1
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Wemelsfelder ML, van de Weem RHG, Luken JS, de Haas M, Niessen RWLM, van der Schoot CE, Hoogeveen H, Oyebolu FB, den Hertog D, Janssen MP. Extensive red blood cell matching considering patient alloimmunization risk. Vox Sang 2024; 119:368-376. [PMID: 38286764 DOI: 10.1111/vox.13594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/08/2024] [Accepted: 01/15/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND AND OBJECTIVES Red blood cell (RBC) transfusions pose a risk of alloantibody development in patients. For patients with increased alloimmunization risk, extended preventive matching is advised, encompassing not only the ABO-D blood groups but also the most clinically relevant minor antigens: C, c, E, e, K, Fya, Fyb, Jka, Jkb, S and s. This study incorporates patient-specific data and the clinical consequences of mismatching into the allocation process. MATERIALS AND METHODS We have redefined the MINimize Relative Alloimmunization Risks (MINRAR) model to include patient group preferences in selecting RBC units from a finite supply. A linear optimization approach was employed, considering both antigen immunogenicity and the clinical impact of mismatches for specific patient groups. We also explore the advantages of informing the blood bank about scheduled transfusions, allowing for a more strategic blood distribution. The model is evaluated using historical data from two Dutch hospitals, measuring shortages and minor antigen mismatches. RESULTS The updated model, emphasizing patient group-specific considerations, achieves a similar number of mismatches as the original, yet shifts mismatches among patient groups and antigens, reducing expected alloimmunization consequences. Simultaneous matching for multiple hospitals at the distribution centre level, considering scheduled demands, led to a 30% decrease in mismatches and a 92% reduction in shortages. CONCLUSION The reduction of expected alloimmunization consequences by incorporating patient group preferences demonstrates our strategy's effectiveness for patient health. Substantial reductions in mismatches and shortages with multi-hospital collaboration highlights the importance of sharing information in the blood supply chain.
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Affiliation(s)
- Merel L Wemelsfelder
- Donor Medicine Research Department, Sanquin Research, Amsterdam, the Netherlands
- Business Analytics Department, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Jessie S Luken
- Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, the Netherlands
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, the Netherlands
| | - Masja de Haas
- Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, the Netherlands
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, the Netherlands
- Department of Hematology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - C Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, the Netherlands
| | - Han Hoogeveen
- Department of Information and Computing Sciences, Utrecht University, Utrecht, the Netherlands
| | | | - Dick den Hertog
- Business Analytics Department, University of Amsterdam, Amsterdam, the Netherlands
| | - Mart P Janssen
- Donor Medicine Research Department, Sanquin Research, Amsterdam, the Netherlands
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2
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Vinkenoog M, Toivonen J, van Leeuwen M, Janssen MP, Arvas M. The added value of ferritin levels and genetic markers for the prediction of haemoglobin deferral. Vox Sang 2023; 118:825-834. [PMID: 37649369 DOI: 10.1111/vox.13517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/28/2023] [Accepted: 08/07/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND AND OBJECTIVES On-site haemoglobin deferral for blood donors is sometimes necessary for donor health but demotivating for donors and inefficient for the blood bank. Deferral rates could be reduced by accurately predicting donors' haemoglobin status before they visit the blood bank. Although such predictive models have been published, there is ample room for improvement in predictive performance. We aim to assess the added value of ferritin levels or genetic markers as predictor variables in haemoglobin deferral prediction models. MATERIALS AND METHODS Support vector machines with and without this information (the full and reduced model, respectively) are compared in Finland and the Netherlands. Genetic markers are available in the Finnish data and ferritin levels in the Dutch data. RESULTS Although there is a clear association between haemoglobin deferral and both ferritin levels and several genetic markers, predictive performance increases only marginally with their inclusion as predictors. The recall of deferrals increases from 68.6% to 69.9% with genetic markers and from 79.7% to 80.0% with ferritin levels included. Subgroup analyses show that the added value of these predictors is higher in specific subgroups, for example, for donors with minor alleles on single-nucleotide polymorphism 17:58358769, recall of deferral increases from 73.3% to 93.3%. CONCLUSION Including ferritin levels or genetic markers in haemoglobin deferral prediction models improves predictive performance. The increase in overall performance is small but may be substantial for specific subgroups. We recommend including this information as predictor variables when available, but not to collect it for this purpose only.
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Affiliation(s)
- Marieke Vinkenoog
- Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
- Leiden Institute of Advanced Computer Science, Leiden University, Leiden, The Netherlands
| | - Jarkko Toivonen
- Research and Development, Finnish Red Cross Blood Service, Helsinki, Finland
| | - Matthijs van Leeuwen
- Leiden Institute of Advanced Computer Science, Leiden University, Leiden, The Netherlands
| | - Mart P Janssen
- Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| | - Mikko Arvas
- Research and Development, Finnish Red Cross Blood Service, Helsinki, Finland
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3
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Rudokaite J, Ong LLS, Onal Ertugrul I, Janssen MP, Huis In 't Veld EMJ. Predicting vasovagal reactions to needles with anticipatory facial temperature profiles. Sci Rep 2023; 13:9667. [PMID: 37316637 DOI: 10.1038/s41598-023-36207-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 05/31/2023] [Indexed: 06/16/2023] Open
Abstract
Around one-third of adults are scared of needles, which can result in adverse emotional and physical responses such as dizziness and fainting (e.g. vasovagal reactions; VVR) and consequently, avoidance of healthcare, treatments, and immunizations. Unfortunately, most people are not aware of vasovagal reactions until they escalate, at which time it is too late to intervene. This study aims to investigate whether facial temperature profiles measured in the waiting room, prior to a blood donation, can be used to classify who will and will not experience VVR during the donation. Average temperature profiles from six facial regions were extracted from pre-donation recordings of 193 blood donors, and machine learning was used to classify whether a donor would experience low or high levels of VVR during the donation. An XGBoost classifier was able to classify vasovagal groups from an adverse reaction during a blood donation based on this early facial temperature data, with a sensitivity of 0.87, specificity of 0.84, F1 score of 0.86, and PR-AUC of 0.93. Temperature fluctuations in the area under the nose, chin and forehead have the highest predictive value. This study is the first to demonstrate that it is possible to classify vasovagal responses during a blood donation using temperature profiles.
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Affiliation(s)
- Judita Rudokaite
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, Tilburg, The Netherlands.
- Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands.
- Department of Cognitive Science & Artificial Intelligence, Tilburg University, PO Box 90153, Warandelaan 2 (Room D147), 5000 LE, Tilburg, The Netherlands.
| | - L L Sharon Ong
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, Tilburg, The Netherlands
| | - Itir Onal Ertugrul
- Department of Information and Computing Sciences, Utrecht University, Utrecht, The Netherlands
| | - Mart P Janssen
- Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| | - Elisabeth M J Huis In 't Veld
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, Tilburg, The Netherlands
- Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
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4
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Kroes SKS, van Leeuwen M, Groenwold RHH, Janssen MP. Generating synthetic mixed discrete-continuous health records with mixed sum-product networks. J Am Med Inform Assoc 2022; 30:16-25. [PMID: 36228120 PMCID: PMC9748584 DOI: 10.1093/jamia/ocac184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/09/2022] [Accepted: 10/01/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Privacy is a concern whenever individual patient health data is exchanged for scientific research. We propose using mixed sum-product networks (MSPNs) as private representations of data and take samples from the network to generate synthetic data that can be shared for subsequent statistical analysis. This anonymization method was evaluated with respect to privacy and information loss. MATERIALS AND METHODS Using a simulation study, information loss was quantified by assessing whether synthetic data could reproduce regression parameters obtained from the original data. Predictors variable types were varied between continuous, count, categorical, and mixed discrete-continuous. Additionally, we measured whether the MSPN approach successfully anonymizes the data by removing associations between background and sensitive information for these datasets. RESULTS The synthetic data generated with MSPNs yielded regression results highly similar to those generated with original data, differing less than 5% in most simulation scenarios. Standard errors increased compared to the original data. Particularly for smaller datasets (1000 records), this resulted in a discrepancy between the estimated and empirical standard errors. Sensitive values could no longer be inferred from background information for at least 99% of tested individuals. DISCUSSION The proposed anonymization approach yields very promising results. Further research is required to evaluate its performance with other types of data and analyses, and to predict how user parameter choices affect a bias-privacy trade-off. CONCLUSION Generating synthetic data from MSPNs is a promising, easy-to-use approach for anonymization of sensitive individual health data that yields informative and private data.
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Affiliation(s)
- Shannon K S Kroes
- Transfusion Technology Assessment Group, Donor Medicine Research Department, Sanquin Research, Amsterdam, The Netherlands
- Leiden Institute of Advanced Computer Science, Computer Science, Leiden University, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Matthijs van Leeuwen
- Leiden Institute of Advanced Computer Science, Computer Science, Leiden University, Leiden, The Netherlands
| | - Rolf H H Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Mart P Janssen
- Transfusion Technology Assessment Group, Donor Medicine Research Department, Sanquin Research, Amsterdam, The Netherlands
- Leiden Institute of Advanced Computer Science, Computer Science, Leiden University, Leiden, The Netherlands
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5
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Wemelsfelder ML, den Hertog D, Wisman O, Ihalainen J, Janssen MP. Determining optimal locations for blood distribution centers. Transfusion 2022; 62:2515-2524. [PMID: 36239229 PMCID: PMC10092065 DOI: 10.1111/trf.17147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Blood banks have to be thoughtful about supply chain decisions to effectively satisfy the blood product demand of hospitals. These decisions include the number and locations of distribution centers (DC), as this has a strong impact on both transportation cost and the ability to deliver emergency orders in time. STUDY DESIGN AND METHODS We propose a mixed-integer linear programming approach to find optimal DC locations for supplying individual hospitals. The model maximizes the number of hospitals reachable from a DC within a given time-limit, and minimizes transportation cost. The minimal amount of data required is a set of hospital locations. The model can be further attuned to the user's needs by adding various model extensions. The model's use is demonstrated by two case studies, considering the blood banks of the Netherlands and Finland. RESULTS For both case studies re-locating the DCs would result in a reduction of transportation cost of about 10% without affecting the reliability of delivery. In addition, to save facility exploitation costs, the number of DCs may be reduced in both countries while maintaining the reliability of delivery. The model was also shown to be robust against changes in hospital ordering behavior. DISCUSSION We demonstrated the general usability and added value of the model by successfully optimizing the blood supply chains of the Netherlands and Finland, which differ substantially. Nonetheless, in both countries potential savings in both transportation and facility exploitation cost could be shown. The model code is open source and freely accessible online.
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Affiliation(s)
- Merel L Wemelsfelder
- Donor Medicine Department, Sanquin Research, Amsterdam, The Netherlands.,Business Analytics Department, University of Amsterdam, Amsterdam, The Netherlands
| | - Dick den Hertog
- Business Analytics Department, University of Amsterdam, Amsterdam, The Netherlands
| | - Onno Wisman
- Sanquin Blood Bank, Amsterdam, The Netherlands
| | - Jarkko Ihalainen
- Products and Medical Services, Finnish Red Cross Blood Service, Helsinki, Finland
| | - Mart P Janssen
- Donor Medicine Department, Sanquin Research, Amsterdam, The Netherlands
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6
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Vinkenoog M, van Leeuwen M, Janssen MP. Explainable haemoglobin deferral predictions using machine learning models: Interpretation and consequences for the blood supply. Vox Sang 2022; 117:1262-1270. [PMID: 36102148 PMCID: PMC9826045 DOI: 10.1111/vox.13350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/29/2022] [Accepted: 08/09/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Accurate predictions of haemoglobin (Hb) deferral for whole-blood donors could aid blood banks in reducing deferral rates and increasing efficiency and donor motivation. Complex models are needed to make accurate predictions, but predictions must also be explainable. Before the implementation of a prediction model, its impact on the blood supply should be estimated to avoid shortages. MATERIALS AND METHODS Donation visits between October 2017 and December 2021 were selected from Sanquin's database system. The following variables were available for each visit: donor sex, age, donation start time, month, number of donations in the last 24 months, most recent ferritin level, days since last ferritin measurement, Hb at nth previous visit (n between 1 and 5), days since the nth previous visit. Outcome Hb deferral has two classes: deferred and not deferred. Support vector machines were used as prediction models, and SHapley Additive exPlanations values were used to quantify the contribution of each variable to the model predictions. Performance was assessed using precision and recall. The potential impact on blood supply was estimated by predicting deferral at earlier or later donation dates. RESULTS We present a model that predicts Hb deferral in an explainable way. If used in practice, 64% of non-deferred donors would be invited on or before their original donation date, while 80% of deferred donors would be invited later. CONCLUSION By using this model to invite donors, the number of blood bank visits would increase by 15%, while deferral rates would decrease by 60% (currently 3% for women and 1% for men).
