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Blood Transfusion A Risk Factor ?

Blood Transfusion A Risk Factor ?. THIS NEW DRUG SHOULD BE A MIRACLE...!. Blood Transfusion A Risk Factor ?. COMPLICATIONS: Immunological Non-immunological Infectious. Blood Transfusion A Risk Factor ?. Immunological Complications: Red cells Haemolytic transfusion reaction Acute

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Blood Transfusion A Risk Factor ?

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  1. Blood TransfusionA Risk Factor ? • THIS NEW DRUG • SHOULD BE A MIRACLE...! JJO marts 2002

  2. Blood Transfusion A Risk Factor ? COMPLICATIONS: Immunological Non-immunological Infectious JJO marts 2002

  3. Blood Transfusion A Risk Factor ? Immunological Complications: Red cells Haemolytic transfusion reaction • Acute • Delayed JJO marts 2002

  4. Blood Transfusion A Risk Factor ? Immunological Complications: Red cells White cells Febrile reaction TRALI TA-GvHD JJO marts 2002

  5. Blood Transfusion A Risk Factor ? Immunological Complications: Red cells White cells Platelets Post transfusion purpura JJO marts 2002

  6. Blood Transfusion A Risk Factor ? Immunological Complications: Red cells White cells Platelets Other antigens Urticaria  Anaphylactic shock Plasma proteins: Ig A Atopens: Penicillin Nickel JJO marts 2002

  7. Blood Transfusion A Risk Factor ? Immunological Complications: Red cells White cells Platelets Other antigens Other Interaction Changeof the immune response Improved survival of transplanted kidneys Postoperative infections ? Cancer recurrence ? JJO marts 2002

  8. Blood Transfusion A Risk Factor ? Non-immunological complications: Vasoactive substances Prekallicrein substances Hypotension, vasodilatation, nausea JJO marts 2002

  9. Blood Transfusion A Risk Factor ? Non-immunological complications: Vasoactive substances Pyrogens Bacterial contamination Endogenous pyrogens JJO marts 2002

  10. Blood Transfusion A Risk Factor ? Non-immunological complications: Vasoactive substances Pyrogens Cold blood Cardiac arrest JJO marts 2002

  11. Blood Transfusion A Risk Factor ? Non-immunological complications: Vasoactive substances Pyrogens Cold blood Citrate toxicity Muscle tremor Cardiac output decrease Hypotension JJO marts 2002

  12. Blood Transfusion A Risk Factor ? Non-immunological complications: Vasoactive substances Pyrogens Cold blood Citrate toxicity Potassium toxicity JJO marts 2002

  13. Blood Transfusion A Risk Factor ? Non-immunological complications: Vasoactive substances Pyrogens Cold blood Citrate toxicity Potassium toxicity Air embolism JJO marts 2002

  14. Blood Transfusion A Risk Factor ? Non-immunological complications: Vasoactive substances Pyrogens Cold blood Citrate toxicity Potassium toxicity Air embolism Micro embolism Cell aggregates JJO marts 2002

  15. Blood Transfusion A Risk Factor ? Non-immunological complications: Vasoactive substances Pyrogens Cold blood Citrate toxicity Potassium toxicity Air embolism Micro embolism Septic thrombophlebitis JJO marts 2002

  16. Blood Transfusion A Risk Factor ? Non-immunological complications: Vasoactive substances Pyrogens Cold blood Citrate toxicity Potassium toxicity Air embolism Micro embolism Septic thrombophlebitis Overload JJO marts 2002

  17. Blood Transfusion A Risk Factor ? Non-immunological complications: Vasoactive substances Pyrogens Cold blood Citrate toxicity Potassium toxicity Air embolism Micro embolism Septic thrombophlebitis Overload Haemosiderosis JJO marts 2002

  18. Blood Transfusion A Risk Factor ? Infectious Complications: Bacteria Virus Protozoes Parasites Prions: CJD, vCJD ? JJO marts 2002

  19. Blood Transfusion A Risk Factor ? • ...WONDER HOW OFTEN • THESE SIDE EFFECTS OCCUR...? JJO marts 2002

  20. Blood Transfusion A Risk Factor ? SHOT and DART SHOT: “Severe Hazards of Transfusion” UK 1996 DART: “Danish Registration of Transfusion Risks” DK 1999 Voluntary and confidential collecting of data about transfusion risks, using report forms. The aim is to improve transfusion safety JJO marts 2002

  21. Blood Transfusion A Risk Factor ? SHOT and DART DART SHOT (1999-2001) (1996-2000) Reports collected (severe risk) 72 862 Transfused components 1.35 m 13 m Report rate (per 100,000 transf.) 5.3 6.6 JJO marts 2002

