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LETTER TO EDITOR
Year : 2018  |  Volume : 3  |  Issue : 1  |  Page : 76-77

A pilot study analysis of transfusion-related adverse events at the tertiary care hospital in Eastern India: Encourages the establishment of institutional hemovigilance program


1 Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
2 Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

Date of Web Publication5-Apr-2018

Correspondence Address:
Dr. Dibyajyoti Sahoo
Departments of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/GJTM.GJTM_50_17

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How to cite this article:
Mukherjee S, Sahoo D, Ramnath A, Maiti R. A pilot study analysis of transfusion-related adverse events at the tertiary care hospital in Eastern India: Encourages the establishment of institutional hemovigilance program. Glob J Transfus Med 2018;3:76-7

How to cite this URL:
Mukherjee S, Sahoo D, Ramnath A, Maiti R. A pilot study analysis of transfusion-related adverse events at the tertiary care hospital in Eastern India: Encourages the establishment of institutional hemovigilance program. Glob J Transfus Med [serial online] 2018 [cited 2018 Aug 17];3:76-7. Available from: http://www.gjtmonline.com/text.asp?2018/3/1/76/229334



Sir,

We conducted a study on transfusion-related adverse reactions under the support of the Indian Council of Medical Research short-term student project at our institute. This prospective and observational study was conducted after obtaining clearance from the institutional ethics committee for 6 months (May 2016 to October 2016, and compared to the reporting of previous 6 months) to detect and analyze the spectrum of Adverse Transfusion Reactions (ATR) and to establish an institutional hemovigilance program with the main goal to improve transfusion safety. Blood transfusion is a life-saving measure, but it has its inherent risks.[1] The evaluation of transfusion reaction broadly included clerical checks, clinical evaluation, visual inspection, investigations in the department of transfusion medicine (blood grouping, cross-matching, direct and indirect Coombs test, antibody screening, and identification); a few special investigations such as urine for hemoglobinuria, plasma hemoglobin, peripheral blood smear for schistocytes and spherocytes, serum lactate dehydrogenase, unconjugated bilirubin to rule out hemolytic reaction and some other relevant investigations such as chest X-ray and bacteriological culture to rule out any possibility of nonhemolytic reactions, especially bacterial sepsis and transfusion-related acute lung injury. During the study, a total of 1313 units of blood and blood components (packed red blood cell [PRBC] 932 units, whole blood 210 units, fresh frozen plasma 118 units, and platelet concentrate 53 units) were transfused to 778 patients. The median age of the study population was 48 years. Four patients developed ATRs to PRBC transfusion [Table 1]. The mean volume of blood transfused was 145 ml. Among these reactions, the most common were febrile nonhemolytic reactions (FNHTR) (75%), followed by allergic reactions (25%). The risk of adverse reaction was calculated per 1000 transfusions of that component, i.e., (total number of implicated reactions/total number of components transfused) × 1000. The estimated risk for FNHTR following red cell transfusions is 3.2, while that for allergic reaction is 1.07/1000 red cell transfusions. The overall frequency of transfusion reactions was 0.3% (4 out of 1313 units). Our study found higher frequency of transfusion reactions (0.3%) than the studies in other tertiary care institutions, which shows the frequency of transfusion reactions from 0.05% to 0.18%.[2],[3] The higher value in this study could be due to the small duration of study and the small study population. The estimated risk of FNHTRs was 3.2/1000 red cell transfusions (3/932 PRBC units). A study by Vasudev et al.[4] revealed estimated risk 0.8/1000 transfusions and that by Kumar et al.[2] showed 0.04%. The relatively higher value in this study could be due to use of nonleukoreduced blood. The incidence of allergic reactions was 1.07/1000 red cell transfusions, which was comparable to other studies.[3],[4]
Table 1: Details of patients who developed transfusion reactions

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Prior to implementation of hemovigilance program, we had reporting of 0.25% ATRs (2 cases of 786 transfusions) which improved to reporting of 0.31% cases during the study. The above data analysis shows that the implementation of the hemovigilance system in the institute combined with use of better transfusion techniques especially leukoreduction along with basic education in Transfusion Medicine to the students, resident doctors, and nursing staff could be a comprehensive approach to tackle the current issues. A recent analysis by Agnihotri and Agnihotri [5] on implementation of hemovigilance program in India has also substantiated our finding. The study revealed that the rate of reporting of all transfusion reactions significantly improves (incidence of 0.32% [P< 0.005]) following the implementation of hemovigilance program in our country.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Delaney M, Wendel S, Bercovitz RS, Cid J, Cohn C, Dunbar NM, et al. Transfusion reactions: Prevention, diagnosis, and treatment. Lancet 2016;388:2825-36.  Back to cited text no. 1
    
2.
Kumar P, Thapliyal R, Coshic P, Chatterjee K. Retrospective evaluation of adverse transfusion reactions following blood product transfusion from a tertiary care hospital: A preliminary step towards hemovigilance. Asian J Transfus Sci 2013;7:109-15.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Bhattacharya P, Marwaha N, Dhawan HK, Roy P, Sharma RR. Transfusion-related adverse events at the tertiary care center in North India: An institutional hemovigilance effort. Asian J Transfus Sci 2011;5:164-70.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Vasudev R, Sawhney V, Dogra M, Raina TR. Transfusion-related adverse reactions: From institutional hemovigilance effort to National Hemovigilance Program. Asian J Transfus Sci 2016;10:31-6.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Agnihotri N, Agnihotri A. Active hemovigilance significantly improves reporting of acute non-infectious adverse reactions to blood transfusion. Indian J Hematol Blood Transfus 2016;32:335-42.  Back to cited text no. 5
    



 
 
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