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Frequency and timing of all‐cause deaths in visits involving suspected transfusion reactions, and the significance of cardiopulmonary disturbances
Author(s) -
McVey Mark J.,
Cohen Robert,
Arsenault Valerie,
Escorcia Alioska,
Tasmin Farzana,
Pendergrast Jacob,
Lieberman Lani,
Lin Yulia,
Callum Jeannie,
CsertiGazdewich Christine
Publication year - 2021
Publication title -
vox sanguinis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.68
H-Index - 83
eISSN - 1423-0410
pISSN - 0042-9007
DOI - 10.1111/vox.13086
Subject(s) - medicine , interquartile range , pediatrics , emergency medicine , intensive care medicine
Background/objectives Transfusion reactions (TRs) may cause or contribute to death. Cardiopulmonary TRs are distressing, and collectively account for most transfusion fatalities, though the degree to which they alter survival more broadly is unclear. Deaths (and their timing) after TRs may provide further insights. Materials/Methods Adult (tri‐hospital network) haemovigilance data (2013–2016) recorded referrals with conclusions ranging from unrelated to transfusion (UTR) to entities such as: septic TRs, serologic/haemolytic reactions, transfusion‐associated circulatory overload (TACO), transfusion‐associated dyspnoea (TAD), transfusion‐related acute lung injury (TRALI), allergic transfusion reaction (ATR), and others. For (in‐ or out‐patient) visits involving suspected TRs (VISTRs), all‐cause mortalities (% [95% confidence interval]) and associated time‐to‐death (TTD) (median days, [interquartile range]) were compared. Diagnoses were defined inclusively (possible‐to‐definite) or strictly (probable‐to‐definite). Results Of 1144 events, rank order VISTR mortality following (possible‐to‐definite) TRs, and associated TTDs, were led by: DHTR 33% [6–19], 1 death at 123d; TRALI 32% [15–54], 6 deaths: 3d [2–20]; BaCon 21% [14–31], 17 deaths: 10d [3–28]; TACO 18% [12–26], 23 deaths: 16d [6–28]; TAD 17% [11–26]: 18 deaths, 6d [3–12]. Higher‐certainty TRs ranked similarly (DHTR 50% [9–91]; BaCon 29% [12–55], 4 deaths: 12d [3–22]; and TACO 25% [16–38], 15 deaths: 21d [6–28]). VISTR mortality after TACO or TRALI significantly exceeded ATR (3·3% [2·4–5·8], P < 0·00001) but was not different from UTR events ( P = 0·3). Conclusions Only half of cardiopulmonary TRs constituted high certainty diagnoses. Nevertheless, cardiopulmonary TRs and suspected BaCon marked higher VISTR mortality with shorter TTDs. Short (<1 week) TTDs in TAD, BaCon or TRALI imply either contributing roles in death, treatment refractoriness and/or applicable TR susceptibilities in the dying.