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Masarova L, Verstovsek S, Liu T, Rao S, Sajeev G, Fillbrunn M, Simpson R, Li W, Yang J, Lorier YL, Gorsh B, Signorovitch J. Transfusion-related cost offsets and time burden in patients with myelofibrosis on momelotinib vs. danazol from MOMENTUM. Future Oncol 2024:1-12. [PMID: 39072442 DOI: 10.1080/14796694.2024.2368450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 06/12/2024] [Indexed: 07/30/2024] Open
Abstract
Aim: To estimate projected US-based cost and time burden for patients with myelofibrosis and anemia treated with momelotinib compared with danazol. Methods: Cost and time burden were calculated based on the transfusion status of patients in the MOMENTUM trial and estimates extracted from previous studies. Results: Reductions in transfusion associated with momelotinib are projected to result in cost and time savings compared with danazol in transfusion-dependent and transfusion-independent/requiring patients with myelofibrosis, respectively: annual medical costs ($53,143 and $46,455 per person), outpatient transfusion costs ($42,021 and $8,370 per person) and annual time savings (173 and 35 h per person). Conclusion: Fewer transfusions with momelotinib are projected to result in cost and time savings in patients with myelofibrosis and anemia compared with danazol.
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Affiliation(s)
- Lucia Masarova
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer, Houston, TX 77030, USA
| | - Srdan Verstovsek
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer, Houston, TX 77030, USA
| | - Tom Liu
- GSK plc, Philadelphia, PA 19104, USA
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Riley BC, Phuong J, Hasan RA, Stansbury LG, Hess JR, Roubik DJ. Expired blood transfusion and mortality outcomes in combat trauma patients. Transfusion 2024. [PMID: 38965905 DOI: 10.1111/trf.17943] [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: 05/21/2024] [Accepted: 06/17/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Expired blood can be transfused if clinically indicated but outcome data do not exist. We hypothesized that modestly outdated blood can effectively support a hemorrhaging patient until surgical control is achieved. This study assessed whether expired blood was associated with mortality in combat trauma patients. STUDY DESIGN AND METHODS A retrospective analysis of Armed Services Blood Program and Department of Defense Trauma Registry databases evaluated combat casualty records (2001-2023). The intervention of interest was transfusion of at least one unit of whole blood (WB), red blood cells (RBC), or platelets within one week past expiration. The outcome of interest was mortality at discharge. A control cohort that only received in-date blood was matched to the treatment cohort for logistic regression analysis. RESULTS One hundred patients received expired RBCs (86), WB (11), and platelets (3). Mortality at discharge was 11.6% for expired RBC recipients and 13.4% for the control cohort (p = .97). After adjustment for injury severity, expired RBCs were not associated with mortality (OR = 0.40 [95% CI, 0.14-1.16]; p = .09). Of 10 patients who received the most expired RBCs by volume or storage duration, two were deceased at discharge. All 14 expired WB and platelet recipients were alive at discharge, but sample sizes were underpowered for regression analysis. DISCUSSION Transfusion of modestly outdated RBCs was not associated with mortality in combat trauma patients. Expired WB and platelet recipients did well, but sample sizes were too small to draw significant conclusions. Expired blood should be further investigated for possible use in extenuating circumstances.
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Affiliation(s)
- Brian C Riley
- University of Washington School of Medicine, Seattle, Washington, USA
- Harborview Injury Prevention & Research Center, Seattle, Washington, USA
| | - Jimmy Phuong
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Rida A Hasan
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lynn G Stansbury
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Anesthesia and Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - John R Hess
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Daniel J Roubik
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, USA
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3
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Lewin A, McGowan E, Ou-Yang J, Boateng LA, Dinardo CL, Mandal S, Almozain N, Ribeiro J, Sasongko SL. The future of blood services amid a tight balance between the supply and demand of blood products: Perspectives from the ISBT Young Professional Council. Vox Sang 2024; 119:505-513. [PMID: 38272856 DOI: 10.1111/vox.13590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/07/2023] [Accepted: 12/29/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND AND OBJECTIVES Blood services manage the increasingly tight balance between the supply and demand of blood products, and their role in health research is expanding. This review explores the themes that may define the future of blood banking. MATERIALS AND METHODS We reviewed the PubMed database for articles on emerging/new blood-derived products and the utilization of blood donors in health research. RESULTS In high-income countries (HICs), blood services may consider offering these products: whole blood, cold-stored platelets, synthetic blood components, convalescent plasma, lyophilized plasma and cryopreserved/lyophilized platelets. Many low- and middle-income countries (LMICs) aim to establish a pool of volunteer, non-remunerated blood donors and wean themselves off family replacement donors; and many HICs are relaxing the deferral criteria targeting racial and sexual minorities. Blood services in HICs could achieve plasma self-sufficiency by building plasma-dedicated centres, in collaboration with the private sector. Lastly, blood services should expand their involvement in health research by establishing donor cohorts, conducting serosurveys, studying non-infectious diseases and participating in clinical trials. CONCLUSION This article provides a vision of the future for blood services. The introduction of some of these changes will be slower in LMICs, where addressing key operational challenges will likely be prioritized.
