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Berg P, Heiden M, Müller S, Meyer B, Witzenhausen C, Ruppert-Seipp G, Kehr S, Funk MB. A national surveillance system for continuous monitoring of blood transfusion safety: German haemovigilance data. Vox Sang 2024. [PMID: 38889998 DOI: 10.1111/vox.13694] [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: 12/09/2023] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND AND OBJECTIVES Haemovigilance (HV) systems aim to improve transfusion outcomes in patients and donor safety. An important question for blood regulators is how to ensure an effective HV system. MATERIALS AND METHODS We retrospectively analysed the HV reports submitted to Paul-Ehrlich-Institut over the last two decades. RESULTS Between 2011 and 2020, 50.86 million units of blood components were used, and 8931 suspected serious donor and recipient adverse reactions (SARs), 874 serious adverse events (SAEs) and 12,073 donor look-backs were reported. Following implementation of specific risk-minimization measures (RMMs) between 2000 and 2010, SAR reporting rates decreased for transfusion-transmitted viral infections (TTVIs), transfusion-related acute lung injury (TRALI) and transfusion-transmitted bacterial infections (TTBIs), while increasing for other serious adverse transfusion reactions. Within this decade, the overall blood component use decreased. CONCLUSION Long-term data collection forms the basis to establish trends and changes in reporting and to evaluate the effect of RMM. Standardized criteria for reaction types, seriousness and imputability assessments and availability of a denominator are important elements. Central data collection and independent assessment allow for monitoring HV data in a nationwide context over time. Stakeholder involvement and transparent feedback on the benefit of RMM will help to achieve the objectives of HV.
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Affiliation(s)
- Philipp Berg
- Division Safety of Biomedicines and Diagnostics, Paul-Ehrlich-Institut (PEI), Langen, Germany
| | - Margarethe Heiden
- Division Safety of Biomedicines and Diagnostics, Paul-Ehrlich-Institut (PEI), Langen, Germany
| | - Susanne Müller
- Division Safety of Biomedicines and Diagnostics, Paul-Ehrlich-Institut (PEI), Langen, Germany
| | - Britta Meyer
- Division Safety of Biomedicines and Diagnostics, Paul-Ehrlich-Institut (PEI), Langen, Germany
| | - Cornelia Witzenhausen
- Division Safety of Biomedicines and Diagnostics, Paul-Ehrlich-Institut (PEI), Langen, Germany
| | - Gabriele Ruppert-Seipp
- Division Safety of Biomedicines and Diagnostics, Paul-Ehrlich-Institut (PEI), Langen, Germany
| | - Sarah Kehr
- Division Safety of Biomedicines and Diagnostics, Paul-Ehrlich-Institut (PEI), Langen, Germany
| | - Markus B Funk
- Division Safety of Biomedicines and Diagnostics, Paul-Ehrlich-Institut (PEI), Langen, Germany
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Samukange WT, Kluempers V, Porwal M, Mudyiwenyama L, Mutoti K, Aineplan N, Gardarsdottir H, Mantel-Teeuwisse AK, Nuebling CM. Implementation and performance of haemovigilance systems in 10 sub-saharan African countries is sub-optimal. BMC Health Serv Res 2021; 21:1258. [PMID: 34801022 PMCID: PMC8605544 DOI: 10.1186/s12913-021-07235-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background Haemovigilance is an important element of blood regulation. It includes collecting and evaluating the information on adverse events resulting from the use of blood and blood components with the aim to improve donor and patient safety. We describe the results of the pilot of the integrated GBT+ Blood for the haemovigilance function in 10 sub-Saharan African countries. Methods We piloted the integrated WHO Global Benchmarking Tool plus Blood (GBT+ Blood) to assess the haemovigilance function of national regulatory authorities (NRAs) in Ethiopia, Kenya, Malawi, Nigeria, Liberia, Rwanda, South Africa, Tanzania, Uganda, and Zimbabwe. Data obtained from documents and face to face interviews were used to determine the status of implementation and performance of the following six indicators; legal provisions regulations and guidelines, organisation and governance, human resources, regulatory processes, transparency and accountability and finally, monitoring progress and assessing impact, by estimating median scores across 20 sub-indicators. In addition, a cluster analysis was performed. Results The countries showed inter-organisation variability in implementation and performance of the haemovigilance function. The overall median score (all sub-indicators) was 44 % (range: 7.5 % - 70 %). The lowest average performance scores were for the arrangement for effective organisation and coordination (35 %) and human resources (35 %) indicators. The highest average scores were observed for the mechanism to promote transparency and mechanism to monitor regulatory performance indicators (50 % and 60 %, respectively). We identified clusters of best-implemented sub-indicators from the procedures for haemovigilance and poorly implemented sub-indicators from the legal provisions, regulations and guidelines for haemovigilance and human resources. Conclusions Implementation of sub-indicators and performance of haemovigilance systems varied greatly for all countries with a few countries performing reasonably well in the implementation of some sub-indicators under procedures for haemovigilance. Most countries were poorly implementing sub-indicators in the legal provisions, arrangement for effective organisation and human resources indicators. The legislative provisions in most countries were at a nascent stage. There is a need to set up targeted and customised technical support coupled with prioritised interventions to strengthen the capacities of NRAs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07235-0.
