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Item does not contain fulltext BACKGROUND AND OBJECTIVES: Di-ethyl-hexyl-phthalate (DEHP) is currently the main plasticizer used for whole blood collection systems. However, in Europe, after May 2025, DEHP may no longer be used above 0.1% (w/w) in medical devices. DEHP stabilizes red cell membranes, thereby suppressing haemolysis during storage. Here we compared in vitro quality parameters of red cell concentrates (RCCs) collected and stored in DEHP-, DINCH- or DINCH/BTHC-PVC hybrid blood bags with saline-adenine-glucose-mannitol (SAGM) or phosphate-adenine-glucose-guanosine-saline-mannitol (PAGGSM) storage solution. Last, we performed haemovigilance surveillance for RCC collected in DINCH-PVC and stored in PAGGSM/BTHC-PVC. MATERIALS AND METHODS: In vitro quality parameters of RCC were determined during 42 days of storage. Haemovigilance surveillance was conducted to compare the frequency and type of transfusion reaction. RESULTS: Haemolysis levels were increased in SAGM/BTHC-PVC as compared to SAGM/DEHP-PVC (0.66% ± 0.18% vs. 0.36% ± 0.17%). PAGGSM storage solution was able to adequately suppress haemolysis to levels observed during storage in SAGM/DEHP-PVC, both in BTHC-PVC (0.38% ± 0.12%), and to a slightly lesser extent in DINCH-PVC (0.48% ± 0.17%). A total of 1650 PAGGSM/BTHC-PVC and 5662 SAGM/DEHP-PVC RCC were transfused yielding a transfusion reaction frequency of 0.24% (95% CI 0.0000-0.0048) and 0.44% (95% CI 0.0027-0.0061) respectively. CONCLUSION: The in vitro quality of RCC stored in PAGGSM/BTHC-PVC and SAGM/DEHP-PVC is comparable. There is no indication that transfusion of erythrocytes stored in PAGGSM/BTHC-PVC results in increased transfusion reaction frequency. These initial results provide a basis for further clinical evaluation to narrow down the confidence interval of transfusion reaction frequency.

Despite significant advances in screening and understanding of transfusion-related complications, transfusion of allogeneic blood products will always involve inherent risk due to the sourcing of blood from donors, the limits of screening technology, and the potential for human error. While life-threatening transfusion reactions from hemolysis, TACO, and TRALI are rare, they can have devastating consequences for patients receiving transfusions. Blood products should always be given with caution and with the understanding that a variety of reactions are possible. Leukoreduction, irradiation, storage guidelines, and selective donor procedures for certain allogeneic products have limited risks to patients to a considerable degree. In addition, commonly known life-threatening chronic infections are now rarely transmitted from allogeneic blood due to the extensive screening process for blood donations, but the threat of new emerging pathogens is always a concern. Unfortunately, there exists few definitive treatments for the variety of transfusion reactions beyond cessation of product administration and supportive medical care. The blood bank and appropriate medical staff should be notified in all instances of suspected transfusion reactions, regardless of the seriousness of the reaction.

Background: Patients with hematological diseases are polytransfused and often immunocompromised, therefore susceptible to transfusion reactions (TR). This study aims to document the incidence of TRs in adult hematological patients and assess the effect of changes in the production of blood components and transfusion practice on their occurrence. Study design and methods: Retrospective observational analysis of TRs reported from 1993 to 2019 was performed. For the analysis of the effect of changes on the incidence of TRs, the evaluated time was divided into two periods: the 1st period before the introduction of changes in production, when leukoreduced blood components were used only selectively, and the 2nd period, when semi-automated method of production and universal leukoreduction was introduced. Results: The decrease in the incidence of TRs was observed for both red blood cell (RBC) and platelet concentrate (PC) transfusions in the 2nd period. Since platelet additive solution has been used, a further decrease in the incidence was reported. The decrease in incidence was also observed for delayed hemolytic/serological transfusion reactions and for transfusion- transmitted bacterial infections. Four cases of incorrect blood transfusions were uniquely related to the hematological patients, caused by antigen loss and transfusion ordering after ABO- incompatible hematopoietic stem cell transplantation. Discussion: Our results provided evidence that the introduction of tools offered by modern transfusion medicine: universal leukodepletion, plasma replacement with additive solutions, sensitive laboratory techniques, prophylactic antigen matching policy, informatization, and automatization, decreased the incidence of TRs and improved transfusion safety.

Im Zuge der Transfusion von Erythrozytenkonzentraten gilt es Komplikationen, wie zum Beispiel hämolytische Transfusionsreaktionen, zu vermeiden. Diese können unter anderem durch Alloantikörper verursacht werden, die gegen Antigene gerichtet sind, welche auf den eigenen Erythrozyten nicht exprimiert werden. Bei Transfusion eines antigenpositiven Erythrozytenkonzentrates besteht je nach Spezifität des Alloantikörpers die Gefahr einer intravasalen oder extravasalen Hämolyse. Daher werden inkompatible Transfusionen im Regelfall vermieden, in manchen Fällen aber kann es sein, dass kein kompatibles Erythrozytenkonzentrat verfügbar ist. Der in dieser Arbeit behandelte Alloantikörper, welcher gegen das c-Antigen des Rhesussytems gerichtet ist, das Allo-Anti-c, wird in der Literatur als klinisch relevanter Alloantikörper beschrieben. Erhält ein*e Patient*in mit diesem Alloantikörper ein antigenpositives Erythrozytenkonzentrat, kann dadurch eine leichte bis schwere hämolytische Transfusionsreaktionen verursacht werden, die in vivo vom Monozyten-Makrophagen-System vermittelt wird. Mit Hilfe des Monozyten Monolayer Assays (MMA) ist es möglich, die klinische Relevanz von Alloantikörpern unterschiedlicher Antikörperträger*innen anhand der Phagozytoseraten individuell zu beurteilen und deren Risiko bei Transfusionen besser einzuschätzen. In dieser Studie werden die Sera bzw. Plasmen von 18 Alloantikörperträger*innen, die ein Anti-c gebildet haben, mit jeweils sechs Erythrozytenkonzentraten getestet. Durch den Einsatz des MMA wird überprüft, ob die Phagozytoseraten innerhalb einer Alloantikörperprobe Schwankungen aufweisen. Weiters wird die Reproduzierbarkeit der klinischen Relevanz der Alloantikörperspezifität Anti-c bei unterschiedlichen Alloantikörperträger*innen untersucht. Zusätzlich wird von allen Proben die Höhe des Alloantikörpertiters bestimmt, um nachzuweisen, ob die Titerstufe des Alloantikörpers mit der Höhe der Phagozytoserate des MMA korreliert oder nicht. Bei keiner der 18 Alloantikörperproben ist eine signifikante Schwankung der Phagozytoseraten vorhanden, alle Schwankungsbreiten liegen unterhalb des festgelegten Grenzwertes von 20%. Jedoch unterscheiden sich – trotz nicht vorhandener signifikanter Schwankung – die klinischen Relevanzen der verschiedenen Alloantikörperträger*innen und stimmen teilweise nicht mit der Literatur überein. Eine Reproduzierbarkeit der klinischen Relevanz des Allo-Anti-c ist bei den untersuchten Proben somit nicht gegeben. In Bezug auf die Korrelation der Höhe des Alloantikörpertiters und der Phagozytoseraten ist ein Trend erkennbar. Demnach ist bei höheren Titerstufen auch mit einer höheren Phagozytoserate zu rechnen und kann somit ein Hinweis auf eine mögliche klinische Relevanz sein. Alles in allem bietet der MMA die Möglichkeit, mehr Informationen für individuelle Transfusionsentscheidungen zu gewinnen. Aufgrund der aufwändigen Durchführung und der Tatsache, dass die Phagozytoseraten bei Testung verschiedener Spender*innenerythrozyten keine signifikanten Unterschiede aufweisen, wird der Einsatz des MMA nur in Einzelfällen als sinnvoll erachtet. In the course of transfusion of red cell concentrates, complications such as hemolytic transfusion reactions must be avoided. These can be caused by alloantibodies directed against antigens that are not expressed on the patient's own red blood cells. Transfusion of antigen-positive red cell concentrates carry the risk of intravascular or extravascular hemolysis, depending on the specificity of the alloantibody. Therefore, incompatible transfusions should be avoided – but sometimes, a compatible red cell concentrate may not be available. This paper discusses the anti-c, an alloantibody which is directed against the c-antigen of the rhesus system, is described as a clinically relevant alloantibody in the literature. If a patient with this alloantibody receives an antigen-positive red cell concentrate, mild to severe hemolytic transfusion reactions can be caused, which are mediated in vivo by the monocyte-macrophage system. Using the monocyte monolayer assay (MMA), it is possible to individually assess the clinical relevance of alloantibodies from different antibody carriers based on phagocytosis. In this study, the sera or plasmas of 18 alloantibody carriers that developed an anti-c are tested with six red cell concentrates. The MMA will be used to determine whether phagocytosis rates vary within an alloantibody sample or not. Furthermore, the reproducibility of the clinical relevance of the alloantibody specificity anti-c of different alloantibody carriers will be investigated. In addition, the alloantibody titer level will be detected from all samples to demonstrate whether the titer level of the alloantibody correlates with the level of the phagocytosis rate of the MMA or not. No significant variation of phagocytosis rates is present in any of the 18 alloantibody samples and all ranges of variation are below the established threshold of 20%. However, despite the absence of significant variation, the clinical relevance of different alloantibody carriers deviates and is not comparable with the literature in some cases. A reproducibility of the clinical relevance of the alloantibody is therefore not given for the investigated samples. Regarding the correlation of the alloantibody titer level and the phagocytosis rates, a trend can be recognized. Accordingly, higher titer levels can also be expected to result in higher phagocytosis rates and may thus be an indication of possible clinical relevance. All in all, the MMA offers the possibility to gain more information for individual transfusion decisions. Due to the complexity of the procedure and the fact that the phagocytosis rates do not differ significantly between different donor erythrocytes, the use of the MMA is only considered useful in special cases.

