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Affiliation(s)
- Matthew D Neal
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Beverley J Hunt
- Thrombosis and Haemophilia Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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2
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Thelliez A, Sumian C, Chazard E, Reichenberg S, Lecoeur M, Decaudin B. Migration of di(2-ethylhexyl) phthalate, diisononylcyclohexane-1,2-dicarboxylate and di(2-ethylhexyl) terephthalate from transfusion medical devices in labile blood products: A comparative study. Vox Sang 2023; 118:533-542. [PMID: 37246454 DOI: 10.1111/vox.13446] [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: 01/12/2023] [Revised: 04/28/2023] [Accepted: 04/29/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND OBJECTIVES Polyvinyl chloride (PVC) plasticized with di(2-ethylhexyl) phthalate (DEHP) is a widely used material for medical transfusion devices. Not covalently bound to PVC, DEHP can migrate into blood products during storage. Recognized as an endocrine disruptor and raising concerns about its potential carcinogenicity and reprotoxicity, DEHP is gradually being withdrawn from the medical device market. Therefore, the use of alternative plasticizers, such as diisononylcyclohexane-1,2-dicarboxylate (DINCH) and di(2-ethylhexyl) terephthalate (DEHT), as potential candidates for the replacement of DEHP in medical transfusion devices has been investigated. The purpose of this study was to evaluate the quantity of PVC-plasticizers in the blood components according to their preparation, storage conditions and in function of the plasticizer. MATERIALS AND METHODS Whole blood was collected, and labile blood products (LBPs) were prepared by the buffy-coat method with a PVC blood bag plasticized either with DEHP, DINCH or DEHT. DINCH and DEHT equivalent concentrations were quantified in LBPs by liquid chromatography-tandem mass spectrometry or coupled with UV and compared to DEHP equivalent concentrations. RESULTS The plasticizer equivalent concentration to which a patient is exposed during a transfusion depends on the preparation of LBPs as well as their storage conditions, that is, temperature and storage time. At day 1, for all LBPs, the migration of DEHP is 5.0 and 8.5 times greater than DINCH and DEHT, respectively. At the end of the 49 days storage period, the DEHP equivalent concentration in red blood cells concentrate is statistically higher when compared to DINCH and DEHT, with maximal values of 1.85, 1.13 and 0.86 μg/dm2 /mL, respectively. CONCLUSION In addition to lower toxicity, transfused patients using PVC-DEHT or PVC-DINCH blood bags are less exposed to plasticizers than using PVC-DEHP bags with a ranging exposure reduction from 38.9% to 87.3%, due to lower leachability into blood components.
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Affiliation(s)
- Aurélie Thelliez
- ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et Technologies Associées, Université de Lille, CHU Lille, Lille, France
- Macopharma, Tourcoing, France
| | | | - Emmanuel Chazard
- ULR 2694-METRICS, CERIMS, Université de Lille, CHU Lille, Lille, France
| | | | - Marie Lecoeur
- ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et Technologies Associées, Université de Lille, CHU Lille, Lille, France
| | - Bertrand Decaudin
- ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et Technologies Associées, Université de Lille, CHU Lille, Lille, France
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3
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Lozano M, Cid J. How do we forecast tomorrows' transfusion: Non-transfusional hemotherapy. Transfus Clin Biol 2023; 30:282-286. [PMID: 36754141 DOI: 10.1016/j.tracli.2023.01.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 02/09/2023]
Abstract
Hemotherapy is the treatment of diseases by the use of blood or blood products from blood donation (by others of for oneself). It is clear that blood components transfusion represents the most important part of the activities of the professionals (doctors, nurses, technicians…) working in hemotherapy. But there are others forms of hemotherapy that are steadily growing, that we will discuss: plasma exchange, mononuclear cells collections for cellular therapies, extracorporeal photoapheresis, ABO antigen specific immunoadsorption and autologous platelet lysate.
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Affiliation(s)
- Miquel Lozano
- Apheresis and Cellular Therapy Unit. Department of Hemotherapy and Hemostasis, Clinic Institute of Hematology and Oncology, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, Barcelona. Spain.
| | - Joan Cid
- Apheresis and Cellular Therapy Unit. Department of Hemotherapy and Hemostasis, Clinic Institute of Hematology and Oncology, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, Barcelona. Spain
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4
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Irving AH, Harris A, Petrie D, Higgins A, Smith JA, Tran L, Reid CM, McQuilten ZK. Economic Evaluation of National Patient Blood Management Clinical Guidelines in Cardiac Surgery. Value Health 2022; 25:419-426. [PMID: 35227454 DOI: 10.1016/j.jval.2021.07.014] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/02/2021] [Accepted: 07/22/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To the best of our knowledge, no published clinical guidelines have ever undergone an economic evaluation to determine whether their implementation represented an efficient allocation of resources. Here, we perform an economic evaluation of national clinical guidelines designed to reduce unnecessary blood transfusions before, during, and after surgery published in 2012 by Australia's sole public blood provider, the National Blood Authority (NBA). METHODS We performed a cost analysis from the government perspective, comparing the NBA's cost of implementing their perioperative patient blood management guidelines with the estimated resource savings in the years after publication. The impact on blood products, patient outcomes, and medication use were estimated for cardiac surgeries only using a large national registry. We adopted conservative counterfactual positions over a base-case 3-year time horizon with outcomes predicted from an interrupted time-series model controlling for differences in patient characteristics and hospitals. RESULTS The estimated indexed cost of implementing the guidelines of A$1.5 million (2018-2019 financial year prices) was outweighed by the predicted blood products resource saving alone of A$5.1 million (95% confidence interval A$1.4 million-A$8.8 million) including savings of A$2.4 million, A$1.6 million, and A$1.2 million from reduced red blood cell, platelet, and fresh frozen plasma use, respectively. Estimated differences in patient outcomes were highly uncertain and estimated differences in medication were financially insignificant. CONCLUSIONS Insofar as they led to a reduction in red blood cell, platelet, and fresh frozen plasma use during cardiac surgery, implementing the perioperative patient blood management guidelines represented an efficient use of the NBA's resources.
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Affiliation(s)
- Adam H Irving
- Centre for Health Economics, Monash University, Melbourne, Australia.
| | - Anthony Harris
- Centre for Health Economics, Monash University, Melbourne, Australia
| | - Dennis Petrie
- Centre for Health Economics, Monash University, Melbourne, Australia
| | - Alisa Higgins
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Julian A Smith
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Cardiothoracic Surgery, Monash Health, Monash University, Melbourne, Australia
| | - Lavinia Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; School of Public Health, Curtin University, Perth, Australia
| | - Zoe K McQuilten
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Haematology, Monash Health, Monash University, Melbourne, Australia
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Hameed I, Cifu AS, Geirsson A. Blood Management in High-risk Surgery. JAMA 2022; 327:578-579. [PMID: 35133425 DOI: 10.1001/jama.2021.25299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Irbaz Hameed
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | | | - Arnar Geirsson
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
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6
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Stanworth SJ, Walwyn R, Grant-Casey J, Hartley S, Moreau L, Lorencatto F, Francis J, Gould N, Swart N, Rowley M, Morris S, Grimshaw J, Farrin A, Foy R. Effectiveness of Enhanced Performance Feedback on Appropriate Use of Blood Transfusions: A Comparison of 2 Cluster Randomized Trials. JAMA Netw Open 2022; 5:e220364. [PMID: 35201305 PMCID: PMC8874348 DOI: 10.1001/jamanetworkopen.2022.0364] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
IMPORTANCE Auditing and feedback are frequently used to improve patient care. However, it remains unclear how to optimize feedback effectiveness for the appropriate use of treatments such as blood transfusion, a common but costly procedure that is more often overused than underused. OBJECTIVE To evaluate 2 theoretically informed feedback interventions to improve the appropriate use of blood transfusions. DESIGN, SETTING, AND PARTICIPANTS Two sequential, linked 2 × 2 cluster randomized trials were performed in hospitals in the UK participating in national audits of transfusion for perioperative anemia and management of hematological disorders. Data were collected for a surgical trial from October 1, 2014, to October 31, 2016, with follow-up completed on October 31, 2016. Data were collected for a hematological trial through follow-up from July 1, 2015, to June 30, 2017. Trial data were analyzed from November 1, 2016, to June 1, 2019. INTERVENTIONS Hospitals were randomized to standard content or enhanced content to improve feedback clarity and usability and to standard support or enhanced support for staff to act on feedback. MAIN OUTCOMES AND MEASURES The primary end point was appropriateness of transfusions audited at 12 months. Secondary end points included volume of transfusions (aiming for reductions at patient and cluster levels) and transfusion-related adverse events and reactions. RESULTS One hundred thirty-five of 152 eligible clusters participated in the surgical audit (2714 patients; mean [SD] age, 74.9 [14.0] years; 1809 women [66.7%]), and 134 of 141 participated in the hematological audit (4439 patients; median age, 72.0 [IQR, 64.0-80.0] years; 2641 men [59.5%]). Fifty-seven of 69 clusters (82.6%) in the surgical audit randomized to enhanced content downloaded reports compared with 52 of 66 clusters (78.8%) randomized to standard reports. Fifty-nine of 68 clusters (86.8%) randomized to enhanced support logged onto the toolkit. The proportion of patients with appropriate transfusions was 0.184 for standard content and 0.176 for enhanced content (adjusted odds ratio [OR], 0.91 [97.5% CI, 0.61-1.36]) and 0.181 for standard support and 0.180 for enhanced support (adjusted OR, 1.05 [97.5% CI, 0.68-1.61]). For the hematological audit, 53 of 66 clusters (80.3%) randomized to enhanced content downloaded the reports compared with 53 of 68 clusters (77.9%) randomized to standard content. Forty-nine of 67 clusters sites (73.1%) assigned to enhanced support logged into the toolkit at least once. The proportion of patients with appropriate transfusions was 0.744 for standard content and 0.714 for enhanced content (adjusted OR, 0.81 [97.5% CI, 0.56-1.12]), and 0.739 for standard support and 0.721 for enhanced support (adjusted OR, 0.96 [97.5% CI, 0.67-1.38]). CONCLUSIONS AND RELEVANCE This comparison of cluster randomized trials found that interventions to improve feedback usability and guide local action were no more effective than standard feedback in increasing the appropriate use of blood transfusions. Auditing and feedback delivered at scale is a complex and costly program; therefore, effective responses may depend on developing robust local quality improvement arrangements, which can be evaluated using rigorous experimental designs embedded within national programs. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN15490813.
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Affiliation(s)
- Simon J. Stanworth
- NHS Blood and Transplant, John Radcliffe Hospital, Oxford, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Radcliffe Department of Medicine and Oxford Biomedical Research Center Haematology Theme, University of Oxford, Oxford, United Kingdom
| | - Rebecca Walwyn
- Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - John Grant-Casey
- NHS Blood and Transplant, John Radcliffe Hospital, Oxford, United Kingdom
| | - Suzanne Hartley
- Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Lauren Moreau
- Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Fabiana Lorencatto
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Jill Francis
- School of Health Sciences City, University of London, London, United Kingdom
- School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Natalie Gould
- School of Health Sciences City, University of London, London, United Kingdom
| | - Nick Swart
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Megan Rowley
- Scottish National Blood Transfusion Service, Edinburgh, Edinburgh, United Kingdom
| | - Steve Morris
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Jeremy Grimshaw
- Faculty of Medicine, University of Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Amanda Farrin
- Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
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7
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Hynes AM, Geng Z, Schmulevich D, Fox EE, Meador CL, Scantling DR, Holena DN, Abella BS, Young AJ, Holland S, Cacchione PZ, Wade CE, Cannon JW. Staying on target: Maintaining a balanced resuscitation during damage-control resuscitation improves survival. J Trauma Acute Care Surg 2021; 91:841-848. [PMID: 33901052 PMCID: PMC8547746 DOI: 10.1097/ta.0000000000003245] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/17/2021] [Accepted: 04/10/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Damage-control resuscitation (DCR) improves survival in severely bleeding patients. However, deviating from balanced transfusion ratios during a resuscitation may limit this benefit. We hypothesized that maintaining a balanced resuscitation during DCR is independently associated with improved survival. METHODS This was a secondary analysis of the Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study. Patients receiving >3 U of packed red blood cells (PRBCs) during any 1-hour period over the first 6 hours and surviving beyond 30 minutes were included. Linear regression assessed the effect of percent time in a high-ratio range on 24-hour survival. We identified an optimal ratio and percent of time above the target ratio threshold by Youden's index. We compared patients with a 6-hour ratio above the target and above the percent time threshold (on-target) with all others (off-target). Kaplan-Meier analysis assessed the combined effect of blood product ratio and percent time over the target ratio on 24-hour and 30-day survival. Multivariable logistic regression identified factors independently associated with 24-hour and 30-day survival. RESULTS Of 1,245 PROMMTT patients, 524 met the inclusion criteria. Optimal targets were plasma/PRBC and platelet/PRBC of 0.75 (3:4) and ≥40% time spent over this threshold. For plasma/PRBC, on-target (n = 213) versus off-target (n = 311) patients were younger (median, 31 years; interquartile range, [22-50] vs. 40 [25-54]; p = 0.002) with similar injury burdens and presenting physiology. Similar patterns were observed for platelet/PRBC on-target (n = 116) and off-target (n = 408) patients. After adjusting for differences, on-target plasma/PRBC patients had significantly improved 24-hour (odds ratio, 2.25; 95% confidence interval, 1.20-4.23) and 30-day (odds ratio, 1.97; 95% confidence interval, 1.14-3.41) survival, while on-target platelet/PRBC patients did not. CONCLUSION Maintaining a high ratio of plasma/PRBC during DCR is independently associated with improved survival. Performance improvement efforts and prospective studies should capture time spent in a high-ratio range. LEVEL OF EVIDENCE Epidemiologic/prognostic study, level II; Therapeutic, level IV.
