1
|
van Sambeeck JHJ, van der Schoot CE, van Dijk NM, Schonewille H, Janssen MP. Extended red blood cell matching for all transfusion recipients is feasible. Transfus Med 2021; 32:221-228. [PMID: 34845765 DOI: 10.1111/tme.12831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 10/08/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To demonstrate the feasibility and effectiveness of extended matching of red blood cells (RBC) in practice. BACKGROUND At present, alloimmunisation preventing matching strategies are only applied for specific transfusion recipient groups and include a limited number of RBC antigens. The general assumption is that providing fully matched RBC units to all transfusion recipients is not feasible. In this article we refute this assumption and compute the proportion of alloimmunisation that can be prevented, when all donors and transfusion recipients are typed for A, B, D plus twelve minor blood group antigens (C, c, E, e, K, Fya , Fyb , Jka , Jkb , M, S and s). METHODS We developed a mathematical model that determines the optimal sequence for antigen matching. The model allows for various matching strategies, issuing policies and inventory sizes. RESULTS For a dynamic inventory composition (accounting for randomness in the phenotypes supplied and requested) and an antigen identical issuing policy 97% and 94% of alloimmunisation events can be prevented, when respectively one and two RBC units per recipient are requested from an inventory of 1000 units. Although this proportion decreases with smaller inventory sizes, even for an inventory of 60 units almost 50% of all alloimmunisation events can be prevented. CONCLUSION In case antigen of both donors and recipients are comprehensively typed, extended preventive matching is feasible for all transfusion recipients in practice and will significantly reduce transfusion-induced alloimmunisation and (alloantibody-induced) haemolytic transfusion reactions.
Collapse
Affiliation(s)
- Joost H J van Sambeeck
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands.,Center for Healthcare Operations Improvement and Research, University of Twente, Enschede, The Netherlands.,Department of Stochastic Operations Research, University of Twente, Enschede, The Netherlands
| | - C Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands.,Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nico M van Dijk
- Center for Healthcare Operations Improvement and Research, University of Twente, Enschede, The Netherlands.,Department of Stochastic Operations Research, University of Twente, Enschede, The Netherlands
| | - Henk Schonewille
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands
| | - Mart P Janssen
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| |
Collapse
|
2
|
Vanden Broeck J, Beeckman K, Van Gastel E, De Keersmaecker L, Devos T, Gérard C, Noens L, Putzeys D, Van Poucke K, Haelterman M, Deneys V, Schots R. Improvement of transfusion practice and reduction in red blood cell utilization in Belgian hospitals: Results of a national survey and benchmarking. Vox Sang 2021; 117:259-267. [PMID: 34374093 DOI: 10.1111/vox.13187] [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: 01/11/2021] [Revised: 06/01/2021] [Accepted: 07/08/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Belgian health authorities launched a national platform in 2011 to improve the quality of transfusion practices and blood use in Belgian hospitals. No data were available about the quality of hospital transfusion practice at the national level. MATERIALS AND METHODS Three consecutive national surveys (2012, 2014 and 2016) were performed in all 111 Belgian hospitals to assess the degree of implementation of standards in four process domains related to red blood cell (RBC) transfusion: general quality aspects, ordering of RBC, electronic traceability and reporting of adverse events. The surveys were part of a methodology based on informing, feedback and benchmarking. Responses to questions were analysed semi-quantitatively, and hospitals could score 10 points on each of the domains. RESULTS The proportion of hospitals scoring below 5 per domain decreased from 16%, 70%, 14% and 11% (2012) to 2%, 17%, 1% and 1% (2016), respectively. Similarly, scores above 7.5 increased from 25%, 1%, 23% and 36% (2012) to 64%, 30%, 68% and 81% (2016), respectively. In 2016, overall quality of transfusion practices, including the four pre-specified domains, improved continuously with an average total score (max = 40) increasing from 24.2 to 30.5 (p = 0.0005). In addition, there was a decrease in the number of distributed and transfused RBC per 1000 population between 2011 and 2019 from 47.0 to 36.5 and 43.5 to 36.1, respectively. CONCLUSION These data show that the applied methodology was a powerful tool to improve quality of transfusion practices and to optimize utilization of RBC at the national level.
