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Shen A, Di Meo B, Perez IA, Hashim Y, Ko A, Margulies DR, Klapper EB, Barmparas G. Reconsidering Fresh Frozen Plasma Availability to Reduce Blood Product Waste During Massive Transfusion Events in Trauma. Am Surg 2024; 90:2530-2533. [PMID: 38658467 DOI: 10.1177/00031348241248811] [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] [Indexed: 04/26/2024]
Abstract
BACKGROUND Within component therapy of massive transfusion protocol (MTP) in trauma, thawed plasma is particularly susceptible to expiring without use given its short 5-day shelf life. Optimizing the number of thawed products without compromising safety is important for hospital resource management. The goal is to examine thawed plasma utilization rates in trauma MTP events and optimize the MTP cooler content at our Level I trauma center. METHODS Trauma MTP activations from 01/2019 to 12/2022 were retrospectively reviewed. During the study period, blood products were distributed in a 12:12:1 ratio of packed red blood cells (pRBC): plasma: platelets per cooler, with up to 4 additional units of low-titer, group O whole blood (LTOWB) available. The primary measure was percent return of unused, thawed plasma. RESULTS There were 367 trauma MTP activations with a median (IQR) activation call-to-first cooler delivery time of 8 (6-10) minutes. 73.0% of thawed plasma was returned to the blood bank unused. In one third of MTP activations, all dispensed plasma was returned. The majority (74.1%) of patients required 6 or fewer units of plasma. In 81.5% of activations, 10 or fewer units of plasma and 10 or fewer units of pRBC were used. DISCUSSION The majority of trauma MTP requirements may be accommodated with a reduced cooler content of 6 units pRBC, 6 units plasma, and 1 pheresis platelets, buffered by up to 4 units LTOWB (approximates 4 units of pRBC/4 units plasma), in conjunction with a sub-10min cooler delivery time. Follow-up longitudinal studies are needed.
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Affiliation(s)
- Aricia Shen
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Brent Di Meo
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ingrid A Perez
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Yassar Hashim
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ara Ko
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel R Margulies
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ellen B Klapper
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Galinos Barmparas
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Hajjaj OI, Modi D, Cameron T, Barty R, Owens W, Heddle N, Zhang L, Thompson T, Callum J. Reducing blood product wastage through the inter-hospital redistribution of near-outdate inventory. Transfusion 2024; 64:1207-1216. [PMID: 38752381 DOI: 10.1111/trf.17876] [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: 03/26/2024] [Revised: 04/23/2024] [Accepted: 05/04/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Hospital transfusion services order blood products to satisfy orders and maintain inventory levels during unexpected periods of increased blood demand. Surplus inventory may outdate before being allocated to a recipient. Blood product outdating is the largest contributor to blood wastage. STUDY DESIGN A province-wide redistribution program was designed and implemented to redistribute near-outdate plasma protein and related blood products from low-usage to high-usage hospitals. Program operations and details are described in this paper. Two transport container configurations were designed and validated for transport of all blood products. A cost-analysis was performed to determine the effectiveness of this redistribution program. RESULTS A total of 130 hospital transfusion services contributed at least one near-outdate blood product for redistribution between January 2012 and March 2020. These services redistributed 15,499 products through 3412 shipments, preventing the outdating of $17,570,700 CAD worth of product. Program costs were $14,900 for shipping and $30,000 for staffing. Failed time limits or non-compliance with packing configurations resulted in $388,200 worth of blood products (97 shipments containing 816 products) being discarded. Courier transport delays was the most common reason (42/97; 43%) for transport failure. CONCLUSION Redistributing near-outdate blood products between hospitals is a feasible solution to minimize outdating. Despite heterogeneity of Canadian blood product inventory, all products (each with unique storage and transport requirements) were successfully redistributed in one of two validated and simple containers. Total operation costs of this program were small in comparison to the $17.6 million in savings associated with preventing the discard of outdated products.
