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van Wonderen SF, Peters AL, Grey S, Rajbhandary S, de Jonge LL, Andrzejewski C, Narayan S, Wiersum-Osselton JC, Vlaar APJ. Standardized reporting of pulmonary transfusion complications: Development of a model reporting form and flowchart. Transfusion 2023. [PMID: 37060282 DOI: 10.1111/trf.17346] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Pulmonary complications of blood transfusion, including transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), and transfusion-associated dyspnea, are generally underdiagnosed and under-reported. The international TRALI and TACO definitions have recently been updated. Currently, no standardized pulmonary transfusion reaction reporting form exists and most of the hemovigilance forms have not yet incorporated the updated definitions. We developed a harmonized reporting form, aimed at improved data collection on pulmonary transfusion reactions for hemovigilance and research purposes by developing a standardized model reporting form and flowchart. MATERIALS AND METHODS Using a modified Delphi method among an international, multidisciplinary panel of 24 hemovigilance experts, detailed recommendations were developed for a standardized model reporting form for pulmonary complications of blood transfusion. Two Delphi rounds, including scoring systems, took place and several subsequent meetings were held to discuss issues and obtain consensus. Additionally, a flowchart was developed incorporating recently published redefinitions of pulmonary transfusion reactions. RESULTS In total, 17 participants completed the first questionnaire (70.8% response rate) and 14 participants completed the second questionnaire (58.3% response rate). According to the results from the questionnaires, the standardized model reporting form was divided into various subcategories: general information, patient history and transfusion characteristics, reaction details, investigations, treatment and supportive care, narrative, and transfused product. CONCLUSION In this article, we present the recommendations from a global group of experts in the hemovigilance field. The standardized model reporting form and flowchart provide an initiative that may improve data collected to address pulmonary transfusion reactions.
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Affiliation(s)
- Stefan F van Wonderen
- Department of Intensive Care, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Anna L Peters
- Division Vital Functions, Department of Anesthesiology, University Medical Center Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Sharran Grey
- Lancashire Haematology Centre, Blackpool Teaching Hospitals NHS Foundation Trust, North Lancashire, UK
| | - Srijana Rajbhandary
- Department of Research, Association for the Advancement of Blood and Biotherapies, Bethesda, Maryland, USA
| | - Layla L de Jonge
- TRIP (Transfusion and Transplantation Reactions in Patients) Hemovigilance and Biovigilance Office, Leiden, Netherlands
| | - Chester Andrzejewski
- Department of Pathology, Transfusion and Apheresis Medicine Services, Baystate Medical Center, Baystate Health, Springfield, Massachusetts, USA
| | - Shruthi Narayan
- Bristol Institute for Transfusion Sciences, National Health Service Blood and Transplant, Bristol, UK
| | - Johanna C Wiersum-Osselton
- TRIP (Transfusion and Transplantation Reactions in Patients) Hemovigilance and Biovigilance Office, Leiden, Netherlands
| | - Alexander P J Vlaar
- Department of Intensive Care, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
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2
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Van Buren NL, Rajbhandary S, Reynolds V, Gorlin JB, Stramer SL, Notari EP, Conti G, Katz L, Stubbs JR, van Buskirk CM, Kuttner K, Smith DL, Ngamsuntikul SG, Pandey S, Ward DC, Ziman A, Hiskey M, Townsend M, Sachais BS. Demographics of first-time donors returning for donation during the pandemic: COVID-19 convalescent plasma versus standard blood product donors. Transfusion 2023; 63:552-563. [PMID: 36550639 PMCID: PMC9880744 DOI: 10.1111/trf.17229] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Previous studies have demonstrated low first-time donor return rates (DRR) following catastrophic events. Little is known, however, about the influence of demographic factors on the DRR of first-time donors during the COVID-19 pandemic, including the unique motivation of COVID-19 convalescent plasma (CCP) donors as compared to non-CCP donors. STUDY DESIGN AND METHODS Thirteen blood collection organizations submitted deidentified data from first-time CCP and non-CCP donors returning for regular (non-CCP) donations during the pandemic. DRR was calculated as frequencies. Demographic factors associated with returning donors: race/ethnicity, gender, and generation (Gen Z: 19-24, Millennial: 25-40, Gen X: 41-56, and Boomer: ≥57 years old), within the CCP and non-CCP first-time cohorts were compared using chi-square test at p < .05 statistical significance. RESULTS From March 2020 through December 2021, there were a total of 44,274 first-time CCP and 980,201 first-time non-CCP donors. DRR were 14.6% (range 11.9%-43.3%) and 46.6% (range 10.0%-76.9%) for CCP and non-CCP cohorts, respectively. Age over 40 years (Gen X and Boomers), female gender, and White race were each associated with higher return in both donor cohorts (p < .001). For the non-CCP return donor cohort, the Millennial and Boomers were comparable. CONCLUSION The findings demonstrate differences in returning donor trends between the two donor cohorts. The motivation of a first-time CCP donor may be different than that of a non-CCP donor. Further study to improve first-time donor engagement would be worthwhile to expand the donor base with a focus on blood donor diversity emphasizing engagement of underrepresented minorities and younger donors.
