background:
According to data collected by the U.S. Food and Drug Administration (FDA) on transfusion-related deaths from 2014 to 2018, hemolytic transfusion reactions (HTRs) are the third leading cause of transfusion-related deaths. HTRs are defined as the incompatibility of the patient with the blood type of the donor, resulting in hemolysis and destruction of the donor's red blood cells. The U.S. National HealthCare Safety Network (NHSN) defines delayed haemolytic transfusion reactions (DHTRs) as adverse reactions that occur 24 to 28 days after transfusion, evidence of alloantibodies and extravascular hemolysis that can be found in patients.
Studies have shown that people underestimate the true incidence of transfusion reactions, including severe cardiopulmonary disease. The incidence of DHTRs is more likely to be underestimated because most patients have been discharged from the hospital before the onset of clinical symptoms of haemolysis, patients do not repeat screening antibodies after transfusions, or have other diseases at the same time, which provide an explanation for anemia.
Trauma patients are at high risk for DHTRs because they are more likely to transfuse blood that is not cross-matched in an emergency and are more likely to transfuse blood than other patient populations. In addition, there is currently insufficient research on this population. The purpose of this study was to determine the incidence of DHTRs at a trauma center.
method:
The authors assessed the incidence of DHTRs per transfusion and per patient. When DHTR is observed, relevant information about the patient is recorded and a retrospective investigation of all newly discovered alloant antibodies detected is performed to identify any new OCCURRENCEs of DHTR. The amount of red blood cell (RBC) infusion, the number of specific patients, the type of alloantibody and the number of cases of blood transfusion are obtained from the transfusion record.
outcome:
Between 1 January 2017 and 31 December 2019, the median amount of RBC infusion per patient was 12U, and 29 cases of DHTR were observed in patients with newly discovered alloantibodies. A total of 6905 patients were enrolled in the study, with a total number of blood transfusions of 24633, and the incidence of DHTR was 1 in 849 (1 in 849 transfusions of DHTR) and 1 in 238 (1 in 238 transfusion patients). In addition, 5 patients found evidence of delayed hemolysis during emergency resuscitation and found that RBC antibodies were already present in their bodies.
Figure 1 Study design flowchart
Table 2 Characteristics of 29 patients with DEVELOPR
Table 3 Characteristics of 5 patients who had hemolytic transfusion reactions due to incompatibility with transfusion of incompatible type O RBC
conclusion:
Despite a general decrease in blood use rates, this study found that the incidence of DHTR was higher than previously reported. Future studies will improve the recognition and screening of DHTRRs, which is critical to understanding their impact on length of hospital stay, transfusion treatment, and patient outcomes.
bibliography
Hasan, Rida Abid et al. “Rates of delayed hemolytic transfusion reactions observed in a trauma center.” Transfusion vol. 61,7 (2021): 2035-2040. doi:10.1111/trf.16433
Department of Blood Transfusion, Zhejiang Provincial People's Hospital, Chen Qinhong, Chen Bingyu
Source: Transfusion man