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Affiliation(s)
- Omar I Hajjaj
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
- Department of Laboratory Medicine & Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Dimpy Modi
- Department of Laboratory Medicine & Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Tracy Cameron
- Ontario Regional Blood Coordinating Network Office, Toronto, Ontario, Canada
| | - Rebecca Barty
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Ontario Regional Blood Coordinating Network Office, Toronto, Ontario, Canada
| | - Wendy Owens
- Ontario Regional Blood Coordinating Network Office, Toronto, Ontario, Canada
| | - Nancy Heddle
- Ontario Regional Blood Coordinating Network Office, Toronto, Ontario, Canada
- Centre for Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Liying Zhang
- Department of Laboratory Medicine & Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Troy Thompson
- Centre for Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Jeannie Callum
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
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Nguyen A, Burnett-Greenup S, Riddle D, Enderle J, Carman C, Rajendran R. Blood usage and wastage at an academic teaching hospital before the initial wave of COVID-19 and during and after its quarantine periods. Lab Med 2024; 55:198-203. [PMID: 37478411 DOI: 10.1093/labmed/lmad059] [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] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Transfusion services aim to maintain sufficient blood inventory to support patients, even with challenges introduced by COVID-19. OBJECTIVES To review blood usage and wastage before, during, and after COVID-19 surges, and to evaluate effects on inventory. METHODS In a retrospective review, we evaluated the association between time periods corresponding to the initial wave of COVID-19 (pre-COVID-19, quarantine, and postquarantine) and blood usage/wastage. Data were stratified by period, and χ2 testing was used to examine the association between these time periods and blood usage/wastage. RESULTS In the period before COVID-19, the transfusion service used more units, and in the period after quarantine, more units went to waste. Across all time periods, the most-used product was RBCs, and the most wasted product was plasma. A statistically significant association existed between usage (χ2 [6/3209 (0.2%)]) = 24.534; P ≤.001; Cramer V = 0.62), wastage (χ2 [6/775 (0.8%)]) = 21.673; P = .001; Cramer V = 0.118), and time period. The postquarantine period displayed the highest wastage costs ($51,032.35), compared with the pre-COVID-19 period ($29,734.45). CONCLUSION Changes in blood inventory use and waste are significantly associated with the onset and continuation of COVID-19.
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Affiliation(s)
- Amber Nguyen
- Department of Clinical Laboratory Sciences, University of Texas Medical Branch, Galveston, TX
| | - Sarah Burnett-Greenup
- Department of Clinical Laboratory Sciences, University of Texas Medical Branch, Galveston, TX
| | - Diana Riddle
- Department of Clinical Laboratory Sciences, University of Texas Medical Branch, Galveston, TX
| | - Janet Enderle
- Department of Clinical Laboratory Sciences, University of Texas Medical Branch, Galveston, TX
| | - Carol Carman
- Department of Clinical Laboratory Sciences, University of Texas Medical Branch, Galveston, TX
| | - Rajkumar Rajendran
- Department of Clinical Laboratory Sciences, University of Texas Medical Branch, Galveston, TX
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Sánchez-Guzmán MDJ, Loyola-Cruz MÁ, López-Ornelas A, Cruz-Cruz C, Durán-Manuel EM, Bello-López JM. In situ and in vitro evaluation of two antiseptics for blood bank based on chlorhexidine gluconate/isopropyl alcohol and povidone-iodine. Transfus Apher Sci 2024; 63:103854. [PMID: 38061923 DOI: 10.1016/j.transci.2023.103854] [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: 03/30/2023] [Revised: 11/03/2023] [Accepted: 11/22/2023] [Indexed: 03/10/2024]
Abstract
BACKGROUND Poor disinfection is the main cause of blood contamination, so its elimination is key to limiting the entry of bacteria into the collection system. With the advancement of antiseptic technology, antiseptics with sterile, disposable applicators are now available. AIM To evaluate in situ two antiseptics (with and without applicators) for blood banks and to demonstrate in vitro antiseptic activity on bacterial biofilms of importance in transfusion medicine. METHODS Antiseptic A (2% sterile solution of chlorhexidine gluconate/70% isopropyl alcohol provided with applicator) and bulk antiseptic B (10% povidone-iodine) were evaluated. The deferred blood donor arms were subjected to disinfection with antiseptics A and B and the contralateral arms were cultured to determine the baseline bacterial load (control). Antiseptic activity was assessed by ANOVA and logaritmic reduction values (LRV) and percentage reduction values (PRV) were calculated. Finally, the in vitro activity of antiseptic A was analyzed by confocal laser scanning microscopy (CLSM) on biofilm models. RESULTS Prior to disinfection tests, commensal and clinically important bacteria were identified; antiseptic A showed post-disinfection bacterial growth rates of zero compared to controls (p < 0.0001). The frequency of bacterial growth with antiseptic B was 74%. A significant difference was identified between both antiseptics, where antiseptic A showed higher activity (p < 0.5468). LRV and PRV were 0.6-2.5/100% and 0.3-1.7/66.7-99.7% for antiseptics A and B, respectively. Through CLSM, disinfectant A (without applicator) showed lower in vitro antiseptic activity on the tested biofilms at the exposure times recommended by the manufacturer. CONCLUSIONS Sterile solution of chlorhexidine gluconate/isopropyl alcohol with applicator showed advantages disinfection in deferred blood donors over povidone-iodine.