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Affiliation(s)
- Antoine Lewin
- Medical Affairs and Innovation, Héma-Québec, Montreal, Quebec, Canada
- Medicine faculty and health science, Sherbrooke University, Sherbrooke, Quebec, Canada
| | - Eunike McGowan
- Research and Development, Australian Red Cross Lifeblood, Brisbane, Australia
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | | | - Lilian Antwi Boateng
- Department of Medical Diagnostics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Immunohaematology laboratory, University Health Services, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Saikat Mandal
- Medical Oncology, Hull York Medical School, University of Hull, Hull, UK
| | - Nour Almozain
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Jannison Ribeiro
- Centro de Hematologia e Hemoterapia do Ceará - Hemoce, Fortaleza, Brazil
- Instituto Pró-Hemo Saúde - IPH, Fortaleza, Brazil
| | - Syeldy Langi Sasongko
- Department of Public and Occupational Health, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
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4
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Chowdhury F, Estcourt L, Murphy MF. Mitigating the impact of blood shortages in England. Br J Haematol 2024; 204:1660-1671. [PMID: 38419589 DOI: 10.1111/bjh.19344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
The supply of blood components and products in sufficient quantities is key to any effective health care system. This report describes the challenges faced by the English blood service, NHS Blood and Transplant (NHSBT), towards the end of the COVID-19 pandemic, which in October 2022 led to an Amber Alert being declared to hospitals indicating an impending blood shortage. The impact on the hospital transfusion services and clinical users is explained. The actions taken by NHSBT to mitigate the blood supply challenges and ensure equity of transfusion support for hospitals in England including revisions to the national blood shortage plans are described. This report focuses on the collaboration and communication between NHSBT, NHS England (NHSE), Department of Health and Social Care (DHSC), National Blood Transfusion Committee (NBTC), National Transfusion Laboratory Managers Advisory Group for NBTC (NTLM), National Transfusion Practitioners Network, the medical Royal Colleges and clinical colleagues across the NHS.
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Affiliation(s)
- Fateha Chowdhury
- NHS Blood and Transplant, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Lise Estcourt
- NHS Blood and Transplant, London, UK
- University of Oxford, Oxford, UK
| | - Michael F Murphy
- NHS Blood and Transplant, London, UK
- University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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5
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Mould-Millman NK, Wogu AF, Fosdick BK, Dixon JM, Beaty BL, Bhaumik S, Lategan HJ, Stassen W, Schauer SG, Steyn E, Verster J, Wylie C, de Vries S, Jamison M, Kohlbrenner M, Mayet M, Hodsdon L, Wagner L, Snyders LO, Doubell K, Lourens D, Bebarta VS. Association of freeze-dried plasma with 24-h mortality among trauma patients at risk for hemorrhage. Transfusion 2024; 64 Suppl 2:S155-S166. [PMID: 38501905 DOI: 10.1111/trf.17792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Blood products form the cornerstone of contemporary hemorrhage control but are limited resources. Freeze-dried plasma (FDP), which contains coagulation factors, is a promising adjunct in hemostatic resuscitation. We explore the association between FDP alone or in combination with other blood products on 24-h mortality. STUDY DESIGN AND METHODS This is a secondary data analysis from a cross-sectional prospective observational multicenter study of adult trauma patients in the Western Cape of South Africa. We compare mortality among trauma patients at risk of hemorrhage in three treatment groups: Blood Products only, FDP + Blood Products, and FDP only. We apply inverse probability of treatment weighting and fit a multivariable Cox proportional hazards model to assess the hazard of 24-h mortality. RESULTS Four hundred and forty-eight patients were included, and 55 (12.2%) died within 24 h of hospital arrival. Compared to the Blood Products only group, we found no difference in 24-h mortality for the FDP + Blood Product group (p = .40) and a lower hazard of death for the FDP only group (hazard = 0.38; 95% CI, 0.15-1.00; p = .05). However, sensitivity analyses showed no difference in 24-h mortality across treatments in subgroups with moderate and severe shock, early blood product administration, and accounting for immortal time bias. CONCLUSION We found insufficient evidence to conclude there is a difference in relative 24-h mortality among trauma patients at risk for hemorrhage who received FDP alone, blood products alone, or blood products with FDP. There may be an adjunctive role for FDP in hemorrhagic shock resuscitation in settings with significantly restricted access to blood products.
