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Bush K, Shea L, San Roman J, Pailloz E, Gaughan J, Porter J, Goldenberg-Sandau A. Whole Blood in Trauma Resuscitation: What is the Real Cost? J Surg Res 2022; 275:155-160. [DOI: 10.1016/j.jss.2022.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 12/30/2021] [Accepted: 01/29/2022] [Indexed: 10/18/2022]
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2
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Shamshirian A, Mohseni AR, Pourfathollah AA, Mehdipour S, Hosseini S, Ghorbanpour A, Azizi S. A review of blood usage and wastage in a tertiary heart center. Acta Clin Belg 2020; 75:96-103. [PMID: 30513064 DOI: 10.1080/17843286.2018.1555113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background/Objectives: Blood is a vital resource that its utilization is ever increasing throughout the world and blood wastage is a global challenge that needs to be controlled. Most blood resources are used during complications of pregnancy, trauma, severe childhood anemia, gynecology, cancers, surgery, hematology disorders, and chronic diseases. Units that are expired, broken bags, returning the blood unit after 30 min, blood clotted units, etc., which are due to lack of awareness may result in the wastage of blood products. The objective of this study is to analyze the usage and wastage of blood and its products in Mazandaran heart center.Methods: In this retrospective study, the survey was carried out on the data that were obtained from Mazandaran heart center of Sari, Iran during 2012-2017. Data included details of usage and wastage on blood and its product units. MS Excel 2016 and SPSS 16.0 were used in analysis and diagrams.Results: A total of 35,686 blood units were consumed, which included 55.7% packed red blood cells (PRBCs), 33.9% platelets (Plts), 8.9% fresh-frozen-plasma (FFP), and 8.9% cryoprecipitates. Moreover, 823 blood units including 41.4% FFP, 37.2% PRBCs, and 21.4% Plts were wasted mostly because of inappropriate order (70.6%). Cross-match to transfusion ratio was 1.13. The intensive care unit reported the highest level of blood intake by 45.0%. The blood group O+ was the most frequent by 34.8%. In addition, blood wastage has decreased over study period by approximately 10.0%.Conclusion: Our study showed not only the increasing pattern of blood usage but also the dropping pattern of blood wastage due to hemovigilance performance and additional training in our healthcare center. We found that the main reason for the blood wastage in this center is an excessive order of blood units.
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Affiliation(s)
- Amir Shamshirian
- Department of Medical Laboratory Sciences, Student Research Committee, School of Allied Medical sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Reza Mohseni
- Department of Medical Laboratory Sciences, School of Allied Medical sciences, Mazandaran University of Medical Sciences, Sari, Iran
- Thalassemia Research Center, Hemoglobinopathy institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Akbar Pourfathollah
- Blood Transfusion Research Centre, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
- Departments of Immunology, Faculty of Medicine, Tarbiat Modares University, Tehran, Iran
| | - Shirin Mehdipour
- Mazandaran Heart Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Samira Hosseini
- Department of Medical Laboratory Sciences, Student Research Committee, School of Allied Medical sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Atiyeh Ghorbanpour
- Department of Medical Laboratory Sciences, Student Research Committee, School of Allied Medical sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Soheil Azizi
- Department of Medical Laboratory Sciences, School of Allied Medical sciences, Mazandaran University of Medical Sciences, Sari, Iran
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3
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Flint AW, McQuilten ZK, Irwin G, Rushford K, Haysom HE, Wood EM. Is Platelet Expiring Out of Date? A Systematic Review. Transfus Med Rev 2019; 34:42-50. [PMID: 31685352 DOI: 10.1016/j.tmrv.2019.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 08/16/2019] [Accepted: 08/29/2019] [Indexed: 10/25/2022]
Abstract
Current platelet concentrates are perishable blood products with short shelf lives. Combined with often unpredictable demand, this results in platelet inventory management problems, manifested by high rates of outdating frequently reported at 10% to 20%, and sometimes inadequate clinical supply. The objective of this study was to critically review the published methodologies on measures to reduce platelet outdating rates, in order to determine how platelet outdating and availability can be improved. We performed a systematic review of journal articles published in English to May 2019 identified from MEDLINE, with reported methods to improve platelet inventory outdating rates and availability. The complexity of each methodology was scored based on whether a typical blood bank manager could design, implement and run a platelet outdating program based on the methodology. Twenty-four relevant citations were found-these included 8 citations employing operational research (OR) methodologies, 7 evaluation/best practice, 6 simulation and 3 forecasting. Over half the included studies have been published within the last decade. The citations reporting the lowest predicted outdating were also the most complex methods. Overall predicted outdating and shortages were less than 4% based on the available data. In conclusion, we found that research interest in platelet inventory management problems has increased in line with platelet demand and methods to assist in reducing outdating rates without increased shortages have been available now for 4 decades; high rates of platelet outdating do however continue to be reported around the world. Developments in platelet preparation and storage, and other new approaches, may assist in addressing this problem.
