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Cheng Q, Hoad VC, Roy Choudhury A, Seed CR, Bentley P, Shih STF, Kwon JA, Gray RT, Wiseman V. Removing hepatitis C antibody testing for Australian blood donations: A cost-effectiveness analysis. Vox Sang 2023; 118:471-479. [PMID: 37183482 PMCID: PMC10952740 DOI: 10.1111/vox.13429] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/07/2023] [Accepted: 04/04/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND OBJECTIVES The risk of transfusion-transmitted hepatitis C virus (HCV) infections is extremely low in Australia. This study aims to conduct a cost-effectiveness analysis of different testing strategies for HCV infection in blood donations. MATERIALS AND METHODS The four testing strategies evaluated in this study were universal testing with both HCV antibody (anti-HCV) and nucleic acid testing (NAT); anti-HCV and NAT for first-time donations and NAT only for repeat donations; anti-HCV and NAT for transfusible component donations and NAT only for plasma for further manufacture; and universal testing with NAT only. A decision-analytical model was developed to assess the cost-effectiveness of alternative HCV testing strategies. Sensitivity analysis and threshold analysis were conducted to account for data uncertainty. RESULTS The number of potential transfusion-transmitted cases of acute hepatitis C and chronic hepatitis C was approximately zero in all four strategies. Universal testing with NAT only was the most cost-effective strategy due to the lowest testing cost. The threshold analysis showed that for the current practice to be cost-effective, the residual risks of other testing strategies would have to be at least 1 HCV infection in 2424 donations, which is over 60,000 times the baseline residual risk (1 in 151 million donations). CONCLUSION The screening strategy for HCV in blood donations currently implemented in Australia is not cost-effective compared with targeted testing or universal testing with NAT only. Partial or total removal of anti-HCV testing would bring significant cost savings without compromising blood recipient safety.
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Affiliation(s)
| | | | - Avijoy Roy Choudhury
- UWA Medical SchoolThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - Clive R. Seed
- Australian Red Cross LifebloodPerthWestern AustraliaAustralia
| | - Peter Bentley
- Australian Red Cross LifebloodPerthWestern AustraliaAustralia
- UWA Medical SchoolThe University of Western AustraliaPerthWestern AustraliaAustralia
| | | | | | | | - Virginia Wiseman
- Kirby InstituteUNSW SydneySydneyAustralia
- Department of Global Health and DevelopmentLondon School of Hygiene & Tropical MedicineLondonUK
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2
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Sayers M. Reflections on paths not taken. Transfusion 2023; 63:476-479. [PMID: 36715331 DOI: 10.1111/trf.17260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/16/2023] [Indexed: 01/31/2023]
Affiliation(s)
- Merlyn Sayers
- Carter BloodCare, Bedford, Texas, USA
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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3
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Hofmann A, Spahn DR, Holtorf AP. Making patient blood management the new norm(al) as experienced by implementors in diverse countries. BMC Health Serv Res 2021; 21:634. [PMID: 34215251 PMCID: PMC8249439 DOI: 10.1186/s12913-021-06484-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 05/06/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patient blood management (PBM) describes a set of evidence-based practices to optimize medical and surgical patient outcomes by clinically managing and preserving a patient's own blood. This concepts aims to detect and treat anemia, minimize the risk for blood loss and the need for blood replacement for each patient through a coordinated multidisciplinary care process. In combination with blood loss, anemia is the main driver for transfusion and all three are independent risk factors for adverse outcomes including morbidity and mortality. Evidence demonstrates that PBM significantly improves outcomes and safety while reducing cost by macroeconomic magnitudes. Despite its huge potential to improve healthcare systems, PBM is not yet adopted broadly. The aim of this study is to analyze the collective experiences of a diverse group of PBM implementors across countries reflecting different healthcare contexts and to use these experiences to develop a guidance for initiating and orchestrating PBM implementation for stakeholders from diverse professional backgrounds. METHODS Semi-structured interviews were conducted with 1-4 PBM implementors from 12 countries in Asia, Latin America, Australia, Central and Eastern Europe, the Middle East, and Africa. Responses reflecting the drivers, barriers, measures, and stakeholders regarding the implementation of PBM were summarized per country and underwent qualitative content analysis. Clustering the resulting implementation measures by levels of intervention for PBM implementation informed a PBM implementation framework. RESULTS A set of PBM implementation measures were extracted from the interviews with the implementors. Most of these measures relate to one of six levels of implementation including government, healthcare providers, funding, research, training/education, and patients/public. Essential cross-level measures are multi-stakeholder communication and collaboration. CONCLUSION The implementation matrix resulting from this research helps to decompose the complexity of PBM implementation into concrete measures on each implementation level. It provides guidance for diverse stakeholders to design, initiate and develop strategies and plans to make PBM a national standard of care, thus closing current practice gaps and matching this unmet public health need.
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Affiliation(s)
- Axel Hofmann
- Institute of Anesthesiology, University and University Hospital of Zurich, Zurich, Switzerland
- University of Western Australia Faculty of Health and Medical Sciences, Perth, Australia
| | - Donat R. Spahn
- Institute of Anesthesiology, University and University Hospital of Zurich, Zurich, Switzerland
| | - Anke-Peggy Holtorf
- Health Outcomes Strategies GmbH, Colmarerstrasse 58, CH4055 Basel, Switzerland
- Faculty of the College of Pharmacy, University of Utah, Salt Lake City, UT USA
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4
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Murugesan M, Padmanaban M, Malodan R, Chellaiya GK, Nayanar SK. Modeling predonation testing strategies in platelet donations - Approach from low throughput apheresis blood center from India. Asian J Transfus Sci 2021; 14:131-136. [PMID: 33767539 PMCID: PMC7983134 DOI: 10.4103/ajts.ajts_93_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/16/2020] [Accepted: 10/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Hospital-based blood centers in India adopt pre-donation testing for transfusion-transmitted infections (TTI) before plateletpheresis donations. However, the WHO emphasizes on TTI tests be performed on samples collected during the donation process. The study objective was to determine whether cost implications by adopting product testing along with predonation testing or only product testing strategy in platelet donation in Indian blood centers. MATERIALS AND METHODS: Cross-sectional study on registered plateletpheresis donors, strategy-1 with predonation testing using rapid tests and product testing using chemiluminescence (CLIA) were compared with alternate models: Strategy-2 (predonation test using CLIA and product testing with rapid test) and strategy-3 (product testing). For strategy-1 and 2, donors wait for predonation test to complete or visit blood center twice, while strategy-3 donors donate plateletpheresis immediately. The cost implications of these strategies were compared among registered plateletpheresis donors. RESULTS: Out of 560 donors registered with strategy-1, three donors were reactive in predonation tests and six platelet units were discarded at product testing. After modeling, for strategy-2, nine donors would be identified as sero-reactive at pre-donation test only, while in strategy-3, nine units would be discarded in product testing. Only 506 donations were completed in strategy 1 after donor attrition. Recoverable costs was greater for strategy-3 (INR 5,146,500) than strategy-2 (INR 5,120,000) and strategy-1 (INR 5,069,000). CONCLUSION: Strategy-3 appears cost-effective but requires regulatory changes in the Indian setting. Testing apheresis procedures using Strategy 2 had greater cost recovery, and also prevents infectious donations and thereby enhances blood safety with the present guidelines.
