Hemovigilance
Hemovigilance is a monitoring system introduced by the European Union that monitors the entire blood transfusion chain and registers and analyzes adverse effects before, during and after the administration of blood products. The obligation to report undesirable transfusion reactions is enshrined in law. In Germany, unwanted transfusion reactions must be reported to the Paul Ehrlich Institute , in Switzerland to Swissmedic .
Various professional groups are involved in the blood transfusion process. The manufacturer controls the delivery of a faultless product with its quality assurance system, the supplier ensures product-specific delivery (temperature), and the doctor responsible for the transfusion for the indication for the transfusion. Finally, the medical staff ensures that the blood product is administered correctly. Errors can occur in the individual process sections and must be reported. In addition, 3 in 1000 transfusions produce reactions that cannot be avoided clinically. Like the errors, these must also be reported to a haemovigilance officer appointed by the hospital. The haemovigilance officer analyzes the report and forwards it to the registration authority.
Transfusion reactions and errors
- Near miss event (near miss) : Near miss is understood to mean incidents which, undetected, would have led to a false transfusion or to incorrect results or laboratory findings, e.g. B. Taking blood from wrong patient.
- Transfusion failure : a blood product was mistakenly administered regardless of the effect. The blood product was unsuitable or intended for another patient.
- Febrile non- hemolytic transfusion reactions : The febrile (febrile) non- hemolytic transfusion reactions are very common and mostly occur with cellular blood products ( platelet and erythrocyte concentrate ). The temperature rise of at least 1 ° C rarely goes above 39 ° C. They are self-limiting and usually show up at the end of the transfusion or within 4 hours. It usually affects polytransfused patients.
- Allergic transfusion reactions : The allergic transfusion reactions are common and usually occur harmlessly as hives ( urticaria ). They mostly occur in products containing plasma (thrombocyte concentrate, freshly frozen plasma ) and occur up to 4 hours after the transfusion.
- Anaphylactic transfusion reaction : The anaphylactic transfusion reaction is life-threatening but rare. It occurs after a small amount and an anaphylactoid reaction occurs.
- Haemolytic transfusion reaction : The haemolytic transfusion reaction is life-threatening but rare. It usually occurs after an AB0- incompatible transfusion and directly after the start of the transfusion. Typical signs are malaise, dyspnoea , fever , nausea, kidney pain, shock , coagulation disorders ( DIC ) and dark urine ( hemoglobinuria ).
- Allo-antibodies, delayed haemolytic transfusion reaction : This reaction is relatively common and is caused by allo-antibodies in the recipient's blood (from previous transfusions or pregnancy). The reaction depends on the antibody density.
- Bacterial contamination : Bacterial contamination is life-threatening, occurs most frequently in TK, the reaction depends on the amount and type of germs.
- TACO (Transfusion associated circulatory overload) : This is a volume overload; pulmonary edema is characteristic and can occur up to 24 hours after the transfusion.
- TRALI (Transfusion related acute lung injury) : TRALI is rare, it is most likely to occur with thrombocyte concentrates and fresh frozen plasma. The mortality rate is 5–20%. It is characterized by acute dyspnoea, bilateral interstitial infiltrates of the lungs can be detected in the X-ray. Therapy is symptomatic. TRALI can sometimes occur up to 6 hours after the transfusion.
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- Markus Fopp, Martin Wernli: The safety of blood transfusions today . In: Swiss Medical Forum , Vol. 6 (2006), pp. 139–144, ISSN 1424-3784 .
