Impact of Implementing a Standard Operating Procedure to Reduce Blood Wastage in Blood Centers of Iran

BACKGROUND

Blood wastage leads to additional costs and reduced blood availability to patients. Above all is the moral issue of wasting donor gifts. This study aimed to determine the rate of blood wastage before and after implementing a new standard operating procedure (SOP) in Iran.

METHODS

In this interventional study, a SOP for wastage management was prepared and implemented in all blood centers throughout the country. Data were extracted from the integrated software of the Iranian Blood Transfusion Organization (IBTO). The wastage rate of blood components in the post-intervention years (2016-2017) was then compared with that in the pre-intervention years (2013-2015) using the Z test.

RESULTS

The overall wastage rate decreased by 36.86% (P<0.001, 95% CI [36.84-36.88]) after the intervention. Red blood cell (RBC) wastage decreased from 2.6% to 2.5%, platelet wastage from 19.5% to 10.6% and plasma wastage from 15.5% to 7.3% (P<0.001). The highest percentage of waste reduction pertained to plasma components, which decreased by 52.90% (P<0.001, 95% CI [52.86-52.94]). Expiration was the most common cause of RBC and platelet wastage. The most common causes of plasma wastage were RBC contamination and rupture or leakage of the bags. The intervention resulted in a drop of over 250000 discarded components each year, equal to approximately thirty-six million dollars in savings.

CONCLUSION

This intervention effectively reduced waste and increased efficiency. Ongoing blood wastage reviews, auditing, and receiving feedback from the central headquarters were powerful tools in following the compliance of blood centers. Further studies are recommended, especially concerning blood wastage in hospital blood banks and various wards.

Blood components requirement in Brazilian dengue outbreaks: A retrospective analysis between 2008 to 2019

INTRODUCTION

Dengue is the most fatal virus disease spread by mosquito bites and Aedes aegypti is the main transmitting agent. It is an endemic disease in the tropical and subtropical regions, currently affecting more than 100 countries. Although most patients present mild forms of the disease, a considerable proportion of individuals has severe alterations in the blood count. The aim of this study was to evaluate the consumption pattern of blood components in epidemic and non-epidemic periods and to verify if there was an impact on dengue cases and the death rate.

METHOD

This is a retrospective cross-sectional study conducted through the collection and analysis of data from the Brazilian Ministry of Health from 2008 to 2019 on new cases and deaths from dengue, as well as the consumption of blood components in the period mentioned by hemovigilance bulletins of the Brazilian authority.

RESULTS

Regarding the results, no significant difference was found between the absolute amount of blood components used in years with an epidemic peak. Regarding the relative values, an important variation was shown among the distributive consumption patterns of blood components in the outbreak years. In the univariate linear regression analysis, there was statistical significance between the increase in the number of dengue cases and deaths from dengue with the increase in the consumption of red blood cell concentrates (RBP), platelet concentrates (PP), fresh frozen plasma (FFP) and cryoprecipitate (Cryo) (p-value < 0.05). The increase in dengue cases was related to the increase in Cryo consumption with clinical significance (R² > 0.5), but dengue deaths were not correlated to the same. In multivariate analysis, all regression models had clinical and statistical significance.

CONCLUSION

The data obtained in the present study demonstrate that there is a relevant relationship between the increase in cases and deaths from dengue with the blood components usage, especially PP, FFP and cryoprecipitate.

Link between human ABO blood groups with diseases influencing blood donors and recipients frequency at RBTC, Delhi, India

Blood groups had associations with many diseases that affect blood transfusion services by increasing or decreasing the blood demand of particular blood group. The present study was designed to compare the frequency of ABO and Rh blood groups among blood donors and blood component recipients. The ABO and Rh(D) blood groups of donors and recipients were determined using Gel card method. The frequency of blood donors and blood component recipients from January 1, 2020, to December 31, 2023, at regional blood transfusion centre of Delhi, were compared using χ² test. The ABO blood group frequencies of blood donors (n=23025) were: A(23.1%), B(37.53%), AB(10.09%), and O(29.29%). The blood issue (n=20255) was significantly (p=0.0000) higher in A(24.96%), B(39.92%), and lower in AB(9.76%) and O(25.37%). The RDP issue (n=7239) was significantly (p=0.0000) higher in A(24.71%), B(39.34%), and AB(11.53%) and lower in O(24.41%). The FFP issue (n=4164) was significantly (p=0.00024) higher in AB (12.3%) and lower in A (22.05%), B(37.32%), and O(28.14%). The difference between the blood donor frequencies of Rh(D)+Ve(95.19%) and Rh(D)-Ve(4.81%) and the blood issued by Rh(D)+Ve(95.06%) and Rh(D)-Ve(4.94%) was statistically not significant(P=0.52).Blood issues were higher in blood group A and B than in O, platelet issues were higher in A, B and AB than in O, and FFP issues were higher in the AB. Non-O blood groups may have a higher frequency of blood transfusions, while O blood groups may have a protective influence against diseases due to their innate immune response.

