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Mitteilungen des Arbeitskreises Blut des Bundesministeriums für Gesundheit. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:964-967. [PMID: 39060680 DOI: 10.1007/s00103-024-03897-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
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Ferreira CM, Vieites Y, Goldszmidt R, Barros LSG, Andrade EB. Short- and long-term effects of incentives on prosocial behavior: The case of ride vouchers to a blood collection agency. Soc Sci Med 2024; 352:117019. [PMID: 38810507 DOI: 10.1016/j.socscimed.2024.117019] [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: 11/17/2023] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 05/31/2024]
Abstract
This study addresses the challenge of low blood donation rates in developing countries by examining the effectiveness of a barrier-removal incentive-a one-day transportation voucher-to promote blood donation. Utilizing a longitudinal dataset of 23,750 donors from a Brazilian blood collection agency (BCA) collected between March 2018 and May 2020, we examine the short and long-term effects of this campaign on donation rates. Our results show that the incentive had a large positive influence on both donation attempts and successful donations on the day of the campaign. However, the short-term success of the intervention had an unintended consequence: the significant increase in prospective donors' waiting time at the BCA during the intervention day, which may help explain the negative impact on return rates in the 24-month follow-up. Despite these opposing outcomes, the net effect of the one-day blood donation incentive was still positive, offering valuable insights for BCAs aiming to enhance donor recruitment and retention strategies and emphasizing the need to balance immediate benefits with potential long-term impacts.
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Affiliation(s)
- Claudio M Ferreira
- FGV EBAPE Brazilian School of Public and Business Administration, Fundação Getulio Vargas, Rua Jornalista Orlando Dantas, 30, Botafogo, Rio de Janeiro, RJ, 22231-010, Brazil.
| | - Yan Vieites
- FGV EBAPE Brazilian School of Public and Business Administration, Fundação Getulio Vargas, Rua Jornalista Orlando Dantas, 30, Botafogo, Rio de Janeiro, RJ, 22231-010, Brazil.
| | - Rafael Goldszmidt
- FGV EBAPE Brazilian School of Public and Business Administration, Fundação Getulio Vargas, Rua Jornalista Orlando Dantas, 30, Botafogo, Rio de Janeiro, RJ, 22231-010, Brazil.
| | - Lucia S G Barros
- FGV EAESP Business Administration School of São Paulo, Fundação Getulio Vargas, Av. 9 de julho, 2029, Bela Vista, São Paulo, SP, 01313-902, Brazil.
| | - Eduardo B Andrade
- FGV EBAPE Brazilian School of Public and Business Administration, Fundação Getulio Vargas, Rua Jornalista Orlando Dantas, 30, Botafogo, Rio de Janeiro, RJ, 22231-010, Brazil; Imperial College Business School, Imperial College London, South Kensington Campus, Exhibition Rd, London, SW7 2AZ, United Kingdom.
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Kim OS, Ji S, Jung HW, Matthews SA, Cha YJ, Moon SD, Kim K. Future Blood Debt: Projecting Blood Supply and Demand of Korea Based on Subnational Population Projections (2021-2050). J Korean Med Sci 2024; 39:e168. [PMID: 38804012 PMCID: PMC11136676 DOI: 10.3346/jkms.2024.39.e168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND South Korea faces a critical challenge with its rapidly declining fertility rates and an increasingly aging population, which significantly impacts the country's blood supply and demand. Despite these nationwide trends, regional disparities in blood supply and demand have not been thoroughly studied. METHODS This research utilized blood donation data from the Korean Red Cross and blood transfusion data from the Health Insurance Review and Assessment Service. We analyzed these datasets in conjunction with regional population projections to simulate blood supply and demand from 2021 to 2050 across South Korea. Sensitivity analyses were conducted to assess the impact of various factors, including the number of donors, age eligibility criteria for donations, frequency of donations, and blood discard rates. RESULTS Our projections indicate a decreasing trend in blood supply, from 2.6 million units in 2021 to 1.4 million units by 2050, while demand is expected to peak at 5.1 million units by 2045 before declining. Metropolitan areas, particularly Gyeonggi Province, are projected to experience the most severe shortages. Sensitivity analyses suggest that increasing the donation frequency of existing donors and relaxing age eligibility criteria are more effective strategies in addressing these imbalances than merely increasing the number of new donors. Blood discard rates showed minimal impact on the overall blood shortage. CONCLUSION The findings emphasize the urgent need for targeted strategies to mitigate national and regional blood supply shortages in South Korea. Encouraging frequent donations from experienced donors and broadening eligibility criteria are critical steps toward stabilizing the blood supply amidst demographic shifts. These strategies must be prioritized to address the impending regional disparities in blood availability.
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Affiliation(s)
- Oh Seok Kim
- Department of Geography, Graduate School of Korea University, Seoul, Korea
- Department of Geography Education, College of Education, Korea University, Seoul, Korea
- Institute of Future Land, Korea University, Korea University, Seoul, Korea.
| | - Sunghwan Ji
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee-Won Jung
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Stephen A Matthews
- Department of Sociology and Criminology, Penn State University, University Park, PA, USA
- Department of Anthropology, Penn State University, University Park, PA, USA
| | - Young Joo Cha
- Corporate R&D Center for Biological Standards and Control, Resources and Innovation Cooperative, Hanam, Korea
| | - Sung Do Moon
- Department of Internal Medicine, Hospital Medicine Center, Seoul National University Hospital, Seoul, Korea
| | - KeeWhan Kim
- Department of Big Data Science, Korea University, Sejong, Korea
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Cao C, Wang J, Guo T, Hu X, Li B, Wu C, Liu Z, Pan SW. Voluntary blood donation preferences in China: A discrete choice experiment among experienced and inexperienced donors. Vox Sang 2024; 119:428-438. [PMID: 38389330 DOI: 10.1111/vox.13604] [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: 09/07/2023] [Revised: 02/03/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND AND OBJECTIVES Due partly to an ageing population, China faces an increasingly dire blood shortage crisis requiring greater voluntary blood donations. A better understanding of blood donation preferences can inform blood donation policies and potentially increase donations. We used an online survey and discrete choice experiment to achieve our study objective: identify the most influential structural facilitators and barriers to voluntary blood donation in China. MATERIALS AND METHODS First, we identified six structural attributes (travel time, venue, donation volume, paid leave, scheduling and gifts) that were hypothesized to influence voluntary blood donation; attribute selection was based on a literature review and qualitative interviews. Second, a d-efficient design with 36 choice sets and 9 blocks was developed. Participants were asked to complete four choice sets, and in each choice set, they were asked to choose from three options: two voluntary blood donation scenarios and a 'Do not donate blood' option. Study participants were recruited through an online survey platform company in China. Voluntary blood donation preferences and preferences by blood donation history were estimated with random-parameter logit models and interaction terms. RESULTS In 2022, 1185 individuals enrolled in the study. Most participants had college education (92%). Generally, participants preferred longer paid leave, lower blood donation volumes and gifts after donation. Based on interaction analyses, experienced and inexperienced donors exhibited similar preferences. CONCLUSION Campaigns to increase voluntary blood donation rates in China should consider implementing paid leave after voluntary blood donation, lower blood donation volumes and small gifts conferred after donation.
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Affiliation(s)
- Chuqing Cao
- Department of Applied Mathematics, Xi'an Jiaotong-Liverpool University, Suzhou, China
| | - Jing Wang
- School of Public Health, Harvard University, Cambridge, Massachusetts, USA
| | - Tianyu Guo
- Department of Chemistry, Xi'an Jiaotong-Liverpool University, Suzhou, China
| | - Xinwen Hu
- Duke Kunshan University, Suzhou, China
| | - Bo Li
- Wisdom Lake Pharmacy Academy, Xi'an Jiaotong-Liverpool University, Suzhou, China
| | - Caixia Wu
- Department of Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, China
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, China
- Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, Chengdu, China
| | - Zhong Liu
- Department of Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, China
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, China
- Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, Chengdu, China
| | - Stephen W Pan
- Department of Health and Environmental Sciences, Xi'an Jiaotong-Liverpool University, Suzhou, China
- Department of Public Health, The University of Texas at San Antonio, San Antonio, Texas, USA
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Chegini A, Jamalian A, Abolhassani MR, Alavi AB. A review of issues and challenges of implementation of patient blood management. Asian J Transfus Sci 2024; 18:115-123. [PMID: 39036697 PMCID: PMC11259357 DOI: 10.4103/ajts.ajts_128_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 06/14/2022] [Accepted: 07/10/2022] [Indexed: 07/23/2024] Open
Abstract
INTRODUCTION Patient blood management (PBM) is outlined as evidence-based medical and surgical concepts with a multidisciplinary method. AIMS AND OBJECTIVES The aim of this article is to review the PBM implementation and analyses the issues, challenges, and opportunities. METHODOLOGY In this article, we have an overview of PBM implementation in literature and our experience in one hospital in Iran. We used databases including Embase, CINAHL, Scopus, Google Scholar, Google, Science Direct, ProQuest, ISI Web of Knowledge, and PubMed to attain the related literature published in the English language. RESULTS There are different barriers and challenges of implementation of PBM, such as hospital culture confrontation, reduced staff with restricted time, lack of interdisciplinary conversation, change of practice, the lack of experience with PBM, the feasibility to integrate PBM, electronic documentation and schedule budget for required instruments, resources, and personnel. Hospitals differ globally in the aspect of infrastructure, personnel and properties, and it is necessary to individualize according to the local situation. CONCLUSION The review highlights the importance of PBM and its implementation for obtaining patient safety. PBM establishing in hospitals as a complex process have different challenges and barriers. Sharing experiences is essential to success in the PBM programs. Cooperation between countries will be useful in PBM spreading.
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Affiliation(s)
- Azita Chegini
- Department of Immunohematology, Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Sorkheh Hesar, Tehran, Iran
| | - Ali Jamalian
- Department of Cardiac and Cardiac Surgery, Shahid Lavasani Hospital, Sorkheh Hesar, Tehran, Iran
| | | | - Ali Boroujerdi Alavi
- Department of Cardiac and Cardiac Surgery, Shahid Lavasani Hospital, Sorkheh Hesar, Tehran, Iran
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Bonn J, Baltin CT, Osterkamp V, Scheid C, Holtick U, Irsch J, Kron F. Health Economic Aspects of Platelet Concentrates: Comparing Cost and Reimbursement of Pathogen Inactivated and Conventional Platelet Concentrates in a German Comprehensive Cancer Center. Oncol Res Treat 2023; 46:362-369. [PMID: 37482056 PMCID: PMC10664333 DOI: 10.1159/000531742] [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: 12/22/2022] [Accepted: 06/19/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Pathogen inactivation (PI) utilizing amotosalen and UVA light (INTERCEPT® Blood System) is a well-established method for the production of safer platelet concentrates (PCs). While many studies describe clinical and logistical benefits of PI, the implications and potential challenges from a hospital management perspective have not yet been analyzed - health economic analyses considering reimbursement of PI are lacking. The objective of this analysis was to examine the real-life inpatient treatment costs from a hospital perspective and to assess the economic impact of PI-PC versus conventional PC (CONV-PC) administration in Germany. METHODS Real-life cost data for inpatient cancer cases from 2020 of the University Hospital Cologne were identified by operating and procedure codes. The German diagnosis-related groups, extra fees, case mix index (CMI), length of stay (LOS), and average resource consumption of PC were evaluated from a micro-management perspective. The potential economic impact of implementing PI-treated PCs was modeled retrospectively. RESULTS In total, 951 inpatient cases were analyzed (CMI [median 4.7-9.9], LOS [median 26 days], number of cases in intensive care units [38%]). The median DRG fee was between EUR 13,800 and EUR 26,400. According to our model, the use of PI-PC compared to CONV-PC would result in savings between EUR 184 and EUR 306 per case. CONCLUSION From a hospital management perspective, oncological cases requiring PC transfusion are associated with a high CMI (reimbursement per DRG flat fee) and moderate costs with sufficient add-on payment for PI on a case level. Investment and process costs for PI implementation can be analyzed for site-specific scenarios.
