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Hoorn LC, Graf C, Merz EM. Money matters: The association between blood donation rates and healthcare system quality across 171 countries. Transfusion 2024. [PMID: 38853367 DOI: 10.1111/trf.17915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Worldwide, insufficient blood donations cause blood shortages that jeopardize vital medical treatments for patients. Blood donation rates vary widely across countries, yet the determinants of this variation remain poorly understood. This study aims to illuminate the role of the institutional context in which blood donation is embedded by examining the link between country-level blood donation rates and healthcare system quality. STUDY DESIGN AND METHODS The study employed a cross-sectional design using data on blood donation rates from 171 countries from the 2021 WHO Global Status Report on Blood Safety and Availability and three healthcare quality indicators (i.e., Healthcare Access and Quality [HAQ] Index, life expectancy, and health expenditures). The pre-registered hypotheses are tested using multiple linear regression. Robustness checks control for confounding factors. RESULTS HAQ Index and health expenditures are positively associated with blood donation rates, whereas life expectancy is not related to blood donation when controlling for confounds. Health expenditures display the most robust association with blood donations, even when controlling for confounding factors, and when comparing countries within the same continent. CONCLUSION Higher healthcare system quality in terms of HAQ Index and higher healthcare expenditures are related to higher blood donation rates. The finding that healthcare expenditures are most consistently related to blood donation rates indicates that policymakers should consider prioritizing financial support for the healthcare system, including blood-collecting institutions. More broadly, a better understanding of the role of contextual factors for blood donation may be needed to increase blood availability worldwide.
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Affiliation(s)
- Lieke C Hoorn
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Caroline Graf
- Department of Sociology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, the Netherlands
| | - Eva-Maria Merz
- Department of Sociology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, the Netherlands
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2
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Simsek Şimşek AK, Ecevit Alpar SŞ, Cayli Çaylı N. Nurses' self-efficiency levels in safe blood and blood component transfusion: The case of Turkey. Transfus Apher Sci 2024; 63:103888. [PMID: 38368120 DOI: 10.1016/j.transci.2024.103888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE The study aimed to determine nurses' self-efficacy levels for safe transfusion of blood and blood components. METHOD The design of this study is descriptive and cross-sectional. Before starting the study, ethics committee approval and institution approval was obtained. The participants were informed about the purpose of the study, and their written consent was obtained. The research was conducted between the dates 01 March 2022 and 01 May 2022, a private hospital in Turkey. The study sample consisted of 482 nurses. Data were collected using descriptive characteristics form and the Safe Blood and Blood Products Transfusion Self-Efficacy Scale (SBT-SES). RESULTS The total SBT-SES scores of the nurses were high (202.7 ± 50.1), and the behavioral sub-factor self-efficacy scores were moderate (48.2 ± 19.5). When the SBT-SES scores were analyzed based on demographic characteristics, it was found that those who had received previous safe blood transfusion training scored higher than those who had not, and women scored higher than men (p < 0.05). In addition, no relationship was found between age, working time, number of weekly blood transfusions, and self-efficacy levels. DISCUSSION As a result, nurses' self-efficacy levels towards blood transfusion are high. However, the behavioral sub-factor self-efficacy level is not sufficient. CONCLUSION Based on these results, in order to increase the behavioral self-efficacy levels of nurses, our recommendations are as follows: investigating appropriate training methods, considering the sex factor when choosing training methods and techniques, investigating the barriers to safe transfusion behaviors, and measuring self-efficacy levels at regular intervals.
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Affiliation(s)
| | | | - Nazan Cayli Çaylı
- Medicana Ataşehir Hospital, Department of Education, Istanbul, Turkey
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3
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Yost MT, Driban M, Dissak Delon FN, Mbianyor MA, Kinge T, Njock R, Nkusu D, Tsiagadigui JG, Carvalho M, Oke R, Chichom-Mefire A, Juillard C, Christie SA. Crystalloid resuscitation is associated with decreased treatment delays and improved systolic blood pressures in a blood-constrained setting. Trauma Surg Acute Care Open 2024; 9:e001290. [PMID: 38616791 PMCID: PMC11015245 DOI: 10.1136/tsaco-2023-001290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 03/22/2024] [Indexed: 04/16/2024] Open
Abstract
Objectives We analyzed resuscitation practices in Cameroonian patients with trauma as a first step toward developing a context-appropriate resuscitation protocol. We hypothesized that more patients would receive crystalloid-based (CB) resuscitation with a faster time to administration than blood product (BL) resuscitation. Methods We included patients enrolled between 2017 and 2019 in the Cameroon Trauma Registry (CTR). Patients presenting with hemorrhagic shock (systolic blood pressure (SBP) <100 mm Hg and active bleeding) were categorized as receiving CB, BL, or no resuscitation (NR). We evaluated differences between cohorts with the Kruskal-Wallis test for continuous variables and Fisher's exact test for categorical variables. We compared time to treatment with the Wilcoxon rank sum test. Results Of 9635 patients, 403 (4%) presented with hemorrhagic shock. Of these, 278 (69%) patients received CB, 39 (10%) received BL, and 86 (21%) received NR. BL patients presented with greater injury severity (Highest Estimated Abbreviated Injury Scale (HEAIS) 4 BL vs 3 CB vs 1 NR, p<0.001), and lower median hemoglobin (8.0 g/dL BL, 11.4 g/dL CB, 10.6 g/dL NR, p<0.001). CB showed greater initial improvement in SBP (12 mm Hg CB vs 9 mm Hg BL vs 0 NR mm Hg, p=0.04) compared with BL or no resuscitation, respectively. Median time to treatment was lower for CB than BL (12 vs 131 min, p<0.01). Multivariate logistic regression adjusted for injury severity found no association between resuscitation type and mortality (CB adjusted OR (aOR) 1.28, p=0.82; BL aOR 1.05, p=0.97). Conclusions CB was associated with faster treatment, greater SBP elevation, and similar survival compared with BL in Cameroonian patients with trauma with hemorrhagic shock. In blood-constrained settings, treatment delays associated with blood product transfusion may offset the physiologic benefits of an early BL strategy. CB prior to definitive hemorrhage control in this resource-limited setting may be a necessary strategy to optimize perfusion pressure. Level of evidence and study type III, retrospective study.
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Affiliation(s)
- Mark T Yost
- Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Matt Driban
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | | | | | - Melissa Carvalho
- Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Rasheedat Oke
- Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | | | - Catherine Juillard
- Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - S Ariane Christie
- Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
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4
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Wise R, Hood K, Bishop D, Sharp G, Rodseth R. Analysis of a 5-year, evidenced-based, rational blood utilisation project in a South African regional hospital. Transfus Med 2024; 34:154-164. [PMID: 38152867 DOI: 10.1111/tme.13025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/26/2023] [Accepted: 12/09/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Blood products are a lifesaving but limited resource, particularly in resource-limited settings. Evidence-based transfusion criteria tailored to local hospitals have shown great promise in reducing costs, minimising shortages, and ameliorating the morbidity and mortality associated with liberal blood product usage. We implemented the "Saving Blood, Saving Lives" project to: promote responsible blood product use and reduce blood product ordering inefficiencies and expenditure. METHODS A comprehensive change management programme, preceded by 3 months of clinical department consultation and training, was implemented. A new evidence-based protocol for blood product utilisation was developed, together with an accountability form. This form was used in monthly audit meetings to refine policies, identify new problems, improve communication, and to drive hospital staff accountability and training. The primary measure of the programme's success was the change in the number of red cell concentrate units ordered. RESULTS Project implementation required minimal time and no additional budget or staff. Annual red cell concentrate usage reduced from 7211 units in year one to 4077 units in year 5 (p < 0.001). Similar reductions were seen in freeze-dried plasma and platelet usage, as well as administrative costs. Total project saving, adjusted to baseline admission numbers, amounted to over R46 million ($2.5 million). CONCLUSIONS As a change management programme centred the "Saving Blood, Saving Lives" project, was able to significantly reduce blood product-related administration and expenditure by implementing evidence-based transfusion criteria. The programme is simple, replicable and cost effective, making it ideally suited for use in resource-constrained environments.
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Affiliation(s)
- Robert Wise
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
- Adult Intensive Care Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Faculty Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Kirsten Hood
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - David Bishop
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Gary Sharp
- Statistics Department, Nelson Mandela University, South Campus, Port Elizabeth, South Africa
| | - Reitze Rodseth
- Department of Anaesthetics, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa
- Netcare Limited, Sandton, South Africa
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5
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Lasocki S, Delahaye D, Fuks D, Savoie PH, Dussart C, Hofmann A, Paubel P. Management of perioperative iron deficiency anemia as part of patient blood management in France: A budget impact model-based analysis based on real world data. Transfusion 2023; 63:1692-1700. [PMID: 37610057 DOI: 10.1111/trf.17495] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES Patient Blood Management (PBM) is defined as a patient-centered, systematic, evidence-based approach to improve patient outcomes by managing and preserving a patient's own blood, while promoting patient safety and empowerment. As a corollary, it also reduces the utilization of allogeneic blood components. However, demonstrating cost-effectiveness depends on the health insurance system considered. This analysis aims to estimate the one-year budget impact of PBM in four elective surgical areas, from French National Health Insurance and hospital perspectives. METHODS A budget impact model was developed to estimate the difference in the cost of care between scenarios with and without PBM. The impact of hematopoiesis optimization (first pillar of PBM) was studied throughout the management of preoperative anemia and iron deficiency in four types of surgeries: orthopedic, cardiac & cardiovascular, vascular & thoracic, and urologic & visceral surgery. Estimation of model's parameters was based on data collected in 10 French hospitals, literature, and on data from the French national medico-administrative database. RESULTS A total of 980,125 patients were modeled for all four therapeutic areas. Results shows that implementation of a PBM program could generate annual savings up to €1079 M from the French National Health Insurance perspective (€1018 M from the hospital perspective), and the sparing of 181,451 red blood cells units per year. The deterministic sensitivity analysis showed that PBM generates savings for both perspectives in most parameters tested. CONCLUSION Implementing PBM programs could result in important savings for the health care system in France.
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Affiliation(s)
- Sigismond Lasocki
- Département Anesthésie Réanimation, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - D Delahaye
- Département Anesthésie Réanimation, Assistance Publique - Hôpitaux de Marseille, hôpital Sainte-Marguerite, Marseille, France
| | - D Fuks
- Département de chirurgie digestive hépato-billiaire endocrinienne, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - P H Savoie
- Service d'Urologie, Hôpital d'Instruction des armées Sainte Anne, Toulon, France
| | - C Dussart
- Hospices Civils de Lyon, Lyon, France
| | - A Hofmann
- University of Western Australia, Perth, Australia, University Hospital Zurich, Zurich, Switzerland
| | - P Paubel
- Inserm UMR S 1145, Université Paris Cité, Paris, France
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Delaney M, Telke S, Zou S, Williams MJ, Aridi JO, Rudd KE, Puyana JC, Kumar P, Appiah B, Dei-Adomakoh Y, Asamoah-Akuoko L, Olayemi E, Singogo E, Hosseinipour MC, m’baya B, Chipeta E, Reilly C. The BLOODSAFE program: Building the future of access to safe blood in Sub-Saharan Africa. Transfusion 2022; 62:2282-2290. [PMID: 36173295 PMCID: PMC9643608 DOI: 10.1111/trf.17091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/30/2022] [Accepted: 07/12/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The supply of blood in many low- and middle-income nations in Sub-Saharan Africa (SSA) does not meet the patient care needs. Lack and delay of blood transfusion cause harm to patients and slow the rate of progress in other parts of the health system. Recognizing the power of implementation science, the BLOODSAFE Program was initiated which supports three SSA research study teams and one data coordinating center (DCC) with the goal to improve access to safe blood transfusion in SSA. STUDY DESIGN AND METHODS The study team in Ghana is focusing on studying and decreasing iron deficiency in blood donors and evaluating social engagement of blood donors through different approaches. The study team in Kenya is building a "vein to vein" workflow model to elucidate and devise strategies to overcome barriers to blood donation and improve infrastructural components of blood product production and use. The Malawi team is studying the infectious disease ramifications of blood donation as well as blood donor retention strategies aimed at blood donors who commence their donation career in secondary schools. RESULTS AND DISCUSSION Together the project teams and the DCC work as a consortium to support each other through a shared study protocol that will study donor motivations, outcomes, and adverse events across all three countries. The BLOODSAFE Program has the potential to lead to generalizable improvement approaches for increasing access to safe blood in SSA as well as mentoring and building the research capacity and careers of many investigators.