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Affiliation(s)
- Nee-Kofi Mould-Millman
- Department of Emergency Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Adane F Wogu
- Department of Biostatistics and Informatics, Colorado School of Public Health, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Bailey K Fosdick
- Department of Biostatistics and Informatics, Colorado School of Public Health, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Julia M Dixon
- Department of Emergency Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Brenda L Beaty
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Smitha Bhaumik
- Department of Emergency Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Hendrick J Lategan
- Division of Surgery, Department of Surgical Sciences, Stellenbosch University, Cape Town, South Africa
| | - Willem Stassen
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Steven G Schauer
- Department of Anesthesia, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Elmin Steyn
- Division of Surgery, Department of Surgical Sciences, Stellenbosch University, Cape Town, South Africa
| | - Janette Verster
- Division of Forensic Medicine, Department of Pathology, Stellenbosch University, Cape Town, South Africa
| | - Craig Wylie
- Department of Health and Wellness, Western Cape Government, Cape Town, South Africa
| | - Shaheem de Vries
- Collaborative for Emergency Care in Africa, Cape Town, South Africa
| | - Maria Jamison
- Department of Emergency Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Maria Kohlbrenner
- Department of Emergency Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Mohammed Mayet
- Department of Health and Wellness, Western Cape Government, Cape Town, South Africa
| | - Lesley Hodsdon
- Department of Health and Wellness, Western Cape Government, Cape Town, South Africa
| | - Leigh Wagner
- Department of Health and Wellness, Western Cape Government, Cape Town, South Africa
| | - L' Oreal Snyders
- Department of Health and Wellness, Western Cape Government, Cape Town, South Africa
| | - Karlien Doubell
- Department of Health and Wellness, Western Cape Government, Cape Town, South Africa
| | - Denise Lourens
- Department of Health and Wellness, Western Cape Government, Cape Town, South Africa
| | - Vikhyat S Bebarta
- Department of Emergency Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
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6
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Raykar NP, Raguveer V, Abdella YE, Ali-Awadh A, Arora H, Asamoah-Akuoko L, Barnes LS, Cap AP, Chowdhury A, Cooper Z, Delaney M, DelSignore M, Inam S, Ismavel VA, Jensen K, Kumar N, Lokoel G, Mammen JJ, Nathani P, Nisingizwe MP, Puyana JC, Riviello R, Roy N, Salim A, Tayou-Tagny C, Virk S, Wangamati CW. Innovative blood transfusion strategies to address global blood deserts: a consensus statement from the Blood Delivery via Emerging Strategies for Emergency Remote Transfusion (Blood DESERT) Coalition. Lancet Glob Health 2024; 12:e522-e529. [PMID: 38365422 PMCID: PMC10882207 DOI: 10.1016/s2214-109x(23)00564-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 11/10/2023] [Accepted: 11/28/2023] [Indexed: 02/18/2024]
Abstract
In rural settings worldwide, many people live in effective blood deserts without access to any blood transfusion. The traditional system of blood banking is logistically complex and expensive for many resource-restricted settings and demands innovative and multidisciplinary solutions. 17 international experts in medicine, industry, and policy participated in an exploratory process with a 2-day hybrid seminar centred on three promising innovative strategies for blood transfusions in blood deserts: civilian walking blood banks, intraoperative autotransfusion, and drone-based blood delivery. Participant working groups conducted literature reviews and interviews to develop three white papers focused on the current state and knowledge gaps of each innovation. Seminar discussion focused on defining blood deserts and developing innovation-specific implementation agendas with key research and policy priorities for future work. Moving forward, advocates should prioritise the identification of blood deserts and address the context-specific challenges for these innovations to alleviate the ongoing crisis in blood deserts.
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Affiliation(s)
- Nakul P Raykar
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| | - Vanitha Raguveer
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | | | - Asma Ali-Awadh
- Sub-county Langata and Kibera, Nairobi Metropolitan Health Services, Nairobi, Kenya; Sisu Global Health, Baltimore, MD, USA
| | - Harshit Arora
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Lucy Asamoah-Akuoko
- Department of Research, Planning, Monitoring, and Evaluation, National Blood Service, Accra, Ghana
| | | | - Andrew P Cap
- US Army Institute of Surgical Research, Houston, TX, USA
| | - Aulina Chowdhury
- Department of Anesthesia, Boston Children's Hospital, Boston, MA, USA
| | - Zara Cooper
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Meghan Delaney
- Department of Pathology and Laboratory Medicine, Children's National Hospital, Washington, DC, USA
| | | | - Sidra Inam
- Allied Hospital Faisalabad, Faisalabad, Pakistan
| | | | - Kennedy Jensen
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Nikathan Kumar
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Department of Surgery, University of California San Francisco, East Bay, Oakland, CA, USA
| | - Gilchrist Lokoel
- Department of Medical Services, Turkana County Government, Lodwar, Kenya
| | - Joy John Mammen
- Department of Transfusion Medicine, Christian Medical College, Vellore, India
| | - Priyansh Nathani
- Dr RN Cooper Municipal Medical College and General Hospital: Hinduhridaysamrat Balasaheb Thackeray Medical College and Rustom Narsi Cooper Municipal General Hospital, Mumbai, India; WHO Collaboration Center for Research in Surgical Care Delivery in Low and Middle Income Countries, Mumbai, India
| | - Marie Paul Nisingizwe
- Department of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Juan Carlos Puyana
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Robert Riviello
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Nobhojit Roy
- Operative Care, Clinical Services and Systems, WHO, Geneva, Switzerland
| | - Ali Salim
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Claude Tayou-Tagny
- Department of Haematology and Transfusion Medicine, University of Yaoundé, Yaoundé, Cameroon
| | - Sargun Virk
- WHO Collaboration Center for Research in Surgical Care Delivery in Low and Middle Income Countries, Mumbai, India
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7
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Curci N, Iacono R, Segura DR, Cillo M, Cobucci-Ponzano B, Strazzulli A, Leonardi A, Giger L, Moracci M. Novel GH109 enzymes for bioconversion of group A red blood cells to the universal donor group O. N Biotechnol 2023; 77:130-138. [PMID: 37643666 DOI: 10.1016/j.nbt.2023.08.002] [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: 04/05/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 08/31/2023]
Abstract
Glycoside hydrolases (GHs) have been employed for industrial and biotechnological purposes and often play an important role in new applications. The red blood cell (RBC) antigen system depends on the composition of oligosaccharides on the surface of erythrocytes, thus defining the ABO blood type classification. Incorrect blood transfusions may lead to fatal consequences, making the availability of the correct blood group critical. In this regard, it has been demonstrated that some GHs may be helpful in the conversion of groups A and B blood types to produce group O universal donor blood. GHs belonging to the GH109 family are of particular interest for this application due to their ability to convert blood from group A to group O. This work describes the biochemical characterisation of three novel GH109 enzymes (NAg68, NAg69 and NAg71) and the exploration of their ability to produce enzymatically converted RBCs (ECO-RBC). The three enzymes showed superior specificity on pNP-α-N-acetylgalactosamine compared to previously reported GH109 enzymes. These novel enzymes were able to act on purified antigen-A trisaccharides and produce ECO-RBC from human donor blood. NAg71 converted type A RBC to group O with increased efficiency in the presence of dextran compared to a commercially available GH109, previously used for this application.
