Adverse reactions following transfusion of blood components, with a focus on some rare reactions: Reports to the International Haemovigilance Network Database (ISTARE) in 2012-2016.

OBJECTIVES: The International Haemovigilance Network's (IHN) ISTARE database collects surveillance data on all adverse reactions (AR) associated with transfusion of blood and blood components, facilitating the sharing of best practice and benchmarking for improving blood safety and quality. Up to 2012, no publications discussed certain rare AR. The aim of this study is to examine ISTARE data on AR from 2012 to 2016, focusing on hypotensive reactions, post-transfusion purpura (PTP), transfusion-associated graft versus host disease (TA-GvHD), hyperkalemia and hypocalcemia. MATERIALS AND METHODS: National Haemovigilance Systems (HVS), provided aggregate annual data on AR by type of reaction, severity, imputability to transfusion, and blood component implicated. Twenty-nine HVS provided 104 annual reports covering 107,778,290 blood units issued. RESULTS: Among AR reported, 25% were serious, including 368 deaths. The 284 transfusion-transmitted infections included 187 bacterial infections, 84 viral and 13 parasitic or fungal; nine deaths resulted. AR related to the respiratory system transfusion-associated circulatory overload, transfusion-related acute lung injury and transfusion-associated dyspnoea accounted for 8.3% of all AR, 20.1% of serious, and 52.2% of deaths. Of 1634 rare AR, 1565 were hypotensive, 38 PTP, 17 GvHD, 9 hyperkalemia and 5 hypercalcemia. Half were serious and 16 fatalities were recorded (13 hypotensive, 2 GvHD, one PTP). Among 14 countries that reported any hypotensive AR, incidences diverged widely. CONCLUSIONS: ARs in this group are frequently severe or life-threatening. Hypotensive AR are the most common, but may have been overlooked and counted under allergic and other AR presenting with hypotension. Compliance with the ISBT definition may be suboptimal, thus its real incidence may be higher. Data on GvHD may contribute to clarifying the role of leukodepletion with or without irradiation. ISTARE continues to be a useful surveillance tool for all transfusion AR and provides relevant insights into overlooked and rare AR, thus offering important contributions towards maximising transfusion safety.

[The seroprevalence for hepatitis E viral antibodies in the northern region of Portugal (among the donor population)]. / Seroprevalência de anticorpos para o vírus da hepatite E na região Norte de Portugal (numa população de dadores).

The authors have undertaken a study in the north of Portugal in what concerns the prevalence of antibodies for HEV donors. This study was transverse through observation and survey. A sample of 1.473 donors was randomly selected from among the population of donors of the Oporto Regional Blood Centre. This sample was representative of the northern region and stratified by district. The usual EIA method has been used to search for HEV antibodies. The results, which were repeatedly reactive, have been confirmed by Western Blot. The prevalence of antibodies for Hepatitis E was 2.5%. The test identified a possible cohort effect and the sample showed that the average age of the donors with or without antibodies was identical. No difference was observed regarding sex, distribution by districts or the presence of antibodies for HB virus. Hepatitis E is benign, without chronic state carrier and almost every patient presents acute symptomatology. The value of prevalence found as well as the absence of clinical symptomatology in the observed donors and the normal state of the hepatic markers, indicate that the use of blood and components obtained from this population should not be a problem. The recommendation proposed by the European Council does not mention the systematic research of HEV. However the epidemiological HEV survey is considered important from the transfusional point of view and as an indicator of the sanitary development of the population. Bearing in mind the developing status of Portugal in this area, it is of utmost importance to create the means to reach European standards.