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Blood Transfusion A Risk Factor ?. THIS NEW DRUG SHOULD BE A MIRACLE...!. Blood Transfusion A Risk Factor ?. COMPLICATIONS: Immunological Non-immunological Infectious. Blood Transfusion A Risk Factor ?. Immunological Complications: Red cells Haemolytic transfusion reaction Acute

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Blood Transfusion A Risk Factor ?

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Blood transfusion a risk factor l.jpg

Blood TransfusionA Risk Factor ?

  • THIS NEW DRUG

  • SHOULD BE A MIRACLE...!

JJO marts 2002


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Blood Transfusion A Risk Factor ?

COMPLICATIONS:

Immunological

Non-immunological

Infectious

JJO marts 2002


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Blood Transfusion A Risk Factor ?

Immunological Complications:

Red cells

Haemolytic transfusion reaction

  • Acute

  • Delayed

JJO marts 2002


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Blood Transfusion A Risk Factor ?

Immunological Complications:

Red cells

White cells

Febrile reaction

TRALI

TA-GvHD

JJO marts 2002


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Blood Transfusion A Risk Factor ?

Immunological Complications:

Red cells

White cells

Platelets

Post transfusion purpura

JJO marts 2002


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Blood Transfusion A Risk Factor ?

Immunological Complications:

Red cells

White cells

Platelets

Other antigens

Urticaria  Anaphylactic shock

Plasma proteins: Ig A

Atopens: Penicillin

Nickel

JJO marts 2002


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Blood Transfusion A Risk Factor ?

Immunological Complications:

Red cells

White cells

Platelets

Other antigens

Other Interaction

Changeof the immune response

Improved survival of transplanted kidneys

Postoperative infections ?

Cancer recurrence ?

JJO marts 2002


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Blood Transfusion A Risk Factor ?

Non-immunological complications:

Vasoactive substances

Prekallicrein substances

Hypotension, vasodilatation, nausea

JJO marts 2002


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Blood Transfusion A Risk Factor ?

Non-immunological complications:

Vasoactive substances

Pyrogens

Bacterial contamination

Endogenous pyrogens

JJO marts 2002


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Blood Transfusion A Risk Factor ?

Non-immunological complications:

Vasoactive substances

Pyrogens

Cold blood

Cardiac arrest

JJO marts 2002


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Blood Transfusion A Risk Factor ?

Non-immunological complications:

Vasoactive substances

Pyrogens

Cold blood

Citrate toxicity

Muscle tremor

Cardiac output decrease

Hypotension

JJO marts 2002


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Blood Transfusion A Risk Factor ?

Non-immunological complications:

Vasoactive substances

Pyrogens

Cold blood

Citrate toxicity

Potassium toxicity

JJO marts 2002


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Blood Transfusion A Risk Factor ?

Non-immunological complications:

Vasoactive substances

Pyrogens

Cold blood

Citrate toxicity

Potassium toxicity

Air embolism

JJO marts 2002


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Blood Transfusion A Risk Factor ?

Non-immunological complications:

Vasoactive substances

Pyrogens

Cold blood

Citrate toxicity

Potassium toxicity

Air embolism

Micro embolism

Cell aggregates

JJO marts 2002


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Blood Transfusion A Risk Factor ?

Non-immunological complications:

Vasoactive substances

Pyrogens

Cold blood

Citrate toxicity

Potassium toxicity

Air embolism

Micro embolism

Septic thrombophlebitis

JJO marts 2002


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Blood Transfusion A Risk Factor ?

Non-immunological complications:

Vasoactive substances

Pyrogens

Cold blood

Citrate toxicity

Potassium toxicity

Air embolism

Micro embolism

Septic thrombophlebitis

Overload

JJO marts 2002


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Blood Transfusion A Risk Factor ?

Non-immunological complications:

Vasoactive substances

Pyrogens

Cold blood

Citrate toxicity

Potassium toxicity

Air embolism

Micro embolism

Septic thrombophlebitis

Overload

Haemosiderosis

JJO marts 2002


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Blood Transfusion A Risk Factor ?

Infectious Complications:

Bacteria

Virus

Protozoes

Parasites

Prions:

CJD, vCJD ?

JJO marts 2002


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Blood Transfusion A Risk Factor ?

  • ...WONDER HOW OFTEN

  • THESE SIDE EFFECTS OCCUR...?

JJO marts 2002


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Blood Transfusion A Risk Factor ?

SHOT and DART

SHOT: “Severe Hazards of Transfusion”UK 1996

DART: “Danish Registration of Transfusion Risks” DK 1999

Voluntary and confidential collecting of data about transfusion risks, using report forms.

The aim is to improve transfusion safety

JJO marts 2002


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Blood Transfusion A Risk Factor ?