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Affiliation(s)
| | - Christoph T. Baltin
- VITIS Healthcare Group, Cologne, Germany
- Clinic and Polyclinic for Orthopaedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
- Competence Center for Medical Economics, FOM University of Applied Sciences, Essen, Germany
| | | | - Christof Scheid
- Department I of Internal Medicine, Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, Medical Faculty and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Udo Holtick
- Department I of Internal Medicine, Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, Medical Faculty and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | | | - Florian Kron
- VITIS Healthcare Group, Cologne, Germany
- Competence Center for Medical Economics, FOM University of Applied Sciences, Essen, Germany
- Department I of Internal Medicine, Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, Medical Faculty and University Hospital of Cologne, University of Cologne, Cologne, Germany
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Kusudo E, Murata Y, Matsumoto T, Kawamoto S, Egi M. Platelet function of whole blood after short-term cold storage: A prospective in vitro observational study. Transfusion 2023; 63:384-392. [PMID: 36477860 DOI: 10.1111/trf.17216] [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: 10/28/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is no standardized storage temperature of whole blood for acute normovolemic hemodilution (ANH). STUDY DESIGN AND METHODS We conducted a prospective observational study to examine the difference in platelet function between short-term whole blood storage at 4 and 22°C. Venous blood (40 ml) was collected from seven healthy subjects who gave prior written consent. The samples were divided into three groups: before storage (group Pre), cold (4°C) storage (group C), and room temperature (22°C) storage (group R). Groups C and R were tested after 6 h of blood storage. Platelet aggregability, platelet factor 4 (PF4), β-thromboglobulin (β-TG), P-selectin expression, pH, PO2 , PCO2 , glucose, lactate, blood count, and thromboelastography (TEG) parameters were measured. The percentage change in each parameter in groups C and R was calculated using the value in group Pre as a reference. These data were then compared between groups C and R using a Wilcoxon matched pairs test. p < 0.05 was considered to be statistically significant. RESULTS Compared with group R, group C showed significantly higher platelet aggregability with adenosine diphosphate (ADP) 2, 4, and 6 μM (all p = 0.016) and collagen 1 μg/ml (p = 0.047) stimulation, and significantly lower PF4 and β-TG elevation (both p = 0.031), glucose consumption (p = 0.031), and lactate production (p = 0.016). The ADP channel in TEG showed a significant increase in platelet aggregation rate in group C compared to group R. DISCUSSION Cold storage of whole blood in ANH may provide improved storage conditions for platelets and contribute to improved hemostasis compared to room temperature storage.
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Affiliation(s)
- Eriko Kusudo
- Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan
| | - Yutaka Murata
- Department of Anesthesia, Kitano Hospital, Osaka, Japan
| | | | - Shuji Kawamoto
- Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan
| | - Moritoki Egi
- Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan
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Harrell S, Simons AM, Clasen P. Promoting blood donation through social media: Evidence from Brazil, India and the USA. Soc Sci Med 2022; 315:115485. [PMID: 36402012 DOI: 10.1016/j.socscimed.2022.115485] [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: 04/01/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 11/10/2022]
Abstract
Social media has the potential to encourage prosocial behaviors at scale, yet very little causal evidence exists on the impact of related efforts. Blood donation is a particularly difficult, but essential prosocial behavior that is often critically undersupplied. We examine the effect of Facebook's blood donation tool on voluntary blood donation. We partnered with four major blood banks in the United States covering 363 collection facilities in 46 states and Washington, D.C. We tracked the tool's impact on blood donations during its staggered rollout on a sample of more than 47,000 facility-date observations from March 2019 to September 2019. The tool caused an increase of 0.55 total donations per facility per day (+4.0% [95% CI: 0.04%-8.0%]), and an increase of 0.15 donations from first-time donors per facility per day (+18.9% [95% CI: 4.7%-33.1%]). Longitudinal evidence from Brazil and India suggests the share of donors who both received a message from the tool and stated they were influenced by Facebook to donate increased from 0% to 14.1% [95% CI: 12.1%-16.2%] in the first year of the tool's deployment (i.e., September 2018 to August 2019). These meaningful increases, especially from first-time donors, demonstrate that social media platforms can play an important role in fostering offline prosocial behaviors that benefit the health and well-being of societies around the world.
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Guo K, Song S, Qiu L, Wang X, Ma S. Prediction of Red Blood Cell Demand for Pediatric Patients Using a Time-Series Model: A Single-Center Study in China. Front Med (Lausanne) 2022; 9:706284. [PMID: 35665347 PMCID: PMC9162489 DOI: 10.3389/fmed.2022.706284] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 04/26/2022] [Indexed: 11/25/2022] Open
Abstract
Background Red blood cells (RBCs) are an essential factor to consider for modern medicine, but planning the future collection of RBCs and supply efforts for coping with fluctuating demands is still a major challenge. Objectives This study aimed to explore the feasibility of the time-series model in predicting the clinical demand of RBCs for pediatric patients each month. Methods Our study collected clinical RBC transfusion data from years 2014 to 2019 in the National Center for Children's Health (Beijing) in China, with the goal of constructing a time-series, autoregressive integrated moving average (ARIMA) model by fitting the monthly usage of RBCs from 2014 to 2018. Furthermore, the optimal model was used to forecast the monthly usage of RBCs in 2019, and we subsequently compared the data with actual values to verify the validity of the model. Results The seasonal multiplicative model SARIMA (0, 1, 1) (1, 1, 0)12 (normalized BIC = 8.740, R2 = 0.730) was the best prediction model and could better fit and predict the monthly usage of RBCs for pediatric patients in this medical center in 2019. The model residual sequence was white noise (Ljung-Box Q(18) = 15.127, P > 0.05), and its autocorrelation function (ACF) and partial autocorrelation function (PACF) coefficients also fell within the 95% confidence intervals (CIs). The parameter test results were statistically significant (P < 0.05). 91.67% of the actual values were within the 95% CIs of the forecasted values of the model, and the average relative error of the forecasted and actual values was 6.44%, within 10%. Conclusions The SARIMA model can simulate the changing trend in monthly usage of RBCs of pediatric patients in a time-series aspect, which represents a short-term prediction model with high accuracy. The continuously revised SARIMA model may better serve the clinical environments and aid with planning for RBC demand. A clinical study including more data on blood use should be conducted in the future to confirm these results.
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Grüßer L, Keszei A, Coburn M, Rossaint R, Ziemann S, Kowark A. Intraoperative transfusion practices and perioperative outcome in the European elderly: A secondary analysis of the observational ETPOS study. PLoS One 2022; 17:e0262110. [PMID: 34982801 PMCID: PMC8726458 DOI: 10.1371/journal.pone.0262110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 12/17/2021] [Indexed: 01/28/2023] Open
Abstract
The demographic development suggests a dramatic growth in the number of elderly patients undergoing surgery in Europe. Most red blood cell transfusions (RBCT) are administered to older people, but little is known about perioperative transfusion practices in this population. In this secondary analysis of the prospective observational multicentre European Transfusion Practice and Outcome Study (ETPOS), we specifically evaluated intraoperative transfusion practices and the related outcomes of 3149 patients aged 65 years and older. Enrolled patients underwent elective surgery in 123 European hospitals, received at least one RBCT intraoperatively and were followed up for 30 days maximum. The mean haemoglobin value at the beginning of surgery was 108 (21) g/l, 84 (15) g/l before transfusion and 101 (16) g/l at the end of surgery. A median of 2 [1-2] units of RBCT were administered. Mostly, more than one transfusion trigger was present, with physiological triggers being preeminent. We revealed a descriptive association between each intraoperatively administered RBCT and mortality and discharge respectively, within the first 10 postoperative days but not thereafter. In our unadjusted model the hazard ratio (HR) for mortality was 1.11 (95% CI: 1.08-1.15) and the HR for discharge was 0.78 (95% CI: 0.74-0.83). After adjustment for several variables, such as age, preoperative haemoglobin and blood loss, the HR for mortality was 1.10 (95% CI: 1.05-1.15) and HR for discharge was 0.82 (95% CI: 0.78-0.87). Pre-operative anaemia in European elderly surgical patients is undertreated. Various triggers seem to support the decision for RBCT. A closer monitoring of elderly patients receiving intraoperative RBCT for the first 10 postoperative days might be justifiable. Further research on the causal relationship between RBCT and outcomes and on optimal transfusion strategies in the elderly population is warranted. A thorough analysis of different time periods within the first 30 postoperative days is recommended.
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Affiliation(s)
- Linda Grüßer
- Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - András Keszei
- Center for Translational & Clinical Research Aachen (CTC-A), Medical Faculty RWTH Aachen University, Aachen, Germany
| | - Mark Coburn
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Rolf Rossaint
- Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Sebastian Ziemann
- Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Ana Kowark
- Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany
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Schlesinger T. [Liberal transfusion strategy for prevention of mortality and anemia-associated ischemic events in older noncardiac surgery patients-LIBERAL study]. Anaesthesist 2021; 69:518-520. [PMID: 32291465 DOI: 10.1007/s00101-020-00752-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- T Schlesinger
- Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
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Wittock N, Monforte P, Hustinx L. "Missing minorities" in blood donation: Rethinking blood procurement in Europe as a citizenship regime. Health (London) 2021; 25:535-554. [PMID: 34015951 DOI: 10.1177/13634593211017962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although European blood collection organizations are currently obtaining sufficient and safe blood from the majority population, they report having difficulty recruiting first and second-generation immigrants from non-European countries. Most existing studies on these underrepresented groups, who have been coined the "missing minorities" in blood donation, have adopted an instrumental approach that focuses on the development of targeted recruitment strategies to overcome specific barriers to donation faced by members of these minorities. Although this approach does offer several short-term benefits, our central argument is that it is one-sided in its questioning of the non-participation of ethnic minorities. The literature currently lacks research on how the blood procurement system is failing to include minorities. Drawing on recent social theory, we seek a broader sociological understanding of minority under-representation in blood donor populations by shifting the analytic focus toward a critical examination of the main pillars of the procurement system within the European context. This paper advances a novel analytical framework based on two general propositions. First, we apply the literature on "citizenship regimes" to argue that blood donation is part of one specific institutionalization of citizenship and solidarity. We then reconceptualize the "problem" of missing minorities in European blood donation as an application for social change, suggesting avenues related to blood collection as a way of renegotiating minority-majority relations of solidarity.
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Seeking Strategies to Optimize Blood Utilization: The Preliminary Experience with Implementing a Patient Blood Management Program in a Greek Tertiary Hospital. J Clin Med 2021; 10:jcm10102141. [PMID: 34063464 PMCID: PMC8157216 DOI: 10.3390/jcm10102141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/03/2021] [Accepted: 05/14/2021] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Our aim was to assess blood utilization after implementation of a patient blood management (PBM) program in a Greek tertiary hospital. METHODS An electronic transfusion request form and a prospective audit of transfusion practice were implemented. After the one-year implementation period, a retrospective review was performed to assess transfusion practice in medical patients. RESULTS Pre-PBM, a total of 9478 RBC units were transfused (mean: 1.75 units per patient) compared with 9289 transfused units (mean: 1.57 units per patient) post-PBM. Regarding the post-PBM period, the mean hemoglobin (Hb) level of the 3099 medical patients without comorbidities transfused was 7.19 ± 0.79 gr/dL. Among them, 2065 (66.6%) had Hb levels >7.0 gr/dL, while 167 (5.3%) had Hb levels >8.0 gr/dL. In addition, 331 (25.3%) of the transfused patients with comorbidities had Hb >8.0 gr/dL. The Hb transfusion thresholds significantly differed across the clinics (p < 0.001), while 21.8% of all medical non-bleeding patients received more than one RBC unit transfusion. CONCLUSION A poor adherence with the restrictive transfusion threshold of 7.0 gr/dL was observed. The adoption of a less strict threshold might be a temporary step to allow physicians to become familiar with the program and be informed on the safety and advantages of the restrictive transfusion strategy.
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Eichler H, Feyer AK, Weitmann K, Hoffmann W, Henseler O, Opitz A, Patek A, Hans DN, Schönborn L, Greinacher A. Population-Based Analysis of the Impact of Demographics on the Current and Future Blood Supply in the Saarland. Transfus Med Hemother 2020; 48:175-182. [PMID: 34177423 DOI: 10.1159/000512645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/19/2020] [Indexed: 12/14/2022] Open
Abstract
Background The federal state of Saarland (SL) is experiencing the fastest demographic change in the western part of Germany. In this study, we analyzed retrospective data on the current and future supply of red blood cell concentrates (RBC) in this region and compared it to the current and future RBC demand in SL hospitals. Methods The projection of the SL blood supply in 2030 was modeled based on SL demographics for age distribution and donation frequency of donors, and the RBC transfusion data for in-house patients. These results were compared to published data on the transfusion demand from the state of Mecklenburg-Western Pomerania (MV). Results For the period January 1 to December 31, 2017, a total of 43,205 whole blood donations were collected. The donation frequency in SL never exceeded 80 per 1,000 inhabitants and was well below the numbers in MV. Thirty-one percent of the donors were responsible for 53.5% of the donations, and donors older than 45 years of age contributed highly to the total blood supply. In addition, 40,614 RBC transfusions at 10 SL hospitals were analyzed representing nearly all RBC transfusions for in-house patients in this region. RBC transfusions per 1,000 inhabitants increased with age from 24 (50-54) to 140 (80-84) years. Facing an already existing structural deficit of nearly 8,200 RBC in 2017, the projection predicts a dramatic increase in the regional deficit to >18,300 RBC in 2030. Conclusion Our results on RBC demand in SL are comparable but not identical to those projected for the region of MV in eastern Germany. Due to the ongoing demographic changes in Germany as a whole, regular regional monitoring of RBC demand and the age structure of blood recipients and donors should be implemented to allow for better strategic planning in blood transfusion services and hospitals.