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Affiliation(s)
- Nicola Curci
- Department of Biology, University of Naples "Federico II", Complesso Universitario di Monte S. Angelo, Via Cinthia 21, Naples 80126, Italy; Institute of Biosciences and BioResources, National Research Council of Italy, Via P. Castellino 111, Naples 80131, Italy
| | - Roberta Iacono
- Department of Biology, University of Naples "Federico II", Complesso Universitario di Monte S. Angelo, Via Cinthia 21, Naples 80126, Italy
| | | | - Michele Cillo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples "Federico II", Via Sergio Pansini, 5, Naples 80131, Italy
| | - Beatrice Cobucci-Ponzano
- Institute of Biosciences and BioResources, National Research Council of Italy, Via P. Castellino 111, Naples 80131, Italy
| | - Andrea Strazzulli
- Department of Biology, University of Naples "Federico II", Complesso Universitario di Monte S. Angelo, Via Cinthia 21, Naples 80126, Italy; NBFC, National Biodiversity Future Center, Palermo 90133, Italy
| | - Antonio Leonardi
- Department of Molecular Medicine and Medical Biotechnology, University of Naples "Federico II", Via Sergio Pansini, 5, Naples 80131, Italy
| | - Lars Giger
- Novozymes A/S, Biologiens vej 2, 2800 Kgs. Lyngby, Denmark
| | - Marco Moracci
- Department of Biology, University of Naples "Federico II", Complesso Universitario di Monte S. Angelo, Via Cinthia 21, Naples 80126, Italy; Institute of Biosciences and BioResources, National Research Council of Italy, Via P. Castellino 111, Naples 80131, Italy; NBFC, National Biodiversity Future Center, Palermo 90133, Italy.
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8
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Stassen W, Wylie C, Craig W, Ebrahim I, Mahoney SH, Pusateri AE, Rambharose S, van Koningsbruggen C, Weiskopf RB, Wallis LA. The Effect of Prehospital Clinical Trial-Related Procedures on Scene Interval, Cognitive Load, and Error: A Randomized Simulation Study. PREHOSP EMERG CARE 2023; 28:864-870. [PMID: 37713658 DOI: 10.1080/10903127.2023.2259998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/10/2023] [Accepted: 09/11/2023] [Indexed: 09/17/2023]
Abstract
INTRODUCTION Globally, very few settings have undertaken prehospital randomized controlled trials. Given this lack of experience, there is a risk that such trials in these settings may result in protocol deviations, increased prehospital intervals, and increased cognitive load, leading to error. Ultimately, this may affect patient safety and mortality. The aim of this study was to assess the effect of trial-related procedures on simulated scene interval, self-reported cognitive load, medical errors, and time to action. METHODS This was a prospective simulation study. Using a cross-over design, ten teams of prehospital clinicians were allocated to three separate simulation arms in a random order. Simulations were: (1) Eligibility assessment and administration of freeze-dried plasma (FDP) and a hemoglobin-based oxygen carrier (HBOC), (2) Eligibility assessment and administration of HBOC, (3) Eligibility assessment and standard care. All simulations also required clinical management of hemorrhagic shock. Simulated scene interval, error rates, cognitive load (measured by NASA Task Load Index), and competency in clinical care (assessed using the Simulation Assessment Tool Limiting Assessment Bias (SATLAB)) were measured. Mean differences between simulations with and without trial-related procedures were sought using one-way ANOVA or Kruskal-Wallis test. A p-value of <0.05 within the 95% confidence interval was considered significant. RESULTS Thirty simulations were undertaken, representing our powered sample size. The mean scene intervals were 00:16:56 for Simulation 1 (FDP and HBOC), 00:17:22 for Simulation 2 (HBOC only), and 00:14:24 for Simulation 3 (standard care). Scene interval did not differ between the groups (p = 0.27). There were also no significant differences in error rates (p = 0.28) or cognitive load (p = 0.67) between the simulation groups. There was no correlation between cognitive load and error rates (r = 0.15, p = 0.42). Competency was achieved in all the assessment criteria for all simulation groups. CONCLUSION In a simulated environment, eligibility screening, performance of trial-related procedures, and clinical management of patients with hemorrhagic shock can be completed competently by prehospital advanced life support clinicians without delaying transport or emergency care. Future prehospital clinical trials may use a similar approach to help ensure graded and cautious implementation of clinical trial procedures into prehospital emergency care systems.
