Arbovirus - a threat to transfusion safety in Spain: a narrative review

Arboviruses represent a threat to transfusion safety for several reasons: the presence of vectors and the notification of autochthonous cases in our region, the recent increase in the number of cases transmitted through blood and/or blood component transfusion, the high prevalence rates of RNA of the main arboviruses in asymptomatic blood donors, and their ability to survive processing and storage in the different blood components. In an epidemic outbreak caused by an arbovirus in our region, transfusion centres can apply different measures: reactive measures, related to donor selection or arbovirus screening, and proactive measures, such as pathogen inactivation methods. The study of the epidemiology of the main arboviruses and understanding the effectiveness of the different measures that we can adopt are essential to ensure that our blood components remain safe.

Acte transfusionnel, 18 ans pour une nouvelle instruction : la maturité

The DGS/DHOS/Afssaps circular No. 03/582 of December 15, 2003 has regulated the performance of the transfusion act since 2003. The French Society for Vigilance and Transfusion Therapy (SFVTT) requested the revision of this text from the Directorate General for Health (DGS) in November 2018. Indeed, the new requirements in terms of transfusion safety of the Public Health Code, the National Agency for the Safety of Medicines and Health Products, the High Authority for health, and the desire to deploy patient blood management have have caused practices to evolve. Following the agreement of the DGS, an SFVTT working group was set up, with the objective of redrafting the guidelines. This approach led to the publication of the new instruction No. DGS/PP4/DGOS/PF2/2021/230 of November 16, 2021 relating to the performance of the transfusion act , 18 years after that of the first circular.

Transfusion Safety Officers in the United States: Survey of characteristics and approaches to implementation

BACKGROUND

Transfusion safety officers (TSO) function as liaisons between the blood bank and clinical staff, utilizing audits, quality improvement, reviews, communication, education, and general vigilance to enhance transfusion safety. While hospitals in Europe and Canada have long employed TSOs, a majority of institutions in the United States (US) have yet to implement this resource, despite the mounting evidence to support their effectiveness.

STUDY DESIGN AND METHODS

An anonymous 20-question survey was administered to 104 hospitals with valid email contact information. Survey questions addressed the presence of a TSO, characteristics, backgrounds, and education of TSOs, the reporting and funding structure of the position, and role responsibilities.

RESULTS

53 responses were received, with 52 surveys completed (51 % response rate). The majority of responding institutions have a patient blood management (PBM) program (n = 40, 77 %) and 33 (63 %) have at least 1 TSO. 61 % of TSOs report an educational background in nursing, with 11 additional unique training backgrounds identified. TSO responsibilities are varied and include quality improvement, education, transfusion safety event analysis, and participation in PBM initiatives. Barriers to implementing a TSO position include lack of resources, financial impediments, and a lack of understanding of the position and its value by administrators and clinicians.

DISCUSSION

The results of this survey highlight how TSOs contribute to transfusion safety and PBM and may provide guidance to hospitals interested in implementing a TSO position. It also elucidates the range of TSO responsibilities and approaches that institutions utilize to advocate for, and implement, this position in the US.

Blood School

OBJECTIVES

To describe and evaluate a laboratory-based nursing education activity on transfusion to improve patient safety, an often-neglected opportunity.

METHODS

Our transfusion service developed a day-long "Blood School" to provide knowledge, skills, and behaviors to nurses in four aspects of transfusion: blood ordering, sample collection, transfusion procedures, and recognition and reporting of transfusion reactions. We collected survey data on methods and effects of training and hard data on the number of reported patient safety events.

RESULTS

Nurses want more hands-on experience to understand transfusion concepts, practice hospital procedures, recognize latent problems, and have behaviors to act effectively. We observed that engagement and understanding are best where participation is highest. Reported patient safety events were lower even as self-reported nursing mistakes increased.

CONCLUSIONS

Blood School is a well-received and effective site for nursing education in transfusion. We seek ways to extend and improve laboratory-based nursing training to improve patient safety.

Ensuring safety of the blood supply in the United States: Donor screening, testing, emerging pathogens, and pathogen inactivation

Safety of the blood supply has been a critical aspect of the transfusion medicine field since its inception, including infections that can be passed to a blood product recipient. Reactive efforts to identify potentially infected blood products are used throughout the blood donation process and afterward. Before donation, potential donors are provided educational materials about infection risks, examined and then screened through a series of questions that help temporarily, permanently, or indefinitely defer donors who could harbor acute and/or chronic infections. During donation, aseptic technique and diversion pouches reduce the potential to introduce bacteria into the blood product. Before transfusion, the blood products are tested for several infectious diseases by serology, nucleic acid testing, or a combination. During transfusion, the patient is monitored closely, and suspected transfusion reactions should be reported and investigated. The FDA regularly publishes guidance documents to incorporate knowledge gained regarding transfusion-transmitted infections, so that information can be shared and practices updated so that transfusion-related patient care can be optimized over time. Pathogen reduction processes are being developed and deployed that provide a proactive approach to both recognized and emerging pathogens.

