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Dahlén T, Zhao J, Busch MP, Edgren G. Using routine health-care data to search for unknown transfusion-transmitted disease: a nationwide, agnostic retrospective cohort study. Lancet Digit Health 2024; 6:e105-e113. [PMID: 38278613 DOI: 10.1016/s2589-7500(23)00228-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 10/20/2023] [Accepted: 11/08/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Identification and prevention of transfusion-transmitted disease is essential for blood transfusion safety. However, current surveillance systems are largely driven by reports of sentinel events, which is an approach that might be inadequate for identifying transmission of pathogens not known to be transmissible or pathogens with long incubation periods. Using a combination of health-data registers and blood-bank databases, we aimed to perform an agnostic search for potential transfusion-transmitted diseases and to identify unknown threats to the blood supply. METHODS In this nationwide, agnostic retrospective cohort study, we developed a systematic algorithm for performing a phenome-wide search for transfusion-transmitted disease without consideration of any a-priori suspicion of blood-borne transmissibility. We applied this algorithm to a nationwide Swedish transfusion database (SCANDAT-3S) to test for possible transmission of 1155 disease entities based on all relevant diagnostic coding systems in use during the period. We ascertained health outcomes of blood donors and transfusion recipients from the Swedish National Inpatient Register, Swedish Cause of Death Register, and Swedish Cancer Register. Analyses were two-pronged, studying both disease diagnosis concordance between donors and recipients and a possible shared increased disease risk among all recipients of a given donor. For both approaches, we used Cox proportional hazards regression models with time-dependent covariates. Adjustment for multiple comparisons was done using a false discovery rate method. FINDINGS The analyses included data on 1·72 million patients who had received 18·97 million transfusions (red blood cell, plasma, platelet, or whole blood units) between Jan 1, 1968, and Dec 31, 2017, from 1·04 million blood donors. The median follow-up was 4·5 (IQR 0·9-11·4) years for recipients and 18·5 (8·3-26·2) years for donors. We found evidence of transfusion-transmission for 15 diseases, of which 13 were validated using a second conceptually different approach. We identified transmission of viral hepatitis and its complications (eg, oesophageal varices) but also transmission of other conditions (eg, pneumonia of unknown origin). The diseases that could not be validated in this second approach, HIV and abnormal findings in specimens from male genital organs, were not statistically significant after adjustment for multiple testing. The effect sizes were small (close to 1) for other conditions. INTERPRETATION We find no strong evidence of unexpected, widespread transfusion-transmitted disease. This novel approach serves as a proof-of-concept for agnostic, data-driven surveillance for transfusion-transmitted disease using routinely collected blood-bank and health-care data. FUNDING Department of Health and Human Services, US National Heart, Lung, and Blood Institute, US National Institutes of Health, Swedish Research Council and Region Stockholm.
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Affiliation(s)
- Torsten Dahlén
- Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden; Department of Haematology, Karolinska University Hospital, Stockholm, Sweden
| | - Jingcheng Zhao
- Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Michael P Busch
- Vitalant Research Institute, San Francisco, CA, USA; Department of Laboratory Medicine, UCSF, San Francisco, CA, USA
| | - Gustaf Edgren
- Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Södersjukhuset, Stockholm, Sweden.