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Affiliation(s)
- Andrew Wj Flint
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; The Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Royal Australian Navy, Australia
| | - Zoe K McQuilten
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; The Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Monash Health, Melbourne, Australia
| | | | | | - Helen E Haysom
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Erica M Wood
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Monash Health, Melbourne, Australia.
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4
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Yazer MH, Waters JH. What in the world of transfusion medicine isn't patient blood management? Transfus Med 2018; 28:89-91. [PMID: 29744976 DOI: 10.1111/tme.12522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 02/28/2018] [Accepted: 03/01/2018] [Indexed: 11/28/2022]
Affiliation(s)
- M H Yazer
- The Institute for Transfusion Medicine, Pittsburgh, Pennsylvania, USA.,Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Clinical Immunology, University of Southern Denmark, Odense, Denmark
| | - J H Waters
- Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Connor JP, Raife T, Medow JE. Outcomes of red blood cell transfusions prescribed in organ donors by the Digital Intern, an electronic decision support algorithm. Transfusion 2017; 58:366-371. [PMID: 29194652 DOI: 10.1111/trf.14424] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/21/2017] [Accepted: 10/03/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND The Digital Intern (DI) is an electronic decision support tool for the management of organ donors. One algorithm determines the dose, in units of red blood cells to be transfused, based on hematocrit (Hct) thresholds and targets. The effectiveness of the transfusion dose calculated by the DI in terms of achieving the selected Hct target and the duration of the targeted dose is not known. STUDY DESIGN AND METHODS This was a retrospective study to describe the outcomes of transfusions prescribed by the DI. Pre- and posttransfusion Hct levels were compared to define response and all posttransfusion Hct values were plotted to evaluate the duration of the prescribed dose. RESULTS A total of 120 organ donors were studied and 22 donors had 28 transfusions (six were transfused twice). The transfused donors were a mix of trauma and medical admissions and brain death and cardiac death donors. The transfusion target of 24% Hct was attained in 96% of transfusions. The mean number of units transfused was 1.4 and the mean time from transfusion to procurement was 19.8 hours. There was a decline in Hct over time after transfusion in all but one case with a mean decline of 1.9% Hct over 13 hours. Six donors were transfused twice, likely due to a longer donor time period (41.7 hr vs. 27 hr). CONCLUSIONS The DI provided transfusion dosing that achieved the desired threshold in the majority of organ donors transfused. Ongoing work focuses on application of this technology to transfusions in general patient populations.
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Affiliation(s)
| | | | - Joshua E Medow
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Fadeyi EA, Emery W, Simmons JH, Jones MR, Pomper GJ. Implementation of a new blood cooler insert and tracking technology with educational initiatives and its effect on reducing red blood cell wastage. Transfusion 2017; 57:2477-2482. [PMID: 28703889 DOI: 10.1111/trf.14234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/12/2017] [Accepted: 05/14/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The objective was to report a successful implementation of a blood cooler insert and tracking technology with educational initiatives and its effect on reducing red blood cell (RBC) wastage. STUDY DESIGN AND METHODS The blood bank database was used to quantify and categorize total RBC units issued in blood coolers from January 2010 to December 2015 with and without the new inserts throughout the hospital. Radiofrequency identification tags were used with special software to monitor blood cooler tracking. An educational policy on how to handle the coolers was initiated. Data were gathered from the software that provided a real-time location monitoring of the blood coolers with inserts throughout the institution. RESULTS The implementation of the blood cooler with inserts and tracking device reduced mean yearly RBC wastage by fourfold from 0.64% to 0.17% between 2010 and 2015. The conserved RBCs corresponded to a total cost savings of $167,844 during the 3-year postimplementation period. CONCLUSIONS The implementation of new blood cooler inserts, tracking system, and educational initiatives substantially reduced the mean annual total RBC wastage. The cost to implement this initiative may be small if there is an existing institutional infrastructure to monitor and track hospital equipment into which the blood bank intervention can be adapted when compared to the cost of blood wastage.