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Affiliation(s)
- Nancy L. Van Buren
- Division of New York Blood CenterInnovative Blood ResourcesSaint PaulMinnesotaUSA
- Division of New York Blood CenterCommunity Blood Center of Greater Kansas CityKansas CityMissouriUSA
| | | | - Vanessa Reynolds
- Division of New York Blood CenterInnovative Blood ResourcesSaint PaulMinnesotaUSA
| | - Jed B. Gorlin
- Division of New York Blood CenterInnovative Blood ResourcesSaint PaulMinnesotaUSA
- Division of New York Blood CenterCommunity Blood Center of Greater Kansas CityKansas CityMissouriUSA
| | | | | | - Galen Conti
- Scientific AffairsAmerican Red CrossRockvilleMarylandUSA
| | | | - James R. Stubbs
- Division of Transfusion Medicine, Department of Laboratory Medicine and PathologyMayo ClinicRochesterMinnesotaUSA
| | - Camille M. van Buskirk
- Division of Transfusion Medicine, Department of Laboratory Medicine and PathologyMayo ClinicRochesterMinnesotaUSA
| | - Kip Kuttner
- Miller‐Keystone Blood CenterBethlehemPennsylvaniaUSA
| | | | | | | | - Dawn C. Ward
- Division of Transfusion Medicine, Department of Pathology and Laboratory MedicineDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Alyssa Ziman
- Division of Transfusion Medicine, Department of Pathology and Laboratory MedicineDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
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3
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Cannon JW, Igra NM, Borge PD, Cap AP, Devine D, Doughty H, Geng Z, Guzman JF, Ness PM, Jenkins DH, Rajbhandary S, Schmulevich D, Stubbs JR, Wiebe DJ, Yazer MH, Spinella PC. U.S. cities will not meet blood product resuscitation standards during major mass casualty incidents: Results of a THOR-AABB working party prospective analysis. Transfusion 2022; 62 Suppl 1:S12-S21. [PMID: 35730720 DOI: 10.1111/trf.16960] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/27/2022] [Accepted: 02/01/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Mass casualty incidents (MCIs) create an immediate surge in blood product demand. We hypothesize local inventories in major U.S. cities would not meet this demand. STUDY DESIGN AND METHODS A simulated blast in a large crowd estimated casualty numbers. Ideal resuscitation was defined as equal amounts of red blood cells (RBCs), plasma, platelets, and cryoprecipitate. Inventory was prospectively collected from six major U.S. cities at six time points between January and July 2019. City-wide blood inventories were classified as READY (>1 U/injured survivor), DEFICIENT (<10 U/severely injured survivor), or RISK (between READY and DEFICIENT), before and after resupply from local distribution centers (DC), and features of DEFICIENT cities were identified. RESULTS The simulated blast resulted in 2218 injured survivors including 95 with severe injuries. Balanced resuscitation would require between 950 and 2218 units each RBC, plasma, platelets and cryoprecipitate. Inventories in 88 hospitals/health systems and 10 DCs were assessed. Of 36 city-wide surveys, RISK inventories included RBCs (n = 16; 44%), plasma (n = 24; 67%), platelets (n = 6; 17%), and cryoprecipitate (n = 22; 61%) while DEFICIENT inventories included platelets (n = 30; 83%) and cryoprecipitate (n = 12; 33%). Resupply shifted most RBC and plasma inventories to READY, but some platelet and cryoprecipitate inventories remained at RISK (n = 24; 67% and n = 12; 33%, respectively) or even DEFICIENT (n = 11; 31% and n = 6; 17%, respectively). Cities with DEFICIENT inventories were smaller (p <.001) with fewer blood products per trauma bed (p <.001). DISCUSSION In this simulated blast event, blood product demand exceeded local supply in some major U.S. cities. Options for closing this gap should be explored to optimize resuscitation during MCIs.
