SHOT Report: Transfusion-Related Mortality in the UK Increased in 2024

The number of transfusion-related mortalities reported to the United Kingdom’s Serious Hazards of Transfusion (SHOT) Program increased by 55% in 2024 to a total of 59, up from 38 in 2023, according to the recently released SHOT Annual Report. Transfusion-associated circulatory overload (TACO) accounted for the most transfusion-related deaths.

SHOT is the U.K.’s independent, professionally led hemovigilance program and is affiliated with the Royal College of Pathologists. Since 1996, SHOT has collected and analyzed information on adverse events and reactions in blood transfusion from almost all of the health care organizations involved in the transfusion of blood and blood components in the U.K.

Approximately 2.2 million blood components were issued by the four U.K. blood services in 2024. The risk of transfusion-related mortality in the U.K. is 1 in approximately 37,000 components issued, while the risk of serious harm is approximately 1 in 11,500 components issued (this includes solvent detergent-treated fresh-frozen plasma data), based on the reports submitted to SHOT.

In 2024, 5,033 reports were submitted to SHOT, comparable with the number from 2023 (4,972). However, the total number of reports analyzed in the 2024 Annual SHOT Report was 3,998.

While there were no reports of mortality in 2024 considered to be directly and solely the result of transfusion, the number of reports with potential for patient harm increased by 158 reports, up from 2,154 in 2023. These numbers excluded reports of “near miss” and “right blood, right patient.”

“Errors continue to account for the majority of reports,” the authors wrote. “In 2024, 3,322/3,998 (83.1%) of all reports (including near miss [NM] and right blood right patient [RBRP]), and 70.8% of incidents excluding NM and RBRP were due to errors.

The report noted that “near miss events continue to account for a large proportion, 1,408 of 3,998 [35.2%] of the incidents reported to SHOT.”

The SHOT report noted that “inadequate staffing, lack of appropriate training, suboptimal supervision and poor safety culture continue to be identified as contributory factors to numerous incidents reported.”

In addition, while the numbers for most reporting categories were comparable for 2024 and 2023, there were notable exceptions. Delayed and avoidable transfusions both saw large increases in 2024. Delays increased by 47.2%, from 212 in 2023 to 312 in 2024, and avoidable transfusions increased by 33.9%, from 127 in 2023 to 170 in 2024.

In 2024, TACO was responsible for the highest number of transfusion-related deaths (n=31) in a single category, followed by delays (n=18). The number of TACO-related deaths doubled from 15 in 2023 to 31 in 2024, while the number of deaths associated with delays increased by more than a third, rising from 13 to 18.

A total of 68 anti-D-antigen immunizations were reported. These events were counted separately as part of a stand-alone study. Of these, 13 cases were associated with no previous pregnancy while 55 cases had previous pregnancies; 94.1% resulted in live births and 43.8% of babies required treatment for hemolytic disease of the fetus and newborn. The report noted that omission or late administration of anti-D immunoglobulin following potentially sensitizing events continues to be an identifiable risk factor for D immunization

Notably, SHOT released an anti-D Ig safety notice in 2024 that includes a checklist that local staff can use to measure compliance, to identify gaps and develop an action plan for improvement.

No confirmed or probable transfusion-transmitted infections were reported in 2024.