Collapse
Affiliation(s)
- Jana Vanden Broeck
- Department of Hematology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Federal Public Service Health, Food Chain Safety and Environment, Brussels, Belgium
| | - Katrien Beeckman
- Nursing and Midwifery Research Unit, University Hospital Brussels, Brussels, Belgium.,Nursing and Midwifery Research Unit, Faculty of Medicine and Pharmacy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Centre for Research and Innovation in Care, Midwifery Research Education and Policymaking (MIDREP), Verpleeg- en vroedkunde, Universiteit Antwerpen, Antwerp, Belgium
| | | | | | - Timothy Devos
- Department of Hematology, Universitair Ziekenhuis Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - Lucien Noens
- Blood Bank, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Dominique Putzeys
- Department of Nursing, Centre Hospitalier Régional de la Citadelle Liège, Liège, Belgium
| | - Karin Van Poucke
- Clinical Laboratory, Algemeen Ziekenhuis Nikolaas, Sint-Niklaas, Belgium
| | - Margareta Haelterman
- Federal Public Service Health, Food Chain Safety and Environment, Brussels, Belgium
| | - Véronique Deneys
- Blood Bank, Département des Laboratoires Cliniques, Cliniques universitaires Saint-Luc, Université Catholique de Louvain Brussels, Brussels, Belgium
| | - Rik Schots
- Department of Hematology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| |
Collapse
|
3
|
Argyrou A, Valsami S, Pouliakis A, Gavalaki M, Aggelidis A, Voulgaridou V, Pliatsika V, Adraktas T, Papachronis A, Alepi C, Giannopoulou V, Siourounis P, Tsagia S, Martinis G, Kontekaki E, Zervou E, Koliofotis S, Kyriakou E, Mougiou A, Dimitra L, Chairopoulou A, Tsakania A, Baka M, Apostolidou I, Moschandreou D, Livada A, Politou M, Roussinou F, Pappa C, Koika V, Vgontza N, Gafou A, Dendrinou I, Sakellaridi F, Labrianou L, Alexandropoulou Z, Sochali V, Malekas K, Skordilaki A, Kakava G, Lebesopoulos K, Stamoulis K, Grouzi E. Current Practice in FFP Preparation and Use in Greece: A National Survey. Turk J Haematol 2021; 38:22-32. [PMID: 33233876 PMCID: PMC7927442 DOI: 10.4274/tjh.galenos.2020.2020.0241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 11/18/2020] [Indexed: 12/01/2022] Open
Abstract
Objective Fresh frozen plasma (FFP) transfusion is widely used in modern clinical settings. Practices regarding its use vary due to lack of guidelines from randomized trials. The aim of this study was to assess both the current practices regarding FFP production, use, and wastage and the implementation of quality control (QC), female donor plasma production policies, and use of pharmaceutical hemostatic agents in Greece. Materials and Methods The study was conducted during February-April 2018. For the first part of the study, data including FFP transfusion indication, hospital department, diagnosis, FFP units/transfusion episode, ABO compatibility, blood donor’s sex, and reasons for discarding were collected. For the second part, questionnaire data were analyzed. Results According to data from 20 Greek hospitals, 12655 FFP units were transfused to 2700 patients during 5069 transfusion episodes in the studied period of time. Most patients were hospitalized in internal medicine, general surgery, and intensive care unit departments. Each patient received on average 4.69 units (2.5 units/episode). Transfusion requests were in accordance with international guidelines in 63.44% of cases and 99.04% of the units were given to ABO-identical patients. Main reasons for discarding included failure to meet quality requirements (30.06%), female donors (22.17%), and other causes (27.26%). Among 96.9% of all transfusion services across the country, 28.26% perform QC according to the directions of the European Directorate for the Quality of Medicines & Health Care and 68.83% discard plasma from female donors. Pharmaceutic hemostatic agents are used in 37.23% of the hospitals. Conclusion This is the first national survey regarding FFP production and transfusion in Greece. Staff of internal medicine, general surgery, and ICU departments, where most FFP-transfused patients are hospitalized, should be regularly involved in training on contemporary transfusion guidelines. Upcoming centralization of FFP production and inventory management could help in homogenizing practices regarding FFP use and improve product quality. Strengthening the use of pharmaceutic hemostatic agents could improve patients’ management.