Jaleah Hawkins,1 Richard H Aster,2,3 Brian R Curtis2,3 1Versiti, Blood Center of Michigan, Grand Rapids, MI, USA; 2Versiti, Blood Center of Wisconsin, Milwaukee, WI, USA; 3Blood Research Institute, Milwaukee, WI, USACorrespondence: Brian R CurtisVersiti, Blood Center of Wisconsin, P.O. Box 2178, Milwaukee, WI 53201-2178, USATel +1 414 937 6087Fax +1 414 937 6242Email brcurtis@versiti.orgAbstract: Post transfusion purpura (PTP) is an uncommonly reported post transfusion adverse event that can present with severe thrombocytopenia; sometimes resulting in significant bleeding and hemorrhage. Its diagnosis can be elusive given its substantial symptomatic overlap with other thrombocytopenic syndromes. Underdiagnosis and underreporting make the true incidence of disease difficult to define. While clinical suspicion is key, laboratory evidence of platelet-targeted antibodies and identification of the antigen(s) they recognize are necessary to confirm the diagnosis. A curious aspect of PTP is paradoxical destruction of both transfused and autologous platelets. Although the first case was reported over 50 years ago, this aspect of PTP pathogenesis is still not fully understood and is widely debated. Several theories exist, but conclusive evidence to support most is lacking. Despite limited understanding of disease incidence and etiology, treatment with IVIG (Intravenous Immunoglobulin) has become standard practice and can be highly effective. Although recurrence is rare, precautions should be taken if patients with a history of PTP require transfusions in the future.Keywords: thrombocytopenia, platelet antibodies, transfusion reactions

La médecine transfusionnelle féline a connu une croissance exponentielle au cours des dix dernières années. La découverte du système de groupes sanguins AB et la meilleure compréhension des mécanismes d’incompatibilité donneur-receveur, ainsi que le développement de systèmes de collecte adaptés au chat et de techniques de typage sanguin au chevet du patient ont permis d’améliorer la sécurité des transfusions. Notre travail s’est intégré dans cette volonté d’optimiser la sécurité des transfusions sanguines chez le chat en se concentrant sur deux aspects différents : le prélèvement de sang et les antigènes érythrocytaires à l’origine d’incompatibilités donneur-receveur non expliquées par le système AB. Dans un premier temps, un système de collecte de sang adapté au chat a été fabriqué afin de permettre un prélèvement fermé et autoriser le stockage des produits sanguins. Ce système a été comparé à un système ouvert composé de seringues. Le système fermé apparaît adapté au prélèvement de sang car aucune différence significative n’a été enregistrée dans les paramètres vitaux des donneurs après le prélèvement, le succès du prélèvement, ou la qualité du produit sanguin en termes de contamination bactérienne et d’hémolyse, entre les deux systèmes. Le net avantage du système fermé est qu’il assure un temps de prélèvement plus rapide que le système ouvert. Dans un second temps, en réalisant des tests de compatibilité chez 258 chats de type A, nous avons montré que la probabilité de détecter des incompatibilités entre deux chats de groupe A sélectionnés aléatoirement était de 3.9 %, et que 7 % des chats de groupe A présentaient des allo-anticorps naturels extérieurs au système AB. Sept des 18 allo-anticorps naturels détectés ont été utilisés comme réactifs lors d’un typage sanguin extensif. Les analyses sur l’accord des résultats du typage obtenus avec les différents réactifs ont permis d’identifier cinq nouveaux antigènes érythrocytaires félins différents, nommés FEA 1 à FEA 5 (pour feline erythrocyte antigen), dont l’hérédité, la prévalence, la distribution géographique et par race, ainsi que l’immunogénicité restent encore à déterminer., Feline transfusion medicine has grown exponentially over the past decade. The discovery of the AB blood group system and the better understanding of the mechanisms of donor-receiver incompatibility, as well as the development of cat-friendly collection systems and bedside blood typing techniques have improved transfusion safety. Our work has been part of this effort to optimize the safety of blood transfusions in cats by focusing on two different aspects: blood collection and red blood cell antigens that cause donor-recipient incompatibilities unexplained by the AB system. First, a blood collection system adapted to the cat was manufactured to allow collection in a closed-system and storage of blood products. This system was compared to an open system consisting of syringes. The closed system appeared well-adapted for feline blood collection because no significant difference was found in the vital parameters of the donors after collection, the success of the collection, or the quality of the blood product in terms of bacterial contamination and hemolysis. The distinct advantage of the closed system was that it provided a shorter duration of collection than the open system. Secondly, based on the systematic crossmatches of 258 cats, we showed that the probability of detecting incompatibilities by randomly crossmatching two type A cats was 3.9 %, which resulted in at least 7 % of type A cats having naturally occurring alloantibodies outside the AB blood group system. Seven of the 18 detected naturally occurring alloantibodies were used as reagents in an extensive blood typing. Comparison of the results obtained from this extensive blood typing supports the existence of five, presumably different, new feline erythrocyte antigens, named FEA 1 to FEA 5, whose mode of inheritance, geographical and breed distribution, frequency and immunogenicity have yet to be determined.

Leukoreduction (LR) is a technique that consists of reducing the number of leukocytes in whole blood or blood components that can contribute to decreasing storage lesions and the occurrence of post-transfusion complications. We propose that using a blood bag with pre-storage leukocyte filtration is sufficient for blood conservation under field conditions. Ten healthy Nelore cows were used. Whole blood was sampled from each animal and stored at 2 to 6 &deg, C in CPD/SAG-M (citrate phosphate dextrose bag with a saline, adenine, glucose, mannitol satellite bag) triple bags (Control) and in CPD/SAG-M quadruple bags with a leukocyte filter (Filter). At baseline and after 7, 14, 21, 28, 35, and 42 days (D0, D7, D14, D21, D28, D35, and D42, respectively), complete hematological, blood gas, and biochemical evaluations were determined. The filtered bag removed 99.3% of white blood cells from cattle blood, and the entire filtration process was performed in the field. There was a reduction in the number of red blood cells (RBCs) in both groups from D14 onward, with a decrease of 19.7% and 17.1% at D42 for the Control and Filter bags, respectively. The hemoglobin (Hb) concentration had variation in both groups. Potassium, pO2, pCO2, and sO2 increased, and sodium, bicarbonate, and pH decreased during storage. The filtered bag was efficient in removing white cells from cattle whole blood and could be used under field conditions. Blood stored after LR showed differences (p &lt, 0.05) in blood gas analysis towards a better quality of stored blood (e.g., higher pH, lower pCO2, higher sO2). Further experimental studies are required to prove that blood without white cells results in a decrease in transfusion reactions in cattle.

Submitted by Jeferson Carlos da Veiga Rodrigues (jveigar@unisinos.br) on 2021-03-18T13:03:01Z No. of bitstreams: 1 Dayane Oliveira de Almeida_.pdf: 9105720 bytes, checksum: ed46514555d4f9288ce16bf72ad50455 (MD5) Made available in DSpace on 2021-03-18T13:03:01Z (GMT). No. of bitstreams: 1 Dayane Oliveira de Almeida_.pdf: 9105720 bytes, checksum: ed46514555d4f9288ce16bf72ad50455 (MD5) Previous issue date: 2020-11-30 Nenhuma O presente estudo está vinculado à linha de pesquisa “Cuidado em Saúde e Enfermagem do Programa de Pós-Graduação da Universidade do Vale do Rio dos Sinos - nível Mestrado Profissional em Enfermagem”. Possui como objetivo e produto do Mestrado, a elaboração de um vídeo educativo: Evidências cientificas para a assistência de enfermagem nas reações transfusionais imediatas. Para buscar as melhores evidências para o desenvolvimento do vídeo, realizou-se uma revisão integrativa de literatura (RIL) nas bases de banco de dados Scientifican Eletronic Lybrary On Line (SCIELO), Base de dados de Enfermagem (BDENF), CINAHL, (via EBSCOHOST), CAPES, Public MEDLINE (via PUBMED e BIREME), Literatura Latino Americana e do Caribe em Ciências da Saúde (LILACS). Para o desenvolvimento deste estudo o escopo do guia focalizou-se na questão de pesquisa: Quais as recomendações para a elaboração de uma tecnologia educativa (TE) na assistência de enfermagem nas reações transfusionais imediatas (RTI)? A pesquisa seguiu o formato do acrônimo PICO para responder as questões específicas acerca das principais recomendações de assistência de enfermagem nas reações transfusionais imediatas. Para avaliação da qualidade dos estudos foi utilizado o sistema GRADE. A estratégia de busca dos dados resultou em 48 artigos dos quais 11 foram incluídos na pesquisa. O vídeo educativo resultou nas principais evidências científicas apresentadas acerca do tema, que foi revisado por seis revisores através do instrumento IVCES. Conclui-se que a construção deste vídeo servirá para corroborar para a capacitação dos profissionais de enfermagem de diferentes instituições que atuam diretamente com transfusão de sangue. The present study is a qualitative study, linked to the research line “Health Care and Nursing in the Graduate Program of the University of Vale do Rio dos Sinos - Professional Master's Degree in Nursing”. It has as objective and product of the Master, the elaboration of an educational video: Scientific evidence for the nursing assistance in the immediate transfusion reactions. To search for scientific evidence for the development of the video, an integrative literature review was carried out in the databases SCIELO, BDENF, CINAHL (via EBSCOHOST), CAPES, Public MEDLINE (via PUBMED and BIREME and LILACS. For the development of this study, the scope of the guide focused on the research question: What are the recommendations for the development of an educational technology (ET) in nursing care in immediate transfusion reactions (ITR)? The research followed the format of the acronym PICO to answer specific questions about the main recommendations for nursing care in immediate transfusion reactions. To evaluate the quality of the studies, the GRADE system was used. The data search strategy resulted in 48 articles of which 11 were included in the survey. The educational video resulted from the main scientific evidence presented on the topic, which was reviewed by six reviewers using the IVCES instrument. It is concluded that the construction of this video will serve to corroborate for the training of nursing professionals from different institutions that work directly with blood transfusion.

BACKGROUND Rh blood group system is based on the presence or absence of the Rh antigen, often called the Rh factor, on the cell membranes of the red blood cells (erythrocytes).Some red cells possess the D antigen but it is expressed so weakly that the cells are not agglutinated directly by anti-D sera. An indirect antiglobulin test is necessary to identify patients with the Weak D (formerly known as Du ) phenotype.1 Detecting the Rh blood group as well as Du testing among the Rh-negative individuals is important as the antibodies against Rh antigen can cause transfusion reaction and haemolytic anaemias.2 MATERIALS AND METHODS This Cross-sectional study was done on 6346 individuals who were blood donors and recipients of blood bank of PESIMSR, Kuppam over a period of 6 months. They were grouped for ABO Rh D antigen and those negative for Rh D antigen were subjected to Du test by IAT (indirect antiglobulin test). RESULTS Among 6346 individuals who were blood donors and recipients subjected to Rh typing, 422(6.64%) individuals were found to be Rh negative and 5924 (93.36%) individuals were found to be Rh positive. Out of 422 Rh negative samples, 1(0.24%) was found to be Du positive, while the remaining 421(99.76%) samples were Du negative. CONCLUSION Detection of weak Du positive blood donors and recipients would remarkably reduce the incidence of transfusion reactions and save on the scarce O negative blood for emergencies.

Post transfusion purpura (PTP) is an uncommonly reported post transfusion adverse event that can present with severe thrombocytopenia; sometimes resulting in significant bleeding and hemorrhage. Its diagnosis can be elusive given its substantial symptomatic overlap with other thrombocytopenic syndromes. Underdiagnosis and underreporting make the true incidence of disease difficult to define. While clinical suspicion is key, laboratory evidence of platelet-targeted antibodies and identification of the antigen(s) they recognize are necessary to confirm the diagnosis. A curious aspect of PTP is paradoxical destruction of both transfused and autologous platelets. Although the first case was reported over 50 years ago, this aspect of PTP pathogenesis is still not fully understood and is widely debated. Several theories exist, but conclusive evidence to support most is lacking. Despite limited understanding of disease incidence and etiology, treatment with IVIG (Intravenous Immunoglobulin) has become standard practice and can be highly effective. Although recurrence is rare, precautions should be taken if patients with a history of PTP require transfusions in the future.

