Residual risk and retrospective analysis of transfusion-transmitted bacterial infection reported by the French National Hemovigilance Network from 2000 to 2008.

BACKGROUND: Regarding blood safety, transfusion-transmitted bacterial infection (TTBI) remains the most frequent infectious risk. The incidence of these episodes needs to be assessed and updated frequently to accurately manage this risk. STUDY DESIGN AND METHODS: TTBIs were reported by the French network of local correspondents in each hospital and blood center. The regional coordinator managed the investigation. A multidisciplinary expert group from the French National Agency of Medicine and Health Products Safety (ANSM) analyzed each TTBI according to a standardized scale of imputability and severity. Only cases with likely or certain imputability are reported in this study. RESULTS: In France, 18.0 × 10(6) red blood cell (RBC) products, 1.94 × 10(6) platelet concentrates (PCs), and 2.44 × 10(6) fresh-frozen plasma units were transfused throughout 2000 to 2008. The incidence of TTBI was 2.45, 24.7, and 0.39 per million blood components (BCs), PCs, and RBCs, respectively. For PCs, the incidences of severe (vital threat or death) and fatal TTBI were 13.4 and 5.14 per million, respectively. PCs were responsible for 87% of TTBIs. A total of 66.7% of the implicated bacteria were Gram positive, most of them belonging to the normal skin flora. A total of 33.3% of the other implicated bacteria were Gram negative. CONCLUSION: The French hemovigilance system provides an accurate estimate of the TTBI incidence during a period with diversion and improving skin disinfection but without bacterial detection screening. This tool would be able to evaluate further additional safety procedures like bacterial screening and pathogen reduction technology.

Transfusion-related acute lung injury: reports to the French Hemovigilance Network 2007 through 2008.

BACKGROUND: Transfusion-related acute lung injury (TRALI) is a major cause of transfusion-related mortality and morbidity. Epidemiologic studies using data from national transfusion schemes can help achieve a better understanding of TRALI incidence. STUDY DESIGN AND METHODS: A multidisciplinary working group analyzed TRALI cases extracted from the French Hemovigilance Network Database (2007-2008). All notified cases were reviewed for diagnosis. Those meeting the Canadian Consensus Conference criteria for TRALI were classified according to imputability to transfusion and clinical severity. Patient data (clinical characteristics, number and types of products transfused, and serology results) were obtained. RESULTS: There were 62 TRALI cases and 23 possible TRALI cases during the 2-year period. An immune-mediated mechanism was identified in 30 of 50 TRALI cases with complete serology. TRALI was considered to be the cause of death in 7.1% of patients and might have contributed to death in an additional 9.4% of TRALI or possible TRALI patients. Occurrence ranked high in obstetrics (15%), after surgery (34%), and in hematologic malignancies (21%). Single-donor high-plasma-volume components were involved in half of the cases where the implicated blood product could be determined and carried the highest risk per component (1:31,000 for single-donor fresh-frozen plasma units and apheresis platelet [PLT] concentrates, and 1:173,000 for red blood cells). No incident could be definitively related to the transfusion of solvent/detergent-treated pooled plasma (>200,000 units transfused), nor to pooled PLT concentrates. CONCLUSION: The proportion of TRALI cases related to plasma-rich components was lower than previously described.

Epidemiology of Transfusion Related Acute Lung Injury in France: Preliminary Results.

SUMMARY: The French Hemovigilance Network has been established in 1994 and records all adverse events associated with the transfusion of a labile blood products (LBP) regardless of their severity. From 1994 to 2006 35,423,172 LBP were issued, 85,812 adverse transfusion reactions notified, and 139 cases of transfusion related acute lung injury (TRALI) observed. The LBP most at risk is fresh frozen plasma (FFP), followed by platelets concentrates (PC) and packed red cells (PRC). However, because the use of FFP is not frequent in France, it only accounts for about 10% of TRALI, whereas PRC and PC are involved in the remaining cases. In no case, pooled FFP treated with solvent-detergent were involved. Patients' profiles are peculiar with a high disease burden. Therefore, targeting a prevention policy only on FFP would result in a marginal reduction of TRALI in France.

[Haemovigilance donors: methods and results]. / Hémovigilance donneurs: modalités et résultats.