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Affiliation(s)
- Hermann Eichler
- Universität des Saarlandes, Institut für Klinische Hämostaseologie und Transfusionsmedizin, Homburg, Germany
| | - Anna Katharina Feyer
- Universität des Saarlandes, Institut für Klinische Hämostaseologie und Transfusionsmedizin, Homburg, Germany
| | - Kerstin Weitmann
- Universitätsmedizin Greifswald, Institut für Community Medicine, Greifswald, Germany
| | - Wolfgang Hoffmann
- Universitätsmedizin Greifswald, Institut für Community Medicine, Greifswald, Germany
| | | | - Andreas Opitz
- DRK-Blutspendedienst Rheinland-Pfalz und Saarland, Bad Kreuznach, Germany
| | - Alexander Patek
- Blutspendezentrale Saar-Pfalz, Klinikum Saarbrücken, Saarbrücken, Germany
| | | | - Linda Schönborn
- Universitätsmedizin Greifswald, Institut für Immunologie und Transfusionsmedizin, Greifswald, Germany
| | - Andreas Greinacher
- Universitätsmedizin Greifswald, Institut für Immunologie und Transfusionsmedizin, Greifswald, Germany
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Bolliger D, Erb JM, Buser A. Controversies in the Clinical Practice of Patient Blood Management. J Cardiothorac Vasc Anesth 2020; 35:1933-1941. [PMID: 33277164 DOI: 10.1053/j.jvca.2020.11.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/28/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
Patient blood management (PBM) has been proposed as a standard of care in modern perioperative medicine. PBM-related interventions usually are implemented as bundles, but randomized controlled trials on the implementation of PBM as a bundle are missing. This special article focuses on the current evidence and controversies in the clinical practice of PBM and on emerging data related to specific PBM-related interventions in patients undergoing cardiac surgery. Strong evidence for many PBM-related interventions is limited because of missing studies or the poor quality of published findings and study endpoints. Restrictive blood transfusion and timely interventions to maintain hemoglobin concentration and to reduce blood loss potentially might result in improved patient outcome, although the latter has yet to be proven.
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Affiliation(s)
- Daniel Bolliger
- Department for Anesthesia, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland.
| | - Joachim M Erb
- Department for Anesthesia, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Andreas Buser
- Regional Blood Transfusion Service, Swiss Red Cross, Basel, Switzerland; Department of Hematology, University Hospital Basel, Basel, Switzerland
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Schönborn L, Weitmann K, Greinacher A, Hoffmann W. Characteristics of Recipients of Red Blood Cell Concentrates in a German Federal State. Transfus Med Hemother 2020; 47:370-377. [PMID: 33173455 PMCID: PMC7590768 DOI: 10.1159/000510207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/05/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Annual transfusion rates in many European countries range between 25 and 35 red blood cell concentrates (RBCs)/1,000 population. It is unclear why transfusion rates in Germany are considerably higher (approx. 50-55 RBCs/1,000 population). METHODS We assessed the characteristics of transfusion recipients at all hospitals of the German federal state Mecklenburg-Western Pomerania during a 10-year longitudinal study. RESULTS Although 75% of patients received ≤4 RBCs/patient in 2015 (1 RBC: 11.3%; 2 RBCs: 42.6%; 3 RBCs: 6.3%; 4 RBCs: 15.0%), the mean transfusion index was 4.6 RBCs due to a minority of patients with a high transfusion demand. Two thirds of all RBCs were transfused to only 25% of RBC recipients. Consistently, male patients received a higher number of RBCs (2005: 54.2%; 2015: 56.8%) and had a higher mean transfusion index than female patients (mean 5.1 ± 7.2; median 2; inter-quartile range [IQR] 2-4 vs. mean 4.0 ± 5.8; median 2; IQR 2-4). The absolute transfusion demand decreased between 2005 and 2015 by 13.5% due to a composite of active reduction (clinical practice change) and population decline in the 65- to 75-year age group (lower birth rate cohort 1940-1950); however, with major differences between hospitals (range from -61.0 to +41.4%). CONCLUSION Transfusion demand in a population could largely be driven by patients with high transfusion demand. Different treatment practices in this group of patients probably add to the major differences in transfusion demand per 1,000 individuals between countries. The available data cannot prove this hypothesis. Implementation of a diagnosis-related group-based monitoring system is urgently needed to allow informative monitoring on the population level and meaningful comparisons between transfusion practices.
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Affiliation(s)
- Linda Schönborn
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Kerstin Weitmann
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Andreas Greinacher
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
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Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus. Aging Clin Exp Res 2020; 32:1647-1673. [PMID: 32651902 PMCID: PMC7508736 DOI: 10.1007/s40520-020-01624-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/03/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Surgical outcomes in geriatric patients may be complicated by factors such as multiple comorbidities, low functional performance, frailty, reduced homeostatic capacity, and cognitive impairment. An integrated multidisciplinary approach to management is, therefore, essential in this population, but at present, the use of such an approach is uncommon. The Perioperative Management of Elderly patients (PriME) project has been established to address this issue. AIMS To develop evidence-based recommendations for the integrated care of geriatric surgical patients. METHODS A 14-member Expert Task Force of surgeons, anesthetists, and geriatricians was established to develop evidence-based recommendations for the pre-, intra-, and postoperative care of hospitalized older patients (≥ 65 years) undergoing elective surgery. A modified Delphi approach was used to achieve consensus, and the strength of recommendations and quality of evidence was rated using the U.S. Preventative Services Task Force criteria. RESULTS A total of 81 recommendations were proposed, covering preoperative evaluation and care (30 items), intraoperative management (19 items), and postoperative care and discharge (32 items). CONCLUSIONS These recommendations should facilitate the multidisciplinary management of older surgical patients, integrating the expertise of the surgeon, the anesthetist, the geriatrician, and other specialists and health care professionals (where available) as needed. These roles may vary according to the phase and setting of care and the patient's conditions.
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Kaufner L, von Heymann C, Henkelmann A, Pace NL, Weibel S, Kranke P, Meerpohl JJ, Gill R. Erythropoietin plus iron versus control treatment including placebo or iron for preoperative anaemic adults undergoing non-cardiac surgery. Cochrane Database Syst Rev 2020; 8:CD012451. [PMID: 32790892 PMCID: PMC8095002 DOI: 10.1002/14651858.cd012451.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Approximately 30% of adults undergoing non-cardiac surgery suffer from preoperative anaemia. Preoperative anaemia is a risk factor for mortality and adverse outcomes in different surgical specialties and is frequently the reason for blood transfusion. The most common causes are renal, chronic diseases, and iron deficiency. International guidelines recommend that the cause of anaemia guide preoperative anaemia treatment. Recombinant human erythropoietin (rHuEPO) with iron supplementation has frequently been used to increase preoperative haemoglobin concentrations in patients in order to avoid the need for perioperative allogeneic red blood cell (RBC) transfusion. OBJECTIVES To evaluate the efficacy of preoperative rHuEPO therapy (subcutaneous or parenteral) with iron (enteral or parenteral) in reducing the need for allogeneic RBC transfusions in preoperatively anaemic adults undergoing non-cardiac surgery. SEARCH METHODS We searched CENTRAL, Ovid MEDLINE(R), Ovid Embase, ISI Web of Science: SCI-EXPANDED and CPCI-S, and clinical trial registries WHO ICTRP and ClinicalTrials.gov on 29 August 2019. SELECTION CRITERIA We included all randomized controlled trials (RCTs) that compared preoperative rHuEPO + iron therapy to control treatment (placebo, no treatment, or standard of care with or without iron) for preoperatively anaemic adults undergoing non-cardiac surgery. We used the World Health Organization (WHO) definition of anaemia: haemoglobin concentration (g/dL) less than 13 g/dL for males, and 12 g/dL for non-pregnant females (decision of inclusion based on mean haemoglobin concentration). We defined two subgroups of rHuEPO dosage: 'low' for 150 to 300 international units (IU)/kg body weight, and 'high' for 500 to 600 IU/kg body weight. DATA COLLECTION AND ANALYSIS Two review authors collected data from the included studies. Our primary outcome was the need for RBC transfusion (no autologous transfusion, fresh frozen plasma or platelets), measured in transfused participants during surgery (intraoperative) and up to five days after surgery. Secondary outcomes of interest were: haemoglobin concentration (directly before surgery), number of RBC units (where one unit contains 250 to 450 mL) transfused per participant (intraoperative and up to five days after surgery), mortality (within 30 days after surgery), length of hospital stay, and adverse events (e.g. renal dysfunction, thromboembolism, hypertension, allergic reaction, headache, fever, constipation). MAIN RESULTS Most of the included trials were in orthopaedic, gastrointestinal, and gynaecological surgery and included participants with mild and moderate preoperative anaemia (haemoglobin from 10 to 12 g/dL). The duration of preoperative rHuEPO treatment varied across the trials, ranging from once a week to daily or a 5-to-10-day period, and in one trial preoperative rHuEPO was given on the morning of surgery and for five days postoperatively. We included 12 trials (participants = 1880) in the quantitative analysis of the need for RBC transfusion following preoperative treatment with rHuEPO + iron to correct preoperative anaemia in non-cardiac surgery; two studies were multiarmed trials with two different dose regimens. Preoperative rHuEPO + iron given to anaemic adults reduced the need RBC transfusion (risk ratio (RR) 0.55, 95% confidence interval (CI) 0.38 to 0.80; participants = 1880; studies = 12; I2 = 84%; moderate-quality evidence due to inconsistency). This analysis suggests that on average, the combined administration of rHuEPO + iron will mean 231 fewer individuals will need transfusion for every 1000 individuals compared to the control group. Preoperative high-dose rHuEPO + iron given to anaemic adults increased the haemoglobin concentration (mean difference (MD) 1.87 g/dL, 95% CI 1.26 to 2.49; participants = 852; studies = 3; I2 = 89%; low-quality evidence due to inconsistency and risk of bias) but not low-dose rHuEPO + iron (MD 0.11 g/dL, 95% CI -0.46 to 0.69; participants = 334; studies = 4; I2 = 69%; low-quality evidence due to inconsistency and risk of bias). There was probably little or no difference in the number of RBC units when rHuEPO + iron was given preoperatively (MD -0.09, 95% CI -0.23 to 0.05; participants = 1420; studies = 6; I2 = 2%; moderate-quality evidence due to imprecision). There was probably little or no difference in the risk of mortality within 30 days of surgery (RR 1.19, 95% CI 0.39 to 3.63; participants = 230; studies = 2; I2 = 0%; moderate-quality evidence due to imprecision) or of adverse events including local rash, fever, constipation, or transient hypertension (RR 0.93, 95% CI 0.68 to 1.28; participants = 1722; studies = 10; I2 = 0%; moderate-quality evidence due to imprecision). The administration of rHuEPO + iron before non-cardiac surgery did not clearly reduce the length of hospital stay of preoperative anaemic adults (MD -1.07, 95% CI -4.12 to 1.98; participants = 293; studies = 3; I2 = 87%; low-quality evidence due to inconsistency and imprecision). AUTHORS' CONCLUSIONS Moderate-quality evidence suggests that preoperative rHuEPO + iron therapy for anaemic adults prior to non-cardiac surgery reduces the need for RBC transfusion and, when given at higher doses, increases the haemoglobin concentration preoperatively. The administration of rHuEPO + iron treatment did not decrease the mean number of units of RBC transfused per patient. There were no important differences in the risk of adverse events or mortality within 30 days, nor in length of hospital stay. Further, well-designed, adequately powered RCTs are required to estimate the impact of this combined treatment more precisely.