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Affiliation(s)
- Mohandoss Murugesan
- Department of Transfusion Medicine, Malabar Cancer Centre, Thalassery, Kerala, India
| | - Maya Padmanaban
- Department of Clinical Research and Biostatistics, Malabar Cancer Centre, Thalassery, Kerala, India
| | - Riyas Malodan
- Department of Clinical Research and Biostatistics, Malabar Cancer Centre, Thalassery, Kerala, India
| | - Gayathiri K Chellaiya
- Department of Transfusion Medicine, Malabar Cancer Centre, Thalassery, Kerala, India
| | - Sangeetha K Nayanar
- Department of Oncopathology, Malabar Cancer Centre, Thalassery, Kerala, India
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5
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Russell WA, Custer B, Brandeau ML. Optimal portfolios of blood safety interventions: test, defer or modify? Health Care Manag Sci 2021; 24:551-568. [PMID: 33666808 DOI: 10.1007/s10729-021-09557-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 02/09/2021] [Indexed: 01/13/2023]
Abstract
A safe supply of blood for transfusion is a critical component of the healthcare system in all countries. Most health systems manage the risk of transfusion-transmissible infections (TTIs) through a portfolio of blood safety interventions. These portfolios must be updated periodically to reflect shifting epidemiological conditions, emerging infectious diseases, and new technologies. However, the number of available blood safety portfolios grows exponentially with the number of available interventions, making it impossible for policymakers to evaluate all feasible portfolios without the assistance of a computer model. We develop a novel optimization model for evaluating blood safety portfolios that enables systematic comparison of all feasible portfolios of deferral, testing, and modification interventions to identify the portfolio that is preferred from a cost-utility perspective. We present structural properties that reduce the state space and required computation time in certain cases, and we develop a linear approximation of the model. We apply the model to retrospectively evaluate U.S. blood safety policies for Zika and West Nile virus for the years 2017, 2018, and 2019, defining donor groups based on season and geography. We leverage structural properties to efficiently find an optimal solution. We find that the optimal portfolio varies geographically, seasonally, and over time. Additionally, we show that for this problem the approximated model yields the same optimal solution as the exact model. Our method enables systematic identification of the optimal blood safety portfolio in any setting and any time period, thereby supporting decision makers in efforts to ensure the safety of the blood supply.
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Affiliation(s)
- W Alton Russell
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA. .,Vitalant Research Institute, San Francisco, CA, USA.
| | - Brian Custer
- Vitalant Research Institute, San Francisco, CA, USA.,The University of California, San Francisco, San Francisco, CA, USA
| | - Margaret L Brandeau
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
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6
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McCullough J. Transfusion‐Transmitted Diseases. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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7
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Wasiluk T, Rogowska A, Boczkowska-Radziwon B, Zebrowska A, Bolkun L, Piszcz J, Radziwon P. Maintaining plasma quality and safety in the state of ongoing epidemic - The role of pathogen reduction. Transfus Apher Sci 2021; 60:102953. [PMID: 33023853 PMCID: PMC7832281 DOI: 10.1016/j.transci.2020.102953] [Citation(s) in RCA: 3] [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: 06/09/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 01/22/2023]
Abstract
In the field of transfusion medicine, many pathogen reduction techniques (PRTs) are currently available, including those based on photochemical (PI) and photodynamic inactivation (PDI). This is particularly important in the face of emerging viral pathogens that may pose a threat to blood recipients, as in the case of the COVID-19 pandemic. However, PRTs have some limitations, primarily related to their adverse effects on coagulation factors, which should be considered before their intended use. A comprehensive search of PubMed, Wiley Online Library and Science Direct databases was conducted to identify original papers. As a result, ten studies evaluating fresh plasma and frozen-thawed plasma treated with different PI/ PDI methods and evaluating concentrations of coagulation factors and natural anticoagulants both before and after photochemical treatment were included in the review. The use of PI and PDI is associated with a significant decrease in the activity of all analysed coagulation factors, while the recovery of natural anticoagulants remains at a satisfactory level, variable for individual inactivation methods. In addition, the published evidence reviewed above does not unequivocally favour the implementation of PI/PDI either before freezing or after thawing as plasma products obtained with these two approaches seem to satisfy the existing quality criteria. Based on current evidence, if implemented responsibly and in accordance with the current guidelines, both PI and PDI can ensure satisfactory plasma quality and improve its safety.
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Affiliation(s)
- Tomasz Wasiluk
- Regional Centre for Transfusion Medicine, Bialystok, Poland.
| | - Anna Rogowska
- Regional Centre for Transfusion Medicine, Bialystok, Poland
| | | | | | - Lukasz Bolkun
- Department of Haematology, Medical University of Bialystok, Bialystok, Poland
| | - Jaroslaw Piszcz
- Department of Haematology, Medical University of Bialystok, Bialystok, Poland
| | - Piotr Radziwon
- Regional Centre for Transfusion Medicine, Bialystok, Poland; Department of Haematology, Medical University of Bialystok, Bialystok, Poland
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8
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Pitt AL, Goldhaber-Fiebert JD, Brandeau ML. Public Health Interventions with Harms and Benefits: A Graphical Framework for Evaluating Tradeoffs. Med Decis Making 2020; 40:978-989. [PMID: 32996356 PMCID: PMC8056742 DOI: 10.1177/0272989x20960458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Evaluations of public health interventions typically report benefits and harms aggregated over the population. However, benefits and harms are not always evenly distributed. Examining disaggregated outcomes enables decision makers to consider health benefits and harms accruing to both intended intervention recipients and others in the population. METHODS We provide a graphical framework for categorizing and comparing public health interventions that examines the distribution of benefit and harm between and within population subgroups for a single intervention and compares distributions of harm and benefit for multiple interventions. We demonstrate the framework through a case study of a hypothetical increase in the price of meat (5%, 10%, 25%, or 50%) that, via elasticity of demand, reduces consumption and consequently reduces body mass index. We examine how inequalities in benefits and harms (measured by quality-adjusted life-years) are distributed across a population of white and black males and females. RESULTS A 50% meat price increase would yield the greatest net benefit to the population. However, because of reduced consumption among low-weight individuals, black males would bear disproportionate harm relative to the benefit they receive. With increasing meat price, the distribution of harm relative to benefit becomes less "internal" to those receiving benefit and more "distributed" to those not receiving commensurate benefit. When we segment the population by sex only, this result does not hold. CONCLUSIONS Disaggregating harms and benefits to understand their differential impact on subgroups can strongly affect which decision alternative is deemed optimal, as can the approach to segmenting the population. Our framework provides a useful tool for illuminating key tradeoffs relevant to harm-averse decision makers and those concerned with both equity and efficiency.
