Skip to main content

Advertisement

SpringerLink
Log in

Red Blood Cell Transfusion Safety: Probabilistic Risk Assessment and Cost/ Benefits of Risk Reduction Strategies

  • Published:
Annals of Operations Research Aims and scope Submit manuscript

Abstract

While transfusion safety, particularly with respect to transfusion-transmitted infectious diseases, has improved dramatically over the past several decades, progress in other clinical processes of blood product transfusion continue with highly variable practices and human errors that contribute to adverse outcomes. In this paper, we study the adverse outcome risk in red blood cell (RBC) transfusion in the United States using Probabilistic Risk Assessment (PRA). PRA allows us to map, in a comprehensive manner, the various types of events that may contribute to an adverse outcome, including socio-technical factors such as the risk coming from human error; and allows us to formalize the logical relationships among those events and the adverse outcome risk. We utilize the PRA model to assess the risk to the patient from RBC transfusion in the United States, to identify the major risk points in the transfusion process, and to evaluate the costs and benefits of several risk reduction strategies. Our data come from published studies in the medical literature.

We find that the risk of a potentially severe outcome (e.g., mortality, major injury or other serious long-term consequences, a life threatening incident) from RBC transfusion lies in the interval [10.4327,511.2] per 100,000 units of RBC transfused, with a point estimate of 25.4527. The leading causes of severe outcomes include circulatory overload and bacterial infection. Acute hemolytic reactions, which are mainly caused by erroneous administration of the blood, also contribute significantly to severe outcomes of transfusion. Interestingly, our analysis indicates that an intervention that is targeted at reducing the risk of the erroneous administration of blood (through training programs or technology investments) has a higher potential impact in reducing the severe outcome risk from RBC transfusion than additional screening to further reduce the risk of transfusion-transmitted viral infections, of HIV 1-2, hepatitis B, and hepatitis C, which the lay public fears most. Furthermore, such an error reduction program will be more cost-effective than the additional screening of donated blood. Our study provides guidelines for public policy to improve the safety of RBC transfusion in the United States.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Alter, H. J., & Bradley, D. W. (1995). Non-A, non-B hepatitis unrelated to hepatitis C virus (non-ABC). Seminars in Liver Disease, 15, 110–120.

    Article  Google Scholar 

  • Alter, H. J., & Seeff, L. B. (2000). Recovery, persistence, and sequelae in HCV infection: A perspective on long-term outcome. Seminars in Liver Disease, 20, 17–35.

    Article  Google Scholar 

  • Bierbaum, B. E., Callaghan, J. J., & Galante, J. O. (1999). An analysis of blood management in patients having a total hip or knee arthroplasty. Journal of Bone and Joint Surgery. American Volume, 81A, 2–10.

    Google Scholar 

  • Biggerstaff, B. J., & Petersen, L. R. (2003). Estimated risk of transmission of the West Nile virus through blood transfusion in the US. Transfusion, 43, 1007–1017.

    Article  Google Scholar 

  • Brower, W. A., Nainan, O. V., & Han, X. (2000). Duration of viremia in hepatitis A virus infection. The Journal of Infectious Diseases, 182, 12–17.

    Article  Google Scholar 

  • Burgmeier, J. (2002). Failure mode and effect analysis: An application in reducing risk in blood transfusion. Journal of Quality Improvement, 28, 331–339.

    Google Scholar 

  • Busch, M. P. (2001). Insights into the epidemiology, natural history, and pathogenesis of hepatitis C infection from studies of infected donors and blood-product recipients. Transfusion Clinique Et Biologique, 8, 200–206.

    Article  Google Scholar 

  • Chen, B., Avrunin, G. S., Clarke, L. A., & Osterweil, L. J. (2006). Automatic fault tree derivation from little-JIL process definitions. In Q. Wang, D. Pfahl, D. Raffo, & P. Wernick (Eds.), Lecture notes in computer science: Vol. 3966. Software process change (pp. 150–158). Berlin: Springer.

    Chapter  Google Scholar 

  • Davies, A., Staves, J., Kay, J., Casbard, A., & Murphy, M. F. (2006). End-to-end electronic control of the hospital transfusion process to increase the safety of blood transfusion: Strengths and weaknesses. Transfusion, 46, 352–364.

    Article  Google Scholar 

  • Despotis, G., Eby, C., & Lublin, D. M. (2008). A review of tansfusion risks and optimal management of perioperative bleeding with cardiac surgery. Transfusion, 48, 1S–30S.