Collapse
Affiliation(s)
- Aspasia Argyrou
- These authors contributed equally to this work
- Agioi Anargyroi Hospital, Department of Blood Transfusion, Athens, Greece
| | - Serena Valsami
- These authors contributed equally to this work
- National and Kapodistrian University of Athens, Aretaieion University Hospital, Medical School, Hematology Laboratory-Blood Bank Department, Athens, Greece
| | - Abraham Pouliakis
- National and Kapodistrian University of Athens, Attikon University Hospital, Second Department of Pathology, Athens, Greece
| | - Maria Gavalaki
- National and Kapodistrian University of Athens, Attikon University Hospital, Second Department of Pathology, Athens, Greece
| | - Antonis Aggelidis
- Konstantopouleio-Neas Ionias General Hospital, Department of Blood Transfusion, Athens, Greece
| | - Vasiliki Voulgaridou
- AHEPA, University Hospital, Department of Blood Transfusion, Thessaloniki, Greece
| | - Vasiliki Pliatsika
- AHEPA, University Hospital, Department of Blood Transfusion, Thessaloniki, Greece
| | - Theofanis Adraktas
- National and Kapodistrian University of Athens, Attikon University Hospital, Second Department of Pathology, Athens, Greece
| | - Andreas Papachronis
- National and Kapodistrian University of Athens, Attikon University Hospital, Second Department of Pathology, Athens, Greece
| | - Chrysoula Alepi
- General Hospital Tzaneio, Department of Blood Transfusion, Piraeus, Greece
| | | | - Panagiotis Siourounis
- Agios Panteleimon General Hospital of Nikaia, Department of Blood Transfusion, Athens, Greece
| | - Sofia Tsagia
- Agios Panteleimon General Hospital of Nikaia, Department of Blood Transfusion, Athens, Greece
| | - Georges Martinis
- University Hospital, Department of Blood Transfusion, Alexandroupolis, Greece
| | - Eftihia Kontekaki
- University Hospital, Department of Blood Transfusion, Alexandroupolis, Greece
| | - Eleftheria Zervou
- University Hospital, Department of Blood Transfusion, Ioannina, Greece
| | - Spiridon Koliofotis
- Attikon University Hospital, Laboratory of Hematology and Blood Bank Unit, Athens, Greece
| | - Elias Kyriakou
- Attikon University Hospital, Laboratory of Hematology and Blood Bank Unit, Athens, Greece
| | - Athina Mougiou
- University Hospital, Blood Transfusion Center, Patras, Greece
| | | | | | - Aggeliki Tsakania
- Sismanogleio General Hospital, Department of Blood Transfusion, Athens, Greece
| | - Maria Baka
- Thriasio General Hospital, Department of Blood Transfusion, Athens, Greece
| | - Ioanna Apostolidou
- Thriasio General Hospital, Department of Blood Transfusion, Athens, Greece
| | - Dimitra Moschandreou
- Saint Savvas Oncology Hospital, Department of Blood Transfusion and Clinical Hemostasis, Athens, Greece
| | - Anastasia Livada
- Saint Savvas Oncology Hospital, Department of Blood Transfusion and Clinical Hemostasis, Athens, Greece
| | - Marianna Politou
- National and Kapodistrian University of Athens, Aretaieion University Hospital, Medical School, Hematology Laboratory-Blood Bank Department, Athens, Greece
| | - Fragoula Roussinou
- National and Kapodistrian University of Athens, Aretaieion University Hospital, Medical School, Hematology Laboratory-Blood Bank Department, Athens, Greece
| | - Christina Pappa
- General Hospital, Department of Blood Transfusion, Korinthos, Greece
| | - Vasiliki Koika
- General Hospital, Department of Blood Transfusion, Korinthos, Greece
| | - Niki Vgontza
- Konstantopouleio-Neas Ionias General Hospital, Department of Blood Transfusion, Athens, Greece
| | - Anthippi Gafou
- Agioi Anargyroi Hospital, Department of Blood Transfusion, Athens, Greece
| | - Ioanna Dendrinou
- Konstantopouleio-Neas Ionias General Hospital, Department of Blood Transfusion, Athens, Greece
| | | | | | | | - Vasiliki Sochali
- General Hospital, Department of Blood Transfusion, Giannitsa, Greece
| | - Kostas Malekas
- General Hospital, Department of Blood Transfusion, Livadia, Greece
| | - Areti Skordilaki
- General Hospital, Department of Blood Transfusion, Chania, Greece
| | - Georgia Kakava
- Pammakaristos General Hospital, Department of Blood Transfusion, Athens, Greece
| | | | | | - Elisavet Grouzi
- Saint Savvas Oncology Hospital, Department of Blood Transfusion and Clinical Hemostasis, Athens, Greece
| |
Collapse
|
4
|