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Affiliation(s)
- Allison L Pitt
- Department of Management Science and Engineering, Stanford University, Stanford, CA
| | - Jeremy D Goldhaber-Fiebert
- Stanford Health Policy, Centers for Health Policy and Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | - Margaret L Brandeau
- Department of Management Science and Engineering, Stanford University, Stanford, CA
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9
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Fong IW. Blood Transfusion-Associated Infections in the Twenty-First Century: New Challenges. CURRENT TRENDS AND CONCERNS IN INFECTIOUS DISEASES 2020. [PMCID: PMC7120358 DOI: 10.1007/978-3-030-36966-8_8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Blood transfusions are vital components of modern medical treatment to which there is no viable alternative despite efforts to create artificial blood. Each year thousands of lives are saved by blood transfusions in every country of the world. However, blood and blood products can result in significant adverse events including immunologic reactions, infections, inefficacy, and others which can sometimes result in death and severe disability. Thus, the sustainability of safe blood systems and costs are considered to be at crisis level. In industrialized countries, the risk of transfusion-transmitted infections such as HIV, syphilis, hepatitis viruses B and C are very low [generally [<1 in a million units], but in developing countries [especially in Africa] blood safety is still not assured. Compounding the problem of blood/product safety with respect to infectious agents are new emerging infectious microbes that are not being routinely tested for in blood that are donated. This chapter reviews the infectious risk of blood transfusions, types, mode and geographic variation, and the methods being used by blood services to attenuate and prevent these risks.
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10
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Storch EK, Custer BS, Jacobs MR, Menitove JE, Mintz PD. Review of current transfusion therapy and blood banking practices. Blood Rev 2019; 38:100593. [PMID: 31405535 DOI: 10.1016/j.blre.2019.100593] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/08/2019] [Accepted: 07/23/2019] [Indexed: 01/28/2023]
Abstract
Transfusion Medicine is a dynamically evolving field. Recent high-quality research has reshaped the paradigms guiding blood transfusion. As increasing evidence supports the benefit of limiting transfusion, guidelines have been developed and disseminated into clinical practice governing optimal transfusion of red cells, platelets, plasma and cryoprecipitate. Concepts ranging from transfusion thresholds to prophylactic use to maximal storage time are addressed in guidelines. Patient blood management programs have developed to implement principles of patient safety through limiting transfusion in clinical practice. Data from National Hemovigilance Surveys showing dramatic declines in blood utilization over the past decade demonstrate the practical uptake of current principles guiding patient safety. In parallel with decreasing use of traditional blood products, the development of new technologies for blood transfusion such as freeze drying and cold storage has accelerated. Approaches to policy decision making to augment blood safety have also changed. Drivers of these changes include a deeper understanding of emerging threats and adverse events based on hemovigilance, and an increasing healthcare system expectation to align blood safety decision making with approaches used in other healthcare disciplines.
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Affiliation(s)
| | - Brian S Custer
- UCSF Department of Laboratory Medicine, Blood Systems Research Institute, USA.
| | - Michael R Jacobs
- Department of Pathology, Case Western Reserve University, USA; Department of Clinical Microbiology, University Hospitals Cleveland Medical Center, USA.
| | - Jay E Menitove
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, USA
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11
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Atreya C, Glynn S, Busch M, Kleinman S, Snyder E, Rutter S, AuBuchon J, Flegel W, Reeve D, Devine D, Cohn C, Custer B, Goodrich R, Benjamin RJ, Razatos A, Cancelas J, Wagner S, Maclean M, Gelderman M, Cap A, Ness P. Proceedings of the Food and Drug Administration public workshop on pathogen reduction technologies for blood safety 2018 (Commentary, p. 3026). Transfusion 2019; 59:3002-3025. [PMID: 31144334 PMCID: PMC6726584 DOI: 10.1111/trf.15344] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Chintamani Atreya
- US Food and Drug Administration, Center for Biologics Evaluation and ResearchOffice of Blood Research and ReviewSilver SpringMaryland
| | - Simone Glynn
- National Heart Lung and Blood InstituteBethesdaMarylandUSA
| | | | | | - Edward Snyder
- Blood BankYale‐New Haven HospitalNew HavenConnecticut
| | - Sara Rutter
- Department of Pathology and Laboratory MedicineYale School of MedicineNew HavenConnecticut
| | - James AuBuchon
- Department of PathologyDartmouth‐Hitchcock Medical CenterLebanonNew Hampshire
| | - Willy Flegel
- Department of Transfusion MedicineNIH Clinical CenterBethesdaMaryland
| | - David Reeve
- Blood ComponentsAmerican Red CrossRockvilleMaryland
| | - Dana Devine
- Department of Lab Medicine and PathologyUniversity of Minnesota Medical CenterMinneapolisMinnesota
| | - Claudia Cohn
- Department of Lab Medicine and PathologyUniversity of Minnesota Medical CenterMinneapolisMinnesota
| | - Brian Custer
- Vitalant Research InstituteSan FranciscoCalifornia
| | - Raymond Goodrich
- Department of Microbiology, Immunology and PathologyColorado State UniversityFort CollinsColorado
| | | | | | - Jose Cancelas
- Hoxworth Blood CenterUniversity of Cincinnati HealthCincinnatiOhio
| | | | - Michelle Maclean
- The Robertson Trust Laboratory for Electronic Sterilisation Technologies (ROLEST)University of StrathclydeGlasgowScotland
| | - Monique Gelderman
- Department of HematologyCenter for Biologics Evaluation and Research, US Food and Drug AdministrationSilver SpringMaryland
| | - Andrew Cap
- U.S. Army Institute of Surgical ResearchSan AntonioTexas
| | - Paul Ness
- Blood BankJohns Hopkins HospitalBaltimoreMaryland
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12
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Prevention of transfusion-transmitted infections. Blood 2019; 133:1854-1864. [PMID: 30808637 DOI: 10.1182/blood-2018-11-833996] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/03/2019] [Indexed: 01/10/2023] Open
Abstract
Since the 1970s, introduction of serological assays targeting virus-specific antibodies and antigens has been effective in identifying blood donations infected with the classic transfusion-transmitted infectious agents (TTIs; hepatitis B virus [HBV], HIV, human T-cell lymphotropic virus types I and II, hepatitis C virus [HCV]). Subsequently, progressive implementation of nucleic acid-amplification technology (NAT) screening for HIV, HCV, and HBV has reduced the residual risk of infectious-window-period donations, such that per unit risks are <1 in 1 000 000 in the United States, other high-income countries, and in high-incidence regions performing NAT. NAT screening has emerged as the preferred option for detection of newer TTIs including West Nile virus, Zika virus (ZIKV), and Babesia microti Although there is continual need to monitor current risks due to established TTI, ongoing challenges in blood safety relate primarily to surveillance for emerging agents coupled with development of rapid response mechanisms when such agents are identified. Recent progress in development and implementation of pathogen-reduction technologies (PRTs) provide the opportunity for proactive rather than reactive response to blood-safety threats. Risk-based decision-making tools and cost-effectiveness models have proved useful to quantify infectious risks and place new interventions in context. However, as evidenced by the 2015 to 2017 ZIKV pandemic, a level of tolerable risk has yet to be defined in such a way that conflicting factors (eg, theoretical recipient risk, blood availability, cost, and commercial interests) can be reconciled. A unified approach to TTIs is needed, whereby novel tests and PRTs replace, rather than add to, existing interventions, thereby ameliorating cost and logistical burden to blood centers and hospitals.