    Article  Google Scholar 

  • Dodd, R. Y. (1994). Adverse Consequences of blood transfusion: Quantitative risk estimates. In S. T. Nance (Ed.), Blood supply: Risks perceptions, and prospects for the future (pp. 1–24). Bethesda: American Association of Blood Banks.

    Google Scholar 

  • Dodd, R. Y., Notari, E. P., & Stramer, S. L. (2002). Current prevalence and incidence of infectious disease markers and estimated window-period risk in the American Red Cross blood donor population. Transfusion, 42, 975–979.

    Article  Google Scholar 

  • Dzik, W. H. (2005). Technology for enhanced transfusion safety. American Society of Hematology (pp. 476–482).

  • Dzik, W. H., & Cooley, E. (2003). Lecture 2002: Transfusion safety in the hospital. Transfusion, 1190–1198.

  • Glynn, S. A., Kleinman, S., & Wright, D. J. (2002). International application of the incidence rate/window period model. Transfusion, 42, 966–972.

    Article  Google Scholar 

  • Goodnough, L. T. (2003). Risk of blood transfusion. Critical Care Medicine, 31(12 (Suppl.)), 680–686.

    Google Scholar 

  • Goodnough, L. T., Shander, A., & Brecher, M. E. (2003). Transfusion medicine: Looking to the future. Lancet, 361, 161–169.

    Article  Google Scholar 

  • Greenwalt, T. J. (1997). A short history of transfusion medicine. Transfusion, 37, 550–563.

    Article  Google Scholar 

  • Guerrero, I. C., Weniger, B. C., & Schultz, M. G. (1983). Transfusion malaria in the United States, 1972–1981. Annals of Internal Medicine, 99, 221–226.

    Article  Google Scholar 

  • Haimes, Y. Y. (1998). Risk modeling, assessment, and management. New York: Wiley.

    Google Scholar 

  • Jackson, B. R., Busch, M. P., Stramer, S. L., & AuBuchon, J. P. (2003). The cost-effectiveness of NAT for HIV, HCV, and HBV in whole-blood donations. Transfusion, 43, 721–729.

    Article  Google Scholar 

  • Klein, H. G., Spahn, D. R., & Carson, J. L. (2007). Red blood cell transfusion in clinical practice. Lancet, 370, 415–426.

    Article  Google Scholar 

  • Kleinman, S. H., & Busch, M. (2001). Hepatitis B virus amplified and back in the blood safety spotlight. Transfusion, 41, 1081–1085.

    Article  Google Scholar 

  • Kleinman, S., Busch, M. P., & Korelitz, J. J. (1997). The incidence/window period model and its use to assess the risk of transfusion-transmitted HIV and HCV infection. Transfusion Medicine Reviews, 11, 155–172.

    Article  Google Scholar 

  • Kleinman, S., Chan, P., & Robillard, P. (2003a). Risks associated with transfusion of cellular blood components in Canada. Transfusion Medicine Reviews, 17(2), 120–162.

    Article  Google Scholar 

  • Kleinman, S. H., Kuhns, M. C., & Todd, D. S. (2003b). Frequency of HBV DNA detection in US blood donors positive for anti-HBC: Implications for transfusion transmission and donor screening. Transfusion, 43(6), 696–704.

    Article  Google Scholar 

  • Kumamoto, H., & Henley, E. J. (2000). Probabilistic risk assessment and management for engineers and scientists (2nd ed.). New York: Wiley-IEEE Press.

    Book  Google Scholar 

  • Laupacis, A., Brown, J., & Costello, B. (2001). Prevention of posttransfusion CMV in the era of universal leukoreduction: A consensus statement. Transfusion, 41, 560–569.

    Article  Google Scholar 

  • Leiby, D. A. (2001). Parasites and other emergent infectious agents. In S. Stramer (Ed.), Blood safety in the new millenium (pp. 55–78). Bethesda: American Association of Blood Banks.

    Google Scholar 

  • Linden, J. V., Wagner, K., & Voytovich, A. E. (2000). Transfusion errors in New York State: An analysis of 10 years’ experience. Transfusion, 40, 1207–1213.

    Article  Google Scholar 

  • Lyons, M., Adams, S., Woloshynowych, M., & Vincent, C. (2004). Human reliability analysis in healthcare: A review of techniques. The International Journal of Risk and Safety in Medicine 16, 223–237.

    Google Scholar 

  • Mayer, K. (1982). A Different view of transfusion safety—Type and screen, transfusion of Coombs incompatible cells, and fatal transfusion induced graft versus host disease. In H. F. Polesky & R. H. Walker (Eds.), Safety in transfusion practices. Skokie: College of American Pathologists.