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Eichler H, Feyer AK, Weitmann K, Hoffmann W, Henseler O, Opitz A, Patek A, Hans DN, Schönborn L, Greinacher A. Population-Based Analysis of the Impact of Demographics on the Current and Future Blood Supply in the Saarland. Transfus Med Hemother 2020; 48:175-182. [PMID: 34177423 DOI: 10.1159/000512645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/19/2020] [Indexed: 12/14/2022] Open
Abstract
Background The federal state of Saarland (SL) is experiencing the fastest demographic change in the western part of Germany. In this study, we analyzed retrospective data on the current and future supply of red blood cell concentrates (RBC) in this region and compared it to the current and future RBC demand in SL hospitals. Methods The projection of the SL blood supply in 2030 was modeled based on SL demographics for age distribution and donation frequency of donors, and the RBC transfusion data for in-house patients. These results were compared to published data on the transfusion demand from the state of Mecklenburg-Western Pomerania (MV). Results For the period January 1 to December 31, 2017, a total of 43,205 whole blood donations were collected. The donation frequency in SL never exceeded 80 per 1,000 inhabitants and was well below the numbers in MV. Thirty-one percent of the donors were responsible for 53.5% of the donations, and donors older than 45 years of age contributed highly to the total blood supply. In addition, 40,614 RBC transfusions at 10 SL hospitals were analyzed representing nearly all RBC transfusions for in-house patients in this region. RBC transfusions per 1,000 inhabitants increased with age from 24 (50-54) to 140 (80-84) years. Facing an already existing structural deficit of nearly 8,200 RBC in 2017, the projection predicts a dramatic increase in the regional deficit to >18,300 RBC in 2030. Conclusion Our results on RBC demand in SL are comparable but not identical to those projected for the region of MV in eastern Germany. Due to the ongoing demographic changes in Germany as a whole, regular regional monitoring of RBC demand and the age structure of blood recipients and donors should be implemented to allow for better strategic planning in blood transfusion services and hospitals.
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Affiliation(s)
- Hermann Eichler
- Universität des Saarlandes, Institut für Klinische Hämostaseologie und Transfusionsmedizin, Homburg, Germany
| | - Anna Katharina Feyer
- Universität des Saarlandes, Institut für Klinische Hämostaseologie und Transfusionsmedizin, Homburg, Germany
| | - Kerstin Weitmann
- Universitätsmedizin Greifswald, Institut für Community Medicine, Greifswald, Germany
| | - Wolfgang Hoffmann
- Universitätsmedizin Greifswald, Institut für Community Medicine, Greifswald, Germany
| | | | - Andreas Opitz
- DRK-Blutspendedienst Rheinland-Pfalz und Saarland, Bad Kreuznach, Germany
| | - Alexander Patek
- Blutspendezentrale Saar-Pfalz, Klinikum Saarbrücken, Saarbrücken, Germany
| | | | - Linda Schönborn
- Universitätsmedizin Greifswald, Institut für Immunologie und Transfusionsmedizin, Greifswald, Germany
| | - Andreas Greinacher
- Universitätsmedizin Greifswald, Institut für Immunologie und Transfusionsmedizin, Greifswald, Germany
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Schönborn L, Weitmann K, Greinacher A, Hoffmann W. Characteristics of Recipients of Red Blood Cell Concentrates in a German Federal State. Transfus Med Hemother 2020; 47:370-377. [PMID: 33173455 PMCID: PMC7590768 DOI: 10.1159/000510207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/05/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Annual transfusion rates in many European countries range between 25 and 35 red blood cell concentrates (RBCs)/1,000 population. It is unclear why transfusion rates in Germany are considerably higher (approx. 50-55 RBCs/1,000 population). METHODS We assessed the characteristics of transfusion recipients at all hospitals of the German federal state Mecklenburg-Western Pomerania during a 10-year longitudinal study. RESULTS Although 75% of patients received ≤4 RBCs/patient in 2015 (1 RBC: 11.3%; 2 RBCs: 42.6%; 3 RBCs: 6.3%; 4 RBCs: 15.0%), the mean transfusion index was 4.6 RBCs due to a minority of patients with a high transfusion demand. Two thirds of all RBCs were transfused to only 25% of RBC recipients. Consistently, male patients received a higher number of RBCs (2005: 54.2%; 2015: 56.8%) and had a higher mean transfusion index than female patients (mean 5.1 ± 7.2; median 2; inter-quartile range [IQR] 2-4 vs. mean 4.0 ± 5.8; median 2; IQR 2-4). The absolute transfusion demand decreased between 2005 and 2015 by 13.5% due to a composite of active reduction (clinical practice change) and population decline in the 65- to 75-year age group (lower birth rate cohort 1940-1950); however, with major differences between hospitals (range from -61.0 to +41.4%). CONCLUSION Transfusion demand in a population could largely be driven by patients with high transfusion demand. Different treatment practices in this group of patients probably add to the major differences in transfusion demand per 1,000 individuals between countries. The available data cannot prove this hypothesis. Implementation of a diagnosis-related group-based monitoring system is urgently needed to allow informative monitoring on the population level and meaningful comparisons between transfusion practices.