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Affiliation(s)
- Meghan Delaney
- Division of Pathology & Laboratory Medicine, Children’s National Hospital, Washington DC, USA
| | - Susan Telke
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Shimian Zou
- Division of Blood Diseases and Resources, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Makeda J. Williams
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Jackline O. Aridi
- Institute of Healthcare Management, Strathmore Business School, Nairobi, Kenya
| | - Kristina E. Rudd
- The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Juan Carlos Puyana
- Departments of Surgery and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Pratap Kumar
- Institute of Healthcare Management, Strathmore Business School, Nairobi, Kenya
| | - Bernard Appiah
- Research Program on Health Communication and Public Engagement (H-COPE), Department of Public Health, Falk College, Syracuse University, Syracuse, NY
| | - Yvonne Dei-Adomakoh
- Department of Hematology, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Lucy Asamoah-Akuoko
- Research and Development Department, National Blood Service Ghana, Accra, Ghana
| | - Edeghonghon Olayemi
- Department of Hematology, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | | | - Mina C. Hosseinipour
- University of North Carolina, Project Malawi, Lilongwe, Malawi
- University of North Carolina at Chapel Hill School of Medicine, Department of medicine, Division of Infectious Disease, Chapel Hill, NC, USA
| | | | - Effie Chipeta
- Kamuzu University of Health Sciences, Centre for Reproductive Health, Blantyre Malawi
| | - Cavan Reilly
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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7
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Argent AC, Ranjit S, Peters MJ, Andre-von Arnim AVS, Chisti MJ, Jabornisky R, Musa NL, Kissoon N. Factors to be Considered in Advancing Pediatric Critical Care Across the World. Crit Care Clin 2022; 38:707-720. [PMID: 36162906 DOI: 10.1016/j.ccc.2022.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This article reviews the many factors that have to be taken into account as we consider the advancement of pediatric critical care (PCC) in multiple settings across the world. The extent of PCC and the range of patients who are cared for in this environment are considered. Along with a review of the ongoing treatment and technology advances in the PCC setting, the structures and systems required to support these services are also considered. Finally the question of how PCC can be made sustainable in a volatile world with the impacts of global crises such as climate change is addressed.
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Affiliation(s)
- Andrew C Argent
- Department of Paediatrics and Child Health, University of Cape Town, Red Cross War Memorial Children's Hospital, Klipfontein Road, Rondebosch, Cape Town, 7700, South Africa.
| | - Suchitra Ranjit
- Pediatric ICU, Apollo Children's Hospital, 15, Shafee Mhd Road, Chennai 600006, India
| | - Mark J Peters
- University College London Great Ormond Street Institute of Child Health, London, WC1N 3JH, UK; Paediatric Intensive Care Unit, Great Ormond Street Hospital NHS Foundation Trust, London, WC1N 1EH, UK
| | - Amelie von Saint Andre-von Arnim
- Department of Pediatrics, Division of Pediatric Critical Care, University of Washington, Seattle Children's, 4800 Sand Point Way NorthEast, Seattle, WA 98105, USA; Department of Global Health, University of Washington, Seattle Children's, 4800 Sand Point Way NorthEast, Seattle, WA 98105, USA
| | - Md Jobayer Chisti
- ARI Ward, Dhaka Hospital, Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh
| | - Roberto Jabornisky
- Universidad Nacional Del Nordeste, Argentina. Pediatric Intensive Care Unit (Hospital Juan Pablo II and Hospital Olga Stuky) Argentina, Sociedad Latinoamericana de Cuidados Intensivos Pediátricos, LARed Network, Universidad Nacional Del Nordeste, 1420 Mariano Moreno, Corrientes 3400, Argentina
| | - Ndidiamaka L Musa
- Paediatric Critical Care, University of Washington, 4800 Sand Point Way NorthEast, Seattle, WA 98105, USA
| | - Niranjan Kissoon
- British Columbia Children's Hospital and The University of British Columbia, Vancouver, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
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McGann PT, Weyand AC. Lessons learned from the COVID-19 pandemic blood supply crisis. J Hosp Med 2022; 17:574-576. [PMID: 35729854 PMCID: PMC9349403 DOI: 10.1002/jhm.12843] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Patrick T. McGann
- Department of PediatricsAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
- Division of Pediatric Hematology/OncologyHasbro Children's HospitalProvidenceRhode IslandUSA
| | - Angela C. Weyand
- Division of Pediatric Hematology and OncologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
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9
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Arghittu A, Dettori M, Deriu GM, Soddu S, Manca PC, Carboni AA, Collu I, Palmieri A, Deiana G, Azara A, Castiglia P, Masia MD. Controlling Infectious Risk in Transfusion: Assessing the Effectiveness of Skin Disinfection in Blood Donors. Healthcare (Basel) 2022; 10:healthcare10050845. [PMID: 35627982 PMCID: PMC9141022 DOI: 10.3390/healthcare10050845] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/22/2022] [Accepted: 05/02/2022] [Indexed: 02/01/2023] Open
Abstract
Bacterial infectious risk is a major problem in transfusion medicine. The type of micro-organisms isolated during bacterial contamination of blood products indicates that the donor’s skin is its main source. In this context, the primary measures to reduce this risk are: (a) optimal disinfection of the donor’s arm and (b) satellite bag diversion of the initial volume of blood collected. This work aimed to verify the effectiveness of skin disinfection of the blood donor’s venipuncture site. Two methodological approaches were used: (a) qualitative and quantitative microbiological testing of the skin at the collection site, before and post-disinfection; (b) qualitative microbiological testing of the first deviated blood. Pre-disinfection testing showed skin microbial load values between 3 and >200 CFU/plate. More than two-thirds of the isolates were Gram-positive bacteria (77.8%) of which 57.7% were staphylococci. Among Gram-negative bacteria, Pseudomonadaceae, Enterobacteriaceae, and Acinetobacter spp. were isolated from the blood donors (BDs). Post-disinfection, a 100% reduction in microbial load was observed in 84.4% of BDs. Microbiological testing of the first blood diverted sample revealed the presence of microbial flora in 1.9% samples; of the isolates, 83.3% were non-aureus staphylococci. This study highlights the importance of the correct application of skin disinfection procedures in order to ensure blood safety.
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Affiliation(s)
- Antonella Arghittu
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (A.A.); (I.C.); (G.D.)
- University Hospital of Sassari, 07100 Sassari, Italy; (G.M.D.); (S.S.); (P.C.M.); (A.A.C.); (A.P.); (A.A.); (P.C.)
| | - Marco Dettori
- University Hospital of Sassari, 07100 Sassari, Italy; (G.M.D.); (S.S.); (P.C.M.); (A.A.C.); (A.P.); (A.A.); (P.C.)
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy;
- Correspondence:
| | - Grazia Maria Deriu
- University Hospital of Sassari, 07100 Sassari, Italy; (G.M.D.); (S.S.); (P.C.M.); (A.A.C.); (A.P.); (A.A.); (P.C.)
| | - Serena Soddu
- University Hospital of Sassari, 07100 Sassari, Italy; (G.M.D.); (S.S.); (P.C.M.); (A.A.C.); (A.P.); (A.A.); (P.C.)
| | - Pietro Carmelo Manca
- University Hospital of Sassari, 07100 Sassari, Italy; (G.M.D.); (S.S.); (P.C.M.); (A.A.C.); (A.P.); (A.A.); (P.C.)
| | - Anna Angela Carboni
- University Hospital of Sassari, 07100 Sassari, Italy; (G.M.D.); (S.S.); (P.C.M.); (A.A.C.); (A.P.); (A.A.); (P.C.)
| | - Irene Collu
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (A.A.); (I.C.); (G.D.)
| | - Alessandra Palmieri
- University Hospital of Sassari, 07100 Sassari, Italy; (G.M.D.); (S.S.); (P.C.M.); (A.A.C.); (A.P.); (A.A.); (P.C.)
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Giovanna Deiana
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (A.A.); (I.C.); (G.D.)
- University Hospital of Sassari, 07100 Sassari, Italy; (G.M.D.); (S.S.); (P.C.M.); (A.A.C.); (A.P.); (A.A.); (P.C.)
| | - Antonio Azara
- University Hospital of Sassari, 07100 Sassari, Italy; (G.M.D.); (S.S.); (P.C.M.); (A.A.C.); (A.P.); (A.A.); (P.C.)
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Paolo Castiglia
- University Hospital of Sassari, 07100 Sassari, Italy; (G.M.D.); (S.S.); (P.C.M.); (A.A.C.); (A.P.); (A.A.); (P.C.)
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Maria Dolores Masia
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy;
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10
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Barnes LS, Stanley J, Bloch EM, Pagano MB, Ipe TS, Eichbaum Q, Wendel S, Indrikovs A, Cai W, Delaney M. Status of hospital-based blood transfusion services in low-income and middle-income countries: a cross-sectional international survey. BMJ Open 2022; 12:e055017. [PMID: 35168978 PMCID: PMC8852762 DOI: 10.1136/bmjopen-2021-055017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Blood transfusion is life-saving for patients experiencing acute blood loss and severe anaemia. In low-income and middle-income countries (LMICs), low blood donation rates and unavailability of whole blood and blood components (blood products) impairs timely blood transfusion. To fulfil patient-specific blood orders, a hospital blood transfusion service (HBTS) receives orders from a prescriber for blood transfusion, tests and prepares blood products for the patient. This study sought to describe the current state of LMIC HBTS. DESIGN A cross-sectional survey explored LMIC HBTS access to blood products, testing methods, policies and structure. Surveys were administered in English, Spanish, French and Russian, followed by a mixed-methods analysis. SETTING HBTS within LMICs. PARTICIPANTS From among 124 public and private facilities invited to participate, we received 71 (57%) responses. Of these responses, 50 HBTS from 27 LMICs performed on-site blood transfusions. RESULTS Most LMIC HBTS perform blood collection to generate blood products for their patients (36/47, 77%); few relied exclusively on an external supply of blood products (11/47, 23%). The primary reason for blood transfusion was adult anaemia for non-malignant conditions (17/112, 15%). Testing methods varied by gross national income per capita. Blood transfusion delays to patients were common (17/30, 57%) attributed to inadequate blood inventories (13/29, 45%). Other barriers included lack of regular clinician education about transfusion (8/29, 28%) and sustainable financial models for the HBTS (4/29, 14%). CONCLUSION This survey describes the status of HBTS in diverse LMICs, illustrating that the availability of blood products remains a principal problem, requiring HBTS to generate its own facility's blood supply. Currently, blood shortages are not reported as a patient-specific adverse event making systematic tracking of delays in transfusion difficult. These findings highlight areas for further exploration related to the lack of available blood inventories for transfusions at HBTS in LMICs.