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Affiliation(s)
- Willem Stassen
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Craig Wylie
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
- Division of Emergency Medicine, Stellenbosch University, Stellenbosch, South Africa
| | - Wesley Craig
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Ismaeel Ebrahim
- Division of Emergency Medicine, Stellenbosch University, Stellenbosch, South Africa
| | - Scott H Mahoney
- Division of Emergency Medicine, Stellenbosch University, Stellenbosch, South Africa
| | - Anthony E Pusateri
- Naval Medical Research Unit-San Antonio, Fort Sam Houston, San Antonio, Texas, USA
| | - Sanjeev Rambharose
- Division of Emergency Medicine, Stellenbosch University, Stellenbosch, South Africa
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | | | - Lee A Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
- Division of Emergency Medicine, Stellenbosch University, Stellenbosch, South Africa
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9
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Munoz-Valencia A, Aridi JO, Barnes LS, Rudd KE, Bidanda B, Epuu T, Kamu R, Kivuli T, Macleod J, Makanga CM, Makin J, Mate M, Muiru CN, Murithi G, Musa A, Nyagol H, Ochieng K, Rajgopal J, Raykar NP, Tian Y, Yazer MH, Zeng B, Olayo B, Kumar P, Puyana JC. Protocol: identifying policy, system, and environment change interventions to enhance availability of blood for transfusion in Kenya, a mixed-methods study. BMC Health Serv Res 2023; 23:963. [PMID: 37679772 PMCID: PMC10486046 DOI: 10.1186/s12913-023-09936-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 08/17/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Safe blood is essential for the care of patients with life-threatening anemia and hemorrhage. Low blood donation rates, inefficient testing procedures, and other supply chain disruptions in blood administration affect patients in low-resource settings across Sub-Saharan countries, including Kenya. Most efforts to improve access to transfusion have been unidimensional, usually focusing on only point along the blood system continuum, and have excluded community stakeholders from early stages of intervention development. Context-appropriate interventions to improve the availability of safe blood at the point of use in low-resource settings are of paramount importance. Thus, this protocol proposes a multifaceted approach to characterize the Kenyan blood supply chain through quantitative and qualitative analyses as well as an industrial engineering approach. METHODS This study will use a mixed-methods approach in addition to engineering process mapping, modeling and simulation of blood availability in Kenya. It will be guided by a multidimensional three-by-three-by-three matrix: three socioeconomic settings, three components of the blood system continuum, and three levels of urgency of blood transfusion. Qualitative data collection includes one-on-one interviews and focus group discussions with stakeholders across the continuum to characterize ground-level deficits and potential policy, systems, and environment (PSE) interventions. Prospectively-collected quantitative data will be used to estimate blood collection and transfusion of blood. We will create a process map of the blood system continuum to model the response to PSE changes proposed by stakeholders. Lastly, we will identify those PSE changes that may have the greatest impact on blood transfusion availability, accounting for differences across socioeconomic settings and levels of urgency. DISCUSSION Identifying and prioritizing community-driven interventions to improve blood supply in low-resource settings are of utmost importance. Varied constraints in blood collection, processing, delivery, and use make each socioeconomic setting unique. Using a multifaceted approach to understand the Kenyan blood supply and model the response to stakeholder-proposed PSE changes may lead to identification of contextually appropriate intervention targets to meet the transfusion needs of the population.
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Affiliation(s)
- Alejandro Munoz-Valencia
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jackline O Aridi
- Institute of Healthcare Management, Strathmore University Business School, Nairobi, Kenya
| | - Linda S Barnes
- Linda S. Barnes Consulting, Seattle, WA, USA
- Doctor of Public Health Leadership, University of Illinois-Chicago, Chicago, IL, USA
| | - Kristina E Rudd
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bopaya Bidanda
- Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tonny Epuu
- Institute of Healthcare Management, Strathmore University Business School, Nairobi, Kenya
| | - Robert Kamu
- Institute of Healthcare Management, Strathmore University Business School, Nairobi, Kenya
| | - Tecla Kivuli
- Institute of Healthcare Management, Strathmore University Business School, Nairobi, Kenya
| | - Jana Macleod
- Institute of Healthcare Management, Strathmore University Business School, Nairobi, Kenya
- Department of Surgery, Kenyatta University, Nairobi, Kenya
| | - Cindy M Makanga
- Institute of Healthcare Management, Strathmore University Business School, Nairobi, Kenya
| | - Jennifer Makin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center Magee Women's Hospital, Pittsburgh, PA, USA
| | - Muthoni Mate
- Center for Public Health and Development, Kisumu, Kenya
| | - Carolyne Njoki Muiru
- Institute of Healthcare Management, Strathmore University Business School, Nairobi, Kenya
- Department of Surgery, Egerton University, Nakuru, Kenya
| | | | - Abdirahaman Musa
- Institute of Healthcare Management, Strathmore University Business School, Nairobi, Kenya
- Ministry of Health & Sanitation, Turkana County Government, Turkana, Kenya
| | - Hellen Nyagol
- Center for Public Health and Development, Kisumu, Kenya
| | - Kevin Ochieng
- Center for Public Health and Development, Kisumu, Kenya
| | - Jayant Rajgopal
- Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nakul P Raykar
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Yiqi Tian
- Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bo Zeng
- Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bernard Olayo
- Center for Public Health and Development, Kisumu, Kenya
| | - Pratap Kumar
- Institute of Healthcare Management, Strathmore University Business School, Nairobi, Kenya.