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Affiliation(s)
- Linda Schönborn
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Kerstin Weitmann
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Andreas Greinacher
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
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4
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Millbourn C, Psaros Einberg A, Lindh G, Hökeberg I, Fischler B, Lindahl K. Prevalence and outcome of post-transfusion hepatitis C acquired at different ages and detected in look-back screening. Scand J Gastroenterol 2018; 53:870-875. [PMID: 29909701 DOI: 10.1080/00365521.2018.1476911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The prevalence of hepatitis C virus (HCV) infection in Sweden is estimated to 0.5%. Before 1992, blood transfusion posed a risk of HCV transmission. The primary aim of this study was to estimate anti-HCV prevalence in Stockholm County among individuals receiving blood transfusions 1965-1991. The secondary aim was to study the effect of age at transfusion on the development of liver disease and treatment outcome. MATERIALS AND METHODS This is a retrospective analysis of individuals found to be anti-HCV tested positive in Stockholm County during a national screening campaign in Sweden 2008-2010. All anti-HCV-positive individuals were also HCV RNA tested. Data on age at transfusion, age at diagnosis, HCV genotype, viral load, fibrosis score, liver histology and antiviral treatment were recorded. RESULTS Out of 7473, 134 (1.8%) tested individuals were anti-HCV positive and 102 were HCV RNA positive resulting in a prevalence of chronic hepatitis C (CHC) of 1.4%. The rate of advanced liver damage was 18% (10/56). Patients younger than 19 years of age at transfusion were significantly more often started on antiviral treatment compared to adult patients, 65% vs 29% p < .001. No significant correlation was found between treatment outcome and gender or age at transfusion. CONCLUSIONS In this study, we found an anti-HCV prevalence of 1.8% which is considerably higher than the estimated prevalence in the Swedish general population (0.5%), and patients infected during childhood were more likely to receive antiviral treatment. Additional data on the HCV epidemic in Sweden are needed regarding prevalence and age distribution.
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Affiliation(s)
- Charlotta Millbourn
- a Department of Medicine Huddinge , Karolinska Institutet , Stockholm , Sweden.,b Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
| | - Afrodite Psaros Einberg
- c Department of Pediatrics , Karolinska University Hospital , Stockholm , Sweden.,d CLINTEC Karolinska Institutet , Stockholm , Sweden
| | - Gudrun Lindh
- a Department of Medicine Huddinge , Karolinska Institutet , Stockholm , Sweden
| | - Ingegerd Hökeberg
- e Department of Communicable Disease Prevention and Control , Stockholm , Sweden
| | - Björn Fischler
- c Department of Pediatrics , Karolinska University Hospital , Stockholm , Sweden.,d CLINTEC Karolinska Institutet , Stockholm , Sweden
| | - Karin Lindahl
- a Department of Medicine Huddinge , Karolinska Institutet , Stockholm , Sweden
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5
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Didriksen M, Rostgaard K, Grønbaek K, Pedersen OB, Titlestad K, Erikstrup C, Nielsen KR, Edgren G, Ullum H, Hjalgrim H. Epidemiology of chronic red-cell transfusion recipients in Sweden and Denmark-a 10 year follow-up study. Vox Sang 2018; 113:770-778. [PMID: 30270539 DOI: 10.1111/vox.12715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/30/2018] [Accepted: 09/03/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Chronic red-cell transfusions may be an indispensable part of patient treatment and may require early intervention to avoid adverse transfusion effects. The population of chronic transfusion recipients including common diagnoses and survival remains poorly characterised. Thus, the objective was to examine the complete range of chronic transfusion recipients, including demographic and patient characteristics and survival. MATERIALS AND METHODS All patients who received their first transfusion in Sweden or Denmark from January 1, 2002 to December 31, 2010 were followed up for subsequent transfusion episodes until December 31, 2012. Data on patient characteristics at time of the first and subsequent transfusions were retrieved from the national registers. We estimated the proportion of transfused patients who experienced 20 or more red-cell transfusion episodes (with an episode defined as all transfusions received 4 days or less apart) and characterised this patient population with respect to diagnoses, demographics and survival. RESULTS Among 893 117 first time red-cell transfusion recipients, 6157 (0·7%) experienced 20 or more episodes in total. The most common diagnoses among these patients were haematologic malignancies followed by non-haematologic malignancies and non-malignant blood and immune system related diseases. On average, chronically transfused patients had a median survival of less than 1 year following their 20th transfusion episode. CONCLUSION This study provides an overview of patient characteristics related to repeat red-cell transfusions and of the amount of red-cell transfusion episodes administered during a 10-year period in two countries. Patients who become chronically transfused suffer from diseases with poor prognosis.
