Blood transfusion is an essential part of modern health care which can save lives and improve health   (1 ).Transfusion of blood and blood  components is always associated with a potential risk.Transfusion reaction means any transfusion related adverse event that occurs during or after the transfusion of whole blood, blood components, or human derived plasma products. Transfusion reactions are classified according to the time interval between transfusion and presentation of adverse effects. A transfusion reaction with signs and symptoms presenting during or within 24 hours of transfusion is defined as an acute transfusion reaction. A transfusion reaction with signs and symptoms presenting after 24 hours of transfusion is defined as delayed transfusion reaction.The incidence of adverse events due to human errors, ABO incompatibility, alloimmunization, bacterial contamination and immunomodulation phenomena remain a matter of concern (2).An informed decision about transfusion has to be taken based on the risk -benefit ratio associated with blood transfusion for a particular patient ( 3).

Knowledge about various types of adverse transfusion reactions will help not only in their early identification and management but also in taking adequate measures to prevent the same. In addition ,it will also help the blood

transfusion consultant to create awareness amongst their clinical counterpart about safe transfusion practices so that proper reporting can be achieved to provide better patient care(4,5).Hence the present study was done with the primary objective to determine the frequency and types of adverse transfusion reactions occurring in hospitalized patients who required blood product transfusion at a tertiary care hospital in South India.

The present study was conducted in the Department of Transfusion medicine, Government General Hospital and Medical College, Kadapa Andhra Pradesh, India.This was a hospital based descriptive study which was conducted over a period of one year i.e., from January 2023 to December 2023.The study was approved by the the Institutional Ethics Committee, Government Medical College, Kadapa. Inclusion Criteria: 1. Blood transfusions in patient admitted in Government General Hospital and Medical College, Kadapa, Transfusion reactions reported/noticed within 24hours of blood transfusion. Exclusion Criteria: 1. Patients taking antihistaminic or/ and steroid medication. 2. Adverse transfusion reactions beyond 24hours of blood transfusion. 3. Blood transfusions outside Government General Hospital and Medical College, Kadapa. Data will be analysed using suitable statistical d 0;p’0ov[ software. METHODOLOGY: Patients were monitored at ward from the start of each transfusion till the end. As per the SOP for blood issue, every unit of blood component was issued along with a transfusion reaction/evaluation form to record the details of transfusion including patient details, component details, date and time of transfusion, vital parameters, and record of transfusion reaction if any. If the transfusion procedure was uneventful, the transfusion form had to be completely filled providing the date and time of starting and completion of the transfusion, patient’s pre and post -transfusion vital signs, and returned to the blood bank with the empty blood bag. This helped us to trace the fate of every blood unit. To the extent possible, efforts have been made to monitor the recipient personally. Instructions were given to the healthcare personnel to monitor for any signs of reaction and to report to the blood bank. In case of ATR, the form had to be completely filled with details of reaction (time of onset of reaction) and sent to blood bank along with the left-over blood product bag with the attached transfusion set and patient postreaction blood samples – ethylenediaminetetraacetic acid (EDTA) and plain vacutainer. These cases were worked up by the transfusion medicine physician according to the standard protocol. As part of the routine transfusion reaction evaluation the patients blood sample and blood components were checked for clerical errors. Relevant clinical history regarding indications of blood transfusion, history of any previous similar episodes of adverse events, any previous history of transfusions and in the case of female patients, history of pregnancy were collected. Donor unit was checked for any abnormal mass or clot, any peculiar odour coming from the blood bag to rule out any abnormal delay in transfusion and improper storage after release of the unit from the blood bank, any leakage / breakage, number of ports broken from the blood bag and the condition of transfusion set filter was observed. The serum or plasma in a post-reaction blood sample was inspected for any evidence of hemolysis and compared with a pre-reaction sample. Urine examination was carried out for every case of transfusion reaction. The tests performed after the occurrence of transfusion reaction were patient’s ABO and Rh group on pre- and post-reaction samples, donor’s ABO and Rh group, patient and donor re-crossmatching on pre- and post-reaction samples (minor and major cross matching), direct antiglobulin test on patient’s pre- and post-reaction samples.. Blood bag transfusion set and the patient’s blood samples were sent for culture. Recipient blood sample was analysed for post transfusion complete blood counts, peripheral blood smears for schistocytes and spherocytes, reticulocyte count, serum bilirubin, plasma haemoglobin, liver function tests (LFT), renal function tests (RFT) and lactate dehydrogenase (LDH) levels. Fresh urine sample was collected to test for the presence of haemoglobinuria and urobilinogen and blood samples from the bag and the recipient were subjected for bacterial culture If there is suspicion of TRALI, X-ray Chest AP view was requested. Based on the clinical features experienced by the recipient and laboratory parameters, these reactions were classified by standards and recognized definitions defined by American Association of Blood Banks( 6).

During 1 year study period, a total of 7498 blood and blood components were issued to various clinical departments in Government General Hospital and Medical College, Kadapa, (Table-1).

TABLE1 : TYPE OF BLOOD PRODUCT ISSUED DURING 1 YEAR STUDY PERIOD

TABLE 2 : DISTRIBUTION OF DIFFERENT TYPES OF TRANSFUSION REACTION

The total number of transfusion reactions occurred were 48.The incidence of febrile non hemolytic transfusion reactions (FNHTR) were the maximum 30 (62.5%) followed by allergic 16 (33.3%) and anaphylactic reactions 2(6.2%)  (Table-2).