El rastreo de anticuerpos anti-eritrocitarios es una de las pruebas pretransfusionales más importantes en medicina transfusional por su aporte en la prevención de reacciones adversas luego de la administración de hemocomponentes. Sin embargo, no todos los bancos de sangre ecuatorianos han incluido esta prueba en sus protocolos de trabajo. Para demostrar su importancia se realizó el presente estudio cuyo propósito fue alertar al sistema nacional de salud sobre la existencia de aloinmunización en la población de donantes de sangre. Se estableció una prevalencia de anticuerpos anti-eritrocitarios del 0,27% y se identificó una mayor frecuencia en el género femenino. Los anticuerpos identificados estuvieron relacionados con los sistemas eritrocitarios Rh (RH), Kell (KEL), Duffy (FY) y Kidd (JK). Una de las limitaciones para la inclusión de esta prueba en los bancos de sangre y servicios de medicina transfusional es el elevado costo de los reactivos y la falta de paneles de células eritrocitarias de composición homocigota y heterocigota para la identificación de anticuerpos anti-eritrocitarios nativos, situación que constituye una oportunidad para que el Ministerio de Salud Pública del Ecuador promueva mejores estrategias para la importación de reactivos, reducción de costos y disponibilidad de paneles de células. The screening of anti-erythrocyte antibodies is one of the most important pretransfusion tests in transfusion medicine because of its contribution to the prevention of adverse reactions after the administration of blood components, however not all blood banks in Ecuador have included this test in their work protocols. This study has the purpose to alert the national health system about the existence of alloimmunization in the blood donour population. A prevalence of anti-erythrocyte antibodies of 0.27% was established, with a higher frequency being found in the female gender. The identified antibodies are related to the erythrocyte systems Rh (RH), Kell (KEL), Duffy (FY) and Kidd (JK). One of the limitations for the inclusion of this test in blood banks and transfusion medicine services is the excessive cost of serological and gel methodology reagents, and the lack of homozygous and heterozygous erythrocyte cell panels for the identification of native anti-erythrocyte antibodies. That situation constitutes an opportunity for the Ministry of Public Health of Ecuador to promote better strategies for the imports of reagents, cost reduction and availability in the country. O rastreamento de anticorpos anti-eritrocitários é um dos testes pré-transfusão mais importantes na medicina transfusional pela sua contribuição na prevenção de reações adversas após a administração de componentes sanguíneos. No entanto, nem todos os bancos de sangue do Equador tem incluído esse teste em seus protocolos de trabalho. Para demonstrar a sua importância, foi realizado o presente estudo que teve como objetivo alertar o sistema nacional de saúde sobre a existência de aloimunização na população de doadores de sangue. Foi estabelecida uma prevalência de anticorpos anti-eritrocitários de 0,27%, identificando maior frequência no sexo feminino. Os anticorpos identificados estiveram relacionados com os sistemas eritrocitários Rh (RH), Kell (KEL), Duffy (FY) e Kidd (JK). Uma das limitações para a inclusão destes testes em bancos de sangue e serviços de medicina da transfusão é o alto custo dos reagentes, além da falta de painéis de células eritrocitárias de composição homozigótica e heterozigótica para a identificação de anticorpos anti-eritrocitários nativos, situação que constitui uma oportunidade para que o Ministério da Saúde Pública do Equador promova melhores estratégias para a importação de reagentes, redução de custos e disponibilidade de painéis de células.

Transfusion reactions. As with any therapy, blood transfusion may be responsible for side effects that are referred to as «adverse recipient events». They can occur during or within hours of a transfusion or later in the days or weeks after . Their declaration to the haemovigilance device is mandatory. Whether immediate or delayed, there are three main mechanisms are defined: immunological, infectious and overload. The haemovigilance device in proportion to severity and accountability. Their prevention is based on the safety of the prepared products as well as on the compliance with the rules on prescription, selection and transfusion concerning in particular recipient identification. Their diagnosis requires a close monitoring during and after the transfusion procedure.Réactions transfusionnelles. Comme toute thérapeutique, la transfusion sanguine peut être responsable d’effets indésirables qui sont dénommés « évènements indésirables receveurs ». Ils peuvent survenir durant ou dans les heures qui suivent une transfusion ou dans les jours voire les semaines au décours de l’acte. Leur déclaration au dispositif d’hémovigilance est obligatoire. Qu’ils soient immédiats ou retardés, trois principaux mécanismes sont définis : immunologique, infectieux et surchage. Le dispositif d’hémovigilance en cote la gravité et l’imputabilité. Leur prévention repose sur la sécurité des produits préparés ainsi que sur le respect des règles de prescription, de sélection et de transfusion concernant notamment l’identitovigilance. Leur diagnostic impose une surveillance rapprochée pendant et au décours de l’acte transfusionnel.

BACKGROUND: Tracking transfusion reactions is essential to improve patient safety. Under-reporting of transfusion reactions was suspected in our institution. To evaluate this phenomenon, we followed an active surveillance protocol for transfusion reactions for 3 months in 2016 and compared transfusion reaction rates during that period with 2015 and 2017. METHODS: The study was carried out in a tertiary care hospital over 3 months in 2016. Investigators visited hospital units and collected data on all patients who received a transfusion in the preceding 24 h. Further details were obtained about all cases that are suspected to have had a transfusion reaction. Transfusion reactions were defined according to the definitions provided by National Healthcare Safety Network Biovigilance Component Hemovigilance Module Surveillance Protocol 2016. Rates that were obtained through active surveillance were compared through appropriate statistical methods with transfusion reaction rates obtained through passive reporting from 2015 and 2017. RESULTS: During the study period, a total of 47 transfusion reactions were captured through active surveillance and passive reporting (transfusion reaction rate 0.79%). There was a statistically significant difference between these rates in comparison with rates detected in similar months from 2015 (0.26%) and 2017 (0.17%). CONCLUSIONS: Active surveillance for transfusion reactions is an effective method for improving rates of the detection of suspected transfusion reactions. The phenomenon of under-reporting of transfusion reactions requires thorough evaluation by transfusion medicine professionals to introduce targeted solutions and improve reporting rates.

Christopher M Hillis,1–3,* Andrew W Shih,1,3,* Nancy M Heddle1,3,4 1Department of Medicine, 2Department of Oncology, 3McMaster Transfusion Research Program, McMaster University, Hamilton, 4Centre for Innovation, Canadian Blood Services, Ottawa, ON, Canada*These authors contributed equally to this work Abstract: An acute transfusion reaction (ATR) is any reaction to blood, blood components, or plasma derivatives that occurs within 24 hours of a transfusion. The frequencies of ATRs and the associated symptoms, reported by the sentinel sites of the Ontario Transfusion Transmitted Injuries Surveillance System from 2008 to 2012, illustrate an overlap in presenting symptoms. Despite this complexity, the differential diagnosis of an ATR can be determined by considering predominant signs or symptoms, such as fever, dyspnea, rash, and/or hypotension, as these signs and symptoms guide further investigations and management. Reporting of ATRs locally and to hemovigilance systems enhances the safety of the blood supply. Challenges to the development of an international transfusion reaction reporting system are discussed, including the issue of jurisdiction and issues of standardization for definitions, investigations, and reporting requirements. This review discusses a symptom-guided approach to the differential diagnosis of ATRs, the evolution of hemovigilance systems, an overview of the current Canadian system, and proposes a best practice model for hemovigilance based on a World Health Organization patient safety framework. Keywords: blood transfusion, blood components, hemovigilance

The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040 . 1

The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040 . 1

Background and Objectives Despite increasingly meticulous haemovigilance reporting throughout the world, a systematic assessment of the cost of transfusion reactions is still lacking. This is partly caused by the fact that such an assessment requires a subjective expert assessment of the additional costs linked to the adverse reaction. Data on the cost of transfusion reactions could support decision-making regarding blood transfusion safety measures. Materials and Methods Thirteen experts from nine hospitals were asked to estimate the additional care required following various types of transfusion reactions. Additional care was quantified as the proportion of reactions requiring care, and the amount of care required (e.g. hospitalization days, additional physician's time). Experts were also asked to provide, per type of transfusion reaction, an estimate of the proportion of transfusion reactions preventable. Structured quantitative expert elicitation methods were applied to obtain and combine expert estimates. Results The estimated annual in-hospital cost of transfusion reactions in the Netherlands is €933 356 per year (€1.52 per transfusion). Two-thirds (64%) of these are incurred by non-serious transfusion reactions. Circulatory overload, TRALI and anaphylaxis clearly dominate the costs of serious adverse transfusion reactions (66% in total); non-haemolytic transfusion reactions incur 46% of the cost of non-serious transfusion reactions. Additional safety measures targeting circulatory overload and new antibody formation potentially offer the highest cost reduction. Conclusion In-hospital costs of transfusion reactions are substantial but contribute to less than 1% of the total cost of transfusion in the Netherlands. A considerable part of these costs (24%) might be preventable.

BACKGROUND AND OBJECTIVES:Many hospitals require transfusions to be discontinued when vital signs stray from predetermined ranges, regardless of clinical symptoms. Variations in vital signs may be unrelated to transfusion, however, and needlessly stopping a transfusion may delay medical care while increasing donor exposures and healthcare costs. We hypothesized that a detailed study of vital sign changes associated with transfusion of blood product by component, including those associated with potential reactions (complicated) and those deemed to be uncomplicated, would establish a useful framework of reference for treating clinicians and transfusion services alike. MATERIALS AND METHODS:A retrospective electronic record review of transfusion service and transfusion recipient data was completed on 3852 inpatient transfusion episodes over a 6-month period at four academic tertiary care hospitals across the United States. Vital signs pre- and post-transfusion were recorded by trained clinical research nurses. Serious reactions were adjudicated by a panel of transfusion medicine experts. RESULTS:In both uncomplicated transfusions (n = 3765) and those including an adverse reaction (n = 87), vital sign fluctuations were generally modest. Compared to uncomplicated transfusions, transfusions complicated by febrile reactions were associated with higher pretransfusion temperature and higher pretransfusion pulse rates. Episodes of transfusion circulatory overload were associated with higher pretransfusion respiration rates compared to uncomplicated transfusions. CONCLUSION:Most transfusions are associated with only modest changes in vital signs. Pretransfusion vital signs may be an important yet previously understudied predictor of vital sign changes during transfusion. The optimal role of vital sign assessment during blood transfusion deserves further study.