SHOT and DART

DARTSHOT

(1999-2001)(1996-2000)

Reports collected (severe risk)72862

Transfused components1.35 m13 m

Report rate (per 100,000 transf.)5.36.6

JJO marts 2002


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Blood Transfusion A Risk Factor ?

  • RISK RATES

    • Number of risks per 100,000

    • transfused blood components

JJO marts 2002


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Blood Transfusion A Risk Factor ?

JJO marts 2002


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Blood Transfusion A Risk Factor ?

JJO marts 2002


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Blood Transfusion A Risk Factor ?

JJO marts 2002


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Blood Transfusion A Risk Factor ?

JJO marts 2002


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Blood Transfusion A Risk Factor ?

JJO marts 2002


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Blood Transfusion A Risk Factor ?

Hazards of Blood Transfusion

Versus

Hazards of Everyday Life

JJO marts 2002


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Blood Transfusion A Risk Factor ?

1 per20,000Severe hazards of transfusion

1 per40,000Incorrect blood component transfused

1 per40,000Immune complication

1 per50,000Death attributed to general anaesthesia

JJO marts 2002


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Blood Transfusion A Risk Factor ?

1 per20,000Severe hazards of transfusion

1 per40,000Incorrect blood component transfused

1 per40,000Immune complication

1 per50,000Death attributed to general anaesthesia

1 per300,000Death (transfusion of blood component)

1 per 700,000Death (immune complication)

1 per 700,000Transfusion transmitted infection

JJO marts 2002


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Blood Transfusion A Risk Factor ?

1 per20,000Severe hazards of transfusion

1 per40,000Incorrect blood component transfused

1 per40,000Immune complication

1 per50,000Death attributed to general anaesthesia

1 per300,000Death (transfusion of blood component)

1 per 700,000Death (immune complication)

1 per 700,000Transfusion transmitted infection

1 per1-2 mDeath (IBCT)

1 per1-2 mTransfusion transmitted HIV infection (calculated)

JJO marts 2002


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Blood Transfusion A Risk Factor ?

1 per20,000Severe hazards of transfusion

1 per40,000Incorrect blood component transfused

1 per40,000Immune complication

1 per50,000Death attributed to general anaesthesia

1 per300,000Death (transfusion of blood component)

1 per 700,000Death (immune complication)

1 per 700,000Transfusion transmitted infection

1 per1-2 mDeath (IBCT)

1 per1-2 mTransfusion transmitted HIV infection (calculated)

Survival 5 years after blood transfusion: 50%

JJO marts 2002


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Blood Transfusion A Risk Factor ?

JJO marts 2002


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Blood TransfusionA Risk Factor ?

MAYBE IT’S NOT SO

DANGEROUS AFTER ALL........

JJO marts 2002


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Blood Transfusion A Risk Factor ?

Reduction of Risks

Incorrect Blood Component Transfused:

Establishing standards for transfusion medicine

Blood samples for blood grouping and cross-match

Delivery of blood component from the hospital Blood Bank

Transfusion of blood components

Verification of identity between component and patient

Transfusion complications, description and treatment

Education (standards)

Audit (are the standards being followed)

Bedside computerized verification of bar code identity on blood component and wristband

JJO marts 2002


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Blood Transfusion A Risk Factor ?

Reduction of Risks

Immune Complications:

Avoid overuse of blood components, especially

FFP and platelets (higher complication rate than red cells)

Use of FFP from non-transfused male donors

No HLA antibodies (TRALI)

Increase the sensitivity of serological methods

in order to detect weak Kidd antibodies

JJO marts 2002


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Blood Transfusion A Risk Factor ?

Reduction of Risks

Transfusion Transmitted Infection:

Donor criteria

Exclude donors at risk

Screening for Infectious agents

PCR for detection of virus

Inactivation of Infectious agents

Intercept

JJO marts 2002


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Blood Transfusion A Risk Factor ?

Conclusions

Blood transfusion is still a risk to the patient

However, the rate is low compared with other kinds of risks

JJO marts 2002


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Blood Transfusion A Risk Factor ?

Conclusions

Blood transfusion is still a risk to the patient

However, the rate is low compared with other kinds of risks

Some are relatively common and should never occur (IBCT)

The rate can be reduced in a simple way and at low cost

JJO marts 2002


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Blood Transfusion A Risk Factor ?

Conclusions

Blood transfusion is still a risk to the patient

However, the rate is low compared to other kinds of risks

Some are relatively common and should never occur (IBCT)

The rate can be reduced in a simple way and at low cost

Others are very seldom, but create a lot of fear (HIV)

They can be avoided only in a complicated expensive way.

JJO marts 2002


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Blood Transfusion A Risk Factor ?

WHAT WILL I GET FOR ALL

THE TAX MONEY I PAID ?

JJO marts 2002


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Blood Transfusion A Risk Factor ?

A REAL DECREASE OF

THE OVERALL RISK

or

A DIMINISHED FEAR OF

HIV INFECTION

JJO marts 2002


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