Unacknowledged adverse transfusion reactions: Are they a mine to dig?

OBJECTIVES: Haemovigilance has long tried to characterize and understand transfusion reactions in order to prevent them. Unacknowledged ones are now a minority but they question us. Are they the result of incomplete clinical setting and/or insufficient medical reasoning, or can they contain real new entities we have not yet understood? MATERIAL AND METHODS: Ten volunteer experts reviewed 30 recent unacknowledged cases. Their diagnostic propositions were compared with data issued from a five-year repository we have analysed in terms of statistical links between clinical signs and diagnoses. RESULTS: Experts' opinions are only quite unanimous in 60% of the cases, and the proposed diagnosis remains unacknowledged in 53%. Repository comparison shows that signs like pain or digestive symptoms are far more frequent in unknown reactions. However, it is more the absence of some other signs which drives to that conclusion, in a default diagnosis mechanism. CONCLUSION: Errors in transfusion reactions medical analysis are rare. Unacknowledged cases are more often linked to poor or unspecific clinical setting. But a particular attention must be paid with infrequent diagnoses which are far less characterised, like metabolic complications. Pain high occurrence in unknown cases also commands us to go further in the characterisation of acute pain transfusion reaction diagnosis, which is suggested by some authors.

[Evolution of the blood products distribution in France - detailed analysis in a regional blood transfusion centre]. / Evolution de la distribution des produits sanguins labiles en France - analyse détaillée au sein d'un Etablissement français du sang interrégional.

OBJECTIVE: The present increase of blood products distribution raises some adaptation questions. To understand this evolution, it is necessary to assure patients needs satisfaction. STUDY DESIGN: The study focuses on years 1997 to 2007. All blood products and hospitals are taken into account. The possible impact of size and clinical specialties is analyzed for the main hospitals. RESULTS: The evolution varies according to blood product: continuous drop for autologous red cells and plasmas, drop and rise for homologous red cells and platelets with a turnaround in 2001-2002, reverse and more chaotic movement for homologous plasmas. These movements are the result of public hospitals, with an upsurge of the medium sized ones. Private hospitals go down for all blood products, with a concentration on the larger ones. Surgical hospitals fall from 3 to 4% for all blood products, while medical ones rise of 3% for homologous red cells, 27% for platelets and fall of 10% for homologous plasmas. Private mixed hospitals fall for all blood products, while public ones rise for homologous red cells and platelets. CONCLUSION: Evolution understanding of blood products distribution requires precisions about the kind of products and the hospitals status and specialties: medical, surgical, even obstetrical or urgency-related. The present trend is a rise for public hospitals and medical specialties, which are both the largest. Blood transfusion needs will thus go on rising in the years to come.