conference abstract · Blood
In regional referral hospitals in Dar es Salaam, Tanzania, resource constraints frequently necessitate the transfusion of non-leukoreduced whole blood rather than separated blood components. A cross-sectional investigation of 151 patients receiving whole blood for severe anaemia revealed that 33.8 per cent experienced acute transfusion reactions within 24 hours. The most frequent complications observed were febrile non-haemolytic reactions and allergic responses, alongside rarer events such as post-transfusion purpura, anaphylaxis, and acute haemolytic reactions. Statistical analysis identified that recipients with blood groups AB, B, and O faced significantly elevated risks of reactions compared to group A recipients. Conversely, patients with obstetric and gynaecological conditions exhibited a lower risk. Direct antiglobulin tests were positive in over 15 per cent of reaction cases, indicating underlying immune mechanisms.
Blood transfusions are critical medical interventions, but adverse reactions present significant risks to patient recovery and survival. In resource-constrained settings relying on whole blood, documenting high reaction rates and associated risk factors provides clinical evidence necessary to advocate for safer transfusion practices, including blood component separation, leukoreduction, and enhanced antibody screening.
The abstract does not indicate a direct commercial application pathway, as it focuses on clinical epidemiology. However, the identified risks point to potential operational opportunities for providers of blood-processing equipment, such as component separation, pre-storage leukoreduction filters, antibody screening assays, and digital haemovigilance tracking tools suitable for adoption by regional hospital networks.
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Abstract Background: Blood transfusion is a lifesaving procedure, essential in the management of various medical and surgical conditions including severe anemia, infection, bleeding and malignancies. Despite its usefulness, it may be associated with adverse reactions resulting from various pathophysiology. Acute transfusion reactions (ATR) are adverse events occurring within 24 hours post-transfusion. These reactions range from mild to severe and remain a major safety concern for both patients and providers. Due to limited resources for preparation of blood products, most regional hospitals in the country of Tanzania transfuse whole blood. This poses an increased risk for acute transfusion reactions due to unnecessary transfusion of plasma and other components. There is a significant paucity of data on transfusion reactions in Tanzania, hence this study was conducted to determine the prevalence of acute transfusion reactions and identify the associated risk factors. Objective To determine the prevalence and factors associated with ATRs among patients receiving blood transfusions in regional referral hospitals in Dar es Salaam, Tanzania. Methods A cross-sectional study was conducted from October 2024 to March 2025 in three regional referral hospitals which are Amana, Mwananyamala, and Temeke hospitals in Dar es Salaam. A total of 151 patients receiving whole blood for severe anemia were enrolled. Transfusion data, which included patient demographics, blood product and dose, and transfusion indication were collected using the Tanzania Ministry of Health transfusion monitoring forms. Immunohematology tests including ABO grouping, compatibility testing, and direct antiglobulin test (DAT) were performed in all patients with ATRs. Statistical analysis using STATA v25 involved bivariate and multivariable Poisson regression was utilized to determine factors associated with ATRs, expressed as adjusted prevalence ratios (aPRs) with 95% confidence intervals. Results A total of 151 participants were included in the study. Females accounted for 53.6% of the total population. The median age of all participants was 30 years (IQR: 21–41), with the majority aged 18–39, (58.3%). Those who were aged below 18 and above 59 years accounted for 13.2%, and 8.6%, respectively. 51 (33.8%) patients developed ATRs. Underlying diagnoses of those with ATR included gastrointestinal bleeding/renal disease (29.6%), hematological disorders (41.5%), infection (39%), pregnancy (16%), and trauma (20%). Among those who developed ATR, Amana hospital had 20 patients (39.2%), Mwananyamala hospital with 16 patients (31.4%) and Temeke hospital had 15 patients (29.4%). The most common reactions were febrile non-hemolytic transfusion reactions (43.1%), followed by allergic reactions (31.4%), post-transfusion purpura (9.8%), anaphylaxis (7.8%), acute hemolytic reactions (3.9%), and transfusion-associated circulatory overload (3.9%). DAT was positive in 24 (15.7%) of ATR cases but the subtype of antibody implicated was not determined. Multivariable analysis showed significantly lower ATR risk among patients with obstetric and gynecological diagnoses (aPR = 0.39; 95% CI: 0.25–0.60; p < 0.001). In contrast, blood groups AB (aPR = 2.84; p = 0.015), B (aPR = 2.16; p = 0.043), and O (aPR = 2.53; p < 0.001) were associated with higher ATR risk compared to group A. No significant associations were found with age, sex, transfusion dose, or health facility. Conclusion A high prevalence of ATRs was observed, predominantly febrile and allergic reaction, likely exacerbated by the exclusive use of non-leukoreduced whole blood. Blood group and clinical diagnosis were significant predictors of ATRs, while traditional demographic variables were not. The detection of positive DAT in some cases suggests alloimmune mechanisms not routinely addressed in current transfusion practice. From this study, we believe that four mechanisms may lead to a decrease in ATR: transitioning from whole blood transfusion to component therapy, use of pre-storage leukoreduction, introduction of routine antibody screening and extended red cell phenotyping, and integration of hemovigilance systems across all transfusion sites. These strategies are critical to reducing preventable transfusion-related morbidity in resource-limited settings and set us up for future studies in the field.
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DOI: 10.1182/blood-2025-3141
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