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Trends in the incidence of delayed hemolytic and delayed serologic transfusion reactions
A A Pineda1, E C Vamvakas, L D Gorden
1Department of Laboratory Medicine and Pathology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA. Pineda.Alvaro@Mayo.edu
Background:
An increasing incidence of delayed hemolytic and delayed serologic transfusion reactions (DHTRs/DSTRs) has been seen at the Mayo Clinic since 1978. Recently, the average length of stay (LOS) for inpatients and the average number of red cell transfusions per inpatient (TPI) decreased, and the albumin and papain technique for RBC antibody detection was replaced by a polyethylene glycol technique. These changes may have affected the incidence of DHTRs/DSTRs.
Study Design And Methods:
The diagnoses of DHTR and DSTR made at the Mayo Clinic from 1993 through 1998 were reviewed. These data were compared with previously published Mayo Clinic data from 1980 through 1992. The LOS for inpatients and the average TPI were also obtained from hospital data.
Results:
The incidence of DHTR/DSTR increased from 1 in 1899 in 1980 through 1992 to 1 in 1300 in the 1993 through 1998 period (p < 0.05). Similarly, DSTR increased from 1 in 2990 in 1980 through 1992 to 1 in 1612 in the 1993 through 1998 period (p < 0.05). The incidence of DHTR showed a trend toward decrease, from 1 in 5405 in 1980 through 1992 to 1 in 6715 in 1993 through 1998. No alloantibody specificities were statistically associated with DHTRs in 1993 through 1998, unlike in the 1980 through 1992 period. Moreover, the incidence of Jka antibodies increased in 1993 through 1998, while the incidence of other alloantibodies remained stable. Average LOS and TPI declined by 24.5 percent and 8.8 percent, respectively, between the two periods.
Conclusion:
Recently, a trend toward a decrease in the incidence of DHTR and a significant increase in DSTRs has occurred at the Mayo Clinic. These changes are most likely due to a combination of factors, including a decrease in average LOS and the adoption of the polyethylene glycol antibody detection system.
Insights
The incidence of delayed serologic transfusion reactions (DSTRs) significantly increased, while delayed hemolytic transfusion reactions (DHTRs) showed a decreasing trend. These shifts are linked to reduced hospital stays and new antibody detection methods.
Area of Science:
- Transfusion Medicine
- Immunology
- Clinical Pathology
Background:
- An increasing incidence of delayed hemolytic and delayed serologic transfusion reactions (DHTRs/DSTRs) was observed at Mayo Clinic.
- Recent changes included decreased inpatient length of stay (LOS) and red cell transfusions per inpatient (TPI).
- A shift occurred in red blood cell (RBC) antibody detection techniques, from albumin and papain to polyethylene glycol (PEG).
Purpose of the Study:
- To compare the incidence of DHTRs and DSTRs at Mayo Clinic between 1993-1998 and 1980-1992.
- To evaluate the impact of changes in LOS, TPI, and antibody detection methods on transfusion reaction rates.
Main Methods:
- Retrospective review of DHTR and DSTR diagnoses from 1993-1998.
- Comparison with previously published data from 1980-1992.
- Analysis of hospital data for average LOS and TPI.
Main Results:
- DHTR/DSTR incidence rose from 1:1899 (1980-1992) to 1:1300 (1993-1998).
- DSTR incidence increased significantly from 1:2990 to 1:1612.
- DHTR incidence trended towards a decrease (1:5405 to 1:6715), with no specific alloantibodies statistically associated.
- Jka antibody incidence rose, while other alloantibodies remained stable; average LOS and TPI decreased.
Conclusions:
- A trend toward decreased DHTR incidence and a significant increase in DSTRs occurred at Mayo Clinic.
- These changes are likely multifactorial, involving reduced LOS and the adoption of the PEG antibody detection system.
- The findings highlight evolving patterns in transfusion reaction epidemiology.