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Simsek Şimşek AK, Ecevit Alpar SŞ, Cayli Çaylı N. Nurses' self-efficiency levels in safe blood and blood component transfusion: The case of Turkey. Transfus Apher Sci 2024; 63:103888. [PMID: 38368120 DOI: 10.1016/j.transci.2024.103888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE The study aimed to determine nurses' self-efficacy levels for safe transfusion of blood and blood components. METHOD The design of this study is descriptive and cross-sectional. Before starting the study, ethics committee approval and institution approval was obtained. The participants were informed about the purpose of the study, and their written consent was obtained. The research was conducted between the dates 01 March 2022 and 01 May 2022, a private hospital in Turkey. The study sample consisted of 482 nurses. Data were collected using descriptive characteristics form and the Safe Blood and Blood Products Transfusion Self-Efficacy Scale (SBT-SES). RESULTS The total SBT-SES scores of the nurses were high (202.7 ± 50.1), and the behavioral sub-factor self-efficacy scores were moderate (48.2 ± 19.5). When the SBT-SES scores were analyzed based on demographic characteristics, it was found that those who had received previous safe blood transfusion training scored higher than those who had not, and women scored higher than men (p < 0.05). In addition, no relationship was found between age, working time, number of weekly blood transfusions, and self-efficacy levels. DISCUSSION As a result, nurses' self-efficacy levels towards blood transfusion are high. However, the behavioral sub-factor self-efficacy level is not sufficient. CONCLUSION Based on these results, in order to increase the behavioral self-efficacy levels of nurses, our recommendations are as follows: investigating appropriate training methods, considering the sex factor when choosing training methods and techniques, investigating the barriers to safe transfusion behaviors, and measuring self-efficacy levels at regular intervals.
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Affiliation(s)
| | | | - Nazan Cayli Çaylı
- Medicana Ataşehir Hospital, Department of Education, Istanbul, Turkey
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2
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Madkaiker D, Iyer K, Jagriti, Chenna D, Mohan G, Shastry S. S.O.S. - Save our supplies: Understanding reasons to tackle the challenge of wasted returned blood products. Transfus Clin Biol 2024; 31:76-80. [PMID: 38211935 DOI: 10.1016/j.tracli.2024.01.003] [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: 10/19/2023] [Revised: 12/26/2023] [Accepted: 01/03/2024] [Indexed: 01/13/2024]
Abstract
OBJECTIVES To evaluate the return of blood components across different hospital areas, reasons for the same and suggest preventive strategies which might reduce out of controlled temperature storage (CTS) blood logistics and wastage. MATERIAL AND METHODS A retrospective audit was carried out in the department of Transfusion Medicine from January 2019 to December 2022. Data related to returned blood components was compiled using departmental records and blood centre software entries. RESULTS A total of 218 instances of returned components were noted and the total number of components returned were 442 (0.4% of all issued components) (38.4% (170) packed red blood cells, 16.2% (72) single donor cryoprecipitate concentrate, 19.6% (87) platelet concentrate and 25.5% (113) fresh frozen plasma). Components were returned back within 30 mins in only 27% (59/218) of all instances . Wards followed by high dependency units/intensive care units were noted to have the highest number of instances (86 (39.4%) and 69 (31.6%) respectively) with emergency department having the least,comprising 19 instances (8.7%). 77.9% (170/218) instances were observed for routine transfusion requests and 44.5% (97/218) of all instances could have been prevented by an appropriate clinical status assessment of the patient. CONCLUSION Stakeholders such as clinicians, transfusion laboratory professional and nursing staff must take consolidated efforts to eliminate wastage of blood components. Instances of returned blood components can be targeted by the hospital quality team as a quality improvement project.
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Affiliation(s)
- Deep Madkaiker
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kartik Iyer
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Jagriti
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Deepika Chenna
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ganesh Mohan
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shamee Shastry
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
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3
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Staves J, Ashford P, Bullock T, Coates T, Lodge L, Patel N, Rowley M, Sargant N, George CE. Guidelines for the specification, implementation and management of IT systems in hospital transfusion laboratories: A British Society for Haematology Guideline. Transfus Med 2024; 34:83-111. [PMID: 38265158 DOI: 10.1111/tme.13027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/27/2023] [Accepted: 12/12/2023] [Indexed: 01/25/2024]
Affiliation(s)
- Julie Staves
- Transfusion Laboratory, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Paul Ashford
- IT consultant, Roper Management Consultants Ltd, Kent, UK
| | - Tom Bullock
- Red Cell Immunohaematology, NHS Blood and Transplant, Bristol, England
| | - Tony Coates
- Transfusion Laboratory, Betsi Cadwaladr University Health Board, Wales, UK
| | - Linda Lodge
- Clinical Services, Scottish National Blood Transfusion Service, Edinburgh, Scotland
| | - Nishil Patel
- Haematology, Royal Free London NHS Foundation Trust, Barnet, UK
| | - Megan Rowley
- Clinical Services, Scottish National Blood Transfusion Service, Edinburgh, Scotland
| | - Nigel Sargant
- Haematology, East Sussex Healthcare NHS Trust, East Sussex, UK
| | - Chloë E George
- Clinical Services, Welsh Blood Service, Velindre NHS Trust, Cardiff, UK
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4
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Naik S, Nirale A, Bharadwaj S, Sangeetha RP, Shukla D, Kamath S. Post-operative anemia in children undergoing elective neurosurgery: An analysis of incidence, risk factors, and outcomes. J Neurosci Rural Pract 2024; 15:29-33. [PMID: 38476436 PMCID: PMC10927067 DOI: 10.25259/jnrp_338_2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/05/2023] [Indexed: 03/14/2024] Open
Abstract
Objectives Pediatric neurosurgeries carry a considerable risk of intraoperative bleeding and, subsequently, anemia in the post-operative period. Postoperative anemia is often multifactorial with several factors contributing to its occurrence. The present study aims to quantify the incidence of postoperative anemia, identify potential risk factors, and assess the impact of post-operative anemia on clinical outcomes in the pediatric neurosurgery population. Materials and Methods This was a single-center and retrospective cohort study which included children <18 years of age undergoing elective neurosurgery. The data were extracted from the electronic and physical patient health records. Post-operative anemia was defined for this study as a hemoglobin value below 10 g/dL at any time up to 3 days after surgery. Results A total of 300 children were recruited during the study period. The incidence of post-operative anemia after elective pediatric neurosurgery was 21.33%. Children in the post-operative anemia group were younger (P = 0.004), had lower pre-operative hemoglobin values (P < 0.001), belonged to higher American Society of Anesthesiologists (ASA) physical status (P = 0.023), underwent predominantly supratentorial (P = 0.041) and non-tumor surgeries (0.004), and received lesser intraoperative blood transfusion (P = 0.010) compared to no post-operative anemia group. The factors that remained predictive of post-operative anemia on multivariate analysis were ASA physical status (P = 0.018, odds ratio [OR] = 1.94, 95% confidence interval [CI] of 1.12-3.36), pre-operative hemoglobin (P < 0.001, OR = 0.64, 95% CI of 0.50-0.82), and intraoperative transfusion (P = 0.028, OR = 0.45, 95% CI of 0.22-0.92). Conclusion Optimization of modifiable risk factors is essential to reduce the occurrence of post-operative anemia and improve outcomes in pediatric neurosurgical patients.
