BOF: Transfusion (Haematovigilence)

The Serious Hazards of Transfusion (SHOT) UK confidential haemovigilance reporting scheme is the largest of its kind in the world and has become an international source of data for improving safety in transfusion practice. In which ONE of the following clinical scenarios, should a report to SHOT be made?

a) A patient undergoes a platelet transfusion. A temperature rise of 36.9°C to 37.5°C is made and the patient complains of nausea during the transfusion.

b) A patient undergoes a red cell transfusion. Baseline BP is 135/80. Thirty minutes following completion, BP is recorded as 115/70.

c) A patient undergoes a red cell transfusion. BP rises from 126/80 at baseline to 170/ 95 following transfusion.

d) A patient undergoing a red cell transfusion has a recorded temperature rise from 37.4°C pre transfusion to 38.1°C 45 minutes into the transfusion

e) A patient undergoing a red cell transfusion is noted to have a pruritic skin rash with associated angio-oedema following transfusion but is otherwise systemically well with no change in observations

Answer:

e) A patient undergoing a red cell transfusion is noted to have a pruritic skin rash with associated angio-oedema following transfusion but is otherwise systemically well with no change in observations

Explanation:

Until 2015 SHOT recommended that the following features of acute transfusion reactions (ATRs) should be reported, falling into the categories of febrile, allergic, mixed febrile and allergic and hypotensive:

FEBRILE TYPE: Isolated febrile rise in temperature >1°C

ALLERGIC TYPE: Minor allergic skin +/- rash

However, this was revised to recommend only reactions graded moderate or severe should be reported, hence:

FEBRILE TYPE: Isolated febrile rise in temperature >2°C or to >39°C

ALLERGIC TYPE: Anaphylactic hypotension with one or more of: urticaria, rash, dyspnoea, angioedema, stridor, wheeze, pruritus, within 24 hrs of transfusion,

Severe allergic reaction with risk to life occurring within 24 hours of transfusion, characterised by bronchospasm causing hypoxia, or angioedema causing respiratory distress

HYPOTENSIVE: A drop in systolic and/or diastolic pressure of >30mm Hg occurring within one hour of completing transfusion, provided all other adverse reactions have been excluded together with underlying conditions that could explain hypotension.

Reference:

HB Bolton-Maggs (Ed) D Poles et al. on behalf of the Serious Hazards of Transfusion (SHOT) Steering Group. The 2015 Annual SHOT Report (2016).