When Karl Landsteiner accepted the Nobel Prize in 1930 for his landmark definition of the major human blood groups, he said more work was needed to reveal the causes of undesirable side-effects of transfusion and eliminate the “slight risks” which it still involved.
“He was being optimistic,” according to Associate Professor Erica Wood, head of the Transfusion Research Unit at Monash University in Melbourne.
“Although blood supplies in Australia and New Zealand are now very safe from many infectious and other hazards, our clinical transfusion practice can undoubtedly be safer than it currently is,” she said.
Professor Wood was delivering the Sanger Oration at the HAA meeting, named after Australian haematologist Ruth Sanger who forged a career in England in the mid-20th century and co-authored six editions of a pivotal textbook, Blood Groups in Man, from 1950 to 1975. Professor Wood also has an internationally-prominent career, including leadership of a number of haematology and transfusion medicine societies.
She described how haemovigilance emerged as a discipline over the last 20 years. “Haemovigilance is a tool to identify, understand and quantify risks in order to prioritise efforts to reduce hazards from transfusion, to improve clinical outcomes, and to make best use of available resources,” she said.
In Australia, for example, the Serious Transfusion Incident Reporting (STIR) system is active in four jurisdictions.
In the United Kingdom the Serious Hazards of Transfusion (SHOT) network provides high-quality analysis and interpretation of adverse events. It identified 93 deaths directly related to transfusion between 2010 and 2015.
“Even if a system is based on good ideas, smart people and careful planning, there is no guarantee it will always work,” Professor Wood said. “The concepts adopted by SHOT stress that safety is based on ‘everything going right’ rather than ‘nothing going wrong’.”
Massive databases on blood products are now available, including information on more than 170 million units captured by ISTARE – the International Surveillance of Transfusion-Associated Reactions and Events maintained by the International Haemovigilance Network.
“Before haemovigilance systems, public health reporting covered key infectious complications of transfusion, but there were limited measures for reporting and analysis of non-infectious hazards,” Professor Wood said.
“International haemovigilance systems have now described complications including transfusion-associated circulatory overload, transfusion-related acute lung injury, bacterial contamination of blood components, and the frequent and potentially fatal consequences of human errors.
“Sharing experiences and results has led to international collaborative action to reduce risks, and many of the lessons from haemovigilance apply equally to other medical products of human origin, including cells, organs and tissues for transplantation.”
She said blood products cost Australia more than a billion dollars every year.
“We need much better information on product utilisation and donor and patient outcomes. Investments in haemovigilance, side-by-side with efforts in patient blood management, will improve the safety of transfusion into the future.”