(P-TS-91) Resident Screening of Possible Transfusion Reactions

Transfusion of allogenic blood products is a common and safe medical procedure. However, the administration of such products is not without risk. Clinical evaluation during the course of a transfusion is required to determine if any change in patient symptoms constitute a transfusion reaction. If a reaction is observed, the clinical team should contact the blood bank. A transfusion service can either accept any reported reaction from the clinical team and do a full transfusion reaction work up, or the reactions can be screened by physicians to evaluate if the reported reaction meets criteria for full evaluation.

Study

Design/Methods:

Transfusion reaction events were retrospectively collected over a period of 8 months at a large quaternary medical center. For each of these events, the clinical pathology resident was contacted, and they discussed the case with the clinical team to see if the event met criteria for a transfusion reaction.  For reactions that met criteria, a full workup, including a post-transfusion direct antiglobulin test and evaluation for plasma hemolysis, was performed. The diagnosis was recorded, and a pathology report was generated. For cases which did not meet criteria for a full evaluation, presenting symptoms were logged but no workup was completed, or pathology report generated. The documented rationale which categorized reactions as not meeting criteria for evaluation was standardized for comparison.

Results/Findings:

A total of 289 reactions were reported to the blood bank over this period. Of these, 250 were deemed to be true reactions. Thirty-nine cases (14.2%) were determined to not meet the criteria for a reaction. The clinical team was informed that they could continue to transfuse the product and should contact the blood bank again if symptoms changed. For cases which did not meet criteria, the most common presenting symptom was an increase in temperature that was either under a 1°C change, for non-platelet units, or was under 38°C (48%) followed by non-specific hypotension not meeting the criteria for a hypotensive transfusion reaction (12%).

Conclusions:

It can be argued that the cancellation of possible transfusion reactions provides a cost savings for the blood bank and more efficient care for patients. For every reaction that requires a full transfusion reaction work up, the unit being transfused must be stopped and returned to the blood bank. If the patient still requires transfusion, a new unit must be sent, which incurs additional cost and exposes the patient to new donor antigens. However, the relative cost-benefit of this approach may be worth further analysis as relatively few cases are cancelled, approximately five per month over the course of the period of interest, and because there is also a risk to cancelling such evaluations, which may result in missing a true transfusion reaction.