Incidents Related to the Transfusion By Hemosiderosis Notified to the National Haemovigilancy System: Results from Last Two YEARS in Our Hospital
Authors: Garcia Ruiz Maria Almudena , Francisco Jose Romero Martinez , Garrido Collado Maria Pilar , Morente Constantin Estefania , Jurado Manuel 
Published: October 2019

Abstract
OBJECTIVES
According to the World Health Organization, "Haemovigilance is required to identify and prevent occurrence or recurrence of transfusion related unwanted events, to increase the safety, efficacy and efficiency of blood transfusion, covering all activities of the transfusion chain from donor to recipient."
The system should include monitoring, identification, reporting, investigation and analysis of adverse events near-misses and reactions related to transfusion and manufacturing.
Transfusion-dependent patients receive iron overdose in each transfusion: one packed red blood cells containing 200-250 mg iron (1 mg/ml), which accumulates gradually in different tissues. Transfusions of packed red blood cells in a volume â‰¥120 mL / kg can cause iron overload, which correlates with ferritin levels in serum equal to or greater than 1000 g/L. The iron overload may be detected after 10 to 20 transfused packed red blood cells, increasing the risk of morbidity and mortality.
PATIENTS, MATERIAL AND METHODS
We studied the hematological patients with iron overload in 2013 and 2014, analyzing theirs levels of ferritin. The database of the transfusion service was also used, as well as the transfusion history of patients who had received more than 10 packed red blood cells, correlating with greater than 1000 mg/L ferritin.
In 2013, 57 cases transfused with packed red blood cells were reported: 32 men and 25 women between 20 and 87 years (average: 56). Results vary between 10 and 73 concentrates (average: 25). Posttransfusion ferritin levels exceeded 1.000 mg/L, with an average of 2869 mg/L. The accountability and severity was recorded as non-assessable.
In 2014, 76 cases were reported between the ages of 24 and 83 years (average: 56 years), with 50 men and 26 women. The number of packed red blood cells transfused ranged from 10 to 130 (average: 31). The ferritin posttransfusion quantities ranged from 1.041 to 15.190 mg/L. Regarding accountability, 23 were grade 2, 43 were grade 1 and 10 were not assessable. The severity was recorded as non-assessable.
Table. Cases reported in 2013 and 2014 Year Cases (nÂº) Average Packed red blood cells average per patient Posttransfusion ferritin levels 2.013 57 56 25 2.869 Î¼g/L (average) 2.014 76 56 31 Values between 1041-15190 Î¼g/L
CONCLUSIONS
It is very important to keep track of ferritin levels in polytransfused patients. In order to reduce the risk of hemosiderosis, it is essential the optimal use of component (safe, efficient and clinically effective) and that the transfusion is performed when the patient needs it. Chelation reduce morbidity in patients with transfusional dependency and iron overload.
In the annual report of Andalusian Health Service, the incorporation of Haemovigilance system of notifications of post-transfusion hemosiderosis stands out, although only 4 hospitals shared the information, therefore working in this field is necessary. We believe it is essential to establish protocols to improve the reporting of incidents by hemosiderosis Haemovigilance System.

Disclosures
No relevant conflicts of interest to declare.