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Affiliation(s)
- Marieke Vinkenoog
- Department of Donor Medicine ResearchSanquin ResearchAmsterdamthe Netherlands,Leiden Institute of Advanced Computer ScienceLeiden UniversityLeidenthe Netherlands
| | - Matthijs van Leeuwen
- Leiden Institute of Advanced Computer ScienceLeiden UniversityLeidenthe Netherlands
| | - Mart P. Janssen
- Department of Donor Medicine ResearchSanquin ResearchAmsterdamthe Netherlands
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7
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Janssen MP. Why the majority of on‐site repeat donor deferrals are completely unwarranted…. Transfusion 2022; 62:2068-2075. [DOI: 10.1111/trf.17085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Mart P. Janssen
- Transfusion Technology Assessment Group, Department of Donor Medicine Research Sanquin Research Amsterdam The Netherlands
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8
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Luken JS, Ritsema SP, Van der Wal MM, van der Schoot CE, Rouwette EAJA, de Haas M, Janssen MP. Mapping anticipated advantages and disadvantages of implementation of extensive donor genotyping: A focus group approach. Transfus Med 2022; 32:366-374. [PMID: 35668008 DOI: 10.1111/tme.12887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/11/2022] [Accepted: 04/24/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Current genotyping techniques allow typing of all relevant red cell, human leukocyte and platelet antigens in a single analysis. Even genetic markers related to donor health can be added. Implementation of this technology will affect various stakeholders within the transfusion chain. This study aims to systematically map the anticipated advantages and disadvantages of a national rollout of blood group genotyping of donors, which will affect the availability of rare donors and the implementation of an extensively typed blood transfusion policy. MATERIALS AND METHODS Two focus-group sessions were held with a wide representation of stakeholders, including representatives of donor and patient organisations. A dedicated software tool was used to collect the reflections of participants on genotyping for blood group antigens and extensive matching. Additionally, stakeholders and experts discussed various prepared propositions. All information collected was categorised. RESULTS From 162 statements collected, 59 statements (36%) were labelled as 'hopes' and 77 (48%) as 'fears'. Twenty-six (16%) statements remained unlabelled. The statements were divided in 18 categories under seven main themes: patient health, genotyping, privacy issues and ethical aspects, donor management, inventory management and logistics, hospital and transfusion laboratory and general aspects. The discussion on the propositions was analysed and summarised. CONCLUSION Stakeholders believe that a genotyped donor pool can result in a reduction of alloimmunization and higher availability of typed blood products. There are concerns regarding logistics, costs, consent for extended typing, data sharing, privacy issues and donor management. These concerns need to be carefully addressed before further implementation.
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Affiliation(s)
- Jessie S Luken
- Department of Immunohaematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Sebastien P Ritsema
- Transfusion Technology Assessment Group, Donor Medicine Research Department, Sanquin Research, Amsterdam, The Netherlands
| | - Merel M Van der Wal
- Institute for Management Research, Radboud University, Nijmegen, The Netherlands
| | - C Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands
| | | | - Masja de Haas
- Department of Immunohaematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands.,Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mart P Janssen
- Transfusion Technology Assessment Group, Donor Medicine Research Department, Sanquin Research, Amsterdam, The Netherlands
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9
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Turkulainen EV, Wemelsfelder ML, Janssen MP, Arvas M. A robust autonomous method for blood demand forecasting. Transfusion 2022; 62:1261-1268. [PMID: 35383944 PMCID: PMC9325496 DOI: 10.1111/trf.16870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 11/27/2022]
Abstract
Background Blood supply chain management requires estimates about the demand of blood products. The more accurate these estimates are, the less wastage and fewer shortages occur. While the current literature demonstrates tangible benefits from statistical forecasting approaches, it highlights issues that discourage their use in blood supply chain optimization: there is no single approach that works everywhere, and there are no guarantees that any favorable method performance continues into the future. Study Design and Methods We design a novel autonomous forecasting system to solve the aforementioned issues. We show how possible changes in blood demand could affect prediction performance using partly synthetic demand data. We use these data then to investigate the performances of different method selection heuristics. Finally, the performances of the heuristics and single method approaches were compared using historical demand data from Finland and the Netherlands. The development code is publicly accessible. Results We find that a shift in the demand signal behavior from stochastic to seasonal would affect the relative performances of the methods. Our autonomous system outperforms all examined individual methods when forecasting the synthetic demand series, exhibiting meaningful robustness. When forecasting with real data, the most accurate methods in Finland and in the Netherlands are the autonomous system and the method average, respectively. Discussion Optimal use of method selection heuristics, as with our autonomous system, may overcome the need to constantly supervise forecasts in anticipation of changes in demand while being sufficiently accurate in the absence of such changes.
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Affiliation(s)
- Esa V Turkulainen
- Research and Development, Finnish Red Cross Blood Service, Helsinki, Finland
| | - Merel L Wemelsfelder
- Transfusion Technology Assessment Group, Donor Medicine Department, Sanquin Research, Amsterdam, the Netherlands
| | - Mart P Janssen
- Transfusion Technology Assessment Group, Donor Medicine Department, Sanquin Research, Amsterdam, the Netherlands
| | - Mikko Arvas
- Research and Development, Finnish Red Cross Blood Service, Helsinki, Finland
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10
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Vinkenoog M, Steenhuis M, Brinke AT, van Hasselt JGC, Janssen MP, van Leeuwen M, Swaneveld FH, Vrielink H, van de Watering L, Quee F, van den Hurk K, Rispens T, Hogema B, van der Schoot CE. Associations Between Symptoms, Donor Characteristics and IgG Antibody Response in 2082 COVID-19 Convalescent Plasma Donors. Front Immunol 2022; 13:821721. [PMID: 35296077 PMCID: PMC8918483 DOI: 10.3389/fimmu.2022.821721] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/03/2022] [Indexed: 12/13/2022] Open
Abstract
Many studies already reported on the association between patient characteristics on the severity of COVID-19 disease outcome, but the relation with SARS-CoV-2 antibody levels is less clear. To investigate this in more detail, we performed a retrospective observational study in which we used the IgG antibody response from 11,118 longitudinal antibody measurements of 2,082 unique COVID convalescent plasma donors. COVID-19 symptoms and donor characteristics were obtained by a questionnaire. Antibody responses were modelled using a linear mixed-effects model. Our study confirms that the SARS-CoV-2 antibody response is associated with patient characteristics like body mass index and age. Antibody decay was faster in male than in female donors (average half-life of 62 versus 72 days). Most interestingly, we also found that three symptoms (headache, anosmia, nasal cold) were associated with lower peak IgG, while six other symptoms (dry cough, fatigue, diarrhoea, fever, dyspnoea, muscle weakness) were associated with higher IgG concentrations.
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Affiliation(s)
- Marieke Vinkenoog
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, Netherlands
- Leiden Institute of Advanced Computer Science, Leiden University, Leiden, Netherlands
| | - Maurice Steenhuis
- Department of Immunopathology, Sanquin Research, Amsterdam, Netherlands
- Landsteiner Laboratory, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Anja ten Brinke
- Department of Immunopathology, Sanquin Research, Amsterdam, Netherlands
- Landsteiner Laboratory, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - J. G. Coen van Hasselt
- Division of Systems Biomedicine and Pharmacology, Leiden Academic Centre for Drug Research, Leiden University, Leiden, Netherlands
| | - Mart P. Janssen
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, Netherlands
- Leiden Institute of Advanced Computer Science, Leiden University, Leiden, Netherlands
| | - Matthijs van Leeuwen
- Leiden Institute of Advanced Computer Science, Leiden University, Leiden, Netherlands
| | - Francis H. Swaneveld
- Department of Transfusion Medicine, Sanquin Blood Supply, Amsterdam, Netherlands
| | - Hans Vrielink
- Department of Transfusion Medicine, Sanquin Blood Supply, Amsterdam, Netherlands
| | - Leo van de Watering
- Department of Transfusion Medicine, Sanquin Blood Supply, Amsterdam, Netherlands
| | - Franke Quee
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, Netherlands
| | - Katja van den Hurk
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research, Amsterdam, Netherlands
- Landsteiner Laboratory, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Boris Hogema
- Department of Virology, Sanquin Diagnostic Services, Amsterdam, Netherlands
| | - C. Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory Amsterdam University Medical Centre, Amsterdam, Netherlands
- *Correspondence: C. Ellen van der Schoot,
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11
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Rudokaite J, Ong LLS, P Janssen M, Postma E, Huis In 't Veld E. Predicting vasovagal reactions to a virtual blood donation using facial image analysis. Transfusion 2022; 62:838-847. [PMID: 35191034 PMCID: PMC9306567 DOI: 10.1111/trf.16832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/31/2022] [Accepted: 01/31/2022] [Indexed: 01/13/2023]
Abstract
Background People with needle fear experience not only anxiety and stress but also vasovagal reactions (VVR), including nausea, dizziness, sweating, pallor changes, or even fainting. However, the mechanism behind needle fear and the VVR response are not yet well understood. The aim of our study was to explore whether fluctuations in facial temperature in several facial regions are related to the level of experienced vasovagal reactions, in a simulated blood donation. Study design and methods We recruited 45 students at Tilburg University and filmed them throughout a virtual blood donation procedure using an Infrared Thermal Imaging (ITI) camera. Participants reported their fear of needles and level of experienced vasovagal reactions. ITI data pre‐processing was completed on each video frame by detecting facial landmarks and image alignment before extracting the mean temperature from the six regions of interest. Results Temperatures of the chin and left and right cheek areas increased during the virtual blood donation. Mixed‐effects linear regression showed a significant association between self‐reported vasovagal reactions and temperature fluctuations in the area below the nose. Discussion Our results suggest that the area below the nose may be an interesting target for measuring vasovagal reactions using video imaging techniques. This is the first in a line of studies, which assess whether it is possible to automatically detect levels of fear and vasovagal reactions using facial imaging, from which the development of e‐health solutions and interventions can benefit.
