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JPAC PDF Generated 06/12/2021 09:59 Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee Transfusion Handbook 5: Adverse effects of transfusion verse-effects-of-transfusion 5: Adverse effects of transfusion Essentials Modern blood transfusion is very safe but preventable death and major morbidity still occurs. Inappropriate decisions to transfuse put patients at unnecessary risk of transfusion errors, reactions and transfusion-transmitted infection. Identification errors (of patients, blood samples and blood components) by hospital staff are the root cause of most ‘wrong blood into patient’ incidents, including ABO-incompatible transfusions. Severe acute transfusion reactions are the most common cause of major morbidity. These include immunological reactions (predominantly allergy/anaphylaxis, haemolytic reactions and lung injury), circulatory overload and rare bacterial contamination of blood components. If a serious transfusion reaction is suspected – stop the transfusion; assess clinically and start resuscitation if necessary; check that the details on the patient’s ID band and the compatibility label of the blood component match; call for medical assistance; contact the transfusion laboratory. Transfusion-transmitted infection is now a very rare event, underpinned by voluntary donation, donor selection procedures and microbiological testing, but constant vigilance is required as new threats emerge. Variant CJD transmission by blood has had a major impact on transfusion practice in the UK although the risk appears to be receding. Compared with many medical and surgical procedures modern blood transfusion is extremely safe but deaths and major morbidity still do occur. Errors in the identification of patients, blood samples and blood components are the root cause of many preventable serious adverse events (see Chapter 4). Around 1 in 13 000 blood component units is transfused to the wrong patient (not always with adverse consequences) and up to 1 in 1 300 pre-transfusion blood samples are taken from the wrong patient. Serious acute transfusion reactions are often unpredictable but patients are put at unnecessary risk by inappropriate decisions to transfuse. In its 2012 Annual Report, the UK Serious Hazards of Transfusion haemovigilance scheme (SHOT – http://www.shotuk.org/) described 252 incidents of ‘incorrect blood component transfused’ (each underpinned by 100 near misses). Ten ABO-incompatible transfusions (all due to clinical errors) and 145 incidents of ‘avoidable, delayed or under-transfusion’ were reported. There were nine transfusion-related deaths (six associated with transfusion-associated circulatory overload) and 134 cases of major morbidity (most often following acute transfusion reactions). Transfusion-transmitted infection is now a rare event but there is no room for complacency as the emergence of new infectious agents requires constant vigilance. Transfusion Handbook / 5: Adverse effects of transfusion page 2 of 17 5.1: Haemovigilance Haemovigilance is the ‘systematic surveillance of adverse reactions and adverse events related to transfusion’ with the aim of improving transfusion safety. Transfusion reactions and adverse events should be investigated by the clinical team and hospital transfusion team and reviewed by the hospital transfusion committee. SHOT invites voluntary reporting of serious adverse transfusion reactions, errors and events as well as near-miss incidents. Under the Blood Safety and Quality Regulations 2005 (BSQR) there is a legal requirement to report serious adverse reactions and events to the Medicines and Healthcare Products Regulatory Agency (MHRA). The MHRA also inspects blood establishments (transfusion centres) and hospital transfusion laboratories to ensure their processes and quality standards comply with the BSQR. SHOT and MHRA work closely together and have a joint reporting system through the SABRE IT system (Haemovigilance can identify transfusion hazards and demonstrate the effectiveness of interventions. SHOT reporting highlighted the importance of transfusion-related acute lung injury (TRALI) as a potentially lethal risk of transfusion and confirmed the benefit of sourcing fresh frozen plasma (FFP) from male donors. More recently, transfusion-associated circulatory overload (TACO) has been identified as an important preventable cause of death or major