title: Incidence of transfusion reactions: a multicenter study utilizing systematic active surveillance and expert adjudication.
abstract: BACKGROUND
  Prevalence estimates of the serious hazards of transfusion vary widely. We hypothesized that the current reporting infrastructure in the United States fails to capture many transfusion reactions and undertook a multicenter study using active surveillance, data review, and adjudication to test this hypothesis.
  
  
  METHODS
  A retrospective record review was completed for a random sample of 17% of all inpatient transfusion episodes over 6 months at four academic tertiary care hospitals, with an episode defined as all blood products released to a patient in 6 hours. Data were recorded by trained clinical research nurses, and serious reactions were adjudicated by a panel of transfusion medicine experts.
  
  
  RESULTS
  Of 4857 transfusion episodes investigated, 1.1% were associated with a serious reaction. Transfusion-associated circulatory overload was the most frequent serious reaction noted, being identified in 1% of transfusion episodes. Despite clinical notes describing a potential transfusion association in 59% of these cases, only 5.1% were reported to the transfusion service. Suspected transfusion-related acute lung injury/possible transfusion-related acute lung injury, anaphylactic, and hypotensive reactions were noted in 0.08, 0.02, and 0.02% of transfusion episodes, respectively. Minor reactions, including febrile nonhemolytic and allergic, were noted in 0.62 and 0.29% of transfusion episodes, respectively, with 30 and 50% reported to the transfusion service.
  
  
  CONCLUSIONS
  Underreporting of cardiopulmonary transfusion reactions is striking among academic, tertiary care hospitals. Complete and accurate reporting is essential to identify, define, establish pathogenesis, and mitigate/treat transfusion reactions. A better understanding of the failure to report may improve the accuracy of passive reporting systems.
authors.affiliation: Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT. jeanne.hendrickson@yale.edu.|Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut. jeanne.hendrickson@yale.edu.
authors.forename: Jeanne E
authors.initials: JE
authors.lastname: Hendrickson
authors.affiliation: Department of Laboratory Medicine, University of California, San Francisco, CA.|Blood Systems Research Institute, San Francisco, California.
authors.forename: Nareg H
authors.initials: NH
authors.lastname: Roubinian
authors.affiliation: RTI International, Rockville, Maryland.
authors.forename: Dhuly
authors.initials: D
authors.lastname: Chowdhury
authors.affiliation: RTI International, Rockville, Maryland.
authors.forename: Don
authors.initials: D
authors.lastname: Brambilla
authors.affiliation: Department of Laboratory Medicine, University of California, San Francisco, CA.|Blood Systems Research Institute, San Francisco, California.
authors.forename: Edward L
authors.initials: EL
authors.lastname: Murphy
authors.affiliation: Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT.|Bloodworks Northwest, Seattle, Washington.
authors.forename: Yanyun
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Division of Transfusion Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Ness
authors.affiliation: Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Gehrie
authors.affiliation: Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT.
authors.forename: Edward L
authors.initials: EL
authors.lastname: Snyder
authors.affiliation: Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT.
authors.forename: R
authors.initials: R
authors.lastname: George Hauser
authors.affiliation: Blood Center of Wisconsin, Milwaukee, WI.|Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Jerome L
authors.initials: JL
authors.lastname: Gottschall
authors.affiliation: Center for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Steve
authors.initials: S
authors.lastname: Kleinman
authors.affiliation: Retired, Clarksburg, Maryland.
authors.forename: Ram
authors.initials: R
authors.lastname: Kakaiya
authors.affiliation: The Institute for Transfusion Medicine, Pittsburgh, Pennsylvania.
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Strauss
mesh_terms: D058731:Blood Safety / Q000379:methods; D006801:Humans; D015994:Incidence; D012189:Retrospective Studies; D012308:Risk Management / Q000706:statistics & numerical data*; D062606:Tertiary Care Centers; D064826:Transfusion Medicine / Q000379:methods; D065227:Transfusion Reaction / Q000453:epidemiology*