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Affiliation(s)
- Judita Rudokaite
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, Tilburg, the Netherlands.,Department of Donor Medicine Research, Sanquin, Amsterdam, the Netherlands
| | - Lee-Ling Sharon Ong
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, Tilburg, the Netherlands
| | - Mart P Janssen
- Department of Donor Medicine Research, Sanquin, Amsterdam, the Netherlands
| | - Eric Postma
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, Tilburg, the Netherlands
| | - Elisabeth Huis In 't Veld
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, Tilburg, the Netherlands.,Department of Donor Medicine Research, Sanquin, Amsterdam, the Netherlands
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12
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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: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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13
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van de Weem RHG, Wemelsfelder ML, Luken JS, de Haas M, Niessen RWLM, van der Schoot CE, Hoogeveen H, Janssen MP. Preventing alloimmunization using a new model for matching extensively typed red blood cells. Vox Sang 2021; 117:580-586. [PMID: 34725840 DOI: 10.1111/vox.13217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/06/2021] [Accepted: 10/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Alloimmunization is a well-known adverse event associated with red blood cell (RBC) transfusions, caused by phenotype incompatibilities between donor and patient RBCs that may lead to haemolytic transfusion reactions on subsequent transfusions. Alloimmunization can be prevented by transfusing fully matched RBC units. Advances in RBC genotyping render the extensive typing of both donors and patients affordable in the foreseeable future. However, the exponential increase in the variety of extensively typed RBCs asks for a software-driven selection to determine the 'best product for a given patient'. MATERIALS AND METHODS We propose the MINimize Relative Alloimmunization Risks (MINRAR) model for matching extensively typed RBC units to extensively typed patients to minimize the risk of alloimmunization. The key idea behind this model is to use antigen immunogenicity to represent the clinical implication of a mismatch. Using simulations of non-elective transfusions in Caucasian donor and patient populations, the effect on the alloimmunization rate of the MINRAR model is compared with that of a baseline model that matches antigens A, B and RhD only. RESULTS Our simulations show that with the MINRAR model, even for small inventories, the expected number of alloimmunizations can be reduced by 78.3% compared with a policy of only matching on antigens A, B and RhD. Furthermore, a reduction of 93.7% can be achieved when blood is issued from larger inventories. CONCLUSION Despite an exponential increase in phenotype variety, matching of extensively typed RBCs can be effectively implemented using our MINRAR model, effectuating a substantial reduction in alloimmunization risk without introducing additional outdating or shortages.
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Affiliation(s)
- Ronald H G van de Weem
- Transfusion Technology Assessment Group, Donor Medicine Research Department, Sanquin Research, Amsterdam, The Netherlands
| | - Merel L Wemelsfelder
- Transfusion Technology Assessment Group, Donor Medicine Research Department, Sanquin Research, Amsterdam, The Netherlands
| | | | | | | | - C Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands
| | | | - Mart P Janssen
- Transfusion Technology Assessment Group, Donor Medicine Research Department, Sanquin Research, Amsterdam, The Netherlands
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14
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Abstract
Although data protection is compulsory when personal data is shared, there is no systematic method available to evaluate to what extent each individual is at risk of a privacy breach. We use a collection of measures that quantify how much information is needed to uncover sensitive information. Combined with visualization techniques, our approach can be used to perform a detailed privacy analysis of medical data. Because privacy is evaluated per variable, these adjustments can be made while incorporating how likely it is that these variables will be exploited to uncover sensitive information in practice, as is mandatory in the European Union. Additionally, the analysis of privacy can be used to evaluate to what extent knowledge on specific variables in the data can contribute to privacy breaches, which can subsequently guide the use of anonymization techniques, such as generalization.
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Affiliation(s)
- Shannon Ks Kroes
- Sanquin Research, the Netherlands.,Leiden University, the Netherlands.,Leiden University Medical Center, the Netherlands
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15
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Langi Sasongko P, van den Hurk K, van Kraaij M, Rouwette EAJA, Marchau VAWJ, Janssen MP. Not a crystal ball: Mapping opportunities and threats for the future demand of red blood cells in the Netherlands using a scenario approach. Transfusion 2021; 61:2356-2367. [PMID: 34058022 DOI: 10.1111/trf.16532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/29/2021] [Accepted: 04/29/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND As Western blood transfusion practices are changing, there is interest and need in anticipating the future demand of blood products and how a blood establishment can actively prepare for various long-term developments. This article provides an overview of how a scenario approach was used to prioritize key categories of drivers for the future demand of red blood cells and the organizational implications thereof for Sanquin, the Dutch national blood establishment. STUDY DESIGN AND METHODS Based on previously identified drivers from interviews and a literature review (Step 1), we conducted scenario sessions and a survey to rank a list of drivers ("themes") with its related opportunities and threats (Step 2), to identify mitigating measures per theme through focus groups (Step 3). RESULTS In Step 2, 10 themes were found that were classified in terms of importance and uncertainty. These were plotted on a two-dimensional graph with an ellipse to indicate the interquartile ranges per theme. Experts rated the top three most important themes to be the blood supply organization, precision medicine, and red blood cell replacements. In Step 3, focus groups identified specific mitigating measures per theme. These measures had parallel ideas, such as the need for an innovative mentality, internal and external communication and collaboration, and building Sanquin's reputation and trust with the public. CONCLUSION Having identified the most important themes with suggestions for mitigating measures, Sanquin can take steps to become adaptive and proactive. Other blood establishments may also use a scenario approach to create contextualized long-term strategies.
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Affiliation(s)
- Praiseldy Langi Sasongko
- Department of Donor Medicine Research, Transfusion Technology Assessment, Sanquin Research, Amsterdam, The Netherlands.,Department of Donor Medicine Research, Donor Studies, Sanquin Research, Amsterdam, The Netherlands
| | - Katja van den Hurk
- Department of Donor Medicine Research, Donor Studies, Sanquin Research, Amsterdam, The Netherlands
| | - Marian van Kraaij
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Mart P Janssen
- Department of Donor Medicine Research, Transfusion Technology Assessment, Sanquin Research, Amsterdam, The Netherlands
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16
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Garzon Jimenez RC, Lieshout-Krikke RW, Janssen MP. West Nile virus and blood transfusion safety: A European perspective. Vox Sang 2021; 116:1094-1101. [PMID: 33900632 DOI: 10.1111/vox.13112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/28/2021] [Accepted: 04/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES There is a growing concern for the transmission of arboviral infections by blood transfusion in Europe. However, no assessment of the risk of transmission through all European blood supplies has been reported. Risk regulations at a European level should take differences in local transmission risk and the risk of transmission by travelling donors into consideration. MATERIALS AND METHODS A risk model and publicly available tool were developed to calculate the risk of transmission by all European blood supplies for arboviral outbreaks within Europe. Data on individual European blood supplies from Council of Europe reports and inter-European travel data from EUROSTAT were used to populate this model. RESULTS Each neuroinvasive case of WNV reported in Europe will on average result in 0·43 (95%CI: 0·32-0·55) infected blood product by locally infected donors and 0·010 (95%CI: 0·006-0·015) infected products by travelling donors. On basis of the 1373 neuroinvasive human WNV cases reported in the outbreak of 2018, it is estimated that without safety interventions this outbreak would have resulted in 708 (95%CI: 523-922) infected components derived from resident donors. Noncompliance to European regulations, which requires donor deferral or testing of donors who visited WNV-infected areas, would have resulted in 7.4 (95%CI: 4·7-11·1) infected blood components derived from infectious travelling donors exposed in outbreak areas throughout Europe. CONCLUSION The risk of WNV transmission by a local outbreak is on average 113 times (95%CI: 95-139), so two orders of magnitude higher than the risk of transmission by travelling donors in Europe.
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Affiliation(s)
- Rossana C Garzon Jimenez
- Transfusion Technology Assessment Group, Donor Medicine Research Department, Sanquin Research, Amsterdam, The Netherlands
| | - Ryanne W Lieshout-Krikke
- Medical Affairs, Corporate Staff, Sanquin, Amsterdam, The Netherlands.,Emerging Infectious Diseases - Monitor Working Group, European Blood Alliance, Amsterdam, The Netherlands
| | - Mart P Janssen
- Transfusion Technology Assessment Group, Donor Medicine Research Department, Sanquin Research, Amsterdam, The Netherlands
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17
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Luken JS, Folman CC, Lukens MV, Meekers JH, Ligthart PC, Schonewille H, Zwaginga JJ, Janssen MP, van der Schoot CE, van der Bom JG, de Haas M. Reduction of anti-K-mediated hemolytic disease of newborns after the introduction of a matched transfusion policy: A nation-wide policy change evaluation study in the Netherlands. Transfusion 2021; 61:713-721. [PMID: 33528025 PMCID: PMC7986406 DOI: 10.1111/trf.16276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/27/2020] [Accepted: 12/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND During pregnancy, maternal red blood cell (RBC) antibodies can lead to life-threatening fetal hemolysis and anemia. Women can become immunized by a pregnancy or an unmatched transfusion. Our aim was to quantify the effect of a nationwide K-matched transfusion policy for women of childbearing age potential to prevent K-immunization in pregnancy. STUDY DESIGN AND METHODS In this nation-wide policy change evaluation study we determined the occurrence of RBC antibodies before and after introduction of a K-matched transfusion policy and evaluated the cause K alloimmunization 10 years after introduction of this measure. K-matched transfusion for females under 45 years of age is advised in the Dutch transfusion guideline since 2004. We used laboratory data from pregnancies with RBC antibodies identified in the period 1999-2018 obtained as part of a population-based screening program in the Netherlands. RESULTS Tests of 36 286 pregnancies produced a positive antibody screening result which concerned anti-K in 1550 pregnancies. The occurrence of anti-K decreased from 67.9 to 20.2 per 100 000 pregnancies. The relative risk reduction was 0.70 which largely exceeded the relative risk reduction of 0.27 for antibodies against RBC antigens for which no preventive matching is required. The number of pregnancies at risk for anti-K-mediated disease decreased from 9.7 to 4.2 per 100 000 pregnancies. CONCLUSIONS A K-matched transfusion policy is associated with a major decrease in a number of pregnant women with anti-K and pregnancies at risk for anti-K-mediated disease. A relatively simple measure is now shown to impact prevention of hemolytic disease in the fetus and newborn.
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Affiliation(s)
- Jessie S Luken
- Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Claudia C Folman
- Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Michaël V Lukens
- Department of Laboratory Medicine, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Johan H Meekers
- Department of Laboratory Medicine, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Peter C Ligthart
- Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Henk Schonewille
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands.,Landsteiner Laboratory, University of Amsterdam, Amsterdam, The Netherlands
| | - Jaap Jan Zwaginga
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands.,Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
| | - Mart P Janssen
- Transfusion Technology Assessment Department, Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| | - C Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands.,Landsteiner Laboratory, University of Amsterdam, Amsterdam, The Netherlands
| | - Johanna G van der Bom
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Masja de Haas
- Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands.,Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands.,Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
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18
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Janssen MP, Nuebling CM, Lery FX, Maryuningsih YS, Epstein JS. A WHO tool for risk-based decision making on blood safety interventions. Transfusion 2020; 61:503-515. [PMID: 33368381 PMCID: PMC7898802 DOI: 10.1111/trf.16231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/22/2020] [Accepted: 11/25/2020] [Indexed: 11/28/2022]
Abstract
Background Risk‐based decision making is increasingly recognized as key to support national blood policy makers and blood operators concerning the implementation of safety interventions, especially to address emerging infectious threats and new technology opportunities. There is an urgent need for practical decision support tools, especially for low‐ and middle‐income countries that may not have the financial or technical capability to develop risk models. WHO supported the development of such a tool for blood safety. The tool enables users to perform both a quantitative Multi‐Criteria Decision Assessment and a novel step‐by‐step qualitative assessment. Study Design and Methods This paper summarizes the content, functionalities, and added value of the new WHO tool. A fictitious case study of a safety intervention to reduce the risk of HIV transmission by transfusion was used to demonstrate the use and usefulness of the tool. Results Application of the tool highlighted strengths and weaknesses of both the quantitative and qualitative approaches. The quantitative approach facilitates assessment of the robustness of the decision but lacks nuances and interpretability especially when multiple constraints are taken into consideration. Conversely, while unable to provide an assessment of robustness, the step‐by‐step qualitative approach helps structuring the thought process and argumentation for a preferred intervention in a systematic manner. Conclusion The relative strengths and weaknesses of the quantitative and step‐by‐step qualitative approach to risk‐based decision making are complementary and mutually enhancing. A combination of the two approaches is therefore advisable to support the selection of appropriate blood safety interventions for a particular setting.