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Affiliation(s)
- María de Jesús Sánchez-Guzmán
- División de Investigación, Hospital Juárez de México, Mexico City, Mexico; Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Mexico City, Mexico
| | | | | | - Clemente Cruz-Cruz
- División de Investigación, Hospital Juárez de México, Mexico City, Mexico; Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Mexico City, Mexico
| | - Emilio Mariano Durán-Manuel
- División de Investigación, Hospital Juárez de México, Mexico City, Mexico; Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Mexico City, Mexico
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Jacobs JW, Stephens LD, Booth GS, Woo JS, Adkins BD. Assessing transfusion-related costs: More than just the price of blood. J Trauma Acute Care Surg 2023; 95:e49-e50. [PMID: 37518902 DOI: 10.1097/ta.0000000000004038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
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Roh J, Park S, Kang HJ. Recent trends in perioperative blood transfusion during elective kidney transplantation. KOREAN JOURNAL OF TRANSPLANTATION 2023; 37:197-202. [PMID: 37751967 PMCID: PMC10583966 DOI: 10.4285/kjt.23.0041] [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: 07/24/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
Background Accurately predicting the demand for blood transfusions is crucial for blood banks. Given the potential for emergency situations, it is imperative that blood banks maintain a sufficient inventory of blood products. In this study, we examined the use of perioperative transfusions in patients undergoing elective kidney transplants. Methods Data on all complement-dependent cytotoxicity-crossmatched assays between 2013 and 2022 were collected. We excluded repeated assays and patients who did not undergo kidney transplantation. Transfusion records and transfusion adverse reactions were reviewed retrospectively. Results In total, 30 patients underwent elective kidney transplantation from 2013 to 2022. The mean age of the patients was 48.1±9.7 years. The male-to-female ratio was 1.5:1. Four patients received transfusions intraoperatively, whereas eight patients were transfused postoperatively. The postoperative hemoglobin level of the transfusion group (n=9, 8.9±1.3) was significantly lower than that of the nontransfusion group (n=21, 10.4±1.2). The most commonly transfused blood product intraoperatively was leuko-reduced filtered red blood cells, followed by fresh frozen plasma. When the study period was divided into two halves based on the time of operation, the first half showed a higher number of significant transfusions. Conclusions In most elective kidney transplant cases, surgery was conducted without the need for blood transfusion. The timing of transfusion, when necessary, shifted from during the operation to after the operation. The implementation of patient blood management, coupled with advancements in surgical techniques, appears to have impacted the pattern of perioperative transfusion.
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Affiliation(s)
- Juhye Roh
- Department of Laboratory Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sangkeun Park
- Department of Laboratory Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Hee Jung Kang
- Department of Laboratory Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
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Lou SS, Dewey MM, Bollini ML, Harford DR, Ingold C, Wildes TS, Stevens TW, Martin JL, Grossman BJ, Kangrga I. Reducing perioperative red blood cell unit issue orders, returns, and waste using failure modes and effects analysis. Transfusion 2023; 63:755-762. [PMID: 36752098 PMCID: PMC10089960 DOI: 10.1111/trf.17275] [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: 09/01/2022] [Revised: 11/07/2022] [Accepted: 01/13/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Surgical transfusion has an outsized impact on hospital-based transfusion services, leading to blood product waste and unnecessary costs. The objective of this study was to design and implement a streamlined, reliable process for perioperative blood issue ordering and delivery to reduce waste. STUDY DESIGN AND METHODS To address the high rates of surgical blood issue requests and red blood cell (RBC) unit waste at a large academic medical center, a failure modes and effects analysis was used to systematically examine perioperative blood management practices. Based on identified failure modes (e.g., miscommunication, knowledge gaps), a multi-component action plan was devised involving process changes, education, electronic clinical decision support, audit, and feedback. Changes in RBC unit issue requests, returns, waste, labor, and cost were measured pre- and post-intervention. RESULTS The number of perioperative RBC unit issue requests decreased from 358 per month (SD 24) pre-intervention to 282 per month (SD 16) post-intervention (p < .001), resulting in an estimated savings of 8.9 h per month in blood bank staff labor. The issue-to-transfusion ratio decreased from 2.7 to 2.1 (p < .001). Perioperative RBC unit waste decreased from 4.5% of units issued pre-intervention to 0.8% of units issued post-intervention (p < .001), saving an estimated $148,543 in RBC unit acquisition costs and $546,093 in overhead costs per year. DISCUSSION Our intervention, designed based on a structured failure modes analysis, achieved sustained reductions in perioperative RBC unit issue orders, returns, and waste, with associated benefits for blood conservation and transfusion program costs.
