Diagnostic approaches to acute transfusion reactions

Area of Science:

• Transfusion Medicine
• Immunology
• Pathology

Background:

• ABO-incompatible red cell transfusions can lead to severe acute hemolytic transfusion reactions (AHTR), with mortality under 10%.
• Accurate identification of transfusion errors is crucial for patient safety and determining causality.

Purpose of the Study:

• To outline the diagnostic process for erroneous transfusions.
• To differentiate AHTR from other transfusion-related adverse events.

Main Methods:

• Patient identification, blood sample, and blood bag verification.
• Serological and immunohistochemical analyses for confirmation.
• Differential diagnosis including TRALI, FNHTR, allergic reactions, bacterial contamination, TACO, and other rare events.

Main Results:

• Most erroneous transfusions are identified through simple identity checks.
• Serological and immunohistochemical methods confirm transfusion errors.
• In fatalities, a comprehensive evaluation including medical records, serology, microbiology, autopsy, and histology clarifies causality.

Conclusions:

• Rigorous patient and sample identification protocols are paramount in preventing AHTR.
• A systematic diagnostic approach is essential for confirming erroneous transfusions and ruling out other adverse events.
• Multifaceted investigations are necessary to establish causality in fatal transfusion reactions.