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Affiliation(s)
- Washington T Samukange
- Division of Pharmacoepidemiology & Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands.,Paul Ehrlich Institut, Langen, Germany
| | | | | | | | - Khamusi Mutoti
- South African Health Products Regulatory Authority (SAHPRA), Pretoria, South Africa
| | | | - Helga Gardarsdottir
- Division of Pharmacoepidemiology & Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - Aukje K Mantel-Teeuwisse
- Division of Pharmacoepidemiology & Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - C Micha Nuebling
- Paul Ehrlich Institut, Langen, Germany. .,Major Policy and International Relations, Paul Ehrlich Institut, Langen, Germany.
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Yin Y, Tian X, Li L, Kong Y, Wang J, Lin F, Song N, Chen Q, Gan J, Peng T, Li X, Wu Y, Ge H, Wang H, Jiang J, Bai L, Ji H, Zhao G, Huang Y, Liu Z. First annual report of Chinese haemovigilance network. Vox Sang 2021; 116:718-724. [PMID: 33423307 DOI: 10.1111/vox.13059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/25/2020] [Accepted: 12/02/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Haemovigilance involves surveillance of the whole chain of blood transfusion with the aim of identifying adverse events and errors and improving outcomes for patients. The Chinese Haemovigilance Network, founded in August 2017, has witnessed a rapid development in the last three years. MATERIALS AND METHODS Based on the 1,022 cases in 2019, we analysed the adverse reactions (ARs) by blood component, clinical outcome severity and demography of recipients in an effort to publish the first annual Chinese haemovigilance report. RESULTS The AR rate associated with blood transfusion in 2019 was 0·2% in China. Allergic reactions and FNHTR were the two most common adverse symptoms, accounting for 97·7% of the reports. Two-thirds of the TAD, AHTR and TACO and all of the HTR and DHTR resulted in hospitalization or prolongation of hospitalization. Plasma and AP were usually associated with allergic reaction (81·1%), whereas red cells more commonly cause FNHTR (68·8%) and all the AHTR, HTR, DSTR and DHTR. 84·1% of patients were aged 16 years or over, and the majority of the TAD, AHTR, TACO and HTR involved patients aged 60 and above. The ratio of serious adverse reactions (SARs) was 8·2%. Allergic reaction and FNHTR were top two (85·7%) SARs. The first case related to anti-D immunoglobulin was detected in a DHTR report. CONCLUSION This report provides the world's first overview of transfusion-related adverse reactions in China. This report is useful for better understanding transfusion risks in China.