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Affiliation(s)
- Allyson M. Hynes
- From the Division of Traumatology (A.M.H., D.S., D.R.S., D.N.H., S.H., J.W.C.), Surgical Critical Care and Emergency Surgery, Penn Acute Research Collaboration (A.M.H., D.S., D.N.H., B.S.A., P.Z.C., J.W.C.), Perelman School of Medicine, Leonard Davis Institute of Health Economics (Z.G., J.W.C.), University of Pennsylvania, Philadelphia, Pennsylvania; Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery (E.E.F., C.E.W.), Medical School, University of Texas Health Science Center at Houston, Houston; Arcos, Inc. (C.L.M.), Missouri City, Texas; Center for Resuscitation Science, Department of Emergency Medicine (B.S.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Trauma, Critical Care, and Burn, Department of Surgery (A.J.Y.), The Ohio State University, Columbus, Ohio; Department of Nursing (P.Z.C.), Penn Presbyterian Medical Center, Philadelphia, Pennsylvania; and Department of Surgery (J.W.C.), Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Zhi Geng
- From the Division of Traumatology (A.M.H., D.S., D.R.S., D.N.H., S.H., J.W.C.), Surgical Critical Care and Emergency Surgery, Penn Acute Research Collaboration (A.M.H., D.S., D.N.H., B.S.A., P.Z.C., J.W.C.), Perelman School of Medicine, Leonard Davis Institute of Health Economics (Z.G., J.W.C.), University of Pennsylvania, Philadelphia, Pennsylvania; Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery (E.E.F., C.E.W.), Medical School, University of Texas Health Science Center at Houston, Houston; Arcos, Inc. (C.L.M.), Missouri City, Texas; Center for Resuscitation Science, Department of Emergency Medicine (B.S.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Trauma, Critical Care, and Burn, Department of Surgery (A.J.Y.), The Ohio State University, Columbus, Ohio; Department of Nursing (P.Z.C.), Penn Presbyterian Medical Center, Philadelphia, Pennsylvania; and Department of Surgery (J.W.C.), Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Daniela Schmulevich
- From the Division of Traumatology (A.M.H., D.S., D.R.S., D.N.H., S.H., J.W.C.), Surgical Critical Care and Emergency Surgery, Penn Acute Research Collaboration (A.M.H., D.S., D.N.H., B.S.A., P.Z.C., J.W.C.), Perelman School of Medicine, Leonard Davis Institute of Health Economics (Z.G., J.W.C.), University of Pennsylvania, Philadelphia, Pennsylvania; Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery (E.E.F., C.E.W.), Medical School, University of Texas Health Science Center at Houston, Houston; Arcos, Inc. (C.L.M.), Missouri City, Texas; Center for Resuscitation Science, Department of Emergency Medicine (B.S.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Trauma, Critical Care, and Burn, Department of Surgery (A.J.Y.), The Ohio State University, Columbus, Ohio; Department of Nursing (P.Z.C.), Penn Presbyterian Medical Center, Philadelphia, Pennsylvania; and Department of Surgery (J.W.C.), Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Erin E. Fox
- From the Division of Traumatology (A.M.H., D.S., D.R.S., D.N.H., S.H., J.W.C.), Surgical Critical Care and Emergency Surgery, Penn Acute Research Collaboration (A.M.H., D.S., D.N.H., B.S.A., P.Z.C., J.W.C.), Perelman School of Medicine, Leonard Davis Institute of Health Economics (Z.G., J.W.C.), University of Pennsylvania, Philadelphia, Pennsylvania; Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery (E.E.F., C.E.W.), Medical School, University of Texas Health Science Center at Houston, Houston; Arcos, Inc. (C.L.M.), Missouri City, Texas; Center for Resuscitation Science, Department of Emergency Medicine (B.S.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Trauma, Critical Care, and Burn, Department of Surgery (A.J.Y.), The Ohio State University, Columbus, Ohio; Department of Nursing (P.Z.C.), Penn Presbyterian Medical Center, Philadelphia, Pennsylvania; and Department of Surgery (J.W.C.), Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Christopher L. Meador
- From the Division of Traumatology (A.M.H., D.S., D.R.S., D.N.H., S.H., J.W.C.), Surgical Critical Care and Emergency Surgery, Penn Acute Research Collaboration (A.M.H., D.S., D.N.H., B.S.A., P.Z.C., J.W.C.), Perelman School of Medicine, Leonard Davis Institute of Health Economics (Z.G., J.W.C.), University of Pennsylvania, Philadelphia, Pennsylvania; Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery (E.E.F., C.E.W.), Medical School, University of Texas Health Science Center at Houston, Houston; Arcos, Inc. (C.L.M.), Missouri City, Texas; Center for Resuscitation Science, Department of Emergency Medicine (B.S.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Trauma, Critical Care, and Burn, Department of Surgery (A.J.Y.), The Ohio State University, Columbus, Ohio; Department of Nursing (P.Z.C.), Penn Presbyterian Medical Center, Philadelphia, Pennsylvania; and Department of Surgery (J.W.C.), Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Dane R. Scantling
- From the Division of Traumatology (A.M.H., D.S., D.R.S., D.N.H., S.H., J.W.C.), Surgical Critical Care and Emergency Surgery, Penn Acute Research Collaboration (A.M.H., D.S., D.N.H., B.S.A., P.Z.C., J.W.C.), Perelman School of Medicine, Leonard Davis Institute of Health Economics (Z.G., J.W.C.), University of Pennsylvania, Philadelphia, Pennsylvania; Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery (E.E.F., C.E.W.), Medical School, University of Texas Health Science Center at Houston, Houston; Arcos, Inc. (C.L.M.), Missouri City, Texas; Center for Resuscitation Science, Department of Emergency Medicine (B.S.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Trauma, Critical Care, and Burn, Department of Surgery (A.J.Y.), The Ohio State University, Columbus, Ohio; Department of Nursing (P.Z.C.), Penn Presbyterian Medical Center, Philadelphia, Pennsylvania; and Department of Surgery (J.W.C.), Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Daniel N. Holena
- From the Division of Traumatology (A.M.H., D.S., D.R.S., D.N.H., S.H., J.W.C.), Surgical Critical Care and Emergency Surgery, Penn Acute Research Collaboration (A.M.H., D.S., D.N.H., B.S.A., P.Z.C., J.W.C.), Perelman School of Medicine, Leonard Davis Institute of Health Economics (Z.G., J.W.C.), University of Pennsylvania, Philadelphia, Pennsylvania; Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery (E.E.F., C.E.W.), Medical School, University of Texas Health Science Center at Houston, Houston; Arcos, Inc. (C.L.M.), Missouri City, Texas; Center for Resuscitation Science, Department of Emergency Medicine (B.S.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Trauma, Critical Care, and Burn, Department of Surgery (A.J.Y.), The Ohio State University, Columbus, Ohio; Department of Nursing (P.Z.C.), Penn Presbyterian Medical Center, Philadelphia, Pennsylvania; and Department of Surgery (J.W.C.), Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Benjamin S. Abella
- From the Division of Traumatology (A.M.H., D.S., D.R.S., D.N.H., S.H., J.W.C.), Surgical Critical Care and Emergency Surgery, Penn Acute Research Collaboration (A.M.H., D.S., D.N.H., B.S.A., P.Z.C., J.W.C.), Perelman School of Medicine, Leonard Davis Institute of Health Economics (Z.G., J.W.C.), University of Pennsylvania, Philadelphia, Pennsylvania; Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery (E.E.F., C.E.W.), Medical School, University of Texas Health Science Center at Houston, Houston; Arcos, Inc. (C.L.M.), Missouri City, Texas; Center for Resuscitation Science, Department of Emergency Medicine (B.S.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Trauma, Critical Care, and Burn, Department of Surgery (A.J.Y.), The Ohio State University, Columbus, Ohio; Department of Nursing (P.Z.C.), Penn Presbyterian Medical Center, Philadelphia, Pennsylvania; and Department of Surgery (J.W.C.), Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Andrew J. Young
- From the Division of Traumatology (A.M.H., D.S., D.R.S., D.N.H., S.H., J.W.C.), Surgical Critical Care and Emergency Surgery, Penn Acute Research Collaboration (A.M.H., D.S., D.N.H., B.S.A., P.Z.C., J.W.C.), Perelman School of Medicine, Leonard Davis Institute of Health Economics (Z.G., J.W.C.), University of Pennsylvania, Philadelphia, Pennsylvania; Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery (E.E.F., C.E.W.), Medical School, University of Texas Health Science Center at Houston, Houston; Arcos, Inc. (C.L.M.), Missouri City, Texas; Center for Resuscitation Science, Department of Emergency Medicine (B.S.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Trauma, Critical Care, and Burn, Department of Surgery (A.J.Y.), The Ohio State University, Columbus, Ohio; Department of Nursing (P.Z.C.), Penn Presbyterian Medical Center, Philadelphia, Pennsylvania; and Department of Surgery (J.W.C.), Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Sara Holland
- From the Division of Traumatology (A.M.H., D.S., D.R.S., D.N.H., S.H., J.W.C.), Surgical Critical Care and Emergency Surgery, Penn Acute Research Collaboration (A.M.H., D.S., D.N.H., B.S.A., P.Z.C., J.W.C.), Perelman School of Medicine, Leonard Davis Institute of Health Economics (Z.G., J.W.C.), University of Pennsylvania, Philadelphia, Pennsylvania; Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery (E.E.F., C.E.W.), Medical School, University of Texas Health Science Center at Houston, Houston; Arcos, Inc. (C.L.M.), Missouri City, Texas; Center for Resuscitation Science, Department of Emergency Medicine (B.S.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Trauma, Critical Care, and Burn, Department of Surgery (A.J.Y.), The Ohio State University, Columbus, Ohio; Department of Nursing (P.Z.C.), Penn Presbyterian Medical Center, Philadelphia, Pennsylvania; and Department of Surgery (J.W.C.), Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Pamela Z. Cacchione
- From the Division of Traumatology (A.M.H., D.S., D.R.S., D.N.H., S.H., J.W.C.), Surgical Critical Care and Emergency Surgery, Penn Acute Research Collaboration (A.M.H., D.S., D.N.H., B.S.A., P.Z.C., J.W.C.), Perelman School of Medicine, Leonard Davis Institute of Health Economics (Z.G., J.W.C.), University of Pennsylvania, Philadelphia, Pennsylvania; Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery (E.E.F., C.E.W.), Medical School, University of Texas Health Science Center at Houston, Houston; Arcos, Inc. (C.L.M.), Missouri City, Texas; Center for Resuscitation Science, Department of Emergency Medicine (B.S.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Trauma, Critical Care, and Burn, Department of Surgery (A.J.Y.), The Ohio State University, Columbus, Ohio; Department of Nursing (P.Z.C.), Penn Presbyterian Medical Center, Philadelphia, Pennsylvania; and Department of Surgery (J.W.C.), Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Charles E. Wade
- From the Division of Traumatology (A.M.H., D.S., D.R.S., D.N.H., S.H., J.W.C.), Surgical Critical Care and Emergency Surgery, Penn Acute Research Collaboration (A.M.H., D.S., D.N.H., B.S.A., P.Z.C., J.W.C.), Perelman School of Medicine, Leonard Davis Institute of Health Economics (Z.G., J.W.C.), University of Pennsylvania, Philadelphia, Pennsylvania; Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery (E.E.F., C.E.W.), Medical School, University of Texas Health Science Center at Houston, Houston; Arcos, Inc. (C.L.M.), Missouri City, Texas; Center for Resuscitation Science, Department of Emergency Medicine (B.S.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Trauma, Critical Care, and Burn, Department of Surgery (A.J.Y.), The Ohio State University, Columbus, Ohio; Department of Nursing (P.Z.C.), Penn Presbyterian Medical Center, Philadelphia, Pennsylvania; and Department of Surgery (J.W.C.), Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jeremy W. Cannon
- From the Division of Traumatology (A.M.H., D.S., D.R.S., D.N.H., S.H., J.W.C.), Surgical Critical Care and Emergency Surgery, Penn Acute Research Collaboration (A.M.H., D.S., D.N.H., B.S.A., P.Z.C., J.W.C.), Perelman School of Medicine, Leonard Davis Institute of Health Economics (Z.G., J.W.C.), University of Pennsylvania, Philadelphia, Pennsylvania; Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery (E.E.F., C.E.W.), Medical School, University of Texas Health Science Center at Houston, Houston; Arcos, Inc. (C.L.M.), Missouri City, Texas; Center for Resuscitation Science, Department of Emergency Medicine (B.S.A.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Trauma, Critical Care, and Burn, Department of Surgery (A.J.Y.), The Ohio State University, Columbus, Ohio; Department of Nursing (P.Z.C.), Penn Presbyterian Medical Center, Philadelphia, Pennsylvania; and Department of Surgery (J.W.C.), Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Abstract
BACKGROUND Health care in deployed military environments requires robust clinical nursing skills to care for patients with traumatic injuries. Blood product administration is a critical skill in which nurses should be competent. However, in non-deployed environments, blood transfusions are performed less frequently, resulting in skill competency loss. AIMS Our clinical inquiry focused on maintaining competency for infrequently performed nursing skills, specifically blood product administration. METHODS A literature review and critical appraisal were executed, followed by an evidence-based practice change. A knowledge test, objective and subjective assessment, and training satisfaction evaluation were performed to measure the practice change outcomes. Both inpatient and outpatient nurses were included. RESULTS Sixteen articles were identified and appraised. The evidence recommended a blended education approach, that is, lecture plus hands-on practice. Thus, a classroom lecture and simulation scenario were put into practice with an existing computer-based training for blood administration. The nurses met knowledge test standards (≥ 90%) before and after implementation, while skill performance improved by 13% and improved self-competence scores by 7%. Nurses in outpatient settings improved performance scores by 18.4% compared to inpatient nurses, whose scores improved by 9.4%. The simulation scenario completion time decreased by 8.3 minutes post-implementation, and the training program earned a 90% satisfactory rating. LINKING EVIDENCE TO ACTION A blended education program improves clinical skill performance and enhances confidence in performing critical interventions. Blended education provides a safe learning environment for nurses to be prepared for the management of low-volume patient care emergencies.
