Impact of 13.56-MHz radiofrequency identification systems on the quality of stored red blood cells

Mobile phone induced EMF stress is reversed upon the use of protective devices: results from two experiments testing different boundary conditions

This work examines (a) the impact of electromagnetic fields (EMF) on heart rate variability (HRV), saliva cortisol, arterial blood oxygenation, and tympanic temperature, and (b) the potential effect of protective devices developed to counter EMF-induced stress. In a pilot study, recordings were taken during a 15-min mobile phone call emitting a high burden of EMF (electric, magnetic, high frequency) after a baseline measurement at rest with very low EMF. In a second visit, this was repeated with participants using three protective devices (insoles, pendant, mobile phone chip). In the main study, four experimental arms were employed, two of which replicated the experimental setup of the pilot study, and two of which examined the effect of only one mobile phone chip in an open-hidden-paradigm. In both experiments, exposure to EMF decreased HRV and increased salivary cortisol. In the protective experimental condition, HRV increased above and cortisol decreased below the level of the baseline measures. All differences were large and specific and not modulated by non-specific effects like placebo effects.

A structured approach to analyse logistics risks in the blood transfusion process

Blood transfusion is a critical health care process due to the nature of the products handled and the complexity driven by the strong interdependence among the sub-processes involved. Most of the errors causing adverse events originate during the blood logistics activities. Several literature contributions apply risk management to the transfusion process but often in a fragmented and reactive way. Moreover, few of them focus on logistics risks and assess the effectiveness of risk responses through operational key performance indicators (KPIs). The present paper applies a comprehensive and structured approach to proactively identify and analyse logistics risks as well as define responses to improve blood bag traceability, focusing on hospital wards. The implementation of such actions is monitored by specific KPIs whose measurement enables an improved communication flow among actors allowing to uncover residual risks. Future research will extend the application to further blood transfusion settings and supply chain echelons. The outcomes of this work might assist practitioners in improving policy making about blood supply chains. As a matter of fact, they allow a better understanding of the associated material and informational flows and the related risks, which supports setting effective strategies to either prevent adverse events or mitigate their effects.

Evaluating the Impact of Radio Frequency Identification Retained Surgical Instruments Tracking on Patient Safety: Literature Review

BACKGROUND

Retained surgical instruments (RSI) are one of the most serious preventable complications in operating room settings, potentially leading to profound adverse effects for patients, as well as costly legal and financial consequences for hospitals. Safety measures to eliminate RSIs have been widely adopted in the United States and abroad, but despite widespread efforts, medical errors with RSI have not been eliminated.

OBJECTIVE

Through a systematic review of recent studies, we aimed to identify the impact of radio frequency identification (RFID) technology on reducing RSI errors and improving patient safety.

METHODS

A literature search on the effects of RFID technology on RSI error reduction was conducted in PubMed and CINAHL (2000-2016). Relevant articles were selected and reviewed by 4 researchers.

RESULTS

After the literature search, 385 articles were identified and the full texts of the 88 articles were assessed for eligibility. Of these, 5 articles were included to evaluate the benefits and drawbacks of using RFID for preventing RSI-related errors. The use of RFID resulted in rapid detection of RSI through body tissue with high accuracy rates, reducing risk of counting errors and improving workflow.

CONCLUSIONS

Based on the existing literature, RFID technology seems to have the potential to substantially improve patient safety by reducing RSI errors, although the body of evidence is currently limited. Better designed research studies are needed to get a clear understanding of this domain and to find new opportunities to use this technology and improve patient safety.

The Value of Radio Frequency Identification in Quality Management of the Blood Transfusion Chain in an Academic Hospital Setting

Background

A complex process like the blood transfusion chain could benefit from modern technologies such as radio frequency identification (RFID). RFID could, for example, play an important role in generating logistic and temperature data of blood products, which are important in assessing the quality of the logistic process of blood transfusions and the product itself.

Objective

This study aimed to evaluate whether location, time stamp, and temperature data generated in real time by an active RFID system containing temperature sensors attached to red blood cell (RBC) products can be used to assess the compliance of the management of RBCs to 4 intrahospital European and Dutch guidelines prescribing logistic and temperature constraints in an academic hospital setting.

