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Best practices in the differential diagnosis and reporting of acute transfusion reactions

Authors Hillis C, Shih A, Heddle N

Received 19 March 2015

Accepted for publication 26 June 2015

Published 21 January 2016 Volume 2016:4 Pages 1—14

DOI https://doi.org/10.2147/IJCTM.S60920

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 6

Editor who approved publication: Prof. Dr. Cees Th. Smit Sibinga


Christopher M Hillis,1–3,* Andrew W Shih,1,3,* Nancy M Heddle1,3,4

1Department of Medicine, 2Department of Oncology, 3McMaster Transfusion Research Program, McMaster University, Hamilton, 4Centre for Innovation, Canadian Blood Services, Ottawa, ON, Canada
  
*These authors contributed equally to this work

Abstract: An acute transfusion reaction (ATR) is any reaction to blood, blood components, or plasma derivatives that occurs within 24 hours of a transfusion. The frequencies of ATRs and the associated symptoms, reported by the sentinel sites of the Ontario Transfusion Transmitted Injuries Surveillance System from 2008 to 2012, illustrate an overlap in presenting symptoms. Despite this complexity, the differential diagnosis of an ATR can be determined by considering predominant signs or symptoms, such as fever, dyspnea, rash, and/or hypotension, as these signs and symptoms guide further investigations and management. Reporting of ATRs locally and to hemovigilance systems enhances the safety of the blood supply. Challenges to the development of an international transfusion reaction reporting system are discussed, including the issue of jurisdiction and issues of standardization for definitions, investigations, and reporting requirements. This review discusses a symptom-guided approach to the differential diagnosis of ATRs, the evolution of hemovigilance systems, an overview of the current Canadian system, and proposes a best practice model for hemovigilance based on a World Health Organization patient safety framework.

Keywords: blood transfusion, blood components, hemovigilance

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