Choice of ABO Group for Blood Component Transfusion in ABO-Incompatible Solid Organ Transplantation: A Questionnaire Survey in Korea and Guideline Proposal

The number of ABO-incompatible solid organ transplantations (ABOi SOTs) has markedly increased worldwide since the early 2000s. We investigated the choice of ABO group for blood component transfusion in ABOi SOT. We conducted a survey by e-mailing a questionnaire to blood bank specialists at 77 major hospitals in Korea, among whom 34 responded to the survey. In major ABOi SOT, for red blood cells (RBCs), the recipient’s type (70.6%) was the most common choice, followed by group O (29.4%); for platelets, group AB (50.0%) was the most common choice, followed by the donor type (38.2%); for plasma, group AB (55.9%) was the most common choice, followed by the donor type (32.4%). In bidirectional ABOi SOT, for RBCs, the recipient’s type (55.9%) was the most common choice, followed by group O (44.1%); for platelets and plasma, group AB was the most common choice (94.1% and 97.1%, respectively). The policies for transfusion in ABOi SOT were diverse. We suggest a guideline on the choice of ABO group for transfusion in ABOi SOT to secure patient health and enable an efficient use of blood components.

Validation of blood components transport through a pneumatic tube system

Introduction

Urgent blood component transfusions may be life-saving for patients in hemorrhagic shock. Measures to reduce the time taken to provide these transfusions, such as uncrossmatched transfusion or abbreviated testing, are available. However, transport time is still an additional delay and the use of a pneumatic tube system (PTS) may be an alternative to shorten the transport time of blood components.

Objectives

To assess pneumatic tube system transportation of blood components based on a validation protocol. Methods: Pre- and post-transport quality control laboratory parameters, visual appearance, transport time and temperature of the packed red blood cells (RBCs), thawed fresh plasma (TFP), cryoprecipitate (CR), and platelet concentrate (PC) were evaluated. Parameters were compared between transport via pneumatic tube and courier.

Results

A total of 23 units of RBCs, 50 units of TFP, 30 units of CR and ten units of PC were evaluated. No statistically significant differences were found between pre- and post-transport laboratory results. There was also no difference in laboratory parameters between transport modalities (PTS versus courier). All blood components transported matched regulatory requirements for quality criteria. The temperature during transport remained stable and the transport time via PTS was significantly shorter than the courier's transport time (p < 0.05).

Conclusion

The PTS was considered a fast, safe and reliable means of transportation for blood components, also securing quality prerequisites.

microti infection in BALB/c mice]

OBJECTIVE

To evaluate the effects of intravenous injection of different blood components containing Babesia microti on B. microti infection in mice.

METHODS

Healthy mice were infected with B. microti, and then blood samples were collected from the mouse orbit to prepare whole blood, serum-free blood components and pure red blood cells containing B. microti. Twenty seven BALB/c mice were divided into three groups, including the whole blood group, the serum-free blood component group and the pure red blood cell group, of 9 mice in each group, and then, each group was divided into three subgroups, of 3 mice in each subgroup, which were injected with 100 μL of blood components containing B. microti at concentrations of 9.00, 0.90, 0.09 B. microti parasites/μL (900, 90, 9 B. microti parasites) via the tail vein, respectively. Blood samples were collected from the mouse tail tip every other day since one day post-injection to prepare thin blood smears. Following Giemsa staining of blood smears, B. microti infection was identified in red blood cells using microscopy.

RESULTS

Following injection of 900 B. microti parasites, B. microti was identified in the peripheral blood in the whole blood group and the serum-free blood component group 3 days post-injection, and the density of B. microti parasites started to increase 15 days post-injection and peaked 21 days post-injection, with 2.21% and 1.76% rates of B. microti infection in red blood cells, respectively. Subsequently, the density of B. microti parasites declined, and the percentage of B. microti infection in red blood cells tended to be 0 31 days post-injection. During the study period, no B. microti was found in the peripheral blood in the pure red blood cell group. Following injection of 90 B. microti parasites, B. microti was identified in the peripheral blood in the whole blood group 3 days post-injection, and the density of B. microti parasites increased 15 days post-injection and peaked 21 days post-injection, with a 1.35% rate of B. microti infection in red blood cells, while the percentage of B. microti infection in red blood cells tended to be 0 31 days post-injection. During the study period, no B. microti was detected in the peripheral blood in the serum-free blood component group or the pure red blood cell group. Following injection of 9 B. microti parasites, no B. microti was detected in the peripheral blood in the whole blood group, the serum-free blood component group or the pure red blood cell group.

