Transfusion-related mortality: the ongoing risks of allogeneic blood transfusion and the available strategies for their prevention.
As the risks of allogeneic blood transfusion (ABT)-transmitted viruses were reduced to exceedingly low levels in the US, transfusion-related acute lung injury (TRALI), hemolytic transfusion reactions (HTRs), and transfusion-associated sepsis (TAS) emerged as the leading causes of ABT-related deaths. Since 2004, preventive measures for TRALI and TAS have been implemented, but their implementation remains incomplete. Infectious causes of ABT-related deaths currently account for less than 15% of all transfusion-related mortality, but the possibility remains that a new transfusion-transmitted agent causing a fatal infectious disease may emerge in the future. Aside from these established complications of ABT, randomized controlled trials comparing recipients of non-white blood cell (WBC)-reduced versus WBC-reduced blood components in cardiac surgery have documented increased mortality in association with the use of non-WBC-reduced ABT. ABT-related mortality can thus be further reduced by universally applying the policies of avoiding prospective donors alloimmunized to WBC antigens from donating plasma products, adopting strategies to prevent HTRs, WBC-reducing components transfused to patients undergoing cardiac surgery, reducing exposure to allogeneic donors through conservative transfusion guidelines and avoidance of product pooling, and implementing pathogen-reduction technologies to address the residual risk of TAS as well as the potential risk of the next transfusion-transmitted agent to emerge in the foreseeable future.
Vamvakas
Eleftherios C
EC
Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Blajchman
Morris A
MA
D001787:Blood Group Incompatibility / Q000097:blood / Q000401:mortality* / Q000517:prevention & control; D001803:Blood Transfusion / Q000401:mortality*; D006801:Humans; D017053:Infection Control; D007239:Infections / Q000097:blood / Q000401:mortality*; D008171:Lung Diseases / Q000097:blood / Q000401:mortality* / Q000517:prevention & control; D012307:Risk Factors; D065227:Transfusion Reaction