Other complications

Transfusion-Associated Necrotising Enterocolitis (TANEC):

Definition

Necrotising enterocolitis (NEC) is a serious neonatal gastrointestinal condition that affects about 1 in 20 very premature babies; about 1 in 3 will die of the disease, and survivors are at high risk of long-term health and developmental problems. TANEC is a case of NEC occurring within 48 hours of a blood transfusion.

Frequency

Frequency is not known. Some clinicians do not believe the cause of the NEC is transfusion, but instead that it is related to the hypoxia of tissues in the gut due to anaemia. Serious Hazards of Transfusion (SHOT) states that this appears to be under-reported.

Reducing the risk

Some clinicians advocate withholding enteral feeds to neonates receiving a transfusion for a period of time prior to, during and after transfusion.

The WHEAT International trial (WithHolding Enteral feeds Around packed red cell Transfusions) is randomised controlled trial exploring whether withholding enteral feeds (or milk feeds) around the time of blood transfusions will reduce the rate of NEC in preterm babies. It is comparing two care practices already taking place to determine if one approach is more beneficial than the other to preterm babies (to determine which is best). The trial is running in the UK and Canada and will recruit an estimated 4,500 babies over 4 years. If your health board/trust is participating in this trial then you should familiarise yourself with the study information.

Transfusion-Associated Graft versus Host Disease (TA‑GvHD)

Definition

Engraftment and clonal expansion of viable donor lymphocytes in a susceptible host, characterised by fever, rash, liver dysfunction, diarrhoea, pancytopenia and bone marrow hypoplasia occurring less than 30 days after transfusion.

Frequency

Very rare (<1 in 10,000).

Reducing the risk

In most cases, TA-GvHD is fatal. Irradiation of cellular blood components (red cells, platelets, granulocytes) greatly reduces occurrence. If your patient might be at risk of TA-GvHD, you must ensure the need for irradiated blood components is clearly communicated.

Since 1999, all allogeneic blood components produced in the UK have been subjected to a leucocyte depletion process, with very few stated exceptions (e.g. granulocytes).

No cases of TA-GvHD have been reported in patients receiving leucodepleted components. However, as it cannot be assured that leucodepletion is fully protective, irradiation is still required.

Further information and resources

An NHS Blood and Transplant (NHSBT) clinical information sheet is currently under review.