Transfusion reactions reported to the Québec haemovigilance system between 2005 and 2022: A comparison of paediatric and adult recipients

Few studies have compared the prevalence of transfusion reactions (TRs) in paediatric and adult recipients, and none have been conducted in Canada. We carried out a retrospective cross-sectional study of TRs reported in a Canadian haemovigilance system (i.e. Québec's haemovigilance system [QHS]) from 1 January 2005 to 31 December 2022. QHS is a province-wide voluntary haemovigilance system that records TRs among blood recipients. Overall, 5 372 752 transfusions were recorded; 23 946 reactions deemed definitely, probably or possibly associated with transfusion were analysed (paediatric recipients = 1951 [8.2%]; adults = 21 995 [91.9%]). Paediatric recipients experienced higher rates (95% confidence interval) of reported TRs than adults (97.05 [92.79-101.45] vs. 42.53 [41.97-43.10] per 10 000 transfusions). This difference was predominantly driven by children (age: ≥12 months to <18 years), platelets, red blood cells and minor allergic reactions (all p < 0.0001). Similar results were obtained for nearly all individual TRs except transfusion-associated circulatory overload, whose rates were lower among paediatric recipients (p < 0.0001). However, paediatric age subgroups exhibited divergent patterns: recipients aged <1 month had lower rates than adults, while those aged ≥1 to <12 months and ≥12 months to <18 years had higher rates (all p < 0.0001). The aforementioned differences were consistently observed throughout the 18-year period, with only minor year-to-year variations in subgroups and for individual TRs. We conclude that paediatric recipients consistently exhibited higher rates of reported TRs than adult recipients.