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Affiliation(s)
- Shweta Naik
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Amruta Nirale
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suparna Bharadwaj
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - R. P. Sangeetha
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sriganesh Kamath
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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5
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Boudreaux J. Transfusion management in thalassemia. Ann N Y Acad Sci 2023; 1527:42-48. [PMID: 37531552 DOI: 10.1111/nyas.15049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
This review describes the current challenges and recommendations in the transfusion management of thalassemia patients. In addition, it reviews the components of blood safety and blood product modification in special populations. Adverse transfusion reactions are described as are some of the newer technologies being utilized to reduce potential transfusion-associated pathogens. Lastly, research in blood storage and in manufactured blood is briefly described.
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Affiliation(s)
- Jeanne Boudreaux
- Aflac Cancer & Blood Disorders Center, Emory University, Atlanta, Georgia, USA
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6
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Soutar R, McSporran W, Tomlinson T, Booth C, Grey S. Guideline on the investigation and management of acute transfusion reactions. Br J Haematol 2023; 201:832-844. [PMID: 37211954 DOI: 10.1111/bjh.18789] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 05/23/2023]
Affiliation(s)
- Richard Soutar
- Garnavel General Hospital NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | | | - Catherine Booth
- NHS Blood and Transplant, London, UK
- Barts Health NHS Trust, London, UK
| | - Sharran Grey
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
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7
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Arora S, Goel R, Al-Riyami AZ, Al-Rawas AH, Al Hosni S, Montanari M, Costantini B, Ling CLL, Mustafa N, Joo CK, Dhawan HK, Malhotra S, Sharma RR, New H, Moss R, Davis J, Robitaille N, Arsenault V, Saifee NH, Taroc AM, Rahimi-Levene N, Peer V, Badawi M, Snijder PM, Huisman EJ, Salegui JZ, Pato JR, Navarro JS, Kutner JM, Yokoyama APH, Lam JCM, Zhong XN, Heng ML, Torres OW, Dhabangi A, van Zyl A, Mundey N, Louw V, van den Berg K, Dunbar N. International Forum on Small-Volume Transfusions in Neonates and Paediatric Patients: Responses. Vox Sang 2023; 118:230-251. [PMID: 36648446 DOI: 10.1111/vox.13398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/18/2023]
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8
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Al-Riyami AZ, Bielby L, Moss R, Rahimi-Levene N, O'Kane A, Hess JR, Saba NE, Kim KH, Arora S, Dua S, Barrett CL, Gonzalez CA, Ferrari DM, Cini PV, Kumagawa M, O'Reilly C, Thrift L, Wendel S, Fachini R, Dias LFS, Tran D, Steinsvåg CT, Dunbar N. International Forum on Transfusion Education for Healthcare Professionals Who Administer Blood to Patients in Hospitals and Health Services: Responses. Vox Sang 2023; 118:319-336. [PMID: 36762629 DOI: 10.1111/vox.13409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 02/11/2023]
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9
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Panteli M, Vun JSH, Ahmadi M, West RM, Howard AJ, Chloros G, Pountos I, Giannoudis PV. Blood loss and transfusion risk in intramedullary nailing for subtrochanteric fractures. Transfus Med 2023; 33:49-60. [PMID: 36053808 DOI: 10.1111/tme.12904] [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: 01/04/2022] [Revised: 04/16/2022] [Accepted: 07/26/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The incidence of hip fractures and subtrochanteric fractures in particular is increasing, along with the globally expanding aging population. Intramedullary nailing remains the 'gold standard' of their treatment. Blood loss can be a result of the original trauma, but also secondary to the subsequent surgical insult, especially during the reaming of the intramedullary canal. OBJECTIVES The aim of our study was to report on the blood loss and incidence of blood transfusion in patients presenting with a subtrochanteric fracture treated with intramedullary nailing. Most importantly, we aim to identify factors associated with the need for transfusion within the first 48 h post-operatively. METHODS Following institutional board approval, 431 consecutive patients (131 males; age: 79.03 years old, SD 13.68 years) presenting in a Level 1 Trauma Centre with a subtrochanteric fracture treated with an intramedullary nail were retrospectively identified, over an 8-year period. Exclusion criteria included patients with high energy injuries, pathological fractures, primary operations at other institutions and patients lost to follow-up. To identify risk factors leading to increased risk of transfusion, we first compared patients requiring intra-operative transfusion or transfusion during the first 48 h post-operatively against those who did not require transfusion. This was then followed by multivariate regression analysis adjusted for confounding factors to identify the most important risk factors associated with need for transfusion within the first 48 h post-operatively. RESULTS Incidence of blood transfusion was 6.0% pre-operatively, compared to 62.7% post-operatively. A total of 230 patients (52.3%) required either intra-operative transfusion or transfusion during the first 48 h following surgery. Patients having a transfusion within the first 48 h post-operatively had a higher incidence of escalation in their care (p = 0.050), LOS (p = 0.015), 30-day (p = 0.033) and one-year mortality (p = 0.004). Multivariate regression analysis adjusted for confounding factors identified that the most important association of a need for transfusion within the first 48 post-operative hours was a pre-operative Hb <100 g/L (OR 6.64); a nail/canal ratio <70% (OR 3.92), followed by need for open reduction (OR 2.66). Fracture involving the lesser trochanter was also implicated with an increased risk (OR 2.08). Additionally, pre-operative moderate/severe renal impairment (OR 4.56), as well as hypoalbuminaemia on admission (OR 2.10) were biochemical predictors of an increased risk of transfusion. Most importantly, the need for transfusion was associated with an increase in 30-day mortality (OR 12.07). CONCLUSION Several patient, fracture and surgery related factors are implicated with an increased risk for transfusion within the first 48-h post-operatively. Early identification, and where possible correction of these factors can potentially reduce blood loss and risk of transfusion, along with all the associated sequelae and mortality risk. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Michalis Panteli
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,Leeds Orthopaedic & Trauma Sciences, Leeds General Infirmary, University of Leeds, Leeds, UK
| | - James S H Vun
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,Leeds Orthopaedic & Trauma Sciences, Leeds General Infirmary, University of Leeds, Leeds, UK
| | - Milad Ahmadi
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK
| | - Robert M West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Anthony J Howard
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,Leeds Orthopaedic & Trauma Sciences, Leeds General Infirmary, University of Leeds, Leeds, UK
| | - George Chloros
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,Leeds Orthopaedic & Trauma Sciences, Leeds General Infirmary, University of Leeds, Leeds, UK
| | - Ippokratis Pountos