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Affiliation(s)
- Jeremy W Cannon
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Surgery, Uniformed Services University F. Edward Hébert School of Medicine, Bethesda, Maryland, USA
| | - Noah M Igra
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Sackler School of Medicine at Tel Aviv University, Tel Aviv, Israel
| | - P Dayand Borge
- Biomedical Services, American Red Cross, Philadelphia, Pennsylvania, USA
| | - Andrew P Cap
- U.S. Army Institute of Surgical Research, Joint Base San Antonio-FT Sam, Houston, Texas, USA
| | - Dana Devine
- Canadian Blood Services, Vancouver, British Columbia, Canada
| | - Heidi Doughty
- NIHR Surgical Reconstruction and Microbiology Research Centre, Institute of Translational Medicine, Birmingham, UK
| | - Zhi Geng
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jessica F Guzman
- Department of Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Paul M Ness
- Department of Pathology, Division of Transfusion Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Donald H Jenkins
- Department of Surgery, Division of Trauma and Emergency Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | | | - Daniela Schmulevich
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Douglas J Wiebe
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Penn Injury Science Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Philip C Spinella
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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4
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Rajbhandary S, Andrzejewski C, Fridey J, Stotler B, Tsang HC, Hindawi S, Reddy O, Medina MC, Razatos A, Narayan S, Fung M. Incorporating the entity of under-transfusion into hemovigilance monitoring: Documenting cases due to lack of inventory. Transfusion 2022; 62:540-545. [PMID: 35044688 DOI: 10.1111/trf.16792] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Under-transfusion is an underreported entity within most hospitals and hemovigilance systems. While critical blood shortages are being reported more frequently, without incident codes to document instances of under-transfusion due to lack of inventory, estimating its impact on patient care as it relates to hemotherapy (HT) has hampered our ability to assess and inform strategic initiatives to combat inventory issues as well as prepare for future blood supply threats. STUDY DESIGN AND METHOD An 11-member working group of the AABB (Association for the Advancement of Blood and Biotherapies) Hemovigilance Committee was formed in October 2020 to study the topic of under-transfusion including its potential causes and clinical expressions. The group was also charged with proposing simple definition/incident codes to be used by hemovigilance systems to document such instances. RESULTS The working group proposed four simple incident codes under the new process code-No Blood (NB)-that can be used by hemovigilance systems to appropriately document instances of under-transfusion due to lack of inventory. The codes were described as: (1) NB 01-Inventory less than usual level due to supplier shortage; (2) NB 02-Demand for blood product exceeding usual inventory levels; (3) NB 03-Substitution with incompatible/inappropriate units; and (4) NB 04-Suboptimal dose/no transfusion given. CONCLUSION The adoption of these codes within hemovigilance systems globally would assist in recognition and reporting instances of under-transfusion due to inventory, thus supporting development of better collection strategies, inventory management techniques as well as effective policies to improve blood safety and availability.
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Affiliation(s)
| | | | - Joy Fridey
- American Red Cross Blood Services, Scientific Affairs, Pomona, California, USA
| | - Brie Stotler
- Columbia University Irving Medical Center, New York, New York, USA
| | | | - Salwa Hindawi
- Faculty of Medicine King Abdulaziz University, Jeddah, Saudi Arabia
| | - Opal Reddy
- Keck Medicine of USC, Los Angeles, California, USA
| | | | - Anna Razatos
- Terumo Blood and Cell Technologies, Lakewood, Colorado, USA
| | | | - Mark Fung
- University of Vermont Health Network, Burlington, Vermont, USA
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5
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Rajbhandary S, Shmookler A, Cohn CS, Nunes E, Karafin MS, Stubbs J, Pagano MB. Hospital transfusion service operations during the SARS-CoV-2 pandemic: Lessons learned from the AABB hospital survey in preparation for the next infectious disease outbreak. Transfusion 2021; 61:3129-3138. [PMID: 34469010 PMCID: PMC8661942 DOI: 10.1111/trf.16643] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 07/02/2021] [Revised: 08/15/2021] [Accepted: 08/15/2021] [Indexed: 01/28/2023]
Abstract
Background The SARS‐CoV‐2 pandemic disrupted hospital operations, affected the blood supply, and challenged the health care system to develop new therapeutic options, including convalescent plasma (CCP). The aim of this study is to describe and analyze blood supply fluctuations and the use of convalescent plasma in 2020. Methods AABB distributed a weekly and biweekly questionnaire through email to hospital‐based members (HBM). Results The survey was sent to 887 HBM with 479 unique respondents, most of the hospitals served pediatric and adult patients, and all states of the country participated, except Idaho and Vermont. Fifty four percent of HBM reported increased wastage in the early phase of the pandemic (May), which decreased to 4% by the end of June and throughout the rest of the year. The majority of HBM reported receiving alerts from their blood suppliers reporting blood shortages throughout the year. During March and April, only 12% of HBM were performing elective surgical procedures. The top reasons to delay procedures were: bed availability (28%); COVID‐19 caseload (23%; and blood availability (19%). By mid‐April, 42% HBM had transfused CCP and reported >24 h delay in getting the units; the vast majority obtained CCP using the Expanded Access Protocol, and later, the Emergency Use Authorization. HBM consistently prioritized the most severe patients to receive CCP, but the proportion of severely ill recipients fell from 52% to 37% between May and October, with an increase from 5% to 21% of HBM providing CCP transfusion early in the course of the disease. Discussion Blood utilization and availability fluctuated during the pandemic. The fluctuations appeared to be related to the number of COVID‐19 in the community. The use and regulatory landscape of CCP rapidly evolved over the first 8 months of the pandemic.