    Google Scholar 

  • Mazzei, C. A., Popovsky, M. A., & Kopko, P. M. (2002). Noninfectious complications of blood transfusion. In M. E. Brecher (Ed.), AABB technical manual (14th ed.) (pp. 586–587). Bethesda: American Association of Blood Banks.

    Google Scholar 

  • Mungai, M., Tegtmeier, G., & Chamberland, M. (2001). Transfusion-transmitted malaria in the United States from 1963 through 1999. The New England Journal of Medicine, 344, 1973–1978.

    Article  Google Scholar 

  • Pineda, A. A., Vamvakas, E. C., & Gorden, L. D. (1999). Trends in the incidence of delayed hemolytic and delayed serologic transfusion reactions. Transfusion, 39, 1097–1103.

    Article  Google Scholar 

  • Popovsky, M. A., & Moore, S. B. (1985). Diagnostic and pathogenetic considerations in transfusion-related acute lung injury. Transfusion, 25, 573–577.

    Article  Google Scholar 

  • Popovsky, M. A., & Taswell, H. F. (1985). Circulatory overload: An underdiagnosed consequence of transfusion. Transfusion, 25, 469.

    Google Scholar 

  • Preiksaitis, J. K. (2000). The cytomegalovirus “safe” blood product: Is leukoreduction equivalent to antibody screening? Transfusion Medicine Reviews, 14, 112–136.

    Article  Google Scholar 

  • Rausand, M., & Høyland, A. (2004). Wiley series in probability and statistics. System reliability theory: Models, statistical methods, and applications (2nd ed.). Hoboken: Wiley-Interscience.

    Google Scholar 

  • Ross, S. M. (2007). Introduction to probability models. Amsterdam: Academic Press.

    Google Scholar 

  • Saxena, S., Ramer, L., & Shulman, I. A. (2004). A comprehensive assessment program to improve blood-administering practices Using the FOCUS–PDCA model. Transfusion, 44, 1350–1356.

    Article  Google Scholar 

  • Schaefer, A. J., Bailey, M. D., Shechter, S. M., & Roberts, M. S. (2004). Modeling medical treatment using Markov decision processes. In M. L. Brandeau, F. Sainfort, & W. P. Pierskalla (Eds.), Kluwer’s International Series Operations research and health care (pp. 593–612). Berlin: Springer.

    Google Scholar 

  • Schreiber, G. B., Busch, M. P., & Kleinman, S. H. (1996). The risk of transfusion-transmitted viral infection. The New England Journal of Medicine, 334, 1685–1690.

    Article  Google Scholar 

  • Stockwell, D. C., & Slonim, A. D. (2006). Quality and safety in the intensive care unit. Journal of Intensive Care Medicine, 21(4), 199–210.

    Article  Google Scholar 

  • Stramer, S. L. (2007). Current risks of transfusion-transmitted agents: A review. Archives of Pathology & Laboratory Medicine, 131, 702–707.

    Google Scholar 

  • Stramer, S. L., Dodd, R. Y., & Leiby, D. A. (2007). Blood donor screening for Chagas disease—United States, 2006–2007. Morbidity and Mortality Weekly Report, 56, 141–143.

    Google Scholar 

  • Trammell, S. R., & Wright, R. D. (1999). Integrating risk assessment into management systems. In Electronics manufacturing technology symposium twenty-fourth IEEE/CPMT (pp. 156–159).

    Chapter  Google Scholar 

  • Turner, C. L., Casbard, A. C., & Murphy, M. F. (2003). Barcode technology: Its role in increasing the safety of blood transfusion. Transfusion, 43, 1200–1209.

    Article  Google Scholar 

  • Williamson, L. M., & Warwick, R. M. (1995). Transfusion-associated graft-versus-host disease and its prevention. The Blood Review, 9, 251–261.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Carilion Medical Center, 1906 Belleview Avenue, Roanoke, VA, 24014, USA

    Anthony D. Slonim

  2. Grado Department of Industrial and Systems Engineering, Virginia Polytechnic Institute and State University, Blacksburg, VA, 24061-0118, USA

    Ebru K. Bish & Ryan S. Xie

Authors
  1. Anthony D. Slonim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ebru K. Bish
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ryan S. Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ebru K. Bish.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Slonim, A.D., Bish, E.K. & Xie, R.S. Red Blood Cell Transfusion Safety: Probabilistic Risk Assessment and Cost/ Benefits of Risk Reduction Strategies. Ann Oper Res 221, 377–406 (2014). https://doi.org/10.1007/s10479-011-0925-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10479-011-0925-0

Keywords

Search

Navigation