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Affiliation(s)
- Maria Didriksen
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Division of Epidemiology, Statens Serum Institut, Copenhagen, Denmark
| | - Klaus Rostgaard
- Division of Epidemiology, Statens Serum Institut, Copenhagen, Denmark
| | - Kirsten Grønbaek
- Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Biotech Research and Innovation Centre, University of Copenhagen, Copenhagen, Denmark
| | - Ole B Pedersen
- Department of Clinical Immunology, Naestved Hospital, Naestved, Denmark
| | - Kjell Titlestad
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Kaspar R Nielsen
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Gustaf Edgren
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.,Haematology Centre, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Ullum
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henrik Hjalgrim
- Division of Epidemiology, Statens Serum Institut, Copenhagen, Denmark.,Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Profiles of blood and blood component transfusion recipients in Zimbabwe. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 13:600-9. [PMID: 26192782 DOI: 10.2450/2015.0019-15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 04/27/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND There are limited published data on the characteristics of blood transfusion recipients in sub-Saharan Africa. This study describes the demographic characteristics of blood transfusion recipients and patterns of blood and blood component use in Zimbabwe. MATERIALS AND METHODS Data on the characteristics of the blood transfusion recipients (age, sex, blood group), blood components received (type, quantity), discharge diagnoses and outcomes following transfusion (discharge status, duration of stay in hospital), were retrospectively collected from four major hospitals for the period from January 1, 2012 to December 31, 2012. Diagnoses were grouped into broad categories according to the disease headings of the International Classification of Diseases (ICD-10). Surgical procedures were grouped into broad categories according to organ system using ICD-9. RESULTS Most of the 1,793 transfusion recipients studied were female (63.2%) and in the reproductive age group, i.e. 15-49 years (65.3%). The median age of the recipients was 33 years (range, 0-93). The majority of these recipients (n=1,642; 91.6%) received a red blood cell transfusion. The majority of the patients were diagnosed with conditions related to pregnancy and childbirth (22.3%), and diseases of blood and blood-forming organs (17.7%). The median time spent in hospital was 8 days (range, 0-214) and in-hospital mortality was 15.4%. DISCUSSION Our sample of blood transfusion recipients were fairly young and most of them received red blood cell transfusions. The majority of patients in the reproductive age group received blood transfusions for pregnancy and childbirth-related diagnoses.
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Edgren G, Rostgaard K, Vasan SK, Wikman A, Norda R, Pedersen OB, Erikstrup C, Nielsen KR, Titlestad K, Ullum H, Melbye M, Nyrén O, Hjalgrim H. The new Scandinavian Donations and Transfusions database (SCANDAT2): a blood safety resource with added versatility. Transfusion 2015; 55:1600-6. [DOI: 10.1111/trf.12986] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/01/2014] [Accepted: 11/12/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Gustaf Edgren
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
- Hematology Centre; Karolinska University Hospital; Stockholm Sweden
| | - Klaus Rostgaard
- Department of Epidemiology Research; Statens Serum Institut; Copenhagen Denmark
| | - Senthil K. Vasan
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - Agneta Wikman
- Department of Clinical Immunology and Transfusion Medicine; Karolinska University Hospital; Stockholm Sweden
| | - Rut Norda
- Department of Immunology, Genetics and Pathology; Uppsala University; Uppsala Sweden
| | | | - Christian Erikstrup
- Department of Clinical Immunology; Aarhus University Hospital; Aarhus Denmark
| | - Kaspar René Nielsen
- Department of Clinical Immunology; Aalborg University Hospital; Aalborg Denmark
| | - Kjell Titlestad
- Department of Clinical Immunology; Odense University Hospital; Odense Denmark
| | - Henrik Ullum
- Department of Clinical Immunology; the Blood Bank; Rigshospitalet; University Hospital of Copenhagen; Copenhagen Denmark
| | - Mads Melbye
- Department of Epidemiology Research; Statens Serum Institut; Copenhagen Denmark
- Department of Clinical Medicine; Copenhagen University; Copenhagen Denmark
- Department of Medicine; Stanford School of Medicine; Stanford California
| | - Olof Nyrén
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - Henrik Hjalgrim
