BACKGROUND: Acute complications are among the most common complications in blood transfusion reactions and one of the leading causes of death. The reduction in acute complications as well as blood safety and health of patients should be considered. The aim of this short report study is to determine the prevalence of allergic reactions in acute complications of packed red blood cell (RBC) injections in patients hospitalized in Sina Hospital, Kamyaran City, Iran, from 2014 to 2018.METHODS: This was a retrospective cross-sectional study with the statistical population including all patients who required blood transfusion in Sina hospital in Kamyaran City since 2014 to 2018. The standard checklist called "A form of reporting unwanted complications after blood transfusions and its related products" was used in this study. Data were entered into the SPSS statistical software. Descriptive statistics were analyzed as mean and standard deviation (SD) and analytical results were analyzed using Fisher's exact test.RESULTS: In this study, the prevalence of transfusion complications during this period was 0.016. 5 (29%) and 12 (71%) of the patients were men and women, respectively. The most common sign of blood transfusion included restlessness and tachycardia. The most common acute complication of blood transfusions was allergic reaction (47%). Based on the Fisher's exact test, a statistically significant relationship was found between the blood group, sex, and history of injection with the diagnosis of transfusion (P &lt; 0.001).CONCLUSION: Registering the complications of blood transfusion is always a concern and important for the blood transfusion organization. In this study, it was found that the most common acute complication of blood transfusions was allergic reactions (8 out of 17)

Baghernasab, Mohammad Jafar

Servatyari, Karo

Valizadeh-Ardalan, Pooya

Yazdanpanah, Hero

English

Chronic Diseases Journal (Kurdistan University of Medical Sciences)

