Although blood transfusions are very safe, patients continue to be put at risk by errors; which were responsible for 87% of adverse incident reports last year. Dr Paula Bolton-Maggs –medical director for Serious Hazards of Transfusion (SHOT), the UK’s national haemovigilance scheme –discusses the findings of the group’s annual report.
Transfusion of blood and its components forms an important treatment for the management of many conditions, particularly major surgery and the management of malignancy. Some people require life-long transfusions for inherited disorders of haemoglobin. Unfortunately in a minority of cases there may be an adverse incident. The UK national haemovigilance scheme (Serious Hazards of Transfusion, SHOT) started in 1996, partly as a result of recognition of infection (human immunodeficiency virus and hepatitis viruses) in the blood supply, but also because there was no systematic collection of data on adverse outcomes of transfusion. Haemovigilance involves surveillance of transfusion from donor to recipient with monitoring of the outcome. All UK National Health Service hospitals were invited to participate and report any adverse events or reactions under a series of different headings.
Infection in the blood supply is very rare
Blood and its components are now very safe with very few infection transmissions, just a single case (hepatitis E) in 2016 in 2.5 million components issued that year (only 79 cases in total in 20 years).1 Careful donor selection and testing of all donations have contributed to this improvement in safety. Other adverse reactions such as transfusionrelated acute lung injury (TRALI) have also decreased following recognition from SHOT reporting that it was more likely following transfusion of plasma-rich components from female donors. As a result, the blood services have restricted preparation of fresh frozen plasma and cryoprecipitate to male donors. The most common adverse reaction is an allergic or febrile acute transfusion reaction as shown in Figure 1. These reactions cannot be predicted and may occur in any patient after any transfusion and this is the reason for pre-transfusion check of the vital signs and their repeat at 15 minutes into the transfusion. The most severe reaction, anaphylaxis, is fortunately rare (30-40 recorded each year) and requires urgent treatment with adrenaline. Guidelines are available to aid management of these reactions.2
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