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Affiliation(s)
| | - Aaron Shmookler
- WVU, Pathology, Anatomy and Laboratory Medicine, Morgantown, West Virginia, USA
| | - Claudia S Cohn
- Lab Medicine and Pathology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | | | - Matthew S Karafin
- University of North Carolina System, Chapel Hill, North Carolina, USA
| | - James Stubbs
- Mayo Clinic Rochester, Transfusion Medicine, Rochester, Minnesota, USA
| | - Monica B Pagano
- Department of Laboratory Medicine, The University of Washington, Seattle, Washington, USA
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6
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Pandey S, Belanger GA, Rajbhandary S, Cohn CS, Benjamin RJ, Bracey AW, Katz LM, Menitove JE, Mintz PD, Gammon RR. A survey of US hospitals on platelet inventory management, transfusion practice, and platelet availability. Transfusion 2021; 61:2611-2620. [PMID: 34287930 DOI: 10.1111/trf.16561] [Citation(s) in RCA: 3] [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] [Received: 03/16/2021] [Revised: 05/27/2021] [Accepted: 06/04/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND A survey of US hospitals was conducted to increase our understanding of the current state of platelet (PLT) practice and supply. The survey captures information on transfusion practice and inventory management, including stock levels, outdate rates, ability to return or transfer PLTs, and low dose PLTs. Notably, the survey also elucidates PLT availability challenges and impact to patient care. STUDY DESIGN AND METHODS A 27 question online survey was distributed directly to over 995 US hospitals and indirectly through blood centers to many more between September 27 and October 25, 2019. Descriptive statistics were used for respondent characteristics. Bivariate analysis was performed and correlation coefficients, chi square tests, and p values determined statistical significance of relationships between variables. RESULTS Four hundred and eighty-one hospitals completed the survey of which 21.6%, 53.2%, and 25.2% were characterized as small, medium, and large hospitals, respectively. Some key observations from this survey include: (1) there is an opportunity for greater adherence to evidence-based guidelines; (2) higher outdate rates occur in hospitals stocking less than five PLTs and the ability to return or transfer PLTs lowers outdates; (3) use of low dose apheresis PLTs varies; and (4) decreased PLT availability is commonly reported, especially in hospitals with high usage, and can lead to delays in transfusions or surgeries. CONCLUSION This survey represents a comprehensive national assessment of inventory management practices and PLT availability challenges in US hospitals. Findings from this survey can be used to guide further research, help shape future guidance for industry, and assist with policy decisions.
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Affiliation(s)
- Suchitra Pandey
- Department of Pathology, Stanford University, Palo Alto, California, USA.,Medical Services, Operations Excellence, Stanford Blood Center, Stanford Health Care, Palo Alto, California, USA
| | - Geoffrey A Belanger
- Medical Services, Operations Excellence, Stanford Blood Center, Stanford Health Care, Palo Alto, California, USA
| | | | - Claudia S Cohn
- Department of Research, AABB, Bethesda, Maryland, USA.,Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Richard J Benjamin
- Clinical Research and Medical Affairs, Cerus Corporation, Concord, California, USA
| | - Arthur W Bracey
- Department of Pathology, Baylor St Luke's Medical Center, Houston, Texas, USA
| | - Louis M Katz
- Medical Affairs, ImpactLife (formerly Mississippi Valley Regional Blood Center), Davenport, Iowa, USA
| | - Jay E Menitove
- Department of Pathology and Lab Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Paul D Mintz
- Medical Affairs, Verax Biomedical, Inc, Marlborough, Massachusetts, USA
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7
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Cho JH, Rajbhandary S, van Buren NL, Fung MK, Al-Ghafry M, Fridey JL, Dy BA, Ziman A, Schreiber GB, Gammon RR, Reik R, Stubbs JR, van Buskirk CM, Kamel H, Townsend MJ, Zeller MP, Gottschall JL. The safety of COVID-19 convalescent plasma donation: A multi-institutional donor hemovigilance study. Transfusion 2021; 61:2668-2676. [PMID: 34227689 PMCID: PMC8447310 DOI: 10.1111/trf.16572] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although the safety and therapeutic efficacy of COVID-19 convalescent plasma (CCP) has been extensively evaluated, the safety of CCP donation has not been explored in a multi-institutional context. STUDY DESIGN AND METHODS Nine blood collection organizations (BCOs) participated in a multi-institutional donor hemovigilance effort to assess the safety of CCP donation. Donor adverse events (DAEs) were defined according to the Standard for Surveillance of Complications Related to Blood Donation, and severity was assessed using the severity grading tool. Multivariate analysis was performed to determine attributes associated with DAE severity. RESULTS The overall DAE rate was 37.7 per 1000 donations. Repeat apheresis and apheresis-naïve donors experienced adverse event rates of 19.9 and 49.8 per 1000 donations, respectively. Female donors contributed 51.9% of CCP donations with a DAE rate of 49.4 per 1000 donations. The DAE rate for male donors was 27.4 per 1000 donations. Vasovagal reactions accounted for over half of all reported DAEs (51.1%). After adjustment, volume of CCP donated was associated with vasovagal reaction severity (odds ratio [OR] 6.5, 95% confidence interval [CI] 2.5-17.1). Donor age and donation history were also associated with DAE severity. Considerable differences in DAE types and rates were observed across the participating BCOs despite the use of standardized hemovigilance definitions. CONCLUSION The safety of CCP donation appears comparable to that of conventional apheresis plasma donation with similar associated risk factors for DAE types and severity.
