Blood Transfusion A Risk Factor ?

1
Blood TransfusionA Risk Factor ?

• THIS NEW DRUG
• SHOULD BE A MIRACLE...!

2
Blood Transfusion A Risk Factor ?

• COMPLICATIONS
• Immunological
• Non-immunological
• Infectious

3
Blood Transfusion A Risk Factor ?

• Immunological Complications
• Red cells
• Haemolytic transfusion reaction
• Acute
• Delayed

4
Blood Transfusion A Risk Factor ?

• Immunological Complications
• Red cells
• White cells
• Febrile reaction
• TRALI
• TA-GvHD

5
Blood Transfusion A Risk Factor ?

• Immunological Complications
• Red cells
• White cells
• Platelets
• Post transfusion purpura

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

7
Blood Transfusion A Risk Factor ?

• Immunological Complications
• Red cells
• White cells
• Platelets
• Other antigens
• Other Interaction
• Change of the immune response
• Improved survival of transplanted kidneys
• Postoperative infections ?
• Cancer recurrence ?

8
Blood Transfusion A Risk Factor ?

• Non-immunological complications
• Vasoactive substances
• Prekallicrein substances
• Hypotension, vasodilatation, nausea

9
Blood Transfusion A Risk Factor ?

• Non-immunological complications
• Vasoactive substances
• Pyrogens
• Bacterial contamination
• Endogenous pyrogens

10
Blood Transfusion A Risk Factor ?

• Non-immunological complications
• Vasoactive substances
• Pyrogens
• Cold blood
• Cardiac arrest

11
Blood Transfusion A Risk Factor ?

• Non-immunological complications
• Vasoactive substances
• Pyrogens
• Cold blood
• Citrate toxicity
• Muscle tremor
• Cardiac output decrease
• Hypotension

12
Blood Transfusion A Risk Factor ?

• Non-immunological complications
• Vasoactive substances
• Pyrogens
• Cold blood
• Citrate toxicity
• Potassium toxicity

13
Blood Transfusion A Risk Factor ?

• Non-immunological complications
• Vasoactive substances
• Pyrogens
• Cold blood
• Citrate toxicity
• Potassium toxicity
• Air embolism

14
Blood Transfusion A Risk Factor ?

• Non-immunological complications
• Vasoactive substances
• Pyrogens
• Cold blood
• Citrate toxicity
• Potassium toxicity
• Air embolism
• Micro embolism
• Cell aggregates

15
Blood Transfusion A Risk Factor ?

• Non-immunological complications
• Vasoactive substances
• Pyrogens
• Cold blood
• Citrate toxicity
• Potassium toxicity
• Air embolism
• Micro embolism
• Septic thrombophlebitis

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

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

18
Blood Transfusion A Risk Factor ?

• Infectious Complications
• Bacteria
• Virus
• Protozoes
• Parasites
• Prions
• CJD, vCJD ?

19
Blood Transfusion A Risk Factor ?

• ...WONDER HOW OFTEN
• THESE SIDE EFFECTS OCCUR...?

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

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

22
Blood Transfusion A Risk Factor ?

• RISK RATES
• Number of risks per 100,000
• transfused blood components

23
Blood Transfusion A Risk Factor ?
24
Blood Transfusion A Risk Factor ?
25
Blood Transfusion A Risk Factor ?
26
Blood Transfusion A Risk Factor ?
27
Blood Transfusion A Risk Factor ?
28
Blood Transfusion A Risk Factor ?

• Hazards of Blood Transfusion
• Versus
• Hazards of Everyday Life

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

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

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)

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

33
Blood Transfusion A Risk Factor ?
34
Blood TransfusionA Risk Factor ?
MAYBE ITS NOT SO DANGEROUS AFTER
ALL........
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

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

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

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

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

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.

41
Blood Transfusion A Risk Factor ?
WHAT WILL I GET FOR ALL THE TAX MONEY I PAID ?
42
Blood Transfusion A Risk Factor ?
A REAL DECREASE OF THE OVERALL RISK or A
DIMINISHED FEAR OF HIV INFECTION