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Affiliation(s)
- Savannah Jumpp
- Clinical Investigation FacilityDavid Grant USAF Medical CenterTravis AFBCAUSA
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9
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Tibi P, McClure RS, Huang J, Baker RA, Fitzgerald D, Mazer CD, Stone M, Chu D, Stammers AH, Dickinson T, Shore-Lesserson L, Ferraris V, Firestone S, Kissoon K, Moffatt-Bruce S. STS/SCA/AmSECT/SABM Update to the Clinical Practice Guidelines on Patient Blood Management. Ann Thorac Surg 2021; 112:981-1004. [PMID: 34217505 DOI: 10.1016/j.athoracsur.2021.03.033] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Pierre Tibi
- Department of Cardiovascular Surgery, Yavapai Regional Medical Center, Prescott, Arizona
| | - R Scott McClure
- Division of Cardiac Surgery, Libin Cardiovascular Institute, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada
| | - Jiapeng Huang
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, Kentucky
| | - Robert A Baker
- Cardiac Surgery Research and Perfusion, Flinders University and Flinders Medical Centre, Adelaide, South Australia, Australia
| | - David Fitzgerald
- Division of Cardiovascular Perfusion, Medical University of South Carolina, Charleston, South Carolina
| | - C David Mazer
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Marc Stone
- Department of Anesthesia, Mount Sinai Medical Center, New York, New York
| | - Danny Chu
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Tim Dickinson
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Linda Shore-Lesserson
- Department of Anesthesiology, Zucker School of Medicine at Hofstra/Northwell Northshore University Hospital, Manhasset, New York
| | - Victor Ferraris
- Division of Cardiovascular and Thoracic Surgery, University of Kentucky, Lexington, Kentucky
| | | | | | - Susan Moffatt-Bruce
- Division of Thoracic Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.
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10
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Zayed S, Nguyen TK, Lin C, Boldt G, Beriwal S, Creutzberg CL, Kamrava M, Mendez LC, Velker V, Doll C, Taggar A, Leung E, D’Souza DP. Red Blood Cell Transfusion Practices for Patients With Cervical Cancer Undergoing Radiotherapy. JAMA Netw Open 2021; 4:e213531. [PMID: 33818620 PMCID: PMC8022218 DOI: 10.1001/jamanetworkopen.2021.3531] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Packed red blood cell (PRBC) transfusions are used to treat anemia in patients with cervical cancer undergoing radiotherapy (RT) owing to concerns of hypoxia-induced radioresistance. In the absence of high-quality evidence informing transfusion practices for patients receiving external beam RT (EBRT) and brachytherapy, various arbitrary hemoglobin target levels are used worldwide. OBJECTIVE To develop consensus statements to guide PRBC transfusion practices in patients with cervical cancer receiving curative-intent RT with EBRT and brachytherapy. DESIGN, SETTING, AND PARTICIPANTS This international Delphi consensus study was completed between November 1, 2019, and July 31, 2020. A total of 63 international clinical experts in gynecologic radiation oncology were invited; 39 (62%) accepted and consented to participate. Consensus building was achieved using a 3-round anonymous Delphi consensus method. Participants rated their agreement or disagreement with statements using a 5-point Likert scale. An a priori threshold of 75% or more was required for consensus. MAIN OUTCOMES AND MEASURES The preplanned primary outcome of this study was to assess hemoglobin transfusion thresholds and targets for both EBRT and brachytherapy by expert consensus. RESULTS Response rates of 100% (39 of 39), 92% (36 of 39), and 97% (35 of 36) were achieved for the first, second, and third rounds of surveys, respectively. Twenty-three experts (59%) practiced in Canada, 11 (28%) in the United States, 3 (8%) in South America, 1 (3%) in Europe, and 1 (3%) in Asia. Consensus was reached for 44 of 103 statements (43%), which were combined to form the final 27-statement consensus guideline. No specific hemoglobin transfusion threshold was agreed on by consensus for EBRT or brachytherapy. By consensus (89% [31 of 35]), a hemoglobin transfusion target for patients who receive a PRBC transfusion should be 9 g/dL or more and less than 12 g/dL. CONCLUSIONS AND RELEVANCE This study presents the first international expert consensus guideline informing PRBC transfusion practices for patients with cervical cancer undergoing EBRT and brachytherapy. A minimum hemoglobin transfusion target of 9 g/dL was endorsed to balance tumor radiosensitivity with appropriate use of a scarce resource. Randomized clinical trials are required to evaluate the optimal transfusion threshold and target that maximize clinical benefit in this patient population.
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Affiliation(s)
- Sondos Zayed
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Timothy K. Nguyen
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Cindy Lin
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Gabriel Boldt
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Sushil Beriwal
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Carien L. Creutzberg
- Department of Radiation Oncology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Mitchell Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Lucas C. Mendez
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Vikram Velker
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Corinne Doll
- Department of Radiation Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Amandeep Taggar
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Eric Leung
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - David P. D’Souza
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
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11
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Argyrou A, Valsami S, Pouliakis A, Gavalaki M, Aggelidis A, Voulgaridou V, Pliatsika V, Adraktas T, Papachronis A, Alepi C, Giannopoulou V, Siourounis P, Tsagia S, Martinis G, Kontekaki E, Zervou E, Koliofotis S, Kyriakou E, Mougiou A, Dimitra L, Chairopoulou A, Tsakania A, Baka M, Apostolidou I, Moschandreou D, Livada A, Politou M, Roussinou F, Pappa C, Koika V, Vgontza N, Gafou A, Dendrinou I, Sakellaridi F, Labrianou L, Alexandropoulou Z, Sochali V, Malekas K, Skordilaki A, Kakava G, Lebesopoulos K, Stamoulis K, Grouzi E. Current Practice in FFP Preparation and Use in Greece: A National Survey. Turk J Haematol 2021; 38:22-32. [PMID: 33233876 PMCID: PMC7927442 DOI: 10.4274/tjh.galenos.2020.2020.0241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 11/18/2020] [Indexed: 12/01/2022] Open
Abstract
Objective Fresh frozen plasma (FFP) transfusion is widely used in modern clinical settings. Practices regarding its use vary due to lack of guidelines from randomized trials. The aim of this study was to assess both the current practices regarding FFP production, use, and wastage and the implementation of quality control (QC), female donor plasma production policies, and use of pharmaceutical hemostatic agents in Greece. Materials and Methods The study was conducted during February-April 2018. For the first part of the study, data including FFP transfusion indication, hospital department, diagnosis, FFP units/transfusion episode, ABO compatibility, blood donor’s sex, and reasons for discarding were collected. For the second part, questionnaire data were analyzed. Results According to data from 20 Greek hospitals, 12655 FFP units were transfused to 2700 patients during 5069 transfusion episodes in the studied period of time. Most patients were hospitalized in internal medicine, general surgery, and intensive care unit departments. Each patient received on average 4.69 units (2.5 units/episode). Transfusion requests were in accordance with international guidelines in 63.44% of cases and 99.04% of the units were given to ABO-identical patients. Main reasons for discarding included failure to meet quality requirements (30.06%), female donors (22.17%), and other causes (27.26%). Among 96.9% of all transfusion services across the country, 28.26% perform QC according to the directions of the European Directorate for the Quality of Medicines & Health Care and 68.83% discard plasma from female donors. Pharmaceutic hemostatic agents are used in 37.23% of the hospitals. Conclusion This is the first national survey regarding FFP production and transfusion in Greece. Staff of internal medicine, general surgery, and ICU departments, where most FFP-transfused patients are hospitalized, should be regularly involved in training on contemporary transfusion guidelines. Upcoming centralization of FFP production and inventory management could help in homogenizing practices regarding FFP use and improve product quality. Strengthening the use of pharmaceutic hemostatic agents could improve patients’ management.
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Affiliation(s)
- Aspasia Argyrou
- These authors contributed equally to this work
- Agioi Anargyroi Hospital, Department of Blood Transfusion, Athens, Greece
| | - Serena Valsami
- These authors contributed equally to this work
- National and Kapodistrian University of Athens, Aretaieion University Hospital, Medical School, Hematology Laboratory-Blood Bank Department, Athens, Greece
| | - Abraham Pouliakis
- National and Kapodistrian University of Athens, Attikon University Hospital, Second Department of Pathology, Athens, Greece
| | - Maria Gavalaki
- National and Kapodistrian University of Athens, Attikon University Hospital, Second Department of Pathology, Athens, Greece
| | - Antonis Aggelidis
- Konstantopouleio-Neas Ionias General Hospital, Department of Blood Transfusion, Athens, Greece
| | - Vasiliki Voulgaridou
- AHEPA, University Hospital, Department of Blood Transfusion, Thessaloniki, Greece
| | - Vasiliki Pliatsika
- AHEPA, University Hospital, Department of Blood Transfusion, Thessaloniki, Greece
| | - Theofanis Adraktas
- National and Kapodistrian University of Athens, Attikon University Hospital, Second Department of Pathology, Athens, Greece
| | - Andreas Papachronis
- National and Kapodistrian University of Athens, Attikon University Hospital, Second Department of Pathology, Athens, Greece
| | - Chrysoula Alepi
- General Hospital Tzaneio, Department of Blood Transfusion, Piraeus, Greece
| | | | - Panagiotis Siourounis
- Agios Panteleimon General Hospital of Nikaia, Department of Blood Transfusion, Athens, Greece
| | - Sofia Tsagia
- Agios Panteleimon General Hospital of Nikaia, Department of Blood Transfusion, Athens, Greece
| | - Georges Martinis
- University Hospital, Department of Blood Transfusion, Alexandroupolis, Greece
| | - Eftihia Kontekaki
- University Hospital, Department of Blood Transfusion, Alexandroupolis, Greece
| | - Eleftheria Zervou
- University Hospital, Department of Blood Transfusion, Ioannina, Greece
| | - Spiridon Koliofotis
- Attikon University Hospital, Laboratory of Hematology and Blood Bank Unit, Athens, Greece
| | - Elias Kyriakou
- Attikon University Hospital, Laboratory of Hematology and Blood Bank Unit, Athens, Greece
| | - Athina Mougiou
- University Hospital, Blood Transfusion Center, Patras, Greece
| | | | | | - Aggeliki Tsakania
- Sismanogleio General Hospital, Department of Blood Transfusion, Athens, Greece
| | - Maria Baka
- Thriasio General Hospital, Department of Blood Transfusion, Athens, Greece
| | - Ioanna Apostolidou
- Thriasio General Hospital, Department of Blood Transfusion, Athens, Greece
| | - Dimitra Moschandreou
- Saint Savvas Oncology Hospital, Department of Blood Transfusion and Clinical Hemostasis, Athens, Greece
| | - Anastasia Livada
- Saint Savvas Oncology Hospital, Department of Blood Transfusion and Clinical Hemostasis, Athens, Greece
| | - Marianna Politou
- National and Kapodistrian University of Athens, Aretaieion University Hospital, Medical School, Hematology Laboratory-Blood Bank Department, Athens, Greece
| | - Fragoula Roussinou
- National and Kapodistrian University of Athens, Aretaieion University Hospital, Medical School, Hematology Laboratory-Blood Bank Department, Athens, Greece
| | - Christina Pappa
- General Hospital, Department of Blood Transfusion, Korinthos, Greece
| | - Vasiliki Koika
- General Hospital, Department of Blood Transfusion, Korinthos, Greece
| | - Niki Vgontza
- Konstantopouleio-Neas Ionias General Hospital, Department of Blood Transfusion, Athens, Greece
| | - Anthippi Gafou
- Agioi Anargyroi Hospital, Department of Blood Transfusion, Athens, Greece
| | - Ioanna Dendrinou
- Konstantopouleio-Neas Ionias General Hospital, Department of Blood Transfusion, Athens, Greece
| | | | | | | | - Vasiliki Sochali
- General Hospital, Department of Blood Transfusion, Giannitsa, Greece
| | - Kostas Malekas
- General Hospital, Department of Blood Transfusion, Livadia, Greece
| | - Areti Skordilaki
- General Hospital, Department of Blood Transfusion, Chania, Greece
| | - Georgia Kakava
- Pammakaristos General Hospital, Department of Blood Transfusion, Athens, Greece
| | | | | | - Elisavet Grouzi
- Saint Savvas Oncology Hospital, Department of Blood Transfusion and Clinical Hemostasis, Athens, Greece
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Zhao Y, Xi C, Xu W, Yan J. Role of tranexamic acid in blood loss control and blood transfusion management of patients undergoing multilevel spine surgery: A meta-analysis. Medicine (Baltimore) 2021; 100:e24678. [PMID: 33607807 PMCID: PMC7899852 DOI: 10.1097/md.0000000000024678] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 01/16/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND This study aimed to explore the role of tranexamic acid (TXA) in blood loss control and blood transfusion management of patients undergoing multilevel spine surgery. METHODS In this meta-analysis, a comprehensive search of literatures was performed from PubMed, Embase, Cochrane Library, and Web of Science from inception to June 23rd, 2020. Weighed mean difference (WMD) was used as the effect size for measurement data, and risk ratio for enumeration data. Publication bias was assessed by Begg test. RESULTS Totally 23 studies (11 randomized controlled trials and 12 cohort studies) involving 1621 participants were enrolled in this meta-analysis. The results showed that the administration of TXA can significantly decrease the intraoperative [WMD: -215.655, 95%CI: (-307.462, -123.847), P < .001], postoperative [WMD: -69.213, 95%CI: (-104.443, -33.983), P = .001] and total [WMD: -284.388, 95%CI: (-437.66, -131.116), P < .001] volumes of blood loss of patients undergoing multilevel spine surgery. It can also significantly reduce the intraoperative [WMD: -333.775, 95%CI: (-540.45, -127.099), P = .002] and postoperative [WMD: -114.661, 95%CI: (-219.58, -9.742), P = .032] volumes of transfusion. In addition, TXA was found to significantly increase the preoperative [WMD: 0.213, 95%CI: (0.037, 0.389), P = .018] and postoperative [WMD: 0.433, 95%CI: (0.244, 0.622), P < .001] hemoglobin levels as well as the preoperative platelet count [WMD: 14.069, 95%CI: (0.122, 28.015), P = .048]. CONCLUSION The administration of TXA can effectively reduce blood loss and transfusion, and improve hemoglobin levels and preoperative platelet count in patients undergoing multilevel spine surgery.