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Affiliation(s)
- Joseph H Cho
- Medical Sciences Institute, Versiti, Milwaukee, Wisconsin, USA
| | | | - Nancy L van Buren
- Innovative Blood Resources, Division of New York Blood Center, St. Paul, Minnesota, USA
| | - Mark K Fung
- Department of Pathology and Laboratory Medicine, The University of Vermont Health Network, Burlington, Vermont, USA
| | | | - Joy L Fridey
- American Red Cross Blood Services, Southern California Region, Pomona, California, USA
| | - Beth A Dy
- American Red Cross Biomedical Services, Washington, District of Columbia, USA
| | - Alyssa Ziman
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | | | - Richard R Gammon
- Scientific, Medical, Technical Direction, OneBlood, Orlando, Florida, USA
| | - Rita Reik
- Scientific, Medical, Technical Direction, OneBlood, Orlando, Florida, USA
| | - James R Stubbs
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Camille M van Buskirk
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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8
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Reeves HM, Goodhue Meyer E, Harm SK, Lieberman L, Pyles R, Rajbhandary S, Whitaker BI, Delaney M. Neonatal and pediatric blood bank practice in the United States: Results from the AABB pediatric transfusion medicine subsection survey. Transfusion 2021; 61:2265-2276. [PMID: 34110629 DOI: 10.1111/trf.16520] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 02/05/2021] [Accepted: 04/21/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND There are limited standards guiding the selection and processing of blood components specific for neonatal and pediatric transfusions. Therefore, blood banks (BBs) and transfusion services must create their own policies and procedures. STUDY DESIGN AND METHODS The American Association of Blood Banks (AABB) Pediatric Transfusion Medicine Subsection Committee developed a 74-question survey to capture neonatal and pediatric BB practices in the United States. RESULTS Thirty-five centers completed the survey: a response rate 15.8%. Responses indicated that most carry a mixed inventory of red blood cells (RBCs); 94.2% allow more than one type of RBC product for small-volume (SV) and large-volume (LV) transfusions to neonatal and pediatric patients. Many had storage age thresholds for RBCs transfused to neonates (SV = 60%, LV = 67.7%) but not older pediatric patients. The use of Group O for nonurgent RBC transfusion in neonates was common (74.2%). Responses related to special processing of RBCs and platelets indicated that 100% RBC and platelets are leukocyte-reduced (LR) for neonates and 97% for non-neonates. Irradiation of RBCs and platelets was commonly performed for neonatal transfusion (88.6%). Providing cytomegalovirus (CMV) seronegative products, volume reduction, and washing were variable. All centers transfused single-donor apheresis platelets; 20% allowed pathogen reduction (PR). The majority of centers have strategies limiting the amount of incompatible plasma transfused; however, few titrate ABO isoagglutinins in plasma-containing products (20% for platelets and 9.1% for plasma). CONCLUSIONS Variability exists in BB practice for neonatal and pediatric transfusion. Future studies are needed to understand and define best BB practices in these patient populations.
