Steps taken to alleviate under-reporting of transfusion reactions at a public sector hospital in Pakistan

Steps taken to alleviate under-reporting of transfusion reactions at a public sector hospital in Pakistan TO THE EDITOR: A transfusion reaction (TR) is any untoward event that occurs during or after blood transfusion and is not related to the patient's underlying illness. It has been estimated that about 10% of all transfusions carry the risk of an adverse event [1]. Both, infectious and non-infectious TRs are associated with significant mortality and morbidity [2]. The frequency of TR is estimated to be 0.5 to 2.9 per 1,000 blood units [3-6]. However, the actual TR incidence is frequently underestimated; therefore, every hospital should have a hemovigilance program aimed at effectively reporting and analyzing TR in order to improve transfusion patient safety [5]. Here we describe a clinical audit conducted at the Isratul Ebad Khan Institute of Blood Diseases (IEKIBD), Dow University Hospital, Pakistan. The audit was undertaken as an institutional effort towards hemovigilance with the aim of observing the frequency of reported TRs and assessing the effects of measures taken to avoid TR under-reporting. A standard TR investigation protocol was used (Fig. 1) and TRs were classified according to standard AABB definitions. blood units were released for transfusion. Out of these blood units, only one febrile non-hemolytic transfusion reaction (FNHTR) was reported. The estimated rate of TR was found to be 0.2 per 1,000 blood units administered (Table 1). This rate of TR was found to be low when compared to local and international studies, where the rate of TRs per 1,000 units was 0.93 to 1.16 [3, 4] and 0.4 to 2.9 [5, 6], respectively. To investigate the root cause of this presumed under-reporting of TR, we designed and distributed an in-house questionnaire regarding the signs and symptoms of TRs to evaluate the ability of medical and nursing staff to recognize and report any adverse TR. An open-ended question was included about the reasons for not reporting a TR. On evaluation , it was found that about 73% of medical and nursing staff were well aware of the signs and symptoms of TR. Reasons for TR under-reporting were found to be multi-factorial and mainly included a lack of easy accessibility of TR forms in different hospital units, a lack of awareness about existing TR reporting systems among newly inducted interns and residents, and the irrational use of transfusion premedication (antihistamines and NSAIDs) without knowing the patient's previous history of TR. The …