Transfusion-associated circulatory overload risk mitigation: survey on hospital policies for compliance with AABB Standard 5.9.17.

BACKGROUND: AABB Standards for Blood Banks and Transfusion Services require accredited institutions to have a policy for handling requests for blood components on patients clinically identified as being at high risk for transfusion-associated circulatory overload (TACO; Standard 5.19.7, 31st edition). This survey elucidated how AABB accredited hospital transfusion services/blood banks around the world are complying with this Standard. METHODS: A link to a Web-based survey in English was e-mailed under the auspice of the AABB to each AABB accredited hospital transfusion service/blood bank (n = 851) asking for details on how their institution is complying with this Standard and for general information on any TACO risk mitigation strategies in place. RESULTS: Of the 290 responses received (34% response rate), 282 met the criteria for analysis. There were 174 of 282 (62%) respondents who indicated that their institution has a formal policy for complying with the Standard, and 108 of 282 (38%) who indicated that their institution does not have a formal policy. A diverse range of policies and practices were in place at the institutions with and without a formal policy ranging from writing advice/recommendations in the charts of patients at increased risk of TACO, promulgating policies from the transfusion service/blood bank or institution itself that would reduce the risk, or using decision support tools to provide education about reducing the risk of TACO. CONCLUSIONS: Many but not all AABB accredited institutions have policies to comply with the TACO risk mitigation Standard. However, the vast majority conduct activities that could mitigate risk for TACO.

Prevalence and laboratorial determinants of the clinical relevance of antibodies of undetermined specificity.

BACKGROUND AND OBJECTIVES: Antibodies of unknown specificity (AUS) are frequently identified in the pre-transfusion testing. These antibodies can be insignificant or potentially cause post-transfusion haemolysis. Information about the prevalence of clinically relevant AUS is still lacking. Our aim was to predict the potential clinical relevance of AUS using the monocyte monolayer assay (MMA) and to identify the clinical and laboratorial determinants of AUS' significance. MATERIALS AND METHODS: Antibodies of unknown specificity identified at a single institution from 2015-2017 were evaluated through MMA. A monocyte index (MI) of more than 5% was predictive of potential post-transfusion haemolysis. RESULTS: Thirty-two patients with AUS were included in the study. Of the studied AUS, 37·5% (12/32) presented with a monocyte index (MI) more than 5%. In the group of significant AUS, 41·7% of the patients presented with sickle cell disease (SCD) and the AUS were associated with Rh antibodies in 75% of the cases. In the group of insignificant AUS, only 10% of the patients had SCD and the association with Rh antibodies was detected in 20% of the cases. The presence of Rh antibodies was independently associated with the AUS clinical relevance (P = 0·012). CONCLUSION: More than one-third of the AUS are potentially clinically relevant, and the association with Rh antibodies is predictive of AUS relevance. Services must honour AUS in the pre-transfusion process in order to ensure transfusion safety.

Reacción transfusional hemolítica retardada por aloanticuerpo anti-E / Reação transfusional hemolítica tardia por aloanticorpo anti-E / Delayed hemolytic transfusion reaction by anti-E alloantibody

Se presentó el caso de una señora de 47 años, grupo sanguíneo O Rh D positivo, G4P2A2, sin antecedente transfusional, que requería intervención quirúrgica por fibroma uterino sangrante. Las pruebas pretransfusionales resultaron compatibles, transfundiéndole dos concentrados de hematíes, sin presentar manifestaciones clínicas; trascurridos siete días, presentó una crisis hemolítica, con caída brusca de los parámetros hematológicos, palidez cutáneo-mucosa e íctero. Los estudios inmunohematológicos fueron positivos; la muestra de sangre de la enferma fue incompatible con un hijo, esposo y los hematíes transfundidos. Seis meses después se identificó un aloanticuerpo anti-E (es aquél anticuerpo que se produce como resultado de la exposición de un organismo a antígenos extraños) (128 diluciones) en la paciente. Se concluye que la paciente se aloinmunizó durante sus embarazos con un anticuerpo anti-E, donde la transfusión sanguínea fue el estímulo antigénico causante de la reacción transfusional hemolítica tardía(AU)