After Hour Blood Transfusions: A Transfusion Service Perspective

Optimal functioning of blood transfusion service during after hours with limited resources are highly challenging. Best transfusion practice guidelines recommends to avoid non-urgent transfusions during out-of-core hours for the concern of patient's safety. This study aimed to evaluate the after hour packed red cell transfusion practice and to identify the proportion of avoidable transfusions in our center. The transfusion requests received, cross-matched and issued between 8 p.m. and 8 a.m. from September 2015 to August 2016 were analysed and categorized into 3E's based on the clinical need as Group I-evident need, Group 2-empirical need and Group 3-elective need. The proportion of avoidable transfusion in each group was noted based on BCSH guidelines on red cell transfusion including the patient's clinical, laboratory parameters and transfusion details. The proportion of PRBC requests received, crossmatched and issued between 8 p.m. and 8 a.m. were 24.45%, 23.84% and 27.15% respectively. The rationale for PRBC transfusion documented for evident, empirical and elective need were 56.95%, 29.34% and 13.71% respectively. Out of which, 19.21% [876/4559] was identified as avoidable transfusions providing no immediate clinical benefit to patients. This study highlights the proportion of avoidable transfusion during after hours in our center and emphasizes the need for transfusion guidelines that recommends to restrict after hour transfusions to those patients with active bleeding or urgent clinical need in order to prevent transfusion related adverse events and improve patient safety.

Administration Safety of Blood Products - Lessons Learned from a National Registry for Transfusion and Hemotherapy Practice

BACKGROUND

Compared to blood component safety, the administration of blood may not be as safe as intended. The German Interdisciplinary Task Force for Clinical Hemotherapy (IAKH) specialized registry for administration errors of blood products was chosen for a detailed analysis of reports.

METHODS

Voluntarily submitted critical incident reports (n = 138) from 2009 to 2013 were analyzed.

RESULTS

Incidents occurred in the operation room (34.1%), in the ICU (25.2%), and in the peripheral ward (18.5%). Procedural steps with errors were administration to the patient (27.2%), indication and blood order (17.1%), patient identification (17.1%), and blood sample withdrawal and tube labeling (18.0%). Bedside testing (BST) of blood groups avoided errors in only 2.6%. Associated factors were routine work conditions (66%), communication error (36%), emergency case (26%), night or weekend team (39%), untrained personnel (19%). Recommendations addressed process and quality (n = 479) as well as structure quality (n = 314). In 189 instances, an IT solution would have helped to avoid the error.

CONCLUSIONS

The administration process is prone to errors at the patient assessment for the need to transfuse and the application of blood products to patients. BST is only detecting a minority of handling errors. According to the expert recommendations for practice improvement, the potential to improve transfusion safety by a technical solution is considerable.

[Recipients adverse reactions in the Ibn Sina Hospital of Rabat: State 1999-2013]

PURPOSE OF STUDY

The declaration of the recipients adverse reactions (RAR) is one of the field haemovigilance activities. It provides an evaluation of transfusion side effects and thus prevents their appearance. The aim of this study is to analyze, over 14 years, the RAR supports reported in Rabat Ibn Sina hospital.

PATIENTS AND METHODS

All of the RAR supports sending to the blood transfusion service were analyzed. The data collected from these supports are: clinical characteristics of the patient, type of incident observed and type of labile blood products (LBP) transfused.

RESULTS

A total of 353 RAR were declared with a mean cumulative incidence of 1.7/1000 LBP delivered. Febrile non-hemolytic transfusion reactions represent 72.8% of the RAR declared. The RAR were classified as grade 1 in 87.1% of cases and were secondary to a transfusion of the red cell concentrates in 81.9%. ABO incompatibility was found in four cases (0.02/1000 LBP delivered).

CONCLUSION

The number of RAR reported by Rabat Ibn Sina hospital remains underestimated. Management and traceability RAR and rigorous investigation, under the responsibility of the corresponding haemovigilance contribute to the improvement of transfusion safety.