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Affiliation(s)
- Mart P Janssen
- Transfusion Technology Assessment Group, Donor Medicine Research Department, Sanquin Research, Amsterdam, The Netherlands
| | - C Micha Nuebling
- Division of Major Policy Issues, Paul-Ehrlich-Institut, Langen, Germany
| | - François-Xavier Lery
- Technical Standards and Specifications Unit, Health Products Policy and Standards Department, WHO Headquarters, Geneva, Switzerland
| | - Yuyun S Maryuningsih
- Blood and Other Product of Human Origin, Health Products Policy and Standards Department, WHO Headquarters, Geneva, Switzerland
| | - Jay S Epstein
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
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19
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Vinkenoog M, van den Hurk K, van Kraaij M, van Leeuwen M, Janssen MP. First results of a ferritin-based blood donor deferral policy in the Netherlands. Transfusion 2020; 60:1785-1792. [PMID: 32533600 PMCID: PMC7496980 DOI: 10.1111/trf.15906] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Whole blood donors are at risk of becoming iron deficient. To monitor iron stores, Sanquin implemented a new deferral policy based on ferritin levels, in addition to the traditional hemoglobin measurements. METHODS Ferritin levels are determined in every fifth donation, as well as in all first-time donors. Donors with ferritin levels <15 ng/mL (WHO threshold) are deferred for 12 months; those ≥15 and ≤30 ng/mL for 6 months. The first results were analyzed and are presented here. RESULTS The results show that 25% of women (N = 20151, 95% CI 24%-25%) and 1.6% of men (N = 10391, 95% CI 1.4%-1.8%) have ferritin levels ≤30 ng/mL at their first blood center visit. For repeat (non-first-time) donors, these proportions are higher: 53% of women (N = 28329, 95% CI 52%-54%) and 42% of men (N = 31089, 95% CI 41%-43%). After a 6-month deferral, in 88% of returning women (N = 3059, 95% CI 87%-89%) and 99% of returning men (N = 3736, 95% CI 98%-99%) ferritin levels were ≥15 ng/mL. After a 12-month deferral, in 74% of returning women (N = 486, 95% CI 70%-78%) and 95% of returning men (N = 479, 95% CI 94%-97%) ferritin levels increased to ≥15 ng/mL. CONCLUSION Deferral of donors whose pre-donation ferritin levels were ≤30 ng/mL might prevent donors from returning with ferritin levels <15 ng/mL. This policy is promising to mitigate effects of repeated donations on iron stores.
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Affiliation(s)
- Marieke Vinkenoog
- Donor Medicine Research, Sanquin ResearchAmsterdamThe Netherlands
- Leiden Institute of Advanced Computer ScienceLeiden UniversityLeidenThe Netherlands
| | | | | | - Matthijs van Leeuwen
- Leiden Institute of Advanced Computer ScienceLeiden UniversityLeidenThe Netherlands
| | - Mart P. Janssen
- Donor Medicine Research, Sanquin ResearchAmsterdamThe Netherlands
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20
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van Hoeven LR, Janssen MP, Lieshout-Krikke RW, Molenaar-de Backer MW. An assessment of the risk, cost-effectiveness, and perceived benefits of anti-parvovirus B19 tested blood products. Transfusion 2019; 59:2352-2360. [PMID: 31032994 DOI: 10.1111/trf.15324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/14/2019] [Accepted: 03/03/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Parvovirus B19 (B19V) can cause severe anemia, hydrops foetalis, and even death in vulnerable patients. To prevent transfusion-transmitted B19V infection of at-risk patients, B19V antibody screening of blood donors was implemented. The cost-effectiveness of this intervention is unclear, as the likelihood of transmission through blood and subsequent complications for recipients are unknown. This study estimates the cost-effectiveness of anti-B19V donor screening in the Netherlands. STUDY DESIGN AND METHODS The estimates needed for the cost-effectiveness model were: the occurrence of B19V in Dutch blood donors, the number of anti-B19V tested products required by hospitals, the likelihood of morbidity and mortality given B19V infection, treatment costs, and screening costs. These estimates were obtained from literature and observational data. When data were unavailable, structured expert judgment elicitation and statistical modeling were applied. RESULTS The costs of preventing one transfusion transmitted B19V infection are estimated at €68,942 (€42,045 - €102,080). On average, 1.25 cases of morbidity and 0.12 cases of mortality are prevented annually. Although the perceived risk of transfusion transmitted B19V infection was low, half of the treating physicians favored anti-B19V screening. CONCLUSION The estimated mortality and morbidity caused by B19V infection was low in the risk groups. The cost-effectiveness ratio is similar to other blood safety screening measures. No guidance exists to evaluate the acceptability of this ratio. The explicit overview of costs and effects may further guide the discussion of the desirability of B19V safe blood products.
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Affiliation(s)
- Loan R van Hoeven
- Donor Medicine Research Transfusion Technology Assessment Department, Sanquin Research, Amsterdam, The Netherlands
| | - Mart P Janssen
- Donor Medicine Research Transfusion Technology Assessment Department, Sanquin Research, Amsterdam, The Netherlands
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21
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van Sambeeck JHJ, de Wit PD, Luken J, Veldhuisen B, van den Hurk K, van Dongen A, Koopman MMW, van Kraaij MGJ, van der Schoot CE, Schonewille H, de Kort WLAM, Janssen MP. A Conceptual Framework for Optimizing Blood Matching Strategies: Balancing Patient Complications Against Total Costs Incurred. Front Med (Lausanne) 2018; 5:199. [PMID: 30090809 PMCID: PMC6069448 DOI: 10.3389/fmed.2018.00199] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/18/2018] [Indexed: 01/06/2023] Open
Abstract
Alloimmunization is currently the most frequent adverse blood transfusion event. Whilst completely matched donor blood would nullify the alloimmunization risk, this is practically infeasible. Current matching strategies therefore aim at matching a limited number of blood groups only, and have evolved over time by systematically including matching strategies for those blood groups for which (serious) alloimmunization complications most frequently occurred. An optimal matching strategy for controlling the risk of alloimmunization however, would balance alloimmunization complications and costs within the entire blood supply chain, whilst fulfilling all practical requirements and limitations. In this article the outline of an integrated blood management model is described and various potential challenges and prospects foreseen with the development of such a model are discussed.
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Affiliation(s)
- Joost H J van Sambeeck
- Department of Transfusion Technology Assessment, Sanquin Research, Amsterdam, Netherlands.,Center for Healthcare Operations Improvement and Research, University of Twente, Enschede, Netherlands
| | - Puck D de Wit
- Department of Donor Studies, Sanquin Research, Amsterdam, Netherlands
| | - Jessie Luken
- Sanquin Diagnostic Services, Amsterdam, Netherlands
| | - Barbera Veldhuisen
- Sanquin Diagnostic Services, Amsterdam, Netherlands.,Sanquin Research and Landsteiner Laboratory, Department of Experimental Immunohematology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | | | - Anne van Dongen
- Department of Donor Studies, Sanquin Research, Amsterdam, Netherlands
| | - Maria M W Koopman
- Department of Transfusion Medicine, Sanquin Blood Bank, Amsterdam, Netherlands
| | - Marian G J van Kraaij
- Department of Transfusion Medicine, Sanquin Blood Bank, Amsterdam, Netherlands.,Department of Donor Affairs, Sanquin Blood Bank, Amsterdam, Netherlands.,Department of Clinical Transfusion Research, Sanquin Research, Amsterdam, Netherlands
| | - C Ellen van der Schoot
- Sanquin Research and Landsteiner Laboratory, Department of Experimental Immunohematology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Henk Schonewille
- Sanquin Research and Landsteiner Laboratory, Department of Experimental Immunohematology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Wim L A M de Kort
- Department of Donor Studies, Sanquin Research, Amsterdam, Netherlands.,Department of Social Medicine, Academic Medical Center, Amsterdam, Netherlands
| | - Mart P Janssen
- Department of Transfusion Technology Assessment, Sanquin Research, Amsterdam, Netherlands
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22
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de Vos AS, van der Schoot ECE, Rizopoulos D, Janssen MP. Predicting anti-RhD titers in donors: Boostering response and decline rates are personal. PLoS One 2018; 13:e0196382. [PMID: 29698437 PMCID: PMC5919536 DOI: 10.1371/journal.pone.0196382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 04/12/2018] [Indexed: 11/18/2022] Open
Abstract
Background Anti-RhD immunised donors provide anti-RhD immunoglobulins used for the prevention of rhesus disease. These donors are periodically hyper-immunised (boostered) to retain a high titer level of anti-RhD. Study design and methods We analysed anti-RhD donor records from 1998 to 2016, consisting of 30,116 anti-RhD titers from 755 donors, encompassing 3,372 booster events. Various models were fit to these data to allow describing the anti-RhD titers over time. Results A random effects model with a log-linear anti-RhD titer decline over time and a saturating titer response to boostering is shown to fit the data well. This model contains two general model parameters, relating timing and maximum of the booster effect, as well as two parameters characterizing the individual donor, namely how fast the booster effect saturates with current titer and the anti-RhD decline rate. The average individual log2 decline is 0.55 per year, i.e. a 32% decline in absolute titer, with half of the donors declining between 13% and 41% per year. Their anti-RhD titer peaks around 26 days following a booster event. Boostering response reduces with higher titers at boostering; at median titer (log2 11) the mean increase per booster is log2 0.38, that is from an absolute titer of 2048 to 2665 (+30%), with half of all donors increasing between 16% and 65% in their titer. Conclusion The model describes anti-RhD titer change per individual with only four parameters, two of which are donor specific. This information can be used to enhance the blood bank’s immunisation programme, by deriving individualized immunization policies in which boostering is adjusted to the anticipated anti-RhD decline, effectiveness of boostering and titer levels required.
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Affiliation(s)
- Anneke S. de Vos
- Transfusion Technology Assessment Department, Sanquin Research, Amsterdam, the Netherlands
| | | | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Mart P. Janssen
- Transfusion Technology Assessment Department, Sanquin Research, Amsterdam, the Netherlands
- * E-mail:
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23
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van Hoeven LR, Kreuger AL, Roes KC, Kemper PF, Koffijberg H, Kranenburg FJ, Rondeel JM, Janssen MP. Why was this transfusion given? Identifying clinical indications for blood transfusion in health care data. Clin Epidemiol 2018; 10:353-362. [PMID: 29636633 PMCID: PMC5881526 DOI: 10.2147/clep.s147142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background To enhance the utility of transfusion data for research, ideally every transfusion should be linked to a primary clinical indication. In electronic patient records, many diagnostic and procedural codes are registered, but unfortunately, it is usually not specified which one is the reason for transfusion. Therefore, a method is needed to determine the most likely indication for transfusion in an automated way. Study design and methods An algorithm to identify the most likely transfusion indication was developed and evaluated against a gold standard based on the review of medical records for 234 cases by 2 experts. In a second step, information on misclassification was used to fine-tune the initial algorithm. The adapted algorithm predicts, out of all data available, the most likely indication for transfusion using information on medical specialism, surgical procedures, and diagnosis and procedure dates relative to the transfusion date. Results The adapted algorithm was able to predict 74.4% of indications in the sample correctly (extrapolated to the full data set 75.5%). A kappa score, which corrects for the number of options to choose from, was found of 0.63. This indicates that the algorithm performs substantially better than chance level. Conclusion It is possible to use an automated algorithm to predict the indication for transfusion in terms of procedures and/or diagnoses. Before implementation of the algorithm in other data sets, the obtained results should be externally validated in an independent hospital data set.