| | - Juan Carlos Puyana
- Departments of Surgery and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Bharadwaj HR, Wireko AA, Adebusoye FT, Ferreira T, Pacheco‐Barrios N, Abdul‐Rahman T, Mykolayivna NI. Challenges and opportunities in prostate cancer surgery in South America: Insights into robot-assisted radical prostatectomies-A perspective. Health Sci Rep 2023; 6:e1519. [PMID: 37614285 PMCID: PMC10442525 DOI: 10.1002/hsr2.1519] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/02/2023] [Accepted: 08/09/2023] [Indexed: 08/25/2023] Open
Abstract
Background and Aims Prostate cancer imposes a significant health burden, particularly in South America with its high incidence and mortality rates. This article explores the emergence of robot-assisted radical prostatectomy (RARP) as a potential solution in the region. Methods This study relies on a comprehensive review of relevant literature. The analysis highlights the advantages of RARP, identifies impediments to its implementation, and proposes strategies to overcome these barriers. Results RARP demonstrates notable benefits, including improved functional outcomes, reduced complications, and minimized incisions. However, the integration of RARP in South America is hindered by challenges such as regional disparities, financial limitations, and data gaps. Limited healthcare infrastructure and a scarcity of skilled professionals further compound the issues. Conclusion Despite its potential, RARP faces obstacles to widespread adoption in South America. Strategic solutions encompassing technology investment, healthcare infrastructure enhancement, and workforce training are imperative. Overcoming these challenges can establish RARP as a crucial tool in managing prostate cancer in the region, ultimately enhancing patient care and treatment outcomes.
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Affiliation(s)
| | | | | | - Tomas Ferreira
- School of Clinical MedicineUniversity of CambridgeCambridgeUK
| | - Niels Pacheco‐Barrios
- Faculty of Medicine, Alberto Hurtado Medical SchoolCayetano Heredia Peruvian UniversityLimaPeru
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11
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Garraud O, Politis C, Henschler R, Pj Vlaar A, Haddad A, Ertuğrul Örüç N, Laspina S, DE Angelis V, Richardson C, Vuk T. Ethics in transfusion medicine: Are the intricate layers of ethics all universal? A global view. Transfus Clin Biol 2023:S1246-7820(23)00040-X. [PMID: 36965847 DOI: 10.1016/j.tracli.2023.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2023]
Abstract
Ethical principles have been considered, and in several respects regulated, along the entire blood procurement chain from donor motivation to transfusion to the patient. Consent of donors and voluntary non-remunerated donation are fields which have been addressed by codes of ethics and legislation. Caring for donor health is an area of further development of ethical standards. In part, blood products have also become a market, where commercial principles may synergize, but also creating issues in equality and maintaining human dignity that challenge societal solutions. At the bedside, the main global challenge remains to procure enough blood products for each patient in medical need. Allocation of rare blood, ethical evaluation of transfusion triggers, attitudes towards refusing blood transfusion and provision of blood products to remote settings are areas which should receive consideration.
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Affiliation(s)
- Olivier Garraud
- Sainbiose-INSERM_U1059, faculty of medicine, university of Saint-Etienne, Saint-Etienne, France.
