Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Oak Ridge Institute for Science and Education (ORISE), Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Transfusion. 2021 May;61(5):1424-1434. doi: 10.1111/trf.16362. Epub 2021 Apr 20.
Despite current blood safety measures, transfusion recipients can experience transfusion-related adverse reactions. Monitoring these reactions can aid in understanding the effectiveness of current transfusion safety measures. Data from the National Healthcare Safety Network Hemovigilance Module were used to quantify adverse reaction risk.
Facilities reporting at least one month of transfused blood components and transfusion-related adverse reactions during January 2013-December 2018 were included. Adverse reaction rates (number per 100,000 components transfused) were calculated for transfused components stratified by component type, collection, and modification methods.
During 2013-2018, 201 facilities reported 18,308 transfusion-related adverse reactions among 8.34 million blood components transfused (220/100,000). Adverse reactions were higher among apheresis (486/100,000) and pathogen-reduced platelets (579/100,000) than apheresis red blood cells (197/100,000). Allergic reactions (41%) were most common. There were 23 fatalities and 9% of all adverse reactions were serious (severe, life-threatening, or fatal). Reactions involving pulmonary complications (transfusion-associated circulatory overload, transfusion-related acute lung injury and transfusion-associated dyspnea) accounted for 35% of serious reactions but 65% of fatalities. Most (76%) of the 37 transfusion-transmitted infections were serious; none involved pathogen-reduced components.
One in 455 blood components transfused was associated with an adverse reaction although the risk of serious reactions (1 in 6224) or transfusion-transmitted infections (1 in 225,440) was lower. Some serious reactions identified were preventable, suggesting additional safety measures may be beneficial. Higher reaction rates identified among pathogen-reduced platelets require further study. These findings highlight the importance of monitoring reactions through national hemovigilance to inform current safety measures and the need for strategies to increase healthcare facility participation.
尽管目前采取了血液安全措施，但输血接受者仍可能出现输血相关不良反应。监测这些反应有助于了解当前输血安全措施的效果。本研究使用国家医疗保健安全网络血液监测模块的数据来量化不良反应风险。
纳入在 2013 年 1 月至 2018 年 12 月期间报告至少一个月输注血液成分和输血相关不良反应的医疗机构。根据成分类型、采集和修饰方法对输注成分进行分层，计算不良反应发生率（每输注 10 万份成分的不良反应数量）。
2013-2018 年，201 家医疗机构在输注 834 万份血液成分期间报告了 18308 例输血相关不良反应（220/10 万）。与红细胞相比，单采（486/10 万）和病原体减少血小板（579/10 万）的不良反应发生率更高。过敏反应（41%）最为常见。有 23 例死亡，9%的不良反应为严重（严重、危及生命或致命）。涉及肺部并发症（输血相关循环超负荷、输血相关急性肺损伤和输血相关呼吸困难）的反应占严重反应的 35%，但占死亡的 65%。37 例输血传播感染中，大多数（76%）为严重感染；无病原体减少成分相关感染。
每输注 455 份血液成分中就有 1 份与不良反应相关，尽管严重反应（1/6224）或输血传播感染（1/225440）的风险较低。确定的一些严重反应是可以预防的，这表明可能需要采取额外的安全措施。病原体减少血小板的反应发生率较高，需要进一步研究。这些发现强调了通过国家血液监测监测反应以告知当前安全措施的重要性，以及需要制定策略来提高医疗机构参与度。