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Affiliation(s)
- Loan R van Hoeven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.,Transfusion Technology Assessment Department, Sanquin Research, Amsterdam, the Netherlands
| | - Aukje L Kreuger
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.,Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
| | - Kit Cb Roes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter F Kemper
- Transfusion Technology Assessment Department, Sanquin Research, Amsterdam, the Netherlands.,Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
| | - Hendrik Koffijberg
- Department of Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Floris J Kranenburg
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.,Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Intensive Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan Mm Rondeel
- Department of Clinical Chemistry, Isala, Zwolle, the Netherlands
| | - Mart P Janssen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.,Transfusion Technology Assessment Department, Sanquin Research, Amsterdam, the Netherlands
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Koffijberg H, Knies S, Janssen MP. The Impact of Decision Makers' Constraints on the Outcome of Value of Information Analysis. Value Health 2018; 21:203-209. [PMID: 29477402 DOI: 10.1016/j.jval.2017.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 03/13/2017] [Accepted: 04/12/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND When proven effective, decision making regarding reimbursement of new health technology typically involves ethical, social, legal, and health economic aspects and constraints. Nevertheless, when applying standard value of information (VOI) analysis, the value of collecting additional evidence is typically estimated assuming that only cost-effectiveness outcomes guide such decisions. OBJECTIVES To illustrate how decision makers' constraints can be incorporated into VOI analyses and how these may influence VOI outcomes. METHODS A simulation study was performed to estimate the cost-effectiveness of a new hypothetical technology compared with usual care. Constraints were defined for the new technology on 1) the maximum acceptable rate of complications and 2) the maximum acceptable additional budget. The expected value of perfect information (EVPI) for the new technology was estimated in various scenarios, both with and without incorporating these constraints. RESULTS For a willingness-to-pay threshold of €20,000 per quality-adjusted life-year, the probability that the new technology was cost-effective equaled 57%, with an EVPI of €1868 per patient. Applying the complication rate constraint reduced the EVPI to €1137. Similarly, the EVPI reduced to €770 when applying the budget constraint. Applying both constraints simultaneously further reduced the EVPI to €318. CONCLUSIONS When decision makers explicitly apply additional constraints, beyond a willingness-to-pay threshold, to reimbursement decisions, these constraints can and should be incorporated into VOI analysis as well, because they may influence VOI outcomes. This requires continuous interaction between VOI analysts and decision makers and is expected to improve both the relevance and the acceptance of VOI outcomes.
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Affiliation(s)
- Hendrik Koffijberg
- Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands; Department of Medical Technology Assessment, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Saskia Knies
- National Health Care Institute (Zorginstituut Nederland), Diemen, The Netherlands
| | - Mart P Janssen
- Department of Medical Technology Assessment, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands; Transfusion Technology Assessment Department, Sanquin Research, Amsterdam, The Netherlands.
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25
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Janssen MP, van Hulst M, Custer B. Erratum: An assessment of differences in costs and health benefits of serology and NAT screening of donations for blood transfusion in different Western countries. Vox Sang 2018; 113:88. [PMID: 29349815 DOI: 10.1111/vox.12611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Janssen MP, van Tilborgh AJW, de Vooght KMK, Bokhorst AG, Wiersum-Osselton JC. Direct costs of transfusion reactions - an expert judgement approach. Vox Sang 2017; 113:143-151. [PMID: 29124766 DOI: 10.1111/vox.12614] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 10/24/2017] [Accepted: 10/24/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite increasingly meticulous haemovigilance reporting throughout the world, a systematic assessment of the cost of transfusion reactions is still lacking. This is partly caused by the fact that such an assessment requires a subjective expert assessment of the additional costs linked to the adverse reaction. Data on the cost of transfusion reactions could support decision-making regarding blood transfusion safety measures. MATERIALS AND METHODS Thirteen experts from nine hospitals were asked to estimate the additional care required following various types of transfusion reactions. Additional care was quantified as the proportion of reactions requiring care, and the amount of care required (e.g. hospitalization days, additional physician's time). Experts were also asked to provide, per type of transfusion reaction, an estimate of the proportion of transfusion reactions preventable. Structured quantitative expert elicitation methods were applied to obtain and combine expert estimates. RESULTS The estimated annual in-hospital cost of transfusion reactions in the Netherlands is €933 356 per year (€1.52 per transfusion). Two-thirds (64%) of these are incurred by non-serious transfusion reactions. Circulatory overload, TRALI and anaphylaxis clearly dominate the costs of serious adverse transfusion reactions (66% in total); non-haemolytic transfusion reactions incur 46% of the cost of non-serious transfusion reactions. Additional safety measures targeting circulatory overload and new antibody formation potentially offer the highest cost reduction. CONCLUSION In-hospital costs of transfusion reactions are substantial but contribute to less than 1% of the total cost of transfusion in the Netherlands. A considerable part of these costs (24%) might be preventable.
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Affiliation(s)
- M P Janssen
- Transfusion Technology Assessment Unit, Sanquin Research, Amsterdam, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A J W van Tilborgh
- TRIP National Hemovigilance and Biovigilance Office, Leiden, The Netherlands
| | - K M K de Vooght
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A G Bokhorst
- TRIP National Hemovigilance and Biovigilance Office, Leiden, The Netherlands.,Sanquin Blood Supply, Amsterdam, The Netherlands
| | - J C Wiersum-Osselton
- TRIP National Hemovigilance and Biovigilance Office, Leiden, The Netherlands.,Sanquin Blood Supply, Amsterdam, The Netherlands
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27
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Janssen MP, Caron MM, van Rietbergen B, Surtel DA, van Rhijn LW, Welting TJ, Emans PJ. Impairment of the chondrogenic phase of endochondral ossification in vivo by inhibition of cyclooxygenase-2. Eur Cell Mater 2017; 34:202-216. [PMID: 29039630 DOI: 10.22203/ecm.v034a13] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Many studies have reported on the effects of cyclooxygenase-2 (COX-2) inhibition on osteogenesis. However, far less is known about the effects of COX-2 inhibition on chondrogenic differentiation. Previous studies conducted by our group show that COX-2 inhibition influences in vitro chondrogenic differentiation. Importantly, this might have consequences on endochondral ossification processes occurring in vivo, such as bone fracture healing, growth plate development and ectopic generation of cartilage. The goal of our study was to investigate, in vivo, the effect of COX-2 inhibition by celecoxib on the cartilaginous phase of three different endochondral ossification scenarios. 10 mg/kg/day celecoxib or placebo were orally administered for 25 d to skeletally-immature New Zealand White rabbits (n = 6 per group). Endochondral ossification during fracture healing of a non-critical size defect in the ulna, femoral growth plate and ectopically-induced cartilaginous tissue were examined by radiography, micro-computed tomography (µ-CT), histology and gene expression analysis. Celecoxib treatment resulted in delayed bone fracture healing, alterations in growth plate development and progression of mineralisation. In addition, chondrogenic differentiation of ectopically-induced cartilaginous tissue was severely impaired by celecoxib. In conclusion, we found that celecoxib impaired the chondrogenic phase of endochondral ossification.
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Affiliation(s)
| | - M M Caron
- Laboratory for Experimental Orthopaedics, Department of Orthopaedic Surgery, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, the
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28
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Neslo REJ, Oei W, Janssen MP. Insight into "Calculated Risk": An Application to the Prioritization of Emerging Infectious Diseases for Blood Transfusion Safety. Risk Anal 2017; 37:1783-1795. [PMID: 28229466 DOI: 10.1111/risa.12752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/05/2016] [Accepted: 09/15/2016] [Indexed: 06/06/2023]
Abstract
Increasing identification of transmissions of emerging infectious diseases (EIDs) by blood transfusion raised the question which of these EIDs poses the highest risk to blood safety. For a number of the EIDs that are perceived to be a threat to blood safety, evidence on actual disease or transmission characteristics is lacking, which might render measures against such EIDs disputable. On the other hand, the fact that we call them "emerging" implies almost by definition that we are uncertain about at least some of their characteristics. So what is the relative importance of various disease and transmission characteristics, and how are these influenced by the degree of uncertainty associated with their actual values? We identified the likelihood of transmission by blood transfusion, the presence of an asymptomatic phase of infection, prevalence of infection, and the disease impact as the main characteristics of the perceived risk of disease transmission by blood transfusion. A group of experts in the field of infectious diseases and blood transfusion ranked sets of (hypothetical) diseases with varying degrees of uncertainty associated with their disease characteristics, and used probabilistic inversion to obtain probability distributions for the weight of each of these risk characteristics. These distribution weights can be used to rank both existing and newly emerging infectious diseases with (partially) known characteristics. Analyses show that in case there is a lack of data concerning disease characteristics, it is the uncertainty concerning the asymptomatic phase and the disease impact that are the most important drivers of the perceived risk. On the other hand, if disease characteristics are well established, it is the prevalence of infection and the transmissibility of the disease by blood transfusion that will drive the perceived risk. The risk prioritization model derived provides an easy to obtain and rational expert assessment of the relative importance of an (emerging) infectious disease, requiring only a limited amount of information. Such a model might be used to justify a rational and proportional response to an emerging infectious disease, especially in situations where little or no specific information is available.
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Affiliation(s)
- R E J Neslo
- Julius Centre for Health Sciences and Primary Health Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W Oei
- Julius Centre for Health Sciences and Primary Health Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M P Janssen
- Julius Centre for Health Sciences and Primary Health Care, University Medical Center Utrecht, Utrecht, The Netherlands
- TTA department, Sanquin Research, Amsterdam, The Netherlands
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29
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Hoeven LRV, Bruijne MCD, Kemper PF, Koopman MMW, Rondeel JMM, Leyte A, Koffijberg H, Janssen MP, Roes KCB. Validation of multisource electronic health record data: an application to blood transfusion data. BMC Med Inform Decis Mak 2017; 17:107. [PMID: 28709453 PMCID: PMC5512751 DOI: 10.1186/s12911-017-0504-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/10/2017] [Indexed: 11/10/2022] Open
Abstract
Background Although data from electronic health records (EHR) are often used for research purposes, systematic validation of these data prior to their use is not standard practice. Existing validation frameworks discuss validity concepts without translating these into practical implementation steps or addressing the potential influence of linking multiple sources. Therefore we developed a practical approach for validating routinely collected data from multiple sources and to apply it to a blood transfusion data warehouse to evaluate the usability in practice. Methods The approach consists of identifying existing validation frameworks for EHR data or linked data, selecting validity concepts from these frameworks and establishing quantifiable validity outcomes for each concept. The approach distinguishes external validation concepts (e.g. concordance with external reports, previous literature and expert feedback) and internal consistency concepts which use expected associations within the dataset itself (e.g. completeness, uniformity and plausibility). In an example case, the selected concepts were applied to a transfusion dataset and specified in more detail. Results Application of the approach to a transfusion dataset resulted in a structured overview of data validity aspects. This allowed improvement of these aspects through further processing of the data and in some cases adjustment of the data extraction. For example, the proportion of transfused products that could not be linked to the corresponding issued products initially was 2.2% but could be improved by adjusting data extraction criteria to 0.17%. Conclusions This stepwise approach for validating linked multisource data provides a basis for evaluating data quality and enhancing interpretation. When the process of data validation is adopted more broadly, this contributes to increased transparency and greater reliability of research based on routinely collected electronic health records. Electronic supplementary material The online version of this article (doi:10.1186/s12911-017-0504-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Loan R van Hoeven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3508, GA, Utrecht, The Netherlands. .,Transfusion Technology Assessment Department, Sanquin Research, Plesmanlaan 125, 1066, CX, Amsterdam, The Netherlands.