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Peter V Giannoudis
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,Leeds Orthopaedic & Trauma Sciences, Leeds General Infirmary, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
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10
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Plowright C, Ross Deveau S, Fazzini B, Ringer J, Cooper H, Dawson D. BACCN
position statement on non‐medical prescribing in critical care. Nurs Crit Care 2022. [DOI: 10.1111/nicc.12866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | - Jo Ringer
- East Kent Hospitals University NHS Foundation Trust Canterbury United Kingdom
| | | | - Deborah Dawson
- St George's University Hospitals NHS Foundation Trust London United Kingdom
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11
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Cheng JY, Samudram H, Lee Lai Ling C, Nadarajan VS. Deviations in red cell blood component temperature during laboratory processing and at blood return monitored by a time-temperature indicator device. Transfus Med 2022; 32:484-491. [PMID: 36239101 DOI: 10.1111/tme.12924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/13/2022] [Accepted: 09/29/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the performance and utility of a time-temperature indicator (TTI) to determine the cumulative exposure time (CET) of red cell components (RCC) to temperatures above 10°C occurring within and outside the transfusion laboratory. BACKGROUND AND OBJECTIVES Blood centres often use the '30 or 60-min rule' for accepting RCC exposed to room temperature (RT) back into inventory. Effective monitoring of these temperature deviations is however lacking. MATERIALS AND METHODS A Timestrip PLUS® TP153 10°C (TS + 10) TTI was attached to RCC units after preparation of the unit in the blood bank or on issue to the ward, to track the CET > 10°C during laboratory processing and outside the transfusion laboratory. RESULTS The mean CET of 153 RCC tracked within the laboratory was 56 min. Sixty-four (41.8%) and 34 (22.2%) of RCC had core temperature (CT) >10°C for more than 30 and 60 min, respectively. Among the 69 RCC that were returned unused, 27 (39.1%), 17 (24.6%) and 5 (7.2%) RCC units had CT >10°C for more than 30, 60 and 120 min respectively. CONCLUSION A large proportion of RCC have CT >10°C exceeding 30 min during handling within the transfusion laboratory, as well as when RCC are returned unused from transfusion locations. Corrective measures should be implemented to better manage the cold chain to avoid undesirable consequences to blood transfusion. A temperature sensitive device that can also indicate CET can be employed to objectively monitor the period that RCC remained at a CT that exceeds 10°C.
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Affiliation(s)
- Jian Yuan Cheng
- Department of Transfusion Medicine, University Malaya Medical Centre, Jalan Professor Diraja Ungku Aziz, Kuala Lumpur, Malaysia
| | - Hemalatha Samudram
- Department of Transfusion Medicine, University Malaya Medical Centre, Jalan Professor Diraja Ungku Aziz, Kuala Lumpur, Malaysia
| | - Christina Lee Lai Ling
- Department of Transfusion Medicine, University Malaya Medical Centre, Jalan Professor Diraja Ungku Aziz, Kuala Lumpur, Malaysia
| | - Veera Sekaran Nadarajan
- Department of Transfusion Medicine, University Malaya Medical Centre, Jalan Professor Diraja Ungku Aziz, Kuala Lumpur, Malaysia.,Department of Preclinical Sciences, Faculty of Medicine and Health Sciences, University Tunku Abdul Rahman, Kajang, Malaysia
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12
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Stanworth SJ, Dowling K, Curry N, Doughty H, Hunt BJ, Fraser L, Narayan S, Smith J, Sullivan I, Green L. A guideline for the haematological management of major haemorrhage: a British Society for Haematology Guideline. Br J Haematol 2022; 198:654-667. [PMID: 35687716 DOI: 10.1111/bjh.18275] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 12/17/2022]
Affiliation(s)
- Simon J Stanworth
- Transfusion Medicine, NHS Blood and Transplant, Oxford, UK.,Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Radcliffe Department of Medicine, University of Oxford, and NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Kerry Dowling
- Transfusion Laboratory Manager, Southampton University Hospitals NHS Foundation Trust, Southampton, UK
| | - Nikki Curry
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Radcliffe Department of Medicine, University of Oxford, and NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Heidi Doughty
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK
| | - Beverley J Hunt
- Department of Haematology, Guy's and St Thomas's Hospital, London, UK
| | - Laura Fraser
- Transfusion Practitioner, NHS Lanarkshire, University Hospital Wishaw, Wishaw, UK.,National Services Scotland/Scottish National Blood Transfusion, Edinburgh, UK
| | - Shruthi Narayan
- Medical director, Serious Hazards of Transfusion, Manchester, UK
| | - Juliet Smith
- Lead Transfusion Practitioner, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ian Sullivan
- Transfusion Laboratory Manager, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Laura Green
- Transfusion Medicine, NHS Blood and Transplant, London, UK.,Barts Health NHS Trust, London, UK.,Blizzard Institute, Queen Mary University of London, London, UK
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13
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Wolf J, Geneen LJ, Meli A, Doree C, Cardigan R, New HV. Hyperkalaemia Following Blood Transfusion–a Systematic Review Assessing Evidence and Risks. Transfus Med Rev 2022; 36:133-142. [DOI: 10.1016/j.tmrv.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 11/30/2022]
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14
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Czempik PF, Gierczak D, Wilczek D, Krzych ŁJ. The Impact of Red Blood Cell Transfusion on Blood Lactate in Non-Bleeding Critically Ill Patients-A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11041037. [PMID: 35207310 PMCID: PMC8879325 DOI: 10.3390/jcm11041037] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/05/2022] [Accepted: 02/16/2022] [Indexed: 02/04/2023] Open
Abstract
Anemia should preferably be managed without red blood cell transfusion (RBCT); instead, therapy should be focused on causes of anemia along with efforts to minimize blood loss. Lactate could potentially be used as a physiologic RBCT trigger, although there are some limitations to its interpretation. The aim of our study was to analyze the impact of RBCT on blood lactate with consideration of factors known to increase its concentration and to assess the usefulness of blood lactate as a potential physiologic RBCT trigger. We performed a retrospective analysis of all RBCT episodes in non-bleeding critically ill patients. We retrieved demographic data, data on RBCT itself (duration, type of RBC, volume of RBC, age of RBC), laboratory parameters (lactate, hemoglobin, glucose, total bilirubin), and factors potentially increasing lactate. We analyzed 77 RBCTs with elevated pre-RBCT lactate. The median age of patients was 66 (IQR 57–73) years and the distribution of sexes was even. The named factors potentially influencing lactate had no impact on its concentration. The median pre-post RBCT lactate was 2.44 (IQR 2.08–3.27) and 2.13 (IQR 1.75–2.88) mmol/L, respectively (p < 0.01); the median decrease was 0.41 (IQR 0.07–0.92) mmol/L. We conclude that RBCT did not normalize mildly elevated lactate. Common causes of elevated lactate probably had no impact on its concentration. Therefore lactate may have a limited role as a physiologic RBCT trigger in non-bleeding severely anemic critically ill patients.
