TRIP (2008) definitions of transfusion reactions and incidents
Nonhemolytic transfusion reaction (NHTR)
Rise in temperature of ≥ 2 o C (with or without rigors/chills) during or in the first two hours after a transfusion, with no other relevant symptoms or signs; OR rigors/chills with or without a rise in temperature within the same time limits. No evidence (biochemical or blood group serological) for hemolysis, and no alternative explanation.
Mild (nonhemolytic) febrile reaction
Rise in temp. >1°C (<2°C) during or in the first two hours after a transfusion with no other relevant symptoms or signs; optional reporting to TRIP. Hemolysis testing and bacteriology negative if performed.
Acute hemolytic transfusion reaction
Symptoms of hemolysis occurring within a few minutes of commencement of until 24 hours subsequent to a transfusion: one or more of the following: fever/chills, nausea/vomiting, back pain, dark or red urine, decreasing blood pressure or laboratory results indicating hemolysis within the same period.
Biochemical hemolysis testing positive; bloodgroup serological testing possibly positive; bacteriology negative.
Delayed hemolytic transfusion reaction
Symptoms of hemolysis occurring longer than 24 hours after transfusion to a maximum of 28 days: unexplained drop in hemoglobin, dark urine, fever or chills etc; or biochemical hemolysis within the same period. Biochemical testing and blood group serology confirm this.
If new antibodies are found without biochemical confirmation of hemolysis, report as new allo-antibody.
TRALI (Transfusion-related acute lung injury)
Dyspnoea and hypoxia within six hours of the transfusion; chest Xray shows bilateral pulmonary infiltrates.
There are negative investigations (biochemical or blood-group serological) for hemolysis, bacteriology is negative and no other explanation exists. Depending on the findings of tests of leukocyte serology, report is classified as immune-mediated or unknown cause.
Transfusion-associated circulatory overload (TACO)
Dyspnoea, orthopnoea, cyanosis, tachycardia >100/min. or raised central venous pressure (one or more of these signs) within six hours of transfusion, usually in a patient with compromised cardiac function. Chest X-ray consistent.
Anaphylactic transfusion reaction
Rapidly developing reaction occurring within a few seconds to minutes after the start of transfusion, with features such as airway obstruction, in and expiratory stridor, fall in blood pressure ≥ 20mm Hb systolic and/or diastolic, nausea or vomiting or diarrhoea, possibly with skin rash.
Hemolysis testing and bacteriology negative, test for IgA and anti-IgA.
Other allergic reaction
Allergic phenomena such as itching, redness or urticaria but without respiratory, cardiovascular or gastrointestinal features, arising from a few minutes of starting transfusion until a few hours after its completion. Hemolysis testing and bacteriology negative if performed.
New allo-antibody
After receiving a transfusion, demonstration of clinically relevant antibodies against blood cells (irregular antibodies, HLA or HPA antibodies) that were not present previously (as far as is known in that hospital).
Post-transfusion bacteremia/sepsis
Clinical symptoms of bacteremia/sepsis arising during, directly after or some time subsequent to a blood transfusion, for which there is a relevant, positive blood culture of the patient with or without a causal relation to the administered blood component.
Post-transfusion viral infection
A viral infection that can be attributed to a transfused blood component as demonstrated by identical viral strains in donor and recipient and where infection by another route is deemed unlikely.
Hemosiderosis
Iron overload induced by frequent transfusion with a minimum ferritin levelof of 1000 micrograms/l, with or without organ damage.
Post-transfusion purpura (PTP)
Serious self-limiting thrombocytopenia possibly with bleeding manifestations (skin, nose, gastrointestinal, urinary tract, other mucous membranes, brain) 1-24 days after a transfusion of a red cell or platelet concentrate, usually in a patient who has been pregnant. Investigations: HPAantibodies and HPA typing of patient.
Transfusion-associated graft versus host disease (TA-GvHD)
Clinical features of graft versus host disease such as erythema which starts centrally, watery diarrhoea, fever and rise in liver enzymes 1-6 weeks (usually 8-10 days) after transfusion of a T-cell containing (nonirradiated) blood component. Skin (and liver) biopsies can support diagnosis.
Other transfusion reaction
Transfusion reaction which does not fit into the categories above.
Incorrect blood component transfused (IBCT)
All cases in which a patient was transfused with a component that did not fulfil all the requirements of a suitable component for that patient, or that was intended for a different patient. TRIP requests institutions to report these cases, even if there are no adverse consequences for the patient.
Positive bacterial screen
The blood service reports a positive bacteriological screen, but bacterial contamination of the relevant material is not confirmed by a positive culture result on the same material or other products made from the same donation.
Bacterial contamination of a blood component
Relevant numbers of bacteria in a (remnant of) blood component or in the bacterial screen bottle of a platelet component, or in material from the same donation, demonstrated in the approved way with laboratory techniques, preferably including typing of the bacterial strain or strains.
Look-back by the supplier
Retrospective notification of a possibly infectious donation, leading to investigation of the recipient for that infection, but where no infection is demonstrated in the recipient.
Viral contamination of blood component
Retrospective analysis by Sanquin demonstrates viral contamination of an already administered blood component, previously screened and found negative.
Near miss
Any error that, if undetected, could have led to a wrong blood group result or issue or administration of an incorrect blood component, and which was detected before transfusion.
Please indicate where the error arose, any further errors or failed checks, and how the error was discovered.
Hemolysed product
Occurrence of clinical signs / symptoms in a patient associated with the presence of free hemoglobin in a transfused product (from recovered blood).
Heparinisation
Clotting problems associated with incomplete removal of added heparin during automated blood recovery method.
Other incident
Error or incident in the transfusion chain that does not fit into any of the above categories, for instance patient transfused whereas the intention was to keep the blood component in reserve, or transfusing unnecessarily on the basis of an incorrect Hb result or avoidable wastage of a blood component.
IMPORTANT
When reporting an incident please indicate (if known) during which step or procedure the first error occurred; additional errors or failed checks; explain how the incident was discovered and what the consequences for the patient were.