Background: Use of blood and its components is lifesaving. However, their use is often associated with adverse events. Objective: To analyze the pattern of adverse reactions associated with transfusion of blood and its components in pediatric and surgical patients at a tertiary care teaching hospital. Materials and Methods: Patients receiving transfusion of blood or its components in a randomly selected unit each from Departments of Pediatrics, including thalassemia OPD and surgery, were monitored intensively for a period of 6 months. Clinical course, management, outcome, causality, severity, seriousness, and preventability of observed transfusion reactions (TRs) were analyzed. Results: A total of 411 pediatric and 433 surgical patients received 594 and 745 transfusions respectively during the study period. Of these, TRs were observed in 69 (11.6%) children and 63 (8.4%) surgical patients. Majority of reactions in children (48, 69.5%) and surgical patients (51, 80.9%) were acute, developing within 24 h of transfusion. TRs were observed with packed cells (13.2%), cryoprecipitate (10%), platelet concentrate (14.3%) and fresh frozen plasma (1.3%) in pediatric patients and with packed cells (7.2%), whole blood (25%) and platelet concentrate (62.5%) in surgical patients. Most common TRs included febrile nonhemolytic TRs (FNHTRs) and allergic reactions. Reactions were more frequent in patients with a previous history of transfusion or those receiving more than one transfusion and in children, when transfusion was initiated after 30 min of issue of blood component. Majority of reactions were managed with symptomatic treatment, were nonserious, moderately severe, probably preventable and probably associated with the suspect blood component in both populations. Conclusion: Transfusion reactions in children and surgical patients are commonly observed with cellular blood components. Majority of reactions are acute and nonserious. FNHTRs and allergic reactions are the most common transfusion reactions. Risk of transfusion reactions is more in patients receiving multiple transfusions.

Plasma transfusions may result in transfusion reactions. We used the International Surveillance of Transfusion-Associated Reactions and Events (ISTARE) database, containing yearly reported national annual aggregate data on transfusion reactions from participating countries, to investigate risks of plasma transfusion reactions and compare transfusion reaction risks for different plasma types. We calculated risks for plasma transfusion reactions and compared transfusion reaction risks between plasma types using random effects regression on repeated measures. The ISTARE database contains data from 23 countries, reporting units issued and/or transfused and transfusion reactions observed for some portion of 7 years (2006-2012). Interquartile ranges (IQRs) of plasma transfusion reaction risks were: allergic reactions (5·6-72·2 reactions/105 units transfused); febrile non-haemolytic transfusion reactions (0-9·1); transfusion-associated circulatory overload (0-1·9); transfusion related acute lung injury (TRALI) (0-1·2); and hypotensive reactions (0-0·6). Apheresis plasma was associated with more allergic reactions [odds ratio (OR) = 1·29 (95% confidence interval: 1·19-1·40)] and hypotensive reactions [OR = 2·17 (1·38-3·41)] than whole blood-derived plasma. Pathogen-inactivated plasma was associated with fewer transfusion reactions than untreated plasma.

Résumé 1 Hypotension et réactions hypotensives aigues isolées associées aux transfusions de concentrés de plaquettes Objectifs: Les transfusions de concentrés de plaquettes sont associées à plusieurs types de réactions transfusionnelles impliquant de l’hypotension, notamment des réactions hypotensives aigues isolées médiées par la relâche de bradykinines. L’objectif de cette étude est de déterminer l’incidence d’épisodes d’hypotension et plus particulièrement de réactions hypotensives aigues isolées associées aux transfusions de concentrés de plaquettes. Nous avons aussi tenté de déterminer si ces évènements sont associés à un niveau élevé de bradykinines. Matériels et Méthodes: Il s’agit d’une étude prospective descriptive portant sur les transfusions de concentrés de plaquettes au Centre Hospitalier Universitaire Sainte- Justine. L’étude s’est déroulée sur 28 mois. Durant cette période, tous les rapports d’incidents/accidents associés aux transfusions (RIATs) de concentrés de plaquettes transmis à la banque de sang du CHU Sainte-Justine et impliquant un épisode d’hypotension ont été identifiés. Ces RIATs furent revus par un comité d’adjudicateurs qui ont évalué et déterminé l’imputabilité de chaque réaction à la transfusion de plaquettes. Tous les sacs et tubulures des concentrés de plaquettes transfusés ont été retournés à la banque de sang après chaque transfusion. La concentration de bradykinines fut mesurée dans les 168 premiers sacs de concentrés de plaquettes retournés à la banque de sang. Les niveaux de bradykinines des concentrés de plaquettes associés à un épisode d’hypotension et des concentrés de plaquettes non associés à de l’hypotension ont par la suite été comparés. Résultats: 3672 sacs de concentrés de plaquettes furent retournés à la banque de sang parmi lesquels 25 furent associés avec un épisode d’hypotension. Les adjudicateurs ont identifiés 5 épisodes hypotensifs attribuables aux concentrés de plaquettes dont une réaction hypotensive aigue isolée (incidence par transfusion: 0.03%). Le niveau de bradykinines dans cette dernière réaction était de 10 pg/ml, alors qu’il était de 226.2 ±1252 pg/ml (95%CI : 20.0-432.4 pg/ml) dans les 143 concentrés de plaquettes contrôles. Conclusion: L’incidence d’hypotension suivant l’administration de concentrés de plaquettes est faible. Nous n’avons identifié qu’une seule réaction hypotensive aigue isolée. Nous n’avons pas été en mesure d’identifier de corrélation entre le niveau de bradykinines et l’incidence de ces réactions. Résumé 2 Transfusions de plaquettes aux soins intensifs pédiatriques Objectifs: Caractériser l’épidémiologie et les déterminants des transfusions de plaquettes dans une unité de soins intensifs pédiatriques et vérifier s’il existe une association entre ces transfusions et une augmentation de la morbidité et de la mortalité. Méthode: Étude prospective observationnelle unicentrique, combinée à un questionnaire. Lieu: Unité de soins intensifs pédiatriques du Centre Hospitalier Universitaire Sainte- Justine. Patients: Tous les enfants admis à l’unité de soins intensifs d’avril 2009 à avril 2010. Intervention: Aucune. Résultats: Parmi les 842 patients admis consécutivement aux soins intensifs, 60 patients (7.1%) ont reçu au moins une transfusion de plaquettes durant leur séjour. Les déterminants de transfusions de plaquettes identifiés à l’analyse univariée sont un score de PRISM à l’admission >10 (rapport de cotes (RC): 6.80; 95%CI: 2.5-18.3, p 20 (RC: 26.9; 95%CI: 8.88-81.5, p, 1 Incidence of hypotension and acute isolated hypotensive transfusion reactions following platelet concentrate transfusions Background and objectives: Platelet concentrates (PCs) are associated with transfusion reactions involving hypotension, particularly bradykinin-mediated acute isolated hypotensive transfusion reactions. This study aims to determine the incidence of hypotensive events and more specifically acute isolated hypotensive transfusion reactions associated with PC transfusions. We also sought to ascertain whether these reactions are associated with high bradykinin levels. Materials and Methods: This is a prospective descriptive study of PCs administered at Sainte-Justine Hospital over 28 months. All PCs administered during this period were screened for hypotension through review of all transfusion-associated reaction reports (TARRs) sent to the blood bank. All residual PC bags were returned to the blood bank. TARRs associated with hypotension were reviewed by adjudicators who established the imputability of the PC transfusion to the reaction. Bradykinin levels were measured in the first 168 PC bags returned to the blood bank. Levels were compared between PCs associated with hypotension and control PCs not associated with hypotension. Results: A total of 3672 PC bags were returned to the blood bank; 25 PCs were associated with hypotension. Adjudicators ascertained that five hypotensive events were 8 imputable to PCs of which one was an acute isolated hypotensive transfusion reaction (incidence per transfusion: 0.03%). Bradykinin level in the latter PC was 10 pg/ml, whereas levels were 226.2 pg/ml (95%CI : 20.0-432.4 pg/ml) in the 143 control PCs. Conclusion: Our results show a low incidence of hypotension after PC transfusion. We identified only one acute isolated hypotensive transfusion reaction. No correlation between bradykinin level and the occurrence of acute isolated hypotensive reactions could be observed given that only one event was identified. Abstract 2 Platelet transfusions in pediatric intensive care Objectives: To characterize the epidemiology and the determinants of platelet transfusion (PT) in a pediatric intensive care unit (PICU) and determine whether there exists an association between PT and adverse outcomes. Design: Prospective observational single center study, combined with a self-administered survey. Setting: PICU of Sainte-Justine Hospital, a university-affiliated tertiary care institution. Patients: All children admitted to the PICU from April 2009 to April 2010. Intervention: None. Measurements and Main Results: Among 842 consecutive PICU admissions, 60 patients (7.1%) received at least one PT while in PICU. In the univariate analysis, significant determinants for PT transfusion were admission PRISM >10 (odds ratio (OR): 6.80; 95%CI: 2.5-18.3, p 20 (OR: 26.9; 95%CI: 8.88- 81.5, p

BACKGROUND: Hepatitis E virus (HEV) is a small, nonenveloped, single-stranded, RNA virus of emerging concern in industrialized countries. HEV transmission through transfusion of blood components has been reported, but not via plasma-derived medicinal products (PDMPs) manufactured with virus inactivation and/or removal steps. This study aimed to determine the prevalence of HEV among US source plasma donors. STUDY DESIGN AND METHODS: Samples were collected from US source plasma donors at centers across the United States and were initially screened for HEV RNA in 96-sample minipools using the Roche cobas HEV test on the cobas 8800 system. Assuming a sensitivity of 18.6 IU/mL, the minipool screening strategy allowed for reliable detection of individual donations with HEV RNA titers of more than 2 x 10(3) IU/mL. Reactive minipools were resolved to individual donations, which were further analyzed to quantify viral RNA concentration, determine HEV genotype, and immunoglobulin (Ig)G and IgM HEV antibody status. RESULTS: A total of 128,020 samples were collected from 96 CSL Plasma centers in the United States, representing 27 states. The prevalence of HEV RNA-positive samples was 0.002% with three unique HEV-positive donors identified, all HEV Subgenotype 3a. Virus titers of HEV-positive samples were relatively low (10(3)-10(4) IU HEV RNA/mL). One positive donation was HEV IgG seropositive. CONCLUSION: Routine screening of US source plasma donations for HEV would not substantially improve the safety of most PDMPs. The low prevalence and potential viral load of HEV, together with effective virus reduction steps in manufacturing processes, results in a low residual risk and acceptable safety margins for PDMPs derived from US plasma donors.

Background. Haemovigilance hinges on a systematically structured reporting system, which unfortunately does not always exist in resource-limited settings. We determined the incidence and pattern of transfusion-related adverse events reported to the National Blood Service Zimbabwe. Materials and methods. A retrospective review of the transfusion-event records of the National Blood Service Zimbabwe was conducted covering the period from 1 January 1999 to 31 December 2011. All transfusion-related event reports received during the period were analysed. Results. A total of 308 transfusion adverse events (0.046%) were reported for 670,625 blood components distributed. The majority (61.6%) of the patients who experienced an adverse event were female. The median age was 36 years (range, 1-89 years). The majority (68.8%) of the adverse events were acute transfusion reactions consisting of febrile non-haemolytic transfusion reactions (58.5%), minor allergies (31.6%), haemolytic reactions (5.2%), severe allergic reactions (2.4%), anaphylaxis (1.4%) and hypotension (0.9%). Two-thirds (66.6%) of the adverse events occurred following administration of whole blood, although only 10.6% of the blood was distributed as whole blood. Packed cells, which accounted for 75% of blood components distributed, were associated with 20.1% of the events. Discussion. The incidence of suspected transfusion adverse events was generally lower than the incidences reported globally in countries with well-established haemovigilance systems. The administration of whole blood was disproportionately associated with transfusion adverse events. The pattern of the transfusion adverse events reported here highlights the probable differences in practice between different settings. Under-reporting of transfusion events is rife in passive reporting systems. © SIMTI Servizi Srl.