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Affiliation(s)
- Piotr F. Czempik
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
- Correspondence: ; Tel.: +48-32-7894201
| | - Dawid Gierczak
- Students’ Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (D.G.); (D.W.)
| | - Dawid Wilczek
- Students’ Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (D.G.); (D.W.)
| | - Łukasz J. Krzych
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
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15
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O' Herlihy N, Griffin S, Gaffney R, Henn P, Khashan AS, Ring M, Gallagher A, Cahill MR. Proficiency-based progression intern training to reduce critical blood sampling errors including ‘wrong blood in tube’. HRB Open Res 2021. [DOI: 10.12688/hrbopenres.13329.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Blood sampling errors including ‘wrong blood in tube’ (WBIT) may have adverse effects on clinical outcomes. WBIT errors occur when the blood sample in the tube is not that of the patient identified on the label. This study aims to determine the effect of proficiency-based progression (PBP) training in phlebotomy on the rate of blood sampling errors (including WBIT). Methods: A non-randomised controlled trial compared the blood sampling error rate of 43 historical controls who had not undergone PBP training in 2016 to 44 PBP trained interventional groups in 2017. In 2018, the PBP training programme was implemented and the blood sampling error rate of 46 interns was compared to the 43 historical controls in 2016. Data analysis was performed using logistic regression analysis adjusting for sample timing. Results: In 2016, 43 interns had a total blood sample error rate of 2.4%, compared to 44 interns in 2017, who had error rate of 1.2% (adjusted OR=0.50, 95% CI 0.36-0.70; <0.01). In 2018, 46 interns had an error rate of 1.9% (adjusted OR=0.89, 95% CI 0.65-1.21; p=0.46) when compared to the 2016 historical controls. There were three WBITs in 2016, three WBITs in 2017 and five WBITs in 2018. Conclusions: The study demonstrates that PBP training in phlebotomy has the potential to reduce blood sampling errors. Trial registration number: NCT03577561
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16
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McSporran W. Role of the nurse in patient blood management and treating anaemia. Nurs Stand 2021; 36:73-78. [PMID: 34664434 DOI: 10.7748/ns.2021.e11671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2021] [Indexed: 11/09/2022]
Abstract
Patient blood management has been defined as a patient-focused and evidence-based approach to optimising the management of patients during the transfusion of blood components. This article explores the complex factors that can influence clinical decisions and enhance patient safety in the administration of blood components, particularly red blood cell transfusions in patients with anaemia. The article also explores the nurse's role in acting as a patient advocate and considering alternatives to the use of blood components. While this article focuses on anaemia-related transfusions, the author relates the principles of patient blood management to all transfusion care.
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17
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Dunbar NM, Kaufman RM. Factors associated with wrong blood in tube errors: An international case series - The BEST collaborative study. Transfusion 2021; 62:44-50. [PMID: 34726274 DOI: 10.1111/trf.16716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/03/2021] [Accepted: 10/11/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND A wrong blood in tube (WBIT) error signifies a blood sample that does not match the patient identified on the sample label. WBIT errors can result in ABO mistransfusions. STUDY DESIGN AND METHODS In this international, multicenter, descriptive study, healthcare facilities provided detailed information on WBIT errors occurring from 1/1/2019 to 12/31/2020. Factors contributing to WBIT errors were classified as protocol violations, knowledge gaps, and slips/lapses. RESULTS 331 WBIT errors were compiled from 36 centers in 11 countries. WBIT errors were most frequently detected through pretransfusion sample testing (191, 58%), with 38 (20%) detected by a second ("check") sample. WBIT errors were divided almost evenly between intended patient drawn/wrong label applied (166, 50%) and wrong patient drawn/intended label applied (158, 48%). Information on contributing factors was available for 260 WBIT errors; most involved a combination of protocol violations and slips/lapses (139, 53%). The most frequent contributing factor was another patient's sample labels or tubes being available during phlebotomy (61%). Protocol violations were more likely to result in wrong patient being drawn (p = .0007). In 43 WBIT errors, electronic positive patient identification (ePPID) was not used when available or was used incorrectly. CONCLUSIONS Protocol violations and slips/lapses frequently contribute to WBIT errors. Sample collection processes should be designed to minimize error opportunities; staff should be educated on why protocol compliance is critical for patient safety. Using ePPID does not eliminate all WBIT errors. Institutions using ePPID may elect to require check sample verification as an added safety measure.
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Affiliation(s)
- Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Richard M Kaufman
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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18
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Blood Transfusion Knowledge among Nurses in Malaysia: A University Hospital Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111194. [PMID: 34769712 PMCID: PMC8582655 DOI: 10.3390/ijerph182111194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 01/10/2023]
Abstract
Blood transfusion is a fundamental and life-saving procedure where the consequence of errors can be fatal. Nurses’ knowledge plays an essential role in ensuring quality and safety in blood transfusion. The objective of this study was to assess blood transfusion-associated knowledge of tertiary hospital nurses on the east coast of Malaysia. This was a cross-sectional study with 200 registered nurses involved in blood transfusion procedures at Hospital Universiti Sains Malaysia. The knowledge of the nurses was evaluated by using the routine blood transfusion knowledge questionnaire based on five parts, and <50%, 50–74%, or ≥75% of the knowledge was considered as poor, moderate, or high, respectively. Based on the scoring system, the overall knowledge of blood transfusion among Malaysian nurses (33.2 ± 8.4 years) was estimated to be 54.9 ± 7.6%. In individual items, the scoring was 81.0%, 45.4%, 49.2%, 63.0%, and 90.0% in knowledge prior to blood transfusion, on pre-transfusion, on post-transfusion, on complications, and on transfusion policy, respectively. The findings of this study indicated that most of the nurses’ overall knowledge of blood transfusion was at a moderate level; therefore, training courses and continuous medical education are warranted to improve knowledge and skills of the nurses to ensure good practices of blood transfusion.
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Manduzio P. Transfusion-associated graftversus- host disease: A brief comment on blood safety. Hematol Rep 2021; 13:9280. [PMID: 34650784 PMCID: PMC8451072 DOI: 10.4081/hr.2021.9280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/06/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Palma Manduzio
- Diagnostic Department, Clinical Pathology, Agostino Murri Civil Hospital of Fermo, Italy
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20
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Doughty H, Green L. Transfusion support during mass casualty events. Br J Anaesth 2021; 128:e75-e79. [PMID: 34503826 DOI: 10.1016/j.bja.2021.07.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/17/2021] [Accepted: 07/12/2021] [Indexed: 12/24/2022] Open
Abstract
Transfusion support is an essential element of modern emergency healthcare. Blood services together with hospital transfusion teams are required to prepare for, and respond to, mass casualty events as part of wider healthcare emergency planning. Preparedness is a constant collaborative process that actively identifies and manages potential risks, to prevent such events becoming a 'disaster'. The aim of transfusion support during incidents is to provide sufficient and timely supply of blood components and diagnostic services, whilst maintaining support to other patients not involved in the event.