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Affiliation(s)
- Hollie M Reeves
- Department of Pathology, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Erin Goodhue Meyer
- American Red Cross Biomedical Services, Columbus, Ohio, USA.,Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Sarah K Harm
- University of Vermont Medical Center, Burlington, Vermont, USA
| | | | - Ryan Pyles
- SSM Health Cardinal Glennon Children's Hospital, Fenton, Missouri, USA
| | | | - Barbee I Whitaker
- Center for Biologics Evaluation and Research, Office of Biostatistics and Epidemiology, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Meghan Delaney
- Pathology and Laboratory Medicine Division, Children's National Medical Center, Washington, DC, USA.,Pathology and Pediatrics Departments, The George Washington University, Washington, DC, USA
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9
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Pagano MB, Rajbhandary S, Nunes E, Cohn CS. Transfusion services operations during the COVID-19 pandemic: Results from AABB survey. Transfusion 2020; 60:2760-2762. [PMID: 33217023 PMCID: PMC7753805 DOI: 10.1111/trf.15986] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/23/2020] [Accepted: 05/23/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Monica B. Pagano
- Department of Laboratory Medicine and PathologyUniversity of WashingtonSeattleUSA
| | | | - Eduardo Nunes
- Quality, Standards, and Accreditation AABBBethesda, MarylandUSA
| | - Claudia S. Cohn
- Transfusion Medicine Division, Department of PathologyUniversity of MinnesotaMinneapolisMinnesotaUSA
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10
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Townsend M, Kamel H, Van Buren N, Wiersum‐Osselton J, Rosa‐Bray M, Gottschall J, Rajbhandary S. Development and validation of donor adverse reaction severity grading tool: enhancing objective grade assignment to donor adverse events. Transfusion 2020; 60:1231-1242. [DOI: 10.1111/trf.15830] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/06/2020] [Accepted: 03/06/2020] [Indexed: 12/14/2022]
Affiliation(s)
| | | | | | - Johanna Wiersum‐Osselton
- TRIP Hemovigilance and Biovigilance Office Leiden the Netherlands
- Sanquin Blood Bank Amsterdam the Netherlands
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Vossoughi S, Perez G, Whitaker BI, Fung MK, Rajbhandary S, Crews N, Stotler B. Safety incident reports associated with blood transfusions. Transfusion 2019; 59:2827-2832. [PMID: 31254465 DOI: 10.1111/trf.15429] [Citation(s) in RCA: 4] [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: 01/11/2019] [Revised: 04/30/2019] [Accepted: 06/06/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patient safety remains a critical issue in health care. Adverse events related to blood transfusion constitute a threat to patient safety. The aim of this study is to compare and contrast reporting trends of patient safety events that occur during the transfusion of blood components in pediatric and adult hospital care settings. STUDY DESIGN AND METHODS This is a multicenter analysis of reported patient safety incidents occurring during the administration of blood components for four children's and 21 adult hospitals from January 2010 through September 2017. Denominators were pediatric or adult transfusions per year for a subset of two pediatric and two adult hospitals able to provide denominators for the complete reporting period. Rates were calculated on the subset of four hospitals per 100,000 components transfused with Pearson's chi square for comparison (p < 0.05 as significant). RESULTS There were 1902 reports for an estimated 1.1 million transfusions: 358 reports from pediatric hospitals and 1544 reports from adult hospitals. From hospitals able to provide denominator data; there were 192 reports for 128,560 pediatric transfusions and 183 reports for 377,563 adult transfusions. The reporting rate per 100,000 components from these four hospitals was 149 for pediatric and 48 for adult reports (p < 0.01). CONCLUSION This analysis demonstrates the continued need for transfusion safety practices. The type of incident reports differed in the pediatric setting compared to the adult setting. Understanding patient safety event reporting trends related to blood transfusion will help target hemovigilance education and interventions to the appropriate patient populations.
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Affiliation(s)
- Sarah Vossoughi
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
| | - Gabriela Perez
- AABB Center for Patient Safety, AABB, Bethesda, Maryland
| | - Barbee I Whitaker
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Office of Biostatistics and Epidemiology, Silver Spring, Maryland
| | - Mark K Fung
- Department of Pathology and Laboratory Medicine, The University of Vermont Medical Center, Burlington, Vermont
| | | | - Nicole Crews
- Departments of Pathology & Immunology and Pediatrics, Baylor College of Medicine at Texas Children's Hospital, Houston, Texas
| | - Brie Stotler
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York.,Department of Pathology and Cell Biology, New York-Presbyterian Hospital, New York, New York
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Wiersum-Osselton JC, Whitaker B, Grey S, Land K, Perez G, Rajbhandary S, Andrzejewski C, Bolton-Maggs P, Lucero H, Renaudier P, Robillard P, Santos M, Schipperus M. Revised international surveillance case definition of transfusion-associated circulatory overload: a classification agreement validation study. Lancet Haematol 2019; 6:e350-e358. [PMID: 31080132 DOI: 10.1016/s2352-3026(19)30080-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/14/2019] [Accepted: 03/15/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Transfusion-associated circulatory overload (TACO) is a major cause of transfusion-related morbidity and mortality in countries with well developed transfusion services. The International Society of Blood Transfusion, the International Haemovigilance Network, and AABB (formerly American Association of Blood Banks), have developed and validated a revised definition of TACO. METHODS International Haemovigilance Network-member haemovigilance systems (Australia, Austria, Denmark, Finland, Greece, India, Ireland, Italy, Japan, Malta, Netherlands, New Zealand, Norway, Slovenia, United Kingdom and United States) provided cases of respiratory complications categorised by their systems, including clinical parameters listed in the 2017 draft definition (part 1). Individual transfusion professionals were then invited to assess 24 case descriptions according to the draft definition (part 2). Positive and negative agreement and inter-rater agreement (κ) were calculated. Based on validation results, cases were reanalysed and slight adjustments made to yield the final 2018 TACO definition. FINDINGS In part 1, 16 (44%) of 36 haemovigilance systems provided 178 cases, including 126 TACO cases. By use of the 2018 definition, 96 (76%) of 126 cases of TACO were in positive agreement. 19 (37%) of 52 cases were recognised as non-TACO respiratory complications. In part 2 (47 experts from 20 countries), moderate all-case agreement (κ=0·43) and TACO-specific agreement (κ=0·54) were observed. Excluding cases missing some clinical information (eg, N terminal pro-brain natriuretic peptide, distinctive chest x-ray findings, and relationship with existing respiratory co-morbidities like pneumonia and chronic obstructive pulmonary disease) improved all-case agreement to κ=0·50 (moderate) and κ=0·65 (good) for TACO cases. INTERPRETATION The two-part validation exercise showed that the revised 2018 TACO surveillance case definition captures 76% of cases endorsed as TACO by participating haemovigilance systems. This definition can become the basis for internationally consistent surveillance reporting and contribute towards increased awareness and mitigation of TACO. Further research will require reporting more complete clinical information to haemovigilance systems and should focus on improved distinction between TACO and other transfusion respiratory complications. FUNDING International Society of Blood Transfusion, International Haemovigilance Network, and AABB.