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13
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Russell WA, Stramer SL, Busch MP, Custer B. Screening the Blood Supply for Zika Virus in the 50 U.S. States and Puerto Rico: A Cost-Effectiveness Analysis. Ann Intern Med 2019; 170:164-174. [PMID: 30615781 DOI: 10.7326/m18-2238] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In 2016, universal individual donation nucleic acid testing (ID-NAT) of donated blood for Zika virus began in U.S. states and territories. OBJECTIVE To assess the cost-effectiveness of universal ID-NAT in the first year of screening compared with alternatives for the 50 states and separately for Puerto Rico. DESIGN Microsimulation that captured Zika-related harms to transfusion recipients, sexual partners, and their infants. DATA SOURCES National testing results compiled by AABB and costs, utilities, and outcome probabilities estimated from the literature. TARGET POPULATION Transfusion recipients. TIME HORIZON Lifetime. PERSPECTIVE Societal. INTERVENTION Universal ID-NAT, universal mini-pool NAT (MP-NAT), and ID-NAT exclusively for components transfused to women of childbearing age. Seasonally targeted strategies in Puerto Rico and geographically targeted strategies in the 50 states were also considered. OUTCOME MEASURES Costs, quality-adjusted life-years (QALYs), and outcomes. RESULTS OF BASE-CASE ANALYSIS In Puerto Rico, MP-NAT exclusively during high mosquito season was cost-effective at $81 123 per QALY (95% CI, -$49 138 to $978 242 per QALY). No screening policy was cost-effective in the 50 states. Universal ID-NAT cost $341 million per QALY (CI, $125 million to $2.90 billion per QALY) compared with no screening in the 50 states. RESULTS OF SENSITIVITY ANALYSIS In Puerto Rico, MP-NAT only during the season of high mosquito activity was most cost-effective in 64% of probabilistic sensitivity analysis iterations. In the 50 states, no intervention was cost-effective in 99.99% of iterations. Cost-effectiveness was highly dependent on the rate of assumed infectious donations. LIMITATION Data were limited on the component-specific transmissibility of Zika and long-term sequelae of infection. CONCLUSION Screening was cost-effective only in the high mosquito season in Puerto Rico, and no evaluated screening policy was cost-effective in the 50 states. During periods with lower rates of Zika-infectious donations, the cost-effectiveness of screening will be even less favorable. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
| | | | - Michael P Busch
- Vitalant Research Institute and University of California, San Francisco, San Francisco, California (M.P.B., B.C.)
| | - Brian Custer
- Vitalant Research Institute and University of California, San Francisco, San Francisco, California (M.P.B., B.C.)
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14
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Jayawardena T, Hoad V, Styles C, Seed C, Bentley P, Clifford V, Lacey S, Gastrell T. Modelling the risk of transfusion-transmitted syphilis: a reconsideration of blood donation testing strategies. Vox Sang 2018; 114:107-116. [PMID: 30565234 DOI: 10.1111/vox.12741] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/08/2018] [Accepted: 11/20/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Donor syphilis testing began in the 1940s amidst widespread transfusion-transmitted syphilis (TTS). Since then, the introduction of penicillin, pre-donation screening questionnaires and improved storage conditions have contributed to reducing transmission risk. Consequently, universal testing may no longer be cost-effective. This study analysed alternative options for donor syphilis testing to determine the optimal strategy. MATERIALS AND METHODS A model was developed using conservative parameter estimates for factors affecting TTS and 2009-2015 Australian donations to calculate risk outcomes (TTS infections, tertiary syphilis in recipients and transfusion-associated congenital syphilis) and cost-effectiveness of alternative testing strategies. The strategies modelled were as follows: universal testing, targeted-testing of high-risk groups (males ≤50 years old and first-time donors) and no testing. RESULTS The estimated risk of TTS is one in 49·5 million transfusions for universal testing, one in 6 million for targeted-testing of males ≤50 years old, one in 4 million for targeted-testing of first-time donors and one in 2·8 million for no testing. For all strategies, the risk of tertiary and congenital syphilis is <1 in 100 million. Universal testing is the least cost-effective strategy with an incremental cost-effectiveness ratio (ICER) estimated at $538·5 million per disability-adjusted life year averted. CONCLUSION Universal testing is not required to maintain the risk of TTS within tolerable limits and is estimated to greatly exceed acceptable ICERs for blood safety interventions. However, despite a strong economic and risk-based rationale, given the epidemiology of syphilis in Australia is changing, feedback from critical stakeholders is not currently supportive of reducing testing.
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Affiliation(s)
- Thisuri Jayawardena
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
| | - Veronica Hoad
- Australian Red Cross Blood Service, Perth, WA, Australia
| | - Claire Styles
- Australian Red Cross Blood Service, Perth, WA, Australia
| | - Clive Seed
- Australian Red Cross Blood Service, Perth, WA, Australia
| | - Peter Bentley
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia.,Australian Red Cross Blood Service, Perth, WA, Australia
| | | | - Sarina Lacey
- Centre for International Economics, Sydney, NSW, Australia
| | - Tessa Gastrell
- Centre for International Economics, Sydney, NSW, Australia
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15
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Leach Bennett J, Devine DV. Risk-based decision making in transfusion medicine. Vox Sang 2018; 113:737-749. [DOI: 10.1111/vox.12708] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 06/29/2018] [Accepted: 08/06/2018] [Indexed: 11/27/2022]
Affiliation(s)
| | - Dana V. Devine
- Canadian Blood Services; Ottawa ON Canada
- Centre for Blood Research; University of British Columbia; Vancouver BC Canada
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16
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Bloch EM, Ness PM, Tobian AAR, Sugarman J. Revisiting Blood Safety Practices Given Emerging Data about Zika Virus. N Engl J Med 2018; 378:1837-1841. [PMID: 29742377 DOI: 10.1056/nejmsb1704752] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Evan M Bloch
- From the Johns Hopkins University School of Medicine (E.M.B., P.M.N., A.A.R.T., J.S.) and the Berman Institute of Bioethics, Johns Hopkins University (J.S.), Baltimore
| | - Paul M Ness
- From the Johns Hopkins University School of Medicine (E.M.B., P.M.N., A.A.R.T., J.S.) and the Berman Institute of Bioethics, Johns Hopkins University (J.S.), Baltimore
| | - Aaron A R Tobian
- From the Johns Hopkins University School of Medicine (E.M.B., P.M.N., A.A.R.T., J.S.) and the Berman Institute of Bioethics, Johns Hopkins University (J.S.), Baltimore
| | - Jeremy Sugarman
- From the Johns Hopkins University School of Medicine (E.M.B., P.M.N., A.A.R.T., J.S.) and the Berman Institute of Bioethics, Johns Hopkins University (J.S.), Baltimore
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17
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Verweij M, Kramer K. Donor blood screening and moral responsibility: how safe should blood be? JOURNAL OF MEDICAL ETHICS 2018; 44:187-191. [PMID: 26868666 DOI: 10.1136/medethics-2015-103338] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 01/15/2016] [Indexed: 06/05/2023]
Abstract
Some screening tests for donor blood that are used by blood services to prevent transfusion-transmission of infectious diseases offer relatively few health benefits for the resources spent on them. Can good ethical arguments be provided for employing these tests nonetheless? This paper discusses-and ultimately rejects-three such arguments. According to the 'rule of rescue' argument, general standards for cost-effectiveness in healthcare may be ignored when rescuing identifiable individuals. The argument fails in this context, however, because we cannot identify beforehand who will benefit from additional blood screening tests. On the 'imposed risk' argument, general cost-effectiveness standards do not apply when healthcare interventions impose risks on patients. This argument ignores the fact that imposing risks on patients is inevitable in healthcare and that these risks can be countered only within reasonable limits. Finally, the 'manufacturing standard' argument premises that general cost-effectiveness standards do not apply to procedures preventing the contamination of manufactured medical products. We contend that while this argument seems reasonable insofar as commercially manufactured medical products are concerned, publicly funded blood screening tests should respect the standards for general healthcare. We conclude that these particular arguments are unpersuasive, and we offer directions to advance the debate.