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Abstract
Hemorrhaging during operative and other invasive procedures can result in devastating outcomes for surgical patients. An effective plan of action in the form of a massive transfusion protocol (MTP), along with teamwork and clear communication among OR personnel, is critical during a hemorrhagic crisis to improve patient outcomes. However, perioperative personnel may be unprepared to manage a hemorrhagic crisis because they lack experiential knowledge of these uncommon, high-risk scenarios. Perioperative leaders at a 500-bed acute-care hospital in the Midwest developed an educational activity involving a video-recorded simulated MTP scenario, learning modules, and debriefing sessions to educate more than 150 employees. Perioperative personnel received pre-education and watched the video-recorded MTP simulation together, and then participated in team debriefings after watching the video. Based on team debriefings and evaluation feedback, most staff members believed that the activity improved team communication.
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Abstract
SARS-CoV-2 (also known as COVID-19) has been an unprecedented challenge in many parts of the medical field with blood banking being no exception. COVID-19 has had a distinctly negative effect on our blood collection nationwide forcing blood banks, blood centers, and the US government to adopt new policies to adapt to a decreased blood supply as well as to protect our donors from COVID-19. These policies can be seen distinctly in patient blood management and blood bank operations. We are also faced with developing policies and procedures for a nontraditional therapy, convalescent plasma; its efficacy and safety is still not completely elucidated as of yet.
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Affiliation(s)
- Andy Ngo
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Unit, University of Rochester, Strong Memorial Hospital - Blood Bank, 601 Elmwood Avenue, Box 608, Rochester, NY 14642, USA
| | - Debra Masel
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Unit, University of Rochester, Strong Memorial Hospital - Blood Bank, 601 Elmwood Avenue, Box 608, Rochester, NY 14642, USA
| | - Christine Cahill
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Unit, University of Rochester, Strong Memorial Hospital - Blood Bank, 601 Elmwood Avenue, Box 608, Rochester, NY 14642, USA
| | - Neil Blumberg
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Unit, University of Rochester, Strong Memorial Hospital - Blood Bank, 601 Elmwood Avenue, Box 608, Rochester, NY 14642, USA
| | - Majed A Refaai
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Unit, University of Rochester, Strong Memorial Hospital - Blood Bank, 601 Elmwood Avenue, Box 608, Rochester, NY 14642, USA.
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15
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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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16
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Foster M, Presseau J, McCleary N, Carroll K, McIntyre L, Hutton B, Brehaut J. Audit and feedback to improve laboratory test and transfusion ordering in critical care: a systematic review. Implement Sci 2020; 15:46. [PMID: 32560666 PMCID: PMC7303577 DOI: 10.1186/s13012-020-00981-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 03/12/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Laboratory tests and transfusions are sometimes ordered inappropriately, particularly in the critical care setting, which sees frequent use of both. Audit and Feedback (A&F) is a potentially useful intervention for modifying healthcare provider behaviors, but its application to the complex, team-based environment of critical care is not well understood. We conducted a systematic review of the literature on A&F interventions for improving test or transfusion ordering in the critical care setting. METHODS Five databases, two registries, and the bibliographies of relevant articles were searched. We included critical care studies that assessed the use of A&F targeting healthcare provider behaviors, alone or in combination with other interventions to improve test and transfusion ordering, as compared to historical practice, no intervention, or another healthcare behaviour change intervention. Studies were included only if they reported laboratory test or transfusion orders, or the appropriateness of orders, as outcomes. There were no restrictions based on study design, date of publication, or follow-up time. Intervention characteristics and absolute differences in outcomes were summarized. The quality of individual studies was assessed using a modified version of the Effective Practice and Organisation of Care Cochrane Review Group's criteria. RESULTS We identified 16 studies, including 13 uncontrolled before-after studies, one randomized controlled trial, one controlled before-after study, and one controlled clinical trial (quasi-experimental). These studies described 17 interventions, mostly (88%) multifaceted interventions with an A&F component. Feedback was most often provided in a written format only (41%), more than once (53%), and most often only provided data aggregated to the group-level (41%). Most studies saw a change in the hypothesized direction, but not all studies provided statistical analyses to formally test improvement. Overall study quality was low, with studies often lacking a concurrent control group. CONCLUSIONS Our review summarizes characteristics of A&F interventions implemented in the critical care context, points to some mechanisms by which A&F might be made more effective in this setting, and provides an overview of how the appropriateness of orders was reported. Our findings suggest that A&F can be effective in the context of critical care; however, further research is required to characterize approaches that optimize the effectiveness in this setting alongside more rigorous evaluation methods. TRIAL REGISTRATION PROSPERO CRD42016051941.
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Affiliation(s)
- Madison Foster
- School of Epidemiology and Public Health, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, General Campus, 501 Smyth Road, Centre for Practice Changing Research, Box 201B, Ottawa, ON K1H 8L6 Canada
| | - Justin Presseau
- School of Epidemiology and Public Health, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, General Campus, 501 Smyth Road, Centre for Practice Changing Research, Box 201B, Ottawa, ON K1H 8L6 Canada
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Vanier Hall, Ottawa, ON K1N 6N5 Canada
| | - Nicola McCleary
- School of Epidemiology and Public Health, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, General Campus, 501 Smyth Road, Centre for Practice Changing Research, Box 201B, Ottawa, ON K1H 8L6 Canada
| | - Kelly Carroll
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, General Campus, 501 Smyth Road, Centre for Practice Changing Research, Box 201B, Ottawa, ON K1H 8L6 Canada
| | - Lauralyn McIntyre
- School of Epidemiology and Public Health, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, General Campus, 501 Smyth Road, Centre for Practice Changing Research, Box 201B, Ottawa, ON K1H 8L6 Canada
- Department of Critical Care Medicine, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Brian Hutton
- School of Epidemiology and Public Health, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, General Campus, 501 Smyth Road, Centre for Practice Changing Research, Box 201B, Ottawa, ON K1H 8L6 Canada
- Ottawa Hospital Research Institute, Knowledge Synthesis Unit, The Ottawa Hospital, General Campus, 501 Smyth Road, Centre for Practice Changing Research, Box 201B, Ottawa, ON K1H 8L6 Canada
| | - Jamie Brehaut
- School of Epidemiology and Public Health, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, General Campus, 501 Smyth Road, Centre for Practice Changing Research, Box 201B, Ottawa, ON K1H 8L6 Canada
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17
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Abstract
Background: The majority of blood transfusion safety strategies recommended by the WHO for resource-poor countries focus mainly on reducing the risk of transfusion-transmitted infections (TTIs). Other technologies such as leucocyte reduction may represent complementary strategies for improving transfusion safety. Objective: To evaluate the role of using leucocyte reduced blood in a resource-poor country. Methods: Pre-storage leucocyte reduced (LR) red blood cells (RBCs) were specially prepared for the Tissue Oxygenation by Transfusion in severe Anaemia and Lactic acidosis (TOTAL) study, at the Uganda Blood Transfusion Services from February 2013 through May 2015. Quality control tests were performed to evaluate the procedure, and the incremental cost of an LR-RBC unit was estimated. Results: A total of 608 RBCs units were leucocyte reduced. Quality control tests were performed on 55 random RBCs units. The median (IQR) residual leucocyte count was 4 (0·5–10) WBC/uL, equivalent to 1·8x106 WBC per unit. The estimated incremental unit cost of leucocyte reduction was $37 USD per LR RBC unit. Conclusion: Leucocyte reduction of blood in a resource-poor country is doable although relatively costly. As such, its value in resource-poor countries should be weighed against other transfusion safety propositions.
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Affiliation(s)
- Aggrey Dhabangi
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda
- Corresponding author: Aggrey Dhabangi, Child Health and Development Centre, Makerere University College of Health Sciences. Mulago upper hill road, P. O. Box 6717 Kampala, Uganda Tel: +256772833789
| | - Ezra Musisi
- Uganda Blood Transfusion Services, Kampala, Uganda
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Doughty H, Chowdhury F. Emergency preparedness, resilience and response guidance for UK hospital transfusion teams. Transfus Med 2020; 30:177-185. [PMID: 32020684 PMCID: PMC7317494 DOI: 10.1111/tme.12665] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/23/2019] [Accepted: 01/13/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To present Emergency Preparedness, Resilience and Response (EPRR) guidance for Hospital Transfusion Teams on behalf of the National Blood Transfusion Committee emergency planning working group. BACKGROUND The Civil Contingencies Act 2004 requires healthcare organisations to demonstrate that they can deal with major incidents while maintaining critical services. Recent mass casualty events and the use of transfusion-based resuscitation have highlighted the evolving role of the Hospital Transfusion Team. METHODS This multi-disciplinary advice is informed by recent global and national experience, the 2018 NHS England clinical guidelines for Major Incidents, and stakeholder workshops. GUIDANCE Transfusion staff should be familiar with local EPRR plans including casualty type and numbers. Staff should be exercised as part of wider Trust preparation, with documented roles and responsibilities. Transfusion support should be proactive and include blood issue, regulatory compliance and sample handling. Robust LIMS-compatible emergency identification systems are essential to minimise errors. Emergency stock management requires rapid assessment of existing stock and estimated demand before re-ordering. Initial demand should be based on 2 to 4 red blood cells (RBC) per patient admitted. Patients with significant haemorrhage may require further red cells and early haemostatic support. Where "universal" components are demanded, they should be gender appropriate. Senior staff should lead the response, log and communicate key decisions, and prepare for post-incident recovery. CONCLUSIONS Transfusion teams have an important role in ensuring continuity of transfusion support. Teams should develop their EPRR plans based on local plans and national guidance. Emergency preparedness should include post-incident debriefing for ongoing staff support and future service improvement.
