using report forms.risks, using report forms.

The aim is to improve transfusion safetyThe aim is to improve transfusion safety

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SHOT and DARTSHOT and DART

DARTDART SHOTSHOT(1999(1999--2001)2001) (1996(1996--2000)2000)

Reports collected (severe risk)Reports collected (severe risk) 7272 862862Transfused componentsTransfused components 1.35 m1.35 m 13 m13 mReport rate (per 100,000 Report rate (per 100,000 transftransf.).) 5.35.3 6.66.6

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RISK RATESRISK RATESNumberNumber ofof risksrisks per 100,000 per 100,000 transfusedtransfused bloodblood componentscomponents

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IBCT 2.6 3.9IC 2.5 2.5TTI 0.2 0.2Totals 5.3 6.6

IBCT Incorrect Blood Component TransfusedIC Immune ComplicationTTI Transfusion Transmitted Infection

DART (1999-2001) 72 reports; 1,350,000 transfused componentsSHOT (1996-2000) 862 reports; 13,000,000 transfused components

Risk Rate(100,000 transfusions)

DART SHOTCategory

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ATR 1.1 0.9DTR 0.9 0.8TRALI 0.4 0.4PTP 0.1 0.3TA-GvHD 0.1 0.1Totals 2.5 2.5

ATR Acute Transfusion ReactionDTR Delayed Transfusion ReactionTRALI Transfusion Related Acute Lung InjuryPTP Post Transfusion PurpuraTA-GvHD Transfusion Associated Graft versus Host Disease

DART (1999-2001) 72 reports; 1,350,000 transfused componentsSHOT (1996-2000) 862 reports; 13,000,000 transfused components

Immune Complications Rate(100,000 transfusions)

DART SHOTCategory

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Severe Clinical Outcome (SHOT)Death: Attributed to transfusion

Not due to underlying condition

Major Morbidity: Intensive care admission and/or ventilationDialysis and/or renal dysfunctionMajor haemorrhage from transfusion-induced coagulapathyIntravascular haemolysis Potential RhD sensitiation in a female of child-bearing potentialPersistent viral infectionAcute symptomatic confirmed infection

(viral, bacterial or protozoal)

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DART SHOT DART SHOT

IBCT 0.5 0.5 2.6 3.9IC 1.1 0.8 2.5 2.5TTI 0.2 0.2 0.2 0.2

Totals 1.8 1.5 5.3 6.6

34% 23%

Clinical Outcome Rate(100,000 transfusions)

Severe Outcome All HazardsCategory

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DART SHOT DART SHOT DART SHOT

IBCT 0.07 0.06 0.44 0.42 0.51 0.48IC 0.15 0.27 0.96 0.55 1.11 0.82TTI 0.00 0.04 0.15 0.13 0.15 0.17Totals 0.22 0.37 1.55 1.10 1.77 1.47

Number of deaths: 3 48

Transfused components: 1.35 m 13 m

Severe Clinical Outcome Rate(100,000 transfusions)

Death Major Morbidity Death +Major Morbidity

Category

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Hazards of Blood Transfusion Hazards of Blood Transfusion Versus Versus

Hazards of Everyday LifeHazards of Everyday Life

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1 per1 per 20,00020,000 Severe hazards of transfusionSevere hazards of transfusion1 per1 per 40,00040,000 Incorrect blood component transfusedIncorrect blood component transfused1 per1 per 40,00040,000 Immune complicationImmune complication1 per1 per 50,00050,000 Death attributed to general anaesthesiaDeath attributed to general anaesthesia

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1 per1 per 300,000300,000 Death (transfusion of blood component)Death (transfusion of blood component)1 per 1 per 700,000700,000 Death (immune complication)Death (immune complication)1 per 700,0001 per 700,000 Transfusion transmitted infectionTransfusion transmitted infection

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1 per1 per 11--2 m2 m Death (IBCT)Death (IBCT)1 per1 per 11--2 m2 m Transfusion transmitted HIV infection (calculated)Transfusion transmitted HIV infection (calculated)

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1 per1 per 11--2 m2 m Death (IBCT)Death (IBCT)1 per1 per 11--2 m2 m Transfusion transmitted HIV infection (calculated)Transfusion transmitted HIV infection (calculated)

Survival 5 years after blood transfusion: 50%Survival 5 years after blood transfusion: 50%

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1 per10,000 Death in traffic accidents (Denmark)10,000 Severe accidents at home70,000 Cancer from drinking one beer a day for one year

100,000 Skin cancer (Denver)800,000 Drowning in a bath tub

1-2 m Being killed by lightening

Hazards of Everyday Life

Annual risk of

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Reduction of RisksReduction of RisksIncorrect Blood Component Transfused:Incorrect Blood Component Transfused:

Establishing standards for transfusion medicineEstablishing standards for transfusion medicineBlood samples for blood grouping and crossBlood samples for blood grouping and cross--matchmatchDelivery of blood component from the hospital Blood BankDelivery of blood component from the hospital Blood BankTransfusion of blood componentsTransfusion of blood componentsVerification of identity between component and patientVerification of identity between component and patientTransfusion complications, description and treatmentTransfusion complications, description and treatment

Education (standards)Education (standards)Audit (are the standards being followed)Audit (are the standards being followed)Bedside computerized verification of bar code identity Bedside computerized verification of bar code identity on blood component and wristbandon blood component and wristband

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Reduction of RisksReduction of RisksImmune Complications:Immune Complications:

Avoid overuse of blood components, especially Avoid overuse of blood components, especially FFP and platelets (higher complication rate than red cells)FFP and platelets (higher complication rate than red cells)

Use of FFP from nonUse of FFP from non--transfused male donors transfused male donors No HLA antibodies (TRALI)No HLA antibodies (TRALI)

Increase the sensitivity of serological methods Increase the sensitivity of serological methods in order to detect weak Kidd antibodiesin order to detect weak Kidd antibodies

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Reduction of RisksReduction of RisksTransfusion Transmitted Infection:Transfusion Transmitted Infection:

Donor criteriaDonor criteriaExclude donors at riskExclude donors at risk

Screening for Infectious agentsScreening for Infectious agentsPCR for detection of virusPCR for detection of virus

Inactivation of Infectious agentsInactivation of Infectious agentsInterceptIntercept

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ConclusionsConclusionsBlood transfusion is still a risk to the patientBlood transfusion is still a risk to the patientHowever, the rate is low compared with other kinds of risksHowever, the rate is low compared with other kinds of risks

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ConclusionsConclusionsBlood transfusion is still a risk to the patientBlood transfusion is still a risk to the patientHowever, the rate is low compared with other kinds of risksHowever, the rate is low compared with other kinds of risks

Some are relatively common and should never occur (IBCT)Some are relatively common and should never occur (IBCT)The rate can be reduced in a simple way and at low costThe rate can be reduced in a simple way and at low cost

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ConclusionsConclusionsBlood transfusion is still a risk to the patientBlood transfusion is still a risk to the patientHowever, the rate is low compared to other kinds of risksHowever, the rate is low compared to other kinds of risks

Some are relatively common and should never occur (IBCT)Some are relatively common and should never occur (IBCT)The rate can be reduced in a simple way and at low cost The rate can be reduced in a simple way and at low cost

Others are very seldom, but create a lot of fear (HIV)Others are very seldom, but create a lot of fear (HIV)They can be avoided only in a complicated expensive way.They can be avoided only in a complicated expensive way.

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· immunological complications: red cells white cells febrile reaction trali ta-gvhd

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