| | | | - Reinhard Henschler
- Institute of Transfusion Medicine, University Hospital Leipzig, University of Leipzig, Johannisallee 32, D 04318 Leipzig, Germany
| | - Alexander Pj Vlaar
- Department of Intensive Care, Amsterdam UMC, location Academic Medical Center, University of Amsterdam, Meibergdreef 9, PO Box 22660, 1105 AZ Amsterdam, the Netherlands; Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, location Academic Medical Center, University of Amsterdam, Meibergdreef 9, PO Box 22660, 1105 AZ Amsterdam, the Netherlands
| | - Antoine Haddad
- Sacré Cœur Hospital, Beirut, Lebanon; Lebanese University and Lebanese American University, Beirut, Lebanon
| | - Nigar Ertuğrul Örüç
- Health Sciences University Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Stefan Laspina
- Mater Dei Hospital Blood Bank, Pathology Department, Mater Dei Hospital, Malta
| | | | - Clive Richardson
- Panteion University of Social and Political Sciences, Athens, Greece
| | - Tomislav Vuk
- Croatian Institute of Transfusion Medicine, Zagreb, Croatia
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12
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Idris E, Yadeta E, Debella A, Tamiru D, Atnafe G, Arkew M, Teklemariam Z. Blood donation practice and its predictors among undergraduate college students in Harari Regional State, Eastern Ethiopia. SAGE Open Med 2023; 11:20503121231159344. [PMID: 36993777 PMCID: PMC10041578 DOI: 10.1177/20503121231159344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/06/2023] [Indexed: 03/31/2023] Open
Abstract
Objectives The main objective of this study was to assess blood donation practice and its associated factors among undergraduate college students in Harari Region, Eastern Ethiopia. Methods An institutional-based cross-sectional study was employed among 518 college students selected by using a simple random sampling technique. Data was collected using pretested structured self-administered questionnaire. The collected data was entered into Epi-data 3.41 and exported to Statistical Package for Social Science version 22 for analysis. Bivariate and multivariable logistic regressions were utilized to identify factors associated with blood donation practice. p-Values of 0.05 or less was used to declare statistical significance. Results In this study, the overall blood donation practice was 35.7% (95% confidence interval: 31.6, 39.8). Students studying health sciences were more likely than non-health sciences students (53.5%) to donate blood. Having positive knowledge about blood donation (adjusted odds ratio = 4.17; 95% confidence interval: 2.50, 6.92), being male (adjusted odds ratio = 0.57; 95% confidence interval: 0.38, 0.87), being student of midwifery department (adjusted odds ratio = 2.16; 95% confidence interval: 1.07, 4.36) and nursing department (adjusted odds ratio = 2.42; 95% confidence interval: 1.18, 4.98) were significantly associated with blood donation practice. Conclusion Practice of blood donation among college students in the study is relatively low. Knowledge about blood donation, male sex and being a nursing and midwifery student were independently associated with blood donation practice. Therefore, the Regional Health Bureau and Blood Bank in collaboration with college administrators should design and implement appropriate strategies to improve blood donation practice.
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Affiliation(s)
- Elias Idris
- School of Medical Laboratory Sciences, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Elias Yadeta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Elias Yadeta, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dawit Tamiru
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Genanaw Atnafe
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mesay Arkew
- School of Medical Laboratory Sciences, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Zelalem Teklemariam
- School of Medical Laboratory Sciences, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
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13
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Delaney M, Telke S, Zou S, Williams MJ, Aridi JO, Rudd KE, Puyana JC, Kumar P, Appiah B, Dei-Adomakoh Y, Asamoah-Akuoko L, Olayemi E, Singogo E, Hosseinipour MC, m’baya B, Chipeta E, Reilly C. The BLOODSAFE program: Building the future of access to safe blood in Sub-Saharan Africa. Transfusion 2022; 62:2282-2290. [PMID: 36173295 PMCID: PMC9643608 DOI: 10.1111/trf.17091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/30/2022] [Accepted: 07/12/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The supply of blood in many low- and middle-income nations in Sub-Saharan Africa (SSA) does not meet the patient care needs. Lack and delay of blood transfusion cause harm to patients and slow the rate of progress in other parts of the health system. Recognizing the power of implementation science, the BLOODSAFE Program was initiated which supports three SSA research study teams and one data coordinating center (DCC) with the goal to improve access to safe blood transfusion in SSA. STUDY DESIGN AND METHODS The study team in Ghana is focusing on studying and decreasing iron deficiency in blood donors and evaluating social engagement of blood donors through different approaches. The study team in Kenya is building a "vein to vein" workflow model to elucidate and devise strategies to overcome barriers to blood donation and improve infrastructural components of blood product production and use. The Malawi team is studying the infectious disease ramifications of blood donation as well as blood donor retention strategies aimed at blood donors who commence their donation career in secondary schools. RESULTS AND DISCUSSION Together the project teams and the DCC work as a consortium to support each other through a shared study protocol that will study donor motivations, outcomes, and adverse events across all three countries. The BLOODSAFE Program has the potential to lead to generalizable improvement approaches for increasing access to safe blood in SSA as well as mentoring and building the research capacity and careers of many investigators.