   http://cdjournal.muk.ac.ir,    03 April   1   Chron Dis J, Vol. 8, No. 2, Spring 2020 DOI: 10.22122/cdj.v8i2.515 Published by Vesnu Publications The prevalence of allergic reaction in acute complications of injection of packed red blood cell in patients hospitalized in Sina Hospital, Kamyaran City, Iran, during the years 2014-2018  Pooya Valizadeh-Ardalan1, Mohammad Jafar Baghernasab2, Hero Yazdanpanah1, Karo Servatyari1  1 Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran 2 Department of Medical Laboratory Sciences, Sina Hospital, Kurdistan University of Medical Sciences, Kamyaran, Iran  Abstract BACKGROUND: Acute complications are among the most common complications in blood transfusion reactions and one of the leading causes of death. The reduction in acute complications as well as blood safety and health of patients should be considered. The aim of this short report study is to determine the prevalence of allergic reactions in acute complications of packed red blood cell (RBC) injections in patients hospitalized in Sina Hospital, Kamyaran City, Iran, from 2014 to 2018. METHODS: This was a retrospective cross-sectional study with the statistical population including all patients who required blood transfusion in Sina hospital in Kamyaran City since 2014 to 2018. The standard checklist called "A form of reporting unwanted complications after blood transfusions and its related products" was used in this study. Data were entered into the SPSS statistical software. Descriptive statistics were analyzed as mean and standard deviation (SD) and analytical results were analyzed using Fisher's exact test. RESULTS: In this study, the prevalence of transfusion complications during this period was 0.016. 5 (29%) and 12 (71%) of the patients were men and women, respectively. The most common sign of blood transfusion included restlessness and tachycardia. The most common acute complication of blood transfusions was allergic reaction (47%). Based on the Fisher's exact test, a statistically significant relationship was found between the blood group, sex, and history of injection with the diagnosis of transfusion (P < 0.001). CONCLUSION: Registering the complications of blood transfusion is always a concern and important for the blood transfusion organization. In this study, it was found that the most common acute complication of blood transfusions was allergic reactions (8 out of 17). KEYWORDS: Allergy Reaction; Blood Transfusions; Transfusion Reaction; Blood Safety; Iran  Date of submission: 15 Sep. 2019, Date of acceptance: 11 Nov. 2019  Citation: Valizadeh-Ardalan P, Baghernasab MJ, Yazdanpanah H, Servatyari K. The prevalence of allergic reaction in acute complications of injection of packed red blood cell in patients hospitalized in Sina Hospital, Kamyaran City, Iran, during the years 2014-2018. Chron Dis J 2020; 8(2): ???.  Introduction1 Blood transfusion is a process in which the whole blood or blood products such as packed red blood cells (RBCs) (also known as packed cells) are transferred from the donor to another person's circulatory system in order to increase                                                           Corresponding Author: Karo Servatyari; Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran Email: servatyarikaro@yahoo.com tissue oxygenation and prevent bleeding and ultimately improve the prognosis of  the disease.1 Blood transfusion is one of the most common processes for hospitalized patients which can dramatically help revive life of the patients.2  Blood transfusion reactions may be acute or delayed, with the acute reaction occurring during or within the first 24 hours of injection, but the delayed reaction may occur days, weeks, or years later.3 Short Communication     http://cdjournal.muk.ac.ir,    03 April Allergic reaction in packed RBC injections Valizadeh-Ardalan et al.   2   Chron Dis J, Vol. 8, No. 2, Spring 2020 In the past 15 years, the prevention of complications due to the transfer of blood products has gained higher importance than before.4 According to the Iranian Blood Transfusion Organization, 3708 cases of blood transfusions across the country were  reported to the Blood Transfusion and Hemovigilance Unit during 2009- 2013.5 The types of acute complications include febrile non-hemolytic transfusion reactions (FNHTR), allergic reaction, acute hemolytic disorder, septicemia, transfusion-related acute lung injury (TRALI), anaphylaxis shock, and acute pulmonary edema.6 Nowadays, patient safety is affected by various factors, so studies show that nurses have a significant impact on patients' outcomes; they play an important role in identifying life-threatening complications.7 Registration of blood transfusion complications have always been a concern of blood transfusion organizations, hence it is important to take preventive measures as a first step.  