CONCLUSIONS

Blood components and dose of B. microti parasites may affect intravenous injection of B. microti injection in mice, and transfusion of blood components may case a risk of Babesia infection.

Transfusion support in preterm neonates <1500 g and/or <32 weeks in a tertiary care center: A descriptive study

BACKGROUND:

Lack of recent studies focusing on indications, pattern, and benefits of transfusions in low birth weight (B.Wt) and low gestational age (GA) preterm neonates prompted us to undertake this study.

AIM:

To estimate the transfusion requirements and outcomes in preterm neonates <1500 g and/or <32 weeks.

SETTINGS AND DESIGN:

This is a cross-sectional study conducted over a period of 2 years in a tertiary care center.

MATERIALS AND METHODS:

This study was conducted with 101 preterm neonates <1500 g and/or <32 weeks who received blood transfusions in the Neonatal Intensive Care Unit. Restrictive pattern of transfusion was followed. Demographic details and antenatal, neonatal, laboratory, and transfusion parameters were collected.

STATISTICAL ANALYSIS USED:

Statistical analyses were performed using SPSS 16.

RESULTS:

The study participants received 311 transfusions. Transfusion requirements decreased with increasing GA and B.Wt. Majority of blood transfusions occurred during the first 2 weeks of life. Packed red blood cells (PRBCs) were the most frequent blood components transfused. Ninety-six percent of the study population had an uneventful transfusion. Mean hemoglobin improvement after PRBC transfusions was 2.3 ± 2.1 g/dl. Improvement in apnea occurred in 76% PRBC transfusions. Infants with sepsis, patent ductus arteriosus, bronchopulmonary dysplasia, disseminated intravascular coagulation, and dyselectrolytemia received more number of transfusions.

CONCLUSION:

This study would serve as an audit for neonatal blood transfusion therapy. Close adherence to neonatal transfusion policy and restrictive transfusion guidelines helps reduce inappropriate use of blood products and adverse transfusion reactions.

Simultaneous measurement of pulmonary diffusing capacity for carbon monoxide and nitric oxide

In Europe and America, the newly-developed, simultaneous measurement of diffusing capacity for CO (D_LCO) and NO (D_LNO) has replaced the classic D_LCO measurement for detecting the pathophysiological abnormalities in the acinar regions. However, simultaneous measurement of D_LCO and D_LNO is currently not used by Japanese physicians. To encourage the use of D_LNO in Japan, the authors reviewed aspects of simultaneously-estimated D_LCO and D_LNO from previously published manuscripts. The simultaneous D_LCO-D_LNO technique identifies the alveolocapillary membrane-related diffusing capacity (membrane component, D_M) and the blood volume in pulmonary microcirculation (V_C); V_C is the principal factor constituting the blood component of diffusing capacity (D_B,D_B=θ·V_C where θ is the specific gas conductance for CO or NO in the blood). As the association velocity of NO with hemoglobin (Hb) is fast and the affinity of NO with Hb is high in comparison with those of CO, θ_NO can be taken as an invariable simply determined by diffusion limitation inside the erythrocyte. This means that θ_NO is independent of the partial pressure of oxygen (PO₂). However, θ_CO involves the limitations by diffusion and chemical reaction elicited by the erythrocyte, resulting in θ_CO to be a PO₂-dependent variable. Furthermore, D_LCO is determined primarily by D_B (∼77%), while D_LNO is determined equally by D_M (∼55%) and D_B (∼45%). This suggests that D_LCO is more sensitive for detecting microvascular diseases, while D_LNO can equally identify alveolocapillary membrane and microcirculatory abnormalities.

Quantification of Transfusion Recipients at Risk of Receiving Hepatitis B Virus-Contaminated Blood Components: A Korean Study

