A revised classification scheme for acute transfusion reactions.
BACKGROUND
Although the standard classification system for acute transfusion reactions adequately describes the general features associated with the various types of reactions, it was not designed to provide strict criteria for diagnosis and classification. Consequently, its use to classify individual reactions can result in significant inter- and intraobserver variability, which can complicate patient management and clinical research.


METHODS
A total of 595 transfusion reactions that occurred at a single institution between January 1, 1996, and December 31, 2003, were reviewed and were initially classified according to the established conventions of the AABB. Each reaction was then reclassified with a revised system that refines and clarifies reaction categories, adds severity grades in the format of the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE), and includes terminology to indicate the attribution or likelihood that the adverse event is related to the transfusion.


RESULTS
Comparison of the two approaches as applied to these 595 transfusion reactions showed clear advantages for the revised system. Of 128 reactions classified by AABB criteria as inconclusive, a mixture of reaction types, or otherwise qualified, all but 5 were accommodated by discrete categories within our revised scheme. In each case with a classifiable reaction, the severity of the reaction could be readily graded.


CONCLUSIONS
The advantages of this revised classification scheme for acute transfusion reactions warrant prospective evaluation and ultimately consideration of its incorporation into clinical practice.
Sanders
Robert P
RP
Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, USA. robert.sanders@stjude.org
Geiger
Terrence L
TL
Heddle
Nancy
N
Pui
Ching-Hon
CH
Howard
Scott C
SC
D000208:Acute Disease / Q000145:classification*; D000707:Anaphylaxis / Q000209:etiology; D005334:Fever / Q000209:etiology; D006801:Humans; D006967:Hypersensitivity; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology; D065227:Transfusion Reaction