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Affiliation(s)
- Linda S Barnes
- Doctor of Public Health Leadership, University of Illinois--Chicago, Chicago, Illinois, USA
- American Association of Blood Banks, Bethesda, Maryland, USA
| | | | - Evan M Bloch
- Pathology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Monica B Pagano
- Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Tina S Ipe
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Quentin Eichbaum
- Pathology, Immunology and Microbiology | Medical Education and Administration, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Wei Cai
- Stanford Health Care, Stanford, California, USA
| | - Meghan Delaney
- Pathology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA
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11
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Rambiritch V, Verburgh E, Louw VJ. Patient blood management and blood conservation - Complimentary concepts and solutions for blood establishments and clinical services in South Africa and beyond. Transfus Apher Sci 2021; 60:103207. [PMID: 34353706 PMCID: PMC10399285 DOI: 10.1016/j.transci.2021.103207] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Blood transfusions come with risks and high costs, and should be utilized only when clinically indicated. Decisions to transfuse are however not always well informed, and lack of clinician knowledge and education on good clinical transfusion practices contribute to the inappropriate use of blood. Low and middle-income countries in particular take much strain in their efforts to address blood safety challenges, demand-supply imbalances, high blood costs as well as high disease burdens, all of which impact blood usage and blood collections. Patient blood management (PBM), which is a patient-focused approach aimed at improving patient outcomes by preemptively diagnosing and correcting anaemia and limiting blood loss by cell salvage, coagulation optimization and other measures, has become a major approach to addressing many of the challenges mentioned. The associated decrease in the use of blood and blood products may be perceived as being in competition with blood conservation measures, which is the more traditional, but primarily product-focused approach. In this article, we hope to convey the message that PBM and blood conservation should not be seen as competing concepts, but rather complimentary strategies with the common goal of improving patient care. This offers opportunity to improve the culture of transfusion practices with relief to blood establishments and clinical services, not only in South Africa and LMICs, but everywhere. With the COVID-19 pandemic impacting blood supplies worldwide, this is an ideal time to call for educational interventions and awareness as an active strategy to improve transfusion practices, immediately and beyond.
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Affiliation(s)
| | - Estelle Verburgh
- Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Vernon Johan Louw
- Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
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12
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Knowledge Level, Motivators and Barriers of Blood Donation among Students at Qatar University. Healthcare (Basel) 2021; 9:healthcare9080926. [PMID: 34442063 PMCID: PMC8391523 DOI: 10.3390/healthcare9080926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/09/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022] Open
Abstract
In Qatar, one out of every ten patients admitted to the hospitals is in urgent need of a blood transfusion or blood products. The aims of this study are as follows: (1) to assess the level of awareness and knowledge about blood donation and (2) to identify the factors that contribute to the willingness to donate blood among young adults. A cross-sectional survey using a constructed questionnaire was conducted among students at Qatar University. A total of 590 responses were collected, out of which 423 were suitable for analysis. Only 72 out of 472 (15%) participants were blood donors. The chi-square test and t-test were then used to study the association of blood donation status with different factors. Significant values were considered to be p ≤ 0.5. Gender and age were found to be significantly associated with blood donation status, with a higher frequency of donation among males and adults above the age of 24 years old. On the other hand, the total knowledge score was found to not be significantly associated with blood donation status with a mean score of 60.5% for both groups (blood donors, non-blood donors). The most common motivators that encouraged blood donors were donating to help people, followed by having a blood mobile unit come to your place, whereas the most common barriers reported by non-blood donors were failing to meet the requirements, followed by "never having been asked to give blood". This is the first study in Qatar to assess blood donation status. It provides insights that would help in developing effective strategies for the recruitment and retention of young adult blood donors in Qatar and countries with similar cultures. Raising awareness about blood donation, along with providing more mobile blood donation units at public places, will aid in increasing the frequency of blood donation among young adults.
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13
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Elshinawy M, Kamal M, Nazir H, Khater D, Hassan R, Elkinany H, Wali Y. Sepsis-related anemia in a pediatric intensive care unit: transfusion-associated outcomes. Transfusion 2021; 60 Suppl 1:S4-S9. [PMID: 32134129 DOI: 10.1111/trf.15688] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 10/23/2019] [Accepted: 01/01/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric patients with sepsis in intensive care units are at high risk of developing anemia, which might have adverse effects on their prognosis. This study aimed to evaluate the impact of red blood cell (RBC) transfusion on the outcomes of patients admitted to a pediatric intensive care unit (PICU) with sepsis. METHODS We conducted a prospective randomized clinical trial, enrolling 67 children, aged 2 to 144 months who were admitted to a PICU with a new episode of sepsis from November 2017 to April 2018. Patients were allocated randomly to two groups: Group 1, liberal transfusion strategy group, including 33 patients who had initial hemoglobin (Hb) between 7 or greater and less than 10 g/dL and received an RBC top-up transfusion to 12 g/dL; and Group 2, restrictive strategy group, including 34 patients who had the same Hb range and did not receive RBCs. Patients with Hb less than 7 or greater than 10 g/dL were excluded. RESULTS Of 33 patients who received liberal transfusions, 31 (93.94%) required ventilation, and 29 (87.88%) had multiorgan dysfunction. They had a significantly lengthier hospital stay and a higher incidence of acute respiratory distress syndrome and acute lung injury. Moreover, mortality was significantly higher in the liberal transfusion group (42.4% vs. 17.6%). CONCLUSIONS Compared to the restrictive transfusion strategy, liberal transfusion might be associated with a worse outcome. However, the possible role of other known and unknown confounding factors and minor protocol violations should be taken into consideration. We recommend minimizing factors worsening anemia in PICU patients to reduce the need for transfusion.
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Affiliation(s)
- Mohamed Elshinawy
- Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt.,Child Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Maha Kamal
- Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hanan Nazir
- Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt.,Child Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Doaa Khater
- Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt.,Child Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Radwa Hassan
- Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hassan Elkinany
- Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Yasser Wali
- Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt.,Child Health, Sultan Qaboos University Hospital, Muscat, Oman
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14
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Charles KS, Bain T, Beharry TS, Baksh HS, Bernard AA, Bernard C, Bhagoutie S, Chantry A. Knowledge, attitudes and risk perception surrounding blood donation and receipt in two high income Caribbean countries. Transfus Med 2021; 31:339-349. [PMID: 34250655 DOI: 10.1111/tme.12800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/07/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare knowledge, attitudes and risk perception related to blood donation and transfusion in Trinidad and Tobago and Bahamas. BACKGROUND Trinidad and Tobago and the Bahamas are two Caribbean countries whose national blood transfusion systems are heavily reliant (76.2% and 76%) on family replacement donors. The Pan American Health Organisation/World Health Organisation recommends blood collection from exclusively voluntary nonremunerated donors on the grounds that family replacement donor-based blood systems are unsafe and inadequate compared to those based on voluntary nonremunerated blood donors. METHODS/MATERIALS A 23-item questionnaire was distributed online by snowball sampling in these two countries to assess knowledge, attitudes, risk perception and behaviour. SPSS version 24 was used for interpretative and descriptive data analysis, chi-square to measure significance and linear regression the strength of associations. p < 0.05 was used to define statistical significance. RESULTS Four hundred and fifty three (453) responses were obtained from Trinidad and Tobago and 101 from the Bahamas. Knowledge and positive attitudes were high in both countries (75.5% vs. 80.2%, p < 0.001 and 96.6% vs. 100%, p < 0.001). A substantial proportion of respondents held the perception that the local blood donation system was safe or very safe (26.4 and 61.4%, p < 0.001) that was linked to the misconception that the prevalent method of blood donation was voluntary nonremunerated (27.8 and 51.4%, p < 0.001). Concerns about receiving blood were underpinned by mistrust of transfusion-related procedures. CONCLUSION A social interface to transfer information between blood transfusion services and the community could encourage voluntary nonremunerated blood donation and reduce concerns about receiving transfusion.
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Affiliation(s)
- Kenneth S Charles
- Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Teria Bain
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Travis Sunil Beharry
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Habibah Saadia Baksh
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Abigail A Bernard
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Cristal Bernard
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Shivani Bhagoutie
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Andy Chantry
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
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15
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Retrospective Study of the Seroprevalence of HIV, HCV, and HBV in Blood Donors at a Blood Bank of Western Mexico. Pathogens 2021; 10:pathogens10070878. [PMID: 34358028 PMCID: PMC8308904 DOI: 10.3390/pathogens10070878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/08/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022] Open
Abstract
Obtaining blood which is safe for transfusions is one of the principal challenges in the health systems of developing countries. Supply of contaminated blood increases morbidity, mortality, and the costs of patient care. In Mexico, serological screening is mandatory, but only a few of the main blood banks routinely perform a nucleic acid test (NAT). Data from 80,391 blood donations processed between August 2018 and December 2019 at the Central Blood Bank of the Western National Medical Center of the Mexican Social Security Institute (IMSS) were analyzed. All donors were screened for serological markers and NAT was performed. Reactive donors were followed-up to confirm their results. The number of reactive donors and seroprevalence rates for HIV, HCV, and HBV were 152 (18.91/10,000), 385 (47.89/10,000), and 181 (22.51/10,000), respectively; however, these rates decreased when NAT-confirmed reactive results were considered. Male donors were found to have a higher seroprevalence than females, and younger donors higher than older donors. The present study shows that HIV, HCV, and HBV seroprevalence in blood donors in Western Mexico is low. We propose that Mexico should establish future strategies, including pathogen reduction technologies (PRTs), in order to improve blood safety and reduce transfusion-transmissible infections (TTIs).
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16
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Gress KL, Charipova K, Urits I, Viswanath O, Kaye AD. Supply, Demand, and Quality: A Three-Pronged Approach to Blood Product Management in Developing Countries. J Patient Cent Res Rev 2021; 8:121-126. [PMID: 33898644 PMCID: PMC8060046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
While transfusion of blood and blood products is instinctively linked to the provision of emergent care, blood and blood products are also routinely used for the treatment of subacute and chronic conditions. Despite the efforts of the World Health Organization and others, developing countries are faced with a three-part problem when it comes to access to and delivery of transfusions: insufficient supply, excessive demand, and inadequate quality of available supply. Developing countries rely heavily on replacement and remunerated donors rather than voluntary nonremunerated donors due to concerns regarding donation- and transfusion-transmitted infection as well as local and cultural beliefs. While increased awareness of HIV and improved testing techniques have jointly reduced infection-related apprehensions and improved the quality of available blood and blood products, continued efforts are warranted to bolster testing for other bloodborne pathogens. Similarly, although prevalence rates of anemia are high in some areas of the world, success in adequate widespread management of these conditions has been limited. One of the keys to expanding access to high-quality blood and blood products is thus to improve medical management of conditions that would otherwise require transfusion. Through a three-pronged approach to address quantity, quality, and demand, developing countries can enable themselves to build toward self-sufficient blood management services and increased independence from the support of international organizations.
