Frequency and timing of all‐cause deaths in visits involving suspected transfusion reactions, and the significance of cardiopulmonary disturbances

Background/objectives Transfusion reactions (TRs) may cause or contribute to death. Cardiopulmonary TRs are distressing, and collectively account for most transfusion fatalities, though the degree to which they alter survival more broadly is unclear. Deaths (and their timing) after TRs may provide f...

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Bibliographic Details
Published in:Vox sanguinis 2021-09, Vol.116 (8), p.898-909
Main Authors: McVey, Mark J., Cohen, Robert, Arsenault, Valerie, Escorcia, Alioska, Tasmin, Farzana, Pendergrast, Jacob, Lieberman, Lani, Lin, Yulia, Callum, Jeannie, Cserti‐Gazdewich, Christine
Format: Article
Language:English
Subjects:
bacterial contamination
blood safety
Confidence intervals
Death
Dyspnea
Fatalities
haemolytic transfusion reaction
hemovigilance
Hypersensitivity
Mortality
Respiration
Thermal resistance
TRALI
Transfusion
transfusion reactions
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Summary:Background/objectives Transfusion reactions (TRs) may cause or contribute to death. Cardiopulmonary TRs are distressing, and collectively account for most transfusion fatalities, though the degree to which they alter survival more broadly is unclear. Deaths (and their timing) after TRs may provide further insights. Materials/Methods Adult (tri‐hospital network) haemovigilance data (2013–2016) recorded referrals with conclusions ranging from unrelated to transfusion (UTR) to entities such as: septic TRs, serologic/haemolytic reactions, transfusion‐associated circulatory overload (TACO), transfusion‐associated dyspnoea (TAD), transfusion‐related acute lung injury (TRALI), allergic transfusion reaction (ATR), and others. For (in‐ or out‐patient) visits involving suspected TRs (VISTRs), all‐cause mortalities (% [95% confidence interval]) and associated time‐to‐death (TTD) (median days, [interquartile range]) were compared. Diagnoses were defined inclusively (possible‐to‐definite) or strictly (probable‐to‐definite). Results Of 1144 events, rank order VISTR mortality following (possible‐to‐definite) TRs, and associated TTDs, were led by: DHTR 33% [6–19], 1 death at 123d; TRALI 32% [15–54], 6 deaths: 3d [2–20]; BaCon 21% [14–31], 17 deaths: 10d [3–28]; TACO 18% [12–26], 23 deaths: 16d [6–28]; TAD 17% [11–26]: 18 deaths, 6d [3–12]. Higher‐certainty TRs ranked similarly (DHTR 50% [9–91]; BaCon 29% [12–55], 4 deaths: 12d [3–22]; and TACO 25% [16–38], 15 deaths: 21d [6–28]). VISTR mortality after TACO or TRALI significantly exceeded ATR (3·3% [2·4–5·8], P 
ISSN:0042-9007
1423-0410
DOI:10.1111/vox.13086