The aim of this short report study is to determine the prevalence of allergic reaction in acute complications of packed RBC injection in patients hospitalized in Sina Hospital in Kamyaran, Iran, since 2014 to 2018. Materials and Methods This was a cross-sectional study with the statistical population including all patients requiring blood transfusion (emergency and non-emergency) hospitalized in Sina hospital of Kamyaran City in Kurdistan Province. The city is located in 65 km south of Sanandaj, Iran. The city of Kamyaran has only one treatment center and all patients from the surrounding villages are referred to this center, so it covers a high number of patients. The convenience sampling method was used in this study and included all cases of blood transfusion error in Sina Hospital since  2014 to 2018. The tool applied in this study was the national standard checklist "Report Form of Possible Side Effects after Transfusion of Blood and its Products" which includes demographic characteristics, clinical status, history of transfusion, patient blood group, blood product characteristics, clinical symptoms, cause of blood administration, and treatment. The study inclusion criteria included all cases of blood transfusion complications over a period of time and the exclusion criteria were unregistered or altered data. Throughout the project, the patient information was emphasized to be protected. Data were entered into SPSS software (version 16.0, SPSS Inc., Chicago, IL, USA). The descriptive data were analyzed using descriptive statistics [mean and standard deviation (SD)] and analytical results using the Fisher's exact test. Results In this study, of about 1200 cases of blood transfusions performed at the center over the period, about 20 cases of undesirable complications were recorded, of which 3 had confidential information and were excluded from the study. The frequency of inpatient variables is shown in table 1. The prevalence of blood transfusion complications during this period was 0.016. The mean and SD of age of the patients were 45.00 and 20.07, respectively (the age range of 2-76 years old). The most common symptoms after transfusion were restlessness, tachycardia, and chills. The most common side effects diagnosed by the physician were allergic reaction, dyspnea, and FNHTR, respectively. Moreover, the frequency of clinical symptoms caused by packed cell injections was reported by bar graph in Figure 1. Based on the Fisher's exact test, there was a significant statistical relationship between blood group and diagnosis of blood transfusion complications (P < 0.001).      http://cdjournal.muk.ac.ir,    03 April Allergic reaction in packed RBC injections Valizadeh-Ardalan et al.    Chron Dis J, Vol. 8, No. 2, Spring 2020   3 Table 1. Frequency of variables in patients hospitalized in Sina Hospital in Kamyaran City, Iran, from 2014 to 2018 Variable  Frequency Rate (%) Sex Male 5 29.4 Female 12 70.6 Etiology Chronic anemia 8 47.0 Acute anemia 1 5.8 Hemorrhage 6 35.3 Surgery 2 11.7 ABO type A 4 23.5 B 4 23.5 O 9 53.0 AB 0 0.0 Transfusion History Less than 3 months 5 29.4 More than 3 months 3 17.6 No history 9 53.0 Severity Mild  11 64.7 Severe  6 35.3 Diagnosis FNHTR 3 17.6 Allergic reaction 8 47.0 TAD 6 35.3 History of disease Abortion 3 17.6 Reaction history 1 5.8 Cardiac disease 2 11.7 Pulmonary disease 1 5.8 Immune deficiency 1 5.8 Renal disease 5 29.4 None 4  FNHTR: Febrile non-hemolytic transfusion reactions; TAD: Transfusion-associated dyspnea   Figure 1. Bar graph of frequency of clinical symptoms caused by packed red blood cell (RBC) injections in patients hospitalized in Sina Hospital, Kamyaran City, Iran, from 2014 to 2018 The frequency of different blood group types according to the acute complication of blood transfusion in patients hospitalized in Sina Hospital is shown in table 2. Additionally, given table 3, there was a significant relationship between gender and diagnosis of blood transfusion complication  (P < 0.001). Besides, as table 4, there was a significant relationship between blood transfusion history and diagnosis of blood transfusion complications (P = 0.020). Furthermore, in accordance with table 5, there was a significant relationship between the history of blood transfusion and the cause of blood transfusion (P = 0.004). In the case of treatment of adverse events, all transfusions were stopped immediately and appropriate supportive treatments were given to relieve the complication.  