Lee HJ, Oh SH, Jo SY, Kim IS. Platelet Inventory Management Program: Development and Practical Experience. Ann Lab Med 2021; 41:95-100. [PMID: 32829584 PMCID: PMC7443520 DOI: 10.3343/alm.2021.41.1.95] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/02/2020] [Accepted: 08/02/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Patients with ongoing or expected bleeding require platelet (PLT) transfusions; however, owing to the testing required after a blood donation, manufacturing PLT products may take 1.5-2.0 days after a request is made. This supply-demand mismatch leads clinicians to retain spare PLTs for transfusions, leading to increased PLT discard rates. We developed a PLT inventory management program to supply PLTs more efficiently to patients requiring PLT transfusions within the expiration date, while reducing PLT discard rates. METHODS PLT concentrates (58,863 and 58,357 units) and apheresis products (7,905 and 8,441 units) were analyzed from May 2015 to November 2017 and from December 2017 to January 2020, respectively. We developed a program to manage total PLT inventories and prospective PLT transfusion patients based on blood type, blood product, and remaining period of efficacy; the program facilitates PLT preparation transfer to non-designated patients within the remaining period of efficacy. RESULTS The overall PLT concentrate discard rate was 3,254 (2.78%): 1,811 (3.07%) units before and 1,443 units (2.41%) after program application (P<0.001). The discard rate owing to expiration was reduced from 69 units (3.81%) before to two units (0.14%) after program application (P<0.001). CONCLUSIONS This program can guide the allocation of PLT preparations based on the remaining period of efficacy, enabling PLT products to be used before their expiration date and reducing PLT product discard rate.
Collapse
Affiliation(s)
- Hyun-Ji Lee
- Department of Laboratory Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seung-Hwan Oh
- Department of Laboratory Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Su-Yeon Jo
- Department of Laboratory Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - In-Suk Kim
- Department of Laboratory Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| |
Collapse
|
5
|
Kaphan E, Laurin D, Lafeuillade B, Drillat P, Park S. Impact of transfusion on survival in patients with myelodysplastic syndromes: Current knowledge, new insights and transfusion clinical practice. Blood Rev 2019; 41:100649. [PMID: 31918886 DOI: 10.1016/j.blre.2019.100649] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/25/2019] [Accepted: 12/05/2019] [Indexed: 02/01/2023]
Abstract
Red Blood Cell (RBC) transfusion dependence is a prevalent consequence of anaemia in patients with lower risk Myelodysplastic Syndromes (MDS). These patients have shorter survival compared to patients responding to Erythropoiesis-stimulating agents (ESA), raising the question of potential negative effects of chronic RBC transfusions on MDS prognosis, independently of IPSS-R. Besides commonly identified complications of transfusions like iron toxicity or cardiac events, oxidative stress could be a risk factor for ineffective haematopoiesis. Recently, physicochemical changes of RBC during storage have been described. These changes called storage lesions could play a role in immunomodulation in vivo. We review the currently identified sources of potential impact on transfusion-associated effects in MDS patients and we discuss the unexplored potential role of erythrocyte-derived-extracellular vesicles. They could amplify impairment of haematopoiesis in addition to the negative intrinsic effects underlying the pathology in MDS. Thus, chronic RBC transfusions appear to potentially impact the outcome of MDS.
Collapse
Affiliation(s)
- Eléonore Kaphan
- Service d'Hématologie, CHU de Grenoble, CS 10 217, Grenoble Cedex 09 38043, France.
| | - David Laurin
- Département scientifique, Etablissement Français du Sang Auvergne Rhône-Alpes, La Tronche, France; Institute for Advanced Biosciences, Equipe Pathologie Moléculaire des Cancers et Biomarqueurs, Université Grenoble Alpes, INSERM U1209 & CNRS UMR 5309, France
| | - Bruno Lafeuillade
- Service d'Hématologie, CHU de Grenoble, CS 10 217, Grenoble Cedex 09 38043, France
| | - Philippe Drillat
- Service d'Hématologie, CHU de Grenoble, CS 10 217, Grenoble Cedex 09 38043, France; Département scientifique, Etablissement Français du Sang Auvergne Rhône-Alpes, La Tronche, France
| | - Sophie Park
- Service d'Hématologie, CHU de Grenoble, CS 10 217, Grenoble Cedex 09 38043, France; Institute for Advanced Biosciences, Equipe Pathologie Moléculaire des Cancers et Biomarqueurs, Université Grenoble Alpes, INSERM U1209 & CNRS UMR 5309, France.
