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Cumulative risks of early fresh frozen plasma, cryoprecipitate and platelet transfusion in Europe.

BACKGROUND
Injuries are a leading cause of death in the young. Of transfused patients in Sweden about 10% have injuries and 2% receive plasma and 0,2% platelets. Quality, safety, sufficiency and the optimal use of blood and blood components have been the focus for the Council of Europe since 1955 and Guidelines are published. In 2002 the European Community adopted the Directive 2002/98/EC with legally binding requirements for the quality and safety of blood and blood components, including hemovigilance systems.


THE USE OF BLOOD COMPONENTS
Data on the use of blood components are regularly collected by the Council of Europe. The use per 1,000 inhabitants show wide variations.


THE RISKS OF TRANSFUSION
The potential adverse effects of plasma and platelet components, listed in recently published monographs from the Council of Europe, have been compared with published data from hemovigilance systems. There are two principally different hemovigilance systems in Europe, and the reported overall rates show a fifty-fold difference. Severe transfusion reactions are rare or very rare. Transfusion related acute lung injury (TRALI) and sepsis due to inadvertent bacterial contamination are probably of particular inportance for trauma patients. These reactions are presumably insufficiently recognized and reported.


CONCLUSION
Common definitions and systems for hemovigilance will be important for the evaluation of new safety measures. A commonly accepted definition of TRALI will aid in the differential diagnosis of transfusion reactions. Measures to further reduce the rate of transfusion reactions will render the risk-benefit ratio of appropiate transfusions more favorable.