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Affiliation(s)
- Marcel Verweij
- Department of Communication, Philosophy and Technology, Wageningen University, Wageningen, Netherlands
| | - Koen Kramer
- Department of Communication, Philosophy and Technology, Wageningen University, Wageningen, Netherlands
- Sanquin Bloedvoorziening, Amsterdam, Netherlands
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18
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Karkoska K, Louie J, Appiah-Kubi AO, Wolfe L, Rubin L, Rajan S, Aygun B. Transfusion-transmitted babesiosis leading to severe hemolysis in two patients with sickle cell anemia. Pediatr Blood Cancer 2018; 65. [PMID: 28766838 DOI: 10.1002/pbc.26734] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/03/2017] [Accepted: 06/28/2017] [Indexed: 11/09/2022]
Abstract
The intracellular parasites Babesia microti and Babesia duncani can be transmitted by blood transfusion and cause severe life-threatening hemolytic anemia in high-risk patients, including those with sickle cell disease. The rarity of the diagnosis, as well as its similar clinical presentation to delayed hemolytic transfusion reaction, may lead to a delay in diagnosis, as well as inappropriate treatment with steroids or other immunosuppressive agents. The morbidity caused by this disease in especially vulnerable populations justifies the need for a universal blood-screening program in endemic areas.
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Affiliation(s)
- Kristine Karkoska
- Department of Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, New York
| | - James Louie
- Division of Blood Banking/Transfusion Medicine, Northwell Health, New Hyde Park, New York
| | - Abena O Appiah-Kubi
- Division of Pediatric Hematology, Oncology, and Bone Marrow Transplantation, Department of Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, New York
| | - Lawrence Wolfe
- Division of Pediatric Hematology, Oncology, and Bone Marrow Transplantation, Department of Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, New York
| | - Lorry Rubin
- Division of Infectious Diseases, Department of Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, New York
| | - Sujatha Rajan
- Division of Infectious Diseases, Department of Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, New York
| | - Banu Aygun
- Division of Pediatric Hematology, Oncology, and Bone Marrow Transplantation, Department of Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, New York
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19
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Babesia microti: from Mice to Ticks to an Increasing Number of Highly Susceptible Humans. J Clin Microbiol 2017; 55:2903-2912. [PMID: 28747374 DOI: 10.1128/jcm.00504-17] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Babesia microti, a zoonotic intraerythrocytic parasite, is the primary etiological agent of human babesiosis in the United States. Human infections range from subclinical illness to severe disease resulting in death, with symptoms being related to host immune status. Despite advances in our understanding and management of B. microti, the incidence of infection in the United States has increased. Therefore, research focused on eradicating disease and optimizing clinical management is essential. Here we review this remarkable organism, with emphasis on the clinical, diagnostic, and therapeutic aspects of human disease.
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20
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Janssen MP, van Hulst M, Custer B. An assessment of differences in costs and health benefits of serology and NAT screening of donations for blood transfusion in different Western countries. Vox Sang 2017. [DOI: 10.1111/vox.12543] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- M. P. Janssen
- Julius Center for Health Sciences and Primary Care; UMC Utrecht; Utrecht The Netherlands
- Transfusion Technology Assessment Department; Sanquin Research; Sanquin Blood Supply Foundation; Amsterdam The Netherlands
| | - M. van Hulst
- Department of Clinical Pharmacy and Toxicology; Martini Hospital; Groningen The Netherlands
- Department of PharmacoTherapy, -Epidemiology & -Economics; Department of Pharmacy; University of Groningen; Groningen The Netherlands
| | - B. Custer
- Blood Systems Research Institute; San Francisco CA USA
- Department of Laboratory Medicine; UCSF; San Francisco CA USA
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21
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Kramer K, Verweij MF, Zaaijer HL. Are there ethical differences between stopping and not starting blood safety measures? Vox Sang 2017; 112:417-424. [DOI: 10.1111/vox.12525] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/03/2017] [Accepted: 03/27/2017] [Indexed: 11/28/2022]
Affiliation(s)
- K. Kramer
- Department of Blood-borne Infections (BOI); Sanquin Blood Supply Foundation; Amsterdam the Netherlands
- Department of Communication, Philosophy and Technology (CPT); Wageningen University and Research; Wageningen the Netherlands
| | - M. F. Verweij
- Department of Communication, Philosophy and Technology (CPT); Wageningen University and Research; Wageningen the Netherlands
| | - H. L. Zaaijer
- Department of Blood-borne Infections (BOI); Sanquin Blood Supply Foundation; Amsterdam the Netherlands
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22
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Kramer K, Zaaijer HL, Verweij MF. The Precautionary Principle and the Tolerability of Blood Transfusion Risks. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2017; 17:32-43. [PMID: 28207362 DOI: 10.1080/15265161.2016.1276643] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Tolerance for blood transfusion risks is very low, as evidenced by the implementation of expensive blood tests and the rejection of gay men as blood donors. Is this low risk tolerance supported by the precautionary principle, as defenders of such policies claim? We discuss three constraints on applying (any version of) the precautionary principle and show that respecting these implies tolerating certain risks. Consistency means that the precautionary principle cannot prescribe precautions that it must simultaneously forbid taking, considering the harms they might cause. Avoiding counterproductivity requires rejecting precautions that cause more harm than they prevent. Proportionality forbids taking precautions that are more harmful than adequate alternatives. When applying these constraints, we argue, attention should not be restricted to harms that are human caused or that affect human health or the environment. Tolerating transfusion risks can be justified if available precautions have serious side effects, such as high social or economic costs.
