(P-TS-21) Assessing the Impact of Timing of Vital Sign Assessment on the Detection of Transfusion Reactions

Background/Case Studies: Transfusion reactions (TRxn) are thought to occur most frequently during the first 15 minutes of blood product administration, and standard transfusion administration guidelines recommend vital sign (VS) assessment at 15 minutes following transfusion start time. Documentation of peri-transfusion VS is not always clear, and there is a lack of consensus on VS assessment elements and frequency. The aims of this study are to assess TRxn timing and how timing of the first documented VS check may influence the identification of an acute TRxn.

Study

Design/Methods: Blood products transfused with reported TRxns and matched to a corresponding blood product unit between 11/2023 and 11/2024 during patient encounters were extracted from the EMR. All VS recorded during blood product administration were included. Time to first VS check was assigned as the first documented heart rate during transfusion administration. TRxn timing and type independent of imputability was confirmed with chart review.

Results/Findings: A total of 148 TRxns with corresponding single blood product units occurred and included: 1 acute hemolytic, 40 allergic, 63 febrile nonhemolytic (FNHTR), 11 hypotensive, 9 transfusion-associated circulatory overload, 8 transfusion-associated dyspnea, 2 transfusion-related acute lung injury, and 14 not determined reactions. The overall median documented time to reaction was 57 minutes (interquartile range (IQR) 81). Only 24 of 149 (16%) of reactions were documented to have occurred within the first 15 minutes of blood product administration. Documented timing was similar for allergic reactions and FNHTR, with 15% and 14% occurring within the first 15 minutes, respectively.

Based on nursing documentation, 106 of 149 (71%) of included transfusions had documented VS within the first 15 minutes. The median time to reaction in those with documented VS in the first 15 minutes was greater than those without VS in the first 15 minutes (61 compared to 41 minutes, respectively). Findings were similar for allergic and FNHTR subgroups; for allergic, timing of reaction was increased at 52 minutes for those with VS in first 15 minutes compared to 42 minutes for those without, and for FNHTR, timing of reaction was increased at 78 minutes for those with VS in first 15 minutes compared to 42 minutes for those without.

Conclusions: Most TRxns evaluated did not occur during the first 15 minutes of blood product administration. Based on documented time of TRxn being higher in those with VS checked in the first 15 minutes, we did not find evidence to support that a delay in VS check leads to a delay in reaction detection. This study is limited by the retrospective nature and potential variability in reporting, further investigation into TRxn timing and VS assessment effects on TRxn detection is warranted.