| |
Collapse
|
6
|
Thorvaldsson HH, Vidarsson B, Sveinsdottir SV, Olafsson GB, Halldorsdottir AM. Red blood cell utilization and transfusion triggers in patients diagnosed with chronic lymphocytic leukaemia in Iceland 2003-2016. Vox Sang 2019; 114:495-504. [PMID: 30972770 DOI: 10.1111/vox.12775] [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: 08/14/2018] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES Revised Icelandic guidelines proposed a restrictive haemoglobin (Hb) threshold of 70 g/l for red blood cell (RBC) transfusions in general, but 100 g/l for malignancies/bone marrow suppression. Chronic lymphocytic leukaemia (CLL) is frequently complicated by anaemia. The objective was to investigate RBC transfusion practices in CLL. MATERIALS AND METHODS This retrospective nation-wide study utilized an Icelandic registry of CLL patients diagnosed between 2003 and 2016. Medical records were reviewed and haemoglobin transfusion triggers compared for two periods: Earlier (2003-2012) and latter (2013-2017). RESULTS Two hundred and thirteen patients were diagnosed with CLL over the period whereof 77 (36·2%) received RBC transfusion(s). Median time from diagnosis to first transfusion was 2·2 years. Higher age, Rai stage 3/4 at diagnosis (P < 0·05) and chemotherapy (P < 0·001) were associated with increased odds of transfusions. Shorter time to first transfusion correlated with higher age (P < 0·001) and Rai stage (P = 0·02) at diagnosis. The mean Hb trigger was 90·4 and 81·2 in the earlier and latter period respectively (P = 0·01). This difference in Hb triggers was most pronounced in patients without documented bone marrow involvement, or 80·5 g/l compared to 93·5 g/l (P = 0·004). The median time from diagnosis to transfusion was longer in the latter period (2·9 years vs. 1·6 years, P = 0·01). After RBC transfusions the survival decreased significantly (P < 0·001). CONCLUSION One-third of CLL patients received RBC transfusions but few were heavily transfused. Older age, Rai stage, and chemotherapy predicted RBC use. The Hb transfusion trigger decreased over time while time to first RBC transfusion increased. RBC transfusions predict poor survival.
Collapse
Affiliation(s)
| | - Brynjar Vidarsson
- Department of Hematology, Landspitali National University Hospital of Iceland, Reykjavik, Iceland
| | - Signy Vala Sveinsdottir
- Department of Hematology, Landspitali National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Anna Margret Halldorsdottir
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Blood Bank, Landspitali National University Hospital of Iceland, Reykjavik, Iceland
| |
Collapse
|
7
|
Goel R, Patel EU, White JL, Chappidi MR, Ness PM, Cushing MM, Takemoto CM, Shaz BH, Frank SM, Tobian AAR. Factors associated with red blood cell, platelet, and plasma transfusions among inpatient hospitalizations: a nationally representative study in the United States. Transfusion 2018; 59:500-507. [PMID: 30548491 DOI: 10.1111/trf.15088] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 10/19/2018] [Accepted: 10/22/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Demographic and hospital-level factors associated with red blood cell (RBC), plasma, and platelet transfusions in hospitalized patients across the U.S. are not well characterized. METHODS We conducted a retrospective analysis of the National Inpatient Sample (2014). The unit of analysis was a hospitalization; sampling weights were applied to generate nationally-representative estimates. The primary outcome was having ≥ 1 RBC transfusion procedure; plasma and platelet transfusions were similarly assessed as secondary outcomes. For each component, factors associated with transfusion were measured using adjusted prevalence ratios (adjPR) and 95% confidence intervals (95% CI) estimated by multivariable Poisson regression. RESULTS The prevalence of RBC, plasma, and platelet transfusion was 5.8%, 0.9%, and 0.7%, respectively. RBC transfusions were associated with older age (≥ 65 vs. < 18 years; adjPR = 1.80; 95% CI = 1.66-1.96), female sex (adjPR = 1.13; 95% CI = 1.12-1.14), minority race/ethnic status, and hospitalizations in rural hospitals compared to urban teaching hospitals. Prevalence of RBC transfusion was lower among hospitalizations in the Midwest compared to the Northeast (adjPR = 0.73; 95% CI = 0.67-0.80). All components were more likely to be transfused in patients with a primary hematologic diagnosis, patients with a higher number of total diagnoses, patients who experienced a higher number of other procedures, and patients who eventually died in the hospital. In contrast to RBC transfusions, prevalence of platelet transfusion was greater in urban teaching hospitals (vs. rural; adjPR = 1.71; 95% CI = 1.49-1.98) and lower in blacks (vs. whites; adjPR = 0.80; 95% CI = 0.76-0.85). CONCLUSIONS Nationally, there is heterogeneity in factors associated with transfusion between each blood component, including by hospital type and location. This variability presents patient blood management programs with potential opportunities to reduce transfusions.