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Affiliation(s)
- Heidi Doughty
- NHS Blood and TransplantClinical Services, BirminghamUnited Kingdom
| | - Fateha Chowdhury
- NHS Blood and TransplantClinical Services, BirminghamUnited Kingdom
- Imperial College Healthcare NHS TrustLondonUnited Kingdom
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Raturi M, Kusum A. The active role of a blood center in outpacing the transfusion transmission of COVID-19. Transfus Clin Biol 2020; 27:96-97. [PMID: 32284222 PMCID: PMC7151365 DOI: 10.1016/j.tracli.2020.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/24/2020] [Indexed: 01/27/2023]
Affiliation(s)
- Manish Raturi
- Department of Immunohematology and Blood Transfusion, 248016 Uttarakhand, India.
| | - Anuradha Kusum
- Department of Pathology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Swami Ram Nagar, Jolly Grant, Dehradun, 248016 Uttarakhand, India
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Ouldamar K, Gallerand AM. [Health safety in France: from the contaminated blood case to the sanitary vigilance reforms.]. Sante Publique 2020; Vol. 31:517-526. [PMID: 31959252 DOI: 10.3917/spub.194.0517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION To understand the policy for the implementation of the overhaul of the vigilance, it was useful to recall the context by revisiting the literature and regulation related to health security and the tragedy of contaminated blood, which was the founding element of the new health institutions. The concept of health security was born with the creation of several national agencies. They have proved their usefulness but remain, however, compartmentalized with a division of competences, in terms of vigilance, distributed between several agencies, in a complex territorial mesh constituting a hindrance to the declaration of undesirable events. METHOD Review of legal texts and literature, from the crisis of contaminated blood followed by the creation of health safety laws, the creation of health safety agencies to the texts relating to the reform of vigilance. RESULTS Haemovigilance and the creation of the French Blood Establishment, the sole operator of blood transfusions, have been decisive in reducing transfusion chain accidents and the risks associated with infectious diseases. The merging of several agencies has led to a more comprehensive approach to risk assessment related to exposure to contaminants and more effective protection of the health of populations. At the regional level the management of sanitary vigilance at the ARS is well established and contributes locally to the management of alerts and health crises. DISCUSSION The sanitary structures put in place have proved their usefulness but that is not enough. The culture of health events reporting that is insufficiently developed is changing with the implementation of the unique national portal for reporting and the development of health democracy. CONCLUSION In addition, we must constantly prepare ourselves for new or re-emerging threats. The health risk linked to the foreseeable increase in exposure to pollutants and toxic products will be the major challenge for the years to come.
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May LA, Harrell KN, Bell CM, Basham-Saif A, Barker DE, Maxwell RA. Intraoperative Resuscitation by Specialized Trauma Nurse Clinicians Improves Adherence to Massive Transfusion Protocol. Am Surg 2020; 86:35-41. [PMID: 32077414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A massive transfusion protocol (MTP) was implemented at a Level I trauma center in 2007 for patients with massive blood loss. A goal ratio of plasma to pheresed platelets to packed red blood cells (PRBCs) of 1:1:1 was established. From 2007 to 2014, trauma nurse clinicians (TNCs) administered the MTP during initial resuscitation and anesthesia personnel administered the MTP intraoperatively. In 2015, TNCs began administering the MTP intraoperatively. This study evaluates intraoperative blood product ratios and crystalloid volume administered by anesthesia personnel or TNCs. A retrospective review of trauma registry patients requiring MTP from 2007 to 2017 was performed. Patient data were stratified according to MTP administration by either anesthesia personnel (2007-2015) or TNCs (2015-2017). Ninety-seven patients were included with 54 anesthesia patients and 44 TNC patients. Patients undergoing resuscitation by MTP administered by TNCs received less median crystalloid (3000 mL vs 1500 mL, P < 0.001). The ratio of plasma:PRBC (0.75 vs 0.93, P = 0.027) and platelets:PRBC (0.75 vs 1.04, P = 0.003) was found to be significantly closer to 1:1 for TNC patients. MTP intraoperative blood product administration by TNCs reduced the amount of infused crystalloid and improved adherence to MTP in achieving a 1:1:1 ratio of blood products.
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Affiliation(s)
- L Andrew May
- From the *University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee
| | - Kevin N Harrell
- From the *University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee
| | | | | | - Donald E Barker
- From the *University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee
| | - Robert A Maxwell
- From the *University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee
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Bouhou S, Benajiba M. Ensuring a safe and adequate blood supply during the COVID-19 pandemic: the Moroccan national blood center experience. Pan Afr Med J 2020; 37:275. [PMID: 33598089 PMCID: PMC7864269 DOI: 10.11604/pamj.2020.37.275.26639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/09/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sabah Bouhou
- National Center for Blood Transfusion and Hematology, Rabat, Morocco
- Corresponding author: Sabah Bouhou, National Center for Blood Transfusion and Hematology, Rabat, Morocco.
| | - Mohammed Benajiba
- National Center for Blood Transfusion and Hematology, Rabat, Morocco
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Abstract
PURPOSE OF REVIEW To summarize the most recent scientific progress in transfusion medicine genomics and discuss its role within the broad genomic precision medicine model, with a focus on the unique computational and bioinformatic aspects of this emergent field. RECENT FINDINGS Recent publications continue to validate the feasibility of using next-generation sequencing (NGS) for blood group prediction with three distinct approaches: exome sequencing, whole genome sequencing, and PCR-based targeted NGS methods. The reported correlation of NGS with serologic and alternative genotyping methods ranges from 92 to 99%. NGS has demonstrated improved detection of weak antigens, structural changes, copy number variations, novel genomic variants, and microchimerism. Addition of a transfusion medicine interpretation to any clinically sequenced genome is proposed as a strategy to enhance the cost-effectiveness of precision genomic medicine. Interpretation of NGS in the blood group antigen context requires not only advanced immunohematology knowledge, but also specialized software and hardware resources, and a bioinformatics-trained workforce. SUMMARY Blood transfusions are a common inpatient procedure, making blood group genomics a promising facet of precision medicine research. Further efforts are needed to embrace transfusion bioinformatic challenges and evaluate its clinical utility.
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Affiliation(s)
- Celina Montemayor
- Department of Transfusion Medicine, National Institutes of Health Clinical Center, Bethesda, MD
| | - Patricia A. R. Brunker
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD
- American Red Cross, Greater Chesapeake and Potomac Region, Baltimore, MD
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Seghatchian J. An open call out on continual quality/safety improvement strategies in transfusion science and medicine. Transfus Apher Sci 2019; 58:697. [PMID: 31445932 DOI: 10.1016/j.transci.2019.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Jerard Seghatchian
- International Consultancy in Blood Components Quality/Safety Improvement, Audit/Inspection and DDR Strategies, London, England, UK.
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Tang YL, Yousuf R, Wan Nawawi WM, Rahman IL, Zainal Abidin J, Rechard Nathan VR, Leong CF. An Audit on Overnight Transfusion Practice in A Teaching Hospital in Malaysia. Malays J Pathol 2019; 41:161-167. [PMID: 31427551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Overnight transfusion (OT) is the blood transfusion taking place from 9pm to 8am. During this period, patients are exposed to increased risk of errors. This cross-sectional study aims to determine the incidence and practice of OT in Universiti Kebangsaan Malaysia Medical Centre. MATERIALS & METHODS Data from all OT in June and mid-July 2017 were collected from recipients' cards, transfusion request forms and patient's case files, regarding discipline involved, indications, time intervals from request of blood transfusion to the completion of OT on patients, monitoring of patients and adverse reactions. RESULTS A total of 1285 transfusion cases were identified during the study period. 216 (16.8%) cases were OT while the 1069 (83.2%) cases were non-OT. Surgery discipline has the highest (30.1%) OT. The indications of OT were acute clinical need: 82.9%, less acute clinical need: 13.9% and no clinical need: 3.2%. A huge delay (average: 5 hours 40 minutes) in starting transfusion after grouping and crossmatching (GXM) completion was noted. Besides, 25.9% cases took <4 hours to complete OT; 83.4% cases did not have proper transfusion monitoring and three transfusion reactions were reported. DISCUSSION Although most of the OT cases had appropriate clinical indications, the transfusion can be commenced earlier at day time rather than overnight. Cases without absolute indication should avoid OT. The poor monitoring of patient during OT had posed risks to patients' life if an adverse transfusion reaction happened. The major reason for OTs was a huge delay in starting transfusion after the GXM completion. The contravention of 4-hour infusion rule increased the patients' risk of developing bacterial sepsis. The practice of OT should be discouraged wherever possible except for clinically indicated cases.
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Affiliation(s)
- Y L Tang
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Pathology, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia.
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Yu Z, Zhai C. [A Capacitive Venous Transfusion Alertor Based on NB-IoT]. Zhongguo Yi Liao Qi Xie Za Zhi 2019; 43:307-309. [PMID: 31460729 DOI: 10.3969/j.issn.1671-7104.2019.04.020] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This capacitive venous transfusion alertor is based on rise time of RC circuit and input capture function of timer in the microcontroller. The measure element of alertor is integrated with circuit board, it has the advantages of simple structure and low cost. Combined with narrow band intent of things(NB-IoT) technology to upload data, it can reduce the workload of medical personnel and caregivers, avoid unnecessary trouble and danger.
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Affiliation(s)
- Zi'an Yu
- College of Engineering and Science, University of Science and Technology of China, Hefei, 230027
| | - Chao Zhai
- College of Engineering and Science, University of Science and Technology of China, Hefei, 230027
- Engineering and Material Science Experiment Center, University of Science and Technology of China, Hefei, 230027
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Ziemer RE, Newman JS. Practical Considerations in the Dangers Associated With Blood Transfusion: A Century Later. Mayo Clin Proc 2019; 94:1386-1387. [PMID: 31272584 DOI: 10.1016/j.mayocp.2018.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 11/30/2018] [Indexed: 11/24/2022]
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Fatima N, Chandra T, Ali Mahdi A, Agarwal D. Level of hyperlipidemia in blood donors: A correlative study in North Indian population. Diabetes Metab Syndr 2019; 13:2033-2036. [PMID: 31235132 DOI: 10.1016/j.dsx.2019.04.033] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/22/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hyperlipidemia can be caused by abnormal elevation of lipids and lipoproteins in the blood. This increased can lead to heart disease. Risks which can be controlled include alcohol intake, physical activity, smoking, high blood pressure and genetic factors. Markers of increased cardiovascular risk appear to be lower in regular blood donor compared with single time donors as reflected by significantly lower total cholesterol and LDL levels. And it has been thought that there will be a direct relationship between lower risks of Heart diseases with repeated blood donation. AIM The aim of the present study is to determine the effect of blood donation on single time and repeat donors by assessing their lipid levels and their family history of heart diseases. MATERIAL & METHODS This cross-sectional study was carried out on (n = 80) random blood donors from the department of Transfusion Medicine KGMU. RESULTS A significant correlation was found amongst hyperlipidemic level in single time donor & repeat donors and in donors with family history of heart diseases (p < 0.05). A positive association was found between hyperlipidemia with donor's weight (p < 0.05). CONCLUSION Screening random donor platelets for hyperlipidemia and correlating the condition with other donor criteria like family history of heart diseases, types of donors, donors weight age and gender will help in making the patients safe as well as the donor deferral criteria more stringent to improve the quality of blood supply and will enable blood bankers to supply safe blood and improve the guidelines for blood safety.
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Affiliation(s)
- Nishat Fatima
- Department of Transfusion Medicine, King George's Medical University, Lucknow, India; Department of Biotechnology, Dr A.P.J.Abdul Kalam Technical University, U.P, Lucknow, India.
| | - Tulika Chandra
- Department of Transfusion Medicine, King George's Medical University, Lucknow, India; Department of Biotechnology, Dr A.P.J.Abdul Kalam Technical University, U.P, Lucknow, India.
| | - Abbas Ali Mahdi
- Department of Biochemistry King George's Medical University, Lucknow, India
| | - Devisha Agarwal
- Department of Transfusion Medicine, King George's Medical University, Lucknow, India; Department of Biotechnology, Dr A.P.J.Abdul Kalam Technical University, U.P, Lucknow, India
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Ayala-De la Cruz S, Flores-Aréchiga A, Llaca-Díaz J, Pérez-Chávez F, Salazar-Montalvo RG, Casillas-Vega N. [Serological screening in donors in Mexico: advances and technology]. Rev Med Inst Mex Seguro Soc 2019; 57:30-35. [PMID: 31071252] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The residual risk of transfusion-related infections has decreased dramatically in countries that have routinely implemented serological screening. Most of the donation in Mexico is from replacement practice, a risk factor for positive serology. In Mexico, the altruistic donation is only 2.7%. The heterogeneity of technical factors, regional factors and internal policies of each center influences the variability of data on the prevalence of positive screening, as well as the prevalence of confirmed cases. The main advantage of nucleic acid technology is the detection of donors in the period of serological window or occult infections, being occult hepatitis reports in Mexican donors from 1 to 3.4%. The limitation of available technology, the scope of the clinic and perspectives, invites us to improve technology and health policies in the interest of transfusion safety.
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Affiliation(s)
| | | | | | | | | | - Néstor Casillas-Vega
- Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José Eleuterio González”, Departamento de Patología Clínica. Monterrey, Nuevo León, México
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30
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Garland-Kledzik M, Gaffley M, Crouse D, Conrad C, Miller P, Martin RS. Effects of a More Restrictive Transfusion Trigger in Trauma Patients. Am Surg 2019; 85:409-413. [PMID: 31043203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Since the Transfusion Requirements in Critical Care trial, studies have shown that acutely ill patients can drift as a low as 5 g/dL. This study reviews a transfusion trigger change to 6.5 g/dL, which we hypothesize will conserve resources and improve quality of care. This is a retrospective chart review at an urban Level I trauma center from January through December 2015 after our trauma service changed the transfusion trigger from 7 to 6.5 g/dL. Outcomes in patients before (TT7) and after (TT6.5) the change in transfusion threshold were then compared. One hundred thirty-one discrete patients were included in this trial, with 285 instances of a hemoglobin of 7 g/dL or less and 178 transfusions. Seventy-two patients were before the change in threshold and 59 after. There was no change in length of hospital stay, ICU stay, ventilator days, mortality, and organ system failure after change in the transfusion threshold. After initiation of a more conservative threshold, 72 units of blood were saved. Decreased transfusion threshold was associated with no worse outcomes associated with decreased resource utilization.