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Affiliation(s)
- Lutz Kaufner
- Department of Anaesthesiology and Intensive Care Medicine, Charité - University Medicine Berlin, Berlin, Germany
| | - Christian von Heymann
- Department of Anaesthesiology, Intensive Care Medicine, Emergency Care Medicine and Pain Therapy, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Anne Henkelmann
- Department of Anaesthesiology and Intensive Care Medicine, Charité - University Medicine Berlin, Berlin, Germany
| | - Nathan L Pace
- Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
| | - Stephanie Weibel
- Department of Anaesthesia and Critical Care, University of Würzburg, Würzburg, Germany
| | - Peter Kranke
- Department of Anaesthesia and Critical Care, University of Würzburg, Würzburg, Germany
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Ravi Gill
- Department of Anaesthetics, Southampton University Hospital NHS Trust, Southampton, UK
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Olivier RMR, Fischer L, Steinbicker AU. Patient Blood Management. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2020. [DOI: 10.1007/s00398-020-00383-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Nandi AK, Roberts DJ, Nandi AK. Improved long-term time-series predictions of total blood use data from England. Transfusion 2020; 60:2307-2318. [PMID: 32691487 DOI: 10.1111/trf.15966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/25/2020] [Accepted: 06/03/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Red blood cells are essential for modern medicine but managing their collection and supply to cope with fluctuating demands represents a major challenge. As deterministic models based on predicted population changes have been problematic, there remains a need for more precise and reliable prediction of use. Here, we develop three new time-series methods to predict red cell use 4 to 52 weeks ahead. STUDY DESIGN AND METHODS From daily aggregates of red blood cell (RBC) units issued from 2005 to 2011 from the NHS Blood and Transplant, we generated a new set of non-overlapping weekly data by summing the daily data over 7 days and derived the average blood use per week over 4-week and 52-week periods. We used three new methods for linear prediction of blood use by computing the coefficients using Minimum Mean Squared Error (MMSE) algorithm. RESULTS We optimized the time-window size, order of the prediction, and order of the polynomial fit for our data set. By exploiting the annual periodicity of the data, we achieved significant improvements in long-term predictions, as well as modest improvements in short-term predictions. The new methods predicted mean RBC use with a standard deviation of the percentage error of 2.5% for 4 weeks ahead and 3.4% for 52 weeks ahead. CONCLUSION This paradigm allows short- and long-term prediction of RBC use and could provide reliable and precise prediction up to 52 weeks ahead to improve the efficiency of blood services and sufficiency of blood supply with reduced costs.
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Affiliation(s)
- Anita K Nandi
- Big Data Institute, University of Oxford, Oxford, UK
| | - David J Roberts
- Radcliffe Department of Medicine, National Health Service Blood and Transplant, Oxford Centre and BRC Haematology Theme, John Radcliffe Hospital, Oxford, UK
| | - Asoke K Nandi
- Electronic and Computer Engineering, Brunel University London, Uxbridge, UK
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21
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Park YJ, Jeon SH, Kim HK, Suh EJ, Choi SJ, Kim S, Kim HO. Human induced pluripotent stem cell line banking for the production of rare blood type erythrocytes. J Transl Med 2020; 18:236. [PMID: 32532292 PMCID: PMC7291485 DOI: 10.1186/s12967-020-02403-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/04/2020] [Indexed: 02/07/2023] Open
Abstract
Background The in vitro production of mature human red blood cells (RBCs) from induced pluripotent stem cells (iPSCs) has been the focus of research to meet the high demand for blood transfusions. However, limitations like high costs and technological requirements restrict the use of RBCs produced by iPSC differentiation to specific circumstances, such as for patients with rare blood types or alloimmunized patients. In this study, we developed a detailed protocol for the generation of iPSC lines derived from peripheral blood of donors with O D-positive blood and rare blood types (D–and Jr(a-)) and subsequent erythroid differentiation. Methods Mononuclear cells separated from the peripheral blood of O D-positive and rare blood type donors were cultured to produce and expand erythroid progenitors and reprogrammed into iPSCs. A 31-day serum-free, xeno-free erythroid differentiation protocol was used to generate reticulocytes. The stability of iPSC lines was confirmed with chromosomal analysis and RT-PCR. Morphology and cell counts were determined by microscopy observations and flow cytometry. Results Cells from all donors were successfully used to generate iPSC lines, which were differentiated into erythroid precursors without any apparent chromosomal mutations. This differentiation protocol resulted in moderate erythrocyte yield per iPSC. Conclusions It has previously only been hypothesized that erythroid differentiation from iPSCs could be used to produce RBCs for transfusion to patients with rare blood types or who have been alloimmunized. Our results demonstrate the feasibility of producing autologous iPSC-differentiated RBCs for clinical transfusions in patients without alternative options.
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Affiliation(s)
- Yu Jin Park
- Department of Laboratory Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.,Department of Laboratory Medicine, Armed Forces Yangju Hospital, Yangju-si, Gyeonggi-do, Korea
| | - Su-Hee Jeon
- Department of Laboratory Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hyun-Kyung Kim
- Department of Laboratory Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Eun Jung Suh
- Department of Laboratory Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Seung Jun Choi
- Department of Laboratory Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Sinyoung Kim
- Department of Laboratory Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hyun Ok Kim
- Department of Laboratory Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Nandi AK, Roberts DJ, Nandi AK. Prediction paradigm involving time series applied to total blood issues data from England. Transfusion 2020; 60:535-543. [PMID: 32067239 PMCID: PMC7079144 DOI: 10.1111/trf.15705] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Blood products are essential for modern medicine, but managing their collection and supply in the face of fluctuating demands represents a major challenge. As deterministic models based on predicted changes in population have been problematic, there remains a need for more precise and reliable prediction of demands. Here, we propose a paradigm incorporating four different time‐series methods to predict red blood cell (RBC) issues 4 to 24 weeks ahead. STUDY DESIGN AND METHODS We used daily aggregates of RBC units issued from 2005 to 2011 from the National Health Service Blood and Transplant. We generated a new set of nonoverlapping weekly data by summing the daily data over 7 days and derived the average blood issues per week over 4‐week periods. We used four methods for linear prediction of blood demand by computing the coefficients with the minimum mean squared error and weighted least squares error algorithms. RESULTS We optimized the time‐window size, order of the prediction, and order of the polynomial fit for our data set. The four time‐series methods, essentially using different weightings to data points, gave very similar results and predicted mean RBC issues with a standard deviation of the percentage error of 3.0% for 4 weeks ahead and 4.0% for 24 weeks ahead. CONCLUSION This paradigm allows prediction of demand for RBCs and could be developed to provide reliable and precise prediction up to 24 weeks ahead to improve the efficiency of blood services and sufficiency of blood supply with reduced costs.
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Affiliation(s)
- Anita K Nandi
- Big Data Institute, University of Oxford, Oxford, UK
| | - David J Roberts
- Radcliffe Department of Medicine, John Radcliffe Hospital, National Health Service Blood and Transplant, Oxford Centre and BRC Haematology Theme, Oxford, UK
| | - Asoke K Nandi
- Electronic and Computer Engineering, Brunel University London, Uxbridge, UK
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Olivier RMR, Fischer L, Steinbicker AU. [Patient blood management : Medical concept for increasing patient safety]. Anaesthesist 2020; 69:55-71. [PMID: 31925453 DOI: 10.1007/s00101-019-00707-3] [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] [Indexed: 02/05/2023]
Abstract
Patient blood management (PBM) is a multidisciplinary evidence-based treatment model. Aims are to provide treatment of pre-existing or recently occureed deficits in blood volume and of substances that are important for erythropoiesis in patients, as well as the targeted administration of cellular and non-cellular blood products within reasonable and scientifically proven limits. The overall goal is therefore a safe therapy and complication-free course of the disease. PBM follows a strategy based on three pillars, which encompasses the aspects of optimization of anemia and hemoglobin, the handling of bleeding and the use of patient-related resources.
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Affiliation(s)
- R M R Olivier
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - L Fischer
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Memmingen, Deutschland
| | - A U Steinbicker
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland.
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de Oliveira EM, Reis IA. What are the perspectives for blood donations and blood component transfusion worldwide? A systematic review of time series studies. SAO PAULO MED J 2020; 138:54-59. [PMID: 32321106 PMCID: PMC9673854 DOI: 10.1590/1516-3180.2019.0415.r1.06112019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/08/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Analysis of the literature suggests that changes relating to blood donations and blood component transfusion are occurring due to the aging of the population. OBJECTIVE To gain better understanding of the demand and supply of these inputs over time, and to identify the main associated demographic characteristics. DESIGN AND SETTING Systematic review conducted on time series relating to blood donations and blood component transfusions worldwide. METHODS A systematic review of the literature was conducted based on articles that presented time series relating to blood donation or blood component transfusion. RESULTS We found 1,814 articles. After the deletion process, only thirteen were read. Overall, these suggested that there is increasing demand for blood components and decreasing donation. The existence of seasonality regarding blood donation was pointed out. Men usually donated more blood and demanded more blood components than women. Approximately 50% of blood transfusions were performed in people aged ≥ 60 years. CONCLUSIONS This analysis on articles that presented time series relating to blood donations and blood component transfusion showed that aging of the population was the main factor associated with the increasing demand for blood and the decreasing supply of blood.
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Affiliation(s)
- Elias Melo de Oliveira
- MSc. Healthcare Services Manager, Department of Preventive and Social Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
| | - Ilka Afonso Reis
- PhD. Professor, Department of Statistics, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
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Lin SW, Hung YS, Lee WC, Liu CH. Optimal collecting policy for apheresis platelets in a regional blood center. Vox Sang 2019; 115:148-158. [PMID: 31729051 DOI: 10.1111/vox.12837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 06/08/2019] [Accepted: 07/16/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVES Planning platelet collection and inventory must rely not only on adequate forecasts of transfusion demand but also sophisticated mathematical modeling techniques. This research aims to develop a better demand forecasting model of apheresis platelets and a mathematical programming model to determine the best target amounts of apheresis platelet collection. MATERIALS AND METHODS Time series data of apheresis platelets collected from donors and platelets supplied to hospitals daily in Taipei Blood Center from January 2014 to December 2015 was used to fit a forecasting model which combines a regression-type model for formulating the deterministic trends and seasonal variation and an autoregressive moving average model (ARMA) for explaining remaining serial correlations. A seasonal autoregressive integrated moving average (SARIMA) model was also used for benchmarking the prediction performance. A linear programming model was then formulated to solve for the optimal daily target collection volumes that maximize the total social benefits. RESULTS The time series model achieved good predictive power with a mean absolute percentage error less than 10%. The appropriateness of the proposed target collection volumes was also verified by using a simulation model, and the proportion of the total platelets requested by hospitals that can be filled by collected apheresis platelets can increase significantly by using the new policy. CONCLUSION The methods proposed in this study can be easily implemented to enhance the management efficiency of blood collecting and supplying of a blood center, and to decrease the costs of the blood outdates and shortages.
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Affiliation(s)
- Shi-Woei Lin
- Department of Industrial Management, National Taiwan University of Science and Technology, Taipei, Taiwan
| | | | - Wan-Chen Lee
- Department of Industrial Management, National Taiwan University of Science and Technology, Taipei, Taiwan
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Tsamesidis I, Lymperaki E, Pantaleo A, Vagdatli E, Nikza P, Lettas A, Satta A, Oggiano M, Fozza C. Hematological, biochemical and antioxidant indices variations in regular blood donors among Mediterranean regions. Transfus Apher Sci 2019; 58:102659. [PMID: 31735654 DOI: 10.1016/j.transci.2019.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 09/29/2019] [Accepted: 10/03/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND & OBJECTIVES One of the most important problems in Mediterranean regions is finding blood donors to overcome the high need of its population. Understanding the health benefits of blood donation frequency will activate more volunteers to donate. The aim of this study variations of hematological and biochemical indices in regular male and female donors from Greece and Italy METHODS: A cross-sectional study consisted of 350 voluntary blood donors (VDs)was conducted in two mediterranean Blood Banks, Greece and Italy. The first one from the General Hospital of Naousa, Greece on samples of 90 regular and 60 first-time blood donors. The second one from AOU Sassari, Sardinia, Italy on convenient samples of 100 first-time samples and 100 regular blood donors. Donors' particulars were obtained from blood bank records. The hematological and biochemical parameters were determined for all donors and Total Antioxidant Status (TAS) only for greek VDs. RESULTS High frequency blood donation of Greek VDs could be associated with evidence of reduction of body iron stores, reduced oxidative stress and improvement of liver function biomarkers in regular groups. Interestingly, Sardinian regular male VDs presented increased iron stores in compare with the first time VDs. In both Mediterranean populations (Greeks and Italians) the lipid profile of the female regular blood donors has been improved in compare with the first timers. CONCLUSION Regular blood donation increases antioxidant capacity and affects positively the hematological parameters and biochemical biomarkers in donors. Gender plays an important role in relation to all hematological and biochemical parameters. Further studies in larger population should evaluate the beneficial-effect of blood donation and promote people to donate more frequent.
