Blood transfusions have been the cornerstone of life support since the introduction of the ABO classification in the 20th century. The physiologic goal is to restore adequate tissue oxygenation when the demand exceeds the offer. Although it can be a life-saving therapy, blood transfusions can lead to serious adverse effects, and it is essential that physicians remain up to date with the current literature and are aware of the pathophysiology, initial management and risks of each type of transfusion reaction. We aim to provide a structured overview of the pathophysiology, clinical presentation, diagnostic approach and management of acute transfusion reactions based on the literature available in 2022. The numbers of blood transfusions, transfusion reactions and the reporting rate of transfusion reactions differ between countries in Europe. The most frequent transfusion reactions in 2020 were alloimmunizations, febrile non-hemolytic transfusion reactions and allergic transfusion reactions. Transfusion-related acute lung injury, transfusion-associated circulatory overload and septic transfusion reactions were less frequent. Furthermore, the COVID-19 pandemic has challenged the healthcare system with decreasing blood donations and blood supplies, as well as rising concerns within the medical community but also in patients about blood safety and transfusion reactions in COVID-19 patients. The best way to prevent transfusion reactions is to avoid unnecessary blood transfusions and maintain a transfusion-restrictive strategy. Any symptom occurring within 24 h of a blood transfusion should be considered a transfusion reaction and referred to the hemovigilance reporting system. The initial management of blood transfusion reactions requires early identification, immediate interruption of the transfusion, early consultation of the hematologic and ICU departments and fluid resuscitation.
Switzerland is a small country divided into 26 cantons and four language regions (German, French, Italian and Rhaeto-Romanic) with cultural imprints from neighboring countries [1]. The Federal Constitution specifies the distribution of responsibilities between the Confederation and the cantons. The cantons are responsible for hospital organization, health prevention and for the regulation of the health professions. Each canton, thus, has its own Ministry of Health and develops its health system according to its needs, resources and political orientations. Inspired by the health systems of European border countries, emergency medicine in Switzerland is also largely based on Anglo-Saxon concepts [2]. By experimenting with these different models, Switzerland is gradually developing emergency health care professions and building the foundation of a solid decentralized emergency medical aid system.
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