Acute transfusion reactions at a Saudi tertiary care hospital: a five-year retrospective hemovigilance report

Introduction Acute transfusion reactions (ATRs) are an important but under-monitored source of transfusion-related morbidity, and data on their prevalence and pattern in Saudi Arabia remain limited. Methods: In this retrospective institutional hemovigilance report, all transfusion-reaction case records at King Khalid University Hospital (KKUH), Riyadh, from January 2019 to December 2023 were reviewed by consecutive sampling to characterize reaction frequency, type [allergic, febrile non-hemolytic transfusion reaction [FNHTR], or transfusion-associated circulatory overload [TACO]], and demographic pattern. Analyses were descriptive; no inferential testing of subgroup associations was performed. Results Of 100,778 blood-product units transfused, 77 (0.08%; 95% CI 0.06%–0.10%) reactions were recorded. Allergic reactions were most common (n = 42, 54.5%), followed by FNHTR (n = 27, 35.1%) and TACO (n = 8, 10.4%). Reactions occurred in 45 female (58.4%) and 32 male (41.6%) patients (not significant, p = 0.138), and reaction type did not differ significantly by sex, year, or age group (all p > 0.05) or across years within each blood product (borderline for RBC by exact test, p = 0.048). Mean patient age was 41.2 ± 22.3 years, with reactions most frequent at 25–34 years and at 65 years or older. Component-specific reaction rates were 0.105% for RBCs (53/50,345), 0.074% for FFP (15/20,397), and 0.030% for platelets (9/30,036). Discussion Allergic reactions were the most frequent ATR at this Saudi tertiary hospital, consistent with reports from other countries, while the overall reaction rate was low by international comparison, which likely reflects, at least in part, under-ascertainment in a passive, clinician-initiated reporting system. These descriptive baseline findings support continued hemovigilance and improved detection, notification, and documentation of transfusion reactions and should not be interpreted as estimates of differential risk by age, sex, or blood product.