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Affiliation(s)
- Koen Kramer
- a Sanquin Blood Supply Foundation and Wageningen University and Research Center
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23
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Transfusion-Transmitted Diseases. Transfus Med 2016. [DOI: 10.1002/9781119236504.ch15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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24
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Marano G, Vaglio S, Pupella S, Facco G, Catalano L, Piccinini V, Liumbruno GM, Grazzini G. Human T-lymphotropic virus and transfusion safety: does one size fit all? Transfusion 2015; 56:249-60. [PMID: 26388300 DOI: 10.1111/trf.13329] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 07/28/2015] [Accepted: 08/02/2015] [Indexed: 12/17/2022]
Abstract
Human T-cell leukemia viruses (HTLV-1 and HTLV-2) are associated with a variety of human diseases, including some severe ones. Transfusion transmission of HTLV through cellular blood components is undeniable. HTLV screening of blood donations became mandatory in different countries to improve the safety of blood supplies. In Japan and Europe, most HTLV-infected donors are HTLV-1 positive, whereas in the United States a higher prevalence of HTLV-2 is reported. Many industrialized countries have also introduced universal leukoreduction of blood components, and pathogen inactivation technologies might be another effective preventive strategy, especially if and when generalized to all blood cellular products. Considering all measures available to minimize HTLV blood transmission, the question is what would be the most suitable and cost-effective strategy to ensure a high level of blood safety regarding these viruses, considering that there is no solution that can be deemed optimal for all countries.
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Affiliation(s)
| | - Stefania Vaglio
- Italian National Blood Centre, National Institute of Health.,Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | | | - Giuseppina Facco
- Italian National Blood Centre, National Institute of Health.,Immunohaemathology and Transfusion Medicine Unit, Azienda Ospedaliera Città Della Salute e Della Scienza, Turin, Italy
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25
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Custer B, Janssen MP. Health economics and outcomes methods in risk-based decision-making for blood safety. Transfusion 2015; 55:2039-47. [DOI: 10.1111/trf.13080] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 02/05/2015] [Accepted: 02/10/2015] [Indexed: 01/05/2023]
Affiliation(s)
- Brian Custer
- Blood Systems Research Institute and
- Department of Laboratory Medicine; University of California; San Francisco California
| | - Mart P. Janssen
- Transfusion Technology Assessment Unit; Sanquin Research; Amsterdam the Netherlands
- Julius Center for Health Sciences and Primary Care; University Medical Centre Utrecht; Utrecht the Netherlands
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26
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Kacker S, Ness PM, Shirey RS, Savage WJ, King KE, Tobian AAR. The future of red blood cell alloimmunization risk reduction. Transfusion 2015; 55:222-4. [PMID: 25582240 DOI: 10.1111/trf.12866] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Seema Kacker
- Department of Pathology, Johns Hopkins University, Baltimore, MD
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27
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Menitove JE, Leach Bennett J, Tomasulo P, Katz LM. How safe is safe enough, who decides and how? From a zero-risk paradigm to risk-based decision making. Transfusion 2014; 54:753-7. [DOI: 10.1111/trf.12569] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 12/17/2013] [Indexed: 11/30/2022]
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28
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Simon MS, Leff JA, Pandya A, Cushing M, Shaz BH, Calfee DP, Schackman BR, Mushlin AI. Cost-effectiveness of blood donor screening for Babesia microti in endemic regions of the United States. Transfusion 2014; 54:889-99. [PMID: 24252132 PMCID: PMC4039174 DOI: 10.1111/trf.12492] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 09/10/2013] [Accepted: 09/30/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Babesia microti is the leading reported cause of red blood cell (RBC) transfusion-transmitted infection in the United States. Donor screening assays are in development. STUDY DESIGN AND METHODS A decision analytic model estimated the cost-effectiveness of screening strategies for preventing transfusion-transmitted babesiosis (TTB) in a hypothetical cohort of transfusion recipients in Babesia-endemic areas of the United States. Strategies included: 1) no screening; 2) Uniform Donor Health History Questionnaire (UDHQ), "status quo"; 3) recipient risk targeting using donor antibody and polymerase chain reaction (PCR) screening; 4) universal endemic donor antibody screening; and 5) universal endemic donor antibody and PCR screening. Outcome measures were TTB cases averted, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs; $/QALY). We assumed a societal willingness to pay of $1 million/QALY based on screening for other transfusion-transmitted infections. RESULTS Compared to no screening, the UDHQ avoids 0.02 TTB cases per 100,000 RBC transfusions at an ICER of $160,000/QALY whereas recipient risk-targeted strategy using antibody/PCR avoids 1.62 TTB cases per 100,000 RBC transfusions at an ICER of $713,000/QALY compared to the UDHQ. Universal endemic antibody screening avoids 3.39 cases at an ICER of $760,000/QALY compared to the recipient risk-targeted strategy. Universal endemic antibody/PCR screening avoids 3.60 cases and has an ICER of $8.8 million/QALY compared to universal endemic antibody screening. Results are sensitive to blood donor Babesia prevalence, TTB transmission probability, screening test costs, risk and severity of TTB complications, and impact of babesiosis diagnosis on donor quality of life. CONCLUSION Antibody screening for Babesia in endemic regions is appropriate from an economic perspective based on the societal willingness to pay for preventing infectious threats to blood safety.
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Affiliation(s)
- Matthew S Simon
- Department of Public Health, Weill Cornell Medical College, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
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29
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Abstract
The current “manufacturing paradigm” of transfusion practice has detached transfusion from the clinical environment. As an example, fresh whole blood in large-volume hemorrhage may be superior to whole blood reconstituted from multiple components. Multicomponent apheresis can overcome logistical difficulties in matching patient needs with fresh component availability and can deliver the benefits of fresh whole blood. Because of the different transfusion needs of patients in emerging economies and the vulnerability of these blood systems to emerging infections, fresh whole blood and multicomponent apheresis can better meet patient needs when compared with transplants of the “manufacturing paradigm”. We propose that patient blood management, along with panels of repeat, paid, accredited apheresis and fresh whole-blood donors can be used in emerging economies to support decentralized blood services. This alternative transfusion–medicine paradigm could eventually also be adopted by established economies to focus transfusion medicine on local patient needs and to alleviate the problem of the aging volunteer donor base.
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Affiliation(s)
- Albert Farrugia
- College of Medicine, Biology and Environment, Australian National University, Acton, ACT, Australia ; Centre for Orthopaedic Research, Department of Surgery, Faculty of Medicine and Surgery, University of Western Australia, Perth, WA, Australia
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30
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Economic considerations on transfusion medicine and patient blood management. Best Pract Res Clin Anaesthesiol 2014; 27:59-68. [PMID: 23590916 DOI: 10.1016/j.bpa.2013.02.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 02/06/2013] [Indexed: 01/23/2023]
Abstract
In times of escalating health-care cost, it is of great importance to carefully assess the cost-effectiveness and appropriateness of the most resource-consuming health interventions. A long-standing and common clinical practice that has been underestimated in cost and overestimated in effectiveness is the transfusion of allogeneic blood products. Studies show that this intervention comes with largely underestimated service cost and unacceptably high utilisation variability for matched patients, thus adding billions of unnecessary dollars to the health-care expenditure each year. Moreover, a large and increasing body of literature points to a dose-dependent increase of morbidity and mortality and adverse long-term outcomes associated with transfusion whereas published evidence for benefit is extremely limited. This means that transfusion may be a generator for increased hospital stay and possible re-admissions, resulting in additional billions in unnecessary expenditure for the health system. In contrast to this, there are evidence-based and cost-effective treatment options available to pre-empt and reduce allogeneic transfusions. The patient-specific rather than a product-centred application of these multiple modalities is termed patient blood management (PBM). From a health-economic perspective, the expeditious implementation of PBM programmes is clearly indicated. Both patients and payers could benefit from this concept that has recently been endorsed through the World Health Assembly resolution WHA63.12.
