Acute transfusion reactions in sub-Saharan Africa: A systematic review and meta-analysis

Sub-Saharan Africa (SSA) faces significant challenges in implementing effective haemovigilance systems, thereby increasing the risk of adverse events following transfusion. This systematic review and meta-analysis assessed the frequency, clinical patterns and determinants of acute transfusion reactions (ATRs) in the region, in order to inform evidence-based prevention strategies.

The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the studies were a priori stratified by design. Pooled proportions were calculated using a random-effects meta-analysis.

Twenty-six studies conducted in 13 countries and published up to 30 November 2024 were included; 15 were retrospective and 11 were prospective. When calculated per patient, the pooled ATR rate was 64 per 1000 patients in retrospective studies and 112 per 1000 patients in prospective studies. When estimated per unit transfused, the corresponding rates were 23 per 1000 units and 136 per 1000 units, respectively. The most frequently reported manifestations were consistent with febrile non-haemolytic reactions (41.8%) and allergic reactions (24.9%). Potentially life-threatening reactions occurred in 14%, and 0.94% resulted in death. Whole blood transfusion, multiple transfused units and previous transfusion exposure were identified as factors associated with ATR occurrence.

ATRs are common in SSA and are strongly associated with the use of whole blood. The broader implementation of blood component therapy could substantially reduce their burden. Central to ATR prevention in the region are strengthening pre-transfusion evaluation and testing, expanding leukoreduction, establishing robust in-hospital haemovigilance systems and promoting appropriate blood use.