| | - Martine C de Bruijne
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands
| | - Peter F Kemper
- Transfusion Technology Assessment Department, Sanquin Research, Plesmanlaan 125, 1066, CX, Amsterdam, The Netherlands
| | - Maria M W Koopman
- Department of Transfusion Medicine, Sanquin Blood bank, Plesmanlaan 125, 1066, CX, Amsterdam, The Netherlands
| | | | - Anja Leyte
- OLVG, Oosterpark 9, 1091, AC, Amsterdam, The Netherlands
| | - Hendrik Koffijberg
- Department of Health Technology & Services Research, MIRA Institute for biomedical technology and technical medicine, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands
| | - Mart P Janssen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3508, GA, Utrecht, The Netherlands.,Transfusion Technology Assessment Department, Sanquin Research, Plesmanlaan 125, 1066, CX, Amsterdam, The Netherlands
| | - Kit C B Roes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3508, GA, Utrecht, The Netherlands
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30
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Custer B, Janssen MP, Hubben G, Vermeulen M, van Hulst M. Development of a web-based application and multicountry analysis framework for assessing interdicted infections and cost-utility of screening donated blood for HIV, HCV and HBV. Vox Sang 2017; 112:526-534. [PMID: 28597489 DOI: 10.1111/vox.12538] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 03/06/2017] [Accepted: 04/25/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND OBJECTIVES Most countries test donations for HIV, HCV and HBV using serology with or without nucleic acid testing (NAT). Cost-utility analyses provide information on the relative value of different screening options. The aim of this project was to develop an open access risk assessment and cost-utility analysis web-tool for assessing HIV, HCV and HBV screening options (http://www.isbtweb.org/working-parties/transfusion-transmitted-infectious-diseases/). An analysis for six countries (Brazil, Ghana, the Netherlands, South Africa, Thailand and USA) was conducted. MATERIALS AND METHODS Four strategies; (1) antibody assays (Abs) for HIV and HCV + HBsAg, (2) antibody assays that include antigens for HIV and HCV (Combo) + HBsAg, (3) NAT in minipools of variable size (MP NAT) and (4) individual donation (ID) NAT can be evaluated using the tool. Country-specific data on donors, donation testing results, recipient outcomes and costs are entered using the online interface. Results obtained include the number infections interdicted using each screening options, and the (incremental and average) cost-utility of the options. RESULTS In each of the six countries evaluated, the use of antibody assays is cost effective or even cost saving. NAT has varying cost-utility depending on the setting, and where adopted, the incremental cost-utility exceeds any previously defined or proposed threshold in each country. CONCLUSION The web-tool allows an assessment of infectious units interdicted and value for money of different testing strategies. Regardless of gross national income (GNI) per capita, countries appear willing to dedicate healthcare resources to blood supply safety in excess of that for other sectors of health care.
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Affiliation(s)
- B Custer
- Blood Systems Research Institute, San Francisco, CA, USA.,Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - M P Janssen
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands.,Transfusion Technology Assessment Department, Sanquin Research, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | | | - M Vermeulen
- South African National Blood Service, Johannesburg, South Africa
| | - M van Hulst
- Department of PharmacoTherapy, Epidemiology & Economics, University of Groningen, Groningen, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Martini Hospital, Groningen, The Netherlands
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31
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de Vos AS, Janssen MP, Zaaijer HL, Hogema BM. Cost-effectiveness of the screening of blood donations for hepatitis E virus in the Netherlands. Transfusion 2017; 57:258-266. [DOI: 10.1111/trf.13978] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/10/2016] [Accepted: 11/22/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Anneke S. de Vos
- Transfusion Technology Assessment Unit; Sanquin Research; Amsterdam the Netherlands
| | - Mart P. Janssen
- Transfusion Technology Assessment Unit; Sanquin Research; Amsterdam the Netherlands
| | - Hans L. Zaaijer
- Department of Blood-Borne Infections; Sanquin Research; Amsterdam the Netherlands
| | - Boris M. Hogema
- Department of Blood-Borne Infections; Sanquin Research; Amsterdam the Netherlands
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Abstract
INTRODUCTION Blood transfusion has health-related, economical and safety implications. In order to optimise the transfusion chain, comprehensive research data are needed. The Dutch Transfusion Data warehouse (DTD) project aims to establish a data warehouse where data from donors and transfusion recipients are linked. This paper describes the design of the data warehouse, challenges and illustrative applications. STUDY DESIGN AND METHODS Quantitative data on blood donors (eg, age, blood group, antibodies) and products (type of product, processing, storage time) are obtained from the national blood bank. These are linked to data on the transfusion recipients (eg, transfusions administered, patient diagnosis, surgical procedures, laboratory parameters), which are extracted from hospital electronic health records. APPLICATIONS Expected scientific contributions are illustrated for 4 applications: determine risk factors, predict blood use, benchmark blood use and optimise process efficiency. For each application, examples of research questions are given and analyses planned. CONCLUSIONS The DTD project aims to build a national, continuously updated transfusion data warehouse. These data have a wide range of applications, on the donor/production side, recipient studies on blood usage and benchmarking and donor-recipient studies, which ultimately can contribute to the efficiency and safety of blood transfusion.
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Affiliation(s)
- Loan R van Hoeven
- Transfusion Technology Assessment Department, Sanquin Research, Amsterdam, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Babette H Hooftman
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Mart P Janssen
- Transfusion Technology Assessment Department, Sanquin Research, Amsterdam, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martine C de Bruijne
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Karen M K de Vooght
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter Kemper
- Transfusion Technology Assessment Department, Sanquin Research, Amsterdam, The Netherlands
| | - Maria M W Koopman
- Department of Transfusion Medicine, Sanquin Blood Bank, Amsterdam, The Netherlands
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Fischer K, Lewandowski D, Janssen MP. Modelling lifelong effects of different prophylactic treatment strategies for severe haemophilia A. Haemophilia 2016; 22:e375-82. [PMID: 27353496 DOI: 10.1111/hae.13019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lifelong prophylactic replacement therapy with clotting factor concentrates is recommended for severe haemophilia. The prophylactic dose determines both clinical outcome and treatment cost. In the absence of clinical studies, computer simulation was used to explore lifelong effects and clotting factor consumption for various prophylactic dose levels, and optimize strategies for switching between prophylactic and on-demand treatment. DESIGN AND METHODS Individual patients' lifetime joint bleeds, radiological arthropathy (Pettersson score, 0-78) and consumption were simulated for each treatment strategy. Treatment effectiveness (expressed as % of patients maintaining a lifetime Pettersson score ≤14) and clotting factor consumption were modelled for lifelong prophylaxis at dose levels 1000-4500 IU kg(-1) year(-1) , for on-demand treatment and for switching strategies. Treatment efficiency (consumption per unit of effectiveness) was used to compare strategies. RESULTS Compared to lifelong on-demand treatment, lifelong prophylaxis at 1000 IU kg(-1) year(-1) increased effectiveness from 21 to 36%, at an additional consumption of 0.9 × 10(6) IU kg(-1) . For lifelong prophylaxis, each additional 1000 IU kg(-1) year(-1) resulted in a proportional increase in consumption by ±5 × 10(6) IU kg(-1) but a less than proportional reduction in arthropathy by ±50%; consequently, increasing consumption progressively diminished treatment efficiency. Switching strategies slightly reduce effectiveness and consumption. Optimum switching criteria were similar across prophylactic dose levels. CONCLUSION According to the simulation model, low-dose prophylaxis (1000 IU kg(-1) year(-1) ) improved outcome at a limited increase in consumption compared to on-demand treatment. Increasing prophylactic dose further improved health outcomes, but at decreasing efficiency. Optimal prophylactic dose should therefore be selected balancing acceptable health impact and available budget.
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Affiliation(s)
- K Fischer
- Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, The Netherlands. .,Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - D Lewandowski
- Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M P Janssen
- Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, The Netherlands.,Research Division, Transfusion Technology Assessment Department, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
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de Vos AS, Lieshout-Krikke RW, Slot E, Cator EA, Janssen MP. A novel approach to detect test-seeking behaviour in the blood donor population: making the invisible visible. Vox Sang 2016; 111:274-280. [PMID: 27281653 DOI: 10.1111/vox.12422] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 05/12/2016] [Accepted: 05/16/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Individuals may donate blood in order to determine their infection status after exposure to an increased infection risk. Such test-seeking behaviour decreases transfusion safety. Instances of test seeking are difficult to substantiate as donors are unlikely to admit to such behaviour. However, manifestation in a population of repeat donors may be determined using statistical inference. MATERIALS AND METHODS Test-seeking donors would be highly motivated to donate following infection risk, influencing the timing of their donation. Donation intervals within 2005-2014 of all Dutch blood donors who acquired syphilis (N = 50), HIV (N = 13), HTLV (N = 4) or HCV (N = 2) were compared to donation intervals of uninfected blood donors (N = 7 327 836) using the Anderson-Darling test. We adjusted for length bias as well as for age, gender and donation type of the infected. Additionally, the power of the proposed method was investigated by simulation. RESULTS Among the Dutch donors who acquired infection, we found only a non-significant overrepresentation of short donation intervals (P = 0·54). However, we show by simulation that both relatively short and long donation intervals among infected donors can reveal test seeking. The power of the method is >90% if among 69 infected donors >35 (51%) are test seeking, or if among 320 infected donors >90 (30%) are test seeking. CONCLUSION We show how statistical analysis may be used to reveal the extent of test seeking in repeat blood donor populations. In the Dutch setting, indications for test-seeking behaviour were not statistically significant. This may, however, be due to the low number of infected individuals.
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Affiliation(s)
- A S de Vos
- Transfusion Technology Assessment Unit, Sanquin Research, Amsterdam, the Netherlands.
| | - R W Lieshout-Krikke
- Department of Blood-Borne Infections, Sanquin Research, Amsterdam, the Netherlands
| | - E Slot
- Department of Blood-Borne Infections, Sanquin Research, Amsterdam, the Netherlands
| | - E A Cator
- Institute of Mathematics, Astrophysics and Particle Physics, Radboud University, Nijmegen, the Netherlands
| | - M P Janssen
- Transfusion Technology Assessment Unit, Sanquin Research, Amsterdam, the Netherlands. .,Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands.
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35
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Oei W, Neslo R, Janssen MP. A consensus-based tool for ranking the risk of blood-transmissible infections. Transfusion 2016; 56:2108-14. [PMID: 27217225 DOI: 10.1111/trf.13656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Emerging infectious diseases (EIDs) pose a threat to blood transfusion safety. Despite a lack of evidence, safety interventions may be required. However, what should decision makers base their decisions on? A model was developed that allows valuing the perceived risk of an EID for blood safety as derived from a group of experts. The model requires estimates of four disease characteristics and the accuracy of these estimates. STUDY DESIGN AND METHODS Sixteen selected experts ranked 24 hypothetical diseases, each comprising a quantitative estimate of four characteristics: transfusion transmissibility, proportion of asymptomatic infectious phase, prevalence of infection, and disease impact. Each of the characteristics was expressed at one of six predefined levels with varying ranges of uncertainty. The model was derived using probabilistic inversion and was applied to value the perceived risk of most currently known EIDs relevant to blood transfusion. RESULTS The model demonstrated that transmissibility and prevalence are the most important risk drivers. However, disease impact and likelihood of transmission during the asymptomatic phase of infection are more important when the disease characteristics are unknown. In the ranking of currently known EIDs, diseases that have been identified previously as posing a serious risk to blood transfusion appear at the top of the list. CONCLUSION With the current model, the perceived risk of EIDs for transfusion safety can be determined for both known and unknown diseases, even when little information is available. Extension of the expert base, further model development and validation, and continuous updating of the model are recommended.
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Affiliation(s)
- Welling Oei
- Transfusion Technology Assessment Unit, Sanquin Research, Amsterdam, the Netherlands.,Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Rabin Neslo
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Mart P Janssen
- Transfusion Technology Assessment Unit, Sanquin Research, Amsterdam, the Netherlands.,Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
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van Hoeven LR, Berkowska MA, Verhagen OJHM, Koffijberg H, van der Schoot CE, Janssen MP. Prediction of the anti-RhD donor population size for managerial decision-making. Vox Sang 2016; 111:171-7. [PMID: 27077781 DOI: 10.1111/vox.12400] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/23/2016] [Accepted: 02/23/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Rhesus D (RhD)-negative women pregnant with a RhD-positive child receive prophylactic injections to prevent haemolytic disease of the newborn. Because of the success of the prophylaxis, the number of naturally immunized women has decreased, thereby also decreasing the number of potential donors who provide the plasma from which the prophylaxis is made. As the current donor pool is ageing, the availability of the prophylaxis is threatened. OBJECTIVES Objectives are to investigate whether the anti-D population and the changes therein can be described by a relatively simple model, to determine the impact of ageing of the anti-D donors on the decline of the population and how many new donors should be recruited to meet future supply demand. METHODS Data on Dutch anti-D donors in 1994-2013 were used to simulate the donor population size and age composition for various donor recruitment scenarios. RESULTS With a continuous influx of 27 new donors per year and a donor stopping rate of 10% per year, the population size will stabilize at 195 donors, with 2·3% of donors stopping annually due to reaching the donor age limit. A formula is derived to estimate which donor recruitment and retention efforts are required to maintain a prespecified donor pool. CONCLUSION A relatively simple model can already describe and predict the size of the anti-D donor population and the impact of ageing accurately.
