Incidence and risk factors for acute transfusion reactions among children aged 0 - 17 years receiving transfusions at Mulago Hospital

Abstract

Background: Blood transfusion is a commonly performed procedure among children especially in emergency settings. According to WHO, up to 65% of transfusions are given to children below 5 years in low-income countries. Whereas transfusion is considered generally safe, it is also associated with adverse events including transfusion reactions. Acute Transfusion reactions are the commonest adverse events associated with transfusion and can range from minor to life threatening reactions. A few studies have been done in sub-Saharan Africa regarding transfusion reactions and their risk factors among children. Objectives: The study aimed to determine the incidence and risk factors for acute transfusion reactions among children receiving transfusion in Mulago hospital pediatric wards. Methods: A single Centre prospective cohort study was conducted for a period of 4 months at Mulago hospital. A total of 802 children were enrolled and followed up for a period of 24 hours. Vital signs were monitored at 4 time points namely; baseline/ pre transfusion, 15 minutes into transfusion, at the end of transfusion and at 24 hours after enrollment. Any change in vital signs and/or onset of new symptoms was reported as a suspected transfusion reaction. All suspected transfusion reactions were evaluated by a transfusion physician using the CDC hemovigilance criteria to confirm and categorize the transfusion reactions. Continuous and categorical data was summarized using measures of central tendency. The primary outcome was the proportion of children with confirmed acute transfusion reactions. Cox proportional hazards regression model was used to determine the risk factors of ATR using hazard ratios (HR) as the measure of association. Results: A total of 802 children were transfused, monitored, and followed up for 24 hours. Of these ,445 (55.2%) were males, 482 (60.1%) were above 5 years. Mean pre-transfusion xi hemoglobin was 5.3g/dl. The majority 741 (91.9%) received red cell concentrates and the most common indication for transfusion was sickle cell anemia 465 (58%). The incidence of ATR was found to be 3.2 per 100 transfusions (26 out of 802 transfusions), 95CI (2.2-4.7). The commonest reaction was FNHTRs and followed by minor allergic ATRs. Risk factors for ATR were age above 5 years, history of previous transfusion, and sickle cell anemia. Conclusion: ATRs are common among children receiving transfusion and are most likely to be missed because majority are not life threatening. The commonest ATR was FNHTR and minor allergic reactions. The risk of ATR is more in children with history of previous transfusion, underlying hematological diseases. Majority of the ATRs happen within the first hour of transfusion. Keywords: Children, Transfusion, Acute Transfusion Reactions, risk factors.