Background: The Transfusion Transmitted Injuries Surveillance System (TTISS) is a pan-Canadian surveillance system established by the Public Health Agency of Canada (the Agency) in partnership with the provinces and territories to capture non-nominal data on adverse transfusion reactions in Canadian hospitals providing transfusion services with the overarching goal of improving patient safety.
Objective: To summarize transfusion-related adverse reactions reported to the TTISS between 2006 and 2012.
Methods: Hospitals from 10 provinces and two territories participated in the TTISS by collecting and submitting data on all transfusion-related reactions or injuries to the provincial / territorial blood coordinating offices. This data was sent to the Agency where it was consolidated, cleaned, validated and analyzed by type of reactions or outcome. Corresponding rates were also calculated using the total number of units of blood components transfused as a denominator.
Results: From 2006 to 2012, a total of 3,957 adverse reactions were reported to the TTISS, excluding minor allergic reactions. Of these, 2,920 (73.8%) were related to transfusion of blood components and 1,036 (26.2%) were from the transfusion of blood products. Among reactions related to the transfusion of blood components, the most common were: transfusion-associated circulatory overload (n = 1,242, 42.5%), severe allergic / anaphylactic / anaphylactoid reactions (n=411; 14.1%) and hypotensive reactions (n=298; 10.2%). Among those related to transfusion of blood products, close to one-half were intravenous immunoglobulin (IVIG) headache (n=295; 28.5%) or delayed hemolytic reaction (n=175; 16.9%). Death definitely attributable to transfusion was extremely rare: only one case diagnosed with transfusion-related acute lung injury was identified between 2006 and 2012.
Conclusion: The majority of reactions attributable to transfusion resulted in minor or no sequelae. Strengthening the TTISS will improve the monitoring of adverse transfusion reactions which is one of the key components of an overall patient safety strategy. Current initiatives to improve data quality include the development of transfusion-associated circulatory overload / transfusion-related acute lung injury recognition algorithm and the collection of appropriate denominators for the calculation of the rates of adverse reactions from the transfusion of blood products.