Acute transfusion reactions: an update

摘要

Over the last decade the use of blood products by the United Kingdom (UK) military has increased significantly; with the increase in transfusion comes an increased incidence of transfusion-related incidents. Acute transfusion reactions (ATRs) are a common consequence of transfusion, which vary widely in their severity and are likely to be under-reported, although reporting is a regulatory requirement. This paper discusses the importance of identifying ATRs and managing them appropriately. It introduces a flowchart (due to be incorporated in the next version of Joint Service Publication (JSP) 999, Clinical Guidelines for Operations (CGOs)), which is designed to assist the military multi-disciplinary team caring for patients in the operational environment. Introduction Over the last decade in Iraq and Afghanistan there have been significant improvements in trauma resuscitation, resulting in improved casualty survival rates. An element of these improvements has been transfusion, with the introduction of: high plasma to packed cell ratios (1:1) supplemented by platelets and cryoprecipitate; guided component use with rotational thromboelastometry (ROTEM); and pre-hospital fluid resuscitation with blood components (1). These changes, along with the number and severity of casualties, have resulted in a dramatic increase in the volume of blood components used by the UK military on operations (2). During 2012, at the peak of hostilities, there were 11,448 units of blood components transfused in Afghanistan (3). As the use of blood components increases so does the incidence of transfusion-associated adverse events, including ATRs. ATRs are common and vary widely in their severity (4). The most commonly reported ATRs are non-haemolytic febrile and allergic reactions, which carry minimal morbidity, and have an incidence of 0.5-3%.