  22. Blood Transfusion A Risk Factor ? • RISK RATES • Number of risks per 100,000 • transfused blood components JJO marts 2002

  23. Blood Transfusion A Risk Factor ? JJO marts 2002

  24. Blood Transfusion A Risk Factor ? JJO marts 2002

  25. Blood Transfusion A Risk Factor ? JJO marts 2002

  26. Blood Transfusion A Risk Factor ? JJO marts 2002

  27. Blood Transfusion A Risk Factor ? JJO marts 2002

  28. Blood Transfusion A Risk Factor ? Hazards of Blood Transfusion Versus Hazards of Everyday Life JJO marts 2002

  29. Blood Transfusion A Risk Factor ? 1 per 20,000 Severe hazards of transfusion 1 per 40,000 Incorrect blood component transfused 1 per 40,000 Immune complication 1 per 50,000 Death attributed to general anaesthesia JJO marts 2002

  30. Blood Transfusion A Risk Factor ? 1 per 20,000 Severe hazards of transfusion 1 per 40,000 Incorrect blood component transfused 1 per 40,000 Immune complication 1 per 50,000 Death attributed to general anaesthesia 1 per 300,000 Death (transfusion of blood component) 1 per 700,000 Death (immune complication) 1 per 700,000 Transfusion transmitted infection JJO marts 2002

  31. Blood Transfusion A Risk Factor ? 1 per 20,000 Severe hazards of transfusion 1 per 40,000 Incorrect blood component transfused 1 per 40,000 Immune complication 1 per 50,000 Death attributed to general anaesthesia 1 per 300,000 Death (transfusion of blood component) 1 per 700,000 Death (immune complication) 1 per 700,000 Transfusion transmitted infection 1 per 1-2 m Death (IBCT) 1 per 1-2 m Transfusion transmitted HIV infection (calculated) JJO marts 2002

  32. Blood Transfusion A Risk Factor ? 1 per 20,000 Severe hazards of transfusion 1 per 40,000 Incorrect blood component transfused 1 per 40,000 Immune complication 1 per 50,000 Death attributed to general anaesthesia 1 per 300,000 Death (transfusion of blood component) 1 per 700,000 Death (immune complication) 1 per 700,000 Transfusion transmitted infection 1 per 1-2 m Death (IBCT) 1 per 1-2 m Transfusion transmitted HIV infection (calculated) Survival 5 years after blood transfusion: 50% JJO marts 2002

  33. Blood Transfusion A Risk Factor ? JJO marts 2002

  34. Blood TransfusionA Risk Factor ? MAYBE IT’S NOT SO DANGEROUS AFTER ALL........ JJO marts 2002

  35. Blood Transfusion A Risk Factor ? Reduction of Risks Incorrect Blood Component Transfused: Establishing standards for transfusion medicine Blood samples for blood grouping and cross-match Delivery of blood component from the hospital Blood Bank Transfusion of blood components Verification of identity between component and patient Transfusion complications, description and treatment Education (standards) Audit (are the standards being followed) Bedside computerized verification of bar code identity on blood component and wristband JJO marts 2002

  36. Blood Transfusion A Risk Factor ? Reduction of Risks Immune Complications: Avoid overuse of blood components, especially FFP and platelets (higher complication rate than red cells) Use of FFP from non-transfused male donors No HLA antibodies (TRALI) Increase the sensitivity of serological methods in order to detect weak Kidd antibodies JJO marts 2002

  37. Blood Transfusion A Risk Factor ? Reduction of Risks Transfusion Transmitted Infection: Donor criteria Exclude donors at risk Screening for Infectious agents PCR for detection of virus Inactivation of Infectious agents Intercept JJO marts 2002

  38. Blood Transfusion A Risk Factor ? Conclusions Blood transfusion is still a risk to the patient However, the rate is low compared with other kinds of risks JJO marts 2002

  39. Blood Transfusion A Risk Factor ? Conclusions Blood transfusion is still a risk to the patient However, the rate is low compared with other kinds of risks Some are relatively common and should never occur (IBCT) The rate can be reduced in a simple way and at low cost JJO marts 2002

  40. Blood Transfusion A Risk Factor ? Conclusions Blood transfusion is still a risk to the patient However, the rate is low compared to other kinds of risks Some are relatively common and should never occur (IBCT) The rate can be reduced in a simple way and at low cost Others are very seldom, but create a lot of fear (HIV) They can be avoided only in a complicated expensive way. JJO marts 2002

  41. Blood Transfusion A Risk Factor ? WHAT WILL I GET FOR ALL THE TAX MONEY I PAID ? JJO marts 2002

  42. Blood Transfusion A Risk Factor ? A REAL DECREASE OF THE OVERALL RISK or A DIMINISHED FEAR OF HIV INFECTION JJO marts 2002

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