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Affiliation(s)
- Sunny S. Lou
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO
| | - Megan M. Dewey
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO
| | - Mara L. Bollini
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO
| | - Derek R. Harford
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO
| | - Cindy Ingold
- Transfusion Services, Barnes-Jewish Hospital, St Louis, MO
| | - Troy S. Wildes
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO
- Currently at University of Nebraska Medical Center, Omaha, NE
| | - Tracey W. Stevens
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO
| | | | - Brenda J. Grossman
- Transfusion Services, Barnes-Jewish Hospital, St Louis, MO
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO
| | - Ivan Kangrga
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO
- Perioperative Services, Barnes-Jewish Hospital, St Louis, MO
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Booth GS, Savani BN, Adkins BD, Woo JS, Bertram R, Trushinski J, Sharma D, Jacobs JW. Cellular therapy processing laboratory: a workforce hiring nightmare. Bone Marrow Transplant 2023:10.1038/s41409-023-01972-y. [PMID: 36991087 PMCID: PMC10054199 DOI: 10.1038/s41409-023-01972-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 03/31/2023]
Affiliation(s)
- Garrett S Booth
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Bipin N Savani
- Department of Medicine, Hematology, Stem Cell Transplantation and Cellular Therapy Section, Division of Hematology/Oncology, Vanderbilt University Medical Center and Veterans Affairs Medical Center, Nashville, TN, USA
| | - Brian D Adkins
- Department of Pathology, Division of Transfusion Medicine and Hemostasis, University of Texas Southwestern, Dallas, TX, USA
| | - Jennifer S Woo
- Department of Pathology, City of Hope National Medical Center, Irvine, CA, USA
| | - Rickey Bertram
- Department of Pathology, City of Hope National Medical Center, Irvine, CA, USA
| | - Joel Trushinski
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Deva Sharma
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeremy W Jacobs
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
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Jacobs JW, Filkins L, Booth GS, Adkins BD. They come in threes: Marburg virus, emerging infectious diseases, and the blood supply. Transfus Apher Sci 2023; 62:103528. [PMID: 36038475 PMCID: PMC9417361 DOI: 10.1016/j.transci.2022.103528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 08/10/2022] [Accepted: 08/24/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA.
| | - Laura Filkins
- Department of Pathology, University of Texas Southwestern, Dallas, TX, USA
| | - Garrett S Booth
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brian D Adkins
- Department of Pathology, University of Texas Southwestern, Dallas, TX, USA
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Bansal N, Bansal Y, Raturi M, Thakur K, Sood A, Kumar S. Blood Inventory Management During COVID-19 Pandemic Using a Simple Mathematical Tool: A Two-Year Study from a Tertiary Care Hospital in North India. Indian J Hematol Blood Transfus 2023; 39:1-7. [PMID: 36741877 PMCID: PMC9889947 DOI: 10.1007/s12288-023-01631-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 01/20/2023] [Indexed: 02/04/2023] Open
Abstract
Multiple recurrent waves of the coronavirus disease 2019 (COVID-19) resulted in major fluctuations in blood supply and demand, which presented a major challenge for the blood centres to maintain adequate blood inventory. Hence, the primary aim of the present study was to determine whether safety stock as a simple mathematical tool can be used to maintain optimum blood inventory to meet all blood demands. The secondary aim of the study was to test whether daily blood stock index (DBSI), which was a novel index developed by the authors and derived from the calculated safety stock, can be used to minimize blood wastage due to the outdating of packed red blood cells (PRBC)/whole blood (WB) units. The present study was a descriptive, cross-sectional study conducted from 1st October 2019 to 31st December 2021 at a blood centre of a tertiary care hospital. For the purpose of data analysis, the time period of study was divided into 7 periods signifying different phases during the COVID-19 outbreak. Data of PRBC/WB (referred to as red cell) collection, red cell issue and the daily red cell stock were collected for these 7 time periods. Safety stock, percentage of out-dated whole blood/packed red blood cell units (OB) and DBSI were calculated based on the data extracted. Red cell collection as well as red cell utilization decreased during the 1st as well as the 2nd wave of the COVID-19 outbreak. The blood centre was able to meet the blood demand of the hospital at all times, as the daily average red cell stock remained above the calculated safety stock during all periods. OB (12.4%) and DBSI (2.3) were highest during the lockdown period of second wave of COVID-19 outbreak (period E). A strong direct relationship was seen between OB (dependent variable) and DBSI (predictor variable) [R = 0.79; p = 0.03]. Firstly, safety stock is a simple, user-friendly mathematic tool which can be used for efficient blood inventory management not only at times of a pandemic/disaster but also during routine times. Secondly, DBSI is a logical and empirical tool to reduce OB units and consequently reduce blood wastage.