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Affiliation(s)
- Johanna C Wiersum-Osselton
- Transfusion and Transplantation Reactions in Patients Hemovigilance and Biovigilance Office, Leiden, Netherlands
| | - Barbee Whitaker
- Office of Biostatistics and Epidemiology, US Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD, USA
| | - Sharran Grey
- Bolton National Health Service Foundation Trust, Greater Manchester, UK; Serious Hazards of Transfusion, Manchester Blood Centre, Manchester, UK
| | | | | | | | - Chester Andrzejewski
- System Blood Banking and Transfusion/Apheresis Medicine Services, Department of Pathology, University of Massachusetts Medical School-Baystate, Baystate Health/Baystate Medical Center, Springfield, MA, USA
| | | | - Harriet Lucero
- The Christie National Health Service Foundation Trust, Manchester, UK
| | - Philippe Renaudier
- Service d'Hématologie, Hôpital Pierre Zobda-Quitman, Fort-de-France, Cedex, Martinique
| | | | - Matilde Santos
- Instituto Português de Sangue e da Transplantação, Lisbon, Portugal
| | - Martin Schipperus
- Transfusion and Transplantation Reactions in Patients Hemovigilance and Biovigilance Office, Leiden, Netherlands; Haga Teaching Hospital, Leyweg, The Hague, Netherlands
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Whitaker B, Rajbhandary S, Kleinman S, Harris A, Kamani N. Trends in United States blood collection and transfusion: results from the 2013 AABB Blood Collection, Utilization, and Patient Blood Management Survey. Transfusion 2016; 56:2173-83. [DOI: 10.1111/trf.13676] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/25/2016] [Accepted: 04/25/2016] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | - Naynesh Kamani
- Center for Cellular Therapies & ResearchAABBBethesda Maryland
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14
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Martin DL, Goodhew B, Czaicki N, Foster K, Rajbhandary S, Hunter S, Brubaker SA. Trypanosoma cruzi survival following cold storage: possible implications for tissue banking. PLoS One 2014; 9:e95398. [PMID: 24759837 PMCID: PMC3997359 DOI: 10.1371/journal.pone.0095398] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 02/05/2014] [Accepted: 03/26/2014] [Indexed: 11/19/2022] Open
Abstract
While Trypanosoma cruzi, the etiologic agent of Chagas disease, is typically vector-borne, infection can also occur through solid organ transplantation or transfusion of contaminated blood products. The ability of infected human cells, tissues, and cellular and tissue-based products (HCT/Ps) to transmit T. cruzi is dependent upon T. cruzi surviving the processing and storage conditions to which HCT/Ps are subjected. In the studies reported here, T. cruzi trypomastigotes remained infective 24 hours after being spiked into blood and stored at room temperature (N = 20); in 2 of 13 parasite-infected cultures stored 28 days at 4°C; and in samples stored 365 days at -80°C without cryoprotectant (N = 28), despite decreased viability compared to cryopreserved parasites. Detection of viable parasites after multiple freeze/thaws depended upon the duration of frozen storage. The ability of T. cruzi to survive long periods of storage at +4 and -80°C suggests that T. cruzi-infected tissues stored under these conditions are potentially infectious.