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Affiliation(s)
- Yonghua Yin
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, China.,Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, Chengdu, China
| | - Xue Tian
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, China.,Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, Chengdu, China
| | - Ling Li
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, China.,Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, Chengdu, China
| | - Yujie Kong
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, China.,Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, Chengdu, China
| | - Jue Wang
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, China.,Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, Chengdu, China
| | - Feng Lin
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, China.,Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, Chengdu, China
| | - Ning Song
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, China.,Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, Chengdu, China
| | - Qiang Chen
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, China.,Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, Chengdu, China
| | - Jia Gan
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Tao Peng
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiying Li
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | | | - Hongwei Ge
- Beijing Red Cross Blood Center, Beijing, China
| | | | - Jingmei Jiang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Lianjun Bai
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hongwen Ji
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Guohua Zhao
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuguang Huang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhong Liu
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, China.,Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, Chengdu, China
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Wood EM, Ang AL, Bisht A, Bolton-Maggs PH, Bokhorst AG, Flesland O, Land K, Wiersum-Osselton JC, Schipperus MR, Tiberghien P, Whitaker BI. International haemovigilance: what have we learned and what do we need to do next? Transfus Med 2019; 29:221-230. [PMID: 30729612 DOI: 10.1111/tme.12582] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 11/05/2018] [Accepted: 01/12/2019] [Indexed: 02/06/2023]
Abstract
The International Haemovigilance Network (IHN) defines haemovigilance as 'a set of surveillance procedures covering the whole transfusion chain (from the collection of blood and its components to the follow-up of recipients), intended to collect and assess information on unexpected or undesirable effects resulting from the therapeutic use of labile blood products, and to prevent their occurrence or recurrence'. IHN, the International Society of Blood Transfusion and World Health Organization work together to support both developing and established haemovigilance systems. Haemovigilance systems provide valuable data on a range of adverse events related to blood donation and clinical transfusion, from donor syncopal events to transfusion-transmitted infections, immunological complications and the impact of human errors. Harmonised definitions for most adverse reactions have been developed and validated internationally. Definitions of pulmonary complications are again under review. Haemovigilance data have resulted in changes in policy, products and practice, and can complement and inform clinical audit and research, leading to improved blood donor safety, optimised product use and better clinical outcomes after transfusion. However, more work is needed. Not all countries have haemovigilance systems in place. More robust data and careful analysis are required to improve the understanding of the causes, occurrence and clinical outcomes of these events. Wider dissemination of results will facilitate health policy development internationally, and implementation of haemovigilance recommendations will support further important progress in blood safety.
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Affiliation(s)
- E M Wood
- Transfusion Research Unit, Monash University, Melbourne, Victoria, Australia.,Department of Clinical Haematology, Monash Health, Melbourne, Victoria, Australia
| | - A L Ang
- Blood Services Group, Health Sciences Authority, Singapore.,Department of Haematology, Singapore General Hospital, Singapore
| | - A Bisht
- Haemovigilance Programme of India, National Institute of Biologicals, Ministry of Health & Family Welfare, Noida, India
| | - P H Bolton-Maggs
- Serious Hazards of Transfusion, Manchester, UK.,University of Manchester, Manchester, UK
| | - A G Bokhorst
- Transfusion and Transplantation Reactions in Patients (TRIP), National Haemovigilance and Biovigilance Office, Leiden, The Netherlands
| | - O Flesland
- Norwegian Directorate of Health, Oslo, Norway
| | - K Land
- Blood Systems Inc., Tempe, Arizona, USA.,Department of Pathology, University of Texas Health Science Center, San Antonio, Texas, USA
| | - J C Wiersum-Osselton
- Transfusion and Transplantation Reactions in Patients (TRIP), National Haemovigilance and Biovigilance Office, Leiden, The Netherlands
| | - M R Schipperus
- Transfusion and Transplantation Reactions in Patients (TRIP), National Haemovigilance and Biovigilance Office, Leiden, The Netherlands.,Department of Haematology, Haga Teaching Hospital, The Hague, The Netherlands
| | - P Tiberghien
- Etablissement Français du Sang, La Plaine St Denis, France.,Université de Franche-Comté, Inserm, EFS, UMR 1098, Besançon, France
| | - B I Whitaker
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Review US Food & Drug Administration, Silver Spring, Maryland, USA
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Garraud O, Cognasse F, Laradi S, Hamzeh-Cognasse H, Peyrard T, Tissot JD, Fontana S. How to mitigate the risk of inducing transfusion-associated adverse reactions. Transfus Clin Biol 2018; 25:262-268. [DOI: 10.1016/j.tracli.2018.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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