- Department of Epidemiology Research; Statens Serum Institut; Copenhagen Denmark
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Josephson CD, Mondoro TH, Ambruso DR, Sanchez R, Sloan SR, Luban NL, Widness JA. One size will never fit all: the future of research in pediatric transfusion medicine. Pediatr Res 2014; 76:425-31. [PMID: 25119336 PMCID: PMC4408868 DOI: 10.1038/pr.2014.120] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 05/21/2014] [Indexed: 01/19/2023]
Abstract
There is concern at the National Heart, Lung, and Blood Institute (NHLBI) and among transfusion medicine specialists regarding the small number of investigators and studies in the field of pediatric transfusion medicine (PTM). Accordingly, the objective of this article is to provide a snapshot of the clinical and translational PTM research considered to be of high priority by pediatricians, neonatologists, and transfusion medicine specialists. Included is a targeted review of three research areas of importance: (i) transfusion strategies, (ii) short- and long-term clinical consequences, and (iii) transfusion-transmitted infectious diseases. The recommendations by PTM and transfusion medicine specialists represent opportunities and innovative strategies to execute translational research, observational studies, and clinical trials of high relevance to PTM. With the explosion of new biomedical knowledge and increasingly sophisticated methodologies over the past decade, this is an exciting time to consider transfusion medicine as a paradigm for addressing questions related to fields such as cell biology, immunology, neurodevelopment, outcomes research, and many others. Increased awareness of PTM as an important, fertile field and the promotion of accompanying opportunities will help establish PTM as a viable career option and advance basic and clinical investigation to improve the health and wellbeing of children.
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Affiliation(s)
- Cassandra D. Josephson
- Department of Pathology and Laboratory Medicine and Center for Transfusion and Cellular Therapies, Emory University School of Medicine, Atlanta, GA, US
| | - Traci Heath Mondoro
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, US
| | | | - Rosa Sanchez
- Blood Systems Research Institute, San Francisco, CA, US
| | - Steven R. Sloan
- Joint Program in Transfusion Medicine, Children’s Hospital, Boston, MA, US
| | | | - John A. Widness
- Department of Pediatrics, University of Iowa, Iowa City, IA, US
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9
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Monitoring compliance with transfusion guidelines in hospital departments by electronic data capture. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2014; 12:509-19. [PMID: 24960656 DOI: 10.2450/2014.0282-13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 11/06/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND The practice of transfusing red blood cells is still liberal in some centres suggesting a lack of compliance with guidelines recommending transfusion of red blood cells at haemoglobin levels of 6-8 g/dL in the non-bleeding patient. Few databases provide ongoing feedback of data on pre-transfusion haemoglobin levels at the departmental level. In a tertiary care hospital, no such data were produced before this study. Our aim was to establish a Patient Blood Management database based on electronic data capture in order to monitor compliance with transfusion guidelines at departmental and hospital levels. MATERIALS AND METHODS Hospital data on admissions, diagnoses and surgical procedures were used to define the populations of patients. Data on haemoglobin measurements and red blood cell transfusions were used to calculate pre-transfusion haemoglobin, percentage of transfused patients and transfusion volumes. RESULTS The model dataset include 33,587 admissions, of which 10% had received at least one unit of red blood cells. Haemoglobin measurements preceded 96.7% of the units transfused. The median pre-transfusion haemoglobin was 8.9 g/dL (interquartile range 8.2-9.7) at the hospital level. In only 6.5% of the cases, transfusion was initiated at 7.3 g/dL or lower as recommended by the Danish national transfusion guideline. In 27% of the cases, transfusion was initiated when the haemoglobin level was 9.3 g/dL or higher, which is not recommended. A median of two units was transfused per transfusion episode and per hospital admission. Transfusion practice was more liberal in surgical and intensive care units than in medical departments. DISCUSSION We described pre-transfusion haemoglobin levels, transfusion rates and volumes at hospital and departmental levels, and in surgical subpopulations. Initial data revealed an extensive liberal practice and low compliance with national transfusion guidelines, and identified wards in need of intervention.