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Affiliation(s)
- Diana L. Martin
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Brook Goodhew
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Nancy Czaicki
- University of California, Berkeley, California, United States of America
| | - Kawanda Foster
- University of Georgia, Athens, Georgia, United States of America
| | - Srijana Rajbhandary
- Center for Medical Technology Policy, Baltimore, Maryland, United States of America
| | - Shawn Hunter
- Center for Tissue Innovation and Research, Kettering, Ohio, United States of America
| | - Scott A. Brubaker
- American Association of Tissue Banks, McLean, Virginia, United States of America
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15
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Rajbhandary S, Zhao MF, Zhao N, Lu WY, Zhu HB, Xiao X, Deng Q, Li YM. Multiple Cytotoxic Factors Involved in IL-21 Enhanced Antitumor Function of CIK Cells Signaled through STAT-3 and STAT5b Pathways. Asian Pac J Cancer Prev 2013; 14:5825-31. [DOI: 10.7314/apjcp.2013.14.10.5825] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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16
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Naidu GS, Thakur R, Singh AK, Rajbhandary S, Mishra RK, Sagtani A. Oral lesions and immune status of HIV infected adults from eastern Nepal. J Clin Exp Dent 2013; 5:e1-7. [PMID: 24455044 PMCID: PMC3892227 DOI: 10.4317/jced.50888] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [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: 05/30/2012] [Accepted: 11/27/2012] [Indexed: 11/07/2022] Open
Abstract
Objective: To document the prevalence, age and gender distribution of oral lesions in HIV infected adults and the influence of highly active antiretroviral therapy and correlate them to the immune status of the patients.
Materials and Methods: Oral lesions were diagnosed by a detailed physical examination by trained and calibrated examiners according to the case definitions established by the Oral HIV/AIDS research alliance. Demographic details, risk behavior patterns and oral symptoms and habits were collected by a questionnaire.
Results: 81 patients; 54 men and 27 women aged between 20 – 55 years participated in the study. A total of 49 patients; 60.5% had some oral lesion when examined. Oral candidiasis (21 %) and oral melanosis (21%) were the most common lesions, followed by linear gingival erythema, oral hairy leukoplakia, necrotizing ulcerative periodontitis/gingivitis, herpes labialis, parotid gland enlargement and reccurent apthous ulcers. Oral hairy leukoplakia was exclusively seen in men (p=0.018). All six cases of herpes simplex lesion were seen in non - anti retro viral group (p=0.073) while oral candidiasis was commonly noted in the anti retro viral group (p=0.073). Lowering CD4 counts had the strongest association with the prevalence of oral candidasis (p=0.012), pseudomembranous candidiasis (p=0.014) and oral hairy leukoplakia (p= 0.065).
Conclusion: This study shows a high prevalence of oral candidiasis, melanosis, linear gingival erythema and oral hairy leukoplakia in the patients.
Key words:HIV, AIDS, oral lesions, prevalence.
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Affiliation(s)
- Giridhar S Naidu
- (Former) Assistant Professor, Department of Oral Medicine and Radiology. College of Dental Surgery, B.P.Koirala Institute of Health Sciences, Dharan, Sunsari District, Nepal
| | - Rachana Thakur
- Dental Surgeon. College of Dental Surgery, B.P.Koirala Institute of Health Sciences, Dharan, Sunsari District, Nepal
| | - Asutosh K Singh
- Dental Surgeon. College of Dental Surgery, B.P.Koirala Institute of Health Sciences, Dharan, Sunsari District, Nepal
| | - Srijana Rajbhandary
- Dental Surgeon. College of Dental Surgery, B.P.Koirala Institute of Health Sciences, Dharan, Sunsari District, Nepal
| | - Rajeev K Mishra
- Dental Surgeon. College of Dental Surgery, B.P.Koirala Institute of Health Sciences, Dharan, Sunsari District, Nepal
| | - Alok Sagtani
- Associate Professor, Dept of Oral and Maxillofacial Surgery. College of Dental Surgery, B.P.Koirala Institute of Health Sciences, Dharan, Sunsari District, Nepal
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Sharma D, Maskey A, KC BM, Rajbhandary S, Rajbhandary R, Limbu YR, Malla R, Regmi SR, Pradhan B, Shrestha NK. COMPARISION OF TRANSTHORACIC AND TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR THE DETECTION OF LEFT ATRIAL THROMBUS IN RHEUMATIC MITRAL VALVULAR DISEASE. JNMA J Nepal Med Assoc 2004. [DOI: 10.31729/jnma.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Transesophageal echocardiography (TEE) was performed in 114 patients with rheumatic mitral valvulardisease and its results were compared with those of transthoracic echocardiography (TTE). Of 114 patients,LA thrombus was detected in 32 patients by TEE whereas TTE could detect LA thrombus in only 4 of them.Out of 32 cases, thrombus was located in left atrial appendage (LAA) in 20 (62%). TTE could detect LAAthrombus in only one patient. The procedure of TEE was well tolerated and there was no complication. Weconclude that TEE is superior to TTE in detection of LA cavity and LA appendage thrombus. Hence, TEEshould be a routine procedure to detect LA thrombus in patients with rheumatic mitral valvular diseaseprior to any surgical intervention.Key Words: Left atrial appendage (LAA), Transthoracic echocardiography (TTE),Transesophageal echocardiography (TEE)
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