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Affiliation(s)
- Ioannis Tsamesidis
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy; Pharmadev, UMR 152, Université de Toulouse, IRD, UPS, Toulouse, 31400, France.
| | - Evgenia Lymperaki
- Department of Biomedical Sciences, International Hellenic University (ex- Alexander Technological Educational Institute of Thessaloniki), Greece
| | - Antonella Pantaleo
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Eleni Vagdatli
- Department of Biomedical Sciences, International Hellenic University (ex- Alexander Technological Educational Institute of Thessaloniki), Greece
| | - Polyxeni Nikza
- Naoussa General Hospital, Blood Bank Section, Naousa, Greece
| | | | - Agostino Satta
- Servizio Immunotrasfusionale Azienda Ospedaliero Universitaria (A.O.U) Sasssari, Sassari, Italy
| | - Massimiliano Oggiano
- Servizio Immunotrasfusionale Azienda Ospedaliero Universitaria (A.O.U) Sasssari, Sassari, Italy
| | - Claudio Fozza
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
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Yu X, Wang Z, Shen Y, Liu Z, Wang H, Zhang S, Gan J, Xue F, Han W, Shi X, Hu Y, Wang L, Li N, Wu P, Yang C, Jiang J. Population-based projections of blood supply and demand, China, 2017-2036. Bull World Health Organ 2019; 98:10-18. [PMID: 31902958 PMCID: PMC6933428 DOI: 10.2471/blt.19.233361] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 08/17/2019] [Accepted: 08/23/2019] [Indexed: 11/27/2022] Open
Abstract
Objective To estimate the long-term effect of the changing demography in China on blood supply and demand. Methods We developed a predictive model to estimate blood supply and demand during 2017–2036 in mainland China and in 31 province-level regions. Model parameters were obtained from World Population Prospects, China statistical yearbook 2016, China’s report on blood safety and records from a large tertiary hospital. Our main assumptions were stable age-specific per capita blood supply and demand over time. Findings We estimated that the change in demographic structure between 2016 (baseline year) and 2036 would result in a 16.0% decrease in blood supply (from 43.2 million units of 200 mL to 36.3 million units) and a 33.1% increase in demand (from 43.2 million units to 57.5 million units). In 2036, there would be an estimated shortage of 21.2 million units. An annual increase in supply between 0.9% and 1.8% is required to maintain a balance in blood supply and demand. This increase is not enough for every region as regional differences will increase, e.g. a blood demand/supply ratio ≥ 1.45 by 2036 is predicted in regions with large populations older than 65 years. Sensitivity analyses showed that increasing donations by 4.0% annually by people aged 18–34 years or decreasing the overall blood discard rate from 5.0% to 2.0% would not offset but help reduce the blood shortage. Conclusion Multidimensional strategies and tailored, coordinated actions are needed to deal with growing pressures on blood services because of China’s ageing population.
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Affiliation(s)
- Xiaochu Yu
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zixing Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, No. 5, Dong Dan San Tiao, Dong Cheng District, Beijing 100005, China
| | - Yubing Shen
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, No. 5, Dong Dan San Tiao, Dong Cheng District, Beijing 100005, China
| | - Zhong Liu
- Clinical Transfusion Research Center , Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | | | - Shumei Zhang
- School of Statistics, Beijing Normal University, Beijing, China
| | - Jia Gan
- Department of Blood Transfusion, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Fang Xue
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, No. 5, Dong Dan San Tiao, Dong Cheng District, Beijing 100005, China
| | - Wei Han
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, No. 5, Dong Dan San Tiao, Dong Cheng District, Beijing 100005, China
| | - Xin Shi
- Beijing Red Cross Blood Center, Beijing, China
| | - Yaoda Hu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, No. 5, Dong Dan San Tiao, Dong Cheng District, Beijing 100005, China
| | - Lei Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, No. 5, Dong Dan San Tiao, Dong Cheng District, Beijing 100005, China
| | - Ning Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, No. 5, Dong Dan San Tiao, Dong Cheng District, Beijing 100005, China
| | - Peng Wu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, No. 5, Dong Dan San Tiao, Dong Cheng District, Beijing 100005, China
| | - Cuihong Yang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, No. 5, Dong Dan San Tiao, Dong Cheng District, Beijing 100005, China
| | - Jingmei Jiang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, No. 5, Dong Dan San Tiao, Dong Cheng District, Beijing 100005, China
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Liberal transfusion strategy to prevent mortality and anaemia-associated, ischaemic events in elderly non-cardiac surgical patients - the study design of the LIBERAL-Trial. Trials 2019; 20:101. [PMID: 30717805 PMCID: PMC6360712 DOI: 10.1186/s13063-019-3200-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 01/16/2019] [Indexed: 01/28/2023] Open
Abstract
Background Perioperative anaemia leads to impaired oxygen supply with a risk of vital organ ischaemia. In healthy and fit individuals, anaemia can be compensated by several mechanisms. Elderly patients, however, have less compensatory mechanisms because of multiple co-morbidities and age-related decline of functional reserves. The purpose of the study is to evaluate whether elderly surgical patients may benefit from a liberal red blood cell (RBC) transfusion strategy compared to a restrictive transfusion strategy. Methods The LIBERAL Trial is a prospective, randomized, multicentre, controlled clinical phase IV trial randomising 2470 elderly (≥ 70 years) patients undergoing intermediate- or high-risk non-cardiac surgery. Registered patients will be randomised only if Haemoglobin (Hb) reaches ≤9 g/dl during surgery or within 3 days after surgery either to the LIBERAL group (transfusion of a single RBC unit when Hb ≤ 9 g/dl with a target range for the post-transfusion Hb level of 9–10.5 g/dl) or the RESTRICTIVE group (transfusion of a single RBC unit when Hb ≤ 7.5 g/dl with a target range for the post-transfusion Hb level of 7.5–9 g/dl). The intervention per patient will be followed until hospital discharge or up to 30 days after surgery, whichever occurs first. The primary efficacy outcome is defined as a composite of all-cause mortality, acute myocardial infarction, acute ischaemic stroke, acute kidney injury (stage III), acute mesenteric ischaemia and acute peripheral vascular ischaemia within 90 days after surgery. Infections requiring iv antibiotics with re-hospitalisation are assessed as important secondary endpoint. The primary endpoint will be analysed by logistic regression adjusting for age, cancer surgery (y/n), type of surgery (intermediate- or high-risk), and incorporating centres as random effect. Discussion The LIBERAL-Trial will evaluate whether a liberal transfusion strategy reduces the occurrence of major adverse events after non-cardiac surgery in the geriatric population compared to a restrictive strategy within 90 days after surgery. Trial registration ClinicalTrials.gov (identifier: NCT03369210). Electronic supplementary material The online version of this article (10.1186/s13063-019-3200-3) contains supplementary material, which is available to authorized users.
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Mirzaei S, Hershberger PE, DeVon HA. Association Between Adverse Clinical Outcomes After Coronary Artery Bypass Grafting and Perioperative Blood Transfusions. Crit Care Nurse 2019; 39:26-35. [DOI: 10.4037/ccn2019589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Background
Bleeding is a serious complication of coronary artery bypass grafting that often leads to blood transfusion. Approximately 50% of patients who have the surgery receive blood products, and blood transfusions play a role in adverse outcomes after the surgery.
Objective
To examine the association between perioperative blood transfusion and postoperative adverse outcomes in patients undergoing coronary artery bypass grafting.
Methods
A systematic review of the literature, via the matrix method of quality evaluation, was conducted. PubMed, CINAHL, and Science Direct databases for 2000 through 2016 were searched. Inclusion criteria were articles published in English and original research related to clinical outcomes of blood transfusion after coronary artery bypass grafting. Seventeen articles were included in the review.
Results
Mortality, both short- and long-term, was significantly higher in transfusion patients than in nontransfusion patients. Patients with transfusion of red blood cells had higher resource utilization and more complications, including infection, pneumonia, renal failure, graft occlusion, and atrial fibrillation, than did nontransfusion patients.
Conclusion
An association exists between red blood cell transfusions and adverse clinical outcomes for patients undergoing coronary artery bypass grafting. Transfusion of red blood cells is sometimes unnecessary, may be injurious, and should be used cautiously. Even a single-unit increase in perioperative red blood cell transfusions can have a significant adverse impact on outcomes. Individual benefits and risks should be weighed before transfusion to avoid adverse outcomes. Transfusion guidelines should be reviewed to include the latest evidence to guarantee the most appropriate use of blood products.
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Affiliation(s)
- Sahereh Mirzaei
- Sahereh Mirzaei is a doctoral student at the University of Illinois at Chicago, and a clinical practitioner in the open heart intensive care unit, University of Illinois at Chicago, College of Nursing, Chicago, Illinois
| | - Patricia E. Hershberger
- Patricia Hershberger is the doctoral instructor for the Developing Literature Reviews course at the University of Illinois at Chicago
| | - Holli A. DeVon
- Holli DeVon is the doctoral instructor for the Philosophy of Science and Evidence-Based Practice courses at the University of Illinois at Chicago
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Blood’s ontologies-entangled: Qualitative inquiry into the enactment, representation, and organizational modes of coordination of blood’s multiplicity in a Belgian blood establishment. ORGANIZATION 2018. [DOI: 10.1177/1350508418808234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Since British sociologist Titmuss authoritatively conceived blood donation as an altruistic ‘gift relationship’, blood establishments have adopted blood’s highly symbolic status as a core professional belief. However, important developments since the 1970s have resulted in blood’s bio-objectification, making blood a renewed object of concern. Because different versions of this bio-object are simultaneously present and interfere with one another, we ask how the organization renders this multiplicity workable? Studying how ontological versions are enacted in a specific blood establishment and how the organizational model of a blood establishment functions as a mode of coordination, we develop a praxiographic appreciation of blood in the context of a specific Belgian blood establishment. We show how the organizational mode of coordination allocates versions of blood in specific departments along functional and chronological dimensions. Blood remains the object of a gift relationship but is accompanied by blood’s enactment and representation as the object of suspicion, management, research/biology, and a blood economy. Furthermore, the organizational mode of coordination also allocates personalized and depersonalized enactments according to the level of contact with the donor population. This reflects a third dimension: (de)personalization of blood. Whereas the organizational mode of coordination is successful in rendering blood’s multiplicity workable, at times, it causes suboptimal practices. Moreover, we showed how sometimes a focus on intra-departmental modes of coordination is necessary to understand how blood’s multiplicity complicates the practices of the blood establishment.
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Kano C, Takanashi M, Suzuki A, Kawahara K, Chiba K, Nakanishi H, Takamatsu J, Kitai A, Takahashi K. Estimate of future blood demand in Japan and the number of blood donations required. ACTA ACUST UNITED AC 2018. [DOI: 10.1111/voxs.12453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Chiharu Kano
- Japanese Red Cross Society Blood Service Headquarters; Tokyo Japan
| | - Minoko Takanashi
- Japanese Red Cross Society Blood Service Headquarters; Tokyo Japan
| | - Asami Suzuki
- Japanese Red Cross Society Blood Service Headquarters; Tokyo Japan
| | - Kazuo Kawahara
- Medical Politics; Tokyo Medical Dental University; Tokyo Japan
| | - Koichi Chiba
- Japanese Red Cross Society Blood Service Headquarters; Tokyo Japan
| | - Hideo Nakanishi
- Japanese Red Cross Society Blood Service Headquarters; Tokyo Japan
| | - Junki Takamatsu
- Japanese Red Cross Society Blood Service Headquarters; Tokyo Japan
| | - Akiko Kitai
- Japanese Red Cross Society Blood Service Headquarters; Tokyo Japan
| | - Koki Takahashi
- Japanese Red Cross Society Blood Service Headquarters; Tokyo Japan
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Kim B, Park Y, Kim YA, Kang M, Kim S, Kim HO. Analysis of red blood cell use in elective surgeries over 12 years in Korea. Transfusion 2018; 58:2335-2344. [PMID: 30208222 DOI: 10.1111/trf.14839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/24/2018] [Accepted: 05/24/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Red blood cell (RBC) transfusion is a lifesaving process for patients with perioperative bleeding, but transfusion can cause adverse events. Effective utilization and management of blood products as a limited resource is essential when considering cost-efficiency and patient safety. STUDY DESIGN AND METHODS We analyzed the number of RBC units used during the hospitalization of patients who had undergone surgical procedures from 2002 to 2013 using National Health Insurance Service-National Sample Cohort data, which include a total of 487,238 cases for 206 selected operations. RESULTS RBC units were used in 39,637 (8.1%) cases. A total of 60,815 RBC units were transfused with a mean of 0.13 units per patient overall and a mean of 1.53 units per case receiving RBC transfusion. In addition, 56.7% of the RBC units were transfused for females, and 60.1% of RBC units were transfused into patients aged 60 or older. RBC units were used most often in orthopedic surgeries (33.8%), followed by general surgeries (12.0%) and vascular surgeries (11.8%). The number of operations performed in the cohort increased from 27,690 in 2002 to 49,473 in 2013, and the mean number of RBC units used per operation also increased from 0.08 units in 2002 to 0.15 units in 2013. CONCLUSION Continuous management for blood preparation and transfusion is needed for efficient utilization of blood. Periodic investigation on the use of blood products through nationwide studies could suggest data applicable to blood product preparation for various elective surgical operations.