Background. Haemovigilance hinges on a systematically structured reporting system, which unfortunately does not always exist in resource-limited settings. We determined the incidence and pattern of transfusion-related adverse events reported to the National Blood Service Zimbabwe. Materials and methods. A retrospective review of the transfusion-event records of the National Blood Service Zimbabwe was conducted covering the period from 1 January 1999 to 31 December 2011. All transfusion-related event reports received during the period were analysed. Results. A total of 308 transfusion adverse events (0.046%) were reported for 670,625 blood components distributed. The majority (61.6%) of the patients who experienced an adverse event were female. The median age was 36 years (range, 1-89 years). The majority (68.8%) of the adverse events were acute transfusion reactions consisting of febrile non-haemolytic transfusion reactions (58.5%), minor allergies (31.6%), haemolytic reactions (5.2%), severe allergic reactions (2.4%), anaphylaxis (1.4%) and hypotension (0.9%). Two-thirds (66.6%) of the adverse events occurred following administration of whole blood, although only 10.6% of the blood was distributed as whole blood. Packed cells, which accounted for 75% of blood components distributed, were associated with 20.1% of the events. Discussion. The incidence of suspected transfusion adverse events was generally lower than the incidences reported globally in countries with well-established haemovigilance systems. The administration of whole blood was disproportionately associated with transfusion adverse events. The pattern of the transfusion adverse events reported here highlights the probable differences in practice between different settings. Under-reporting of transfusion events is rife in passive reporting systems. © SIMTI Servizi Srl.

Introduction: Thrombocytopenia is one of the most common complications in chronic liver disease and perioperative transplant patients requiring multiple units of platelets transfusion. Aim: This study was undertaken to find out the effectiveness of platelet additive solution (PAS) suspended apheresis platelets in such patients and to compare the in vitro quality of PAS suspended, and plasma suspended apheresis platelets. Materials and Methods: This is a prospective study conducted in the Transfusion Medicine Department of multiorgan transplant center in South India from April 2016 to April 2017. AntiA and antiB isoagglutinin titers were analyzed in O group SSP+ suspended apheresis platelet concentrates (PCs) and response of both SSP+ suspended, and plasma suspended apheresis PCs were analyzed in patients by checking the corrected count increment (CCI). Results: Among 200 single donor platelet (SDP) products, 111 (55.5%) were SSP suspended and 89 (44.5%) were plasma suspended. There were no adverse transfusion reactions in SSP+ suspended PCs. Among 24 individuals with paired plasma suspended and SSP+ suspended SDP products, no statistically significant difference was found in CCI at 24 h. There was a statistically significant difference between pre- and post-anti-A and anti-B titers (P < 0.001). Ten donor units (23.2%) had titer ≥64 for anti-A and anti-B. Conclusion: The ex vivo storage of SDP in PAS offers several advantages in the harvesting of additional plasma for use as transfusable product and reduction of allergic reactions besides maintaining the quality control of platelets.

Summary The Serious Hazards of Transfusion (SHOT) UK confidential haemovigilance reporting scheme began in 1996. Over the 16 years of reporting, the evidence gathered has prompted changes in transfusion practice from the selection and management of donors to changes in hospital practice, particularly better education and training. However, half or more reports relate to errors in the transfusion process despite the introduction of several measures to improve practice. Transfusion in the UK is very safe: 2·9 million components were issued in 2012, and very few deaths are related to transfusion. The risk of death from transfusion as estimated from SHOT data in 2012 is 1 in 322 580 components issued and for major morbidity, 1 in 21 413 components issued; the risk of transfusion-transmitted infection is much lower. Acute transfusion reactions and transfusion-associated circulatory overload carry the highest risk for morbidity and death. The high rate of participation in SHOT by National Health Service organizations, 99·5%, is encouraging. Despite the very useful information gained about transfusion reactions, the main risks remain human factors. The recommendations on reduction of errors through a ‘back to basics’ approach from the first annual SHOT report remain absolutely relevant today.

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No. of bitstreams: 1 NayannaBSF_TESE.pdf: 3573082 bytes, checksum: ddfdfc7465913dd1c55ac398eab942c2 (MD5) Previous issue date: 2016-10-31 Fundação de Apoio à Pesquisa do RN This work aimed to evaluate the clinical, hematological, biochemical, hemogasometric, oxidative stress, lipid peroxidation and transfusion reactions of goats submitted to homologous transfusion of fresh whole blood or stored for 15 and 35 days. Eighteen healthy adult male goats were submitted to the induction of anemia and six hours later were transfused with whole blood stored in CPDA-1 bags (Citrate, phosphate, dextrose and adenine) according to the composite experimental group For 6 animals each: G0 (received fresh blood); G15 and G35 (received blood stored for 15 and 35 days, respectively). The transfusion reactions were recorded during the course of the transfusion, whereas clinical, hematological, biochemical, hemogasometric, oxidative stress and lipid peroxidation parameters were assessed by blood sampling at the following moments: before induction of anemia (TC0); 6 hours after phlebotomy and before transfusion (CT scan); 1, 6, 12, 24 and 96 hours after transfusion (T1, T6, T12, T24 and T96, respectively); 8, 16 and 32 days after transfusion (T8d, T16d and T32d, respectively). Samples of blood were also withdrawn from the pockets, prior to transfusion, for the same analyzes. The pockets of blood stored for 15 and 35 days presented more biochemical changes, hemogasometric, oxidative stress and lipid peroxidation than fresh blood bags. However, the hematological parameters were similar to each other. All groups presented transfusion reactions, among which fasciculations and vocalization occurred more frequently. In the hematological analysis, the animals that received fresh blood presented higher globular volume, number of red blood cells and hemoglobin concentration when compared to the animals that received stored blood. As for the biochemical analysis, after the transfusion it was observed an increase of the proteins in the 3 groups; Transient increase of serum glucose in G0 and G35; Elevation of total bilirubin, direct bilirubin, and urea in G15 and G35; In addition, there was elevation of creatine kinase in the 3 groups. The changes observed in the hemogasometric analysis had no clinical significance, as they were within the reference values for the species. As for oxidative stress, the animals that received stored blood presented disorder in their antioxidant system demonstrated by the alteration of the activity of SOD until the T12. In the analysis of lipid peroxidation there was no difference between the groups for the concentration of malondialdehyde. Thus, it can be concluded that transfusion of fresh total homologous blood was more efficient in restoring blood volume, number of erythrocytes and hemoglobin concentration than the transfusion of stored whole blood. However, transfusion of fresh or stored whole blood did not compromise the blood gas, lipid peroxidation, hepatic and renal functions of goats and proved to be efficient in restoring, among other components, the total proteins. Thus, blood transfusion, as performed in this study, was shown to be safe for use in the clinical practice of this species Este trabalho teve como objetivo avaliar as respostas clínica, hematológica, bioquímica, hemogasométrica, estresse oxidativo, peroxidação lipídica e as reações transfusionais de caprinos submetidos à transfusão homóloga de sangue total fresco ou armazenado por 15 e 35 dias. Foram utilizados 18 caprinos machos, adultos, hígidos, os quais foram submetidos à indução de anemia e, seis horas após, transfundidos com sangue total armazenado em bolsas CPDA-1 (Citrato, fosfato, dextrose e adenina) de acordo com o grupo experimental composto por 6 animais cada: G0 (recebeu sangue fresco); G15 e G35 (receberam sangue armazenado por 15 e 35 dias, respectivamente). As reações transfusionais foram registradas durante o decorrer da transfusão, enquanto que parâmetros clínicos, hematológicos, bioquímicos, hemogasométricos, estresse oxidativo e peroxidação lipídica foram avaliados através da coleta de amostras de sangue nos seguintes momentos: antes da indução da anemia (TC0); 6 horas após a flebotomia e antes de transfusão (TC1); 1, 6, 12, 24 e 96 horas após a transfusão (T1, T6, T12, T24 e T96, respectivamente); 8, 16 e 32 dias após a transfusão (T8d, T16d e T32d, respectivamente). Amostras de sangue também foram retiradas das bolsas, antes da transfusão, para realização das mesmas análises. As bolsas de sangue armazenado por 15 e 35 dias apresentaram mais alterações bioquímicas, hemogasométricas, estresse oxidativo e peroxidação lipídica do que as bolsas de sangue fresco, porém quanto aos parâmetros hematológicos elas foram semelhantes entre si. Todos os grupos apresentaram reações transfusionais, entre as quais fasciculações e vocalização ocorreram com maior frequência. Na análise hematológica, os animais que receberam sangue fresco apresentaram maior volume globular, número de hemácias e concentração de hemoglobina quando comparados aos animais que receberam sangue armazenado. Quanto à análise bioquímica, após a transfusão observou-se aumento das proteínas nos 3 grupos; aumento transitório da glicose sérica no G0 e G35; elevação da bilirrubina total, bilirrubina direta e uréia no G15 e G35; além disso, houve elevação da creatina quinase nos 3 grupos. As alterações observadas na análise hemogasométrica não tiveram significado clínico, pois estavam dentro dos valores de referência para a espécie. Quanto ao estresse oxidativo, os animais que receberam sangue armazenado apresentaram desordem no seu sistema antioxidante demonstrada pela alteração da atividade da SOD até o T12. Na análise da peroxidação lipídica não houve diferença entre os grupos para a concentração de malondialdéido. Sendo assim, pode-se concluir que a transfusão de sangue homólogo total fresco foi mais eficiente em repor a volemia, número de hemácias e concentração de hemoglobina do que a transfusão de sangue total armazenado. Porém, a transfusão seja de sangue total fresco ou armazenado não comprometeu a gasometria, peroxidação lipídica, funções hepática e renal dos caprinos e mostrou-se eficiente em repor entre outros componentes, as proteínas totais. Sendo assim, a transfusão sanguínea, conforme realizada neste estudo, mostrou-se segura para ser utilizada na prática clínica desta espécie 2017-05-03

Audience: This exercise is appropriate for all emergency medicine learners (residents and medical students) and learners from other specialties (internal medicine, family medicine, anesthesia). Introduction: About 85 million red blood cell units are transfused worldwide each year. Transfusion reactions can complicate up to 8% of blood transfusions and can range from benign to life threatening. An emergency physician must be able to discuss the risks and benefits of blood transfusion with patients, as well as manage the associated complications of blood transfusion. Objectives: At the end of this didactic session, the learner will be able to: 1) list the various transfusion reactions and their approximate incidence; 2) understand the pathophysiology behind each transfusion reaction; 3) describe the management for each type of transfusion reaction; and 4) discuss the plan for prevention of future transfusion reactions. Method: This is a classic team based learning exercise (cTBL).

