Underreporting of minor transfusion reactions in cancer patients

Minor adverse reactions following transfusion of blood components to cancer patients are not uncommon. Reporting these minor reactions to the transfusion service needs a careful evaluation. The objectives of this study were to closely monitor the transfusion reactions that occurred and had not been reported to the transfusion service and to evaluate the process by which the medical and nursing staff recognized and managed these reactions.

We prepared a questionnaire with the nursing staff of a selected inpatient unit that addressed important questions, such as signs and symptoms during the transfusion, premedications given, process for physician notification, recommended action, and blood component implicated. Charts of the patients were reviewed, and the process was monitored for a 6-month period.

A total of 58 cases were completed and analyzed. Platelet concentrates were transfused in 43 cases (74.1%), packed red blood cells in 9 cases (15.6%), and fresh frozen plasma in 6 cases (10.3%). Minor adverse reactions that were documented included chills in 11 cases (19.0%), low-grade fever in 11 cases (19.0%), hives and itching in 24 cases (41.4%), nausea and vomiting in 1 case (1.7%), and headaches and nonspecific mild pains in 11 cases (19.0%). Transfusions had been resumed in 27 cases (46.6%) and stopped completely in 13 cases (22.4%). Twenty-seven of 58 (46.6%) were first-time events.

We conclude that underreporting of minor transfusion reactions, such as a febrile nonhemolytic transfusion reaction and allergic reactions, exists. To ensure safety to our cancer patients who are transfusion-dependent, we suggest that careful evaluation of any suspected transfusion reaction event should be referred to the transfusion medicine physicians who will evaluate each case and discuss it with the attending physician. This process will prevent detrimental, acute transfusion reactions.