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Affiliation(s)
- Heidi Doughty
- NHS Blood and Transplant, UK; NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK.
| | - Laura Green
- NHS Blood and Transplant, UK; Barts Health NHS Trust, London, UK; Blizzard Institute, Queen Mary University of London, London, UK
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21
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Amon CC, Paley AR, Forbes JA, Guzman LV, Rajwani AA, Trzcinka A, Comenzo RL, Drzymalski DM. Implementing structured handoffs to verify operating room blood delivery using a quality academy training program: an interrupted time-series analysis. Int J Qual Health Care 2021; 33:6213818. [PMID: 33825860 DOI: 10.1093/intqhc/mzab061] [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: 01/11/2021] [Revised: 03/02/2021] [Accepted: 04/06/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Blood transfusion is a complex process at risk for error. OBJECTIVE To implement a structured handoff during the blood transfusion process to improve delivery verification. METHODS A multidisciplinary team participated in the quality academy training program at an academic medical center and implemented a structured handoff of blood delivery to the operating room (OR) using Plan-Do-Study-Act cycles between 28 October 2019 and 1 December 2019. An interrupted time-series analysis was performed to investigate the proportions of verified deliveries (primary outcome) and of verified deliveries among those without a handoff (secondary outcome). Delivery duration was also assessed. RESULTS A total of 2606 deliveries occurred from 1 July 2019 to 19 April 2020. The baseline trend for verified deliveries was unchanging [parameter coefficient -0.0004; 95% confidence interval (CI) -0.002 to 0.001; P = 0.623]. Following intervention, there was an immediate level change (parameter coefficient 0.115; 95% CI 0.053 to 0.176; P = 0.001) without slope change (parameter coefficient 0.002; 95% CI -0.004 to 0.007; P = 0.559). For the secondary outcome, there was no immediate level change (parameter coefficient -0.039; 95% CI -0.159 to 0.081; P = 0.503) or slope change (parameter coefficient 0.002; 95% CI -0.022 to 0.025; P = 0.866). The mean (SD) delivery duration during the intervention was 12.4 (2.8) min and during the post-intervention period was 9.6 (1.6) min (mean difference 2.8; 95% CI 0.9 to 4.8; P = 0.008). CONCLUSION Using the quality academy framework supported the implementation of a structured handoff during blood delivery to the OR, resulting in a significant increase in verified deliveries.
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Affiliation(s)
- Carly C Amon
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, USA
| | - Adina R Paley
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, USA
| | - Judith A Forbes
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, 800 Washington St, Boston, MA 02111, USA
| | - Leidy V Guzman
- Department of Quality and Patient Safety, Tufts Medical Center, 800 Washington St, Boston, MA 02111, USA
| | - Aliysa A Rajwani
- Department of Quality and Patient Safety, Tufts Medical Center, 800 Washington St, Boston, MA 02111, USA
| | - Agnieszka Trzcinka
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, USA.,Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, 800 Washington St #298 Ziskind Building, 6th Floor, Boston, MA 02111, USA
| | - Raymond L Comenzo
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, USA.,Department of Pathology and Laboratory Medicine, Tufts Medical Center, 800 Washington St, Boston, MA 02111, USA
| | - Dan M Drzymalski
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, USA.,Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, 800 Washington St #298 Ziskind Building, 6th Floor, Boston, MA 02111, USA
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22
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Cottrell S. How to safely collect and deliver blood components for transfusion. Nurs Stand 2021; 36:79-82. [PMID: 34151550 DOI: 10.7748/ns.2021.e11644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 11/09/2022]
Abstract
RATIONALE AND KEY POINTS There are several steps in the transfusion process that aim to ensure the correct blood component is given to the correct patient at the correct time. Ensuring the correct blood component is collected for the correct patient is crucial to safe transfusion practice and patient safety. This article explains the blood component collection and delivery procedure in the UK and outlines the steps that are necessary to enable nurses to collect blood components safely. Nurses in other countries can access their local guidelines and protocols and review these against the guidelines outlined in this article. REFLECTIVE ACTIVITY How to articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of.
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Affiliation(s)
- Susan Cottrell
- transfusion team, Scottish National Blood Transfusion Service, Edinburgh, Scotland
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23
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Affiliation(s)
- Barry Hill
- Director of Education (Employability), Nursing, Midwifery and Health, Northumbria University
| | - Julie Derbyshire
- Director of Education (Apprenticeships), Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne
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24
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Effects of whole blood storage in a polyolefin blood bag on platelets for acute normovolemic hemodilution. Sci Rep 2021; 11:12201. [PMID: 34108583 PMCID: PMC8190119 DOI: 10.1038/s41598-021-91725-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 05/31/2021] [Indexed: 12/04/2022] Open
Abstract
Acute normovolemic hemodilution (ANH) is a potential transfusion method for platelets, as well as for red blood cells. However, previous studies have shown that whole blood storage in ANH decreases platelet aggregability by 14.7–76.3% and that this decrease is not recovered by reinfusion. We investigated whether a new whole blood storage method for 6 h using a polyolefin bag, based on the platelet concentrates storage method, would maintain platelet function better than the conventional method using a polyvinyl chloride bag. We demonstrated that storage of whole blood in a polyolefin bag maintained ADP-induced aggregation rates at more than twofold higher than those in a polyvinyl chloride bag, and also significantly suppressed P-selectin expression, a platelet activation marker (ADP-induced aggregation rates: 24.6 ± 5.1% vs. 51.7 ± 11.5%, p = 0.002; P-selectin expression; 50.3 ± 8.4MFI vs. 31.6 ± 9.3MFI, p = 0.018). These results could be attributed to the high gas permeability of polyolefin, which lowered PCO2 and maintained a high pH with or without agitation. There were no significant changes in platelet count and red blood cell parameters due to the storage methods. Our results suggest that ANH using polyolefin bags is advantageous in improving hemostatic function compared to the conventional method.
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25
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Nasse SA. Autoimmune haemolytic anaemia: emergency blood transfusion. BMJ Case Rep 2021; 14:14/5/e242378. [PMID: 34011642 DOI: 10.1136/bcr-2021-242378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 50-year-old woman, with a background of autoimmune haemolytic anaemia, presented to the emergency department with lethargy and shortness of breath. Investigations revealed a haemoglobin level of 50 g/L. High dose steroids were administered and blood transfusion prescribed. However, the blood transfusion was delayed due to a positive antibody screen and concerns regarding administering blood when the patient was pyrexic. The delay resulted in a significant deterioration in the patient's clinical state with her haemoglobin level falling to 26 g/L 24 hours later. She was urgently transfused with blood and made a full recovery. This report analyses the delays for transfusion and how these could have been minimised. First, guidelines advise that emergency blood should be considered in life-threatening circumstances. Second, fever is not always a contraindication for transfusion, particularly in an emergency setting.