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Mueller MM, Van Remoortel H, Meybohm P, Aranko K, Aubron C, Burger R, Carson JL, Cichutek K, De Buck E, Devine D, Fergusson D, Folléa G, French C, Frey KP, Gammon R, Levy JH, Murphy MF, Ozier Y, Pavenski K, So-Osman C, Tiberghien P, Volmink J, Waters JH, Wood EM, Seifried E. Patient Blood Management: Recommendations From the 2018 Frankfurt Consensus Conference. JAMA 2019; 321:983-997. [PMID: 30860564 DOI: 10.1001/jama.2019.0554] [Citation(s) in RCA: 335] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
IMPORTANCE Blood transfusion is one of the most frequently used therapies worldwide and is associated with benefits, risks, and costs. OBJECTIVE To develop a set of evidence-based recommendations for patient blood management (PBM) and for research. EVIDENCE REVIEW The scientific committee developed 17 Population/Intervention/Comparison/Outcome (PICO) questions for red blood cell (RBC) transfusion in adult patients in 3 areas: preoperative anemia (3 questions), RBC transfusion thresholds (11 questions), and implementation of PBM programs (3 questions). These questions guided the literature search in 4 biomedical databases (MEDLINE, EMBASE, Cochrane Library, Transfusion Evidence Library), searched from inception to January 2018. Meta-analyses were conducted with the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology and the Evidence-to-Decision framework by 3 panels including clinical and scientific experts, nurses, patient representatives, and methodologists, to develop clinical recommendations during a consensus conference in Frankfurt/Main, Germany, in April 2018. FINDINGS From 17 607 literature citations associated with the 17 PICO questions, 145 studies, including 63 randomized clinical trials with 23 143 patients and 82 observational studies with more than 4 million patients, were analyzed. For preoperative anemia, 4 clinical and 3 research recommendations were developed, including the strong recommendation to detect and manage anemia sufficiently early before major elective surgery. For RBC transfusion thresholds, 4 clinical and 6 research recommendations were developed, including 2 strong clinical recommendations for critically ill but clinically stable intensive care patients with or without septic shock (recommended threshold for RBC transfusion, hemoglobin concentration <7 g/dL) as well as for patients undergoing cardiac surgery (recommended threshold for RBC transfusion, hemoglobin concentration <7.5 g/dL). For implementation of PBM programs, 2 clinical and 3 research recommendations were developed, including recommendations to implement comprehensive PBM programs and to use electronic decision support systems (both conditional recommendations) to improve appropriate RBC utilization. CONCLUSIONS AND RELEVANCE The 2018 PBM International Consensus Conference defined the current status of the PBM evidence base for practice and research purposes and established 10 clinical recommendations and 12 research recommendations for preoperative anemia, RBC transfusion thresholds for adults, and implementation of PBM programs. The relative paucity of strong evidence to answer many of the PICO questions supports the need for additional research and an international consensus for accepted definitions and hemoglobin thresholds, as well as clinically meaningful end points for multicenter trials.
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Affiliation(s)
- Markus M Mueller
- German Red Cross Blood Transfusion Service and Goethe University Clinics, Frankfurt/Main, Germany
| | - Hans Van Remoortel
- Centre for Evidence-Based Practice (CEBaP), Belgian Red Cross, Mechelen, Belgium
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Kari Aranko
- European Blood Alliance (EBA), Amsterdam, the Netherlands
| | - Cécile Aubron
- Departments of Intensive Care and of Anesthesia, University Hospital of Brest, Brest, France
| | | | - Jeffrey L Carson
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | | | - Emmy De Buck
- Centre for Evidence-Based Practice (CEBaP), Belgian Red Cross, Mechelen, Belgium
- Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Dana Devine
- Canadian Blood Services, Ottawa, Ontario, Canada
| | - Dean Fergusson
- Departments of Medicine, Surgery, Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Gilles Folléa
- Société Française de Transfusion Sanguine (SFTS), Paris, France
| | - Craig French
- Intensive Care, Western Health, Melbourne, Australia
| | | | | | - Jerrold H Levy
- Department of Cardiothoracic Intensive Care Medicine, Duke University Medical Centre, Durham, North Carolina
| | - Michael F Murphy
- National Health Service Blood and Transplant and University of Oxford, Oxford, United Kingdom
| | - Yves Ozier
- Departments of Intensive Care and of Anesthesia, University Hospital of Brest, Brest, France
| | | | - Cynthia So-Osman
- Sanquin Blood Bank, Leiden and Department of Haematology, Groene Hart Hospital, Gouda, the Netherlands
- International Society of Blood Transfusion (ISBT), Amsterdam, the Netherlands
| | | | - Jimmy Volmink
- Department of Clinical Epidemiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Jonathan H Waters
- Departments of Anesthesiology and Bioengineering, University of Pittsburgh Medical Centre, Pittsburgh, Pennsylvania
| | - Erica M Wood
- International Society of Blood Transfusion (ISBT), Amsterdam, the Netherlands
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Erhard Seifried
- German Red Cross Blood Transfusion Service and Goethe University Clinics, Frankfurt/Main, Germany
- European Blood Alliance (EBA), Amsterdam, the Netherlands
- International Society of Blood Transfusion (ISBT), Amsterdam, the Netherlands
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Song A, Ma T, Yang J. [Analysis of irregular antibody screening and antibody identification results in 31 858 cases of inpatients]. Xi Bao Yu Fen Zi Mian Yi Xue Za Zhi 2019; 35:169-173. [PMID: 30975283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Objective To explore clinical significance of transfusion safety by analyzing the results of screening the irregular antibodies and antibody identification. Methods The micro-column gel test cards were used to screen and identify irregular antibodies of 31 858 inpatients. Results Among the 31 858 cases, 31 517 (98.92%) had positive results in RhD detection, and 341 (1.08%) had negative results in RhD detection. The number of patients who had positive results in screening the irregular antibodies was 92 cases and the positive rate was 0.3%. The highest detected rate of positive results in screening the irregular antibodies was obtained in the patients with hematologic diseases at a rate of 2.21% (11/497), closely followed by the pregnant women at a rate of 0.72% (31/4313). The 92 cases had positive results in antibody identification, including 45 cases of anti-E (48.91%), 11 cases of anti-D (11.96%), 10 cases of anti-c (10.87%), 6 cases of anti-Lea (6.52%), 5 cases of anti-Ec (5.44%), 5 cases of anti-M (5.44%), and 10 cases of other antibodies. Conclusion Screening the irregular antibodies and antibody identification before blood transfusion can effectively avoid the adverse reactions of blood transfusion and improve the quality of blood transfusion.
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Affiliation(s)
- Aowei Song
- Xi'an Medical University, Xi'an 710068; Department of Transfusion Medicine, Shaanxi Provincial People's Hospital, Xi'an 710068, China
| | - Ting Ma
- Department of Transfusion Medicine, Shaanxi Provincial People's Hospital, Xi'an 710068, China
| | - Jiangcun Yang
- Department of Transfusion Medicine, Shaanxi Provincial People's Hospital, Xi'an 710068, China. *Corresponding author, E-mail: 609445783@ qq.com
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Haider MS, Khan MA. Finding blood in metropolis: The smart solution. J PAK MED ASSOC 2019; 69:283. [PMID: 30804601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Yao Y, Li J, Wang M, Chen Z, Wang W, Lei L, Huang C, Yao M, Yuan G, Yan M. Improvements in blood transfusion management: cross-sectional data analysis from nine hospitals in Zhejiang, China. BMC Health Serv Res 2018; 18:856. [PMID: 30428874 PMCID: PMC6237039 DOI: 10.1186/s12913-018-3673-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 10/31/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Since 2008, updated perioperative blood management (PoBM) guidelines have been implemented in Zhejiang, China. These guidelines ensure that the limited blood resources meet increasing clinical needs and patient safety requirements. We assessed the effects of implementing updated PoBM guidelines in hospitals in Zhejiang, China. METHODS We performed a retrospective multicenter study that included adult patients who received blood transfusions during surgical care in the years 2007 and 2011. The volume of allogeneic red blood cells or autologous blood transfusions (cell salvage and acute normovolemic hemodilution [ANH]) for each case was recorded. The rates of performing appropriate pre-transfusion assessments during and after surgery were calculated and compared between the 2 years. RESULTS We reviewed 270,421 cases from nine hospitals. A total of 15,739 patients received blood transfusions during the perioperative period. The rates of intraoperative allogeneic transfusion (74.8% vs. 49.9%, p < 0.001) and postoperative transfusion (51.9% vs. 44.2%, p < 0.001) both decreased from 2007 to 2011; the rates of appropriate assessment increased significantly during (63.0% vs. 78.0%, p < 0.001) and after surgery (70.6% vs. 78.4%, p < 0.001). The number of patients who received cell salvage or ANH was higher in 2011 (27.6% cell salvage; 9.3% ANH) than in 2007 (6.3% cell salvage; 0.1% ANH). CONCLUSION Continuing education and implementation of updated PoBM guidelines resulted in significant improvements in the quality of blood transfusion management in hospitals in Zhejiang, China.
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Affiliation(s)
- Yuanyuan Yao
- Department of Anesthesiology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009 China
| | - Jun Li
- The 2nd Affiliated Hospital & Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Mingcang Wang
- Taizhou Hospital of Zhejiang Province, Taizhou, China
| | | | | | - Lipei Lei
- The Central Hospital of Lishui City, Lishui, China
| | - Changshun Huang
- Ningbo First Hospital (Ningbo Hospital of Zhejiang University), Ningbo, China
| | - Ming Yao
- The First Hospital of Jiaxing, Jiaxing, China
| | | | - Min Yan
- Department of Anesthesiology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009 China
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Out-Of-Hospital Blood Product Administration Considerations. Air Med J 2018; 37:349-50. [PMID: 30424849 DOI: 10.1016/j.amj.2018.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Abonnenc M, Tissot JD, Prudent M. General overview of blood products in vitro quality: Processing and storage lesions. Transfus Clin Biol 2018; 25:269-275. [PMID: 30241785 DOI: 10.1016/j.tracli.2018.08.162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 12/12/2022]
Abstract
Blood products are issued from blood collection. Collected blood is immediately mixed with anticoagulant solutions that immediately induce chemical and/or biochemical modifications. Collected blood is then transformed into different blood products according to various steps of fabrication. All these steps induce either reversible or irreversible "preparation-related" lesions that combine with "storage-related" lesions. This short paper aims to provide an overview of the alterations that are induced by the "non-physiological" processes used to prepare blood products that are used in clinical practice.
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Affiliation(s)
- Mélanie Abonnenc
- Transfusion interrégionale CRS, laboratoire de recherche sur les produits sanguins, route de la Corniche 2, 1066 Epalinges, Switzerland
| | - Jean-Daniel Tissot
- Transfusion interrégionale CRS, laboratoire de recherche sur les produits sanguins, route de la Corniche 2, 1066 Epalinges, Switzerland; Faculté de biologie et de médecine, université de Lausanne, Lausanne, Switzerland
| | - Michel Prudent
- Transfusion interrégionale CRS, laboratoire de recherche sur les produits sanguins, route de la Corniche 2, 1066 Epalinges, Switzerland; Faculté de biologie et de médecine, université de Lausanne, Lausanne, Switzerland.
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Hwang K, Kwon J, Cho J, Heo Y, Lee JCJ, Jung K. Implementation of Trauma Center and Massive Transfusion Protocol Improves Outcomes for Major Trauma Patients: A Study at a Single Institution in Korea. World J Surg 2018; 42:2067-2075. [PMID: 29290073 DOI: 10.1007/s00268-017-4441-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study evaluated the effectiveness and clinical outcomes of the implementation of a trauma center and massive transfusion protocol (TCMTP) in a developing country without a well-established trauma system. METHODS We included patients (1) aged >15 years, (2) with an Injury Severity Score >15, (3) who received ≥10 units of packed red blood cells (PRBCs) within 24 h, (4) who directly visited our institution from 2010 to 2016, and (5) who survived for ≥24 h. Patients treated during the post-TCMTP period (2015-2016) were compared with historical groups treated pre-TCMTP (2010-2012) and interim-TCMTP (2013-2014). Demographics, transfusion and fluid therapy performance, and clinical outcomes were compared between the three groups. RESULTS Overall, 190 patients were included: 64, 64, and 62 patients in the pre-TCMTP, interim-TCMTP, and post-TCMTP groups, respectively. Comparison between the three groups revealed significant differences in the fresh-frozen plasma/PRBC ratio (p = 0.001) and crystalloid infusion (p = 0.007); these variables gradually increased from pre- to post-TCMTP. Conversely, colloid infusion showed a reduction post-TCMTP (p < 0.001). Kaplan-Meier curves revealed that the 90-day survival rate was significantly higher in the post-TCMTP group (pre-TCMTP: 45.3 vs. 75.8%, p = 0.001; interim-TCMTP: 56.3 vs. 75.8%, p = 0.027). In Cox regression hierarchical survival analysis, TCMTP showed a hazard ratio for mortality of 0.380 after adjusting for all potentially confounding factors. CONCLUSIONS Our results suggest that building trauma centers and establishing a massive transfusion protocol according to the specific situations of a country will help improve outcomes for major trauma patients, even in developing countries without a well-established trauma system.