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Leahy MF, Roberts H, Mukhtar SA, Farmer S, Tovey J, Jewlachow V, Dixon T, Lau P, Ward M, Vodanovich M, Trentino K, Kruger PC, Gallagher T, Koay A, Hofmann A, Semmens JB, Towler S. A pragmatic approach to embedding patient blood management in a tertiary hospital. Transfusion 2013; 54:1133-45. [DOI: 10.1111/trf.12362] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 06/21/2013] [Accepted: 06/22/2013] [Indexed: 12/18/2022]
Affiliation(s)
- Michael F. Leahy
- Hematology Department; Fremantle Hospital; Fremantle Western Australia Australia
- University of Western Australia; Perth Western Australia Australia
| | - Heather Roberts
- Department of Health; Curtin University; Perth Western Australia Australia
| | - S. Aqif Mukhtar
- Centre for Population Health Research; Curtin University; Perth Western Australia Australia
| | - Shannon Farmer
- Department of Health; Curtin University; Perth Western Australia Australia
- Centre for Population Health Research; Curtin University; Perth Western Australia Australia
- University of Western Australia; Perth Western Australia Australia
| | - Julie Tovey
- Hematology Department; Fremantle Hospital; Fremantle Western Australia Australia
| | - Val Jewlachow
- Hematology Department; Fremantle Hospital; Fremantle Western Australia Australia
| | - Tracy Dixon
- Hematology Department; Fremantle Hospital; Fremantle Western Australia Australia
| | - Peter Lau
- Hematology Department; Fremantle Hospital; Fremantle Western Australia Australia
| | - Michael Ward
- Anesthetic Department; Fremantle Hospital; Fremantle Western Australia Australia
| | - Matthew Vodanovich
- Hematology Department; Fremantle Hospital; Fremantle Western Australia Australia
| | - Kevin Trentino
- Department of Health; Curtin University; Perth Western Australia Australia
| | - Paul C. Kruger
- Hematology Department; Fremantle Hospital; Fremantle Western Australia Australia
| | - Trudi Gallagher
- Department of Health; Curtin University; Perth Western Australia Australia
| | - Audrey Koay
- Department of Health; Curtin University; Perth Western Australia Australia
| | - Axel Hofmann
- Department of Health; Curtin University; Perth Western Australia Australia
| | - James B. Semmens
- Centre for Population Health Research; Curtin University; Perth Western Australia Australia
| | - Simon Towler
- Department of Health; Curtin University; Perth Western Australia Australia
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Abstract
Blood is a scarce and costly resource to society. Therefore, it is important to understand the costs associated with blood, blood components, and blood transfusions. Previous studies have attempted to account for the cost of blood but, because of different objectives, perspectives, and methodologies, they may have underestimated the true (direct and indirect) costs associated with transfusions. Recognizing these limitations, a panel of experts in blood banking and transfusion medicine gathered at the Cost of Blood Consensus Conference to identify a set of key elements associated with whole blood collection, transfusion processes, follow-up, and to establish a standard methodology in estimating costs. Activity-based costing (ABC), the proposed all-inclusive reference methodology, is expected to produce standard and generalizable estimates of the cost of blood transfusion, and it should prove useful to payers, buyers, and society (all of whom bear the cost of blood). In this article, we argue that the ABC approach should be adopted in future cost-of-transfusion studies. In particular, we address the supply and demand dilemma associated with blood and blood components; evaluate the economic impact of transfusion-related adverse outcomes on overall blood utilization; discuss hemovigilance as it contributes not to the expense, but also the safety of transfusion; review previous cost-of-transfusion studies; and summarize the ABC approach and its utility as a methodology for estimating transfusion costs.