Involvement of transfusion unit staff in the informed consent process

BACKGROUND AND OBJECTIVES

Obtaining informed consent (IC) for a blood transfusion is an absolute requirement. In this study, we compared the depth of understanding of blood transfusion among patients with or without an explanation by the transfusion unit staff and evaluated the usefulness of this intervention in obtaining IC.

MATERIALS AND METHODS

Expert staff from the transfusion unit started to provide patients with a basic explanation of blood transfusion (intervention group, n = 129). The efficacy of this strategy was assessed by comparison with explanation given by the primary doctors only (conventional group, n = 31). We performed a questionnaire survey to analyze the length of time spent providing information of blood transfusion and the depth of understanding of blood transfusion in the two groups.

RESULTS

The median time in providing information in the conventional and intervention groups was 6 and 20 minutes, respectively (P < 0.0001). Patients in the intervention group had a better understanding of several key points on blood transfusion than those in the conventional group.

CONCLUSION

Our results show that expert staff from the transfusion unit should be involved in obtaining IC for a blood transfusion. Patients who were provided information by transfusion unit staff were more likely to have a better understanding of the risks and benefits of transfusion.

Confirmation and follow up of initial "NAT yields": Prospective study from a tertiary healthcare center in India

BACKGROUND

In India variable rate of "NAT yield" has been demonstrated in several published reports. This study was performed with the objective to know the rate of "true NAT yield" in blood donors by confirmation with supplementary tests and follow up of initial "NAT yield" donors.

MATERIALS AND METHODS

A total of 48,441 blood donors were tested for HIV, HBV and HCV with enhanced chemiluminescence and ID-NAT. To know the true NAT yield status confirmation of NAT yield donors was done as with an array of serological tests, repeat ID-NAT and alternate NAT.

RESULTS

The cumulative initial "NAT yield" rate was 1:4404 (11/48,441). Seven of 11 initial "NAT yields" were for hepatitis B whereas two each were in HIV and HCV. Among the 11 "NAT-yield" donors, eight donors were followed-up for confirmation. Out of these eight donors only 4 were found to be true HBV NAT yields. Out of four true NAT yields two were window period donations while the other two were occult hepatitis B infection with anti-HBcore total positive.

CONCLUSION

Our findings suggest that all "initial NAT yields" may not be "true NAT yields". We would also like to suggest that to demonstrate the true "NAT yield" status supplementary tests and donor follow up are important to differentiate true NAT yields.

Claims and compensation for complications resulting from blood transfusions in China from 1998 to 2013

The purpose of this study was to find causes, outcomes, and trends in malpractice litigation involving blood transfusions in China. This study examines 108 claims resulting from transfusion-related complications over a period of 15 years. The primary outcomes associated with these claims included transfusion-transmitted infection (98 cases, 90.8%), transfusion reactions (nine cases, 8.3%), and failures to obtain informed consent (one case, 0.9%). The specialty of obstetrics and gynecology was more likely to be accepted in judgment. As the supreme status of law, Blood Donation Law plays an important role in the blood safety, which results in less HCV infection cases occurred after 1998. Though the 2002 and 2010's rules give opposite liability principle, the fault liability and no-fault liability, the statistics shows that rules do not have an effect on different liabilities in judicial practice. The current study concludes that the risk of serious adverse transfusion reactions may be significantly increased by unnecessary transfusions.

[The transfusion practice in the hepatogastroenterology department of the Campus Teaching Hospital of Lomé (Togo)]

OBJECTIVE

To evaluate transfusion practice in the hepatogastroenterology department of the Campus Teaching Hospital of Lomé.

METHODOLOGY

This is a respective, descriptive and analytical study conducted from January 1 to December 31, 2013 on cases of in-patients' observation in the department. The cases of in-patients of more than 15 years old, having benefited from a blood transfusion were included.

FINDINGS

During the study period, 849 patients were admitted; 136 were transfused, or blood transfusion rate of 16.02%. The average age of patients was of 48.25 years with extremes of 15 and 90 years. The most transfused rhesus blood group was O positive (36.76%). Red blood cell was the most frequently used blood product (94.12%). The transfusion was performed in 58.82% of cases as a matter of emergency. Gastrointestinal bleeding were the main indications (55.88%). The average pre-transfusion hemoglobinemia was 6.51 g/dL±1.67. The average post-transfusion hemoglobinemia was 8.95 g/dL±1.75. Liver disease (cirrhosis and hepatocellular carcinoma) were the main diagnosis associated with blood transfusion (44.85%). The quantity of blood to be transfused was not calculated in 100% of cases. In 11.03% of cases, the compatibility test has not been done in the laboratory. Incidents during blood transfusion were noted in 5 cases.