Collapse
Affiliation(s)
- Ruchika Goel
- Department of Pathology, Johns Hopkins University, Baltimore, MD, United States.,Division of Hematology/Oncology, Simmons Cancer Institute at SIU School of Medicine, Springfield, IL, United States
| | - Eshan U Patel
- Department of Pathology, Johns Hopkins University, Baltimore, MD, United States
| | - Jodie L White
- Department of Pathology, Johns Hopkins University, Baltimore, MD, United States
| | - Meera R Chappidi
- Department of Pathology, Johns Hopkins University, Baltimore, MD, United States
| | - Paul M Ness
- Department of Pathology, Johns Hopkins University, Baltimore, MD, United States
| | - Melissa M Cushing
- Department of Pathology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, United States
| | - Clifford M Takemoto
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD, United States
| | - Beth H Shaz
- New York Blood Center, New York, NY, United States
| | - Steven M Frank
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University, Baltimore, MD, United States
| |
Collapse
|
8
|
Douay L. Why industrial production of red blood cells from stem cells is essential for tomorrow's blood transfusion. Regen Med 2018; 13:627-632. [PMID: 30246611 DOI: 10.2217/rme-2018-0025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Luc Douay
- Erypharm, 27 Rue Chaligny, Paris 75012, France.,Sorbonne Université, Centre de recherche Saint Antoine, 27 Rue Chaligny, Paris 75012, France
| |
Collapse
|
9
|
Estcourt LJ, Malouf R, Hopewell S, Trivella M, Doree C, Stanworth SJ, Murphy MF. Pathogen-reduced platelets for the prevention of bleeding. Cochrane Database Syst Rev 2017; 7:CD009072. [PMID: 28756627 PMCID: PMC5558872 DOI: 10.1002/14651858.cd009072.pub3] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Platelet transfusions are used to prevent and treat bleeding in people who are thrombocytopenic. Despite improvements in donor screening and laboratory testing, a small risk of viral, bacterial, or protozoal contamination of platelets remains. There is also an ongoing risk from newly emerging blood transfusion-transmitted infections for which laboratory tests may not be available at the time of initial outbreak.One solution to reduce the risk of blood transfusion-transmitted infections from platelet transfusion is photochemical pathogen reduction, in which pathogens are either inactivated or significantly depleted in number, thereby reducing the chance of transmission. This process might offer additional benefits, including platelet shelf-life extension, and negate the requirement for gamma-irradiation of platelets. Although current pathogen-reduction technologies have been proven to reduce pathogen load in platelet concentrates, a number of published clinical studies have raised concerns about the effectiveness of pathogen-reduced platelets for post-transfusion platelet count recovery and the prevention of bleeding when compared with standard platelets.This is an update of a Cochrane review first published in 2013. OBJECTIVES To assess the effectiveness of pathogen-reduced platelets for the prevention of bleeding in people of any age requiring platelet transfusions. SEARCH METHODS We searched for randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2016, Issue 9), MEDLINE (from 1946), Embase (from 1974), CINAHL (from 1937), the Transfusion Evidence Library (from 1950), and ongoing trial databases to 24 October 2016. SELECTION CRITERIA We included RCTs comparing the transfusion of pathogen-reduced platelets with standard platelets, or comparing different types of pathogen-reduced platelets. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We identified five new trials in this update of the review. A total of 15 trials were eligible for inclusion in this review, 12 completed trials (2075 participants) and three ongoing trials. Ten of the 12 completed trials were included in the original review. We did not identify any RCTs comparing the transfusion of one type of pathogen-reduced platelets with another.Nine trials compared Intercept® pathogen-reduced platelets to standard platelets, two trials compared Mirasol® pathogen-reduced platelets to standard platelets; and one trial compared both pathogen-reduced platelets types to standard platelets. Three RCTs were randomised