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12
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Papay P, Hackner K, Vogelsang H, Novacek G, Primas C, Reinisch W, Eser A, Mikulits A, Mayr WR, Körmöczi GF. High risk of transfusion-induced alloimmunization of patients with inflammatory bowel disease. Am J Med 2012; 125:717.e1-8. [PMID: 22560809 DOI: 10.1016/j.amjmed.2011.11.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 11/02/2011] [Accepted: 11/02/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anemia is highly prevalent in inflammatory bowel disease patients, and red blood cell transfusion is often indicated already at reproductive age. Both transfusion and pregnancy may induce red cell alloantibodies, potentially complicating further transfusions and pregnancies. As recent evidence suggests that inflammation may promote red cell antibody induction, the alloimmunization risk of these patients after allogenic erythrocyte exposure was investigated. METHODS Red cell alloantibody status and clinical data were analyzed in 193 inflammatory bowel disease patients with a history of transfusion or pregnancy, and compared with transfused controls with noninflammatory diseases (n=357). RESULTS In transfused patients with inflammatory bowel disease, a 2.5-fold-increased red cell antibody prevalence was found (10/119, 8.4%), compared with transfused sex-matched controls with noninflammatory diseases (12/357, 3.4%; P=.023). Patients with inflammatory bowel disease had fewer transfusions (mean 3.0 vs 4.2, P=.003) but higher C-reactive protein levels during transfusion than controls (mean 8.4 vs 5.4 mg/dL, P <.001). The red cell antibodies of inflammatory bowel disease patients were clinically significant, directed against different Rh, Kell, Duffy, or Lutheran blood group antigens, and associated with higher number of transfusions (odds ratio 1.57; 95% confidence interval, 1.03-2.39). Conversely, immunomodulatory therapy during transfusion showed negative association (odds ratio 0.12; 95% confidence interval, 0.02-0.61). Only 1.4% of inflammatory bowel disease patients with pregnancy alone had antibodies. CONCLUSIONS Patients with inflammatory bowel disease exhibited a very high risk of transfusion-induced red cell alloimmunization, possibly potentiated by inflammation. Aside from a restrictive transfusion strategy, the implementation of prophylactic blood group phenotype matching of red cell concentrates (not only for ABO and RhD but also RhCcEe, Kell, Kidd, Duffy) could prevent antibody induction and associated complications in these patients.
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Affiliation(s)
- Pavol Papay
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna General Hospital, Medical University of Vienna, Austria
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Goncalez TT, Sabino EC, Capuani L, Liu J, Wright DJ, Walsh JH, Ferreira JE, Chamone DA, Busch MP, Custer B. Blood transfusion utilization and recipient survival at Hospital das Clinicas in São Paulo, Brazil. Transfusion 2012; 52:729-38. [PMID: 22593845 PMCID: PMC3703955 DOI: 10.1111/j.1537-2995.2011.03387.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The characteristics of blood recipients including diagnoses associated with transfusion and posttransfusion survival are unreported in Brazil. The goals of this analysis were: 1) to describe blood utilization according to clinical diagnoses and patient characteristics and 2) to determine the factors associated with survival of blood recipients. STUDY DESIGN AND METHODS A retrospective cross-sectional analysis was conducted on all inpatients in 2004. Data came from three sources: The first two files consist of data about patient characteristics, clinical diagnosis, and transfusion. Analyses comparing transfused and nontransfused patients were conducted. The third file was used to determine survival recipients up to 3 years after transfusion. Logistic regression was conducted among transfused patients to examine characteristics associated with survival. RESULTS In 2004, a total of 30,779 patients were admitted, with 3835 (12.4%) transfused. These patients had 10,479 transfusions episodes, consisting of 39,561 transfused components: 16,748 (42%) red blood cells, 15,828 (40%) platelets (PLTs), and 6190 (16%) plasma. The median number of components transfused was three (range, 1-656) per patient admission. Mortality during hospitalization was different for patients whose admissions included transfusion or not (24% vs. 4%). After 1 year, 56% of transfusion recipients were alive. The multivariable model of factors associated with mortality after transfusion showed that the most significant factors in descending order were hospital ward, increasing age, increasing number of components transfused, and type of components received. CONCLUSION Ward and transfusion are markers of underlying medical conditions and are associated with the probability of survival. PLT transfusions are common and likely reflect the types of patients treated. This comprehensive blood utilization study, the first of its kind in Brazil, can help in developing transfusion policy analyses in South America.
