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Transfusion has become extremely safe but can still be associated with adverse reactions. Some adverse reactions can be mitigated by applying measures to donor selection, the process of separating blood components as well as hospital-based procedures consisting in matching the donor and the recipient; special attention is given to optimizing the best fit between the component and the beneficiary, which is not only an immuno-hematological challenge (fresh versus old blood, testing for certain viruses such as CMV, parvovirus B19, etc.). Considerable progress has also been achieved to strengthen the overall quality and safety of the whole transfusion chain. Guidelines and recommendations have resulted in substantial progress, and the recent revisiting of patients as part of a more holistic approach has enabled blood management programs to be created. Such programs, when wisely applied in a context of optimal blood use, reinforce patient safety; they enhance hospital recognition of transfusion and hemovigilance specialists as useful players acting in the interests of patients in full compliance with hospital budgets. This review considers the step-by-step processes that reinforce transfusion safety and identifies hurdles that cannot yet be properly addressed; it proposes steps for further progress, in light of personalized medicine., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Background and Objectives: The purpose of this study was to analyse the transfusion-related events recorded in a general university hospital., Materials and Methods: The method we used was retrospective analysis of the data collected between 1999 and 2003., Results: The incidence of transfusion reactions (n = 394) was 4.19 per 1000 blood products distributed: 59% (n = 231) were febrile non-haemolytic transfusion reactions; 22% (n = 88) were caused by allergy; 5% (n = 21) were caused by bacterial infection; and 14% (n = 54) were classified as other reactions. Platelet concentrates gave rise to a significantly greater number of reactions than erythrocyte concentrates and fresh-frozen plasma. Transfusion errors and near-miss events were also observed and were analysed separately. A series of transfusion-related events, such as haemosiderosis, metabolic disturbances or volume overload, were not reported., Conclusions: Our experience prompts us to propose a more comprehensive classification and codification of transfusion-related events.

The aim of this study is to describe a newly implemented haemovigilance system in a general university hospital. We present a series of short cases, highlighting particular aspects of the reports, and an overview of all reported incidents between 1999 and 2001. Incidents related to transfusion of blood products were reported by the clinicians using a standard preformatted form, giving a synopsis of the incident. After analysis, we distinguished, on the one hand, transfusion reactions, that are transfusions which engendered signs or symptoms, and, on the other hand, the incidents where management errors and/or dysfunctions took place. Over 3 years, 233 incidents were reported, corresponding to 4.2 events for 1000 blood products delivered. Of the 233, 198 (85%) were acute transfusion reactions and 35 (15%) were management errors and/or dysfunctions. Platelet units gave rise to statistically (P < 0.001) more transfusion reactions (10.7 per thousand ) than red blood cells (3.5 per thousand ) and fresh frozen plasma (0.8 per thousand ), particularly febrile nonhaemolytic transfusion reactions and allergic reactions. A detailed analysis of some of the transfusion incident reports revealed complex deviations and/or failures of the procedures in place in the hospital, allowing the implementation of corrective and preventive measures. Thus, the haemovigilance system in place in the 'Centre Hospitalier Universitaire Vaudois, CHUV' appears to constitute an excellent instrument for monitoring the security of blood transfusion.

Based on a review of the literature, guidelines for the clinical use of cytomegalovirus (CMV) seronegative cellular blood products are presented. The clinical fields of application include obstetrics and foetal, neonatal, and transplantation medicine. Seronegative blood products are indicated for the transfusion of pregnant women, foetuses, and neonates until the 3rd month of life. They are also indicated in patients undergoing transplantation, if the donor and the recipient are both seronegative for CMV. This indication is extended to all transplanted patients with unknown CMV serology, and for all patients after lung transplantation. Finally, deleucocyted blood products are not equivalent to CMV seronegative blood products, but their use can be an acceptable alternative in the event of shortage of CMV seronegative blood products.

Delayed hemolytic reaction is a well recognized hazard of blood transfusion and occurs mainly in recipients with alloantibodies, due to sensitization to red cell antigens by previous transfusion or pregnancy. Less frequently, such a reaction may be associated with the presence of red cell autoantibodies appearing after alloimmunization. We report the observation of a patient with chronic myelomonocytic leukemia, who presented a transitory episode of delayed hemolysis after multiple transfusions. At first, anti-Kell alloantibodies were identified and, two weeks later, warm "broad-specific" autoantibodies were detected by direct and indirect antiglobulin tests. The anemia was associated with unstable angina. The patient received multiple transfusions and prednisone. After 3 weeks, the transfusion needs diminished and the autoantibodies progressively disappeared from the serum. The direct antiglobulin test was negative 4 months later. This observation illustrates the poorly understood relationships between erythrocytic alloantigen exposure and red cell autoimmunization.