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Affiliation(s)
- Banseok Kim
- Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Yongjung Park
- Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Young Ah Kim
- Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Minjin Kang
- Research Institute, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Sinyoung Kim
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun Ok Kim
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Reeves BC, Pike K, Rogers CA, Brierley RC, Stokes EA, Wordsworth S, Nash RL, Miles A, Mumford AD, Cohen A, Angelini GD, Murphy GJ. A multicentre randomised controlled trial of Transfusion Indication Threshold Reduction on transfusion rates, morbidity and health-care resource use following cardiac surgery (TITRe2). Health Technol Assess 2018; 20:1-260. [PMID: 27527344 DOI: 10.3310/hta20600] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Uncertainty about optimal red blood cell transfusion thresholds in cardiac surgery is reflected in widely varying transfusion rates between surgeons and cardiac centres. OBJECTIVE To test the hypothesis that a restrictive compared with a liberal threshold for red blood cell transfusion after cardiac surgery reduces post-operative morbidity and health-care costs. DESIGN Multicentre, parallel randomised controlled trial and within-trial cost-utility analysis from a UK NHS and Personal Social Services perspective. We could not blind health-care staff but tried to blind participants. Random allocations were generated by computer and minimised by centre and operation. SETTING Seventeen specialist cardiac surgery centres in UK NHS hospitals. PARTICIPANTS Patients aged > 16 years undergoing non-emergency cardiac surgery with post-operative haemoglobin < 9 g/dl. Exclusion criteria were: unwilling to have transfusion owing to beliefs; platelet, red blood cell or clotting disorder; ongoing or recurrent sepsis; and critical limb ischaemia. INTERVENTIONS Participants in the liberal group were eligible for transfusion immediately after randomisation (post-operative haemoglobin < 9 g/dl); participants in the restrictive group were eligible for transfusion if their post-operative haemoglobin fell to < 7.5 g/dl during the index hospital stay. MAIN OUTCOME MEASURES The primary outcome was a composite outcome of any serious infectious (sepsis or wound infection) or ischaemic event (permanent stroke, myocardial infarction, gut infarction or acute kidney injury) during the 3 months after randomisation. Events were verified or adjudicated by blinded personnel. Secondary outcomes included blood products transfused; infectious events; ischaemic events; quality of life (European Quality of Life-5 Dimensions); duration of intensive care or high-dependency unit stay; duration of hospital stay; significant pulmonary morbidity; all-cause mortality; resource use, costs and cost-effectiveness. RESULTS We randomised 2007 participants between 15 July 2009 and 18 February 2013; four withdrew, leaving 1000 and 1003 in the restrictive and liberal groups, respectively. Transfusion rates after randomisation were 53.4% (534/1000) and 92.2% (925/1003). The primary outcome occurred in 35.1% (331/944) and 33.0% (317/962) of participants in the restrictive and liberal groups [odds ratio (OR) 1.11, 95% confidence interval (CI) 0.91 to 1.34; p = 0.30], respectively. There were no subgroup effects for the primary outcome, although some sensitivity analyses substantially altered the estimated OR. There were no differences for secondary clinical outcomes except for mortality, with more deaths in the restrictive group (4.2%, 42/1000 vs. 2.6%, 26/1003; hazard ratio 1.64, 95% CI 1.00 to 2.67; p = 0.045). Serious post-operative complications excluding primary outcome events occurred in 35.7% (354/991) and 34.2% (339/991) of participants in the restrictive and liberal groups, respectively. The total cost per participant from surgery to 3 months postoperatively differed little by group, just £182 less (standard error £488) in the restrictive group, largely owing to the difference in red blood cells cost. In the base-case cost-effectiveness results, the point estimate suggested that the restrictive threshold was cost-effective; however, this result was very uncertain partly owing to the negligible difference in quality-adjusted life-years gained. CONCLUSIONS A restrictive transfusion threshold is not superior to a liberal threshold after cardiac surgery. This finding supports restrictive transfusion due to reduced consumption and costs of red blood cells. However, secondary findings create uncertainty about recommending restrictive transfusion and prompt a new hypothesis that liberal transfusion may be superior after cardiac surgery. Reanalyses of existing trial datasets, excluding all participants who did not breach the liberal threshold, followed by a meta-analysis of the reanalysed results are the most obvious research steps to address the new hypothesis about the possible harm of red blood cell transfusion. TRIAL REGISTRATION Current Controlled Trials ISRCTN70923932. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 60. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Barnaby C Reeves
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Katie Pike
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Chris A Rogers
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Rachel Cm Brierley
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Elizabeth A Stokes
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sarah Wordsworth
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rachel L Nash
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Alice Miles
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Andrew D Mumford
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Alan Cohen
- Division of Specialised Services, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Gianni D Angelini
- Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Gavin J Murphy
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Leicester, UK
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Sadler A, Shi L, Bethge S, Mühlbacher A. Incentives for Blood Donation: A Discrete Choice Experiment to Analyze Extrinsic Motivation. Transfus Med Hemother 2018; 45:116-124. [PMID: 29765295 DOI: 10.1159/000481142] [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: 04/10/2017] [Accepted: 08/26/2017] [Indexed: 11/19/2022] Open
Abstract
Background: Demographic trends affect size and age structure of populations. One of the consequences will be an increasing need for blood products to treat age-related diseases. Donation services rely on voluntariness and charitable motivation. It might be questioned whether there will be sufficient blood supply with voluntary donation. The present study focused on elicitation of preferences for incentives and aimed to contribute to the discussion on how to increase donation rates. Methods: A self-administered discrete choice experiment (DCE) was applied. Respondents were repeatedly asked to choose between hypothetical blood donation centers. In case of reluctance to receiving incentives a none-option was included. Random parameter logit (RPL) and latent class models (LCM) were used for analysis. Results: The study sample included 416 college students from the US and Germany. Choice decisions were significantly influenced by the characteristics of the donation center in the DCE. Incentives most preferred were monetary compensation, paid leave, and blood screening test. LCM identified subgroups with preference heterogeneity. Small subgroups indicated moderate to strong aversion to incentives. Conclusion: The majority of the sample positively responded to incentives and indicated a willingness to accept incentives. In face of future challenges, the judicious use and appropriate utilization of incentives might be an option to motivate potential donors and should be open to discussion.
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Affiliation(s)
- Andrew Sadler
- Gesundheitsökonomie und Medizinmanagement, Hochschule Neubrandenburg, Neubrandenburg, Germany
| | - Ling Shi
- Department of Nursing, University of Massachusetts Boston, Boston, MA, USA
| | - Susanne Bethge
- Gesundheitsökonomie und Medizinmanagement, Hochschule Neubrandenburg, Neubrandenburg, Germany
| | - Axel Mühlbacher
- Gesundheitsökonomie und Medizinmanagement, Hochschule Neubrandenburg, Neubrandenburg, Germany
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Murphy GJ, Mumford AD, Rogers CA, Wordsworth S, Stokes EA, Verheyden V, Kumar T, Harris J, Clayton G, Ellis L, Plummer Z, Dott W, Serraino F, Wozniak M, Morris T, Nath M, Sterne JA, Angelini GD, Reeves BC. Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BackgroundAnaemia, coagulopathic bleeding and transfusion are strongly associated with organ failure, sepsis and death following cardiac surgery.ObjectiveTo evaluate the clinical effectiveness and cost-effectiveness of medical devices used as diagnostic and therapeutic tools for the management of anaemia and bleeding in cardiac surgery.Methods and resultsWorkstream 1 – in the COagulation and Platelet laboratory Testing in Cardiac surgery (COPTIC) study we demonstrated that risk assessment using baseline clinical factors predicted bleeding with a high degree of accuracy. The results from point-of-care (POC) platelet aggregometry or viscoelastometry tests or an expanded range of laboratory reference tests for coagulopathy did not improve predictive accuracy beyond that achieved with the clinical risk score alone. The routine use of POC tests was not cost-effective. A systematic review concluded that POC-based algorithms are not clinically effective. We developed two new clinical risk prediction scores for transfusion and bleeding that are available as e-calculators. Workstream 2 – in the PAtient-SPecific Oxygen monitoring to Reduce blood Transfusion during heart surgery (PASPORT) trial and a systematic review we demonstrated that personalised near-infrared spectroscopy-based algorithms for the optimisation of tissue oxygenation, or as indicators for red cell transfusion, were neither clinically effective nor cost-effective. Workstream 3 – in the REDWASH trial we failed to demonstrate a reduction in inflammation or organ injury in recipients of mechanically washed red cells compared with standard (unwashed) red cells.LimitationsExisting studies evaluating the predictive accuracy or effectiveness of POC tests of coagulopathy or near-infrared spectroscopy were at high risk of bias. Interventions that alter red cell transfusion exposure, a common surrogate outcome in most trials, were not found to be clinically effective.ConclusionsA systematic assessment of devices in clinical use as blood management adjuncts in cardiac surgery did not demonstrate clinical effectiveness or cost-effectiveness. The contribution of anaemia and coagulopathy to adverse clinical outcomes following cardiac surgery remains poorly understood. Further research to define the pathogenesis of these conditions may lead to more accurate diagnoses, more effective treatments and potentially improved clinical outcomes.Study registrationCurrent Controlled Trials ISRCTN20778544 (COPTIC study) and PROSPERO CRD42016033831 (systematic review) (workstream 1); Current Controlled Trials ISRCTN23557269 (PASPORT trial) and PROSPERO CRD4201502769 (systematic review) (workstream 2); and Current Controlled Trials ISRCTN27076315 (REDWASH trial) (workstream 3).FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 17. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Gavin J Murphy
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Leicester, UK
| | - Andrew D Mumford
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Chris A Rogers
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Sarah Wordsworth
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Elizabeth A Stokes
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Veerle Verheyden
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Leicester, UK
| | - Tracy Kumar
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Leicester, UK
| | - Jessica Harris
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Gemma Clayton
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Lucy Ellis
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Zoe Plummer
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - William Dott
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Leicester, UK
| | - Filiberto Serraino
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Leicester, UK
| | - Marcin Wozniak
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Leicester, UK
| | - Tom Morris
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | - Mintu Nath
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Leicester, UK
| | - Jonathan A Sterne
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Gianni D Angelini
- Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Barnaby C Reeves
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
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Wittock N, Hustinx L, Bracke P, Buffel V. Who donates? Cross-country and periodical variation in blood donor demographics in Europe between 1994 and 2014. Transfusion 2017; 57:2619-2628. [PMID: 28840944 DOI: 10.1111/trf.14272] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/09/2017] [Accepted: 06/09/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ageing European populations put pressure on national blood supplies, increasing the need for blood and donor base rejuvenation. Therefore, we investigate how European countries' blood donor populations differ and how they have evolved over the last 2 decades. Previous comparative research, based on 1994 Eurobarometer data, indicate that the typical donor is an educated, middle-aged, white, married male. Other sociodemographic and socioeconomic correlates, such as employment status and type of community, are less clear. STUDY DESIGN AND METHODS Multilevel analyses are performed on repeated cross-level data from the Eurobarometer (waves 1994, 2002, 2009, and 2014) to compare information on "ever having donated" across sociodemographic categories, countries, and periods. RESULTS There are consistent but moderate country and period differences. The donor population rose to become largest in most countries by 2009, and stabilized thereafter. Over the studied period, donors were more likely to be higher educated, married men. Nevertheless, changes across time in donor profiles within countries did occur. Women were less likely to donate blood, especially in Southern and Eastern Europe, but this gender gap has declined. Furthermore, educational attainment seems more relevant for women, although, more recently, to a lesser extent. CONCLUSION Although there is a promising trend in which women, young people, and students are increasingly likely to donate, more attention is needed to reach the unemployed and the low to medium educated. Because the unemployed may lack structural opportunities to donate, and the low to medium educated may lack relevant knowledge on blood donation necessity, we recommend providing practical opportunities and information on the necessity of blood donation.
