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National Effort Scrutinizes Costly Blood Transfusion Complications

   April 12, 2010

Kuehnert says the field of blood safety has also been preoccupied for many years on keeping infectious disease agents out of the blood supply. "But we know that there's a whole university of other adverse events that are not infectious events."

One area the project is focusing on is a type of adverse event that is poorly understood. It occurs when a transfused patient suffers a minor or severe reaction because they were allergic to white cells that were included in red cell or plasma transfusions.

They can cause fever, chilling, shaking, unconsciousness, and other symptoms that require days of extra hospital stays, and, of course, more expense to the healthcare system. Each one may be more or less expensive to treat, Kuehnert says. "But if there are many of them it adds up to a burden of cost. We think that cost analysis can be very important, but it's something we won't know until we have the data from this project."

"In recent years, there's been an effort to reduce the number of white cells in products," a process known as "washing" or leukocyte reduction, which Kuehnert says "is universal" in European hospitals. But because of its substantial cost, it is done only in certain circumstances in the U.S. when certain patients are known to be at high risk of such reactions.

"I would compare it to a catheter infection," Kuehnert says. "It used to be that hospitals thought they were unavoidable, but then we got data to show that catheter events are preventable if you do certain things."

"Some patients we know are at increased risk, and as long as those patients are recognized, they will get irradiated components that will prevent them from coming down with graft versus host reactions. But there are some cases where the patient did not appear to be a risk; the immune system problem wasn't recognized," AuBuchon says.

"Are they preventable or not preventable? How frequently are they occurring. Maybe we can learn from it and try to prevent it."

"These are rare. And often, any one physician or hospital or any blood center would not see them often enough to connect the dots," AuBuchon says.

Katharine Downes, MD, a blood transfusion specialist at Case Western Reserve University, which was one of the first nine hospitals that participated in the project, says she was surprised at how decentralized record-keeping on adverse transfusion reactions had been. Before, she says, if she wanted information about a transfusion reaction, "I had to look in five different places." Now there's only one.

"What this protocol does is actually create these definitions, signs and symptoms, and lab findings, and it also provides a system to grade [the severity] of the adverse reactions," she says.

Whitaker of the AABB is excited about the project's potential. "There's a tremendous amount of information we're going to learn from this that we've not had the chance to look at before."

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