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Affiliation(s)
- Emmanuel A Fadeyi
- Department of Pathology and Laboratory Medicine, Wake Forest University School of Medicine
- Department of Pathology and Laboratory Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Wanda Emery
- Department of Pathology and Laboratory Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Julie H Simmons
- Department of Pathology and Laboratory Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Mary Rose Jones
- Department of Pathology and Laboratory Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Gregory J Pomper
- Department of Pathology and Laboratory Medicine, Wake Forest University School of Medicine
- Department of Pathology and Laboratory Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina
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Javadzadeh Shahshahani H, Taghvai N. Blood wastage management in a regional blood transfusion centre. Transfus Med 2017; 27 Suppl 5:348-353. [DOI: 10.1111/tme.12433] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 04/18/2017] [Accepted: 05/21/2017] [Indexed: 11/30/2022]
Affiliation(s)
- H. Javadzadeh Shahshahani
- Blood Transfusion Research Center; High Institute for Research and Education in Transfusion Medicine; Tehran Iran
| | - N. Taghvai
- Blood Transfusion Research Center; High Institute for Research and Education in Transfusion Medicine; Tehran Iran
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Yates N, Stanger S, Wilding R, Cotton S. Approaches to assessing and minimizing blood wastage in the hospital and blood supply chain. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/voxs.12330] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- N. Yates
- Cranfield School of Management; Bedford UK
| | - S. Stanger
- Cranfield School of Management; Bedford UK
| | - R. Wilding
- Cranfield School of Management; Bedford UK
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Seheult JN, Triulzi DJ, Alarcon LH, Sperry JL, Murdock A, Yazer MH. Measurement of haemolysis markers following transfusion of uncrossmatched, low-titre, group O+ whole blood in civilian trauma patients: initial experience at a level 1 trauma centre. Transfus Med 2016; 27:30-35. [DOI: 10.1111/tme.12372] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/21/2016] [Accepted: 09/23/2016] [Indexed: 12/16/2022]
Affiliation(s)
- J. N. Seheult
- Department of Pathology; University of Pittsburgh; Pittsburgh Pennsylvania USA
| | - D. J. Triulzi
- Department of Pathology; University of Pittsburgh; Pittsburgh Pennsylvania USA
- The Institute for Transfusion Medicine; University of Pittsburgh; Pittsburgh Pennsylvania USA
| | - L. H. Alarcon
- Department of Surgery; University of Pittsburgh; Pittsburgh Pennsylvania USA
| | - J. L. Sperry
- Department of Surgery; University of Pittsburgh; Pittsburgh Pennsylvania USA
| | - A. Murdock
- Department of Surgery; University of Pittsburgh; Pittsburgh Pennsylvania USA
| | - M. H. Yazer
- Department of Pathology; University of Pittsburgh; Pittsburgh Pennsylvania USA
- The Institute for Transfusion Medicine; University of Pittsburgh; Pittsburgh Pennsylvania USA
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Tran MH, Vossoughi S, Harm S, Dunbar N, Fung M. Massive Transfusion Protocol: Communication Ordering Practice Survey (MTP COPS). Am J Clin Pathol 2016; 146:319-23. [PMID: 27510718 DOI: 10.1093/ajcp/aqw123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES We sought to assess ordering practices and quality of communication during massive transfusion at US level I trauma centers. METHODS An anonymous, web-based survey was distributed to blood banks supporting US level I trauma centers. Information gathered in the survey included demographics, utilization of and perceived level of support for computerized physician order entry (CPOE), frequency of order confusion, and nonprotocol ordering. Responses were analyzed using descriptive statistics. RESULTS Responses were received from 43 of 121 centers (35.5% response rate), with the majority completed by blood bank physicians (67.4%) and blood bank supervisors (25.6%). Allowable pathways for massive transfusion protocol (MTP) ordering included CPOE (48.8%), verbal/telephone (86.1%), and written (44.2%). The preferred method of MTP activation was verbal/telephone (86.1%). Initial activation of MTP was well communicated (97.6% agreement), but confusion associated with ongoing needs was reported to occur at least sometimes by 32.6%. CONCLUSIONS Although CPOE-based MTP ordering is offered by nearly half of US level I trauma centers, verbal/telephone ordering is by far the preferred mechanism. Our survey identifies confusion surrounding blood component needs during MTP resuscitation as an opportunity for practice improvement.
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Affiliation(s)
- Minh-Ha Tran
- From the University of California Irvine Health, School of Medicine, Irvine
| | | | - Sarah Harm
- University of Vermont College of Medicine, Burlington
| | | | - Mark Fung
- University of Vermont College of Medicine, Burlington
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