024681012DyspeniaillnessImpatientsChest PainHeadecheHypertentionTachycardiaFeverChilisHotflashNausaeVomitingBackpainRashUrticaria    http://cdjournal.muk.ac.ir,    03 April Allergic reaction in packed RBC injections Valizadeh-Ardalan et al.   4   Chron Dis J, Vol. 8, No. 2, Spring 2020 Table 2. Frequency of different blood group types according to the  acute complication of blood transfusion in patients hospitalized in  Sina Hospital, Kamyaran City, Iran, from 2014 to 2018 Blood group Diagnosis ABO-type [n (%)] Total [n (%)] A+ B+ O+ FNHTR 0 (0) 1 (25) 2 (22) 3 (17.0) Allergic reaction 2 (50) 2 (50) 4 (44) 8 (47.1) TAD 2 (50) 1 (25) 3 (33) 6 (35,0) Total 4 (100) 4 (100) 9 (100) 17 (100) FNHTR: Febrile non-hemolytic transfusion reactions; TAD: Transfusion-associated dyspnea  Table 3. Frequency of gender based on type of acute complications of blood transfusion in patients hospitalized in Sina Hospital, Kamyaran City, Iran, from 2014 to 2018 Sex Diagnosis Male Female Total  [n (%)] [n (%)] FNHTR 1 (20) 2 (16) 3 (17) Allergic reaction 1 (20) 7 (58) 8 (47) TAD 3 (60) 3 (26) 6 (35) Total 4 (100) 5 (100) 12 (100) FNHTR: febrile non-hemolytic transfusion reactions; TAD: Transfusion-associated dyspnea  Discussion In this study, which was carried out for the first time at Sina Hospital of Kamyaran City, about 1200 patients underwent blood transfusion, among whom 20 acute post-injection complications were observed. The percentage of acute complications after transfusion was 1.66%, which is comparable to the statistics reported in the studies by Aminiahidashti et al.8 as 1.24% and Teimuri et al;6 acute complications following blood transfusion were high in both studies.6 The high rate of the complications in the present study may be attributed to the location of Kamyaran City and the high rate of accidents resulting in high emergency blood consumption. The most common clinical symptoms were restlessness, tachycardia, and chills as 10 (58.8%), 7 (41.0%), 6 (35.2%), respectively. The complication diagnosed by the physician was also an allergic reaction as 8 (47.0%). Allergic reaction is seen in the injection of cellular products. The results of the study showed that dense RBC injection is responsible for the allergic reaction.9  Transfusion-associated dyspnea (TAD) and FNHTR as respectively 6 (35.3%) and 3 (17.6%) patients accounted for the highest rate of acute post-injection complications. It should be noted that in all patients, there was no shock and severe decrease in consciousness. In a study by Tajali et al., the incidence of apnea occurred in 19.82% of patients with high prevalence. This finding is in line with the present study.10 However, in other studies such as the study by Bodaghkhan et al.3 conducted in Namazi Hospital of Shiraz, Iran, the rate of allergic reaction was 28.8% (15 out of 52 cases). Besides, in the study by Teimuri et al.6 performed in Tehran and Mazandaran hospitals, 45% allergic reaction (9 out of 20 complicating patients) was reported; in our study, it was higher than both studies.3,6  Table 4. Frequency of blood transfusion history by type of acute complication of blood  transfusion in patients hospitalized in Sina Hospital, Kamyaran City, Iran, from 2014 to 2018 Transfusion history Diagnosis Less than 3 months More than 3 months None Total [n (%)] [n (%)] FNHTR 1 (20) 1 (33) 1 (11) 3 (17.0) Allergic reaction 1 (20) 1 (33) 6 (66) 8 (47.1) TAD 3 (60) 1 (33) 2 (22) 6 (3.1) Total 5 (100) 3 (100) 9 (100) 17 (100) FNHTR: Febrile Non-Hemolytic Transfusion Reactions; TAD: Transfusion-associated dyspnea     http://cdjournal.muk.ac.ir,    03 April Allergic reaction in packed RBC injections Valizadeh-Ardalan et al.    Chron Dis J, Vol. 8, No. 2, Spring 2020   5 Table 5. Frequency of blood product injection based on blood transfusion in patients hospitalized in Sina Hospital, Kamyaran City, Iran, from 2014 to 2018 Transfusion history Diagnosis Less than 3 months More than 3 months None Total [n (%)] [n (%)] Etiology chronic Anemia 4 (80) 1 (33) 3 (33) 8 (47.1) Acute Anemia 0 (0) 1 (33) 0 (0) 1 (5.0) Hemorrhage 1 (20) 0 (0) 5 (55) 6 (35.0) Surgery 0 (0) 1 (33) 1 (11) 2 (11.0) Total 5 (100) 5 (100) 3 (100) 9 (100)  In other countries, the most common type of allergic reaction with a prevalence of 2.51% was reported in the study by Kato et al. in Japan, which is consistent with the present study, in addition, FNHTR had a prevalence of 0.43%.11 Studies have shown that the most common complication of this study has been fever, chills, and allergies.8,12 There was a significant relationship between the blood type of the patient and the type of complication diagnosed by the physician. So O+ blood type had the most prevalence [9 (53%) out of 17]. This result was consistent with the results of other studies.13 On the other hand, there was a significant relationship between gender and diagnosis of blood transfusion complication (P < 0.001).12 out of 17 (70.5%) blood transfusion responders were female; this was consistent with other studies.14 Of these, 7 (58%) developed