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Affiliation(s)
- Meghan Delaney
- Division of Pathology & Laboratory Medicine, Children’s National Hospital, Washington DC, USA
| | - Susan Telke
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Shimian Zou
- Division of Blood Diseases and Resources, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Makeda J. Williams
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Jackline O. Aridi
- Institute of Healthcare Management, Strathmore Business School, Nairobi, Kenya
| | - Kristina E. Rudd
- The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Juan Carlos Puyana
- Departments of Surgery and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Pratap Kumar
- Institute of Healthcare Management, Strathmore Business School, Nairobi, Kenya
| | - Bernard Appiah
- Research Program on Health Communication and Public Engagement (H-COPE), Department of Public Health, Falk College, Syracuse University, Syracuse, NY
| | - Yvonne Dei-Adomakoh
- Department of Hematology, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Lucy Asamoah-Akuoko
- Research and Development Department, National Blood Service Ghana, Accra, Ghana
| | - Edeghonghon Olayemi
- Department of Hematology, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | | | - Mina C. Hosseinipour
- University of North Carolina, Project Malawi, Lilongwe, Malawi
- University of North Carolina at Chapel Hill School of Medicine, Department of medicine, Division of Infectious Disease, Chapel Hill, NC, USA
| | | | - Effie Chipeta
- Kamuzu University of Health Sciences, Centre for Reproductive Health, Blantyre Malawi
| | - Cavan Reilly
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Lei B, Guo M, Deng X, He S, Lu X, Wang Y, Wang L. Intraoperative cell salvage as an effective intervention for postpartum hemorrhage—Evidence from a prospective randomized controlled trial. Front Immunol 2022; 13:953334. [PMID: 36300123 PMCID: PMC9589269 DOI: 10.3389/fimmu.2022.953334] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background Postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality. Promptly recovering blood loss is critical for PPH. Intraoperative cell salvage (ICS) is a method to collect and process red blood cells (RBCs) from the blood lost during surgery and transfuse them to the patient’s circulation during or immediately after surgery. Its effectiveness in reducing the demand for allogeneic blood transfusion has been proven, but its effectiveness and safety as a sole treatment for PPH during Cesarean sections are unclear. This is particularly important for patients who cannot or do not want to accept allogeneic blood transfusion. Materials and methods In this prospective randomized controlled study, patients with high risks of PPH were randomized into the ICS group or the control group, receiving ICS or allogeneic RBC transfusion if their hemoglobin level was less than 80 g/L during operation. Data collected include clinical examination, blood cell count, hemoglobin level, coagulation function, and plasma levels of fetal hemoglobin, tissue factor, and alpha-fetoprotein before and after fetal delivery and 0, 2, and 12 h after treatment. Adverse events were recorded. Results A total of 130 patients were enrolled, aged 33 ± 1 years with a mean gestation period of 37 ± 1 week. The most common cause of Cesarean section was placenta previa, followed by twin pregnancy, scarred uterus, preeclampsia, placental abruption, fetal distress, and placenta accreta spectrum. Bleeding amount was similar between the two groups. The ICS group, compared to controls, had more efficient increases in levels of hemoglobin, RBC, and hematocrit (all p < 0.05). Coagulation function was maintained in the ICS group but reduced in controls 24 h after transfusion, indicated by significantly reduced fibrinogen level and prolonged prothrombin time (PT), thrombin time (TT), and activated partial thromboplastin time (aPTT) (all p < 0.05). There was a transient but significant decrease in plasma tissue factor and alpha-fetoprotein levels and an increase in plasma fetal hemoglobin level with ICS treatment in the postpartum period. No adverse event occurred with ICS intervention. Conclusion ICS is an effective and safe intervention for patients with a high risk of PPH during elective or emergency Cesarean section. It can effectively clear tissue factors and alpha-fetoprotein but not fetal hemoglobin.
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Affiliation(s)
- Bo Lei
- Department of Anesthesiology, Haidian Maternal and Child Health Hospital, Beijing, China
| | - Min Guo
- Department of Anesthesiology, Haidian Maternal and Child Health Hospital, Beijing, China
| | - Xin Deng
- Department of Anesthesiology, Haidian Maternal and Child Health Hospital, Beijing, China
| | - Shujun He
- Department of Anesthesiology, Haidian Maternal and Child Health Hospital, Beijing, China
| | - Xin Lu
- Clinical Laboratory, Haidian Maternal and Child Health Hospital, Beijing, China
| | - Yunjuan Wang
- Department of Anesthesiology, Haidian Maternal and Child Health Hospital, Beijing, China
| | - Lei Wang
- Department of Anesthesiology, Haidian Maternal and Child Health Hospital, Beijing, China
- *Correspondence: Lei Wang,
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15
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Meeting demand—Obstetric hemorrhage and blood availability in Malawi, a qualitative study. PLoS One 2022; 17:e0273426. [PMID: 36001581 PMCID: PMC9401179 DOI: 10.1371/journal.pone.0273426] [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: 03/04/2022] [Accepted: 08/08/2022] [Indexed: 11/22/2022] Open
Abstract
Background Postpartum haemorrhage (PPH) is the leading cause of maternal mortality in Malawi. Despite the presence of a centralized institution supplying blood and blood products for hospitals across the country, a lack of timely blood transfusion has been identified as a critical barrier to successful PPH management. This study aims to understand the factors that affect the blood delivery pipeline and adequate access to blood products for postpartum haemorrhage patients. Methods Qualitative data were collected through in-depth interviews with key stakeholders across the blood delivery pipeline. Interviews were conducted from July 2020 to January 2021 at Queen Elizabeth Central Hospital and Mulanje District Hospital, a referral and district hospital respectively, as well as the Malawi Blood Transfusion Service. Line by line, open coding was used to perform a thematic analysis of the data using Nvivo and Atlas.ti software. Results Five key themes were identified: 1) Lack of blood availability due to an inadequate donor pool, 2) Transportation of blood products and PPH patients is impeded by distance to target sites and competing interests for blood delivery vehicles, 3) The Malawi Blood Transfusion Service has difficulty meeting demand for blood products due to inadequate funding and difficulty retaining blood donors, 4) Current PPH management protocols and practices lead to delays due to inconsistent guidelines on delivery and analysis of patient samples, and 5) Communication between health cadres is inconsistent and affected by a lack of adequate resources. Conclusions Barriers to timely blood transfusion for PPH patients exist across the blood delivery pipeline. While an investment of infrastructure would alleviate many obstacles, several solutions identified in this study can be implemented without additional resources, such as establishing joint department meetings to improve communication between health cadres. Ultimately, given a resource limited setting, it may be worth considering de-centralizing the blood supply.
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