The Korean Journal of Blood Transfusion : eISSN 2383-6881 / pISSN 1226-9336

Table. 2.

Table. 2.

Details of transfusion related incidents

N Phase of transfusion processYear DetailsAdverse event Transfusion reaction Corrective action
1Blood sampling2014Sample for type and cross drawn from the wrong patient O (+) Platelet concentrates transfused to A (+) patientYesNon-hemolytic reactions (urticaria)1. Make sure to double check the patient identification 2. Planning to application of bar-code assisted system
2Blood sampling2018Sample for type and cross drawn from the wrong patient Not using the bar-code assisted O (+) Platelet concentrates transfused to B (+) patientYesNo1. Make sure to double check the patient identification 2. Make sure to application of bar-code assisted system
3Issue of blood components2015Issuing the subdivision platelet apheresis for pediatric patients to wrong patientsNoNo1. Education on the technicians about the instructions
4Issue of blood components2017Issuing the expired blood productsYesNo1. Not issuing the actual blood products during disposal process 2. A stamp called “expired blood products” is stamped on the delivery record
5Issue of blood components2017Issuing the expired blood productsYesNo1. Storing expired blood products separate from other blood products 2. Warning pop-up appears when issuing expired blood products
6Transfusing blood components2014Failure in patient identification prior to transfusion B (+) RBC concentrates transfused to A (+) patientYesHemolytic reaction1. Make sure to double check the patient identification 2. Planning to application of bar-code assisted system
7Transfusing blood components2014Failure in patient identification prior to transfusion AB (+) FFP transfused to B (+) patientNoNo1. Make sure to double check the patient identification 2. Planning to application of bar-code assisted system
Korean J Blood Transfus 2019;30:212-8 https://doi.org/10.17945/kjbt.2019.30.3.212
© 2019 Korean J Blood Transfus