an acute allergic reaction, which it is a high rate. According to table 4, the subjects who did not have a previous blood transfusion was more likely to have an acute complication of blood transfusion that was in contradiction with previous studies.6 Conclusion One of the most important goals of blood transfusion centers is to consume blood and its products properly. Another important goal of blood transfusion is to establish a consistent system between hospitals and the Blood Transfusion Organization to evaluate and analyze the various side effects of all injectable products. On the other hand, training and updating physicians and developing their information will be of great efficiency to the accuracy of blood transfusion registration. Conflict of Interests Authors have no conflict of interests. Acknowledgments Authors would like to gratefully thank to the Department of Research and Technology of Kurdistan University of Medical Sciences, Sanandaj, Iran and Student Research Committee for their supports. This article resulted from an independent research without financial support. References 1. Sullivan MT, Cotten R, Read EJ, Wallace EL. Blood collection and transfusion in the United States in 2001. Transfusion 2007; 47(3): 385-94. 2. Dehghan Nayeri N, Arab Ameri Z, Seylani K. Patient's Safety during Blood Transfusions in Hospitals Affiliated with Tehran University of Medical Sciences. Iran J Nurs 2016; 28(98): 39-49. [In Persian]. 3. Bodaghkhan F, Ramzi M, Vazirian S, Ahmadi M, Hajebi Rajabi M, Kohan N, et al. The prevalence of acute blood transfusion reactions in Nemazee Hospital. Sci J Iran Blood Transfus Organ 2014; 11(3): 247-51. [In Persian]. 4. Dzik S, Aubuchon J, Jeffries L, Kleinman S, Manno C, Murphy MF, et al. Leukocyte reduction of blood components: public policy and new technology. Transfus Med Rev 2000; 14(1): 34-52. 5. Shams-Asanjan K, Zolfaghari S, Balali MR, Mardani A, Niakan G. Clinical training for blood transfusion personnel using the experiences of the Hemvogelians system in Iran and the United Kingdom, Tehran, Iran [Online]. [cited 2014]; Available from: URL: www.ibto.ir/uploads/Hemovigilance_learning_Iran-England.pdf     http://cdjournal.muk.ac.ir,    03 April Allergic reaction in packed RBC injections Valizadeh-Ardalan et al.   6   Chron Dis J, Vol. 8, No. 2, Spring 2020 6. Teimuri H, Imani F, Maghsudlu M, Kia Daliri K, Fallah Tafti M. Prevalence of acute blood transfusion reactions in 11 hospitals of Tehran and Mazandaran province. Sci J Iran Blood Transfus Organ 2007; 4(1): 19-24. [In Persian]. 7. Henneman EA, Roche JP, Fisher DL, Cunningham H, Reilly CA, Nathanson BH, et al. Error identification and recovery by student nurses using human patient simulation: Opportunity to improve patient safety. Appl Nurs Res 2010; 23(1): 11-21. 8. Aminiahidashti H, Bozorgi F, Montazer H, Zeinali F, Seyed Jaber S J. Acute Outcomes of Blood Transfusions in Patients Admitted to Emergency Department. J Mazandaran Univ Med Sci 2016; 25(134): 324-8. [In Persian]. 9. Silliman CC, Boshkov LK, Mehdizadehkashi Z, Elzi DJ, Dickey WO, Podlosky L, et al. Transfusion-related acute lung injury: Epidemiology and a prospective analysis of etiologic factors. Blood 2003; 101(2): 454-62. 10. Tajali S, Tatarpour P, Fallahi M. RBC Transfusion in premature neonates in Mofid Children Hospital 2017. Sci J Iran Blood Transfus Organ 2018; 15(1): 47-54. [In Persian]. 11. Kato H, Nakayama T, Uruma M, Okuyama Y, Handa M, Tomiyama Y, et al. A retrospective observational study to assess adverse transfusion reactions of patients with and without prior transfusion history. Vox Sang 2015; 108(3): 243-50. 12. Salimi S, Feizi A, Vanabadi N. Incidence rate of acute reactions in transfusion of blood and its products prepared by Urumia Blood Refinery Center. Advances in Nursing and Midwifery 2010; 16(66):  8-13. [In Persian]. 13. Asvadi Kermani I, Eyvazi Ziaei J, Nikanfar AR, Maljaie H, Golchin M, Berahmani G, et al. Blood transfusion acute reactions in patients of Shahid Ghazi Hospital. Sci J Iran Blood Transfus Organ 2006; 2(6): 215-20. [In Persian]. 14. Rossi EC, Simon TL, Dzik WH, Stowell CP. Rossi's Principles of Transfusion Medicine. Philadelphia, PA: Lippincott Williams & Wilkins; 2002. 

The prevalence of allergic reaction in acute complications of injection of packed red blood cell in patients hospitalized in Sina Hospital, Kamyaran City, Iran, during the years 2014-2018

http://cdjournal.muk.ac.ir/index.php/cdj/article/download/515/246

The prevalence of allergic reaction in acute complications of injection of packed red blood cell in patients hospitalized in Sina Hospital, Kamyaran City, Iran, during the years 2014-2018

Abstract

Similar works

Full text

Available Versions

Chronic Diseases Journal (Kurdistan University of Medical Sciences)