Blood Transfusion Errors in South Africa

Blood may be incorrectly typed or labelled. Errors in patient identification may occur. Blood screening may also be faulty or inadequate.

ABO-incompatible blood transfusions are among the most dangerous of blood transfusion errors. They involve accidentally giving patients incompatible blood types.

A transfusion can also cause harm if the blood is infected with a virus or other pathogen.

If you may have a medical negligence claim against a hospital or other healthcare provider in South Africa, contact us at DSC Attorneys for expert legal advice and representation.

Blood transfusion risks in South Africa

Like other medical procedures, blood transfusion carries a degree of risk.

It’s important to note that not all negative responses are a result of malpractice.

According to the most recent haemovigilance report released by the South African National Blood Service (SANBS), these are the most frequently reported adverse events associated with blood transfusions:

• febrile non-haemolytic transfusion reactions, or FNHTR (a spike in temperature, most common in platelet transfusions)
• allergic reactions
• transfusion associated dyspnoea (breathing difficulties)
• hypotensive transfusion reaction (low blood pressure).

During the year under review, a total of 989 transfusion-related adverse effects were reported in South Africa. This was equivalent to an incidence rate of 78.1/100,000 units transfused.

Risk of blood-borne infection due to blood transfusion

Thanks to thorough donor and blood screening procedures, it’s very rare for blood-borne viruses, bacteria or parasites to be transmitted through transfused blood. However, the risk does exist.

For example, international studies suggest a 1 in 300,000 risk of contracting hepatitis B from donated blood, and a 1 in 350,000 risk of contracting West Nile Virus.

Many other types of infections can also be transmitted in blood products. Some examples are cytomegalovirus, human T-lymphotropic virus, malaria and parvovirus B19.

Can you get HIV/Aids due to a blood transfusion?

Blood services in South Africa currently test all blood donations for HIV-1, HIV-2, hepatitis B, hepatitis C and syphilis.

Accordingly, the risk of getting HIV through transfused blood is extremely low. However, cases of HIV infection through transfused blood have occurred in South Africa.

Although blood is properly screened, the virus may not be detected if a donor is in the early “window phase” of infection, before testing returns a positive result for the virus.

The Western Cape Blood Service notes that since 2005, it has had no confirmed cases of HIV or hepatitis transmission via a blood product reported to their haemovigilance office.

Blood transfusion mistakes

More common risks involve blood transfusion errors by doctors, nurses or administrative staff.

Transfusing the wrong blood type

A transfusion of the wrong blood type is known as an ABO-incompatible transfusion.

Being transfused with an incompatible blood type can cause acute haemolytic transfusion reaction. The patient’s antibodies perceive the transfused red blood cells as a threat and attack them.

This can cause acute kidney failure and even death.

Giving transfusions to the wrong patients

Mixing up patients is a clear-cut example of malpractice. Where this leads directly to harm, grounds may exist for a personal injury claim.

Incorrect blood component transfused (IBCT) errors

IBCT errors occur when a patient receives a blood component meant for a different patient or for which special requirements – such as CMV‑negative or irradiated components – haven’t been met.

Transfusion-associated circulatory overload (TACO)

If too much blood is given (or given too fast) and it can’t be processed by the patient, it can lead to acute respiratory distress, tachycardia, increased blood pressure and/or acute or worsening pulmonary oedema.

TACO isn’t always a consequence of medical malpractice. Even where it is, this can be difficult to prove.

Responsibilities of medical professionals

The National Health Act (2003), which governs blood transfusions in South Africa, stipulates that medical practitioners have the following responsibilities¹:

• transfusing blood only when medically indicated
• warning patients of potential risks and available alternatives
• obtaining and documenting the patient’s informed consent
• correctly identifying the patient and units of blood to be transfused
• ensuring that appropriate compatibility tests have been performed
• ensuring that the blood has been correctly handled prior to and during transfusion
• ensuring that the blood has not passed its expiry date
• permitting responsible persons to administer blood to the patient
• transfusing blood at the proper rate
• observing and monitoring the patient at the commencement of, and during, the transfusion
• effectively managing any untoward transfusion reaction
• retaining blood samples as required
• reporting untoward reactions or death.

1. Source: Western Province Blood Transfusion Services – Clinical Guidelines, 5th Edition (2014).

When blood transfusion mistakes constitute medical malpractice

Doctors are expected to use their medical knowledge and patients’ medical information to determine when blood transfusions are advisable, on a case-by-case basis.

Failure to do this, or to adhere to any of the responsibilities outlined under the National Health Act (2003), may constitute medical malpractice or negligence.

For example, patients harmed by blood transfusion errors may have medical malpractice claims if:

• the medical practitioner failed to obtain the patient’s informed consent
• the medical practitioner didn’t adequately explain the risks involved
• an administrative error or improper testing led to the wrong blood type being transfused
• a blood transfusion was given when it wasn’t necessary
• a blood transfusion was administered improperly
• infected blood was transfused due to improper screening.