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Affiliation(s)
- Kyle L. Gress
- Georgetown University School of Medicine, Washington, DC
| | | | - Ivan Urits
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Omar Viswanath
- Valley Anesthesiology and Pain Consultants – Envision Physician Services, Phoenix, AZ; Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE
| | - Alan D. Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA
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17
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Al-Saqladi AWM, Albanna TA. A Study of Blood Transfusion in Pediatric Patients at a Teaching Hospital, Aden, Yemen. INTERNATIONAL JOURNAL OF CLINICAL TRANSFUSION MEDICINE 2021. [DOI: 10.2147/ijctm.s293720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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18
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Amjad F, Fatima T, Fayyaz T, Khan MA, Qadeer MI. Novel genetic therapeutic approaches for modulating the severity of β-thalassemia (Review). Biomed Rep 2020; 13:48. [PMID: 32953110 PMCID: PMC7484974 DOI: 10.3892/br.2020.1355] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 05/13/2020] [Indexed: 12/13/2022] Open
Abstract
Thalassemia is a genetic haematological disorder that arises due to defects in the α and β-globin genes. Worldwide, 0.3-0.4 million children are born with haemoglobinopathies per year. Thalassemic patients, as well as their families, face various serious clinical, socio-economic, and psychosocial challenges throughout their life. Different therapies are available in clinical practice to minimize the suffering of thalassemic patients to some extent and potentially cure the disease. Predominantly, patients undergo transfusion therapy to maintain their haemoglobin levels. Due to multiple transfusions, the iron levels in their bodies are elevated. Iron overload results in damage to body organs, resulting in heart failure, liver function failure or endocrine failure, all of which are commonly observed. Certain drugs have been developed to enhance the expression of the γ-gene, which ultimately results in augmentation of fetal haemoglobin (HbF) levels and total haemoglobin levels in the body. However, its effectiveness is dependent on the genetic makeup of the individual patient. At present, allogeneic haematopoietic Stem Cell Transplantation (HSCT) is the only practically available option with a high curative rate. However, the outcome of HSCT is strongly influenced by factors such as age at transplantation, irregular iron chelation history before transplantation, histocompatibility, and source of stem cells. Gene therapy using the lentiglobin vector is the most recent method for cure without any mortality, graft rejection and clonal dominance issues. However, delayed platelet engraftment is being reported in some patients. Genome editing is a novel approach which may be used to treat patients with thalassemia; it makes use of targeted nucleases to correct the mutations in specific DNA sequences and modify the sequence to the normal wild-type sequence. To edit the genome at the required sites, CRISPR/Cas9 is an efficient and accurate tool that is used in various genetic engineering programs. Genome editing mediated by CRISPR/Cas9 has the ability to restore the normal β-globin function with minimal side effects. Using CRISPR/Cas9, expression of BCL11A can be downregulated along with increased production of HbF. However, these genome editing tools are still under in-vitro trials. CRISPR/Cas9 has can be used for precise transcriptional regulation, genome modification and epigenetic editing. Additional research is required in this regard, as CRISPR/Cas9 may potentially exhibit off-target activity and there are legal and ethical considerations regarding its use.
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Affiliation(s)
- Fareeha Amjad
- Department of Microbiology and Molecular Genetics, University of The Punjab, Lahore, Punjab 54590, Pakistan
| | - Tamseel Fatima
- Department of Microbiology and Molecular Genetics, University of The Punjab, Lahore, Punjab 54590, Pakistan
| | - Tuba Fayyaz
- Department of Microbiology and Molecular Genetics, University of The Punjab, Lahore, Punjab 54590, Pakistan
| | - Muhammad Aslam Khan
- Sundas Molecular Analysis Centre (SUNMAC), Sundas Foundation, Lahore, Punjab 54000, Pakistan
| | - Muhammad Imran Qadeer
- Department of Microbiology and Molecular Genetics, University of The Punjab, Lahore, Punjab 54590, Pakistan.,Sundas Molecular Analysis Centre (SUNMAC), Sundas Foundation, Lahore, Punjab 54000, Pakistan
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19
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A Last Resort When There is No Blood: Experiences and Perceptions of Intraoperative Autotransfusion Among Medical Doctors Deployed to Resource-Limited Settings. World J Surg 2020; 44:4052-4059. [PMID: 32856098 PMCID: PMC7599148 DOI: 10.1007/s00268-020-05749-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Four and a half million people die globally every year due to traumatic injuries. One major cause of preventable death is bleeding. Blood for transfusion is often unavailable in resource-limited settings, where a majority of trauma deaths occur. Intraoperative autotransfusion (IAT) has been proposed as a safe and feasible lifesaving alternative to allogeneic blood transfusion. However, there is limited knowledge regarding its use among doctors working for international non-governmental organisations (INGOs) in resource-limited settings. The aim of this study was to explore the experiences and perceptions of IAT among INGO-affiliated medical doctors with clinical experience in resource-limited settings. METHODS We conducted semi-structured interviews via telephone or Skype with 12 purposefully sampled surgeons and anaesthesiologists. The interviews were recorded, transcribed verbatim, and analysed using content analysis. RESULTS We identified three main themes relating to IAT and bottlenecks preventing the scale-up of its use: variation in techniques and systems, contextual factors, and individual medical doctor factors. The participants gave detailed reports of missed opportunities for usage of IAT in resource-limited settings. Bottlenecks included the lack of simple and cost-effective products, limited availability of protocols in the field, and insufficient knowledge and experience of IAT. CONCLUSIONS The participants found that simple IAT is under-utilised in resource-limited settings. Missed opportunities to use IAT were mainly associated with armed conflict settings and obstetrical emergencies. In order to meet the need for IAT in resource-limited settings, we suggest further consideration of the identified bottlenecks.
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20
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Park YJ, Jeon SH, Kim HK, Suh EJ, Choi SJ, Kim S, Kim HO. Human induced pluripotent stem cell line banking for the production of rare blood type erythrocytes. J Transl Med 2020; 18:236. [PMID: 32532292 PMCID: PMC7291485 DOI: 10.1186/s12967-020-02403-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/04/2020] [Indexed: 02/07/2023] Open
Abstract
Background The in vitro production of mature human red blood cells (RBCs) from induced pluripotent stem cells (iPSCs) has been the focus of research to meet the high demand for blood transfusions. However, limitations like high costs and technological requirements restrict the use of RBCs produced by iPSC differentiation to specific circumstances, such as for patients with rare blood types or alloimmunized patients. In this study, we developed a detailed protocol for the generation of iPSC lines derived from peripheral blood of donors with O D-positive blood and rare blood types (D–and Jr(a-)) and subsequent erythroid differentiation. Methods Mononuclear cells separated from the peripheral blood of O D-positive and rare blood type donors were cultured to produce and expand erythroid progenitors and reprogrammed into iPSCs. A 31-day serum-free, xeno-free erythroid differentiation protocol was used to generate reticulocytes. The stability of iPSC lines was confirmed with chromosomal analysis and RT-PCR. Morphology and cell counts were determined by microscopy observations and flow cytometry. Results Cells from all donors were successfully used to generate iPSC lines, which were differentiated into erythroid precursors without any apparent chromosomal mutations. This differentiation protocol resulted in moderate erythrocyte yield per iPSC. Conclusions It has previously only been hypothesized that erythroid differentiation from iPSCs could be used to produce RBCs for transfusion to patients with rare blood types or who have been alloimmunized. Our results demonstrate the feasibility of producing autologous iPSC-differentiated RBCs for clinical transfusions in patients without alternative options.
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Affiliation(s)
- Yu Jin Park
- Department of Laboratory Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.,Department of Laboratory Medicine, Armed Forces Yangju Hospital, Yangju-si, Gyeonggi-do, Korea
| | - Su-Hee Jeon
- Department of Laboratory Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hyun-Kyung Kim
- Department of Laboratory Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Eun Jung Suh
- Department of Laboratory Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Seung Jun Choi
- Department of Laboratory Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Sinyoung Kim
- Department of Laboratory Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hyun Ok Kim
- Department of Laboratory Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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21
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Kolin DA, Shakur-Still H, Bello A, Chaudhri R, Bates I, Roberts I. Risk factors for blood transfusion in traumatic and postpartum hemorrhage patients: Analysis of the CRASH-2 and WOMAN trials. PLoS One 2020; 15:e0233274. [PMID: 32492040 PMCID: PMC7269233 DOI: 10.1371/journal.pone.0233274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 04/30/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Hemorrhage is a leading cause of death after trauma and childbirth. In response to severe hemorrhage, bleeding patients often receive transfusions of red blood cells, plasma, platelets, or other blood components. We examined risk factors for transfusion in acute severe bleeding in two trials of over 20,000 patients to better understand factors associated with transfusion likelihood. STUDY DESIGN AND METHODS We conducted a cohort analysis of data from the CRASH-2 and WOMAN trials, two multinational trials that recruited patients with traumatic and postpartum hemorrhage, respectively. For each trial, we examined the effect of 10 factors on blood transfusion likelihood. Univariate and multivariate Poisson regressions were used to analyze the relationship between risk factors and blood transfusion. RESULTS Of the 20,207 traumatic hemorrhage patients, 10,232 (51%) received blood components. Of the 20,060 women with postpartum hemorrhage, 10,958 (55%) received blood components. For patients who suffered from traumatic hemorrhage, those greater than three hours from injury to hospitalization were more likely to be transfused (ARR 1.37; 95% CI, 1.20-1.56). Postpartum hemorrhage patients had an increased likelihood of transfusion if they gave birth outside the hospital (ARR 1.30; 95% CI 1.22-1.39), gave birth more than three hours before hospitalization (ARR 1.09; 95% CI 1.01-1.17), had a Caesarean section (ARR 1.16; 95% CI 1.08-1.25), and if they had any identifiable causes of hemorrhage other than uterine atony. CONCLUSION Several risk factors are associated with an increased likelihood of transfusion in traumatic and postpartum hemorrhage patients. Altering modifiable factors, by reducing time from injury or childbirth to hospitalization, for example, might be able to reduce transfusions and their complications. TRIAL REGISTRATION CRASH-2 is registered as ISRCTN86750102, ClinicalTrials.gov NCT00375258 and South African Clinical Trial Register DOH-27-0607-1919. WOMAN is registered as ISRCTN76912190, ClinicalTrials.gov NCT00872469, PACTR201007000192283, and EudraCT number 2008-008441-38.