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Affiliation(s)
- L R van Hoeven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Transfusion Technology Assessment Department, Sanquin Blood Supply, Amsterdam, The Netherlands
| | - M A Berkowska
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands.,Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - O J H M Verhagen
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands.,Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - H Koffijberg
- Department of Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - C E van der Schoot
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands.,Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M P Janssen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Transfusion Technology Assessment Department, Sanquin Blood Supply, Amsterdam, The Netherlands
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Mapako T, Oei W, van Hulst M, Kretzschmar ME, Janssen MP. Modelling the risk of transfusion transmission from travelling donors. BMC Infect Dis 2016; 16:143. [PMID: 27038919 PMCID: PMC4818889 DOI: 10.1186/s12879-016-1452-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 03/03/2016] [Indexed: 11/25/2022] Open
Abstract
Background The EUFRAT (European Up-Front Risk Assessment Tool) was developed as an online risk assessment tool (http://eufrattool.ecdc.europa.eu) to help decision-makers assess the transmission risk of emerging infectious diseases (EID) through blood transfusion. The aim of this study is to extend the methodology developed in the EUFRAT project to quantify the transfusion transmission (TT) risk from travelling donors. Methods A generic model for estimating the TT risk from a group of travelling donors that visited an EID risk area was developed. In addition, the new model distinguishes projected future transmissions from those that have already occurred. As an illustration the model was applied to the outbreaks of chikungunya in Italy in 2007 and Q fever in the Netherlands in 2007–2009. Results Formulas for calculating the travelling donors’ TT risk were derived. For the chikungunya outbreak in Italy an early intervention (at the end of week 7 after the start of the outbreak, so after only 19 % of all cases) would have been required to prevent only 41 % of all expected transmissions at that time. For Q fever, in which the transmission of chronic Q fever is considered, even at the end of the third annual outbreak’s peak 47 % of all (chronic) Q fever transmissions could still be prevented. Conclusions The updated model allows estimation of the infection transmission risk from travelling donors. In combination with the distinction between past and future transmissions, these estimates provide valuable information to support decisions concerning communication with the public and/or the implementation of safety interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1452-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tonderai Mapako
- Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.,National Blood Service Zimbabwe, Harare, Zimbabwe
| | - Welling Oei
- Transfusion Technology Assessment Unit, Sanquin Research, Amsterdam, The Netherlands. .,Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Marinus van Hulst
- Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Martini Hospital, Groningen, The Netherlands
| | - Mirjam E Kretzschmar
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.,National Institute for Public Health and the Environment, Bilthoven, The Netherlands.,Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Mart P Janssen
- Transfusion Technology Assessment Unit, Sanquin Research, Amsterdam, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
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38
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Mapako T, Janssen MP, Mvere DA, Emmanuel JC, Rusakaniko S, Postma MJ, van Hulst M. Impact of using different blood donor subpopulations and models on the estimation of transfusion transmission residual risk of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus in Zimbabwe. Transfusion 2016; 56:1520-8. [PMID: 26801952 DOI: 10.1111/trf.13472] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 11/26/2015] [Accepted: 12/05/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Various models for estimating the residual risk (RR) of transmission of infections by blood transfusion have been published mainly based on data from high-income countries. However, to obtain the data required for such an assessment remains challenging for most developing settings. The National Blood Service Zimbabwe (NBSZ) adapted a published incidence-window period (IWP) model, which has less demanding data requirements. In this study we assess the impact of various definitions of blood donor subpopulations and models on RR estimates. We compared the outcomes of two published models and an adapted NBSZ model. STUDY DESIGN AND METHODS The Schreiber IWP model (Model 1), an amended version (Model 2), and an adapted NBSZ model (Model 3) were applied. Variably the three models include prevalence, incidence, preseroconversion intervals, mean lifetime risk, and person-years at risk. Annual mean RR estimates and 95% confidence intervals for each of the three models for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) were determined using NBSZ blood donor data from 2002 through 2011. RESULTS The annual mean RR estimates for Models 1 through 3 were 1 in 6542, 5805, and 6418, respectively for HIV; 1 in 1978, 2027, and 1628 for HBV; and 1 in 9588, 15,126, and 7750, for HCV. CONCLUSIONS The adapted NBSZ model provided comparable results to the published methods and these highlight the high occurrence of HBV in Zimbabwe. The adapted NBSZ model could be used as an alternative to estimate RRs when in settings where two repeat donations are not available.
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Affiliation(s)
- Tonderai Mapako
- Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, the Netherlands.,National Blood Service Zimbabwe, Harare, Zimbabwe
| | - Mart P Janssen
- Julius Center for Health Science and Primary Health Care, University Medical Center Utrecht, the Netherlands
| | | | | | - Simbarashe Rusakaniko
- Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Maarten J Postma
- Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, the Netherlands.,Institute of Science in Healthy Aging & Health caRE (SHARE), University Medical Center Groningen (UMCG)
| | - Marinus van Hulst
- Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, the Netherlands.,Department of Clinical Pharmacy and Toxicology, Martini Hospital, Groningen, the Netherlands
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39
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Oei W, Lieshout-Krikke RW, Kretzschmar ME, Zaaijer HL, Coutinho RA, Eersel M, Jubithana B, Halabi Y, Gerstenbluth I, Maduro E, Tromp M, Janssen MP. Estimating the risk of dengue transmission from Dutch blood donors travelling to Suriname and the Dutch Caribbean. Vox Sang 2016; 110:301-9. [PMID: 26765798 DOI: 10.1111/vox.12370] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 11/24/2015] [Accepted: 11/24/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The risk of dengue transmitted by travellers is known. Methods to estimate the transmission by transfusion (TT) risk from blood donors travelling to risk areas are available, for instance, the European Up-Front Risk Assessment Tool (EUFRAT). This study aimed to validate the estimated risk from travelling donors obtained from EUFRAT. METHODS Surveillance data on notified dengue cases in Suriname and the Dutch Caribbean islands (Aruba, Curaçao, St. Maarten, Bonaire, St. Eustatius and Saba) in 2001-2011 was used to calculate local incidence rates. Information on travel and donation behaviour of Dutch donors was collected. With the EUFRAT model, the TT risks from Dutch travelling donors were calculated. Model estimates were compared with the number of infections in Dutch travellers found by laboratory tests in the Netherlands. RESULTS The expected cumulative number of donors becoming infected during travels to Suriname and the Dutch Caribbean from 2001 to 2011 was estimated at 5 (95% CI, 2-11) and 86 (45-179), respectively. The infection risk inferred from the laboratory-based study was 19 (9-61) and 28 (14-92). Given the independence of the data sources, these estimates are remarkably close. The model estimated that 0·02 (0·001-0·06) and 0·40 (0·01-1·4) recipients would have been infected by these travelling donors. CONCLUSIONS The EUFRAT model provided an estimate close to actual observed number of dengue infections. The dengue TT risk among Dutch travelling donors can be estimated using basic transmission, travel and donation information. The TT risk from Dutch donors travelling to Suriname and the Dutch Caribbean is small.
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Affiliation(s)
- W Oei
- Transfusion Technology Assessment Unit, Sanquin Research, Amsterdam, the Netherlands.,Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - R W Lieshout-Krikke
- Department of blood-borne infections, Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
| | - M E Kretzschmar
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands.,National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - H L Zaaijer
- Department of blood-borne infections, Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
| | - R A Coutinho
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - M Eersel
- Department of Public Health Suriname, Epidemiology Unit, Paramaribo, Suriname
| | - B Jubithana
- Department of Public Health Suriname, Epidemiology Unit, Paramaribo, Suriname
| | - Y Halabi
- Epidemiology and Research Unit, Ministry of Health, The Environment and Nature, Willemstad, Curaçao
| | - I Gerstenbluth
- Epidemiology and Research Unit, Ministry of Health, The Environment and Nature, Willemstad, Curaçao
| | - E Maduro
- Department of Public Health Aruba, Epidemiology and Research Unit, Oranjestad, Aruba
| | - M Tromp
- Department of Public Health Aruba, Epidemiology and Research Unit, Oranjestad, Aruba
| | - M P Janssen
- Transfusion Technology Assessment Unit, Sanquin Research, Amsterdam, the Netherlands.,Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
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40
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van Hoeven LR, Janssen MP, Roes KCB, Koffijberg H. Aiming for a representative sample: Simulating random versus purposive strategies for hospital selection. BMC Med Res Methodol 2015; 15:90. [PMID: 26497748 PMCID: PMC4619525 DOI: 10.1186/s12874-015-0089-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 10/19/2015] [Indexed: 12/05/2022] Open
Abstract
Background A ubiquitous issue in research is that of selecting a representative sample from the study population. While random sampling strategies are the gold standard, in practice, random sampling of participants is not always feasible nor necessarily the optimal choice. In our case, a selection must be made of 12 hospitals (out of 89 Dutch hospitals in total). With this selection of 12 hospitals, it should be possible to estimate blood use in the remaining hospitals as well. In this paper, we evaluate both random and purposive strategies for the case of estimating blood use in Dutch hospitals. Methods Available population-wide data on hospital blood use and number of hospital beds are used to simulate five sampling strategies: (1) select only the largest hospitals, (2) select the largest and the smallest hospitals (‘maximum variation’), (3) select hospitals randomly, (4) select hospitals from as many different geographic regions as possible, (5) select hospitals from only two regions. Simulations of each strategy result in different selections of hospitals, that are each used to estimate blood use in the remaining hospitals. The estimates are compared to the actual population values; the subsequent prediction errors are used to indicate the quality of the sampling strategy. Results The strategy leading to the lowest prediction error in the case study was maximum variation sampling, followed by random, regional variation and two-region sampling, with sampling the largest hospitals resulting in the worst performance. Maximum variation sampling led to a hospital level prediction error of 15 %, whereas random sampling led to a prediction error of 19 % (95 % CI 17 %-26 %). While lowering the sample size reduced the differences between maximum variation and the random strategies, increasing sample size to n = 18 did not change the ranking of the strategies and led to only slightly better predictions. Conclusions The optimal strategy for estimating blood use was maximum variation sampling. When proxy data are available, it is possible to evaluate random and purposive sampling strategies using simulations before the start of the study. The results enable researchers to make a more educated choice of an appropriate sampling strategy. Electronic supplementary material The online version of this article (doi:10.1186/s12874-015-0089-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Loan R van Hoeven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands. .,Sanquin Blood Supply, Transfusion Technology Assessment Department, Sanquin Research, Amsterdam, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands.
| | - Mart P Janssen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands. .,Sanquin Blood Supply, Transfusion Technology Assessment Department, Sanquin Research, Amsterdam, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands.
| | - Kit C B Roes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands.
| | - Hendrik Koffijberg
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands. .,Department of Health Technology & Services Research, MIRA Institute for biomedical technology and technical medicine, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands.
