Abstract
Blood transfusion can cause some transfusion adverse reactions. In order to understand the incidence of adverse transfusion reactions, we performed a meta-analysis in Chinese hospitals. Of 809 literatures, seven studies involving a total of 211, 050 patients with blood transfusion treatment were included in this meta-analysis. Meta-analysis showed that the total incidence of adverse reactions was 0.4% [95% CI (0.2, 0.9), P < 0.0001]. Further subgroup analysis showed that the incidence of febrile and allergic reactions was 0.2% [95% CI (0.1, 0.5), P < 0.0001] and 0.2% [95% CI (0.1, 0.3), P < 0.0001], respectively. The common blood components caused adverse reactions were red blood cell, plasama, and platelet in clinical practice.
Introduction
Blood transfusion has become a commonly irreplaceable treatment for clinical rescue. However, due to the potential risk of blood transfusion and adverse reactions, transfusion safety has become the focus of global concern [1,2]. Common transfusion adverse reactions have been reported to include fever, allergic reactions, and hemolytic reactions in China. Other adverse reactions might occur such as fluid overload, lung injury, destruction of red blood cells, graft-versus-host disease, infections, and complications of massive transfusion so on. However, there lacks a systematic reviews to clarify the incidence of adverse transfusion reactions. Therefore, we performed a metaanalysis in Chinese hospitals.
Materials and Methods
Inclusion and exclusion criteria
The included literatures were the observational studies. The subjects were the patients who received a blood transfusion therapy. The study must report the incidence of adverse reactions, and the retrieval date was set between January 1, 2014 and December 31, 2014. Reviews or commentaries, duplicated literatures, and case reports were excluded in this study. We used the preferred reporting items for systematic review and meta-analyses (PRISMA) statements [3,4] as the guidelines of this present meta-analysis.
Retrieval strategy and data extraction
We searched the Chinese Biomedical Literature Database (CBM), Wanfang Database, Chinese Scientific Journals Full-text Database (VIP), China National Knowledge Infrastructure (CNKI), PubMed and EMBASE database by computer. Data extraction and quality assessment was independently performed by two researchers and any controversies were resolved by consensus.
Statistical analysis
Statistical calculations were performed using Meta Analyst version 3.13 (Boston, MA, USA). Heterogeneity among the studies was evaluated by the Cochran’s chi-squared test (Cochran’s Q) and the I2 statistics. Assessments of heterogeneity determined to adopt a random effects model or a fixed effects model. In this study, the Der Simonian–Laird method was used. A Begg’s funnel plot was used for the assessment of publication bias.
Result
Of 809 literatures, seven studies involving a total of 211,050 patients with blood transfusion treatment were included in this metaanalysis [5-9]. The incidences and types of adverse reactions were seen (Table 1). The distributions of adverse reactions in each of blood components were presented in (Table 2). The results revealed that the common blood components caused adverse reactions were red blood cell, plasama, and platelet in clinical practice.
Table 1: The incidences and types of adverse reactions in this meta-analysis.
Table 2: The distributions of adverse reactions in each of blood components.
Meta-analysis showed that the total incidence of adverse reactions was 0.4% [95% CI (0.2, 0.9), random effect model, P < 0.0001] (Figure 1). Further subgroup analysis showed that the incidence of febrile and allergic reactions was 0.2% [95% CI (0.1, 0.5), random effect model, P < 0.0001] and 0.2% [95% CI (0.1, 0.3), random effect model, P < 0.0001] (Figure 2 and Figure 3), respectively. The asymmetry funnel plot revealed a publication bias occurred in this study (Figure 4).
Figure 1: The meta-analysis of the overall incidence of adverse reactions.
Figure 2: The meta-analysis of the pooled incidence of febrile reactions.
Figure 3: The meta-analysis of the pooled incidence of allergic reactions
Figure 4: The funnel plot of this meta-analysis.
perform the meta-analyses of these effects. This meta-analysis showed that the total incidence of adverse reactions in China was 0.4% [95% CI (0.2, 0.9)]. There only found one case with hemolytic reaction in this meta-analysis. Further subgroup analysis showed that the adverse reactions were febrile reactions and allergic reactions. The common blood components caused adverse reactions were red blood cell, plasama, and platelet in clinical practice, which might be related to the frequencies of these components. However, due to lack of the available relevant data, we couldn’t give further classifications in this study.
In addition, the asymmetry funnel plot revealed a publication bias occurred in this study. The safety of blood and blood products should be overseen by Haemovigilance according to the requests of World Health Organization (WHO). In the UK this data is collected by an independent organization (Serious Hazards of Transfusion). Therefore, we believed that China should take more effective measures to enforce the surveillance of adverse effects of transfusions of blood products. We proposed that China should enforce the supervision on the clinical use of blood and build up a Haemovigilance information platform by internet in the future.
References
3. Tang RT. Investigation of adverse effects in 36 cases with transfusion [J]. Lin Chuang Xue Ye Xue Za Zhi. 2014, 6: 1057-1058.
4. Yao ZJ, Chen HB, Zheng BB, Yang DG. 208 cases of adverse transfusion reactions in Hainan province. Lin Chuang Xue Ye Xue Za Zhi. 2014;
5: 888- 889. 5. Lu GQ, He YY, Shen HY, Yu HD, He YL. Transfusion adverse reaction investigation of 12406 cases of blood transfusion [J]. Zhongguo Wei Shen Jian Yan Za Zhi. 2014; 22: 3313-3314.
6. Dong K. Retrospective analysis of clinical transfusion adverse reactions and intervention measures in 49 blood transfusion cases [J]. Henan Yi Xue Yan Jiu. 2014; 9: 111-113.
7. Ji H. Retrospective study of 131 cases of clinical transfusion adverse reactions.Zhongguo She Qu Yi Shi. 2014; 30: 138-140.
8. Shen L, Wu XY. Analysis and prevention of adverse drug reactions in patients with [J]. Zhongguo Gao Deng Yi Xue Jiao Yu. 2014; 10: 127-142.
9. Zhang YH. Survey and analysis of adverse drug reactions of a hospital beween 2008 to 2011, Zhongguo Wei Shen Zhi Liang Guan Li, 2014; 4:108- 110.
Citation
Gao Y, Li Q, Gao Z, Zhu Y, Zhu C, Sun Y et al. Meta-Analysis of Incidence of Adverse Transfusion Reaction in Clinical Cases in China. SM J Clin Med. 2015; 1(1): 1005.