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31
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Huisman EL, van Eerd MC, Ouwens JNM, de Peuter MA. Cost-effectiveness and budget impact study of solvent/detergent (SD) treated plasma (octaplasLG®) versus fresh-frozen plasma (FFP) in any patient receiving transfusion in Canada. Transfus Apher Sci 2013; 51:25-34. [PMID: 23707561 DOI: 10.1016/j.transci.2013.04.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 04/25/2013] [Indexed: 11/16/2022]
Abstract
The objectives of this study were to evaluate the cost-effectiveness and budget impact of octaplasLG(®) compared with fresh-frozen plasma (FFP) in all patients receiving a transfusion in Canada. A decision analytic framework was used to model acute and long-term complications that could follow plasma transfusion. Over a life time horizon, the cost with octaplasLG(®) were CA$612.91, which is CA$303.14 less than those with FFP. OctaplasLG(®) resulted in 0.021 quality adjusted life years (QALYs) gained in comparison with FFP. Because of higher efficacy and lower costs, octaplasLG(®) is expected to be the dominant treatment option over FFP in Canada.
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Affiliation(s)
- Eline L Huisman
- MAPI Consultancy, De Molen 84, 3995 AX Houten, The Netherlands.
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32
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Kacker S, Frick KD, Tobian AAR. The costs of transfusion: economic evaluations in transfusion medicine, Part 1. Transfusion 2013; 53:1383-5. [PMID: 23560675 DOI: 10.1111/trf.12188] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 02/20/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Seema Kacker
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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33
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Busch MP, Murthy KK, Kleinman SH, Hirschkorn DF, Herring BL, Delwart EL, Racanelli V, Yoon JC, Rehermann B, Alter HJ. Infectivity in chimpanzees (Pan troglodytes) of plasma collected before HCV RNA detectability by FDA-licensed assays: implications for transfusion safety and HCV infection outcomes. Blood 2012; 119:6326-34. [PMID: 22498743 PMCID: PMC3383200 DOI: 10.1182/blood-2011-12-393637] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 03/26/2012] [Indexed: 12/17/2022] Open
Abstract
Serial plasma aliquots (50 mL) obtained from 10 commercial donors who converted from hepatitis C virus (HCV) RNA negative to positive were transfused into 2 chimpanzees to assess infectivity during early HCV infection. Plasma, obtained 4 days before HCV RNA detectability by licensed assays, transmitted HCV infection to chimpanzee X355. The infectious PCR-negative plasma was subsequently shown to be positive in 2 of 23 replicates using a sensitive transcription-mediated amplification (TMA) assay, and estimated to contain 1.2 HCV RNA copies/mL (60 copies/50 mL transfused). Plasma units obtained up to 8 weeks earlier were not infectious in a second susceptible chimp, even when from donors with low-level, intermittent HCV RNA detection. Chimp x355 developed acute viremia with subsequent seroconversion, but cleared both virus and Ab in 17 weeks. When rechallenged 38 months later with 6000 RNA copies/mL from the same donor, X355 was transiently reinfected and again rapidly lost all HCV markers. We conclude that: (1) transfusions can transmit HCV infection before RNA detection, but the interval of test-negative infectivity is very brief; (2) early "blips" of HCV RNA appear noninfectious and can be ignored when calculating residual transfusion risk; and (3) markers of HCV infection can be lost rapidly after exposure to low-dose inocula.
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Affiliation(s)
- Michael P Busch
- Blood Systems Research Institute, San Francisco, CA 94118, USA.
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34
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Blajchman MA, Carson JL, Eikelboom JW, Heddle NM, Lacroix J, Lauer MS, Platt R, Tilley B, Triulzi D, Vickers AJ, Yusuf S, Glynn S, Mondoro TH, Wagner E. The role of comparative effectiveness research in transfusion medicine clinical trials: proceedings of a National Heart, Lung, and Blood Institute workshop. Transfusion 2012; 52:1363-78. [PMID: 22486525 DOI: 10.1111/j.1537-2995.2012.03640.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Comparative effectiveness research (CER) is the study of existing treatments or ways to deliver health care to determine what intervention works best under specific circumstances. CER evaluates evidence from existing studies or generates new evidence, in different populations and under specific conditions in which the treatments are actually used. CER does not embrace one research design over another but compares treatments and variations in practice using methods that are most likely to yield widely generalizable results that are directly relevant to clinical practice. Treatments used in transfusion medicine (TM) are among the most widely used in clinical practice, but are among the least well studied. High-quality evidence is lacking for most transfusion practices, with research efforts hampered by regulatory restrictions and ethical barriers. To begin addressing these issues, the National Heart, Lung, and Blood Institute convened a workshop in June 2011 to address the potential role of CER in the generation of high-quality evidence for TM decision making. Workshop goals were to: 1) evaluate the current landscape of clinical research, 2) review the potential application of CER methods to clinical research, 3) assess potential barriers to the use of CER methodology, 4) determine whether pilot or vanguard studies can be used to facilitate planning of future CER research, and 5) consider the need for and delivery of training in CER methods for researchers.
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35
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[Preoperative anemia in orthopedic surgery: clinical impact, diagnostics and treatment]. DER ORTHOPADE 2012; 40:1018-20, 1023-5, 1027-8. [PMID: 21922268 DOI: 10.1007/s00132-011-1789-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In a national audit of elective orthopedic surgery conducted in the US, 30% of patients were found to have hemoglobin (Hgb) levels < 13 g/dl at preadmission testing. Preoperative anemia has been associated with increased mortality and morbidity after surgery, increased allogeneic blood transfusion therapy and increased rates of postoperative infection leading to a longer length of hospital stay. Because of the risks associated with allogeneic blood transfusions according to German law patients have to be offered the option of autologous transfusion if the risk associated with allogeneic blood transfusion is > 10%. However, one of these measures, the autologous blood donation, can exaggerate anemia and can increase the overall transfusion rates (allogeneic and autologous). As autologous procedures (autologous blood donation and cell salvage) are not always appropriate for anemic patients together with an expected shortage of blood and because preoperative anemia is associated with perioperative risks of blood transfusion, a standardized approach for the detection, evaluation and management of anemia in this setting was identified as an unmet medical need. A panel of multidisciplinary physicians was convened by the Society for Blood Management to develop a clinical care pathway for anemia management in elective surgery patients for whom blood transfusion is an option. In these guidelines elective surgery patients should have Hgb level determination at the latest 28 days before the scheduled surgical procedure. The patient target Hgb before elective surgery should be within the normal range (normal female ≥ 120 g/l, normal male ≥ 130 g/l). Laboratory testing should take place to further determine nutritional deficiencies, chronic renal insufficiency and/or chronic inflammatory diseases. Nutritional deficiencies should be treated and erythropoiesis-stimulating agent (ESA) therapy should be used for anemic patients in whom nutritional deficiencies have been ruled out and/or corrected.