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Affiliation(s)
- David A. Kolin
- Department of Population Health, Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, England, United Kingdom
| | - Haleema Shakur-Still
- Department of Population Health, Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, England, United Kingdom
| | - Adenike Bello
- Department of Obstetrics and Gynecology, University of Ibadan, Ibadan, Nigeria
| | - Rizwana Chaudhri
- Department Obstetrics and Gynecology, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Imelda Bates
- Liverpool School of Tropical Medicine, Liverpool, England, United Kingdom
| | - Ian Roberts
- Department of Population Health, Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, England, United Kingdom
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Atun R, Bhakta N, Denburg A, Frazier AL, Friedrich P, Gupta S, Lam CG, Ward ZJ, Yeh JM, Allemani C, Coleman MP, Di Carlo V, Loucaides E, Fitchett E, Girardi F, Horton SE, Bray F, Steliarova-Foucher E, Sullivan R, Aitken JF, Banavali S, Binagwaho A, Alcasabas P, Antillon F, Arora RS, Barr RD, Bouffet E, Challinor J, Fuentes-Alabi S, Gross T, Hagander L, Hoffman RI, Herrera C, Kutluk T, Marcus KJ, Moreira C, Pritchard-Jones K, Ramirez O, Renner L, Robison LL, Shalkow J, Sung L, Yeoh A, Rodriguez-Galindo C. Sustainable care for children with cancer: a Lancet Oncology Commission. Lancet Oncol 2020; 21:e185-e224. [PMID: 32240612 DOI: 10.1016/s1470-2045(20)30022-x] [Citation(s) in RCA: 159] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/22/2019] [Accepted: 01/14/2020] [Indexed: 12/29/2022]
Abstract
We estimate that there will be 13·7 million new cases of childhood cancer globally between 2020 and 2050. At current levels of health system performance (including access and referral), 6·1 million (44·9%) of these children will be undiagnosed. Between 2020 and 2050, 11·1 million children will die from cancer if no additional investments are made to improve access to health-care services or childhood cancer treatment. Of this total, 9·3 million children (84·1%) will be in low-income and lower-middle-income countries. This burden could be vastly reduced with new funding to scale up cost-effective interventions. Simultaneous comprehensive scale-up of interventions could avert 6·2 million deaths in children with cancer in this period, more than half (56·1%) of the total number of deaths otherwise projected. Taking excess mortality risk into consideration, this reduction in the number of deaths is projected to produce a gain of 318 million life-years. In addition, the global lifetime productivity gains of US$2580 billion in 2020-50 would be four times greater than the cumulative treatment costs of $594 billion, producing a net benefit of $1986 billion on the global investment: a net return of $3 for every $1 invested. In sum, the burden of childhood cancer, which has been grossly underestimated in the past, can be effectively diminished to realise massive health and economic benefits and to avert millions of needless deaths.
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Affiliation(s)
- Rifat Atun
- Department of Global health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston MA, USA.
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Avram Denburg
- Division of Haematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - A Lindsay Frazier
- Dana-Farber and Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Paola Friedrich
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Sumit Gupta
- Division of Haematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Catherine G Lam
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Zachary J Ward
- Center for Health Decision Science, Harvard T H Chan School of Public Health, Harvard University, Boston MA, USA
| | - Jennifer M Yeh
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston MA, USA; Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Claudia Allemani
- Cancer Survival Group, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Michel P Coleman
- Cancer Survival Group, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Veronica Di Carlo
- Cancer Survival Group, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Elizabeth Fitchett
- University College London Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Fabio Girardi
- Cancer Survival Group, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Susan E Horton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, WHO, Lyon, France
| | - Eva Steliarova-Foucher
- Section of Cancer Surveillance, International Agency for Research on Cancer, WHO, Lyon, France
| | - Richard Sullivan
- Institute of Cancer Policy, Conflict and Health Research Group, School of Cancer Sciences, King's College London, London, UK
| | - Joanne F Aitken
- Cancer Council Queensland, Brisbane, QLD, Australia; School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Shripad Banavali
- Department of Medical and Pediatric Oncology, Tata Memorial Center, Mumbai, India; Homi Bhabha National Institute, Mumbai, India
| | | | - Patricia Alcasabas
- Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Federico Antillon
- Unidad Nacional de Oncología Pediátrica and the School of Medicine, Universidad Francisco Marroquín, Guatemala City, Guatemala
| | - Ramandeep S Arora
- Department of Medical Oncology, Max Super-Specialty Hospital, New Delhi, India
| | - Ronald D Barr
- Departments of Pediatrics, Pathology and Medicine, Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Eric Bouffet
- Division of Haematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Julia Challinor
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | | | - Thomas Gross
- Center for Global Health, US National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lars Hagander
- Department of Clinical Sciences Lund, Pediatric Surgery, WHO Collaborating Centre for Surgery and Public Health, Lund University Faculty of Medicine, Lund, Sweden
| | - Ruth I Hoffman
- American Childhood Cancer Organization, Beltsville, MD, USA
| | - Cristian Herrera
- Health Division, Organization for Economic Cooperation and Development, Paris, France; Department of Public Health, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Tezer Kutluk
- Department of Pediatrics, Division of Pediatric Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey; Cancer Institute, Hacettepe University, Ankara, Turkey
| | - Karen J Marcus
- Department of Radiation Oncology, Harvard Medical School, Harvard University, Boston MA, USA; Division of Radiation Oncology, Boston Children's Hospital, Boston, MA, USA
| | - Claude Moreira
- Institut Jean Lemerle, African Paediatric Oncology Formation, Dakar, Senegal; Hôpital Aristide Le Dantec, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Kathy Pritchard-Jones
- University College London Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Oscar Ramirez
- Department of Pediatric Haematology and Oncology, Centro Médico Imbanaco de Cali, Cali, Colombia; Cali Cancer Population-based Registry, Universidad del Valle, Cali, Colombia
| | - Lorna Renner
- Department of Child Health, University of Ghana Medical School Accra, Ghana; Paediatric Oncology Unit, Korle Bu Teaching Hospital, Accra, Ghana
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Jaime Shalkow
- Department of Pediatric Surgical Oncology, National Institute of Pediatrics, Mexico City, Mexico; School of Medicine, Anahuac University, Mexico City, Mexico
| | - Lillian Sung
- Division of Haematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Allen Yeoh
- Division of Paediatric Haematology and Oncology, National University Cancer Institute, Singapore National University Health System, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Carlos Rodriguez-Galindo
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA.
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Sow C, Laughhunn A, Girard YA, Lanteri MC, Amar El Dusouqui S, Stassinopoulos A, Grellier P. Inactivation of Plasmodium falciparum in whole blood using the amustaline and glutathione pathogen reduction technology. Transfusion 2020; 60:799-805. [PMID: 32129497 PMCID: PMC7187285 DOI: 10.1111/trf.15734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/16/2020] [Accepted: 02/04/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Risk of transfusion-transmitted (TT) malaria is mainly associated with whole blood (WB) or red blood cell (RBC) transfusion. Risk mitigation relies mostly on donor deferral while a limited number of countries perform blood testing, both negatively impacting blood availability. This study investigated the efficacy of the pathogen reduction system using amustaline and glutathione (GSH) to inactivate Plasmodium falciparum in WB. STUDY DESIGN AND METHODS WB units were spiked with ring stage P. falciparum infected RBCs. Parasite loads were measured in samples at time of infection, after 24 hours at room temperature (RT), and after a 24-hour incubation at RT post-treatment with 0.2 mM amustaline and 2 mM GSH. Serial 10-fold dilutions of the samples were inoculated to RBC cultures and maintained up to 4 weeks. Parasitemia was quantified by cytometry. RESULTS The P. falciparum viability assay has a limit of detection of a single live parasite per sample. Input parasite titer was >5.7 log10 TCID50 per mL. A 24-hour incubation at RT paused parasite development in controls, but they retained viability and infectivity when tested in culture. In contrast, no infectious parasites were detected in the amustaline/GSH-treated sample after 4 weeks of culture. CONCLUSION A robust level of P. falciparum inactivation was achieved in WB using amustaline/GSH treatment. Parasite log reduction was >5.7 log10 TCID50 per mL. Development of such a pathogen reduction system may provide an opportunity to reduce the risk of TT malaria and improve blood availability.
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Affiliation(s)
- Cissé Sow
- MCAM, UMR 7245, Muséum National dʼHistoire Naturelle, CNRSParisFrance
| | | | | | | | | | | | - Philippe Grellier
- MCAM, UMR 7245, Muséum National dʼHistoire Naturelle, CNRSParisFrance
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24
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Abdelgader AM, Al Ghumlas AK. The future of voluntary blood donation in the Kingdom of Saudi Arabia. Transfusion 2020; 60 Suppl 1:S28-S34. [PMID: 32009238 DOI: 10.1111/trf.15683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/21/2019] [Accepted: 12/18/2019] [Indexed: 12/15/2022]
Abstract
Replacement blood donations are a major source of blood in KSA. This presentation highlights "the peace time and war experiences," where the voluntary donor potential was tested. THE "PEACETIME EXPERIENCE"-KING SAUD UNIVERSITY STUDENT DONOR DRIVE: This donor drive commenced in 1983 with 13 donors in its first and the annual collection reached 4500 blood units in the academic session 1995-1996, when the student enrollment was around 30,000. In 2018 the enrollment jumped to 120,000 students. If we add the staff and auxiliary personnel, the population of potential voluntary blood donors will be enough to cover the current and future blood needs of King Khalid University Hospital. Unfortunately, this drive did not survive due to administrative and organizational difficulties. THE "FIRST" GULF WAR EXPERIENCE: At the end of 1990, when the Allied Forces started to end the Iraqi occupation of Kuwait, the Saudi Ministry of Health waged a publicity campaign asking healthy individuals to donate their blood. The response was phenomenal, and the blood inventory in blood banks swelled about five- to sevenfold. First-time donors broke the "fear barrier," went through the donation experience, and it is hoped they will return to donate voluntarily. CONCLUSIONS: The major lesson learned from the King Saud University student donor drive and Gulf War experience is the enormous voluntary donor potential in Saudi Arabia. There is a need for forward planning to shift the current partial involuntary donor system to a voluntary system based on nonremunerated donors.
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Affiliation(s)
- A M Abdelgader
- College of Medicine, Al Faisal University and King Khalid University Hospital, Riyadh, Saudi Arabia.,The Coagulation Research Laboratory, Department of Physiology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Abeer K Al Ghumlas
- The Coagulation Research Laboratory, Department of Physiology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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25
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The global need and availability of blood products: a modelling study. LANCET HAEMATOLOGY 2019; 6:e606-e615. [PMID: 31631023 DOI: 10.1016/s2352-3026(19)30200-5] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Blood transfusions are an important resource of every health-care system, with often limited supply in low-income and middle-income countries; however, the degree of unmet need for blood transfusions is often unknown. We therefore aimed to estimate the blood transfusion need and supply at national level to determine gaps in transfusion services globally. METHODS We did a modelling study involving 195 countries and territories. We used blood component preparation data from 2011-13 to estimate blood availability for 180 (92%) of 195 countries from the WHO Global Status Report on Blood Safety and Availability. We calculated disease-specific transfusion needs per prevalent case for 20 causes in the USA using the National (Nationwide) Inpatient Sample dataset between the years 2000 and 2014, and the State Inpatient Databases between 2003 and 2007 from the Healthcare Cost and Utilization Project. Using prevalence estimates for the USA from the Global Burden of Disease (GBD) 2017 study, we estimated the ideal disease specific-transfusion rate as the lowest rate from the years 2000 to 2014. We applied this rate to GBD prevalence results for 195 countries to estimate transfusion needs. Unmet need was the difference between the estimated supply and need. FINDINGS In 2017, the global blood need was 304 711 244 (95% uncertainty interval [UI] 293 064 637-314 049 479) and the global blood supply was 272 270 243 (268 002 639-276 698 494) blood product units, with a need-to-supply ratio of 1·12 (95% UI 1·07-1·16). Of the 195 countries, 119 (61%) did not have sufficient blood supply to meet their need. Across these 119 countries, the unmet need totalled 102 359 632 (95% UI 93 381 710-111 360 725) blood product units, equal to 1849 (1687-2011) units per 100 000 population globally. Every country in central, eastern, and western sub-Saharan Africa, Oceania, and south Asia had insufficient blood to meet their needs. INTERPRETATION Our data suggest that the gap between need and supply is large in many low-income and middle-income countries, and reinforce that the WHO target of 10-20 donations per 1000 population is an underestimate for many countries. A continuous expansion and optimisation of national transfusion services and implementation of evidence-based strategies for blood availability is needed globally, as is more government support, financially, structurally, and through establishment of a regulatory oversight to ensure supply, quality, and safety in low-income and middle-income countries. FUNDING National Institutes of Health.