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Affiliation(s)
- Kyungjin Hwang
- Division of Trauma, Department of Surgery, Ajou University School of Medicine and Graduate School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Korea
| | - Junsik Kwon
- Division of Trauma, Department of Surgery, Ajou University School of Medicine and Graduate School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Korea
| | - Jayun Cho
- Division of Trauma, Department of Surgery, Ajou University School of Medicine and Graduate School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Korea
| | - Yunjung Heo
- Department of Medical Humanities and Social Medicine, Ajou University School of Medicine and Graduate School of Medicine, Suwon, Gyeonggi-do, Korea
| | - John Cook-Jong Lee
- Division of Trauma, Department of Surgery, Ajou University School of Medicine and Graduate School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Korea
| | - Kyoungwon Jung
- Division of Trauma, Department of Surgery, Ajou University School of Medicine and Graduate School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Korea.
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Sato Folatre JG, Arnell P, Henning M, Josefsson K, Skallsjö G, Ricksten SE. [Introduction of prehospital blood transfusion programme in Sweden: experiences from a physician staffed helicopter emergency medical service]. Lakartidningen 2018; 115:FADR. [PMID: 30299527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In 2016, physician staffed helicopter emergency medical service (VGR HEMS) became the first Swedish prehospital service to routinely carry and transfuse red blood cells. In this report we describe our implementation and present our results, with preliminary analysis of our data. Out of 1 336 patients a total of 34 patients (2,5 %) were transfused without any adverse events. Our demography is predominantly male and the most common mechanism of injury is trauma. Amongst the most common interventions were endotracheal intubation, thoracostomy and CPR. Preliminary analysis showed an increase in median systolic blood pressure and decrease in median heart rate after prehospital blood transfusion. Half of the patients that received CPR had return of spontaneous circulation (ROSC). We conclude that prehospital blood transfusion in a Swedish physician-staffed helicopter emergency medical service is feasible and safe.
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Affiliation(s)
| | - Per Arnell
- AnOpIva - Östra Sjukhuset Götebog, Sweden AnOpIva - Östra Sjukhuset Götebog, Sweden
| | - Mari Henning
- Sjukhusapoteket Västra Götalandsregionen - Kungälv, Sweden Sjukhusapoteket Västra Götalandsregionen - Kungälv, Sweden
| | - Kristina Josefsson
- Kungälvs sjukhus - Laboratoriemedicin Kungälv, Sweden Laboratoriemedicin - Kungälvs sjukhus Kungälv, Sweden
| | - Gabriel Skallsjö
- Ambulanshelikoptern Västra Götalandsregionen - Göteborg, Sweden Ambulanshelikoptern Västra Götalandsregionen - Göteborg, Sweden
| | - Sven-Erik Ricksten
- Sahlgrenska Akademin, Göteborgs Universitet - Institutionen för kliniska vetenskaper, avdelningen för Anestesi och Intensivvård Göteborg, Sweden Sahlgrenska Akademin, Göteborgs Universitet - Institutionen för kliniska vetenskaper, avdelningen för Anestesi och Intensivvård Göteborg, Sweden
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Damais-Cepitelli A, Leo-Kodeli S, Lovi V, Gouëzec H, Lassale B, Augey L, Berger E, Betbèze V, Bourcier V, Daurat G, Ducroz S, Huchet C, Le Niger C, Pujol S, Puntous M. [Analysis of causes of destruction of labile blood products in health institutions: A multicentric study]. Transfus Clin Biol 2018; 25:242-248. [PMID: 30145111 DOI: 10.1016/j.tracli.2018.07.009] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 07/23/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE One of the tasks of haemovigilance correspondents in Health Institutions (HI) is to reduce the destruction of labile blood components (LBC). The objective of this study was to analyse in depth, five years after a first multicentric study, the causes of LBC destruction in order to assess the impact of measures taken and to define new ways of improvement. METHODS Prospective analysis was carried out throughout 2016. For every LBC destroyed, the following elements were reported: type of LBC, transfusion department, cause of destruction analysed according to a decision tree, subsequently classed as avoidable or unavoidable. RESULTS The study included 15 HI. A total 3058 LBC were destroyed, representing an average 0.90% of issued LBC, and this analysis concerned 2576 LBC. Sixty-seven percent of LBC were issued for surgery, intensive care or emergencies. Forty percent of the causes of destruction were patient-related (death, clinical worsening, adverse effects or abnormal constants prior to delivery). Thirty percent were prescription-related, mainly cases of excessive prescription for different reasons. Eleven percent were linked to organisational issues. The rate of destruction judged avoidable, all causes combined, was 36%. CONCLUSION Comparison with the precedent study shows improvement, thus revealing the efficacy of implemented measures (single-dose distribution, return procedures back to the site of distribution, training of participants). In order to further reduce this rate of destruction, we suggest to promote storage procedures and, above all, to continue to raise awareness within healthcare teams.
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Affiliation(s)
- A Damais-Cepitelli
- Unité d'hémovigilance, groupe hospitalier du Havre, BP 24, 76083 Le Havre, France.
| | - S Leo-Kodeli
- Unité de sécurité transfusionnelle et d'hémovigilance, CHR d'Orléans, 45067 Orléans, France
| | - V Lovi
- Unité de sécurité transfusionnelle et d'hémovigilance, CH de Roubaix, 59100 Roubaix, France
| | - H Gouëzec
- Unité de sécurité transfusionnelle et d'hémovigilance, CHU de Rennes, 35033 Rennes, France
| | - B Lassale
- Unité d'hémovigilance, AP-HM, 13274 Marseille, France
| | - L Augey
- Unité d'hémovigilance, CHU de Lyon, 69495 Lyon, France
| | - E Berger
- Unité d'hémovigilance, CHU de Dijon, 21079 Dijon, France
| | - V Betbèze
- Unité d'hémovigilance, CHU de Nantes, 40093 Nantes, France
| | - V Bourcier
- Unité d'hémovigilance, CHU de Besançon, 25030 Besançon, France
| | - G Daurat
- Unité d'hémovigilance, CHU de Nîmes, 30029 Nîmes, France
| | - S Ducroz
- Unité de sécurité transfusionnelle et d'hémovigilance, CH de Montluçon, 03113 Montluçon, France
| | - C Huchet
- Unité de sécurité transfusionnelle, CH de Bretagne-Atlantique, 56017 Vannes, France
| | - C Le Niger
- Unité d'hémovigilance, CHRU de Brest, 29609 Brest, France
| | - S Pujol
- Unité de sécurité transfusionnelle et d'hémovigilance, CHU de Bordeaux, 33076 Bordeaux, France
| | - M Puntous
- Unité de sécurité transfusionnelle et d'hémovigilance, CHU de Bordeaux, 33076 Bordeaux, France
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Abstract
In November 2017, the deferral on blood donations from high-risk groups in Great Britain was changed to 3 months from last at-risk sexual contact following recommendations from the Advisory Committee on the Safety of Blood, Tissues and Organs. This represented a reduction from 12 months for men who have sex with men, and from a lifetime ban for sex workers. This is a step forward for equality and for reducing stigma around these groups. However, one argument for deferral is the prevalence of infections, which may not be identified due to the fallibility of current testing approaches. Clearly it is vital that the welfare of blood transfusion recipients is prioritised and they are not exposed to unacceptable risks. However, with the increasingly sophisticated technology used to screen blood, it can be argued that the evidence shows that the reduction in deferral does not go far enough.
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Affiliation(s)
| | - Stuart Mucklow
- Department of Clinical Haematology, Royal Berkshire Hospital, Reading, UK
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Kashosi TM, Mutendela JK, Mwenebitu DL, Maotela JK, Mubagwa K. [Assessment of virological quality of transfused blood in the town of Bukavu, South Kivu, Democratic Republic of Congo]. Pan Afr Med J 2018; 30:193. [PMID: 30455822 PMCID: PMC6235500 DOI: 10.11604/pamj.2018.30.193.13457] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 05/28/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION In Bukavu, transfused blood is selected using rapid diagnostic tests (RDTs). These tests are easily performed without specialized equipments. This study aims to evaluate the virological quality of transfused blood assessed using rapid diagnostic tests. METHODS A blood sample was drawn from a blood bag and collected in a 4ml dry tube in 5 Health Care Facilities over a month. Counter analysis was performed on each sample using rapid tests and ELISA. Intrinsic and extrinsic values were calculated. Cohen's kappa coefficient was used to evaluate the reliability of RDT compared with ELISA. RESULTS Three hundred and twelve samples were collected; 5 samples were positive for one or the other virologic marker while 307 samples were negative in all the tests. However Elisa showed, out of the 307 samples which were RDT test negative, 15 other positive samples including 3 samples positive for HIV, 3 for HCV and 9 for HBV. In addition, ELISA validated some RDT-positive samples and contradicted other results. Sensitivity and positive predictive value from rapid diagnostic tests were very low. The reliability of these tests was satisfactory, medium or low. CONCLUSION Blood assessed using RDTs poses a non negligible risk of viral infections. This study highlights the need for more reliable and efficient tests in our Health Care Facilities.
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Affiliation(s)
- Théophile Mitima Kashosi
- Laboratoire de Recherche Biomédicale et de Santé Publique, Département de Sciences Biomédicales, Faculté de Médecine et Santé Communautaire, Université Évangélique en Afrique (UEA), République Démocratique du Congo
- Centre Internationale de Formation et de Recherches Avancées, Bukavu, République Démocratique du Congo
- Section Techniques de Laboratoire, Institut Supérieur des Techniques Médicales (ISTM) de Bukavu, République Démocratique du Congo
| | | | - David Lupande Mwenebitu
- Département de Biologie Clinique, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Université Catholique de Bukavu, République Démocratique du Congo
| | - Jeff Kabinda Maotela
- Centre Provincial de Transfusion Sanguine (CPTS) de Bukavu, Sud-Kivu, République Démocratique du Congo
| | - Kanigula Mubagwa
- Centre Internationale de Formation et de Recherches Avancées, Bukavu, République Démocratique du Congo
- Département Scientifique Cardiovanculaire, Université de Leuven, Leuven, Belgique
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Wallace SK, Halverson JW, Jankowski CJ, DeJong SR, Weaver AL, Weinhold MR, Borah BJ, Moriarty JP, Cliby WA, Kor DJ, Higgins AA, Otto HA, Dowdy SC, Bakkum-Gamez JN. Optimizing Blood Transfusion Practices Through Bundled Intervention Implementation in Patients With Gynecologic Cancer Undergoing Laparotomy. Obstet Gynecol 2018; 131:891-898. [PMID: 29630007 PMCID: PMC5912961 DOI: 10.1097/aog.0000000000002463] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To examine blood transfusion practices and develop a standardized bundle of interventions to address the high rate of perioperative red blood cell transfusion among patients with ovarian and endometrial cancer. METHODS This was a retrospective cohort study. Our primary aim was to determine whether an implemented bundled intervention was associated with a reduction in perioperative red blood cell transfusions among cases of laparotomy for cancer. Secondary aims included comparing perioperative demographic, surgical, complication, and cost data. Interventions included blood transfusion practice standardization using American Society of Anesthesiologists guidelines, an intraoperative hemostasis checklist, standardized intraoperative fluid status communication, and evidence-based use of tranexamic acid. Prospective data from women undergoing laparotomy for ovarian or endometrial cancer from September 28, 2015, to May 31, 2016, defined the study cohort and were compared with historical controls (September 1, 2014, to September 25, 2015). Outcomes were compared in the full unadjusted cohorts and in propensity-matched cohorts. RESULTS In the intervention and historical cohorts, respectively, 89 and 184 women underwent laparotomy for ovarian cancer (n=74 and 152) or advanced endometrial cancer (n=15 and 32). Tranexamic acid was administered in 54 (60.7%) patients. The perioperative transfusion rate was lower for the intervention group compared with historical controls (18.0% [16/89] vs 41.3% [76/184], P<.001), a 56.4% reduction. This improvement in the intervention group remained significant after propensity matching (16.2% [13/80] vs 36.2% [29/80], P=.004). The hospital readmission rate was also lower for the intervention group compared with historical controls (1.1% [1/89] vs 12.5% [23/184], P=.002); however, this improvement did not attain statistical significance after propensity matching (1.2% [1/80] vs 7.5% [6/80], P=.12). Cost analysis demonstrated that this intervention was cost-neutral during index hospitalization plus 30-day follow-up. CONCLUSION Application of a standardized bundle of evidence-based interventions was associated with reduced blood use in our gynecologic oncology practice.