BACKGROUND: Adverse transfusion reactions can cause morbidity and death to patients who receive a blood transfusion. Blood transfusion practice in Mulago Hospital, Kampala, Uganda is analyzed to see if and when these practices play a role in the morbidity and mortality of patients.MATERIALS AND METHODS: An observational study on three wards of Mulago Hospital. Physicians, paramedics, nurses, medical students and nurse students were observed using two questionnaires. For comparison, a limited observational study was performed in the University Medical Centre Groningen (UMCG) in Groningen, The Netherlands.RESULTS: In Mulago Hospital guidelines for blood transfusion practice were not easily available. Medical staff members work on individual professional levels. Students perform poorly due to inconsistency in their supervision. Documentation of blood transfusion in patient files is scarce. There is no immediate bedside observation, so transfusion reactions and obstructions in the blood transfusion flow are not observed.CONCLUSION: The poor blood transfusion practice is likely to play a role in the morbidity and mortality of patients who receive a blood transfusion. There is a need for a blood transfusion policy and current practical guidelines.

Background: Adverse transfusion reactions can cause morbidity and death to patients who receive a blood transfusion. Blood transfusion practice in Mulago Hospital, Kampala, Uganda is analyzed to see if and when these practices play a role in the morbidity and mortality of patients. Materials and Methods: An observational study on three wards of Mulago Hospital. Physicians, paramedics, nurses, medical students and nurse students were observed using two questionnaires. For comparison, a limited observational study was performed in the University Medical Centre Groningen (UMCG) in Groningen, The Netherlands. Results: In Mulago Hospital guidelines for blood transfusion practice were not easily available. Medical staff members work on individual professional levels. Students perform poorly due to inconsistency in their supervision. Documentation of blood transfusion in patient files is scarce. There is no immediate bedside observation, so transfusion reactions and obstructions in the blood transfusion flow are not observed. Conclusion: The poor blood transfusion practice is likely to play a role in the morbidity and mortality of patients who receive a blood transfusion. There is a need for a blood transfusion policy and current practical guidelines.

Background: Febrile nonhemolytic transfusion reactions (FNHTRs) are relatively common complications associated with allogenic transfusion. White blood cells (WBCs or leukocytes) are considered to be an important cause of FNHTRs; the rate of WBC derived pro.inflammatory cytokines increase with storage due to active synthesis of cytokines by these cells. The removal of the WBCs before storage will prevent the accumulation of cytokines during storage that leads to a reduction in the number of FNHTRs. Aim: We have conducted a retrospective analysis comparing the rate of FNHTRs in prestorage leukoreduced (PrSLR) and non leukoreduced RBCs transfusion.Subjects and Methods: A retrospective review of all the transfusion reactions (TRs) reported to the department over a period of 2 years from July 2012 to June 2014 was done. Patients were stratified by the date of reaction and by component received and then divided into two groups: (1) Patients who received allogeneic PrSLR RBCs and (2) nonleukoreduced RBCs. For the PrSLR RBC units, leukoreduction was performed by using buffy coat method of component preparation by quadruple bags and integral bags containing SepacellR Pure RC filters (Fenwal. France). Results: 37,232 RBCs units were transfused and out of which 14149 (38% i.e. is 14149/37232) were prestorage leukoreduced (PrSLR) and 23083 (62%) were non leukoreduced. A total of 142 (0.38%) TRs were reported during that time period, of which 62 (0.17%) were classified as FNHTRs. In the nonleukoreduced group 124 TRs were reported, of which 55 were classified as FNHTRs to RBCs and the overall rate of FNHTR to RBCs was 0.24%. In pre storage leukoreduced group, 18 TRs were reported, of which 7 were classified as FNHTRs to RBCs and the overall rate of FNHTR to RBCs was 0.05% (P . 0.001). This represents a significant reduction in the rate of FNHTR after institution of prestorage leukoreduction.Conclusion: The rate of FNHTRs to allogenic RBC units after the implementation of prestorage leukoreduction has decreased significantly. Cytokines and chemokines accumulating during storage of cellular blood products are responsible for residual FNHTRs.Keywords: Febrile nonhemolytic transfusion reaction, Leukoreduction, Transfusion reactions

From the very beginning of its development, transfusion therapy was accompanied by the occurrence of transfusion reactions. Their incidence is monitored through systematic reporting in order to effectively plan strategy which aims to reduce the frequency of new reactions. Reducing the frequency of transfusion reactions is the task of all health care professionals, who care for patients requiring blood transfusion. Doctors and laboratory staff have an important role in both laboratory processing and the improvement of blood component production. Meanwhile, nurses perform key role during blood sampling, administration of transfusion, patient monitoring and reporting of transfusion reactions. In the past decade, certain changes have been introduced in the production of blood elements which are used in the University Hospital Centre Zagreb. In addition to continuous training of all employees on ways to ensure and improve the quality of care for patients requiring transfusion, the majority of changes relates to the semi-automated method of production and leukofiltration (LF) of blood components. The aim of this research was to determine the effect of implementing the universal leukofiltration of blood components that are produced by applying the semi-automated method on the appearance of transfusion reactions.

Blood transfusion in patients with sickle cell disease (SCD) is limited by the development of alloantibodies to erythrocytes. In the present study, the frequency and risk factors for alloimmunization were determined. Transfusion records and medical charts of 828 SCD patients who had been transfused and followed at the Belo Horizonte Blood Center, Belo Horizonte, MG, Brazil, were retrospectively reviewed. Alloimmunization frequency was 9.9% (95% CI: 7.9 to 11.9%) and 125 alloantibodies were detected, 79% of which belonged to the Rhesus and Kell systems. Female patients developed alloimmunization more frequently (P = 0.03). The median age of the alloimmunized group was 23.3 years, compared to 14.6 years for the non-alloimmunized group (P < 0.0001). Multivariate analyses were applied to the data for 608 hemoglobin (Hb) SS or SC patients whose number of transfusions was recorded accurately. Number of transfusions (P = 0.00006), older age (P = 0.056) and Hb SC (P = 0.02) showed independent statistical associations with alloimmunization. Hb SC patients older than 14 years faced a 2.8-fold higher (95% CI: 1.3 to 6.0) risk of alloimmunization than Hb SS patients. Female Hb SC patients had the highest risk of developing alloantibodies. In patients younger than 14 years, only the number of transfusions was significant. We conclude that an increased risk of alloimmunization was associated with older patients with Hb SC, specially females, even after adjustments were made for the number of transfusions received, the most significant variable.

Acute transfusion reactions have been found to occur during or within 24 hours of transfusion. The aim of this work is to describe the main characteristics of acute reactions reported in a Brazilian transfusion service. A preprinted report form was used to evaluate the age and sex of the transfusion recipients, blood component requested, medical specialty involved and transfusion-related signs and symptoms, transfusionists performed a direct observation during the transfusion and in a period of four hours following transfusion. Data were prospectively collected for 90 days from 30 hospitals and health facilities supplied by the the Service of Hematology and Hemotherapy of São José dos Campos. Acute reactions were recognized as febrile nonhemolytic, allergic, fluid overload, transfusion-related acute lung injury (TRALI), anaphylatic and metabolic reactions. In a total of 8,378 transfusions, 46 acute reactions were recorded (5.5 per 1000 units transfused, 28 febrile nonhemolytic, 12 allergic, 5 anaphylatic and 1 fluid overload). TRALI and metabolic reactions were not detected. The majority (27) was associated with RBCs followed by PLTs 11, FFP 6 and partial units 2. The median age of the recipients was 43 years (3 months to 83 years, 23 males and 23 females). Overall, 12 (26.1%) events were recorded in oncology, 12 (26.1%) in medicine and 7 in intensive care unit departments. This study provides baseline acute transfusion reaction information for a specific period of time in a Brazilian transfusion service.As reações transfusionais agudas ocorrem durante ou em um período de até 24 horas após a transfusão de hemocomponentes. O objetivo deste estudo foi descrever as principais reações transfusionais agudas em um serviço de hemoterapia brasileiro. Através de um formulário próprio contendo a idade e o sexo dos receptores, os hemocomponentes solicitados, as especialidades médicas envolvidas e os sinais e sintomas relacionados, os transfusionistas registraram os eventos durante a transfusão e até quatro horas após seu término. Colheram-se dados de 30 hospitais e clínicas atendidos pelo Serviço de Hematologia e Hemoterapia de São José dos Campos em um período de 90 dias. As reações agudas foram definidas como febril não hemolítica, alérgica, sobrecarga volêmica, TRALI, anafilática e metabólica. Em um total de 8378 transfusões, 46 reações foram registradas (5,5 por 1000 unidades transfundidas) sendo 28 do tipo febril não hemolítica, 12 do tipo alérgica, 5 do tipo anafilática 1 do tipo sobrecarga volêmica. Reações do tipo TRALI não foram observadas. 27 reações foram associadas com a transfusão de concentrado de hemácias, 11 com a transfusão de concentrado de plaquetas, 6 com a transfusão de plasma fresco congelado e 2 com a transfusão de concentrado de hemácias para recém-nascidos. Dentre os receptores com reações, a mediana das idades foi de 43 anos (3 meses a 83 anos) sendo 23 do sexo masculino e 23 do sexo feminino. 12 reações (26,1%) foram provenientes do setor de Oncologia, 12 (26,1%) do setor Clínica Médica e 7 do setor Unidade de Terapia Intensiva. Este estudo descreve as reações transfusionais agudas registradas em um período de tempo específico provenientes de um serviço de hemoterapia brasileiro.

The recognition and management of transfusion reactions (TRs) are critical to ensure patient safety during and after a blood transfusion. Transfusion reactions are classified into acute transfusion reactions (ATRs) or delayed transfusion reactions, and each category includes different subtypes. Different ATRs share common signs and symptoms which can make categorisation difficult at the beginning of the reaction. Moreover, TRs are often under-recognised and under-reported. To ensure uniform practice and safety, it is necessary to implement a national haemovigilance system and a set of national guidelines establishing policies for blood transfusion and for the detection and management of TRs. In Oman, there are currently no local TR guidelines to guide physicians and hospital blood banks. This paper summarises the available literature and provides consensus guidelines to be used in the recognition, management and reporting of ATRs.