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36
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37
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Custer B, Agapova M, Bruhn R, Cusick R, Kamel H, Tomasulo P, Biswas H, Tobler L, Lee TH, Caglioti S, Busch M. Epidemiologic and laboratory findings from 3 years of testing United States blood donors for Trypanosoma cruzi. Transfusion 2012; 52:1901-11. [DOI: 10.1111/j.1537-2995.2012.03569.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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38
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Transfusion‐Transmitted Diseases. Transfus Med 2011. [DOI: 10.1002/9781444398748.ch15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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39
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Prinsze FJ, Zaaijer HL. The outcome of donor screening for Human T-Cell Lymphotropic Virus infection in the Netherlands. Vox Sang 2011; 102:198-203. [DOI: 10.1111/j.1423-0410.2011.01538.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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40
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Wilson K. A Framework for Applying the Precautionary Principle to Transfusion Safety. Transfus Med Rev 2011; 25:177-83. [DOI: 10.1016/j.tmrv.2011.01.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cost-effectiveness study comparing pharmaceutically licensed plasma for transfusion (OctaplasLG®) versus fresh frozen plasma (FFP) in critically Ill patients in the UK. Transfus Apher Sci 2010; 43:251-259. [PMID: 21084224 DOI: 10.1016/j.transci.2010.09.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study evaluates the cost-effectiveness of OctaplasLG® (pharmaceutically licensed plasma for transfusion) versus fresh frozen plasma (FFP) in critically ill patients in the UK using a decision-analytic approach. Transfusion with OctaplasLG® resulted in 0.03 quality adjusted life years (QALYs) and 0.03 life years saved compared with FFP. The discounted cost per life year was £949 ($1504), and the discounted cost per QALY saved was £1030 ($1632) with OctaplasLG® in the UK. Based on a higher price of £70 ($111) for OctaplasLG® versus £28.42 ($45.04) for FFP, OctaplasLG® is considered to be cost-effective at a threshold of £30,000 ($47,548) per QALY.
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Custer B, Agapova M, Martinez RH. The cost-effectiveness of pathogen reduction technology as assessed using a multiple risk reduction model. Transfusion 2010; 50:2461-73. [DOI: 10.1111/j.1537-2995.2010.02704.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Davidson T, Ekermo B, Gaines H, Lesko B, Åkerlind B. The cost-effectiveness of introducing nucleic acid testing to test for hepatitis B, hepatitis C, and human immunodeficiency virus among blood donors in Sweden. Transfusion 2010; 51:421-9. [PMID: 20849409 DOI: 10.1111/j.1537-2995.2010.02877.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The purpose of this study was to estimate the cost-effectiveness of using individual-donor nucleic acid testing (ID-NAT) in addition to serologic tests compared with the sole use of serologic tests for the identification of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) among blood donors in Sweden. STUDY DESIGN AND METHODS The two strategies analyzed were serologic tests and ID-NAT plus serologic tests. A health-economic model was used to estimate the lifetime costs and effects. The effects were measured as infections avoided and quality-adjusted life-years (QALYs) gained. A societal perspective was used. RESULTS The largest number of viral transmissions occurred with serologic testing only. However, the risks for viral transmissions were very low with both strategies. The total cost was mainly influenced by the cost of the test carried out. The cost of using ID-NAT plus serologic tests compared to serologic tests alone was estimated at Swedish Krona (SEK) 101 million (USD 12.7 million) per avoided viral transmission. The cost per QALY gained was SEK 22 million (USD 2.7 million). CONCLUSION Using ID-NAT for testing against HBV, HCV, and HIV among blood donors leads to cost-effectiveness ratios that are far beyond what is usually considered cost-effective. The main reason for this is that with current methods, the risks for virus transmission are very low in Sweden.
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Affiliation(s)
- Thomas Davidson
- Center for Medical Technology Assessment, Department of Clinical and Experimental Medicine, Linköping University, Sweden.
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Agapova M, Busch MP, Custer B. Cost-effectiveness of screening the US blood supply for Trypanosoma cruzi. Transfusion 2010; 50:2220-32. [DOI: 10.1111/j.1537-2995.2010.02686.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vamvakas EC, Blajchman MA. Blood still kills: six strategies to further reduce allogeneic blood transfusion-related mortality. Transfus Med Rev 2010; 24:77-124. [PMID: 20303034 PMCID: PMC7126657 DOI: 10.1016/j.tmrv.2009.11.001] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
After reviewing the relative frequency of the causes of allogeneic blood transfusion-related mortality in the United States today, we present 6 possible strategies for further reducing such transfusion-related mortality. These are (1) avoidance of unnecessary transfusions through the use of evidence-based transfusion guidelines, to reduce potentially fatal (infectious as well as noninfectious) transfusion complications; (2) reduction in the risk of transfusion-related acute lung injury in recipients of platelet transfusions through the use of single-donor platelets collected from male donors, or female donors without a history of pregnancy or who have been shown not to have white blood cell (WBC) antibodies; (3) prevention of hemolytic transfusion reactions through the augmentation of patient identification procedures by the addition of information technologies, as well as through the prevention of additional red blood cell alloantibody formation in patients who are likely to need multiple transfusions in the future; (4) avoidance of pooled blood products (such as pooled whole blood-derived platelets) to reduce the risk of transmission of emerging transfusion-transmitted infections (TTIs) and the residual risk from known TTIs (especially transfusion-associated sepsis [TAS]); (5) WBC reduction of cellular blood components administered in cardiac surgery to prevent the poorly understood increased mortality seen in cardiac surgery patients in association with the receipt of non-WBC-reduced (compared with WBC-reduced) transfusion; and (6) pathogen reduction of platelet and plasma components to prevent the transfusion transmission of most emerging, potentially fatal TTIs and the residual risk of known TTIs (especially TAS).
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Affiliation(s)
- Eleftherios C Vamvakas
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Borkent-Raven BA, Janssen MP, Van Der Poel CL, Schaasberg WP, Bonsel GJ, Van Hout BA. The PROTON study: profiles of blood product transfusion recipients in the Netherlands. Vox Sang 2010; 99:54-64. [DOI: 10.1111/j.1423-0410.2010.01312.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Hofmann A, Farmer S, Shander A. Cost-effectiveness in haemotherapies and transfusion medicine. ACTA ACUST UNITED AC 2009. [DOI: 10.1111/j.1751-2824.2009.01246.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Klein HG, Glynn SA, Ness PM, Blajchman MA. Research opportunities for pathogen reduction/inactivation of blood components: summary of an NHLBI workshop. Transfusion 2009; 49:1262-8. [DOI: 10.1111/j.1537-2995.2009.02210.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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