cross-over trials, and nine were parallel-group trials. Of the 2075 participants enrolled in the trials, 1981 participants received at least one platelet transfusion (1662 participants in Intercept® platelet trials and 319 in Mirasol® platelet trials).One trial included children requiring cardiac surgery (16 participants) or adults requiring a liver transplant (28 participants). All of the other participants were thrombocytopenic individuals who had a haematological or oncological diagnosis. Eight trials included only adults.Four of the included studies were at low risk of bias in every domain, while the remaining eight included studies had some threats to validity.Overall, the quality of the evidence was low to high across different outcomes according to GRADE methodology.We are very uncertain as to whether pathogen-reduced platelets increase the risk of any bleeding (World Health Organization (WHO) Grade 1 to 4) (5 trials, 1085 participants; fixed-effect risk ratio (RR) 1.09, 95% confidence interval (CI) 1.02 to 1.15; I2 = 59%, random-effect RR 1.14, 95% CI 0.93 to 1.38; I2 = 59%; low-quality evidence).There was no evidence of a difference between pathogen-reduced platelets and standard platelets in the incidence of clinically significant bleeding complications (WHO Grade 2 or higher) (5 trials, 1392 participants; RR 1.10, 95% CI 0.97 to 1.25; I2 = 0%; moderate-quality evidence), and there is probably no difference in the risk of developing severe bleeding (WHO Grade 3 or higher) (6 trials, 1495 participants; RR 1.24, 95% CI 0.76 to 2.02; I2 = 32%; moderate-quality evidence).There is probably no difference between pathogen-reduced platelets and standard platelets in the incidence of all-cause mortality at 4 to 12 weeks (6 trials, 1509 participants; RR 0.81, 95% CI 0.50 to 1.29; I2 = 26%; moderate-quality evidence).There is probably no difference between pathogen-reduced platelets and standard platelets in the incidence of serious adverse events (7 trials, 1340 participants; RR 1.09, 95% CI 0.88 to 1.35; I2 = 0%; moderate-quality evidence). However, no bacterial transfusion-transmitted infections occurred in the six trials that reported this outcome.Participants who received pathogen-reduced platelet transfusions had an increased risk of developing platelet refractoriness (7 trials, 1525 participants; RR 2.94, 95% CI 2.08 to 4.16; I2 = 0%; high-quality evidence), though the definition of platelet refractoriness differed between trials.Participants who received pathogen-reduced platelet transfusions required more platelet transfusions (6 trials, 1509 participants; mean difference (MD) 1.23, 95% CI 0.86 to 1.61; I2 = 27%; high-quality evidence), and there was probably a shorter time interval between transfusions (6 trials, 1489 participants; MD -0.42, 95% CI -0.53 to -0.32; I2 = 29%; moderate-quality evidence). Participants who received pathogen-reduced platelet transfusions had a lower 24-hour corrected-count increment (7 trials, 1681 participants; MD -3.02, 95% CI -3.57 to -2.48; I2 = 15%; high-quality evidence).None of the studies reported quality of life.We did not evaluate any economic outcomes.There was evidence of subgroup differences in multiple transfusion trials between the two pathogen-reduced platelet technologies assessed in this review (Intercept® and Mirasol®) for all-cause mortality and the interval between platelet transfusions (favouring Intercept®). AUTHORS' CONCLUSIONS Findings from this review were based on 12 trials, and of the 1981 participants who received a platelet transfusion only 44 did not have a haematological or oncological diagnosis.In people with haematological or oncological disorders who are thrombocytopenic due to their disease or its treatment, we found high-quality evidence that pathogen-reduced platelet transfusions increase the risk of platelet refractoriness and the platelet transfusion requirement. We found moderate-quality evidence that pathogen-reduced platelet transfusions do not affect all-cause mortality, the risk of clinically significant or severe bleeding, or the risk of a serious adverse event. There was insufficient evidence for people with other diagnoses.All three ongoing trials are in adults (planned recruitment 1375 participants) with a haematological or oncological diagnosis.
