Incidence Rate of Adverse Transfusion Reaction in Grade Three Class-A Hospitals in China: A Meta-analysis of Single rate

Review Articles Chin J Evid-based Med 2015, 15(3): 282-289 1,2 2 2 1 1* 2* 1. 4000382. 400042 PubMed EMbase The Cochrane Library 2014 11 CNKI VIP WanFang Data CBM 6 2014 11 2 R 3.1.1 Meta 72 1 660 472 Meta 0.58% 95%CI 0.48 0.69P<0.000 1 0.42% 95%CI 0.31 0.55P<0.000 10.55% 95%CI 0.41 0.70P<0.000 10.56% 95%CI 0.43 0.70P<0.000 1P<0.05 38.85% 95%CI 34.27 43.53P<0.000 1 55.67% 95%CI 50.79 60.50 P<0.000 1 0.41% 95%CI 0.32 0.50P<0.000 1 0.57% 95%CI 0.43 0.72P<0.000 1 1.00% 95%CI 0.73 1.30P<0.000 1 P<0.05 Meta Incidence Rate of Adverse Transfusion Reaction in Grade Three Class-A Hospitals in China: A Meta-analysis of Single rate TENG Fang 1,2, ZHANG Yan 2, SUN Gui-xiang 2, LIN Hui 1, XIONG Hong-yan 1*, WEN Ai-qing 2* 1. Department of Epidemiology, Faculty of Military Prevention Medicine, Third Military Medical University, Chongqing 400038, China; 2. Department of Blood Transfusion, Daping Hospital, Third Military Medical University, Chongqing 400042, China Abstract Objective To systematically review the characteristics of adverse transfusion reaction in Grade Three Class-A hospitals in China, and to provide scientific evidence for related control and prevention work. Methods databases as the PubMed, EMbase, The Cochrane Library (Issue 11, 2014), CNKI, VIP, WanFang Data and CBM were searched for studies investigating the characteristics of adverse transfusion reaction with6 months observation time in Grade Three Class-A hospitals in China up to November 2014. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed by using the R 3.1.1 software. Results Seventy-two studies involving 1 660 472 cases of blood transfusion were included. The results of pooled analysis showed that the total number of adverse transfusion reaction rate was 0.58% (95%CI 0.48 to 0.69). Sub-group analysis shows that the blood transfusion adverse reaction rates in the eastern, central and western regions were 0.42% (95%CI 0.31 to 0.55), 0.55% (95%CI 0.41 to 0.70), 0.56% (95%CI 0.43 to 0.70), respectively; and there were statistical differences between regions (P<0.05). Different types of adverse transfusion reaction rates were 38.85% (95%CI 34.27 to 43.53) for non hemolytic febrile reaction and 55.67% (95%CI 50.79 to 60.50) for allergic. The adverse reactions incidence of different kinds of blood products transfusion occurred were 0.41% (95%CI 0.32 to 0.50) in red blood cell, 0.57% (95%CI 0.43 to 0.72) in plasma, 1.00% (95%CI 0.73 to 1.30) in platelet. The incidence of adverse reaction of platelet transfusion was significantly higher than that of red blood cell and plasma (P<0.05). Conclusion There is a big gap between domestic and foreign blood transfusion adverse reaction reports, therefore comprehensive measures should be taken for further prevention and control. Key words Blood transfusion; Adverse reaction; Transfusion reaction; Incidence; Meta-analysis Such DOI: 10.7507/1672-2531.20150049 1983 Email: tengzi831110@163.com * Email: hongyanxiong@126.com Email: dpyysxkwaq@hotmail.com 282 2015 Editorial Board of Chin J Evid-based Med