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Braun J, Gertz SD, Furer A, Bader T, Frenkel H, Chen J, Glassberg E, Nachman D. The promising future of drones in prehospital medical care and its application to battlefield medicine. J Trauma Acute Care Surg 2019; 87:S28-S34. [PMID: 31246903 DOI: 10.1097/ta.0000000000002221] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Unmanned aerial vehicles, commonly referred to as drones, have been made widely available in recent years leading to an exponential growth in their roles and applications. The rapidly developing field of medical drones is on the verge of revolutionizing prehospital medicine enabling advanced health care delivery to once-inaccessible patients. The aim of this review is to clarify the basic technical properties of currently available medical drones and review recent advances and their usefulness in military and civilian health care missions. A thorough search was conducted using conventional medical literature databases and nonmedical popular search engines. The results indicate increasingly rapid incorporation of unmanned aerial vehicles into search and rescue missions, telemedicine assignments, medical supply routes, public health surveillance, and disaster management. Medical drones appear to be of great benefit for improving survivability of deployed forces on and off the battlefield. The emerging aerial medical delivery systems appear to provide particularly promising solutions for bridging some of the many serious gaps between third world health care systems and their western counterparts and between major metropolitan centers and distant rural communities. The global nature of drone-based health care delivery needs points to a need for an international effort between collaborating civilian and military medical forces to harness the currently available resources and novel emerging technologies for broader lifesaving capabilities. LEVEL OF EVIDENCE: Level V.
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Affiliation(s)
- Jonathan Braun
- From the Military Track of Medicine, The Hebrew University-Hadassah Medical School (J.B., S.D.G. A.F., T.B., H.F., J.C., D.N.) Jerusalem, Israel; The Institute for Research in Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Israel Defense Forces Medical Corps. (S.D.G., T.B., D.N.); the Saul and Joyce Brandman Cardiovascular Research Hub, Institute for Medical Research, Faculty of Medicine, The Hebrew University of Jerusalem (S.D.G.); the Medical Innovation Branch, Israel Defense Forces Medical Corps (A.F.); the Headquarters of the Surgeon General, Israel Defense Forces Medical Corps (T.B., H.F.), Ramat Gan, Israel; the Trauma & Combat Medicine Branch, Israel Defense Forces Medical Corps (J.C.), Ramat Gan, Israel; the Medical Services Command, Israel Defence Forces Medical Corps, Bar Ilan University Faculty of Medicine, Safed, Israel and The Uniformed Services University of the Health Sciences (E.G.), Bethesda, Maryland; and the Department of Internal Medicine A, Hadassah University Hospital (D.N.), Jerusalem, Israel
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27
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Tancred T, Bates I. Improving blood transfusion services. Best Pract Res Clin Obstet Gynaecol 2019; 61:130-142. [PMID: 31285175 DOI: 10.1016/j.bpobgyn.2019.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/01/2019] [Accepted: 05/02/2019] [Indexed: 11/19/2022]
Abstract
Postpartum haemorrhage contributes to 25% of maternal deaths worldwide, rising to 40% in sub-Saharan Africa. Treatment of postpartum haemorrhage-particularly for women with anaemia -requires timely, quality blood transfusions. There are a number of barriers to the provision of transfusion services, especially in low- and middle-income settings where the need is the greatest. These include unavailability of blood, unsafe blood, poor uptake of labour and delivery care, difficulties getting blood to transfusing facilities and poor documentation of patient information. Examples of innovative and practical solutions to overcome these barriers are highlighted.
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Affiliation(s)
- Tara Tancred
- International Public Health, Liverpool School of Tropical Medicine, UK.
| | - Imelda Bates
- International Public Health, Liverpool School of Tropical Medicine, UK
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28
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Tura AK, Trang TL, van den Akker T, van Roosmalen J, Scherjon S, Zwart J, Stekelenburg J. Applicability of the WHO maternal near miss tool in sub-Saharan Africa: a systematic review. BMC Pregnancy Childbirth 2019; 19:79. [PMID: 30808325 PMCID: PMC6390325 DOI: 10.1186/s12884-019-2225-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 02/19/2019] [Indexed: 01/31/2023] Open
Abstract
Background Applicability of the World Health Organization (WHO) maternal near miss criteria in low-income settings is not systematically addressed in the literature. The objective of this review was to determine the applicability of the WHO maternal near miss tool in sub-Saharan Africa. Methods We searched PubMed, Embase, Popline, CINAHL, AJOL, and Google scholar using key words for maternal near miss and sub-Saharan Africa. Studies which applied the WHO maternal near miss criteria, containing clear definitions, and published between January 1st, 2009 and December 31st, 2017 were included. Two authors independently extracted data. Quantitative analysis and narrative synthesis were conducted, and medians with interquartile range (IQR) were calculated for summarizing the findings. Methodological quality of the studies was assessed using the Estabrook’s quality assessment and validity tool. Results Fifteen studies from nine countries comprising 227,077 participants were included. Median maternal near miss ratio was 24.2 (IQR: 12.4–35.8) per 1000 live births ranging from 4.4 in a population-based study in South Africa to 198 in a rural private hospital in Nigeria. Eight studies reported challenges in implementing the WHO maternal near miss tool, especially related to the threshold for blood transfusion, and availability of several laboratory-based criteria. In three studies, local adaptations were made. Conclusion This review showed that the WHO maternal near miss tool is not uniformly applied in sub-Saharan Africa. Therefore, a common adaptation for the region is required to increase its applicability. Electronic supplementary material The online version of this article (10.1186/s12884-019-2225-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia. .,Department of Obstetrics and Gynecology, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700 RB, P.O.B, 30 001, Groningen, The Netherlands.
| | - To Lam Trang
- Department of Obstetrics and Gynecology, Leeuwarden Medical Center, Leeuwarden, The Netherlands
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jos van Roosmalen
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, the Netherlands.,Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sicco Scherjon
- Department of Obstetrics and Gynecology, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700 RB, P.O.B, 30 001, Groningen, The Netherlands
| | - Joost Zwart
- Department of Obstetrics and Gynecology, Deventer Ziekenhuis, Deventer, The Netherlands
| | - Jelle Stekelenburg
- Department of Obstetrics and Gynecology, Leeuwarden Medical Center, Leeuwarden, The Netherlands.,Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Sood R, Yorlets RR, Raykar NP, Menon R, Shah H, Roy N. The global surgery blood drought: frontline provider data on barriers and solutions in Bihar, India. Glob Health Action 2019; 12:1599541. [PMID: 31018826 PMCID: PMC6493310 DOI: 10.1080/16549716.2019.1599541] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 03/14/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Limited access to safe, timely banked blood is a critical barrier to providing basic surgical care in resource-limited settings globally. Contextual, locally driven data are required to elucidate country needs, develop effective interventions, and guide policy decisions. OBJECTIVE We employ qualitative methodology to describe barriers faced and solutions proposed by front-line obstetric providers in Bihar - a poor, populous Indian state where maternal mortality exceeds the national average. We aim to make locally driven recommendations for ongoing policy work in India to strengthen the country's blood transfusion system. METHODS From February to May 2016, two researchers conducted semi-structured interviews with 19 obstetric providers across Bihar. Snowball sampling was employed until thematic saturation was reached. Following immersion into de-identified texts and dual codebook development, a primary analyst completed topical coding, and a secondary analyst confirmed reproducibility. RESULTS Providers report that pervasive banked blood shortages force hospitals to require replacement donation, but patients' families often cannot or will not donate. Providers wait one to six hours for blood, depending on availability of staff and supplies, blood bank proximity, and the ability of the patient being treated to navigate the system. Providers feel forced to refer their patients, often to distant, poorly equipped centers. Providers identify donor education, improved infrastructure, and improved local coordination as focus areas for intervention. CONCLUSIONS A multi-stakeholder approach that aims to increase blood donation through community education, mitigate limited infrastructure through short-term workarounds, and improve local-level coordination through state support and policy change is required in Bihar. This study generates data to guide policy and future research aimed at generating affordable, contextually appropriate interventions to the blood drought.
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Affiliation(s)
- Rachita Sood
- Division of Plastic and Reconstructive Surgery, Northwestern University, Chicago, IL, USA
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Rachel R Yorlets
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, MA, USA
| | - Nakul P Raykar
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | - Nobhojit Roy
- The Program in Global Surgery and Social Change, Department of Public Health Sciences, Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden
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Tagny CT, Laperche S, Murphy EL. Updated characteristics of blood services, donors and blood products in 11 French-speaking African countries. Vox Sang 2018; 113:647-656. [PMID: 30125053 PMCID: PMC6527108 DOI: 10.1111/vox.12702] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 06/22/2018] [Accepted: 07/26/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVES The Francophone Africa Transfusion Research Network conducted the first large and comprehensive surveys on the status of blood safety in francophone African countries in 2009 and 2012. Since then, there has been substantial investment in blood safety but little is known about progress made in the region. MATERIALS AND METHODS This multicentre cross-sectional study describes characteristics of blood services, donors and blood products and compares results with previous data. A web-based questionnaire collected data of 2016 from 38 blood facilities in 11 French-speaking countries. Data were analysed according to type of blood services and compared to similar studies conducted in 2009 and 2012. RESULTS The study included data on 572 933 donations from 366 844 donors. Compared to 2012, there was an increase in the median proportion of voluntary nonremunerated blood donation (+22%) (P = 0·004), and a reduction from 2·1 to 0·9 (P = 0·01), from 10·3 to 6·7 (P = 0·00), from 3·2 to 1·3 (P = 0·006) and from 1 to 0·4 (P = 0·03) in median seroprevalences of HIV, HBV, HCV and syphilis, respectively. The median proportion of blood orders fulfilled decreased (-18·2%) (P = 0·001). The number of technical staff per 1000 donations ranged from 1 to 54 with hospital-based blood transfusion services having 12-fold more staff than National and Regional services. CONCLUSION Several indicators have improved in Francophone Africa Blood services during the last 5 years and national and regional services likely have better indicators than hospital-based services. These findings may support the need for ongoing blood safety initiatives.