Although there are lots of studies about the risk for the hepatitis B virus infection such as the residual risk for donated blood, there is no research on the risk of HBV infection, from the viewpoint of recipients in Korea. Using the data about HBsAg status of donated blood in 2008 and 2009, the distribution of blood components from the claim data of health insurance in 2009, the distribution of HBsAg and HBsAb of recipients, and some assumptions, we quantified the number of recipients in Korea that might be expected to receive HBV-contaminated blood components, as a proxy index for HBV infection by transfusion in 2009. Of the 376,211 recipients, the number who might be expected to receive blood components with HBV in 2009 was 23.2 (95 % CI 13.6, 36.8) in the basic model, 43.2 (95 % CI 25.4, 68.7) in extended model I, 55.2 (95 % CI 32.5, 87.7) in extended model II and 101.6 (95 % CI 59.8, 161.4) in extended model III. The number of HBV-positive samples per 100,000 transfused units was 0.6 in the basic model (95 % CI 0.3, 0.9), 1.1 in extended model I (95 % CI 0.6, 1.8), 1.4 in extended model II (95 % CI 0.8, 2.2), and 2.6 in extended model III (95 % CI 1.5, 4.1). This study showed that a few recipients might receive HBV-contaminated blood component by transfusion. These results could be used as a scientific evidence for health policy on HBV transfusion infection.

Effect of passion fruit seed meal on growth performance, carcass, and blood characteristics in starter pigs

Two experiments were carried out in Paraná State, Brazil, to evaluate the nutritional value of passion fruit seed meal (PFM) and to study the effect of PFM on growth performance, carcass, and blood characteristics in starter pigs (Topigs 20 × Tybor). In experiment 1, 25 castrated males, averaging 19.1-kg body weight, were individually fed in a completely randomized block design, consisting of five treatments and five replicates and an experimental period that lasted 14 days. In experiment 2, a total of 60 pigs (30 females and 30 castrated males) were distributed in a randomized block design with five treatments, six replications, and two animals per experimental unit and 90 days of experimentation. For both experiments, the same PFM inclusion rates were used in the experimental diets, namely, 0, 4, 8, 12, and 16 %. The metabolizable energy of PFM was estimated to be 15.0 MJ/kg. Inclusion of PFM at any level did not affect average daily gain, daily feed intake, feed/gain ratio, backfat thickness, loin depth, and plasma or blood components. It is concluded that passion fruit seed meal for swine in the starting phase can be added at a rate of up to 16 % in the diet without any negative effects on growth performance, carcass, and blood characteristics in starter commercial line pigs.

Determination of rate and causes of wastage of blood and blood products in Iranian hospitals

Objective: The purpose of this study was to determine the rate and causes of wastage of blood and blood products (packed red cells, plasma, platelets, and cryoprecipitate) in Qazvin hospitals.

Materials and Methods: The study was conducted in all hospitals in Qazvin, including 5 teaching hospitals, 2 social welfare hospitals, 3 private hospitals, 1 charity hospital, and 1 military hospital. This descriptive study was based on available data from hospital blood banks in the province of Qazvin. The research instrument was a 2-part questionnaire. The first part was related to demographic characteristics of hospitals and the second part elicited information about blood and blood component wastage. The collected data were then analyzed using descriptive statistic methods and SPSS 11.5.

Results: Blood wastage may occur for a number of reasons, including time expiry, wasted imports, blood medically or surgically ordered but not used, stock time expired, hemolysis, or miscellaneous reasons. Data indicated that approximately 77.9% of wasted pack cell units were wasted for the reason of time expiry. Pack cell wastage in hospitals is reported to range from 1.93% to 30.7%. Wastage at all hospitals averaged 9.8% among 30.913 issued blood products. Overall blood and blood product (packed red cells, plasma, platelets, and cryoprecipitate) wastage was 3048 units and average total wastage per participant hospital for all blood groups was 254 units per year.

Conclusion: Blood transfusion is an essential part of patient care. The blood transfusion system has made significant advancements in areas such as donor management, storage of blood, cross-matching, rational use of blood, and distribution. In order to improve the standards of blood banks and the blood transfusion services in Iran, comprehensive standards have been formulated to ensure better quality control in collection, storage, testing, and distribution of blood and its components for the identified major factors affecting blood product wastage.

Leukoreduced blood components: Advantages and strategies for its implementation in developing countries

Removal of leucocytes from various blood products has been shown to minimize Febrile nonhemolytic transfusion reactions, HLA alloimmunization, platelet refractoriness in multitransfused patients and prevention of transmission of leukotropic viruses such as EBV and CMV. Rapidly growing size of hemato-oncological patients in our country requiring multiple transfusion of blood and components during the course of their management pose a great challenge to transfusion services to provide them red cell and platelet antigen matched products in alloimmunized subjects. Thus removal of leucocytes below a certain threshold, ≤ 5 × 10⁶ in a blood component certainly helps in prevention of alloimmunization and associated risks in these patients. Currently the best Leucoreduction can be achieved with the help of 3rd and 4th generation leukofilters, both in laboratory and patient bed side, and state of the art apheresis devices. The present article briefly reviews the current literature for pros and cons of leucofilteration and its scope of implementation in the cost constrained settings.