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Affiliation(s)
- Naveen Bansal
- Department of Transfusion Medicine, VCSG Government Institute of Medical Science and Research, Srinagar, Uttarakhand India
| | - Yashik Bansal
- Department of Microbiology, VCSG Government Institute of Medical Science and Research, Srinagar, Uttarakhand India
| | - Manish Raturi
- Department of Immunohematology and Blood Transfusion, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, Uttarakhand India
| | - Kusum Thakur
- Department of Transfusion Medicine, MM Institute of Medical Sciences and Research, Mullana, Ambala, Haryana India
| | - Ashwani Sood
- Department of Hospital Administration, MM Institute of Medical Sciences and Research, Mullana, Ambala, Haryana India
| | - Satish Kumar
- Department of Transfusion Medicine, VCSG Government Institute of Medical Science and Research, Srinagar, Uttarakhand India
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Tripathi R, Morales J, Lee V, Gibson CM, Mack MJ, Schneider DJ, Douketis J, Sellke FW, Ohman ME, Thourani VH, Storey RF, Deliargyris EN. Antithrombotic drug removal from whole blood using Haemoadsorption with a porous polymer bead sorbent. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2022; 8:847-856. [PMID: 35657375 PMCID: PMC9716861 DOI: 10.1093/ehjcvp/pvac036] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/25/2022] [Accepted: 05/31/2022] [Indexed: 12/29/2022]
Abstract
AIM To evaluate the ability of the DrugSorb™-AntiThrombotic Removal (ATR) haemoadsorption device utilizing porous polymer bead sorbent technology to remove three commonly used antithrombotic drugs from whole blood. METHODS AND RESULTS We evaluated the removal of apixaban, rivaroxaban, and ticagrelor by the DrugSorb-ATR haemoadsorption device in a benchtop clinical scale model using bovine whole blood. Blood spiked at clinically relevant concentrations of an antithrombotic agent was continuously circulated through a 300-mL DrugSorb-ATR haemoadsorption device at a flow rate of 300 mL/min. Drug concentration was monitored over 6 h to evaluate drug removal. Results were compared with a control circuit without the haemoadsorption device. Removal rates at 30, 60, 120, and 360 minutes were: apixaban: 81.5%, 96.3%, 99.3% >99.8%; rivaroxaban: 80.7%, 95.1%, 98.9%, >99.5%; ticagrelor: 62.5%; 75%, 86.6%, >95% (all P <0.0001 vs. control). Blood pH and haematological parameters were not significantly affected by the DrugSorb-ATR haemoadsorption device when compared with the control circuit. CONCLUSION DrugSorb-ATR efficiently removes apixaban, rivaroxaban, and ticagrelor in a clinical-scale benchtop recirculation circuit with the bulk of removal occurring in the first 60 minutes. The clinical implications of these findings are currently investigated in patients undergoing on-pump cardiothoracic surgery in two US pivotal trials (ClinicalTrials.gov Identifiers: NCT04976530 and NCT05093504).