Background. Haemovigilance hinges on a systematically structured reporting system, which unfortunately does not always exist in resource-limited settings. We determined the incidence and pattern of transfusion-related adverse events reported to the National Blood Service Zimbabwe. Materials and methods. A retrospective review of the transfusion-event records of the National Blood Service Zimbabwe was conducted covering the period from 1 January 1999 to 31 December 2011. All transfusion-related event reports received during the period were analysed. Results. A total of 308 transfusion adverse events (0.046%) were reported for 670,625 blood components distributed. The majority (61.6%) of the patients who experienced an adverse event were female. The median age was 36 years (range, 1-89 years). The majority (68.8%) of the adverse events were acute transfusion reactions consisting of febrile non-haemolytic transfusion reactions (58.5%), minor allergies (31.6%), haemolytic reactions (5.2%), severe allergic reactions (2.4%), anaphylaxis (1.4%) and hypotension (0.9%). Two-thirds (66.6%) of the adverse events occurred following administration of whole blood, although only 10.6% of the blood was distributed as whole blood. Packed cells, which accounted for 75% of blood components distributed, were associated with 20.1% of the events. Discussion. The incidence of suspected transfusion adverse events was generally lower than the incidences reported globally in countries with well-established haemovigilance systems. The administration of whole blood was disproportionately associated with transfusion adverse events. The pattern of the transfusion adverse events reported here highlights the probable differences in practice between different settings. Under-reporting of transfusion events is rife in passive reporting systems. © SIMTI Servizi Srl.

Background: A voluntary system of transfusion reaction monitoring has been present in Croatia since 1999. As the Croatian legislative related to blood and blood products was harmonized with European Council Directives in 2006, establishment of the blood product traceability system and the national system of reporting adverse and unexpected events has become necessary. The Croatian Institute of Transfusion Medicine (CITM) performs Systematic Surveillance of Transfusion Treatment (SSTT) at the national level, i.e. data collection, assessment and categorization of reactions/events, data processing and reporting to the Ministry of Health. Healthcare institutions using blood products in transfusion treatment systematically record, assess and manage reactions, and report all reactions/events in the form of annual report directly to CITM or through their transfusion units. In case of a serious adverse event (SAE) or serious adverse reaction (SAR), healthcare institution reports it in writing to CITM or Ministry of Health within 24 hours. Aims: SSTT collects data on patient transfusion reactions, adverse events and reactions/complications recorded in blood donors. Methods: Reactions to transfusion treatment are classified according to the Proposed Standard Definitions for Surveillance of Non Infectious Adverse Transfusion Reactions (ISBT, IHN, 2011), while their prevalence is expressed per number of units issued for transfusion treatment. Events are classified according to the Medical Event Reporting System for Transfusion Medicine. Reactions/complications in blood donors are classified according to the Standards for Collecting and Reporting Data on Reactions Related to Blood Donation (EHN, ISBT, 2008), and their prevalence is expressed per number of blood donations. Results: Since 2010, the SSTT annual report is published in the Croatian Transfusion Gazette. During the 2010-2012 period, the prevalence of transfusion reactions was 1.2/1000, of which 0.08/1000 reactions were characterized as SAR. A total of 716 adverse events were reported, 186 of the characterized as SAE by subsequent evaluation, mostly due to human error. Out of 12.4/1000 reactions reported in blood donors, 0.12/1000 were characterized as SAR. Summary: SSTT requires continuous education of all professionals involved, including transfusiologists, physicians and nurses at clinical wards, in order to properly recognize and manage reactions, analyze reactions/events, and determine corrective/preventive measures. It is of utmost importance for hospital specialists in transfusion medicine to take active part in these processes through their engagement in hospital boards for transfusion treatment. We plan to introduce reaction/event reporting via e-Delphyn, unique national transfusion software, whereas the SSTT annual report will be upgraded with additional analysis and recommendations.

Background: To determine the frequency and types of blood transfusion reactions during pregnancy. Methods: In this descriptive study 1754 consecutive pregnant women during a period of twelve months, were included. All reactions were reported to the blood bank. Frequency of blood transfusion reactions, type of transfusion reactions, morbidity, complication or mortality was noted. Results: Out of total cases of anaemia (1754), the patients having blood transfusions were 26.6% (n=468). Out of 468 post transfusion reactions were observed in 20.9%. Transfusion reactions were categorized as hemolytic reactions in 4.9% , nonhemolytic reactions in 4.2% and febrile reactions in 11.7%. Out of 98 cases of blood transfusion reactions two cases expired due to severe hemolytic reaction . Conclusion: Blood transfusion for the treatment of anaemia should be reserved only for hemodynamically unstable patients or any other co morbidity during pregnancy.

Background: Croatian haemovigilance report includes transfusion reactions, trans- fusion events and reactions, and donor complications. Aims: To present results of haemovigilance in Croatia in 2011. Methods: Data from all Croatian institutions performing transfusion treatment are collected and processed at Department of Haemovigilance – Systematic Surveillance of Transfusion Treatment (SSTT) at Croatian Institute of Transfusion Medicine. Reac- tions and events are classified according to the Serious Hazards of Transfusion (SHOT) classification. Due to incomplete data on the number of transfused units, ‘number of units issued for transfusion treatment’ is used as a denominator to pres- ent the frequency of reactions to transfusion treatment. Reactions related to blood donation are classified according to the Standards for Collecting and Reporting Data on Reactions Related to Blood Donation (European Haemovigilance Network and International Society of Blood Transfusion, 2008) and their frequency is expressed per number of blood units collected. Results: In 2011, a total of 101 561 blood products were issued and 314 transfusion reactions (1.04/1000 blood products issued for transfusion treatment) reported from 36 Croatian institutions performing transfusion treatment. On reassessment of reac- tion reports at SSTT, 20 reactions were evaluated as severe adverse reactions, which included 10 DHTR, 5 anaphylactic reactions, 4 TACO and 1 possible TRALI. Three hundred adverse events were reported from 11/37 institutions included in the sur- veillance of adverse events associated with collection, processing, storage, distribu- tion and use of blood products. On reassessment of reports at SSTT, 63 events were evaluated as serious adverse events. According to the type of event, there were 6 product errors, 9 equipment failures, 14 ‘other’ events and 34 human errors includ- ing transfusion of erroneous blood product in seven cases, where no transfusion reactions were reported. Other errors were identified on time, before transfusion, and could be characterized as ‘near-miss’ events. In 12 of 13 institutions having submit- ted their reports, 175 808 donations (whole blood and apheresis) were collected and 2206 donation reactions and complications (1.25/1000 donations) reported. Summary: Data processing revealed the lack of uniformity among the institutions in reporting transfusion reactions and events, which is the result of understatement of the existing legal provisions and incomprehensive requirements where, among others, the terms ‘relation to transfusion’ and/or ‘severity of reaction’ are inade- quately explained. Consequently, the definitions of reaction and event are variedly interpreted, while data on investigating the cause of reaction and the level of suspi- cion of its association with transfusion are incomplete, thus hampering evaluation and categorization of the reactions/events. All this calls for amendments of the existing regulations. In addition, continuous education on haemovigilance is needed for all those involved in the transfusion chain to understand the risks associated with transfusion treatment and the importance of reporting reactions/events cor- rectly, thus contributing to upgrading the overall transfusion process.

Aims: In this study we have evaluated the various adverse reactions related to transfusion occurring in our institution as a pilot institutional effort toward a hemovigilance program. This study will also help in understanding the problems faced by blood banks/Transfusion Medicine departments in implementing an effective hemovigilance program. Materials and Methods: All the adverse reactions related to transfusion of whole blood and its components in various clinical specialties were studied for a period of 1 year. Any transfusion-related adverse event was worked up in accordance with guidelines laid down by the Directorate General of Health Services (DGHS) and departmental standard operating procedures. Results: During the study period from November 1, 2011 to October 31, 2012, 45812 components were issued [30939 WB/PRBC; 12704 fresh frozen plasma (FFP); 2169 platelets]. Risk estimation per 1000 units of red cells (WB/PRBC) transfused was estimated to be: 0.8 for febrile nonhemolytic transfusion reaction (FNHTR), 0.7 for allergic reaction, 0.19 for acute hemolytic transfusion reaction (AcHTR), 0.002 for anaphylactoid reactions, 0.1 for bacterial sepsis, and 0.06 for hypervolemia and hypocalcemia. 0.09 is the risk for delayed transfusion reaction and 0.03 is the risk for transfusion-related acute lung injury (TRALI). Risk estimate per 1,000 units of platelets transfused was estimated to be 1.38 for FNHTR, 1.18 for allergic reaction, and 1 in case of bacterial sepsis. Risk estimation per 1,000 units of FFP was estimated to be 0.15 for FNHTR and 0.2 for allergic reactions. Conclusions: Factors such as clerical checks at various levels, improvement in blood storage conditions outside blood banks, leukodepletion, better inventory management, careful donor screening, bedside monitoring of transfusion, and documentation of adverse events may decrease transfusion-related adverse events. Better coordination between transfusion specialists and various clinical specialties is the need of the hour and it will help in making the whole transfusion chain safe and effective. There is a need for a hemovigilance program at the national level so that true incidence and the spectrum of adverse events due to transfusion are known and policies formulated to minimize the risks associated with it.

Introducción: La injuria pulmonar aguda relacionada con la transfusión (TRALI) se constituye en la principal causa de morbimortalidad relacionada con la transfusión reportada a la agencia de alimentos y medicamentos (FDA) y a los diferentes sistemas de hemovigilancia. Métodos: Se diseñó un Sistema de hemovigilancia activa que incluye búsqueda, detección, clasificación y análisis de los efectos no deseados e inesperados de la transfusión sanguínea con el fin de corregir sus causas y prevenir su repetición. Se desarrolló una prueba piloto en el servicio de hematología del instituto nacional de cancerología, incluyendo los pacientes mayores de 15 años que recibieron transfusión de componentes sanguíneos de cualquier tipo y cantidad. Se llevó a cabo vigilancia clínica activa de cualquier tipo de evento adverso en el paciente transfundido, en especial estrés respiratorio. Resultados: se transfundieron 5389 componentes sanguíneos, 45% de los cuales en el servicio de hematología. El porcentaje de reacción adversa a la transfusión en el servicio de hematología fue de 0.28%; siendo reacción alérgica 57%; reacción febril no hemolítica 14% y disnea asociada a la transfusión 28% (2 reacciones; una por plaquetas y otra asociada a glóbulos rojos). Conclusiones: Se logró demostrar que el sistema es oportuno, simple en su estructura y flexible. Se propone una auditoria paralela externa para validar su rendimiento operativo. Se necesita implementar medidas que permitan disminuir el subregistro y aumentar el deseo de participar del personal de atención en salud del INC en la implementación del programa de hemovigilancia. / Abstract. Introduction: Transfusion related acute lung injury (TRALI) constitutes the leading cause of transfusion-related morbidity and mortality reported to the Food and Drug Administration (FDA) and the different hemovigilance systems. Methods: We designed an active hemovigilance system including search, detection, classification and analysis of unwanted and unexpected effects of blood transfusion to correct their cause and prevent recurrence. It was developed a pilot test in the hematology service of the national institute of cancer including patients aged over 15 years who received blood transfusion of any type and quantity. It was carried out active clinical surveillance of any adverse event in the transfused patient, especially respiratory distress. Results: 5389 blood products were transfused, 45% of them in the hematology service. The percentage of adverse transfusion reactions in the hematology service was 0.28%; of then allergic reaction 57%; non-hemolytic febrile reactions 14% and transfusion-associated dyspnea 28% (2 reactions, a platelet-associated and another associated with red blood cells) Conclusions: It was possible to demonstrate that the system is timely, simple in their structure and flexible. We propose a parallel external audit to validate their operating performance. Is necessary to implement measures to reduce the underreporting and increase the willingness to participate in the implementation of hemovigilance program. Otra