2015, 15(3): 282 289 [1] [2] 2000 [3] Meta 1 1.1 6 2000 1.2 PubMed EMbase The Cochrane Library 2014 11 CNKI VIP WanFang Data CBM 6 2014 11 blood transfusion adverse reaction transfusion reaction incidence 2015 EMbase 1 1.3 2 [4-6] 5 1 0 <20% 4 1.4 R 3.1.1 Meta Freeman-Tukey 95%CI [7] Homogeneity test Q α=0.1 I 2 P 0.10 I 2 50% Meta Meta Eggers test Meta α=0.05 2 2.1 8 045 72 1 660 472 1 2.2 [8] 27 16 1 EMbase #1 blood transfusion reaction /exp #2 china /exp or china #3 #1 AND #2 283

Review Articles 29 72 [9-80] 10 2004 2013 1 660 472 211 14 300 1 52 5 20 4 4.72 1 2.3 Meta 2.3.1 72 7 395 0.08% [71] 6.22% [57] Meta 0.58% 95%CI 0.48 0.69P<0.000 1 2 27 16 29 773 163 340 644 546 665 2 970 1 986 2 439 Meta 0.42%95%CI 0.31 0.55P<0.000 1 0.55%95%CI 0.41 0.70P<0.000 10.56%95%CI 0.43 0.70P<0.000 1 Chin J Evid-based Med 2015, 15(3): 282-289 χ 2 =207.159 P<0.05 3 0.42%0.55%χ 2 =207.159 P<0.05 0.56%χ 2 =28.634 P<0.05 [57] [12] [26] 6.22% 5.21% 6.09% 2.3.2 66 Meta 38.85% 95%CI 34.27 43.53P<0.000 1 55.67% 95%CI 50.79 60.50 P<0.000 1 4 2.3.3 49 48 44 460 321 434 726 78 393 1 903 2 176 643 Meta 0.41% 95%CI 0.32 0.50 P<0.000 10.57% 95%CI 0.43 0.72P<0.000 1 1.00% 95%CI 0.73 1.30P<0.000 1 5 n=8 045 PubMed n=269embase n=86the Cochrane Library n=27cnki n=1 838VIP n=1 931 WanFang Data n=2 307CBM n=1 587 n=0 n=4 849 n=4 849 n=4 607 n=366 n=4 241 n=242 n=170 n=93 2000 n=3 n=3 n=70 4 n=1 n=72 Meta n=72 1 284 2015 Editorial Board of Chin J Evid-based Med

2015, 15(3): 282 289 1 / 2006 [9] 2004 39 288 247 125 122 0 88/14 964 68/19 294 91/4 355 4 2007 [10] 2003 2005 6 920 31 16 12 3 4/257 16/3 757 9/2 294 2/612 5 2007 [11] 2005 2006 5 416 20 11 15 4 4 2007 [12] 2006 211 11 2 9 0 2/149 0/13 9/49 4 2007 [13] 2005 2006 19 303 270 113 138 19 2/294 63/7 126 190/10 414 15/584 5 2008 [14] 2006 2007 8 175 56 17 39 0 0/56 13/3 375 32/4 220 11/524 5 2008 [15] 2006 2007 10 628 155 62 84 9 1/24 47/5 200 88/4 833 18/488 5 2008 [16] 2005 2007 8 117 99 78 13 8 1/86 72/4 170 22/3 629 1/113 4 2008 [17] 2007 8 111 42 20 18 4 2/90 13/4 090 22/3 601 5/330 4 2008 [18] 2004 2007 9 986 137 94 36 7 23/105 69/5 065 24/3 983 21/738 5 2008 [19] 2003 2006 9 986 129 92 35 2 2/105 66/5 065 37/3 983 24/738 5 2009 [20] 2005 2007 47 066 175 82 93 0 15/1 575 70/22 289 79/18 310 11/846 5 2009 [21] 2006 2009 41 545 283 130 138 15 1/ 105/ 119/ 17/ 5 2009 [22] 2008 2009 8 996 47 11/3 655 36/5 234 0/88 5 Chen 2009 [23] 2006 2009 27 672 159 4 2009 [24] 2005 2007 26 798 178 74 98 6 17/2 103 56/9 811 101/12 826 4/1 292 4 2009 [25] 2006 9 929 29 15/5 840 6/3 322 8/767 4 2009 [26] 2003 2007 953 58 36 22 0 4 2009 [27] 2005 2008 1 893 5 3 2 0 0/2 3/1 006 2/807 0/78 5 2010 [28] 2008 2009 18 565 196 75 103 18 1/15 73/7 632 105/8 673 16/2 104 5 2010 [29] 2008 2009 11 490 58 18 31 9 1/101 21/3 561 35/7 538 1/241 5 2010 [30] 2007 2009 12 962 35 7 28 0 0/105 8/10 125 12/2 568 15/164 5 2011 [31] 2006 2010 26 873 235 63 166 6 54/ 63/ 117/ 4 2011 [32] 2007 2008 8 012 57 31 