Prevention of Adverse Reactions

Prevention of adverse
reactions: Journey from blood

safety to transfusion safety
Cupuwatie Cahyani
Division of Hematology and Medical Oncology – Department of Internal Medicine

Medical Faculty of Airlangga Univerrsity – Dr.Soetomo Teaching Hospital Surabaya
2019
INTRODUCTION
Transfusion therapy is the main treatment for some patients.
Its own risks causing immediate and delayed adverse reactions :

Transfusion transmitted infectious diseases (TTIDs), antibody formation to
red and white cells, and preformed cytokines result.
There have been many advances in technologies and transfusion strategies to

decrease the risk of transfusion reactions to prevent infectious and non-
infectious complications associated with blood transfusion.
BLOOD SAFETY IMPROVEMENTS
Bacterial
contamination risk
reduction
Platelet additive Prestorage

solutions (PAS) leucoreduction
Pathogen Efforts to
reduction mitigate
technologies TRALI
Bacterial Contamination Risk Reduction
Disinfection methods for the venipuncture site, introduction of the

diversion pouch during the blood collection procedure and
automated bacterial culture of platelet products, as well as platelet
additive solutions and pathogen reduction systems.
The leading sources of blood product contamination are skin

bacteria so Use of povidone iodine or isopropyl alcohol plus
iodine tincture for disinfection has reduce skin infections by 50%
Storage of platelet products at room temperature up to five days

make them more susceptible to bacterial growth.
American Association of Blood Banks (AABB) has recommended

testing of 100% platelet products for bacterial contamination by
Combination of culture and rapid screening tests.
Prestorage Leucoreduction
• The immediate adverse reactions, most common but less severe, are Febrile
Non Hemolytic Transfusion Reactions (FNHTRs) and allergic reactions.
• FNHTR is defined as an increase in temperature of ≥1 C from the baseline
value.
• Pre-storage leucoreduction use of filters for red blood cells to residual
plasma proteins.
Efforts to Mitigate TRALI
Transfusion Related Acute Lung Injury (TRALI) is a severe transfusion

reaction characterized by the acute onset of non-cardiogenic pulmonary
edema occurring within six hours of transfusion which result from
formation of antibodies between recipient human leukocyte antigens
(HLA) on white blood cells and HLA antibodies in donor plasma.
In 2014, AABB recommended that “plasma and whole blood for

allogeneic transfusion shall be from males, females who have not been
pregnant, or females who have been tested since their most recent
pregnancy and results interpreted as negative for HLA antibodies” .
Pathogen Reduction Technologies
• The aim of pathogen reduction is zero risk from pathogens in blood
products.
• Technologies use solvent and detergent, psoralen compound,
amotosalen, methylene blue or riboflavin with ultraviolet (UV) light to
make pathogens non-infectious.
• PR for platelets and plasma inactivates most pathogens with additional

benefits of prevention of Transfusion Associated Graft-versus-host disease
(TA-GVHD), prevention of cytomegalovirus (CMV) disease transmission and
possible reduction of alloimmunization due to inactivation of white blood
cells remaining in blood products.
Platelet additive solutions (PAS)
• Platelet additive solutions (PAS) are isotonic solutions commonly used as a
substitute for plasma to reduce the amount of plasma transfused with
platelets, and thus reduced transfusion adverse events, to provide the
possibility for pathogen inactivation using photochemical treatment and
offers the possibility of adding certain components to improve platelet
storage conditions.
• PAS is an available option to prevent transfusion adverse reactions specially
TRALI in cases of platelet transfusion.
SAFE TRANSFUSION PRACTICES
Irregular antibody screening

Radio frequency and identification and
identification extended phenotyping
Formulation and adherence

to standard operating Audit and
procedures and protocols education
Radio frequency identification
• RFID allows for accurate identification of blood products and recipient,
eliminate transfusion error due to patient mis-identification to long-term
savings and increased productivity.
• At the same time, RFID technology has specific concerns regarding
security and patient confidentiality
Irregular antibody screening and identification and extended phenotyping
Important to detect the appearance of new alloantibodies or

disappearance of old alloantibodies to prevent hemolytic
transfusion reaction during or after allogeneic transfusion.
Regular screening for the development of allo-antibodies in multi-

transfused patients and providing leucoreduced, Rh-phenotyped and
antigen-matched blood would add towards the better management of
patients.
Prevention of RBC allo-antibody formation in multi transfused

patients extends their life expectancy and reduces the need of blood
transfusion.
Formulation and adherence to standard operating procedures and protocols
• Standard Operating Procedures (SOPs) are regularly updated and validated by

competent authority.
• To improve the safety of transfusion, it is important to develop risk reduction protocol
and set of corrective measures
• List of corrective measures are termed as “Plan, Do, Check, Act (PDCA)”.
“Plan” : identification and analysis of potential failures.
“Do” : appears for developing potential solutions.
“Check” : ensures testing the efficacy of each measure
“Act” : appears for the timely and complete implementation of
the corrective measures
Audit and education
• Predetermined transfusion guidelines and transfusion audits are useful
tools in the education of all the stakeholders involved in transfusion
practices.
• Blood transfusion centers should have a proactive role in promoting good
transfusion practice in hospitals as well as supplying blood components
and specialist services.
• Transfusion medicine specialists have been successful in achieving great
progress in blood safety and now it is time for improvements in
transfusion safety by focusing on various processes and practices related
to safe transfusions of blood and blood components.
Thank you

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Prevention of adverse

reactions: Journey from blood

Division of Hematology and Medical Oncology – Department of Internal Medicine

Transfusion therapy is the main treatment for some patients.

Its own risks causing immediate and delayed adverse reactions :

There have been many advances in technologies and transfusion strategies to

Platelet additive Prestorage

Disinfection methods for the venipuncture site, introduction of the

The leading sources of blood product contamination are skin

Storage of platelet products at room temperature up to five days

American Association of Blood Banks (AABB) has recommended

Transfusion Related Acute Lung Injury (TRALI) is a severe transfusion

In 2014, AABB recommended that “plasma and whole blood for

• PR for platelets and plasma inactivates most pathogens with additional

Irregular antibody screening

Formulation and adherence

Important to detect the appearance of new alloantibodies or

Regular screening for the development of allo-antibodies in multi-

Prevention of RBC allo-antibody formation in multi transfused

• Standard Operating Procedures (SOPs) are regularly updated and validated by

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