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41
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Slot E, Janssen MP, Marijt-van der Kreek T, Zaaijer HL, van de Laar TJ. Two decades of risk factors and transfusion-transmissible infections in Dutch blood donors. Transfusion 2015; 56:203-14. [PMID: 26355711 DOI: 10.1111/trf.13298] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/21/2015] [Accepted: 07/27/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Risk behavior-based donor selection procedures are widely used to mitigate the risk of transfusion-transmissible infections (TTIs), but their effectiveness is disputed in countries with low residual risks of TTIs. STUDY DESIGN AND METHODS In 1995 to 2014, Dutch blood donors infected with hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), human T-lymphotropic virus (HTLV), or syphilis were interviewed by trained medical counselors to identify risk factors associated with TTIs. Trends in the prevalence and incidence of TTIs were analyzed using binomial regression models. RESULTS A total of 972 new donors and 381 repeat donors had TTIs. New donors had higher rates of TTIs compared to repeat donors. Although the HBV and HCV prevalence gradually decreased over time, the incidence of all five TTIs remained stable during the past two decades. In new donors the TTIs had the following risk profiles: "blood-blood contact" for HCV, "unprotected sex" for HIV and syphilis, and "country of birth" for HBV and HTLV. In infected repeat donors, sexual risk factors predominated for all TTIs. At posttest counseling, 28% of infected repeat donors admitted to risk factors leading to permanent donor exclusion if revealed during the donor selection procedure (predominantly male-to-male sex and recent diagnosis of syphilis). CONCLUSION The prevalence and incidence of TTIs among Dutch blood donors are six- to 60-fold lower than in the general Dutch population, illustrating the effectiveness of donor selection procedures. However, at least a quarter of infected donors appeared noncompliant to the donor health questionnaire (DHQ), suggesting that DHQs, or the way donor questioning is implemented, can be improved.
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Affiliation(s)
- Ed Slot
- Department of Blood-Borne Infections, Division Research, Sanquin Blood Supply Foundation, Amsterdam
| | - Mart P Janssen
- Department of Transfusion Technology Assessment, Division Research, Blood Supply Foundation, Amsterdam, the Netherlands.,Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, the Netherlands
| | | | - Hans L Zaaijer
- Department of Blood-Borne Infections, Division Research, Sanquin Blood Supply Foundation, Amsterdam.,Department of Clinical Virology (CINIMA), Academic Medical Centre/University of Amsterdam, Amsterdam, the Netherlands
| | - Thijs J van de Laar
- Department of Blood-Borne Infections, Division Research, Sanquin Blood Supply Foundation, Amsterdam.,Department of Virology, Division Diagnostics, Sanquin Blood Supply Foundation, Amsterdam
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42
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Custer B, Janssen MP. Health economics and outcomes methods in risk-based decision-making for blood safety. Transfusion 2015; 55:2039-47. [DOI: 10.1111/trf.13080] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 02/05/2015] [Accepted: 02/10/2015] [Indexed: 01/05/2023]
Affiliation(s)
- Brian Custer
- Blood Systems Research Institute and
- Department of Laboratory Medicine; University of California; San Francisco California
| | - Mart P. Janssen
- Transfusion Technology Assessment Unit; Sanquin Research; Amsterdam the Netherlands
- Julius Center for Health Sciences and Primary Care; University Medical Centre Utrecht; Utrecht the Netherlands
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Janssen MP, Koffijberg H. Research Prioritization In An Mcda Context: Existing Methods - New Results. Value Health 2014; 17:A583. [PMID: 27201974 DOI: 10.1016/j.jval.2014.08.1980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- M P Janssen
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - H Koffijberg
- University Medical Center, Utrecht, The Netherlands
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Oei W, Kretzschmar ME, Zaaijer HL, Coutinho R, van der Poel CL, Janssen MP. Estimating the transfusion transmission risk of Q fever. Transfusion 2014; 54:1705-11. [DOI: 10.1111/trf.12539] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 11/04/2013] [Accepted: 11/10/2013] [Indexed: 12/24/2022]
Affiliation(s)
- Welling Oei
- University Medical Centre Utrecht; Utrecht the Netherlands
| | - Mirjam E.E. Kretzschmar
- University Medical Centre Utrecht; Utrecht the Netherlands
- National Institute for Public Health and the Environment; Bilthoven the Netherlands
| | | | - Roel Coutinho
- University Medical Centre Utrecht; Utrecht the Netherlands
- National Institute for Public Health and the Environment; Bilthoven the Netherlands
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45
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Velthove KJ, Over J, Abbink K, Janssen MP. Viral Safety of Human Plasma–Derived Medicinal Products: Impact of Regulation Requirements. Transfus Med Rev 2013; 27:179-83. [DOI: 10.1016/j.tmrv.2013.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 05/23/2013] [Accepted: 05/24/2013] [Indexed: 01/04/2023]
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46
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Fischer K, Lewandowski D, Janssen MP. Estimating unknown parameters in haemophilia using expert judgement elicitation. Haemophilia 2013; 19:e282-8. [PMID: 23672712 DOI: 10.1111/hae.12166] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2013] [Indexed: 11/30/2022]
Abstract
The increasing attention to healthcare costs and treatment efficiency has led to an increasing demand for quantitative data concerning patient and treatment characteristics in haemophilia. However, most of these data are difficult to obtain. The aim of this study was to use expert judgement elicitation (EJE) to estimate currently unavailable key parameters for treatment models in severe haemophilia A. Using a formal expert elicitation procedure, 19 international experts provided information on (i) natural bleeding frequency according to age and onset of bleeding, (ii) treatment of bleeds, (iii) time needed to control bleeding after starting secondary prophylaxis, (iv) dose requirements for secondary prophylaxis according to onset of bleeding, and (v) life-expectancy. For each parameter experts provided their quantitative estimates (median, P10, P90), which were combined using a graphical method. In addition, information was obtained concerning key decision parameters of haemophilia treatment. There was most agreement between experts regarding bleeding frequencies for patients treated on demand with an average onset of joint bleeding (1.7 years): median 12 joint bleeds per year (95% confidence interval 0.9-36) for patients ≤ 18, and 11 (0.8-61) for adult patients. Less agreement was observed concerning estimated effective dose for secondary prophylaxis in adults: median 2000 IU every other day The majority (63%) of experts expected that a single minor joint bleed could cause irreversible damage, and would accept up to three minor joint bleeds or one trauma related joint bleed annually on prophylaxis. Expert judgement elicitation allowed structured capturing of quantitative expert estimates. It generated novel data to be used in computer modelling, clinical care, and trial design.
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Affiliation(s)
- K Fischer
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands.
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47
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Oei W, Janssen MP, van der Poel CL, van Steenbergen JE, Rehmet S, Kretzschmar MEE. Modeling the transmission risk of emerging infectious diseases through blood transfusion. Transfusion 2012; 53:1421-8. [PMID: 23113823 DOI: 10.1111/j.1537-2995.2012.03941.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 09/05/2012] [Accepted: 09/08/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND A timely risk assessment is desired to guide decisions on preventive transfusion safety measures during emerging infectious disease (EID) outbreaks. The European Up-Front Risk Assessment Tool (EUFRAT) model was developed to provide quantitative transmission risk estimates of EIDs through blood transfusion. STUDY DESIGN AND METHODS The generic model comprises five sequential steps to estimate the infection risks in the blood transfusion chain: 1) the prevalence of infection in the donor population, 2) the risk of obtaining infected donations, 3) infected components, 4) infected blood products, and 5) the risk of transmitting the infection to recipients. The model uses inputs from epidemiologic characteristics of an EID and transfusion practice. The model was applied to data from a recent chikungunya outbreak in Italy. RESULTS Based on data from the outbreak peak, an estimated prevalence of 1.07 (95% confidence interval [CI], 0.38-2.03) per 100,000 donors would lead to 0.04 infected donations (95% CI, 0.01-0.10), 0.13 infected blood components, 0.13 infected end products, and 0.0001 severe infections in recipients. This estimated risk can be reduced by increasing the duration of quarantine of the donated blood and becomes zero after 7 or more days of quarantine. The model also estimated the probability of a donor returning from the outbreak area and subsequently donating infected blood in his home country to be 0.30 (95% CI, 0.01-0.65) per 100,000. CONCLUSION The model can be used to quantify EID outbreak risks to blood transfusion recipients and the effect of targeted safety interventions and as such support public health decision-making.
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Affiliation(s)
- Welling Oei
- Julius Center for Health Science and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
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Fischer K, Lewandowski D, Marijke van den Berg H, Janssen MP. Validity of assessing inhibitor development in haemophilia PUPs using registry data: the EUHASS project. Haemophilia 2011; 18:e241-6. [PMID: 22044445 DOI: 10.1111/j.1365-2516.2011.02687.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Inhibitory antibodies to exogenous FVIII/FIX are a major complication of haemophilia treatment. Up to 30% of previously untreated patients (PUPs) with severe haemophilia A develop inhibitors, most likely during the initial 50 exposure days to concentrate. In addition to classical cohort studies, a European monitoring system (EUHASS) has been set up to evaluate inhibitor development in PUPs. The present study addresses the reliability of estimating the cumulative incidence of inhibitor development in this registry. Data from the retrospective CANAL cohort study, including 288 PUPs with severe haemophilia A and complete treatment records until the 50th exposure to FVIII, were used to simulate the consequences of several cross-sectional sampling techniques on the estimated incidence of inhibitors. Both mathematical calculus and computer modelling were applied to study the effects of sample size and the introduction of a new product. For existing concentrates, both longitudinal cohort study methods and the EUHASS method yielded similar estimates of the cumulative incidence of inhibitor cases over a 5-year time period: 27.9% (95% CI: 21-36) vs. 29.4% (22-38). For a newly introduced concentrate, a reliable estimate of inhibitor incidence with the EUHASS method could only be made after 3-4 years, even in large datasets. The results from EUHASS in inhibitor incidence in PUPs are expected to be valid. After introduction of a new concentrate, the inhibitor incidence on this concentrate can only be reliably determined after an observation period of several years.
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Affiliation(s)
- K Fischer
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
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Borkent-Raven BA, Janssen MP, van der Poel CL, Bonsel GJ, van Hout BA. Cost-effectiveness of additional blood screening tests in the Netherlands. Transfusion 2011; 52:478-88. [DOI: 10.1111/j.1537-2995.2011.03319.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fischer K, Pouw ME, Lewandowski D, Janssen MP, van den Berg HM, van Hout BA. A modeling approach to evaluate long-term outcome of prophylactic and on demand treatment strategies for severe hemophilia A. Haematologica 2011; 96:738-43. [PMID: 21273268 DOI: 10.3324/haematol.2010.029868] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Severe hemophilia requires life-long treatment with expensive clotting factor concentrates; studies comparing effects of different therapeutic strategies over decades are very difficult to perform. A simulation model was developed to evaluate the long-term outcome of on demand, prophylactic and mixed treatment strategies for patients with severe hemophilia A. DESIGN AND METHODS A computer model was developed based on individual patients' data from a Dutch cohort study in which intermediate dose prophylaxis was used and a French cohort study in which on demand treatment was used, and multivariate regression analyses. This model simulated individual patients' life expectancy, onset of bleeding, life-time joint bleeds, radiological outcome and concentrate use according to the different treatment strategies. RESULTS According to the model, life-time on demand treatment would result in an average of 1,494 joint bleeds during the hemophiliac's life, and consumption of 4.9 million IU of factor VIII concentrate. In contrast, life-time intermediate dose prophylaxis resulted in a mean of 357 joint bleeds and factor consumption of 8.3 million IU. A multiple switch strategy (between prophylactic and on demand treatment based on bleeding pattern) resulted in a mean number of 395 joint bleeds and factor consumption of 6.6 million IU. The estimated proportion of patients with Pettersson scores over 28 points was 32% for both the prophylactic and the multiple switching strategies, compared to 76% for continuous on demand treatment. CONCLUSIONS The present model allows evaluation of the impact of various treatment strategies on patients' joint bleeds and clotting factor consumption. It may be expanded with additional data to allow more precise estimates and include economic evaluations of treatment strategies.
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Affiliation(s)
- Kathelijn Fischer
- Julius Center for Health Sciences and Primary Care, Room Str. 6.131, PO Box 85090, 3508 GA Utrecht, The Netherlands.
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