23 3 0/19 22/4 896 24/5 102 11/563 5 2011 [33] 2008 2009 19 865 96 34 57 5 3/209 39/9 012 51/9 918 0/38 5 2011 [34] 2006 2009 31 768 78 30 42 6 1/26 22/18 035 47/17 565 8/3 986 5 2011 [35] 2006 2007 26 302 60 7 51 2 4/1 547 15/9 295 39/14 303 1/960 4 2011 [36] 2008 2009 12 720 62 23 25 4 20/5 489 28/6 371 14/860 5 2012 [37] 2008 2010 9 986 112 67 37 8 49/5 170 57/3 983 6/738 5 2012 [38] 2008 2011 56 825 123 50 29 44 1/218 42/21 301 55/26 464 25/8 580 4 2012 [39] 2009 2010 41 986 46 7 39 0 0/46 9/21 591 7/11 755 30/7 783 5 2012 [40] 2009 2011 7 511 81 4 76 1 2/89 33/3 055 45/3 746 1/525 4 2012 [41] 2004 2010 35 056 91 53 37 1 51/16 786 19/12 833 21/5 437 5 2012 [42] 2011 2012 4 218 78 28 50 0 32/ 41/ 5/ 5 2012 [43] 2009 2012 10 684 29 14 12 3 4 2012 [44] 2008 2011 46 561 41 3 38 0 5 2012 [45] 2005 2010 143 000 143 90 46 7 1/ 94/ 22/ 25/ 4 2012 [46] 2009 2011 13 402 87 40 47 0 7/ 28/ 49/ 3/ 5 2012 [47] 2010 24 452 89 18 65 6 5 2012 [48] 2010 2011 10 337 45 28 17 0 24/5 864 18/3 860 7/1 573 4 2013 [49] 2007 2011 41 615 113 19 92 2 16/ 10/ 83/ 5 2013 [50] 2010 2012 33 135 133 39 94 0 52/16 403 55/12 825 24/3 447 5 2013 [51] 2008 2012 15 002 64 19 41 4 0/9 25/8 371 25/5 833 12/768 5 2013 [52] 2009 2011 54 827 220 4 2013 [53] 2010 2012 17 015 28 8 20 0 2/58 8/5 887 18/10 709 0/361 5 2013 [54] 2012 8 407 48 15 27 6 5 2013 [55] 2010 2011 28 650 83 10 59 14 10/ 22/ 54/ 7/ 5 2015 285

Review Articles Chin J Evid-based Med 2015, 15(3): 282-289 1 / 2013 [56] 2008 2012 11 866 60 23 37 0 23/8 294 31/3 119 6/432 5 2013 [57] 2010 2012 10 000 622 407 202 13 13/625 341/3 652 232/5 016 33/538 5 2013 [58] 2010 2012 49 039 90 19 68 3 4 2013 [59] 2010 2013 6 773 112 59 51 2 20/2 677 88/3 814 3/186 5 2013 [60] 2010 2012 33 096 81 19 50 12 1/199 33/15 234 38/15 431 7/1 970 5 2013 [61] 2012 6 693 30 18 12 0 21/4 070 6/1 259 3/1 364 4 2013 [62] 2009 2011 11 350 62 34 27 1 4 2013 [63] 2011 2012 23 828 48 30 16 2 5 2013 [64] 2007 2012 31 046 63 22 37 4 5 2013 [65] 2005 2012 18 060 150 33 113 4 48/7 404 89/9 876 13/733 5 2013 [66] 2010 2012 7 066 72 52 20 0 6/ 54/ 12/ 0/ 5 2013 [67] 2011 2013 4 103 26 7 19 0 0/2 7/3 521 17/3 433 2/632 5 2013 [68] 2012 2013 7 980 24 9 11 4 5 2013 [69] 2010 2013 14 559 67 36 28 3 23/5 976 35/6 583 4/1 328 5 2013 [70] 2008 2013 18 271 103 56 47 0 2/150 35/6 365 59/10 049 7/1 573 5 2013 [71] 2008 2012 95 308 74 51 15 8 52/53 006 20/35 800 3/6 502 5 2013 [72] 2011 2013 31 983 121 26 104 0 47/14 202 51/11 907 27/4 021 5 2014 [73] 2009 2012 57 266 479 5 2014 [74] 2011 2012 2 610 32 7 16 0 12/ 17/ 2/ 5 2014 [75] 2007 2010 22 789 61 20 35 6 30/8 872 31/6 540 0/242 5 2014 [76] 2013 26 214 61 14 46 1 25/11 682 17/10 100 17/3 568 5 2014 [77] 2010 2013 11 490 58 18 31 9 1/101 21/3 561 35/7 538 1/241 5 2014 [78] 2008 2011 71 528 100 14 77 9 14/29 755 37/37 335 49/4 438 5 2014 [79] 2012 12 325 30 9 18 3 18/6 727 11/3 629 1/210 5 2014 [80] 2013 13 010 107 27 79 1 28/7 288 23/2 501 55/1 492 5 2 Meta Meta 95%CI P 72 [9-80] 7 395 1 660 472 I 2 =98.7% P<0.000 1 0.58% 0.48 0.69 <0.000 1 3 Meta Meta 95%CI P 27 [9,15,17,19,23,25,27,30,31,34,36-38,41,45,47,49,53,56,61,62,64,67,71,77,78] 2 970 773 163 I 2 =98.3% P<0.000 1 0.42% 0.31 0.55 <0.000 1 16 [10,18,21,28,29,32,50,52,60,63,68,69,70,73] 1 986 340 644 I 2 =97% P<0.000 1 0.55% 0.41 0.70 <0.000 1 29 [11,13,14,16,20,22,24,33,35,39,40,42,43,44,46,48,51,54,55,58,59,65,66,72,74,75,76,79,80] 2 439 546 665 I 2 =97.9% P<0.000 1 0.56% 0.43 0.70 <0.000 1 571226 4 Meta Meta 95%CI P 66 [9-21,24,26,28-51,53-72,74,80] 2 762 6 456 I 2 =92.9% P<0.000 1 38.85% 34.27 43.53 <0.000 1 66 [9-21,24,26,28-51,53-72,74,80] 3 383 6 456 I 2 =93.3% P<0.000 1 55.67% 50.79 60.50 <0.000 1 286 2015 Editorial Board of Chin J Evid-based Med

2015, 15(3): 282 289 5 Meta Meta 95%CI P 49 [9,10,12-20,22,24,25,27-30,32-41,48,50,51,53,56-61,65,67,69-72,75-80] 1 903 460 321 I 2 =95.4% P<0.000 1 0.41% 0.32 0.50 <0.000 1 48 [9,10,13-20,22,24,25,27-30,32-41,48,50,51,53,56,57,59-61,65,67,69-72,75-80] 2 176 434 726 I 2 =97.4% P<0.000 1 0.57% 0.43 0.72 <0.000 1 44 [9,10,13-20,24,25,28-30,32,35-41,48,50,51,56,57,59-61,65,67,69-72,76-80] 643 78 393 I 2 =92.8% P<0.000 1 1.00% 0.73 1.30 <0.000 1 57 12 P<0.05 [57] 15.47% [12] 18.37% 2.4 Egger Eggers test P>0.05 3 Meta [81] 3.1 72 1 660 472 Meta 0.58% 0.41% 0.57% 1.00% [82-84] [82] 72 27 16 29 0.42% 0.55%0.56% P<0.05 3.2 2015 [85-87] [88-90] 3.3 11 5 [91] [92] [93] 1,,.., 2011, 24(3): 245-246. 287

Review Articles 2,,,. 113., 2013, 26(9): 915-916. 3,,.. :, 2012: 11-12. 4 Shaikh N, Morone NE, Bost JE, et al. Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J, 2008, 27(4): 302-308. 5 Loney PL, Chambers LW, Bennett KJ, et al. Critical appraisal of the health research literature: prevalence or incidence of a health problem. Chronic Dis Can, 1998, 19(4): 170-176. 6 Juni P, Witschi A, Bloch R, et al. The hazards of scoring the quality of clinical trials for meta-analysis. JAMA, 1999, 282(11): 1054-1060. 7,,,. R Meta., 2013, 13(3): 181-184. 8.., 2006, 32: 44-46. 9,,,.., 2006, 37(1): 59-61. 10,. 2003-2005., 2007, 7(10): 2423. 11,.., 2007, 4(2): 160-161. 12.., 2007, 28(08): 50-52. 13,,,. 270., 2007, 3: 441-442. 14,. 8175., 2008, 3(21): 519-520. 15,,.., 2008, 30(3): 293-294. 16. 99., 2008, 30(12): 1900-1902. 17,,,.., 2008, 46(30): 127-129. 18,,,.., 2008, 5(29): 132-133. 19,,,.., 2008, 21(2): 85-87. 20,. 175., 2009, 31(2): 202-203. 21,,. 283., 2009, 22(12): 655-656. 22,. 47., 2009, 24(9): 2359-2360. 23 Chen QF, Li P, Wang XQ. Clinical analysis of 159 times acute transfusion reaction in single center. Blood, 2009, 114(22): 4196. 24,,,. 178., 2009, 40(10): 663-664. 25,,.., 2009, 15(8): 108-109. 26,,.., 2009, 6(6): 463. 27,. 2005-2008., 2009, 27(1): 91-92. 28,. 196., 2010, 5(09): 120-121. 29,,. 58., 2010, 7(21): 2386-2388. 30,. 2007-2009., 2010, 21(4): 131-132. 31,,,. 235., 2011, 39(06): 50-51. Chin J Evid-based Med 2015, 15(3): 282-289 32,. 57., 2010, 23(02): 520. 33,,,. 96.., 2011, 24(1): 93-94. 34.., 2011, 8(8): 98-99. 35,,. 60., 2011, (08): 109-111. 36,. 62., 2011, 24(05): 443-444. 37,. 112., 2012, 44(3): 211. 38,,,. 2008-2011., 2012, 32(12): 1246-1248. 39,. 46., 2012, 42(3): 63-64. 