Acute blood transfusion reaction in a tertiary care hospital in Southern Punjab, Pakistan

Background: Blood transfusion is a lifesaving process but carries many risks. Majority of these had been reduced with better diagnostic and management strategies. But the risk of non-infectious adverse transfusion reactions though reduced but cannot be eliminated. Hemovigilance is the system to monitor such reactions.Methods: The objective of current study was to know the frequency of adverse transfusion reactions and to compare it with local and international data. Retrospective cross-sectional descriptive study was done in Ibn-e- Sina hospital. Adverse transfusion reactions reported to blood bank was analysed according to hospital protocol.Results: Out of 6050 blood transfusions 23 (0.38%) develop adverse transfusion reactions. Febrile nonhemolytic transfusion reaction was the commonest adverse event and whole blood was the component implicated.Conclusions: Adverse transfusion reactions are non-infectious complications of blood transfusion which in spite of all efforts cannot be avoided. Frequency of adverse transfusion reactions in our study was 0.38% and Febrile nonhemolytic transfusion reaction was commonest reported reaction type. Hemovigilance system is necessary to monitor, investigate and control such activities.

The First Case of Febrile Transfusion Reaction Caused by Anti-HNA-1b Antibody in Korea / 대한수혈학회지

Febrile nonhemolytic transfusion reaction (FNHTR) is one of the most common adverse reactions to the transfusion of blood products. It is caused by antigen-antibody reactions between patient's plasma and transfused cellular components (or the reverse) or bioactive substances such as cytokines generated by leukocytes during storage of cellular blood components. Most of the antibodies involved in FNHTR are anti-HLA antibodies. However, platelet-specific antibodies and rarely granulocyte-specific antibodies may be involved in FNHTR, We found a granulocyte antibody from a 53-year-old male with FNHTR for the first time in Korea. Fever developed during transfusion of a unit of packed RBC after partial cystectomy, and subsided after the adminstration of acetaminophen. The hemolytic transfusion reaction and sepsis were excluded after investigations. Mixed passive hemagglutination test revealed that the patient had antibody against human neutrophil antigen-1b (HNA-1b), and granulocyte antigen genotyping showed granulocyte antigen mismatches between the patient (HNA-1a homozygote) and the unit of transfused RBC (HNA-1a/HNA-1b heterozygote).

Generation of inflammatory cytokines and anaphylatoxins in whole blood under normal blood banking condition / 대한수혈학회지

BACKGROUND: Several recent studies have reported that generation of inflammatory cytokines and activation of complements may be associated with febrile nonhemolytic transfusion reactions (FNHTR). However, few data are available for whole blood, which is still commonly utilized for massive transfusion and for autologous transfusion. METHODS: A total of 15 whole blood units from healthy adult donors was collected and stored at 4degrees C for 35 days. During the storage time, samples for analyses of cytokines including interleukin-1alpha (IL-1alpha), IL-2, IL-6, IL-8, and tumor necrosis factor alpha (TNFalpha) and anaphylatoxins such as C3a and C5a were obtained on day 0, 1, 3, 5, 7, 14, 28, and 35. Cytokines were measured by enzyme-linked immunosorbent assay and anaphylatoxins by radioimmunoassay. RESULTS: IL-1alpha (<0.5 pg/mL), IL-2 (<7 pg/mL), and TNFalpha (<4.4 pg/mL) were not detectable. IL-6 was measured in 4 units with low level (1.1-4.0 pg/mL) and IL-8 showed slightly higher level (10.5 pg/mL) on day 35. Anaphylatoxins (C3a and C5a) were detectable at the level of 1350.0 ng/mL on day 21 and of 14.6 ng/mL on day 14, respectively, which were significantly increased levels compared with those on day 0. The levels of C3a and C5a reached 2513.3 ng/mL and 18.4 ng/mL on day 35, respectively. CONCLUSIONS: It is not likely that cytokines generated during storage of whole blood under normal blood banking condition could explain FNHTR. However, anaphylatoxins are elevated in whole blood after 2 weeks of storage, which might be due to complement activation by the plastic surface of blood bag.