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Affiliation(s)
- Nathan Wittock
- Department of Sociology, Ghent University, Ghent, Belgium
| | - Lesley Hustinx
- Department of Sociology, Ghent University, Ghent, Belgium
| | - Piet Bracke
- Department of Sociology, Ghent University, Ghent, Belgium
| | - Veerle Buffel
- Department of Sociology, Ghent University, Ghent, Belgium
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Suemnig A, Konerding U, Hron G, Lubenow N, Alpen U, Hoffmann W, Kohlmann T, Greinacher A. Motivational factors for blood donation in first-time donors and repeat donors: a cross-sectional study in West Pomerania. Transfus Med 2017; 27:413-420. [PMID: 28786224 DOI: 10.1111/tme.12450] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/29/2017] [Accepted: 07/07/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study aimed to analyse motivational factors for blood donation in different donor groups. BACKGROUND As the demographic change will result in a decrease of the population in age groups of blood donors, the risk of blood product shortage increases. METHODS During a 12-month period, every sixth blood donor presenting at the blood donation centre of the University Hospital was asked to complete a self-administered questionnaire assessing motivational factors for blood donation. Despite the formalised enrolment protocol, frequent donors were over-represented in the study cohort, which was adjusted by weighting donors with different numbers of donations per year in such a way that the distribution of numbers of donations per year was the same in the sample as in the donor population. RESULTS Of 2443 participants, 14·3% were first-time and 85·3% repeat donors. To "help other people" (>90%) and receiving "medical assessment of my blood values" (63-69%) were the strongest motivational factors in all donor groups. Receiving remuneration (49·2% vs 38·1%) was more important for repeat donors than for first-time donors, whereas it was the opposite for "being taken by a friend to the donor clinic" (47·0% vs 15·5%). A potentially important observation is that 33·9% of frequent donors reported feeling physically better after blood donation compared to infrequent donors (29·5%). CONCLUSION Identification of motivational factors can lead to the design of targeted motivation campaigns for blood donation. The underlying cause of the perceived well-being after blood donation requires further studies.
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Affiliation(s)
- A Suemnig
- Institut für Immunologie und Transfusionsmedizin, Ernst-Moritz-Arndt-Universität, Greifswald, Germany
| | - U Konerding
- Trimberg Research Academy, Otto-Friedrich-Universität Bamberg, Bamberg, Germany
| | - G Hron
- Institut für Immunologie und Transfusionsmedizin, Ernst-Moritz-Arndt-Universität, Greifswald, Germany
| | - N Lubenow
- Clinical Immunology and Transfusion Medicine, University Hospital, Uppsala, Sweden
| | - U Alpen
- Institut für Immunologie und Transfusionsmedizin, Ernst-Moritz-Arndt-Universität, Greifswald, Germany
| | - W Hoffmann
- Institut für Community Medicine, Ernst-Moritz-Arndt-Universität Greifswald, Greifswald, Germany
| | - T Kohlmann
- Institut für Community Medicine, Ernst-Moritz-Arndt-Universität Greifswald, Greifswald, Germany
| | - A Greinacher
- Institut für Immunologie und Transfusionsmedizin, Ernst-Moritz-Arndt-Universität, Greifswald, Germany
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Schönborn L, Weitmann K, Greger N, Kiefel V, Hoffmann W, Greinacher A. Longitudinal Changes in the Blood Supply and Demand in North-East-Germany 2005-2015. Transfus Med Hemother 2017; 44:224-231. [PMID: 28924427 DOI: 10.1159/000479538] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/18/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Securing future blood supply is a major issue of transfusion safety. In this prospective 10-year longitudinal study we enrolled all blood donation services and hospitals of the federal state Mecklenburg-Western Pomerania. METHODS AND RESULTS From 2005 to 2015 (time period with major demographic effects), whole blood donation numbers declined by 18%. In male donors this paralleled the demographic change, while donation rates of females declined 12.4% more than expected from demography. In parallel, red cell transfusion rates/1,000 population decreased from 2005 to 2015 from 56 to 51 (-8.4%), primarily due to less transfusions in patients >60 years. However, the transfusion demand declined much less than blood donation numbers: -13.5% versus -18%, and the population >65 years (highest transfusion demand) will further increase. The key question is whether the decline in transfusion demand observed over the previous years will further continue, hereby compensating for reduced blood donation numbers due to the demographic change. The population structure of Mecklenburg-Western Pomerania reflects all Eastern German federal states, while the Western German federal states will reach similar ratios of age groups 18-64 years / ≥65 years about 10 years later. CONCLUSIONS Regular monitoring of age- and sex-specific donation and transfusion data is urgently required to allow transfusion services strategic planning for securing future blood supply.
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Affiliation(s)
- Linda Schönborn
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Kerstin Weitmann
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Nico Greger
- Institut für Transfusionsmedizin, Universitätsmedizin Rostock, Rostock, Germany
| | - Volker Kiefel
- Institut für Transfusionsmedizin, Universitätsmedizin Rostock, Rostock, Germany
| | - Wolfgang Hoffmann
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Andreas Greinacher
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
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Camaj A, Zahuranec DB, Paone G, Benedetti BR, Behr WD, Zimmerman MA, Zhang M, Kramer RS, Penn J, Theurer PF, Paugh TA, Engoren M, DeLucia A, Prager RL, Likosky DS. Organizational Contributors to the Variation in Red Blood Cell Transfusion Practices in Cardiac Surgery: Survey Results From the State of Michigan. Anesth Analg 2017; 125:975-980. [PMID: 28719425 DOI: 10.1213/ane.0000000000002277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND While large volumes of red blood cell transfusions are given to preserve life for cardiac surgical patients, indications for lower volume transfusions (1-2 units) are less well understood. We evaluated the relationship between center-level organizational blood management practices and center-level variability in low volume transfusion rates. METHODS All 33 nonfederal, Michigan cardiac surgical programs were surveyed about their blood management practices for isolated, nonemergent coronary bypass procedures, including: (1) presence and structure of a patient blood management program, (2) policies and procedures, and (3) audit and feedback practices. Practices were compared across low (N = 14, rate: 0.8%-10.1%) and high (N = 18, rate: 11.0%-26.3%) transfusion rate centers. RESULTS Thirty-two (97.0%) of 33 institutions participated in this study. No statistical differences in organizational practices were identified between low- and high-rate groups, including: (1) the membership composition of patient blood management programs among those reporting having a blood management committee (P= .27-1.0), (2) the presence of available red blood cell units within the operating room (4 of 14 low-rate versus 2 of 18 high-rate centers report that they store no units per surgical case, P= .36), and (3) the frequency of internal benchmarking reporting about blood management audit and feedback practices (low rate: 8 of 14 versus high rate: 9 of 18; P= .43). CONCLUSIONS We did not identify meaningful differences in organizational practices between low- and high-rate intraoperative transfusion centers. While a larger sample size may have been able to identify differences in organizational practices, efforts to reduce variation in 1- to 2-unit, intraoperative transfusions may benefit from evaluating other determinants, including organizational culture and provider transfusion practices.
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Affiliation(s)
- Anton Camaj
- From the *Michigan Medicine, Ann Arbor, Michigan; †Department of Neurology, University of Michigan, Ann Arbor, Michigan; ‡Division of Cardiac Surgery, Henry Ford Hospital, Detroit, Michigan; §Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan; ‖Blood Management and Conservation, Bronson Methodist Hospital, Kalamazoo, Michigan; ¶Department of Health Behavior and Health Education, School of Public Health and #Department of Biostatistics, University of Michigan, Ann Arbor, Michigan; **Division of Cardiothoracic Surgery, Maine Medical Center, Portland, Maine; ††Department of Perfusion, Bronson Methodist Hospital, Kalamazoo, Michigan; ‡‡Department of Cardiac Surgery and §§Department of Anesthesiology, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan; and ‖‖Department of Cardiothoracic Surgery, Bronson Methodist Hospital, Bronson, Michigan
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Klinkenberg EF, Romeijn B, de Kort WL, Merz EM. Reasons to end the donor career: a quantitative study among stopped blood donors in the Netherlands. Transfus Med 2017; 28:200-207. [DOI: 10.1111/tme.12442] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/07/2017] [Accepted: 06/07/2017] [Indexed: 11/26/2022]
Affiliation(s)
- E. F. Klinkenberg
- Department of Donor Studies; Sanquin Research; Amsterdam the Netherlands
- Department of Public Health, Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | - B. Romeijn
- Department of Donor Studies; Sanquin Research; Amsterdam the Netherlands
| | - W. L. de Kort
- Department of Donor Studies; Sanquin Research; Amsterdam the Netherlands
- Department of Public Health, Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | - E.-M. Merz
- Department of Donor Studies; Sanquin Research; Amsterdam the Netherlands
- Department of Sociology; VU University Amsterdam; Amsterdam the Netherlands
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41
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A population-based longitudinal study on the implication of demographic changes on blood donation and transfusion demand. Blood Adv 2017; 1:867-874. [PMID: 29296730 DOI: 10.1182/bloodadvances.2017005876] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/10/2017] [Indexed: 01/28/2023] Open
Abstract
Transfusion safety includes the risk of transmission of pathogens, appropriate transfusion thresholds, and sufficient blood supply. All industrialized countries experience major ongoing demographic changes resulting from low birth rates and aging of the baby boom generation. Little evidence exists about whether future blood supply and demand correlate with these demographic changes. The ≥50% decline in birth rate in the eastern part of Germany after 1990 facilitates systematic study of the effects of pronounced demographic changes on blood donation and demand. In this prospective, 10-year longitudinal study, we enrolled all whole blood donors and all patients receiving red blood cell transfusions in the state of Mecklenburg-West Pomerania. We compared projections made in 2005 based on the projected demographic changes with: (1) number and age distribution of blood donors and transfusion recipients in 2015 and (2) blood demand within specific age and patient groups. Blood donation rates closely followed the demographic changes, showing a decrease of -18% (vs projected -23%). In contrast, 2015 transfusion rates were -21.3% lower than projected. We conclude that although changes in demography are highly predictive for the blood supply, transfusion demand is strongly influenced by changes in medical practice. Given ongoing pronounced demographic change, regular monitoring of the donor/recipient age distributions and associated impact on blood demand/supply relationships is required to allow strategic planning to prevent blood shortages or overproduction.
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Abstract
Anemia is a common and often ignored condition in surgical patients. Anemia is usually multifactorial and iron deficiency and inflammation are commonly involved. An exacerbating factor in surgical patients is iatrogenic blood loss. Anemia has been repeatedly shown to be an independent predictor of worse outcomes. Patient blood management (PBM) provides a multimodality framework for prevention and management of anemia and related risk factors. The key strategies in PBM include support of hematopoiesis and improving hemoglobin level, optimizing coagulation and hemostasis, use of interdisciplinary blood conservation modalities, and patient-centered decision making throughout the course of care.
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Affiliation(s)
- Aryeh Shander
- Department of Anesthesiology and Critical Care Medicine, Englewood Hospital and Medical Center, TeamHealth Research Institute, 350 Engle Street, Englewood, NJ 07631, USA.
| | - Gregg P Lobel
- Department of Anesthesiology and Critical Care Medicine, Englewood Hospital and Medical Center, TeamHealth Research Institute, 350 Engle Street, Englewood, NJ 07631, USA
| | - Mazyar Javidroozi
- Department of Anesthesiology and Critical Care Medicine, Englewood Hospital and Medical Center, TeamHealth Research Institute, 350 Engle Street, Englewood, NJ 07631, USA
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Kaufner L, von Heymann C, Henkelmann A, Pace NL, Weibel S, Kranke P, Meerpohl JJ, Gill R. Erythropoietin with iron supplementation for preoperative anaemia in non‐cardiac surgery. Cochrane Database Syst Rev 2016; 2016:CD012451. [PMCID: PMC6463842 DOI: 10.1002/14651858.cd012451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: We aim to evaluate the efficacy and safety of preoperative erythropoietin (rHuEPO) with supplemental iron (parenteral or oral) in reducing perioperative allogeneic red blood cell transfusions in preoperatively anaemic people undergoing non‐cardiac surgery.
