Non-infectious Serious Hazards of Transfusion

نویسنده

  • Sunny Dzik
چکیده

Safe transfusion therapy is a basic requirement for advanced medical care. In order to establish priorities for improving safe transfusion for patients, it is essential to distinguish transfusion safety from blood safety. Blood safety refers to the safety of the product. In contrast, transfusion safety refers to the safety of the overall process of transfusion from donor to recipient. Blood safety is not matched by increases in transfusion safety. Enormous progress has been made in blood safety during the last few decades. Donor restrictions and high performance viral screening assays have virtually eliminated viral transmission by blood transfusion in the developed world. For example, the risk of hepatitis or HIV from transfusion has declined by approximately 10,000 fold. In contrast, during the same period there has been little change in the risk of non-infectious hazards. Some result from medical errors made during the collection of a patient sample or during blood administration. Data suggest that the rate of medical errors occurring in hospitals is increasing and a labor shortage in hospital laboratories also decreases patient safety. For example, a recent study from a prestigious university program documented that from 1993 to 1999 the number of errors rose from 1238 to 2052 per year. It is particularly alarming that errors involving patient samples quadrupled from 112 (10% of total errors) in 1993 to 434 (20% of total) in 1999. The Institute of Medicine report, To Err Is Human, has called attention to the enormous morbidity and mortality associated with hospital-based errors. These errors have been largely ignored by government agencies focused on blood safety. For example, the Canadian Krever Commission selectively applied the precautionary principle only to infectious risks of transfusion, but not to the very real noninfectious hazards of transfusion. Thus, while blood product safety has been a remarkable achievement, emphasis on product safety diverted attention from transfusion safety. Hemovigilance programs and the risk of transfusion. Hemovigilance programs are national systems for reporting adverse events and provide one objective means to assess current risks of transfusion. In reports of adverse occurrences in the United Kingdom, mis-transfusion accounted for over 50% of adverse events and non-infectious hazards of transfusion accounted for over 95%. Similar data generated from hemovigilance programs in France and Canada suggest that innovations to address non-infectious hazards should be given high priority. Viewed from the perspective of risk per individual unit, noninfectious hazards overwhelm current infectious risks. Figure 1 shows current estimates of the risks of an individual unit of blood using the Paling scale. These data demonstrate two important findings. First, the confidence interval of the risk estimate is much more precise for infectious hazards compared with noninfectious hazards. The precision of infectious risk estimates has resulted from studies conducted in the last decade. Similar studies for non-infectious hazards have not been conducted. Secondly—and more importantly—the graph shows the extent to which patients are at greater risk from non-infectious serious hazards of transfusion. For example, estimates of the perunit risk of mis-transfusion errors may exceed the risk of viral infection by as much as 10,000 fold. Examples of non-infectious hazards of transfusion: Mis-transfusion of blood. Mis-transfusion can be summarized as a failure to give “the right blood product to the right patient at the right time for the right reason.” At its worst, mis-transfusion results in major ABO incompatible transfusions. Despite dramatic improvements in overall medical care in the past half-century, the morbidity (renal damage) and mortality associated with ABO hemolytic transfusion reactions has not improved much over that observed decades ago. For example, transfusion errors comprised 2.7 % of all sentinel events reviewed by the Joint Commission on the Accreditation of Hospitals from January 1995 through March 2002, although these and other data from the US based on passive reporting may underestimate the true frequency of mistransfusion. An active audit of transfusions at three university hospitals in Belgium observed numerous unreported mistakes. Overall, the incidence of serious error was 1 in 400 units and the rate of reported errors underestimated the true rate by 30 fold. Transfusion-related acute lung injury (TRALI). TRALI is an immune-mediated lung injury syndrome, which in its worst form is life-threatening and indistinguishable from adult respiratory distress syndrome. The actual incidence is uncertain and many cases undoubtedly are attributed to other causes. Over a two-year period in a general hospital, Clarke et al reported that 46 of 2,430 transfusions of platelets (2%) were associated with respiratory reactions. A more recent study observed frequent oxygen desatu-

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Technology for enhanced transfusion safety.

Data from reporting systems around the world document that non-infectious hazards are the leading cause of serious morbidity or mortality resulting from blood transfusion. Among these non-infectious hazards, mis-transfusion represents the most frequently observed serious hazard and occurs at an estimated rate of 1 in 14,000 transfusions. Mis-transfusion events result from "lapse errors" (slip u...

متن کامل

Nontransfusion hazards of autologous blood donation.

Autologous blood donation may incur hazards that are not directly associated with blood transfusion. Graham et al. 1 reported on 78 patients who donated autologous blood before elective cardiac or orthopedic surgery in Ottawa. Seventy-three (94%) of these patients traveled by automobile to autologous blood donation appointments. These patients drove a mean distance of 130 km (80.8 mi) for this ...

متن کامل

The hazards of blood transfusion in historical perspective.

The beginning of the modern era of blood transfusion coincided with World War II and the resultant need for massive blood replacement. Soon thereafter, the hazards of transfusion, particularly hepatitis and hemolytic transfusion reactions, became increasingly evident. The past half century has seen the near eradication of transfusion-associated hepatitis as well as the emergence of multiple new...

متن کامل

Transfusion-related acute lung injury.

With the success of reducing the risk of transfusion-transmitted infectious diseases, noninfectious serious hazards of transfusion have come to the forefront with respect to transfusion safety. Transfusion-related acute lung injury has emerged as a dominant noninfectious serious hazard of transfusion. Improved understanding of its pathophysiology is needed to improve clinical strategies to deal...

متن کامل

Serious Hazards of Transfusion (SHOT) haemovigilance and progress is improving transfusion safety

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 proces...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:

دوره   شماره 

صفحات  -

تاریخ انتشار 2003