Hemovigilância : eventos transfusionais adversos antes e após implantação de um Comitê Transfusional Hospitalar

AUTOR(ES)
DATA DE PUBLICAÇÃO

2010

RESUMO

Adverse events related to the use of blood may occur, even though the blood and its components are correctly collected, processed, indicated and prepared. Haemovigilance is a tool of the transfusion safety which aims to reduce the blood transfusion’s risks and monitoring the rational use of blood. Haemovigilance’s task is undertaken at the hospital environment by the Hospital Transfusion Committee (HTC). A Before and After Study was conducted to evaluate the transfusion reactions reported before and after the implementation of HTC in the Regional Blood Bank / University Hospital of Londrina State University of Parana. The sources of the data were the monthly reports of blood transfusions (from the SADIHU, an Informatics System of the University Hospital) in the Regional Blood Bank and the notification’s reports of transfusion reactions to the NOTIVISA (Brazilian’s Surveillance System of the Health Ministry). The blood transfusions and their adverse events were characterized. Thereafter, the differences between the incidence’s rates of transfusion reactions (18 months before and 18 months after implementation of HTC) were compared. The number of blood transfusions has decreased in 9.0% and the transfusion reactions also, in 47.1%, after the implementation of HTC. Autologous transfusions were not reported. Packed Red Blood Cells (PRBC), Washed PRBC and Leukodepleted PRBC were the most used (63%). Leukodepleted PRBC had their prescriptions increased (8.7% to 17.9%), while Fresh Frozen Plasma (FFP) reduced (22.7% to 17.6%), after the implementation of HTC. The departments of the hospital where the major quantity of blood was transfused were the ones with patients who had more clinical complexities. The greater quantity of blood recipients were male (57.3%). Concerning the transfusion reactions, PRBC were implicated for the most part of the adverse events (74.4%). Febrile Non Haemolytic Reactions (FNHR) and Allergic Reactions were the most frequent (97%). Female recipients had more transfusion reactions (55.6%) and the women in the elderly (age more than 60 years). The transfusion reactions occurred according to the expected ABO / Rh (D) phenotyping distribution of the general population. 68.4% of the patients with transfusion reactions had already been transfused previously. 91.7% of transfusion reactions were considered mild. Acute Haemolytic Reaction due to ABO Incompatibility was the only adverse event that was considered life-threatening (0.8%). There were no deaths related to transfusions. The rate of incidence of adverse transfusional events was significantly lower in the period after the implementation of HTC (RR:0.58 CI 95%: 0.41-0.83). On the subject of the type of transfusion reaction, the rate of FNHR was significantly lower in the period after HTC (RR: 0.55 CI 95%: 0.35-0.86). Although the rate of incidence has decreased, Allergic Reactions and other types of reactions had no significant differences. It was noticed also, a significant reduction of the rate of incidence in the male, but the risk to have a transfusion reaction was higher for the women, when compared between sex. The results from this study strengthen the importance of HTC, in the Haemovigilance’s context, towards the implementation of strategies to reach a rational use of blood and the consequent decrease of transfusion reactions. It is also highlighted the need for continuous encouragement to notify all the transfusion reactions, keeping the privacy of data and the characteristics of being not mandatory and with no punishments in the Brazilian Haemovigilance System.

ASSUNTO(S)

sangue - transfusão sangue - uso terapêutico sangue - composição sangue - alergia hemovigilância blood transfusion blood therapeutic use

ACESSO AO ARTIGO

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