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Affiliation(s)
- Lutz Kaufner
- Charité ‐ University Medicine BerlinDepartment of Anaesthesiology and Intensive Care MedicineAugustenburger Platz 1BerlinGermany13353
| | - Christian von Heymann
- Vivantes Klinikum im FriedrichshainDepartment of Anaesthesiology, Intensive Care Medicine, Emergency Care Medicine and Pain TherapyLandsberger Allee 49BerlinGermany10249
| | - Anne Henkelmann
- Charité ‐ University Medicine BerlinDepartment of Anaesthesiology and Intensive Care MedicineAugustenburger Platz 1BerlinGermany13353
| | - Nathan Leon Pace
- University of UtahDepartment of Anesthesiology3C444 SOM30 North 1900 EastSalt Lake CityUSA84132‐2304
| | - Stephanie Weibel
- University of WürzburgDepartment of Anaesthesia and Critical CareOberduerrbacher Str. 6WürzburgGermany
| | - Peter Kranke
- University of WürzburgDepartment of Anaesthesia and Critical CareOberduerrbacher Str. 6WürzburgGermany
| | - Joerg J Meerpohl
- Medical Center ‐ University of FreiburgCochrane GermanyBreisacher Straße 153FreiburgGermany79110
| | - Ravi Gill
- Southampton University Hospital NHS TrustDepartment of AnaestheticsTremona RoadSouthamptonUKSO16 6YD
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Fillet AM, Desmarets M, Assari S, Quaranta JF, François A, Pugin A, Schuhmacher A, Lassale B, Monnet E, Cabre P, Legrand D, Binda D, Djoudi R. Blood products use in France: a nationwide cross-sectional survey. Transfusion 2016; 56:3033-3041. [DOI: 10.1111/trf.13887] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 07/22/2016] [Accepted: 07/24/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Anne-Marie Fillet
- Medical Department; Etablissement Français du Sang; La Plaine Saint Denis France
| | - Maxime Desmarets
- Centre d'investigation clinique Inserm CIC1431; CHRU de Besançon; Besançon France
| | - Suzanne Assari
- Medical Department; Etablissement Français du Sang; La Plaine Saint Denis France
| | | | - Anne François
- Medical Department; Etablissement Français du Sang; La Plaine Saint Denis France
| | - Aurore Pugin
- Centre d'investigation clinique Inserm CIC1431; CHRU de Besançon; Besançon France
| | - Anne Schuhmacher
- Etablissement Français du Sang, Lorraine Champagne; Nancy France
| | | | - Elisabeth Monnet
- Centre d'investigation clinique Inserm CIC1431; CHRU de Besançon; Besançon France
| | - Philippe Cabre
- Agence régionale de santé; Nord-Pas-de-Calais-Picardie France
| | | | - Delphine Binda
- Centre d'investigation clinique Inserm CIC1431; CHRU de Besançon; Besançon France
| | - Rachid Djoudi
- Medical Department; Etablissement Français du Sang; La Plaine Saint Denis France
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Red blood cell use in Switzerland: trends and demographic challenges. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2016; 16:73-82. [PMID: 27723455 DOI: 10.2450/2016.0079-16] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/20/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Several studies have raised concerns that future demand for blood products may not be met. The ageing of the general population and the fact that a large proportion of blood products is transfused to elderly patients has been identified as an important driver of blood shortages. The aim of this study was to collect, for the first time, nationally representative data regarding blood donors and transfusion recipients in order to predict the future evolution of blood donations and red blood cell (RBC) use in Switzerland between 2014 and 2035. MATERIALS AND METHODS Blood donor and transfusion recipient data, subdivided by the subjects' age and gender were obtained from Regional Blood Services and nine large, acute-care hospitals in various regions of Switzerland. Generalised additive regression models and time-series models with exponential smoothing were employed to estimate trends of whole blood donations and RBC transfusions. RESULTS The trend models employed suggested that RBC demand could equal supply by 2018 and could eventually cause an increasing shortfall of up to 77,000 RBC units by 2035. DISCUSSION Our study highlights the need for continuous monitoring of trends of blood donations and blood transfusions in order to take proactive measures aimed at preventing blood shortages in Switzerland. Measures should be taken to improve donor retention in order to prevent a further erosion of the blood donor base.
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Greinacher A, Weitmann K, Lebsa A, Alpen U, Gloger D, Stangenberg W, Kiefel V, Hoffmann W. A population-based longitudinal study on the implications of demographics on future blood supply. Transfusion 2016; 56:2986-2994. [PMID: 27667497 DOI: 10.1111/trf.13814] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/08/2016] [Accepted: 07/26/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Changes in demographics with increases in older age groups and decreases in younger age groups imply an increased demand for blood transfusions paralleled by a decrease in the population eligible for blood donation. However, more restrictive transfusion triggers and the patient blood management initiative also reduce the demand for red blood cells (RBCs). Eastern Germany is a model region for the impact of demographic changes, which manifest in this region approximately 10 years earlier than in other regions due to the 50% birth rate decline after 1989. STUDY DESIGN AND METHODS We report the 2010 longitudinal 5-year follow-up of the study assessing all whole blood donations and RBC transfusions in Mecklenburg-West Pomerania. We compared the projections that were made 5 years ago with: 1) the current age structure of the blood donor and transfusion recipient populations and 2) its impact on blood demand and blood donation numbers in specific age groups. RESULTS Transfusion rates were lower and blood donation rates were higher than predicted in 2005. Although transfusion rates/1000 decreased in nearly all age groups, the overall annual transfusion rate increased to 66.4 RBC units/1000 (in 2005, 62.2/1000) due to the absolute increase in the elderly population. Despite a 7.4% decline in the population 18 to 65 years of age, whole blood donations increased by 11.7% between 2005 and 2010, but thereafter decreased by 21% (first-time donors by 39.4%), reflecting the effect of the post-1990 birth rate decline on the donor population. CONCLUSION Changes in demography and medical practice impact the delicate balance between available blood supply and potential future transfusion needs. In times of pronounced demographic changes, regular monitoring of the blood demand and age structure of blood recipients and donors is required to allow strategic planning to prevent blood shortages or overproduction.
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Affiliation(s)
| | - Kerstin Weitmann
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Anne Lebsa
- Institut für Immunologie und Transfusionsmedizin, Greifswald
| | - Ulf Alpen
- Institut für Immunologie und Transfusionsmedizin, Greifswald
| | - Doris Gloger
- Haema Blutspendezentrum Rostock, Rostock, Germany
| | - Wolfgang Stangenberg
- Blutspendedienst Deutsches Rotes Kreuz Mecklenburg-Vorpommern, Neubrandenburg, Germany
| | - Volker Kiefel
- Institut für Transfusionsmedizin, Universitätsmedizin Rostock, Rostock, Germany
| | - Wolfgang Hoffmann
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
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47
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Nielsen AE, Nielsen ND. Assessing productive efficiency and operating scale of community blood centers. Transfusion 2016; 56:1267-73. [PMID: 26830252 DOI: 10.1111/trf.13493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 12/14/2015] [Accepted: 12/14/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND In recent years demand for blood products has decreased, and as a result, the blood product marketplace has become much more competitive. Reducing inefficiency in the procurement and processing of blood products at blood centers can reduce costs while assuring that demand for blood products is met. STUDY DESIGN AND METHODS This study uses data envelopment analysis to compare the productive efficiency of 65 community blood centers to determine to what extent efficiency can be improved, what cost savings and increases in platelet (PLT) production may be obtained by eliminating inefficiency, and what scales of operation are the most efficient from a budgetary and staffing standpoint. Data were collected from the 2012 to 2013 AABB Directory of Community Blood Centers and Hospital Blood Banks. RESULTS The study found that 27 of 65 blood centers are efficient. The remaining 38 blood centers can reduce budget and staff levels and may be able to expand output. If inefficient centers were to eliminate all inefficiency, the total savings would be $671 million, approximately 20% of the aggregated budget ($3.45 billion) of all centers in the study. In addition, the centers would also see a 36% increase in PLT production. Inefficiency of some large blood centers stems from operating at too large a scale, while inefficiency of most small blood centers is scale independent. CONCLUSION The results suggest that reducing inefficiency in blood procurement may be a good strategy to maximize competitiveness in the blood product marketplace. These findings further suggest that the trend of blood center consolidation may be ill advised from a cost containment perspective.
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Affiliation(s)
| | - Nathan D Nielsen
- Department of Medicine, Section of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University School of Medicine, New Orleans, Louisiana
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Kamhieh-Milz S, Kamhieh-Milz J, Tauchmann Y, Ostermann T, Shah Y, Kalus U, Salama A, Michalsen A. Regular blood donation may help in the management of hypertension: an observational study on 292 blood donors. Transfusion 2015; 56:637-44. [PMID: 26643612 DOI: 10.1111/trf.13428] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/09/2015] [Accepted: 10/09/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Hypertension is one of the leading global risks for cardiovascular events worldwide. There is preliminary evidence that regular blood donation may be beneficial. STUDY DESIGN AND METHODS Unselected blood donors were included in this observational study. Blood pressure (BP) was measured before and after blood donation, with participants donating between one and four occasions in a 1-year study period. RESULTS In this study, 292 donors were enrolled. At baseline, 146 had elevated BP (> 140/90 mmHg). In hypertensives, after four blood donations, systolic and diastolic blood pressure (SBP and DBP, respectively) decreased from a mean of 155.9 ± 13.0 to 143.7 ± 15.0 mmHg and from 91.4 ± 9.2 to 84.5 ± 9.3 mmHg, respectively (each p < 0.001). There was a clear dose effect with decreasing BP by the increasing number of blood donations. After at least four blood donations, donors with Stage II hypertensive baseline values (≥ 160 mmHg SBP and/or ≥ 100 mmHg DBP) were found to have the most marked reduction in BP, with 17.1 mmHg (95% confidence interval [CI], -23.2 to -11.0; p < 0.0001) and 11.7 mmHg (95% CI, -17.1 to -6.1; p = 0.0006) for SBP and DBP, respectively. The decrease in BP was not significantly associated with changes of blood count or variables of iron metabolism. CONCLUSIONS Regular blood donation is associated with pronounced decreases of BP in hypertensives. This beneficial effect of blood donation may open a new door regarding community health care and cost reduction in the treatment of hypertension.
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Affiliation(s)
- Sundrela Kamhieh-Milz
- Institute of Social Medicine, Epidemiology and Health Economics.,Institute of Transfusion Medicine, Charité University Medicine Berlin, Berlin, Germany
| | - Julian Kamhieh-Milz
- Institute of Transfusion Medicine, Charité University Medicine Berlin, Berlin, Germany
| | - Yvonne Tauchmann
- Institute of Transfusion Medicine, Charité University Medicine Berlin, Berlin, Germany
| | - Thomas Ostermann
- Faculty of Medicine, Centre for Integrative Medicine, University of Witten/Herdecke, Herdecke, Germany
| | - Yatin Shah
- Institute of Social Medicine, Epidemiology and Health Economics.,Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Ulrich Kalus
- Institute of Transfusion Medicine, Charité University Medicine Berlin, Berlin, Germany
| | - Abdulgabar Salama
- Institute of Transfusion Medicine, Charité University Medicine Berlin, Berlin, Germany
| | - Andreas Michalsen
- Institute of Social Medicine, Epidemiology and Health Economics.,Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Berlin, Germany
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Yuan S, Chang S, Uyeno K, Almquist G, Wang S. Blood donation mobile applications: are donors ready? Transfusion 2015; 56:614-21. [DOI: 10.1111/trf.13387] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/11/2015] [Accepted: 09/12/2015] [Indexed: 01/18/2023]
Affiliation(s)
- Shan Yuan
- Division of Transfusion Medicine Department of Pathology and Laboratory Medicine; City of Hope National Medical Center; Duarte California
| | - Shelley Chang
- Division of Transfusion Medicine Department of Pathology and Laboratory Medicine; UCLA School of Medicine; Los Angeles California
| | - Kasie Uyeno
- Division of Transfusion Medicine Department of Pathology and Laboratory Medicine; City of Hope National Medical Center; Duarte California
| | - Gay Almquist
- Division of Transfusion Medicine Department of Pathology and Laboratory Medicine; City of Hope National Medical Center; Duarte California
| | - Shirong Wang
- Division of Transfusion Medicine Department of Pathology and Laboratory Medicine; City of Hope National Medical Center; Duarte California
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Tinegate H, Pendry K, Murphy M, Babra P, Grant-Casey J, Hopkinson C, Hyare J, Rowley M, Seeney F, Watson D, Wallis J. Where do all the red blood cells (RBCs) go? Results of a survey of RBC use in England and North Wales in 2014. Transfusion 2015; 56:139-45. [DOI: 10.1111/trf.13342] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 08/02/2015] [Accepted: 08/03/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Hazel Tinegate
- Patients' Clinical Team; NHS Blood and Transplant; Newcastle upon Tyne
| | - Kate Pendry
- Patients' Clinical Team; NHS Blood and Transplant; Newcastle upon Tyne
| | - Michael Murphy
- Patients' Clinical Team; NHS Blood and Transplant; Newcastle upon Tyne
| | - Paul Babra
- National Comparative Audit of Blood Transfusion; NHS Blood and Transplant; Newcastle upon Tyne
| | - John Grant-Casey
- National Comparative Audit of Blood Transfusion; NHS Blood and Transplant; Newcastle upon Tyne
| | - Cathy Hopkinson
- Statistics and Clinical Studies; NHS Blood and Transplant; Newcastle upon Tyne
| | - Jot Hyare
- Transfusion Department; University Hospital of Leicester; Leicester, UK
| | - Megan Rowley
- Patients' Clinical Team; NHS Blood and Transplant; Newcastle upon Tyne
| | - Frances Seeney
- Statistics and Clinical Studies; NHS Blood and Transplant; Newcastle upon Tyne
| | - Denise Watson
- Transfusion Department; University Hospital of Leicester; Leicester, UK
| | - Jonathan Wallis
- Department of Haematology; Newcastle upon Tyne Hospitals NHS Foundation Trust; Newcastle upon Tyne UK
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