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26
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Baker E, Crawford D, Davies K. Biological basis of child health 10: function and formation of blood and common blood disorders in children. Nurs Child Young People 2021; 33:e1278. [PMID: 33843166 DOI: 10.7748/ncyp.2021.e1278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2020] [Indexed: 11/09/2022]
Abstract
This article, the tenth in a series on the biological basis of child health, focuses on blood. Blood has a crucial role in the transport of substances such as respiratory gases, nutrients and antibodies, as well as in acid-base balance, fluid balance, blood clotting and the immune system. This article describes the composition, formation and function of blood, outlines normal blood count values and explains the effects of low blood cell counts in children. It also provides an overview of the blood disorders that are commonly seen in children, including anaemia, sickle cell disease, clotting disorders and blood cancers. It is essential for children's nurses to have knowledge and an understanding of blood, including its physiology and pathophysiology, to provide optimal care and support to children and young people and their families.
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Affiliation(s)
- Emily Baker
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, England
| | | | - Kate Davies
- London South Bank University and honorary research fellow in paediatric endocrinology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, England
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27
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Fisayo T. Science in action? A critical view of UK blood donation deferral policy and men who have sex with men. Int J Health Plann Manage 2021; 36:1207-1222. [PMID: 33834528 DOI: 10.1002/hpm.3167] [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: 10/15/2020] [Revised: 01/30/2021] [Accepted: 03/21/2021] [Indexed: 11/06/2022] Open
Abstract
The rules that govern blood donation vary globally. Some potential blood donors are ineligible for immediate blood donation, and as such are deferred until such time that they become eligible. This practice, the blood donation deferral period, is intended to reduce the risk of blood-borne infections being transfused into a blood product-recipient. As blood screening technologies improve, the risk of an infected blood product remaining undetected decreases-and so too have the deferral periods for certain donors. Much has been made of the importance of an evidence-based, scientific approach to protecting blood product-recipients. However, these deferrals are controversial. What exactly determines the blood donation deferral period? This article argues that blood donation deferral periods are not merely the result of enacting empirical data. Instead, the deferral periods represent a negotiation between scientific evidence, experts, politically expedient narratives, institutionalised risk aversion, as well as more mundane concerns such as operational feasibility. As a case study, I examine how the UK Advisory Committee on the Safety of Blood, Tissues and Organs changed the 12-month deferral period for blood donation from men who have sex with men to a 3-month deferral period.
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Affiliation(s)
- Temitope Fisayo
- King's College London School of Medicine, Guy's Campus, London, UK
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28
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Callaghan CJ, Phillips BL, Foukaneli T, Robinson S, Watson CJE. The use of third-party packed red blood cells during ex situ normothermic machine perfusion of organs for transplantation: Underappreciated complexities? Am J Transplant 2021; 21:1376-1381. [PMID: 33048419 DOI: 10.1111/ajt.16355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/23/2020] [Accepted: 09/30/2020] [Indexed: 01/25/2023]
Abstract
Ex situ normothermic machine perfusion (NMP) is being used increasingly in the assessment of higher risk deceased donor organs and to facilitate prolonged organ storage. Third-party packed red blood cells (pRBCs) are often used as an oxygen carrier in the perfusate of ex situ NMP. Despite the increasing interest in NMP, comparatively little attention has been paid to the appropriate selection of pRBCs. This includes the choice of ABO blood group and Rhesus D status, the need for special requirements for selected recipients, and the necessity for traceability of blood components. Flushing organs with cold preservation solution after NMP removes the overwhelming majority of third-party allogeneic pRBCs, but residual pRBCs within the organ may have biologically relevant effects following implantation as they enter the recipient's circulation. This review considers these issues, and suggests that national transplant and blood transfusion agencies work together to develop a co-ordinated approach within each country. This is especially important given the possibility of organ re-allocation between centers after ex situ NMP, and the ongoing development of organ perfusion hubs.
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Affiliation(s)
- Chris J Callaghan
- Department of Nephrology and Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Benedict L Phillips
- Department of Nephrology and Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Theodora Foukaneli
- Department of Haematology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Susan Robinson
- Department of Haematology, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Christopher J E Watson
- Department of Surgery, University of Cambridge, Cambridge, and National Institute of Health Research (NIHR) Cambridge Biomedical Research Centre, and the NIHR Blood and Transplant Research Unit (BTRU) at the University of Cambridge in collaboration with Newcastle University and in partnership with NHS Blood and Transplant (NHSBT), Cambridge, UK
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29
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Davidow EB, Blois SL, Goy-Thollot I, Harris L, Humm K, Musulin S, Nash KJ, Odunayo A, Sharp CR, Spada E, Thomason J, Walton J, Wardrop KJ. Association of Veterinary Hematology and Transfusion Medicine (AVHTM) Transfusion Reaction Small Animal Consensus Statement (TRACS) Part 2: Prevention and monitoring. J Vet Emerg Crit Care (San Antonio) 2021; 31:167-188. [PMID: 33751789 DOI: 10.1111/vec.13045] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/06/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To systematically review available evidence to develop guidelines for the prevention of transfusion reactions and monitoring of transfusion administration in dogs and cats. DESIGN Evidence evaluation of the literature (identified through Medline searches through Pubmed and Google Scholar searches) was carried out for identified transfusion reaction types in dogs and cats. Evidence was evaluated using PICO (Population, Intervention, Comparison, Outcome) questions generated for each reaction type. Evidence was categorized by level of evidence (LOE) and quality (Good, Fair, or Poor). Guidelines for prevention and monitoring were generated based on the synthesis of the evidence. Consensus on the final recommendations and a proposed transfusion administration monitoring form was achieved through Delphi-style surveys. Draft recommendations and the monitoring form were made available through veterinary specialty listservs and comments were incorporated. RESULTS Twenty-nine guidelines and a transfusion administration monitoring form were formulated from the evidence review with a high degree of consensus CONCLUSIONS: This systematic evidence evaluation process yielded recommended prevention and monitoring guidelines and a proposed transfusion administration form. However, significant knowledge gaps were identified, demonstrating the need for additional research in veterinary transfusion medicine.