TABLE 3 : AGE WISE DISTRIBUTION OF TRANSFUSION REACTIONS

Maximum reactions 19 (39.6%) occurred in the age group of 21-40 years (Table-3)

TABLE4  :SEX DISTRIBUTION OF TRANSFUSION REACTIONS

Out of 48 reactions, 15 (31.2%) were seen in males and 33(68.8%) in females (Table-4).

.TABLE 5 : ABO BLOOD GROUP DISTRIBUTION AMONG THE PATIENTS HAVING TRANSFUSION REACTION

Maximum number of transfusion reactions were seen with Blood Group `B’ 21(43.8%), followed by O, A, AB respectively (Table-5)

TABLE 6:TRANSFUSION REACTIONS IN VARIOUS CLINICAL DEPARTMENTS

Maximum reactions 14 (29.1) were from the Department of Gynecology & Obstetrics (Table-6)

TABLE 7: DISTRIBUTION OF TRANSFUSION REACTIONS ASSOCIATED WITH DIFFERENT TYPES OF BLOOD COMPONENTS

Whole Blood (WB), Packed Red Blood Cells (PRBC), Platelet Concentrate (PC), Platelet Rich Plasma (PRP), Fresh Frozen Plasma (FFP) were issued from our center. (Table-7).Most common component involved in transfusion reaction was PRBC 21 (43.7%).

TABLE 8:DISTRIBUTION OF TRANSFUSION REACTION ACCORDING TO 1^ST TIME OR REPEAT TRANSFUSIONS

Out of 48 transfusion reactions, 36 (75%) reactions were associated with history of multiple or repeat transfusions, remaining 12 (25%) reactions were with 1^st time transfusion (Table-8).

The present study was conducted with the primary objective to know the most common type of blood and blood components implicated in transfusion reaction. In our study period a total of 7498 units of blood and components were issued and transfused. Out of these 48 (0.20%) recipients had adverse transfusion reactions.

In our study, the frequency of transfusion reactions was found to be 0.20%. In a similar study done by Bhattacharya et al.(1) the prevalence of transfusion reactions was found to be 0.18%, where as T Ramanathan et al.(7) and Kumar et al.(8) found a rate of 0.21% and 0.05%, respectively,

In our study FNHTR(62.5%) is the most common type of transfusion reaction followed by allergic(33.3%) and anaphylactic (6.2%) transfusion reactions.This is in concordance with the study done by Ramanathan etal(7) and Sangeetha Pahuja etal(9) where FNHTR is the most common type of transfusion reaction followed by allergic reaction.In contrast, Chavan SK et al., (10)reported that allergic (55.6%) is common than FNHTR (33.3%) [3]. Kumar P et al., also reported allergic reaction (55.1%) as commonest followed by FNHTR (35.7%) [9].

In our study majority of the reactions were seen in the age group of 21 to 40 years.A study done by Ramanathan etal (7) found that transfusion reactions were commonly seen in the age group of  30 -40 years .Chakravarty-Vartak et al in their study  noticed that  transfusion reactions were  most common in the  age group of pediatric and young adults. Maximum number (28%) was in the age  group of 11-20 years, and almost half of them were thalassemia patients who had a history of repeated transfusions. The second most common group was 21-30 years [11].

 In our present study, adverse transfusion reactions were more commonly seen in females 33 (68.8%) as compared to males 15 (31.2%) which is similar to the study by Sidhu et al (12). and Kanti  Sinha etal (13).However, Kumar et al. in their study found males to be more affected than females (8).

In our study highest number of Transfusion reactions were found in blood group B (43.8%) followed by blood group O(25%).  However, in kanthi Sinha et al study the highest number of ATR were found in blood group A followed by B.(13).

 In our study majority of the transfusion reactions were occurred in obstetric and gynaecology department(29%).As majority of the blood units were issued to obstetric and gynaecology department,the transfusion reactions are most commonly noticed in this department.

                       In our study , 43.7% of TR occurred with PRBC transfusion, 16.70% with

  whole blood ,12.5% with leuco filtered RBC,14.6% with platelets, and 12.5% with FFP transfusions.A study done by Ramanathan etal (7) found out  that  80% of TR occurred with PRBC transfusion, 11.80% with FFP, 6.40% with PC and 1.80% with PRP transfusions. Chavan SK et al., reported  57.77% TR with WB and 42.22% with PRBC in their study. No TR was reported with PRP and FFP transfusions [10].

In our study among all transfusion  reactions 75% were associated with history of previous transfusion, remaining 25% were associated with first time transfusion.This is because repeated exposure to foreign blood components sensitizes the immune system ,making it much more reactive to subsequent transfusions.

Adverse transfusion reactions following blood/components transfusion is a common complication, which should be kept in mind and transfusion should be given only if necessary. The frequency of transfusion reactions in our present study was 0.20%. Majority of the reactions were FNHTR (62.5% followed by allergic reactions (33.3%).Proper monitoring and knowledge of the signs and symptoms of the ATRs help in the early identification of these reactions and hence timely management and reporting. It is the joint responsibility of the blood transfusion consultant and their clinical counterpart to create awareness about safe transfusion services so that proper hemovigilance system can be achieved to provide patient care. This study is an effort toward this direction.

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