Methods

An RFID infrastructure supported the tracking and tracing of 243 tagged RBCs in a clinical setting inside the hospital at the blood transfusion laboratory, the operating room complex, and the intensive care unit within the Academic Medical Center, a large academic hospital in Amsterdam, the Netherlands. The compliance of the management of 182 out of the 243 tagged RBCs could be assessed on their adherence to the following guidelines on intrahospital storage, transport, and distribution: (1) RBCs must be preserved within an environment with a temperature between 2°C and 6°C; (2) RBCs have to be transfused within 1 hour after they have left a validated cooling system; (3) RBCs that have reached a temperature above 10°C must not be restored or must be transfused within 24 hours or else be destroyed; (4) unused RBCs are to be returned to the BTL within 24 hours after they left the transfusion laboratory.

Results

In total, 4 blood products (4/182 compliant; 2.2%) complied to all applicable guidelines. Moreover, 15 blood products (15/182 not compliant to 1 out of several guidelines; 8.2%) were not compliant to one of the guidelines of either 2 or 3 relevant guidelines. Finally, 148 blood products (148/182 not compliant to 2 guidelines; 81.3%) were not compliant to 2 out of the 3 relevant guidelines.

Conclusions

The results point out the possibilities of using RFID technology to assess the quality of the blood transfusion chain itself inside a hospital setting in reference to intrahospital guidelines concerning the storage, transport, and distribution conditions of RBCs. This study shows the potentials of RFID in identifying potential bottlenecks in hospital organizations’ processes by use of objective data, which are to be tackled in process redesign efforts. The effect of these efforts can subsequently be evaluated by the use of RFID again. As such, RFID can play a significant role in optimization of the quality of the blood transfusion chain.

High-frequency (13.56-MHz) and ultrahigh-frequency (915-MHz) radio identification systems do not affect platelet activation and functions

BACKGROUND

In radiofrequency identification (RFID) systems used in labeling of blood components, blood cells are subjected to the direct influence of electromagnetic waves throughout the storage period. The aim of this study was to prove the safety of storage of platelet concentrates (PCs) in containers labeled with RFID tags.

STUDY DESIGN AND METHODS

Ten pooled PCs obtained from 12 buffy coats each suspended in additive solution were divided into three separate containers that were assigned to three groups: control, PCs labeled with ultrahigh frequency (UHF) range tags and exposed to 915-MHz radio waves, and PCs labeled with high-frequency (HF) range tags and exposed to 13.56-MHz radio waves. PCs were stored at 20 to 24°C for 7 days. In vitro tests of platelet (PLT) function were performed on the first, fifth, and seventh days of storage.

RESULTS

There were no significant differences in pH; hypotonic shock resistance; surface expression of CD62P, CD42a, or CD63; release of PLT-derived microparticles; PLT aggregation; and number of PLTs between PCs stored at a constant exposure to radio waves of two different frequencies and the control group on the first, fifth, and seventh days of storage.

CONCLUSION

The results of the study indicate no impact of electromagnetic radiation generated in HF and UHF RFID systems and constant contact with the tags on the quality of stored PCs.

Effects of Electromagnetic Fields on Automated Blood Cell Measurements

The aim of this study is to investigate whether the electromagnetic fields associated with mobile phones and/or laptops interfere with blood cell counts of hematology analyzers. Random blood samples were analyzed on an Aperture Impedance hematology analyzer. The analysis was performed in four ways: (A) without the presence of any mobile phone or portable computer in use, (B) with mobile phones in use (B1: one mobile, B4: four mobiles), (C) with portable computers (laptops) in use (C1: one laptop, C3: three laptops), and (D) with four mobile phones and three laptops in use simultaneously. The results obtained demonstrated a statistically significant decrease in neutrophil, erythrocyte, and platelet count and an increase in lymphocyte count, mean corpuscular volume, and red blood cell distribution width, notably in the B4 group. Despite this statistical significance, in clinical practice, only the red blood cell reduction could be taken into account, as the mean difference between the A and B4 group was 60,000 cells/µL. In group D, the analyzer gave odd results after 11 measurements and finally stopped working. The combined and multiple use of mobile phones and computers affects the function of hematology analyzers, leading to false results. Consequently, the use of such electronic devices must be avoided.

Impact of constant storage temperatures and multiple warming cycles on the quality of stored red blood cells

BACKGROUND

Red blood cells (RBCs) are routinely stored in liquid state at temperatures below 6°C, and RBC unit core temperature should not exceed 10°C during transport. Since the critical temperature of 10°C was chosen mostly arbitrarily, this study investigated the effect of both constant temperature settings as well as multiple rewarming cycles on stored RBCs with respect to morphology, biochemical parameters and haemolysis.