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Affiliation(s)
- Elizabeth B Davidow
- Veterinary Clinical Sciences, Washington State University, Pullman, Washington, USA
| | - Shauna L Blois
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Canada
| | | | | | - Karen Humm
- Department of Clinical Science and Services, The Royal Veterinary College, London, UK
| | - Sarah Musulin
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Katherine J Nash
- VetMED Emergency and Specialty Veterinary Hospital, Phoenix, Arizona, USA
| | - Adesola Odunayo
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, Tennessee, USA
| | - Claire R Sharp
- School of Veterinary Medicine, Murdoch University, Perth, Australia
| | - Eva Spada
- Department of Veterinary Medicine, University of Milan, Lodi, Italy
| | - John Thomason
- Department of Clinical Sciences, Mississippi State University, Mississippi State, Mississippi, USA
| | | | - K Jane Wardrop
- Veterinary Clinical Sciences, Washington State University, Pullman, Washington, USA
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30
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Gupta P, Pathak S, Andleeb R, Perween R. Blood transfusion set: A possible cause for blood clotting during transfusion? BALI JOURNAL OF ANESTHESIOLOGY 2021. [DOI: 10.4103/bjoa.bjoa_264_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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31
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Elliot J, Narayan S, Poles D, Tuckley V, Bolton-Maggs PHB. Missed irradiation of cellular blood components for vulnerable patients: Insights from 10 years of SHOT data. Transfusion 2020; 61:385-392. [PMID: 33219533 PMCID: PMC7894557 DOI: 10.1111/trf.16189] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 12/17/2022]
Abstract
Background Irradiation of cellular blood components is recommended for patients at risk of transfusion‐associated graft‐vs‐host disease (TA‐GvHD). Prestorage leucodepletion (LD) of blood components is standard in the UK since 1999. Study Design and Methods Analysis of 10 years' reports from UK national hemovigilance scheme, Serious Hazards of Transfusion (2010‐2019), where patients failed to receive irradiated components when indicated according to British Society for Haematology guidelines (2011). Results There were 956 incidents of failure to receive irradiated components all due to errors. One hundred and seventy two incidents were excluded from analysis, 125 of 172 (72.7%) because of missing essential information. No cases of TA‐GvHD were reported in this cohort. The 784 patients received 2809 components (number unknown for 67 incidents). Most failures occurred in patients treated with purine analogues (365) or alemtuzumab (69), or with a history of Hodgkin lymphoma (HL) (192). Together these make up 626 of 784 (79.9%). Poor communication is an important cause of errors. Conclusion Leucodepletion appears to reduce the risk for TA‐GvHD. None of 12 cases of TA‐GvHD reported to SHOT prior to introduction of LD occurred in patients with conditions recommended for irradiated components by current guidelines. Irradiation indefinitely for all stages of HL is not based on good evidence and is a difficult guideline to follow. Further research on long‐term immune function in HL is required. Variation between different national guidelines reflects the very limited evidence.
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Affiliation(s)
- Johnathon Elliot
- Serious Hazards of Transfusion Office, Manchester Blood Center, UK
| | - Shruthi Narayan
- Serious Hazards of Transfusion Office, Manchester Blood Center, UK
| | - Debbi Poles
- Serious Hazards of Transfusion Office, Manchester Blood Center, UK
| | - Victoria Tuckley
- Serious Hazards of Transfusion Office, Manchester Blood Center, UK
| | - Paula H B Bolton-Maggs
- Serious Hazards of Transfusion Office, Manchester Blood Center, UK.,Faculty of Biology, Medicine and Health, University of Manchester, UK
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Castrillo A, Arroyo JL, Romón Í, Rivera J. Compliance with temperature and time requirements during in-hospital distribution of blood components: A national survey among transfusion services. Transfus Apher Sci 2020; 59:102908. [PMID: 32921561 DOI: 10.1016/j.transci.2020.102908] [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: 05/12/2020] [Revised: 07/13/2020] [Accepted: 07/29/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Temperature and time conditions during storage and distribution of blood components (BC) and their permissible deviations are strictly regulated. The degree of compliance with these requirements in daily practice of transfusion services (TS) is not well known. MATERIALS AND METHODS We conducted a survey among Spanish hospital TS covering different aspects of BC management in their daily activity. RESULTS Eighty-three TS managing 56 % of total transfusions answered the survey. Monitoring of red blood concentrates (RBC) temperature during in-hospital distribution was routinely performed by only 12 % of the TS. The main criterion for BC re-entry into the stock was the total time spent outside controlled temperature. Up to 41 % of the TS apply the "30-minute rule" to distributed RBC, while most services use a 60-minute rule for PC. No adverse events were detected when RBC that had remained longer than 30 or 60 min outside the TS were transfused. Fresh frozen plasma is usually thawed 2 h preissue and stored at 4 °C up to 24 h. DISCUSSION AND CONCLUSIONS In the Spanish context, the 30- and 60-minute rules for re-entry of RBC and PC into the TS stock are loosely followed. Feedback for a large number of TS suggests that the extension of the 30-minute RBC rule to at least 60 min is feasible, if other safety requirements are met. Flexibility with some requirements could help reduce product loss without deleterious effect on BC safety.
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Affiliation(s)
- Azucena Castrillo
- Axencia Galega de Sangue, Órganos e Tecidos. Rúa Xoaquín Díaz de Rábago 2-6, 15705, Santiago de Compostela, A Coruña, Spain; Grupo de Trabajo de Procesamiento y Producción de Componentes Sanguíneos de la Sociedad Española de Transfusión Sanguínea y Terapia Celular (SETS).
| | - José L Arroyo
- Banco de Sangre y Tejidos de Cantabria. Hospital Santa Cruz de Liencres. Barrio las Mazas, 39120, Liencres, Cantabria, Spain; Grupo de Trabajo de Procesamiento y Producción de Componentes Sanguíneos de la Sociedad Española de Transfusión Sanguínea y Terapia Celular (SETS)
| | - Íñigo Romón
- Servicio de Trasfusión. Hospital Universitario Marqués de Valdecilla - IDIVAL. Avenida Valdecilla, 25, 39008, Santander, Cantabria, Spain
| | - José Rivera
- Servicio de Hematología y Oncología Médica. Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB, Arrixaca, CIBERER-U765. Paseo de Garay, 2, 30003, Murcia, Spain; Grupo de Trabajo de Procesamiento y Producción de Componentes Sanguíneos de la Sociedad Española de Transfusión Sanguínea y Terapia Celular (SETS)
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Foukaneli T, Kerr P, Bolton‐Maggs PH, Cardigan R, Coles A, Gennery A, Jane D, Kumararatne D, Manson A, New HV, Torpey N. Guidelines on the use of irradiated blood components. Br J Haematol 2020; 191:704-724. [DOI: 10.1111/bjh.17015] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Theodora Foukaneli
- NHS Blood and Transplant Cambridge Cambridge UK
- Department of Haematology Cambridge University Hospitals NHS Foundation Trust Cambridge UK
| | - Paul Kerr
- Department of Haematology Royal Devon & Exeter NHS Foundation Trust Exeter UK
| | - Paula H.B. Bolton‐Maggs
- Faculty of Biology, Medicine and Health University of Manchester Manchester UK
- Serious Hazards of Transfusion Office Manchester Blood Centre Manchester UK
| | - Rebecca Cardigan
- Haematology University of Cambridge Cambridge Biomedical Campus Cambridge UK
| | - Alasdair Coles
- Clinical Neuroscience University of Cambridge Cambridge Biomedical Campus Cambridge UK
