TY - JOUR
T1 - Incidence of transfusion reactions
T2 - a multicenter study utilizing systematic active surveillance and expert adjudication
AU - for the National Heart, Lung, and Blood Institute (NHLBI) Recipient Epidemiology and Donor Evaluation Study (REDS-III)
AU - Hendrickson, Jeanne E.
AU - Roubinian, Nareg H.
AU - Chowdhury, Dhuly
AU - Brambilla, Don
AU - Murphy, Edward L.
AU - Wu, Yanyun
AU - Ness, Paul M.
AU - Gehrie, Eric A.
AU - Snyder, Edward L.
AU - George Hauser, R.
AU - Gottschall, Jerome L.
AU - Kleinman, Steve
AU - Kakaiya, Ram
AU - Strauss, Ronald G.
N1 - Funding Information:
We thank the study nursing coordinators as well as many other team members at the local hospital sites, at RTI International, and at the National Heart, Lung, and Blood Institute who made this study possible. JEH and NHR participated in the study and wrote and edited the article. DH and DB organized the data collection and analysis for the article. All authors contributed to the final version of the article. The funding source (the National Heart, Lung, and Blood Institute [NHLBI]) designated an investigator-led steering committee, which independently oversaw the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, and approval of the article; and the decision to submit the article for publication. Clinical site coordinators, research assistants, and study principal investigator: University of California at San Francisco (Monique Koenigsberg, Dan Hindes, Nareg Roubinian, and Edward Murphy); Yale University (Scott Merenda, Rita Palmarozza, Keiren Smith, Eric Gehrie, R. George Hauser, Jeanne Hendrickson, and Edward Snyder), The Institute for Transfusion Medicine (Rosemary Bolinger, Pam D'Andrea, Darrell Triluzi, and Ronald Strauss), Blood Center of Wisconsin (Cara Harry, Walt Bialkowski, Michael Michalkiewicz, and Jerome Gottschall). Data coordinating center: RTI International (Dhuly Chowdhury, Anne-Lyne McCalla, Debra Fleischmann, Chris Siege, Brenda Hair, Nana Haywood, Don Brambilla, and Violet Abraham). The NHLBI Recipient Epidemiology Donor Evaluation Study-III (REDS-III), domestic component, is the responsibility of the following persons: Hubs: A.E. Mast and J.L. Gottschall (Blood Center of Wisconsin, Milwaukee, WI), D.J. Triulzi and J.E. Kiss (The Institute for Transfusion Medicine, Pittsburgh, PA), E.L. Murphy and E. St. Lezin (University of California at San Francisco, San Francisco, CA), E.L. Snyder (Yale University School of Medicine, New Haven, CT), and R.G. Cable (American Red Cross Blood Services, Farmington, CT). Data coordinating center: D.J. Brambilla and M.T. Sullivan (RTI International, Rockville, MD). Publication Committee Chairman: R.Y. Dodd (American Red Cross, Holland Laboratory, Rockville, MD). Steering Committee Chairman: S.H. Kleinman (University of British Columbia, Victoria, BC, Canada). National Heart, Lung, and Blood Institute, National Institutes of Health: S.A. Glynn and A.M. Cristman (Bethesda, MD).
Publisher Copyright:
© 2016 AABB
PY - 2016/10/1
Y1 - 2016/10/1
N2 - 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.
AB - 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.
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U2 - 10.1111/trf.13730
DO - 10.1111/trf.13730
M3 - Article
C2 - 27460200
AN - SCOPUS:84979582283
SN - 0041-1132
VL - 56
SP - 2587
EP - 2596
JO - Transfusion
JF - Transfusion
IS - 10
ER -