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Affiliation(s)
- Claude T. Tagny
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Hematology and Blood Transfusion Service, University Teaching Hospital of Yaoundé, Cameroon
| | - Syria Laperche
- Institut National de la Transfusion Sanguine, Paris, France
| | - Edward L. Murphy
- University of California San Francisco and Blood Systems Research Institute, both in San Francisco, California, USA
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31
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Aiko Bruce A, Witol A, Alvadj-Korenic T, Mayan M, Greenslade H, Plaha M, Venner MA. "A complex interface: Exploring sickle cell disease from a parent's perspective, after moving from Sub-Saharan Africa to North America". Pediatr Hematol Oncol 2018; 35:373-384. [PMID: 30785354 DOI: 10.1080/08880018.2018.1541949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Sickle cell disease (SCD) is an inherited, multi-system, chronic disease with the highest prevalence affecting people of Sub-Saharan African descent. While major advances in SCD care have occurred over the last few decades in many African countries these advances are not readily available. Prior literature from Ghana and Kenya describe stigma, despair, and economic burden as well as hope when a child has SCD. When people migrate to North America with a child with SCD it is unknown whether their perception of the disease changes. We asked, "How do immigrant parents of children with SCD from Sub-Saharan Africa perceive, and manage the disease in the context of western medical care?" METHODS The research question was explored with qualitative methodology, specifically focused ethnography. Semi-structured interviews were conducted with parent(s). The interviews were audio recorded, transcribed, and open coded. Rigor was determined through methodological coherence, appropriate and sufficient sampling, and iterative data collection and analysis. RESULTS Twelve interviews were conducted. Identified themes are as follows: memories of SCD in Africa, the emotional journey towards acceptance, and parental approach to care for their child. CONCLUSIONS Healthcare providers should be responsive to an immigrant families' needs and not expect linear progression of emotional acceptance to the diagnosis. Healthcare providers patience with the process helps establish trust, works to facilitate and encourage hope and acknowledges the strength of the families, and their dedication to their family member. Healthcare providers should acknowledge parents' sources of support (religion/family) and ensure parents are aware of medical advances.
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Affiliation(s)
- Aisha Aiko Bruce
- a Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine , University of Alberta , Edmonton , AB , Canada.,b Stollery Children's Hospital , Alberta Health Services , Edmonton , AB , Canada
| | - Adrienne Witol
- b Stollery Children's Hospital , Alberta Health Services , Edmonton , AB , Canada
| | - Tatjana Alvadj-Korenic
- c Women and Children's Health Research Institute , Edmonton , AB , Canada.,d Community-University Partnership for the Study of Children, Youth and Families , University of Alberta , Edmonton , AB , Canada
| | - Maria Mayan
- c Women and Children's Health Research Institute , Edmonton , AB , Canada
| | - Haley Greenslade
- b Stollery Children's Hospital , Alberta Health Services , Edmonton , AB , Canada
| | - Mandeep Plaha
- e Alberta Health Services , Foothills Medical Center , Calgary , AB , Canada
| | - Mary Anne Venner
- b Stollery Children's Hospital , Alberta Health Services , Edmonton , AB , Canada
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Kinnear N, O'Callaghan M, Hennessey D, Liddell H, Newell B, Bolt J, Lawrentschuk N. Intra-operative cell salvage in urological surgery: a systematic review and meta-analysis of comparative studies. BJU Int 2018; 123:210-219. [PMID: 29726092 DOI: 10.1111/bju.14373] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate systematically the safety and efficacy of intra-operative cell salvage (ICS) in urology. METHODS A search of Medline, Embase and Cochrane Library to August 2017 was performed using methods pre-published on PROSPERO. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Eligible titles were comparative studies published in English that used ICS in urology. Primary outcomes were allogeneic transfusion rates (ATRs) and tumour recurrence. Secondary outcomes were complications and cost. RESULTS Fourteen observational studies were identified, with a total of 4 536 patients. ICS was compared with no the blood conservation technique (seven studies), preoperative autologous donation (PAD; five studies) or both (two studies). Cohorts underwent open prostatectomy (11 studies), open cystectomy (two studies) or open partial nephrectomy (one study). Meta-analysis was possible only for ATRs within prostatectomy studies. In this setting, ICS reduced ATR compared with no the blood conservation technique (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.15-0.76) but not PAD (OR 0.76, 95% CI 0.39-1.31). In the non-prostatectomy setting, ATRs amongst patients who underwent ICS were significantly higher or similar in one and two studies, respectively. Tumour recurrence was found to be significantly less common (two studies), similar (eight studies) or not measured (four studies). All six studies reporting complications found no difference in their ICS cohorts. Regarding cost, one study from 1995 found ICS more expensive than PAD, while two more recent studies found ICS to be cheaper than no blood conservation technique. As a result of inter-study heterogeneity, meta-analyses were not possible for recurrence, complications or cost. CONCLUSION Low-level evidence exists that, compared with other blood conservation techniques, ICS reduces ATR and cost while not affecting complications. It does not appear to increase tumour recurrence post-prostatectomy, although follow-up durations were short. Small study sizes and short follow-ups mean conclusions cannot be drawn with regard to recurrence after nephrectomy or cystectomy. Randomized trials with long-term follow-up evaluating ICS in urology are required.
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Affiliation(s)
- Ned Kinnear
- Department of Urology, Austin Health, Melbourne, Vic., Australia.,Department of Urology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Michael O'Callaghan
- South Australian Prostate Cancer Clinical Outcomes Collaborative, Flinders Medical Centre, Adelaide, SA, Australia.,School of Medicine, University of Adelaide, Adelaide, SA, Australia.,Flinders Centre for Innovation in Cancer, Adelaide, SA, Australia
| | - Derek Hennessey
- Department of Urology, Austin Health, Melbourne, Vic., Australia.,Department of Urology, Craigavon Area Hospital, Portadown, UK
| | - Heath Liddell
- Department of Urology, Austin Health, Melbourne, Vic., Australia.,Department of Urology, Queen Elizabeth II Jubilee Hospital, Coopers Plains, Melbourne, Vic., Australia
| | - Bradley Newell
- Department of Urology, Austin Health, Melbourne, Vic., Australia
| | - John Bolt
- Department of Urology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Nathan Lawrentschuk
- Department of Urology, Austin Health, Melbourne, Vic., Australia.,Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Olivia Newton-John Cancer Research Institute, Melbourne, Vic., Australia
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Mauka WI, Mtuy TB, Mahande MJ, Msuya SE, Mboya IB, Juma A, Philemon RN. Risk factors for inappropriate blood requisition among hospitals in Tanzania. PLoS One 2018; 13:e0196453. [PMID: 29771998 PMCID: PMC5957429 DOI: 10.1371/journal.pone.0196453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 04/15/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Blood is a critical aspect of treatment in life saving situations, increasing demand. Blood requisition practices greatly effect sufficient supply in blood banks. This study aimed to determine the risk factors for inappropriate blood requisition in Tanzania. METHODS This was a cross sectional study using secondary data of 14,460 patients' blood requests from 42 transfusion hospitals. Primary data were obtained by using cluster-sampling design. Data were analysed using a two-level mixed-effects Poisson regression to determine fixed-effects of individual-level factors and hospital level factors associated with inappropriate blood requests. P-value <0.05 (2-tails) was considered statistically significant. RESULTS Inappropriate requisition was 28.8%. Factors significantly associated with inappropriate requisition were; reporting pulse rate and capillary refill decrease the risk (RR 0.74; 95% CI 0.64, 0.84) and (RR 0.73; 95% CI 0.63, 0.85) respectively and the following increased the risk; having surgery during hospital stay (RR 1.22; 95% CI 1.06, 1.4); being in general surgical ward (RR 3.3; 95% CI 2.7, 4.2), paediatric ward (RR 1.8; 95% CI 1.2, 2.7), obstetric ward (RR 2.5; 95% CI 2.0, 3.1), gynaecological ward (RR 2.1; 95% CI 1.5, 2.9), orthopaedics ward (RR 3.8; 95% CI 2.2, 6.7). Age of the patient, pallor and confirmation of pre-transfusion haemoglobin level were also significantly associated with inappropriate requisition. Majority of appropriate requisitions within the wards were marked in internal medicine (91.7%) and gynaecological wards (77.8%). CONCLUSIONS The proportion of inappropriate blood requests was high. Blood requisition was determined by clinical and laboratory findings and the ward patients were admitted to. Adherence to transfusion guidelines is recommended to assure the best use of limited blood supply.
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Affiliation(s)
- Wilhellmuss I. Mauka
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- * E-mail:
| | - Tara B. Mtuy
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Michael J. Mahande
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Sia E. Msuya
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Innocent B. Mboya
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Abdul Juma
- National Blood Transfusion Services, Dar es Salaam, Tanzania
| | - Rune N. Philemon
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Charles KS, Metivier KS, Sammy S, Labban M, Rudder M, Singh S, Reginald A, Ramoutar S, Legall G, Pooransingh S, Chantry AD. Knowledge, attitudes and risk perception surrounding blood transfusion in Trinidad and Tobago. ACTA ACUST UNITED AC 2018. [DOI: 10.1111/voxs.12434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- K. S. Charles
- Department of Paraclinical Sciences Faculty of Medical Sciences The University of the West Indies, St. Augustine Campus St. Augustine Trinidad and Tobago
| | - K. S. Metivier
- Faculty of Medical Sciences The University of the West Indies, St. Augustine Campus St. Augustine Trinidad and Tobago
| | - S. Sammy
- Faculty of Medical Sciences The University of the West Indies, St. Augustine Campus St. Augustine Trinidad and Tobago
| | - M. Labban
- Faculty of Medical Sciences The University of the West Indies, St. Augustine Campus St. Augustine Trinidad and Tobago
| | - M. Rudder
- Faculty of Medical Sciences The University of the West Indies, St. Augustine Campus St. Augustine Trinidad and Tobago
| | - S. Singh
- Faculty of Medical Sciences The University of the West Indies, St. Augustine Campus St. Augustine Trinidad and Tobago
| | - A. Reginald
- Faculty of Medical Sciences The University of the West Indies, St. Augustine Campus St. Augustine Trinidad and Tobago
| | - S. Ramoutar
- Faculty of Medical Sciences The University of the West Indies, St. Augustine Campus St. Augustine Trinidad and Tobago
| | - G. Legall
- Department of Paraclinical Sciences Faculty of Medical Sciences The University of the West Indies, St. Augustine Campus St. Augustine Trinidad and Tobago
| | - S. Pooransingh
- Department of Paraclinical Sciences Faculty of Medical Sciences The University of the West Indies, St. Augustine Campus St. Augustine Trinidad and Tobago
| | - A. D. Chantry
- Department of Oncology University of Sheffield Sheffield UK
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Custer B, Zou S, Glynn SA, Makani J, Tayou Tagny C, El Ekiaby M, Sabino EC, Choudhury N, Teo D, Nelson K, Peprah E, Price L, Engelgau MM. Addressing gaps in international blood availability and transfusion safety in low- and middle-income countries: a NHLBI workshop. Transfusion 2018. [PMID: 29542130 DOI: 10.1111/trf.14598] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In April 2017, a workshop sponsored by the National Heart, Lung, and Blood Institute, Division of Blood Diseases and Resources, and the Center for Translation Research and Implementation Science was held to discuss blood availability and transfusion safety in low- and middle-income countries (LMICs). The purpose of the workshop was to identify research opportunities for implementation science (IS) to improve the availability of safe blood and blood components and transfusion practices in LMICs. IS describes the late stages of the translational research spectrum and studies optimal and sustainable strategies to deliver proven-effective interventions. Regional working groups were formed to focus on opportunities and challenges in East Africa, Central/West Africa, Middle East and North Africa, Latin America and the Caribbean, Southeast Asia, Western Pacific Asia, Eastern Europe, and Central Asia. The need for an "adequate supply of safe blood" emerged as the major overriding theme. Among the regional working groups, common cross-cutting themes were evident. The majority of research questions, priorities, and strategies fell into the categories of blood availability, blood transfusion safety, appropriate use of blood, quality systems, health economics and budgeting, and training and education in IS. The workshop also brought into focus inadequate country-level data that can be used as the basis for IS initiatives. A mixed approach of needs assessment and targeted interventions with sufficient evidence base to move toward sustainment is an appropriate next step for blood availability and transfusion safety research in LMICs.