We present the case of a 47-year-old woman, blood group O Rh D positive, G4P2A2, with no transfusion history, which required surgical intervention due to bleeding uterine fibroma. The pretransfusional tests were compatible, transfusing two concentrates of red blood cells, without presenting clinical manifestations; after seven days, he presented a haemolytic crisis, with abrupt fall in hematological parameters, cutaneous-mucosal pallor and icterus. The immunohematological studies were positive; the patient's blood sample was incompatible with a son, husband and the transfused red blood cells. Six months later, an anti-E alloantibody (128 dilutions) was identified in the patient. It is concluded that the patient was alloimmunized during her pregnancies with an anti-E antibody, where the blood transfusion was the antigenic stimulus causing the late hemolytic transfusion reaction. Apresentamos o caso de uma mulher de 47 anos, grupo sanguíneo O Rh D positivo, G4P2A2, sem histórico transfusional, que necessitou de intervenção cirúrgica devido ao sangramento do fibroma uterino. Os exames pré-transfusionais foram compatíveis, transfundindo dois concentrados de hemácias, sem apresentar manifestações clínicas; Após sete dias, apresentou crise hemolítica, com queda abrupta nos parâmetros hematológicos, palidez cutâneo-mucosa e icterícia. Os estudos imuno-hematológicos foram positivos; a amostra de sangue do paciente era incompatível com um filho, marido e hemácias transfundidas. Seis meses depois, um aloanticorpo anti-E (128 diluições) foi identificado no paciente. Conclui-se que a paciente foi aloimunizada durante a gestação com anticorpo anti-E, sendo a hemotransfusão o estímulo antigênico causador da reação transfusional hemolítica tardia(AU)

Apresentamos o caso de uma mulher de 47 anos, grupo sanguíneo O Rh D positivo, G4P2A2, sem histórico transfusional, que necessitou de intervenção cirúrgica devido ao sangramento do fibroma uterino. Os exames pré-transfusionais foram compatíveis, transfundindo dois concentrados de hemácias, sem apresentar manifestações clínicas; Após sete dias, apresentou crise hemolítica, com queda abrupta nos parâmetros hematológicos, palidez cutâneo-mucosa e icterícia. Os estudos imuno-hematológicos foram positivos; a amostra de sangue do paciente era incompatível com um filho, marido e hemácias transfundidas. Seis meses depois, um aloanticorpo anti-E (128 diluições) foi identificado no paciente. Conclui-se que a paciente foi aloimunizada durante a gestação com anticorpo anti-E, sendo a hemotransfusão o estímulo antigênico causador da reação transfusional hemolítica tardia(AU)

Reacción hemolítica transfusional tardía en un paciente con anemia de células falciformes: reporte de un caso / Delayed hemolytic reaction to transfusion in sickle cell anemia: report of one case

Sickle cell anemia was a rare disease in Chile, especially in adults, however the recent immigration wave from Haiti is changing this scenario. We report a 29 year old black female from Haiti with a non-disclosed history of sickle cell anemia. She was transfused with two units of red blood cells, found unconscious and with jaundice five days later and admitted to the hospital. On admission she had a hemoglobin of 3.3 g/dL, a total bilirubin of 5.08 mg/dL, a LDH of 1,306 Ui/L. She was transfused again, worsening her condition. An alloimmunization and delayed hemolytic reaction was suspected. A direct Coombs test was positive. She was treated with steroids and her serum hemoglobin rose progressively.

[Delayed hemolytic reaction to transfusion in sickle cell anemia. Report of one case]. / Reacción hemolítica transfusional tardía en un paciente con anemia de células falciformes: reporte de un caso.

Sickle cell anemia was a rare disease in Chile, especially in adults, however the recent immigration wave from Haiti is changing this scenario. We report a 29 year old black female from Haiti with a non-disclosed history of sickle cell anemia. She was transfused with two units of red blood cells, found unconscious and with jaundice five days later and admitted to the hospital. On admission she had a hemoglobin of 3.3 g/dL, a total bilirubin of 5.08 mg/dL, a LDH of 1,306 Ui/L. She was transfused again, worsening her condition. An alloimmunization and delayed hemolytic reaction was suspected. A direct Coombs test was positive. She was treated with steroids and her serum hemoglobin rose progressively.