Background According to the By-Law on the System of Traceability of Blood Components and Monitoring of Serious Adverse Reactions (SAR) and Serious Adverse Events (SAE) from 2007, institutions providing transfusion treatment have been included in systematic surveillance of transfusion treatment in Croatia. Materials and Methods Reactions associated with transfusion treatment were reported on the uniform form through hospital transfusion departments to the Croatian Institute of Transfusion Medicine (CITM). Annual reports on transfusion reactions recorded in 2010 were submitted by 34 institutions out of 36. Out of the 34 institutions having submitted reaction reports, 15 institutions prepare and use blood components (hospital blood establishment), whereas 19 institutions are only engaged in blood product utilization (hospital blood bank). Results In 2010, blood was collected from 177 355 blood donors. According to data available, 286 061 blood components were issued for transfusion therapy, including 159 238 red blood cells (RBC), 76 833 platelets and 49 990 fresh frozen plasma. A total of 375 transfusion reactions or 1.3/1000 blood components issued for transfusion therapy were reported, predominated by febrile nonhemolytic transfusion reactions (46.13%) and allergic reactions (38.93%), followed by reactions classified as 'Other' (5.87%) and delayed hemolytic transfusion reactions (4.00%). Out of 375 transfusion reactions reported, 75% referred to RBC, 14% to plasma, and 11% to platelet blood components. On report reassessment, 32 transfusion reactions or 0.1/1000 blood components issued for transfusion therapy were characterized as serious adverse reactions: acute hemolytic transfusion reaction (AHTR) 1 with lethal outcome, 15 delayed hemolytic transfusion reactions (DHTR), 6 anaphylactic reactions, 1 anaphylactic shock, 1 transfusion-related acute lung injury (TRALI), 2 transfusion associated dyspnea (TAD), 1 post- transfusion purpura (PTP), 3 transfusion associated circulatory overload (TACO) and 2 transfusion transmitted viral infections (TTVI). Conclusion In order to make it available to the public, 2010 National Report has been published in the Croatian Transfusion Gazette.

WOS: 000265357000014 The safe use of transfusion therapy requires proper knowledge on blood groups, blood typing, donor selection, blood collection, transfusion protocols and adverse transfusion reactions. Type B cats have high titres of naturally occurring anti-A isoagglutinins and type A cats have generally low titred anti-B isoagglutinins in their plasma. The severity of incompatibility reactions in blood transfusion is proportional to the alloantibody titres of the recipient blood. Transfusion of type B blood to type A cats may develop a mild transfusion reactions. In contrast, administration of type A blood to type B cats can cause potentially fatal acute hemolytic transfusion reactions. Adverse transfusion reactions can be avoided by typing donor and recipient cats before transfusion and by administering only matched blood. Due to improvement in feline blood typing, collecting and administration procedures, there has been a notable increase in the blood transfusion therapy in these animals. Present paper reviews current understanding of the pactical aspects of transfusion therapy in cats.

Blood transfusion therapy is often under-utilised in feline practice in South Africa. However, it is a technique that can be safely and effectively introduced in practice. Cats have naturally occurring allo-antibodies against the blood type that they lack, which makes blood typing, or alternatively cross-matching, essential before transfusions. Feline blood donors must be carefully selected, be disease free and should be sedated before blood collection. The preferred anticoagulant for feline blood collection is citrate-phosphatedextrose-adenine. Blood can either be administered intravenously or into the medullary cavity, with the transfusion rate depending on the cat's hydration status and cardiac function. Transfusion reactions can be immediate or delayed and they are classified as immunological or non-immunological. Indications, methods and techniques to do feline blood transfusions in a safe and economical way are highlighted.

A partir del año 2003, en el Hospital Docente Provincial “Comandante Faustino Pérez” se inició el control y análisis de los efectos adversos de la transfusión de sangre, mediante el reporte y estudio de todas las reacciones transfusionales, para conocer su frecuencia, tipo y gravedad, así como su relación con el componente utilizado, los días de extraído y el sexo del receptor. Se reportaron los errores detectados y subsanados antes del proceder. Este estudio se realizó bajo la asesoría y control del Banco de Sangre Provincial “Minerva Duarte”, como parte de la vigilancia sobre los productos sanguíneos y la cadena transfusional, con el objetivo de disminuir los efectos adversos e incrementar la seguridad transfusional. Los datos obtenidos demuestran disminución del número de reacciones adversas, de 52 en el 2002 a 14 en el 2005. Las más frecuentes fueron la febril no hemolítica y las alérgicas; la más grave resultó la contaminación bacteriana. Los errores más frecuentes subsanados antes de la transfusión fueron por equivocación del grupo en la bolsa a transfundir. El componente que más reacciones originó fue el concentrado de hematíes y el sexo femenino fue el que más reacciones presentó. El estudio permitió la adopción de medidas correctivas y preventivas para disminuir las reacciones e incrementar la seguridad transfusional en el centro hospitalario.From 2003 on, it was started the control and analysis of the adverse effects of blood transfusion at “Comandante Faustino Pérez” Provincial University Hospital by the report and study of all the transfusion reactions in order to know their frequency, type and severity, as well as their relation to the component used, the date of the extraction, and the sex of the recipient. The errors detected and corrected before the procedure were reported. This study was conducted under the counselling and control of “Minerva Duarte” Provincial Blood Bank as part of the vigilance of the blood products and the transfusion chain aimed at reducing the adverse effects and at increasing transfusion safety. The data obtained showed a decrease of the number of adverse reactions from 52, in 2002, to 14, in 2005. The most common reactions were the non-hemolytic febrile reactions and the allergic reactions, whereas the most serious was bacterial contamination. The most frequent amended mistakes before transfusion were those made by the group with the transfusion bag. The packed cells proved to be the component that originated the greatest amount of reactions. Females had more reactions. The study allowed to take corrective and preventive measures to lower the reactions and improve the transfusion safety in the hospital.

Background. The decision, made by transfusion medicine specialist, for the extent of investigation of the transfusion reaction is based on the clinical course of transfusion reaction, reported by the patient´s physician. Immunohaematological tests are used for testing of compatibility in red blood cells antigen and rarely also in platelet and leucocyte antigens. Evaluation of reported transfusion reactions includes repeated checking of patient identification, of issued component and of the compatibility in AB0 blood groups between the patient and the donors. In cases of suspected immune haemolysis, direct antiglobulin test and antibody screening is performed from the patient´s posttransfusion sample of blood. Whenever, due to the signs and simptoms of transfusion reaction and the results of testing, immune haemolysis is possible, additional immunohaematological tests are done.Conclusions. Specialist of transfusion medicine determines the type of transfusion reaction regarding the clinical course, the response to the treatment and the results of checking and testing. The evaluation is finished with a report for the patient´s physician with further instructions. In addition, a report for the Consulting Service for Blood Component Users in Blood Transfusion Centre of Slovenia is issued. Described routine procedures of evaluation help us in the detection of the possible mistakes in the transfusion process and in the determination of the type of transfusion reaction.

Acute transfusion reactions have been found to occur during or within 24 hours of transfusion. The aim of this work is to describe the main characteristics of acute reactions reported in a Brazilian transfusion service. A preprinted report form was used to evaluate the age and sex of the transfusion recipients, blood component requested, medical specialty involved and transfusion-related signs and symptoms, transfusionists performed a direct observation during the transfusion and in a period of four hours following transfusion. Data were prospectively collected for 90 days from 30 hospitals and health facilities supplied by the the Service of Hematology and Hemotherapy of São José dos Campos. Acute reactions were recognized as febrile nonhemolytic, allergic, fluid overload, transfusion-related acute lung injury (TRALI), anaphylatic and metabolic reactions. In a total of 8,378 transfusions, 46 acute reactions were recorded (5.5 per 1000 units transfused, 28 febrile nonhemolytic, 12 allergic, 5 anaphylatic and 1 fluid overload). TRALI and metabolic reactions were not detected. The majority (27) was associated with RBCs followed by PLTs 11, FFP 6 and partial units 2. The median age of the recipients was 43 years (3 months to 83 years, 23 males and 23 females). Overall, 12 (26.1%) events were recorded in oncology, 12 (26.1%) in medicine and 7 in intensive care unit departments. This study provides baseline acute transfusion reaction information for a specific period of time in a Brazilian transfusion service. As reações transfusionais agudas ocorrem durante ou em um período de até 24 horas após a transfusão de hemocomponentes. O objetivo deste estudo foi descrever as principais reações transfusionais agudas em um serviço de hemoterapia brasileiro. Através de um formulário próprio contendo a idade e o sexo dos receptores, os hemocomponentes solicitados, as especialidades médicas envolvidas e os sinais e sintomas relacionados, os transfusionistas registraram os eventos durante a transfusão e até quatro horas após seu término. Colheram-se dados de 30 hospitais e clínicas atendidos pelo Serviço de Hematologia e Hemoterapia de São José dos Campos em um período de 90 dias. As reações agudas foram definidas como febril não hemolítica, alérgica, sobrecarga volêmica, TRALI, anafilática e metabólica. Em um total de 8378 transfusões, 46 reações foram registradas (5,5 por 1000 unidades transfundidas) sendo 28 do tipo febril não hemolítica, 12 do tipo alérgica, 5 do tipo anafilática 1 do tipo sobrecarga volêmica. Reações do tipo TRALI não foram observadas. 27 reações foram associadas com a transfusão de concentrado de hemácias, 11 com a transfusão de concentrado de plaquetas, 6 com a transfusão de plasma fresco congelado e 2 com a transfusão de concentrado de hemácias para recém-nascidos. Dentre os receptores com reações, a mediana das idades foi de 43 anos (3 meses a 83 anos) sendo 23 do sexo masculino e 23 do sexo feminino. 12 reações (26,1%) foram provenientes do setor de Oncologia, 12 (26,1%) do setor Clínica Médica e 7 do setor Unidade de Terapia Intensiva. Este estudo descreve as reações transfusionais agudas registradas em um período de tempo específico provenientes de um serviço de hemoterapia brasileiro.

Transfusion of blood and its components has undergone technological advancement, and its use is increasing both perioperatively as well as in the Intensive Care Unit. The separation of blood into its various components has made it very economical as blood donated from a single donor can be utilized for many recipients at the same time. However, the transfusion of blood and its components do carry the inherent risk of various transfusion reactions as well as transmission of infections. The indications for transfusion should be strictly adhered to for preventing nonjudicious use. The health care persons involved in transfusion should be well aware of implications of the mismatched transfusion and should be able to provide treatment if such mishaps do occur. A health care professional should carefully weigh the benefits of blood transfusion against the risks involved before subjecting the patients to the transfusion. This manuscript aims to comprehensively review the current evidence based approaches in blood and component transfusion which are being followed in anesthesiology and intensive care practice.