From Surveillance to Intervention: Reducing Transfusion Reactions Through Leukodepletion and Platelet Additive Solution in a High-volume Transfusion Service

Abstract

Objective: – Adverse transfusion reactions (ATRs) remain a major concern in transfusion medicine, impacting patient safety and clinical outcomes. Understanding the epidemiology and trends of ATRs is essential for improving transfusion practices and evaluating the impact of policy implementation. This study aimed to provide a comprehensive review of ATRs at a tertiary hospital in Thailand. Three strategies have been implemented in our center to minimize ATRs and enhance transfusion safety: leukodepleted red blood cell product to reduce febrile reaction, 100% use of platelet additive solution (PAS), and the exclusive use of leukodepleted packed red cells in thalassemia patients. Methods: – A retrospective cohort study was conducted using blood bank adverse reaction records over a 10-year period from January 2013 to December 2022. Results: – Among 980, 596 blood transfusions, 1583 ATRs were reported, representing a rate of 1.61 per 1000 blood transfusions. A total of 184 ATR events were observed in thalassemia patients, accounting for 11.62% of all reported ATRs. Leukodepletion significantly reduced febrile nonhemolytic transfusion reactions in the general population (PRC vs. LDPRC: Odds ratio [OR] 1.94; 95% confidence interval [CI]: 1.35-2.78; P<0.001), and in thalassemia patients from 12.76% to 8.35% (95% CI: 0.84%-7.49% P=0.017). Platelets stored in PAS reduced mild allergic reactions (61/111 vs. 44/103; 95% CI: 3.61%-24.99% P=0.013), but not other ATRs. Conclusions: – This study highlights the need for continued monitoring and targeted interventions to reduce ATRs, particularly in high-risk populations.