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Affiliation(s)
- Ritu Tripathi
- Corresponding Author: Tel: +1-732-329-8885; FAX: +1-732-329-8650;
| | | | - Victoria Lee
- CytoSorbents Medical Inc.305 College Road E, Princeton, NJ-08540, USA
| | - C Michael Gibson
- Department of Medicine at Beth Israel Deaconess Medical Center, The Baim Institute and Harvard Medical School, Boston, MA-02215, USA
| | - Michael J Mack
- Baylor Scott & White Health, Baylor Scott & White Research Institute, Dallas, TX-75093, USA
| | - David J Schneider
- Department of Medicine, Cardiovascular Research Institute, University of Vermont, Burlington VT-05401, USA
| | - James Douketis
- Vascular Medicine and General Internal Medicine, St. Joseph's Healthcare Hamilton, McMaster University, ON-L9C 0E3, Canada
| | - Frank W Sellke
- Division of Cardiothoracic Surgery, Alpert Medical School of Brown University, Providence RI-02903, USA
| | - Magnus E Ohman
- Duke Clinical Research Institute, Duke Heart Center, Duke Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC-27701, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA-30309, USA
| | - Robert F Storey
- Cardiovascular Research Unit, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2RX, UK
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Continuous-Flow Magnetic Fractionation of Red Blood Cells Based on Hemoglobin Content and Oxygen Saturation—Clinical Blood Supply Implications and Sickle Cell Anemia Treatment. Processes (Basel) 2022. [DOI: 10.3390/pr10050927] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Approximately 36,000 units of red blood cells (RBCs) are used every day in the U.S. and there is a great challenge for hospitals to maintain a reliable supply, given the 42-day expiration period from the blood donation date. For many years, research has been conducted to develop ex vivo storage solutions that limit RBC lysis and maintain a high survival rate of the transfused cells. However, little attention is directed towards potential fractionation methods to remove unwanted cell debris or aged blood cells from stored RBC units prior to transfusion, which could not only expand the ex vivo shelf life of RBC units but also avoid adverse events in transfused patients. Such fractionation methods could also limit the number of transfusions required for treating certain pathologies, such as sickle cell disease (SCD). In this work, magnetic fractionation is studied as a potential technology to fractionate functional and healthy RBCs from aged or sickle cells. It has been reported that during ex vivo RBC storage, RBCs lose hemoglobin (Hb) and lipid content via formation of Hb-containing exosomes. Given the magnetic character of deoxygenated- or met-Hb, in this work, we propose the use of a quadrupole magnetic sorter (QMS) to fractionate RBCs based on their Hb content from both healthy stored blood and SCD blood. In our QMS, a cylindrical microchannel placed inside the center of the quadrupolar magnets is subjected to high magnetic fields and constant field gradients (286 T/m), which causes the deflection of the paramagnetic, Hb-enriched, and functional RBCs from their original path and their collection into a different outlet. Our results demonstrated that although we could obtain a significant difference in the magnetic mobility of the sorted fractions (corresponding to a difference in more than 1 pg of Hb per cell), there exists a tradeoff between throughput and purity. Therefore, this technology when optimized could be used to expand the ex vivo shelf life of RBC units and avoid adverse events in transfused individuals or SCD patients requiring blood exchange therapy.
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Chang C, Sun J. Reply to Jacobs et al.: Massive transfusion protocols during the
COVID
‐19 pandemic. Vox Sang 2022; 117:870-871. [PMID: 35352356 PMCID: PMC9115440 DOI: 10.1111/vox.13268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Chih‐Chun Chang
- Department of Clinical Pathology Far Eastern Memorial Hospital New Taipei Taiwan
- Department of Nursing Cardinal Tien Junior College of Healthcare and Management Yilan Taiwan
| | - Jen‐Tang Sun
- Department of Emergency Medicine Far Eastern Memorial Hospital New Taipei Taiwan
- College of Medicine Tzu Chi University Hualien Taiwan
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Jacobs JW, Adkins BD, Booth GS. Massive transfusion protocols during the
COVID
‐19 pandemic. Vox Sang 2022; 117:869. [PMID: 35352351 PMCID: PMC9115436 DOI: 10.1111/vox.13269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/17/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Jeremy W. Jacobs
- Department of Laboratory Medicine Yale School of Medicine New Haven Connecticut USA
| | - Brian D. Adkins
- Department of Pathology, Division of Transfusion Medicine and Hemostasis The University of Texas Southwestern Medical Center Dallas Texas USA
| | - Garrett S. Booth
- Department of Pathology, Microbiology & Immunology Vanderbilt University Medical Center Nashville Tennessee USA
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