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Affiliation(s)
- Thelma T Goncalez
- Blood Systems Research Institute, 270 Masonic Avenue, San Francisco, CA 94118, USA.
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Edgren G, Hjalgrim H. Epidemiological considerations for the use of databases in transfusion research: a Scandinavian perspective. Curr Opin Hematol 2010; 17:596-601. [DOI: 10.1097/moh.0b013e32833e73cf] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Borkent-Raven BA, Janssen MP, Van Der Poel CL, Schaasberg WP, Bonsel GJ, Van Hout BA. The PROTON study: profiles of blood product transfusion recipients in the Netherlands. Vox Sang 2010; 99:54-64. [DOI: 10.1111/j.1423-0410.2010.01312.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Carneiro-Proietti AB, Sabino EC, Sampaio D, Proietti FA, Gonçalez TT, Oliveira CDL, Ferreira JE, Liu J, Custer B, Schreiber GB, Murphy EL, Busch MP. Demographic profile of blood donors at three major Brazilian blood centers: results from the International REDS-II study, 2007 to 2008. Transfusion 2009; 50:918-25. [PMID: 20003051 DOI: 10.1111/j.1537-2995.2009.02529.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The profile of blood donors changed dramatically in Brazil over the past 20 years, from remunerated to nonremunerated and then from replacement to community donors. Donor demographic data from three major blood centers establish current donation profiles in Brazil, serving as baseline for future analyses and tracking longitudinal changes in donor characteristics. STUDY DESIGN AND METHODS Data were extracted from the blood center, compiled in a data warehouse, and analyzed. Population data were obtained from the Brazilian census. RESULTS During 2007 to 2008, there were 615,379 blood donations from 410,423 donors. A total of 426,142 (69.2%) were from repeat (Rpt) donors and 189,237 (30.8%) were from first-time (FT) donors. Twenty percent of FT donors returned to donate in the period. FT donors were more likely to be younger, and Rpt donors were more likely to be community donors. All were predominantly male. Replacement donors still represent 50% of FT and 30% of Rpt donors. The mean percentage of the potentially general population who were donors was approximately 1.2% for the three centers (0.7, 1.5, and 3.1%). Adjusting for the catchment's area, the first two were 2.1 and 1.6%. CONCLUSIONS Donors in the three Brazilian centers tended to be younger with a higher proportion of males than in the general population. Donation rates were lower than desirable. There were substantial differences in sex, age, and community/replacement status by center. Studies on the safety, donation frequencies, and motivations of donors are in progress to orient efforts to enhance the availability of blood.
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Madsen JT, Kimper-Karl ML, Sprogøe U, Georgsen J, Titlestad K. One-year period prevalence of blood transfusion. Transfus Med 2009; 20:191-5. [PMID: 19912580 DOI: 10.1111/j.1365-3148.2009.00977.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Transfusion practice is reported to differ considerably between countries. Comparisons often rely on transfusion rates, incidence - or prevalence rates. In this paper, the one-year period prevalence rate (1-YPPR) of transfusion of red cells (RBC) is presented. Transfusion data, demographic data and patient data were retrospectively combined to calculate sex and diagnosis specific and age standardized 1-YPPR s of RBC transfusion for the complete population in a Danish county. During the calendar year of 2006, 4427 patients received RBC transfusion in Funen County. The crude 1-YPPR of RBC transfusion was 9.2/1000 citizens. Most of the transfused patients had a main diagnosis of neoplasm (22% of recipients), diseases of the circulatory system (15%), the digestive system (15%), injuries (13%) and diseases of the blood (8%). Age standardization reversed the relation between sex specific 1-YPPRs, yielding a statistically significantly higher 1-YPPR in males (6.8/1000) vs. females (6.3/1000). The method for calculating a diagnosis specific 1-YPPR of transfusion of RBC is presented and proposed as an option for comparison of transfusion practice with other transfusion centres. The crude and the diagnosis specific 1-YPPR s are found to increase with age. Thus, age standardization of crude prevalence rates is necessary for meaningful comparisons between populations.
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Affiliation(s)
- J T Madsen
- Department of Clinical Immunology, Odense University Hospital, Odense C, Denmark.
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