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Affiliation(s)
- Sumer K. Wallace
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota
| | - Jessica W. Halverson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | | | - Stephanie R. DeJong
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota
| | - Amy L. Weaver
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Megan R. Weinhold
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota
| | - Bijan J. Borah
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester MN
| | - James P. Moriarty
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester MN
| | - William A. Cliby
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota
| | - Daryl J. Kor
- Department of Anesthesiology and Perioperative Medicine, Blood Management Program, Mayo Clinic, Rochester, MN
| | - Andrew A. Higgins
- Department of Anesthesiology and Perioperative Medicine, Blood Management Program, Mayo Clinic, Rochester, MN
| | - Hilary A. Otto
- Department of Surgery, Division of Surgical Services, Mayo Clinic, Rochester, MN
| | - Sean C. Dowdy
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester MN
| | - Jamie N. Bakkum-Gamez
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota
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Seed CR, Hewitt PE, Dodd RY, Houston F, Cervenakova L. Creutzfeldt-Jakob disease and blood transfusion safety. Vox Sang 2018; 113:220-231. [PMID: 29359329 DOI: 10.1111/vox.12631] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 07/19/2017] [Revised: 11/16/2017] [Accepted: 12/19/2017] [Indexed: 01/09/2023]
Abstract
Transmissible spongiform encephalopathies (TSEs) are untreatable, fatal neurologic diseases affecting mammals. Human disease forms include sporadic, familial and acquired Creutzfeldt-Jakob disease (CJD). While sporadic CJD (sCJD) has been recognized for near on 100 years, variant CJD (vCJD) was first reported in 1996 and is the result of food-borne transmission of the prion of bovine spongiform encephalopathy (BSE, 'mad cow disease'). Currently, 230 vCJD cases have been reported in 12 countries, the majority in the UK (178) and France (27). Animal studies demonstrated highly efficient transmission of natural scrapie and experimental BSE by blood transfusion and fuelled concern that sCJD was potentially transfusion transmissible. No such case has been recorded and case-control evaluations and lookback studies indicate that, if transfusion transmission occurs at all, it is very rare. In contrast, four cases of apparent transfusion transmission of vCJD infectivity have been identified in the UK. Risk minimization strategies in response to the threat of vCJD include leucodepletion, geographically based donor deferrals and deferral of transfusion recipients. A sensitive and specific, high-throughput screening test would provide a potential path to mitigation but despite substantial effort no such test has yet appeared. The initial outbreak of vCJD appears to be over, but concern remains about subsequent waves of disease among those already infected. There is considerable uncertainty about the size of the infected population, and there will be at least a perception of some continuing risk to blood safety. Accordingly, at least some precautionary measures will remain in place and continued surveillance is necessary.
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Affiliation(s)
- C R Seed
- Australian Red Cross Blood Service, Perth, WA, Australia
| | | | - R Y Dodd
- American Red Cross Scientific Affairs, Gaithersburg, MD, USA
| | - F Houston
- The Roslin Institute, University of Edinburgh, Midlothian, Scotland
| | - L Cervenakova
- The Plasma Protein Therapeutics Association (PPTA), Annapolis, MD, USA
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44
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Abstract
Anemia and the necessity of blood product transfusion in perioperative procedures is an important and frequently discussed clinical issue. Presently, a constantly growing interest in this problem is observed among clinicians who search the ways to reduce the number of blood or blood product transfusions in patients after surgical procedures, both during the preoperative period and during and after the surgery. Generally, the decision whether to start transfusion or not should follow the analysis of pros and cons, considering the beneficial effect of transfusion and the risk of undesirable effects. The most effective approach in prophylaxis and treatment of anemia among patients on the orthopedic service should combine surgical anesthetic and pharmacological procedures during the preoperative, perioperative and postoperative periods. The aim of the paper is presenting the latest knowledge of the practical determinants concerning anemia pharmacological treatment, especially considering the principles, value and therapeutic effectiveness of iron supplementation, both at orthopedic injury clinics and outpatient clinics.
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Affiliation(s)
- Wiesław Tomaszewski
- Wyższa Szkoła Biznesu i Nauk o Zdrowiu w Łodzi, Polska / The Academy of Business and Health Sciences of Lodz, Poland
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45
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Donati F, Acciarini R, De Benedittis I, de la Torre X, Pirri D, Prete M, Stampella A, Vernucci E, Botre F. Detecting Autologous Blood Transfusion in Doping Control: Biomarkers of Blood Aging and Storage Measured by Flow Cytofluorimetry. Curr Pharm Biotechnol 2018; 19:124-135. [PMID: 29621963 DOI: 10.2174/1389201019666180405165118] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 01/23/2018] [Accepted: 03/24/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Blood transfusions are banned by the World Anti-Doping Agency as a form of "blood doping". A method of detection of homologous blood transfusion (HBT) has been implemented by the accredited anti-doping laboratories worldwide; however, no internationally recognized method has been finalized so far for the direct detection of autologous blood transfusions, which can at present be revealed only by targeted longitudinal profiling of key blood parameters. METHODS The present article reports the results of an investigation aimed to pre-select potential biomarkers of blood aging and storage that can be measured to identify the presence in the sample of reinfused blood. Microparticles from platelets and erythrocytes, erythrocytes size and density, annexin V (as a marker of phosphatidylserine externalization), and the membrane surface antigens CD 55 and CD 59, were specifically considered as potential biomarkers and measured by flow cytofluorimetric techniques. RESULTS AND CONCLUSION Our results indicate that the parameters more strongly affected by the ex vivo storage of whole blood are erythrocytes size and density, annexin V and microparticles. Although the real diagnostic value of the proposed biomarkers shall obviously be confirmed by further studies carried out on blood samples collected after an actual autologous blood transfusion, these results appear very encouraging towards the development of a direct method for detecting autologous blood transfusion in sport doping.
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Affiliation(s)
- Francesco Donati
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Largo Giulio Onesti 1, 00197 Rome, Italy
| | - Roberta Acciarini
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Largo Giulio Onesti 1, 00197 Rome, Italy
| | - Ilenia De Benedittis
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Largo Giulio Onesti 1, 00197 Rome, Italy
| | - Xavier de la Torre
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Largo Giulio Onesti 1, 00197 Rome, Italy
| | - Daniela Pirri
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Largo Giulio Onesti 1, 00197 Rome, Italy
- Department of Infection, Immunity & Cardiovascular Disease, Faculty of Medicine, Dentistry & Health, Royal Hallamshire Hospital, Beech Hill Road, Sheffield S10 2RX, United Kingdom
| | - Mariangela Prete
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Largo Giulio Onesti 1, 00197 Rome, Italy
| | - Alessandra Stampella
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Largo Giulio Onesti 1, 00197 Rome, Italy
- Laboratory of Tissue Homeostasis and Disease (THD) Skeletal Biology and Engineering Research Center (SBE) KU Leuven, Belgium
| | - Enza Vernucci
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Largo Giulio Onesti 1, 00197 Rome, Italy
- Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE, United States
| | - Francesco Botre
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Largo Giulio Onesti 1, 00197 Rome, Italy
- Dipartimento di Medicina Sperimentale, "Sapienza" Università di Roma, Viale Regina Elena 324, 00161 Rome, Italy
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Frank SM, Thakkar RN, Podlasek SJ, Ken Lee KH, Wintermeyer TL, Yang WW, Liu J, Rotello LC, Fleury TA, Wachter PA, Ishii LE, Demski R, Pronovost PJ, Ness PM. Implementing a Health System-wide Patient Blood Management Program with a Clinical Community Approach. Anesthesiology 2017; 127:754-764. [PMID: 28885446 DOI: 10.1097/aln.0000000000001851] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patient blood management programs are gaining popularity as quality improvement and patient safety initiatives, but methods for implementing such programs across multihospital health systems are not well understood. Having recently incorporated a patient blood management program across our health system using a clinical community approach, we describe our methods and results. METHODS We formed the Johns Hopkins Health System blood management clinical community to reduce transfusion overuse across five hospitals. This physician-led, multidisciplinary, collaborative, quality-improvement team (the clinical community) worked to implement best practices for patient blood management, which we describe in detail. Changes in blood utilization and blood acquisition costs were compared for the pre- and post-patient blood management time periods. RESULTS Across the health system, multiunit erythrocyte transfusion orders decreased from 39.7 to 20.2% (by 49%; P < 0.0001). The percentage of patients transfused decreased for erythrocytes from 11.3 to 10.4%, for plasma from 2.9 to 2.2%, and for platelets from 3.1 to 2.7%, (P < 0.0001 for all three). The number of units transfused per 1,000 patients decreased for erythrocytes from 455 to 365 (by 19.8%; P < 0.0001), for plasma from 175 to 107 (by 38.9%; P = 0.0002), and for platelets from 167 to 141 (by 15.6%; P = 0.04). Blood acquisition cost savings were $2,120,273/yr, an approximate 400% return on investment for our patient blood management efforts. CONCLUSIONS Implementing a health system-wide patient blood management program by using a clinical community approach substantially reduced blood utilization and blood acquisition costs.
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Affiliation(s)
- Steven M Frank
- From the Department of Anesthesiology and Critical Care Medicine (S.M.F., W.W.Y., P.J.P.), Department of Medicine (R.N.T., L.C.R.), Department of Pathology, Transfusion Medicine (S.J.P., J.L., T.A.F., P.M.N.), Armstrong Institute for Patient Safety and Quality (K.H.K.L., T.L.W., P.A.W., R.D., P.J.P.), and Department of Otolaryngology Head and Neck Surgery (L.E.I.), The Johns Hopkins Medical Institutions, Baltimore, Maryland
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Regan DW, Kashiwagi D, Dougan B, Sundsted K, Mauck K. Update in perioperative medicine: practice changing evidence published in 2016. Hosp Pract (1995) 2017; 45:158-164. [PMID: 28749248 DOI: 10.1080/21548331.2017.1359060] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 07/20/2017] [Indexed: 06/07/2023]
Abstract
This summary reviews 18 key articles published in 2016 which have significant practice implications for the perioperative medical care of surgical patients. Due to the multi-disciplinary nature of the practice of perioperative medicine, important new evidence is published in journals representing a variety of medical and surgical specialties. Keeping current with the evidence that drives best practice in perioperative medicine is therefore challenging. We set out to identify, critically review, and summarize key evidence which has the most potential for practice change. We integrated the new evidence into the existing body of medical knowledge and identified practical implications for real world patient care. The articles address issues related to anticoagulation, transfusion threshold, immunosuppressive medications, postoperative delirium, myocardial injury after noncardiac surgery, postoperative pain management, perioperative management of antihypertensives, perioperative fasting, and perioperative diabetic control.
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Affiliation(s)
- Dennis W Regan
- a General Internal Medicine , Mayo Clinic , Rochester , MN , USA
| | | | - Brian Dougan
- a General Internal Medicine , Mayo Clinic , Rochester , MN , USA
| | - Karna Sundsted
- a General Internal Medicine , Mayo Clinic , Rochester , MN , USA
| | - Karen Mauck
- a General Internal Medicine , Mayo Clinic , Rochester , MN , USA
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48
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Rimmer A. Former health secretary is still pushing for justice over contaminated blood scandal. BMJ 2017; 358:j4113. [PMID: 28870980 DOI: 10.1136/bmj.j4113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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49
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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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50
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Tan AJQ, Lee CCS, Lin PY, Cooper S, Lau LST, Chua WL, Liaw SY. Designing and evaluating the effectiveness of a serious game for safe administration of blood transfusion: A randomized controlled trial. Nurse Educ Today 2017; 55:38-44. [PMID: 28521248 DOI: 10.1016/j.nedt.2017.04.027] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [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: 11/17/2016] [Revised: 03/27/2017] [Accepted: 04/28/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Preparing nursing students for the knowledge and skills required for the administration and monitoring of blood components is crucial for entry into clinical practice. Serious games create opportunities to develop this competency, which can be used as a self-directed learning strategy to complement existing didactic learning and simulation-based strategies. AIM To describe the development and evaluation of a serious game to improve nursing students' knowledge, confidence, and performance in blood transfusion. METHOD An experiential gaming model was applied to guide the design of the serious game environment. A clustered, randomized controlled trial was conducted with 103 second-year undergraduate nursing students who were randomized into control or experimental groups. After a baseline evaluation of the participants' knowledge and confidence on blood transfusion procedure, the experimental group undertook a blood transfusion serious game and completed a questionnaire to evaluate their learning experience. All participants' clinical performances were evaluated in a simulated environment. RESULTS The post-test knowledge and confidence mean scores of the experimental group improved significantly (p<0.001) after the serious game intervention compared to pre-test mean scores and to post-test mean scores of the control group (p<0.001). However, no significance difference (p=0.11) was found between the experimental and control groups on the post-test performance mean scores. The participants evaluated the serious game positively. CONCLUSION The study provided evidence on the effectiveness of a serious game in improving the knowledge and confidence of nursing students on blood transfusion practice. The features of this serious game could be further developed to incorporate additional scenarios with repetitive exercises and feedback to enhance the impact on clinical performance. Given the flexibility, practicality, and scalability of such a game, they can serve as a promising approach to optimize learning when blended with high-fidelity simulation.
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Affiliation(s)
| | - Cindy Ching Siang Lee
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | | | - Simon Cooper
- Faculty of Health, Federation University, Australia
| | - Lydia Siew Tiang Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Wei Ling Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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