THE PATTERN OF NON-INFECTIOUS ACUTE AND DELAYED BLOOD TRANSFUSION REACTIONS IN OBAFEMI AWOLOWO UNIVERSITY TEACHING HOSPITALS COMPLEX, ILE-IFE

Abstract

The aim of this study was to evaluate non-infectious blood transfusion
reactions occurring among individuals receiving health care at Obafemi
Awolowo University Teaching Hospitals complex Ile-ife, with a view to
determining the incidence of the various reactions and factors that may
influence them.
Over a period of 19 months, 258 blood transfusion recipients, who had
not been transfused within two weeks prior to the admission, participated in
the study. A questionnaire was prepared and tested in a pilot study of 10
patients for validity, and administered on recipients. Appropriate laboratory
tests were carried out where indicated. Data was collated and analyzed using
descriptive and inferential statistics. A p value <0.05 was significant.
The results showed that 462 transfusions of blood and blood products
were observed in 258 individuals who consisted of adults (60.9%) and
children (39.1%). There were significantly more female adults than males
(p=0.031) and more male children than female (p<0.05). The overall M:F ratio
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was however 1.1:1. The mean (SD) age for adults was 40.38yrs 16.8, and
6.77yrs 2.46 for children. The commonest indication for transfusion of
blood and blood products was moderate/severe anaemia (70.9%), surgical
indications accounted for 16.7%, while others such as chemotherapy,
haemodialysis and exchange transfusions accounted for 12.4% of all
transfusions. Red cell transfusions comprised 71.8% of all blood components
transfused and was mostly required by children (38.2%), followed by adults
in medical wards (28.3%), Obstetrics and Gynaecology (19.3%) and surgical
patients (14.2%).
The overall incidence of adverse transfusion reactions was 8.7%. There
was no significant difference in the incidence of BTR between adults and
children. Individuals with previous history of transfusions had a significantly
higher risk of an adverse event (p<0.05). Adult female recipients had an
insignificant higher incidence of adverse transfusion event than males (15%
to 11%). Incidence of BTR among SCA patients was lower than expected.
Febrile non-haemolytic transfusion reaction constituted the highest burden
occurring in 82.5% of those with adverse reactions. It was however sub
clinical in 23% of such reactions and would have gone unnoticed. 3.9% of all
transfusions were discontinued (n=18). Of the transfusions discontinued,
FNHTR constituted 66.7% but following intervention, only 2.2% of all
transfusions were terminated (n=9). Immediate haemolytic transfusion
reaction was not seen but delayed haemolytic transfusion reaction was
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observed in two patients (0.4%) and constituted 5% of transfusion reactions.
The offending antigen in one patient could however not be determined.
In conclusion, adverse transfusion reactions were not uncommon in the
population studied and occurred in both adults and children alike. FNHTR
was the commonest transfusion reaction observed, and was underreported
having presented sub-clinically in some recipients. Ultimately with
intervention, only half of cases of transfusion that were stopped due to
transfusion reactions were terminated.