There is no official definition of haemovigilance donors. However, it concerns the observation and management of Serious Adverse Events observed in blood donors (SAEDs), Post Donation Informations (PDI), and donor epidemiologic survey. The French Decree of 1 February 2006 imposes the declaration of the SAEDs. In 2006, 196 SAEDs were notified for 2599978 donations (7.5/100,000 donations). The incidence of the SAEDs was of 7/100,000 whole blood donations and 10.7/100,000 aphaeresis donations. Donors that are more susceptible to present a SAED are: women, women under 30, repeat donor and aphaeresis donor. For 2/3 of donors having presented a SAED, a medical consultation was prescribed and 1/3 was hospitalized. Vasovagal reaction is the most frequent category. Seven thousand three hundred and sixty one PDI were notified in 2005. The risks of infection represented the principal cause (mainly ENT). Concerning donor epidemiologic survey, the viral residual risk clearly decreased since 1992 and for the period of 2003-2005 it 1/2600000 for HIV, 1/6500000 for HCV and 1/1000000 for HBV. The first national data already give useful information. This information will permit a better care of blood donors and of blood component recipients as well.

Transfusion related acute lung injury (TRALI) caused by red blood cell transfusion involving residual plasma anti-HLA antibodies: a report on two cases and general considerations.

TRALI is considered a serious hazard among immune complications of blood transfusion and its occurrence is admitted to be globally underestimated. Each type of blood product is likely to cause TRALI. We report here on two consecutive observations of TRALI caused by red blood cell concentrates, in which anti-HLA class I and class II antibodies resulting from post-gravitational allo-immunization were evidenced in donors. HLA class I and II antigenic community between recipients and donors' husbands were found and strong reacting IgG antibodies directed at several of those common antigens were detected in the donors' serum. Both donors had more than 3 pregnancies, raising the issue of blood donor selection or of plasma reduction for cellular products.

The French Haemovigilance System: organization and results for 2003.

In 1993 by law, in France, haemovigilance became a national system of surveillance and alert, from blood collection to the follow-up of the recipients, gathering and analysing all adverse events of blood transfusion in order to prevent their recurrences. In 2003, 2911 incidents with strong imputability have been specially analysed, among them seven confirmed cases of bacterial contamination, 137 incorrect blood components transfused with 12 cases of ABO incompatibility, 15 adverse reactions diagnosed as TRALI and 12 deaths. The analysis of information provided by haemovigilance has led to the implementation of new guidelines.

Hemovigilance network in France: organization and analysis of immediate transfusion incident reports from 1994 to 1998.

BACKGROUND: Hemovigilance networks have been introduced in several countries to improve knowledge of blood transfusion-related morbidity and mortality. The general organization of the French network and its results from 1994 through March 1999 are presented here. STUDY DESIGN AND METHODS: The hemovigilance network relies on blood transfusion centers and hospital correspondents, who analyze unexpected and untoward blood transfusion-related effects and transmit a Transfusion Incident Report (TIR) to a national database (Transfusion Incident Reports Electronic Data Management [GIFIT]). RESULTS: As of March 1, 1999, the GIFIT database contained 24,234 TIRs related to incidents that occurred from the start of the hemovigilance network until December 31, 1998. The network was not fully implemented until 1996; but the reporting rate seems to have since stabilized at approximately 7000 per year (2.5 reports per 1000 blood components). The highest reporting rate is observed with platelet concentrates (4.02/1000), followed by RBCs (1.71/1000) and FFP (0.34/1000). Bacterial contamination quickly appeared as a major cause of morbidity and mortality (185 cases and 18 fatalities). However, a general trend of reduction in this type of incident was observed over time, which can be attributed to adoption of several preventive measures. In contrast, major ABO mismatchings during RBC transfusion remained at a constant rate throughout this period and accounted for six fatalities. After the implementation of universal WBC reduction, some incidents known to be related to WBCs, such as nonhemolytic febrile transfusion reactions (NHFTR) and HLA immunization, were dramatically reduced. CONCLUSION: Hemovigilance is an important tool not only to analyze blood transfusion incidents, but also to measure the effects of new processes or corrective actions at a national level.

Hemovigilance in France

In this work the organization of the hemovigilancesystem in France, the alert system related to undesirabletransfusion effects and the search for seropositive blooddonors is discussed.

No relato são apresentados aspectos daorganização da hemovigilância na França, osistema de alerta relacionado com reaçõestransfusionais indesejáveis e a busca dereceptores sorologicamente positivos.