MATERIALS AND METHODS

Buffy coat-depleted filtered RBCs were used as standard products. RBCs were stored at 1-6°C (reference group, n = 12), 13 and 22°C (test groups, n = 12 each) or stored at 1-6°C and warmed up five times to 10, 13, or 22°C for a period of 24 h each. Various biochemical parameters were measured weekly. RBCs were further investigated using electron microscopy.

RESULTS

Red blood cells stored constantly at 13 or 22°C showed stable haemolysis rates until day 28 and day 14, respectively. RBCs stored at 1-6°C with five warming-up periods to 10, 13 or 22°C each lasting 24 h (total 120 h) did not exceed the limit of the haemolysis rate at the end of storage. Differently shaped erythrocytes were found in all samples, but more crenate erythrocytes appeared after 42 days of storage independent of temperature profiles.

CONCLUSION

Red cells can be kept at constant temperatures above 6°C without apparent harmful effects at least until day 14, whereas multiple warming cycles for no longer than 24 h at 10, 13 or 22°C with subsequent cooling do not cause quality loss as assessed using the in vitro assays employed in this study.

Thermometry of red blood cell concentrate: magnetic resonance decoding warm up process

PURPOSE

Temperature is a key measure in human red blood cell concentrate (RBC) quality control. A precise description of transient temperature distributions in RBC units removed from steady storage exposed to ambient temperature is at present unknown. Magnetic resonance thermometry was employed to visualize and analyse RBC warm up processes, to describe time courses of RBC mean, surface and core temperatures by an analytical model, and to determine and investigate corresponding model parameters.

METHODS

Warm-up processes of 47 RBC units stored at 1-6°C and exposed to 21.25°C ambient temperature were investigated by proton resonance frequency thermometry. Temperature distributions were visualized and analysed with dedicated software allowing derivation of RBC mean, surface and core temperature-time courses during warm up. Time-dependence of mean temperature was assumed to fulfil a lumped capacitive model of heat transfer. Time courses of relative surface and core temperature changes to ambient temperature were similarly assumed to follow shifted exponential decays characterized by a time constant and a relative time shift, respectively.

RESULTS

The lumped capacitive model of heat transfer and shifted exponential decays described time-dependence of mean, surface and core temperatures close to perfect (mean R(2) were 0.999±0.001, 0.996±0.004 and 0.998±0.002, respectively). Mean time constants were τmean = 55.3±3.7 min, τsurface = 41.4±2.9 min and τcore = 76.8±7.1 min, mean relative time shifts were Δsurface = 0.07±0.02 and Δcore = 0.04±0.01. None of the constants correlated significantly with temperature differences between ambient and storage temperature.

CONCLUSION

Lumped capacitive model of heat transfer and shifted exponential decays represent simple analytical formulas to describe transient mean, surface and core temperatures of RBC during warm up, which might be a helpful tool in RBC temperature monitoring and quality control. Independence of constants on differences between ambient and storage temperature suggests validity of models for arbitrary storage and ambient temperatures.

Impact on storage quality of red blood cells and platelets by ultrahigh-frequency radiofrequency identification tags

BACKGROUND

Compared to ISBT128 code labels, radiofrequency identification (RFID) tags have incomparable advantages and gradually applied in blood management system. However, there is no global standard for the uses of RFID frequency. Even though ISBT recommended high-frequency RFID with 13.56MHz, 820- to 960-MHz ultrahigh frequency (UHF) RFID technology in many ways has even more advantages. For this reason, we studied the effect of UHF RFID tags with 820- to 960-MHz exposure on storage quality of red blood cells (RBCs) and platelets (PLTs).

STUDY DESIGN AND METHODS

Thirty units of collected and prepared suspended RBCs (sRBCs) and PLTs were divided into two bags, one each for the test and control groups. The sRBCs were stored in 4±2°C refrigerator and the PLTs in a 22±2°C rocking box. The test groups were exposed to RF reader continuously during storage. Sampling at different time points and biologic changes were tested.

RESULTS

As the extension of storage and the pH and chlorine levels in the supernatant of sRBCs were reduced, free hemoglobin, potassium, and sodium increased, but were not significant between test and control groups (p>0.05). During the storage period, the pH levels, PLT count, and PLT aggregation rate were decreased in both test and control groups, but were not significant (p>0.05).

CONCLUSION

When exposed to 820- to 960-MHz RF, the biologic and biochemical indexes are not found to be exacerbated during 35 days of storage for sRBCs and 5 days for PLTs, respectively.