40,,. 81. ( ), 2012, (11): 330-330. 41,,.., 2012, 25(2): 65-67. 42.., 2012, (36): 361-362. 43,,.., 2012, 25: 140. 44,,,.., 2012, 27(4): 154-155. 45,,,.., 2012, 14(2): 113-115. 46. 87., 2012, (220): 64-65. 47. 89., 2012, 33(13): 2853-2854. 48,. 45., 2012, 9(33): 109-110. 49,,,. 113., 2013, 26(9): 915-916. 50,,,. 133., 2013, 33(3): 419-420. 51,,,. 15002., 2013, 26(6): 572-573. 52. 2009-20115 294., 2013, 26(3): 159-160. 53,,,. 28., 2013, (5): 384-385. 54,. 48., 2013, 26: 330. 55,,. 83., 2013, (6): 136-138. 56,,. 60., 2013, (10): 6. 57. 2010-2012., 2013, 21(8): 403-404. 58,,,... 2013.. 59,.., 2013. 34(23): 3178-3179, 3181. 60.., 2013, 10(11): 1442-1443. 61,,,.., 2013, 19(8): 1176-1177. 288 2015 Editorial Board of Chin J Evid-based Med

2015, 15(3): 282 289 62.., 2013, 12(8): 320-321. 63,.., 2013, (12):20-21. 64.., 2013, 34(11): 1455-1457. 65,,. 150., 2013, 37(9): 794-795. 66,.., 2013, 26(11): 486. 67,,,.., 2013, (36): 217-218, 219. 68,.. ( ), 2013, (6): 329-330. 69. 67., 2013, 13(18): 12-13. 70,,,. 2008-2013., 2013, 6(12A): 109-110. 71,,.., 2013, 20(10): 1074-1075. 72,.., 2013, (41): 257-258. 73. 2009~2012., 2014, 16(2):149-151. 74,,,. 32., 2014, 35(6):799-800. 75,,,. 61., 2014, 16(2): 166-167. 76,,,. 61., 2014, 27(8): 171-171. 77.., 2014, (17): 77-78. 78. 2008-2011., 2014, 21(4): 108-110. 79,.., 2014, 11(19): 2654-2655. 80. 107. ( ), 2014, 24(2): 925. 81,,. Meta Stata., 2012, 12(1): 52-64. 82 Siegenthaler MA, Schneider P, Vu DH, et al. Haemovigilance in a general university hospital: need for a more comprehensive classification and a codification of transfusion-related events 2005. Vox Sanguinis, 2005, 88: 22-30. 83 Andreu G, Morel P, Forestier F, et al. Hemovigilance network in France: organization and analysis of immediate transfusion incident reports from 1994 to1998. Transfusion, 2002, 42: 1356-1364. 84 Robillard P, Nawej KI, Jochem K. The Quebec hemovigilance system: description and results from the first two years. Transfusion and Apheresis Science, 2004, 31: 111-122. 85 Williamson LM, Lowe S, Love EM, et al. Serious hazards of transfusion (SHOT) initiative: analysis of the first two annual reports. BMJ, 1999, 319(7201): 16-19. 86 Rebibo D, Hauser L, Slimani A. The French Haemovigilance System: organizationand resultsfor 2003. Transfusion and Apheresis Science, 2004, 31: 145-153. 87 Keller-Stanislawski B, Lohmann A, Gunay S, et al. The German Haemovigilance System reports of serious adverse transfusion reactions between 1997 and 2007. Transfusion Medicine, 2009, 19: 340-349. 88 Flesland O. A comparison of complication rates based on published haemovigilance data. Intensive Care Med, 2007, 33(1): 17-21. 89 Dr Hannah Cohen, Ms Alison Watt, Ms Debbi Poles, et al. Annual SHOT Report 2011. United Kingdom: Manchester Blood Centre, 2011. 90 Stainsby D, Jones H, Asher D, et al. Serious Hazards of Transfusion:A Decade of Hemovigilance in the UK. Transfusion Medicine Reviews, 2006, 20(4): 273-282. 91,,.., 2006, 19(3): 239-242. 92,.., 2009, 22(10): 5-7. 93,,.., 2004, 17(5): 368-369. 2014 11 17 2015 02 09 2015 289