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Ready access to blood products - such as red blood cells, platelets, and plasma - has revolutionized the medical profession. Many medical and surgical treatments would simply not be possible without blood transfusions.
As with all medical therapies, however, transfusion carries risks, and the role of the UHN Hospital Transfusion Committee is to make those risks as small as possible.
"If you ask most patients what their greatest worry about receiving a blood transfusion is, many would answer the risk of transmitting the virus that causes AIDS or hepatitis C," says Dr. Jacob Pendergrast, Hematologist, UHN Blood Transfusion Service, Laboratory Medicine Program. "Fortunately, the risks of being infected with one of these diseases are lower than it has ever been: approximately 1 in 2.3 million for hepatitis C, and 1 in 7.8 million for HIV."
Although still very rare, the greater risk of transfusion is an acute reaction, one that occurs within hours of the product being given. Examples include hemolytic transfusion reactions due to serologic incompatibility, septic transfusion reactions from a contaminated unit, and transfusion-related acute lung injury (TRALI). TRALI, a condition in which patients develop non-cardiogenic pulmonary edema from a blood product, has recently emerged as the number one cause of transfusion-associated mortality.
Highlights of this policy include a new classification schema to differentiate benign from more serious reactions, algorithms regarding when to return a product to the Blood Bank and when to order additional tests. A transfusion reaction investigation can now also be ordered through Electronic Patient Record (EPR), and the patient's clinical status can be documented on a revised transfusion mount sheet. Final interpretation of the acute transfusion reactions will be reported in EPR and reviewed by the Hospital Transfusion Committee.
Dr. Pendergrast recalls a recent example of a patient receiving a blood transfusion following surgery.
"After the surgery, the patient went into severe respiratory failure - at first clinicians didn't realize what had happened, but it quickly became clear the patient was suffering from transfusion-related acute lung injury," he says. "The adverse reaction was reported to the staff at the Blood Bank, who then worked with Canadian Blood Services to identify the implicated blood donor so that another patient wouldn't be put at risk."
Dr. Pendergrast emphasized that optimal management of transfusion reactions requires close collaboration between Blood Bank and the clinical staff it serves. Good communication between the clinician reporting the reaction and the Blood Bank staff who receives the call is vital.
"There is always a tendency for us to 'silo' ourselves off, especially in big hospitals," he says. "But in the case of acute transfusion reactions, the labs and the clinicians not only need to act quickly, they need to act as a team. In cases such as TRALI, it could mean life or death."