Investigation of adverse transfusion reactions
Blood transfusions pose numerous risks to the patient, one which is the possibility of an adverse transfusion reaction (please refer to the Blood Safety section for more information about these risks). Accurate haemovigilance information relies on clinicians reporting all adverse reactions to blood product transfusions so that the blood service can try to mitigate these events.
Clinicians should report all adverse events to their designated Blood Bank as soon as possible, once the patient has been stabilised.
The Blood Bank requires the return of all used and unused blood products, post-transfusion EDTA samples from the patient, and a completed 'Untoward Reaction Report' form (this can be downloaded below) that details the incident. Serological investigations are initiated by the Blood Bank then sent to the WCBS Reference Laboratory for further testing. Additional blood products are not issued until provisional testing is completed, although incompletely cross-matched blood can be released if the clinician accepts full responsibility for the clinical consequences.
Serological investigations of adverse transfusion reactions include ABO, Rh and antibody screen retesting of the patient's pre- and post-transfusion samples, and units transfused. Careful attention is paid to the detection of haemolysis in the patient's blood that may be indicative of a haemolytic transfusion reaction. Bacterial culture testing of the implicated unit can also be performed by an external laboratory if there is suspicion of bacterial contamination of the blood product. Clinicians should always perform blood culture testing of their patients if this complication is suspected, in order to determine whether the same organism is isolated from the blood product and patient. Additional testing (such as HLA antigen/antibody determination) may be required if transfusion related acute lung injury (TRALI) is being considered.
The WCBS Transfusion Medical Officer reviews all information related to the incident and compiles a report that is sent to the hospital's medical records department for filing in the patient's folder.
For adverse transfusion event medical support and advice please contact Dr Caroline Hilton, WCBS Transfusion Medical Specialist.
Dr Caroline Hilton: Telephone +27 (0)21 507 6329 | Cell 083 282 1612 | Email Caroline@wcbs.org.za