A study investigating transfusion-related complications in
patients receiving either blood or blood products in a
regional hospital in Mauritius
Paper Presenter: Smita SD Goorah, Department of Medicine, Faculty of Science,
University of Mauritius
Author(s):
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Smita SD GOORAH, Department of Medicine, Faculty of Science, University of
Mauritius
Mohammud Fadil Khoyratty, Department of Medicine, Faculty of Science,
University of Mauritius
Reshma Gaya, Ministry of Health and Quality of Life
J Sonoo, Ministry of Health and Quality of Life
Introduction:
Transfusion of blood and its products is a vital therapeutic procedure. Blood transfusions
are of two types: homologous/allogeneic transfusions involving stored blood of donors or
autologous transfusions involving the patient’s own blood. Blood products such as platelets
and fresh frozen plasma may also be transfused. Blood safety involves blood donor
selection, screening for infectious diseases (HIV 1 and 2, Hepatitis B and C, Syphilis) and
grouping of blood. Donor blood is also processed after collection. Compatibility testing is
done before a blood transfusion to ensure that the recipient’s serum is compatible with
antigens on donor red blood cells. Blood is administered intravenously after personal
details are carefully checked so that the correct patient receives the correct transfusion to
minimize clerical errors. One unit of blood (500ml) is usually transfused over 3-4 hours. In
Mauritius, the National Blood Transfusion Service which caters for blood and blood
components reported that nearly 33 000 units of blood components were transfused in the
island in 2003. However patients may still be at risk of adverse effects despite blood safety
measures. These include acute and delayed hemolytic transfusion reactions, febrile nonhemolytic transfusion reactions, transfusion related acute lung injury (TRALI), major and
minor allergic reactions, transfusion associated circulatory overload, hypothermia,
hypotension and transfusion-related transmitted infections. Our aim was to investigate the
prevalence of transfusion-related complications in patients receiving blood or its products
in a regional hospital in Mauritius.
Methodology:
Ethics clearance was received from the Ministry of Health and Quality of Life. Permission
was given by the authorities at the Jawaharlal Nehru hospital for data collection. All
patients receiving transfusion of blood or its products perioperatively and postoperatively
in that hospital over January and February 2005 were invited to participate in the study.
For those who consented, data was collected through questionnaires by direct interviews of
subjects and supplemented by consulting their case sheets. Data was analyzed using SPSS
for Windows statistical package
Results:
117 patients participated in the study over a two month period. 122 units of blood or blood
products were transfused comprising red blood cell concentrate (78%), whole blood
(13%), fresh frozen plasma (7%) and platelets (2%). 64 (55%) out of 117 patients had a
complication associated with transfusion. In this group, 41 (35% of all participants) had a
mild reaction including constitutional symptoms (headaches, chills, hot flushes)
attributable to hemotherapy. Of those 23 (20% of all participants) experiencing a
moderate to severe reaction, 1 had an acute hemolytic transfusion reaction, 5 had a febrile
non-hemolytic transfusion reaction, 11 had allergic type reactions, 4 were mild
anaphylactic cases and there were 2 cases of hypothermia.
Discussion and conclusion:
Acute hemolytic transfusion reactions occur mostly as a result of human error and are
largely avoidable. In our study the prevalence of this serious reaction was 0.85%; it has
been noted in other studies that febrile non-hemolytic transfusion reactions occur in 1% of
red cell transfusions and in18-23% of cases of platelet transfusions. In our study, this
reaction occurred in 4.3% of the sample. It was significant that there were no other
serious life-threatening complications such as bacterial contamination, coagulopathy, heart
failure or TRALI. Thus we can conclude from our study that although 35% of patients had a
mild complication and 20% had a moderate to severe complication, life-threatening
complications were rare demonstrating that transfusion of blood or its products in a
hospital setting in Mauritius is relatively safe.