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Transfusion-associated dyspnea--shadow or substance?

K G Badami1, E Joliffe2, M Stephens2

  • 1New Zealand Blood Service, Christchurch, New Zealand.

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Transfusion reactions categorized as transfusion-associated dyspnoea (TAD) may often be transfusion-associated circulatory overload. Refining diagnostic criteria and improving reporting can reduce misclassification of these significant respiratory events.

Keywords:
dyspnoeaheart failuretransfusion

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Area of Science:

  • Transfusion Medicine
  • Haemovigilance
  • Patient Safety

Background:

  • The New Zealand Blood Service Haemovigilance program categorizes transfusion reactions (TR) using International Society of Blood Transfusion/International Haemovigilance Network definitions.
  • Transfusion-associated dyspnoea (TAD) is a classification for TR with respiratory features (TRRF) lacking definitive diagnoses.
  • TRRF, including TAD, are recognized as clinically significant events.

Purpose of the Study:

  • To review transfusion reactions classified as TAD.
  • To identify potential misclassifications within the TAD category.
  • To suggest improvements for accurate TR classification.

Main Methods:

  • Retrospective review of transfusion reactions classified as TAD.
  • Analysis of clinical information provided in TR reports.
  • Comparison with established definitions for transfusion reactions.

Main Results:

  • A significant proportion of reactions classified as TAD were potentially misclassified.
  • Transfusion-associated circulatory overload (TACO) was identified as a common alternative diagnosis for these cases.
  • Current reporting and diagnostic criteria may lead to misclassification of TRRF.

Conclusions:

  • Many cases categorized as TAD may actually be instances of TACO.
  • Enhanced information in TR reports and refined diagnostic criteria are necessary to minimize misclassification of TRRF.
  • TAD might encompass mild, atypical, overlapping, or currently unexplained conditions, necessitating further investigation.