Collapse
Affiliation(s)
- Lise J Estcourt
- NHS Blood and TransplantHaematology/Transfusion MedicineLevel 2, John Radcliffe HospitalHeadingtonOxfordUKOX3 9BQ
| | - Reem Malouf
- University of OxfordNational Perinatal Epidemiology Unit (NPEU)Old Road CampusOxfordUKOX3 7LF
| | - Sally Hopewell
- University of OxfordOxford Clinical Trials Research UnitNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesWindmill RoadOxfordUKOX3 7LD
| | - Marialena Trivella
- University of OxfordCentre for Statistics in MedicineBotnar Research CentreWindmill RoadOxfordUKOX3 7LD
| | - Carolyn Doree
- NHS Blood and TransplantSystematic Review InitiativeJohn Radcliffe HospitalOxfordUKOX3 9BQ
| | - Simon J Stanworth
- Oxford University Hospitals NHS Foundation Trust and University of OxfordNational Institute for Health Research (NIHR) Oxford Biomedical Research CentreJohn Radcliffe Hospital, Headley WayHeadingtonOxfordUKOX3 9BQ
| | - Michael F Murphy
- Oxford University Hospitals NHS Foundation Trust and University of OxfordNHS Blood and Transplant; National Institute for Health Research (NIHR) Oxford Biomedical Research CentreJohn Radcliffe HospitalHeadingtonOxfordUK
| |
Collapse
|
10
|
Mahmoudi R, Novella JL, Jaïdi Y. [Transfusion in elderly: Take account frailty]. Transfus Clin Biol 2017; 24:200-208. [PMID: 28690038 DOI: 10.1016/j.tracli.2017.06.017] [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: 06/11/2017] [Accepted: 06/12/2017] [Indexed: 10/19/2022]
Abstract
The conjunction of the demographic aging and the increase in the frequency of anemia with the advancing age, mean that the number of globular concentrates delivered each year increases with a consequent heavy pressure on blood collection. The etiologies of anemia in the elderly are often multifactorial and their investigation is an indispensable step and prior to any treatment. Transfusion thresholds, particularly in the elderly, are gradually evolving and a so-called restrictive strategy is now favored. Immediate and delayed complications of transfusion are more frequent in the elderly due to vulnerability factors associated with frailty and the risk of multiple transfusions. The screening of complications related to transfusion of RBCs is essential and makes it possible to avoid their recurrence. The impact of transfusion on the quality of life of elderly patients is not obvious and is a controversial issue. In addition, transfusion of red blood cells (RBCs) is accompanied by an increase in health expenditure and an increase in morbidity and mortality, whose risks can be reduced through alternatives to transfusion. Longitudinal studies, including elderly subjects, would allow a better understanding of the issues involved in the transfusion of RBCs in this population.
Collapse
Affiliation(s)
- R Mahmoudi
- Service de médecine interne et gériatrie aiguë, hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France; EA 3797, faculté de médecine, université de Reims Champagne Ardenne, 51092 Reims cedex, France.
| | - J-L Novella
- Service de médecine interne et gériatrie aiguë, hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France; EA 3797, faculté de médecine, université de Reims Champagne Ardenne, 51092 Reims cedex, France
| | - Y Jaïdi
- Service de médecine interne et gériatrie aiguë, hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France; EA 3797, faculté de médecine, université de Reims Champagne Ardenne, 51092 Reims cedex, France
| |
Collapse
|
11
|
Burnouf T, Elemary M, Radosevic J, Seghatchian J, Goubran H. Platelet transfusion in thrombocytopenic cancer patients: Sometimes justified but likely insidious. Transfus Apher Sci 2017; 56:305-309. [PMID: 28606448 DOI: 10.1016/j.transci.2017.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The transfusion of platelet concentrates prepared from allogeneic single or pooled donations is a standard procedure in transfusion medicine to stop or prevent bleeding in cancer patients with thrombocytopenia undergoing surgery, chemotherapy and/or radiotherapy. While platelet transfusion may appear reasonable in many instances, greater scientific and medical attention should however be given to the possibly insidious impact of transfused platelets on the outcome of cancers. Indeed platelets and the microvesicles they release possess all the biological ingredients capable of supporting tumor growth, protecting circulating tumor cells, and to contributing to metastatic invasion. Until any randomized controlled trials can objectively document their effects on survival or cancer recurrence, minimizing the use of platelet transfusion in cancer patients appears to represent a reasonable precautionary measure.
Collapse
Affiliation(s)
- Thierry Burnouf
- Graduate Institute of Biological Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; International PhD Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan.
| | - Mohamed Elemary
- Saskatoon Cancer Centre and College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | | | - Jerard Seghatchian
- International Consultancy in Blood Components Quality/Safety Improvement, Audit/Inspection and DDR Strategies, London, UK
| | - Hadi Goubran
- Saskatoon Cancer Centre and College of Medicine, University of Saskatchewan, Saskatchewan, Canada.
| |
Collapse
|