| | - Andrew Gennery
- Department of Paediatric Immunology Institute of Cellular Medicine Newcastle University Cambridge Newcastle upon Tyne UK
| | - David Jane
- Department of Medicine University of Cambridge Cambridge Biomedical Campus Cambridge Cambridge UK
| | - Dinakantha Kumararatne
- Department of Clinical Immunology Cambridge University Hospitals NHS Foundation Trust Cambridge UK
| | - Ania Manson
- Department of Clinical Immunology Cambridge University Hospitals NHS Foundation Trust Cambridge UK
| | - Helen V. New
- NHS Blood and Transplant London UK
- Department of Haematology Imperial College London London UK
| | - Nicholas Torpey
- Department of Clinical Nephrology and Transplantation Cambridge University Hospitals NHS Foundation Trust Cambridge UK
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Doughty H, Chowdhury F. Emergency preparedness, resilience and response guidance for UK hospital transfusion teams. Transfus Med 2020; 30:177-185. [PMID: 32020684 PMCID: PMC7317494 DOI: 10.1111/tme.12665] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/23/2019] [Accepted: 01/13/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To present Emergency Preparedness, Resilience and Response (EPRR) guidance for Hospital Transfusion Teams on behalf of the National Blood Transfusion Committee emergency planning working group. BACKGROUND The Civil Contingencies Act 2004 requires healthcare organisations to demonstrate that they can deal with major incidents while maintaining critical services. Recent mass casualty events and the use of transfusion-based resuscitation have highlighted the evolving role of the Hospital Transfusion Team. METHODS This multi-disciplinary advice is informed by recent global and national experience, the 2018 NHS England clinical guidelines for Major Incidents, and stakeholder workshops. GUIDANCE Transfusion staff should be familiar with local EPRR plans including casualty type and numbers. Staff should be exercised as part of wider Trust preparation, with documented roles and responsibilities. Transfusion support should be proactive and include blood issue, regulatory compliance and sample handling. Robust LIMS-compatible emergency identification systems are essential to minimise errors. Emergency stock management requires rapid assessment of existing stock and estimated demand before re-ordering. Initial demand should be based on 2 to 4 red blood cells (RBC) per patient admitted. Patients with significant haemorrhage may require further red cells and early haemostatic support. Where "universal" components are demanded, they should be gender appropriate. Senior staff should lead the response, log and communicate key decisions, and prepare for post-incident recovery. CONCLUSIONS Transfusion teams have an important role in ensuring continuity of transfusion support. Teams should develop their EPRR plans based on local plans and national guidance. Emergency preparedness should include post-incident debriefing for ongoing staff support and future service improvement.
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Affiliation(s)
- Heidi Doughty
- NHS Blood and TransplantClinical Services, BirminghamUnited Kingdom
| | - Fateha Chowdhury
- NHS Blood and TransplantClinical Services, BirminghamUnited Kingdom
- Imperial College Healthcare NHS TrustLondonUnited Kingdom
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35
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Newland A, Bentley R, Jakubowska A, Liebman H, Lorens J, Peck-Radosavljevic M, Taieb V, Takami A, Tateishi R, Younossi ZM. A systematic literature review on the use of platelet transfusions in patients with thrombocytopenia. ACTA ACUST UNITED AC 2020; 24:679-719. [PMID: 31581933 DOI: 10.1080/16078454.2019.1662200] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective: Investigate globally, current treatment patterns, benefit-risk assessments, humanistic, societal and economic burden of platelet transfusion (PT). Methods: Publications from 1998 to June 27, 2018 were identified, based on databases searches including MEDLINE®; Embase and Cochrane Database of Systematic Reviews. Data from studies meeting pre-specified criteria were extracted and validated by independent reviewers. Data were obtained for efficacy and safety from randomized controlled trials (RCTs); data for epidemiology, treatment patterns, effectiveness, safety, humanistic and societal burden from real-world evidence (RWE) studies; and economic data from both. Results: A total of 3425 abstracts, 194 publications (190 studies) were included. PT use varied widely, from 0%-100% of TCP patients; 1.7%-24.5% in large studies (>1000 patients). Most were used prophylactically rather than therapeutically. 5 of 43 RCTs compared prophylactic PT with no intervention, with mixed results. In RWE studies PT generally increased platelet count (PC). This increase varied by patient characteristics and hence did not always translate into a clinically significant reduction in bleeding risk. Safety concerns included infection risk, alloimmunization and refractoriness with associated cost burden. Discussion: In RCTs and RWE studies there was significant heterogeneity in study design and outcome measures. In RWE studies, patients receiving PT may have been at higher risk than those not receiving PT creating potential bias. There were limited data on humanistic and societal burden. Conclusion: Although PTs are used widely for increasing PC in TCP, it is important to understand the limitations of PTs, and to explore the use of alternative treatment options where available.
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Affiliation(s)
- Adrian Newland
- Barts Health National Health Service (NHS) Trust , London , UK
| | | | | | - Howard Liebman
- Jane Anne Nohl Division of Hematology, USC Norris Cancer Hospital , Los Angeles , CA , USA
| | | | - Markus Peck-Radosavljevic
- Department of Gastroenterology & Hepatology, Endocrinology and Nephrology, Klinikum Klagenfurt , Klagenfurt , Austria.,Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna , Vienna , Austria
| | | | - Akiyoshi Takami
- Department of Internal Medicine, Division of Hematology, Aichi Medical University School of Medicine , Nagakute , Japan
| | - Ryosuke Tateishi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo , Tokyo , Japan
| | - Zobair M Younossi
- Department of Medicine, Inova Fairfax Hospital , Falls Church , VA , USA
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36
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Bolton‐Maggs PHB, Watt A. Transfusion errors — can they be eliminated? Br J Haematol 2019; 189:9-20. [DOI: 10.1111/bjh.16256] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 12/14/2022]
Affiliation(s)
| | - Alison Watt
- Serious Hazards of Transfusion Manchester Blood Centre Manchester UK
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37
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Murphy MF, Jayne Addison J, Poles D, Dhiman P, Bolton‐Maggs P. Electronic identification systems reduce the number of wrong components transfused. Transfusion 2019; 59:3601-3607. [DOI: 10.1111/trf.15537] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/21/2019] [Accepted: 08/31/2019] [Indexed: 01/13/2023]
Affiliation(s)
- Michael F. Murphy
- NHS Blood & Transplant (NHSBT) Watford UK
- Oxford NIHR Biomedical Research CentreOxford University Hospitals, University of Oxford Oxford UK
| | - J Jayne Addison
- NHS Blood & Transplant (NHSBT) Watford UK
- Serious Hazards of Transfusion (SHOT) scheme Manchester UK
| | - Debbi Poles
- Serious Hazards of Transfusion (SHOT) scheme Manchester UK
| | - Paula Dhiman
- Oxford NIHR Biomedical Research CentreOxford University Hospitals, University of Oxford Oxford UK
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research CentreUniversity of Oxford Oxford UK
| | - Paula Bolton‐Maggs
- Serious Hazards of Transfusion (SHOT) scheme Manchester UK
- University of Manchester Manchester UK
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