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Affiliation(s)
- Brian Custer
- Blood Systems Research Institute, San Francisco, California.,Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California
| | | | | | - Julie Makani
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Claude Tayou Tagny
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | | | - Ester C Sabino
- Instituto de Medicina Tropical e Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Diana Teo
- Health Sciences Authority, Singapore
| | - Kenrad Nelson
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Emmanuel Peprah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Rockville, Maryland
| | - LeShawndra Price
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Rockville, Maryland
| | - Michael M Engelgau
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Rockville, Maryland
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Haddad A, Bou Assi T, Garraud O. How Can Eastern/Southern Mediterranean Countries Resolve Quality and Safety Issues in Transfusion Medicine? Front Med (Lausanne) 2018. [PMID: 29536009 PMCID: PMC5835071 DOI: 10.3389/fmed.2018.00045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Unlike their Western counterparts, some of the Eastern/Southern Mediterranean countries lack centralized coordinated blood transfusion services leading to an unequal blood safety level. This was recently highlighted by a recent World Health Organization (WHO) regional committee report in which WHO urges these countries to establish and implement a national blood system with well-coordinated blood transfusion activities and to make attempts to reach 100% voluntary non-remunerated blood donation. The objective is thus to meet the same levels or standards as Western countries in term of self-sufficiency and blood safety. This raises the question whether these countries can either comply with Western countries’ guidelines and experiences or develop their own safety scheme based on proper sociopolitical and economic features. Another option is to identify efficient and cost-effective strategies setup successfully in neighbor countries sharing cultural and economic features. To address this issue—and make an attempt to achieve this goal—we designed a number of surveys specifically addressed to Mediterranean countries, which were sent out to the national authorities; so far, five surveys aim at covering all aspects in blood collection, processing, testing, inventory and distribution, as well as patient immune-hematological testing and follow-up (including surveillance and vigilances). It is anticipated that such practice can help identifying and then sharing the more successful and cost-effective experiences, and be really focused on Mediterranean areas while not necessarily copying and pasting experiences designed for Western/Northern areas with significantly distinct situations.
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Affiliation(s)
- Antoine Haddad
- Department of Clinical Pathology and Blood Banking, Sacré-Coeur Hospital, Lebanese University, Beirut, Lebanon.,EA3064, Faculty of Medicine of Saint-Etienne, University of Lyon, Saint-Etienne, France
| | - Tarek Bou Assi
- Department of Laboratory Medicine, Psychiatric Hospital of the Cross, Jal El Dib, Lebanon.,Department of Laboratory Medicine and Blood Banking, Saint Joseph Hospital, Dora, Lebanon
| | - Olivier Garraud
- EA3064, Faculty of Medicine of Saint-Etienne, University of Lyon, Saint-Etienne, France.,Institut National de la Transfusion Sanguine, Paris, France
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37
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Ifland L, Bloch EM, Pitman JP. Funding blood safety in the 21st century. Transfusion 2017; 58:105-112. [PMID: 29030857 DOI: 10.1111/trf.14374] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 08/16/2017] [Accepted: 08/16/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Since 2000, there has been an historic increase in international development assistance, including blood safety projects. The result has been increased blood donations and infectious disease screening in many beneficiary countries. A comprehensive examination of international development assistance for blood safety has yet to be completed. STUDY DESIGN AND METHODS This report examines publicly available information, including donor agency websites and databases and data from the 2008 and 2012 World Health Organization Global Database on Blood Safety. RESULTS Between 2000 and 2015, from $602.4 million to $2.1 billion in international development assistance was allocated to blood safety programs worldwide, mostly as part of the global response to the human immunodeficiency virus/acquired immunodeficiency syndrome epidemic. The US President's Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis, and Malaria were responsible for the majority of blood safety funding, which peaked in 2010 and declined through 2015. CONCLUSION Between 2000 and 2015, countries with high burdens of human immunodeficiency virus/acquired immunodeficiency syndrome received funding and technical assistance to improve national laboratories, increase blood component production, and strengthen clinical practice. Global trends in international development assistance at large, including aid for blood safety, suggest that funding will not rebound.
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Affiliation(s)
- Luke Ifland
- One Heart World-Wide, San Francisco, California
| | - Evan M Bloch
- Division of Transfusion Medicine and Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - John P Pitman
- Institute of Science in Healthy Aging and Health Care (SHARE), University of Groningen, Groningen, the Netherlands
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Yonemura S, Doane S, Keil S, Goodrich R, Pidcoke H, Cardoso M. Improving the safety of whole blood-derived transfusion products with a riboflavin-based pathogen reduction technology. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2017; 15:357-364. [PMID: 28665269 PMCID: PMC5490732 DOI: 10.2450/2017.0320-16] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 12/19/2016] [Indexed: 01/06/2023]
Abstract
Worldwide safety of blood has been positively impacted by technological, economic and social improvements; nevertheless, growing socio-political changes of contemporary society together with environmental changes challenge the practice of blood transfusion with a continuous source of unforeseeable threats with the emergence and re-emergence of blood-borne pathogens. Pathogen reduction (PR) is a proactive strategy to mitigate the risk of transfusion-transmitted infections. PR technologies for the treatment of single plasma units and platelet concentrates are commercially available and have been successfully implemented in more than 2 dozen countries worldwide. Ideally, all labile blood components should be PR treated to ensure a safe and sustainable blood supply in accordance with regional transfusion best practices. Recently, a device (Mirasol® Pathogen Reduction Technology System) for PR treatment of whole blood using riboflavin and UV light has received CE marking, a significant step forward in realising blood safety where WB transfusion is the norm, such as in sub-Saharan Africa and in far-forward combat situations. There is also keen interest in the ability to derive components from Mirasol®-treated whole blood, as it is seen as a more efficient and economical means to implement universal PR in the blood centre environment than treatment of components with different PR systems.
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Affiliation(s)
| | - Suzann Doane
- Terumo BCT, Lakewood, CO, United States of America
| | - Shawn Keil
- Terumo BCT, Lakewood, CO, United States of America
| | - Raymond Goodrich
- Terumo BCT, Lakewood, CO, United States of America
- Infectious Disease Research Center, Colorado State University, Fort Collins, CO, United States of America
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Makani J, Lyimo M, Magesa P, Roberts DJ. Strengthening medical education in haematology and blood transfusion: postgraduate programmes in Tanzania. Br J Haematol 2017; 177:838-845. [PMID: 28369755 DOI: 10.1111/bjh.14644] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Haematology and blood transfusion, as a clinical and laboratory discipline, has a far-reaching impact on healthcare both through direct patient care as well as provision of laboratory and transfusion services. Improvement of haematology and blood transfusion may therefore be significant in achieving advances in health in Africa. In 2005, Tanzania had one of the lowest distributions of doctors in the world, estimated at 2·3 doctors per 100 000 of population, with only one haematologist, a medical doctor with postgraduate medical education in haematology and blood transfusion. Here, we describe the establishment and impact of a postgraduate programme centred on Master of Medicine and Master of Science programmes to build the capacity of postgraduate training in haematology and blood transfusion. The programme was delivered through Muhimbili University of Health and Allied Sciences (MUHAS) with partnership from visiting medical and laboratory staff from the UK and complemented by short-term visits of trainees from Tanzania to Haematology Departments in the UK. The programme had a significant impact on the development of human resources in haematology and blood transfusion, successfully training 17 specialists with a significant influence on delivery of health services and research. This experience shows how a self-sustaining, specialist medical education programme can be developed at low cost within Lower and Middle Income Countries (LMICs) to rapidly enhance delivery of capacity to provide specialist services.
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Affiliation(s)
- Julie Makani
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Magdalena Lyimo
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Pius Magesa
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - David J Roberts
- National Health Service Blood and Transplant, Oxford Centre, John Radcliffe Hospital, Oxford, UK.,BRC Haematology Theme and Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
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Abstract
Importance Travel among US citizens is becoming increasingly common, and travel during pregnancy is also speculated to be increasingly common. During pregnancy, the obstetric provider may be the first or only clinician approached with questions regarding travel. Objective In this review, we discuss the reasons women travel during pregnancy, medical considerations for long-haul air travel, destination-specific medical complications, and precautions for pregnant women to take both before travel and while abroad. To improve the quality of pretravel counseling for patients before or during pregnancy, we have created 2 tools: a guide for assessing the pregnant patient's risk during travel and a pretravel checklist for the obstetric provider. Evidence Acquisition A PubMed search for English-language publications about travel during pregnancy was performed using the search terms "travel" and "pregnancy" and was limited to those published since the year 2000. Studies on subtopics were not limited by year of publication. Results Eight review articles were identified. Three additional studies that analyzed data from travel clinics were found, and 2 studies reported on the frequency of international travel during pregnancy. Additional publications addressed air travel during pregnancy (10 reviews, 16 studies), high-altitude travel during pregnancy (5 reviews, 5 studies), and destination-specific illnesses in pregnant travelers. Conclusions and Relevance Travel during pregnancy including international travel is common. Pregnant travelers have unique travel-related and destination-specific risks. We review those risks and provide tools for obstetric providers to use in counseling pregnant travelers.
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Sickle cell anemia in sub-Saharan Africa: advancing the clinical paradigm through partnerships and research. Blood 2016; 129:155-161. [PMID: 27821508 DOI: 10.1182/blood-2016-09-702324] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 11/03/2016] [Indexed: 01/12/2023] Open
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Perioperative blood transfusion and the clinical outcomes of patients undergoing cholangiocarcinoma surgery: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2016; 28:1233-40. [PMID: 27560845 DOI: 10.1097/meg.0000000000000706] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Several studies have reported different results on the association between perioperative blood transfusion (PBT) and clinical outcomes for patients undergoing cholangiocarcinoma surgery. So far, no systematic review and meta-analysis have focused on this inconsistent issue. Therefore, we carried out a systematic review and meta-analysis to evaluate the association between PBT and the clinical outcomes of cholangiocarcinoma surgery patients. EMBASE, PubMed, Web of Science, and the Cochrane Library were searched from their inception to 6 April 2016 to evaluate the relationship between PBT and clinical outcomes for patients undergoing cholangiocarcinoma surgery. The pooled hazard ratio (HR) with a 95% confidence interval (CI) was calculated using the Cochrane Collaboration's RevMan 5.3 software. A total of 10 studies (1719 patients) were included in the meta-analysis. Pooled analysis showed that PBT was associated with worse 5-year survival rate (HR=1.67, 95% CI=1.41-1.98, P<0.0001) and median overall survival (OS) (HR=1.45, 95% CI=1.14-1.83, P=0.002) in the patients who underwent cholangiocarcinoma surgery. Subgroup analysis showed that intraoperative blood transfusion was also associated with worse 5-year survival rate (HR=1.95, 95% CI=1.49-2.57, P<0.00001). Intraoperative blood transfusion is associated with poor OS for patients undergoing cholangiocarcinoma surgery because it will increase the risk of death. Postoperative blood transfusion may not be associated with OS. In addition, the relationship between PBT and the postoperative complication rate of cholangiocarcinoma surgery is still unclear.
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