Blood Transfusion Error - Medical Malpractice Lawyer
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Blood Transfusion Errors Overview
Blood transfusion errors are more common than we would like to see. While many of the errors are human errors, some are due to slips and errors in the transfusion testing process and errors in the analytic phase of the transfusion chain. These account for a third of all errors. As many as forty percent of bad transfusions occur in the postanalytic phase. These are failures in the final check of the right blood to the right patient. In order to counteract this problem, many hospitals are going to bar code labels, radiofrequency identification tags and even palm vein scanning to make sure the right patient is getting the right blood.
The last phase of transfusion involves careful monitoring of the recipient for adverse symptoms or signs. When this is performed carefully, it can prevent a potentially fatal reaction caused by an earlier processing error or an unavoidable physiological condition.
One of the most serious transfusion risks is an ABO incompatibility between the patient and the blood they are given. It is reported several times per year but has been reported fewer times per year in years past. Hospitals must report this event in order to document mislabeled blood samples and adverse events related to blood transfusions.
Despite mandates that blood samples be labeled in the presence of the patient, one study showed that patient misidentification was associated with 88 percent of preanalytic lab events, which was primarily due to mislabeling during specimen collection.
The incidence of transfusion errors from patient misidentification is only about 1:16,000-19,000 patients. The plan to have two people verify the patient identification to transfusion can become lackadaisical, providing false reassurance rather than really increasing safety.
Human error plays a big role in transfusion reactions. In both laboratory and clinical medicine, a lot goes into preventing transfusion reactions by instituting special policies and procedures designed to prevent these errors from happening. There is a lot of redundancy and detail in the identification of blood and in verifying test results. Still infected blood is getting into the system and there are incompatibilities despite rigid policies that often include a great deal of redundancy.
Transfusion medicine is unique in clinical and laboratory health services in that the result is the delivery of a biological product that can be life-saving or capable of causing harm or death. There are many people involved in several different areas, including the hospital, who must keep the chain of evidence going so that the right blood goes to the right person. In a tertiary care hospital, as many as ten different healthcare professionals are responsible for everything necessary to get the blood to the right person. There are the following steps:
- Physician orders
- Patient identification for specimen collection
- Blood bank work up
- Product selection and issue
- Patient identification for transfusion
- Administration of the blood product to the patient
One study looked at 355 transfusion-related deaths and found any number of errors. Ninety-nine deaths were related to transfusion-related hepatitis or AIDs. Most of the rest were caused by ABO-incompatibility. Other cases involved an acute pulmonary injury (15 percent), bacterial contamination (10 percent), delayed hemolysis (10 percent) and damaged product (3 percent).
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The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here