CONCLUSION

Blood transfusion is frequent in the department. There is a good observance of blood transfusion safety regulations. However, its practice remains to be improved.

[How do I assess requirement of a blood bank and its kind for a healthcare establishment?]

Access to blood components is required for healthcare establishments, particularly for emergency situation and hospital blood bank was often a response to this requirement. However, the complexity of regulation and economic pressures lead healthcare establishment to review regularly their need for a blood bank. This assessment requires analysis of need for transfusions in terms of delay, quantity and clinical situations to which they must respond. When a blood bank is required, three kinds could be under consideration: emergency blood bank, intermediate blood bank and issuance blood bank. According to requirements, advantages and disadvantages of each kind, healthcare establishments would select the most suitable one.

[Not Available]

The Retrovirus Epidemiology Donor Study (REDS) program was established in the United States in 1989 with the purpose of increasing blood transfusion safety in the context of the HIV/AIDS and human T-lymphotropic virus epidemics. REDS and its successor, REDS-II were at first conducted in the US, then expanded in 2006 to include international partnerships with Brazil and China. In 2011, a third wave of REDS renamed the Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) was launched. This seven-year research program focuses on both blood banking and transfusion medicine research in the United States of America, Brazil, China, and South Africa. The main goal of the international programs is to reduce and prevent the transmission of HIV/AIDS and other known and emerging infectious agents through transfusion, and to address research questions aimed at understanding global issues related to the availability of safe blood. This article describes the contribution of REDS-II to transfusion safety in Brazil. Articles published from 2010 to 2013 are summarized, including database analyses to characterize blood donors, deferral rates, and prevalence, incidence and residual risk of the main blood-borne infections. Specific studies were developed to understand donor motivation, the impact of the deferral questions, risk factors and molecular surveillance among HIV-positive donors, and the natural history of Chagas disease. The purpose of this review is to disseminate the acquired knowledge and briefly summarize the findings of the REDS-II studies conducted in Brazil as well as to introduce the scope of the REDS-III program that is now in progress and will continue through 2018.

© 2014 Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. All rights reserved.

[Evaluation of blood grouping in ABO and Rh systems in health facilities in Benin]

STUDY PURPOSE

The goal of this work is to assess the modalities of blood typing achievement in Benin with the view of their improvement.

METHODS

On the basis of a questionnaire including the detailed operative process, a prospective investigation has been achieved in public and private health centers laboratories.

RESULTS

It came out that the execution of ABO and Rh blood typing took place globally on the fringe of the standards. We note that 72.4% of the private laboratories and 48.9% of the public ones lacked at least one equipment and 51.3% at least one material for blood withdrawal; 38.2% of the laboratories did not respect blood withdrawal standards; 1.32% of the laboratories applied the 4×2 rule. The assessment revealed that respectively 10.8% and 30.7% of the blood centers and non-blood centers achieved the globular test solely; the same 40.5% and 46.2% used reagents of different brands. Anti-A1 and anti-H sera, and A1 and A2 red cells were not available in any laboratory. More than 64% of laboratories have senior technicians and biomedical analysis engineers but only 6.6% of the laboratories were directed by biologists, and 9.2% of the laboratories function with only one technician.

CONCLUSION

Instead of some assets, the laboratories assessment noted important non-conformities we ought to raise as a matter of urgency. It is a challenge whose resolution must give blood transfusion centers a reference position relatively to blood grouping when facing blood typing difficulties.

Comparison of automated platelet counts and potential effect on transfusion decisions in cancer patients

OBJECTIVES

To evaluate the accuracy of platelet counts from various hematology analyzers using a reference immunologic method.

METHODS

We tested 403 samples with platelet counts less than 50 × 10(9)/L with the Advia (Siemens, Tarrytown, NY), Sysmex (Mundelein, IL), and Abbott (Santa Clara, CA) analyzers.

RESULTS

All methods showed a positive bias, especially at less than 20 × 10(9)/L and less than 10 × 10(9)/L. Undertransfusion risk ranged from 9.1% to 43.3 % in the groups below 20 × 10(9)/L and below 10 × 10(9)/L, respectively. For patients with optical counts more than 10 × 10(9)/L and CD61 less than 10 × 10(9)/L, 64.5% were transfused within 24 hours of the reported count, while 35.5% were transfused in more than 24 hours, after a subsequent optical platelet count of 10 × 10(9)/L or less was reported.

CONCLUSIONS

Although optical and impedance methods were shown to be falsely increased in severely thrombocytopenic samples, further studies are needed to determine if more accurate methods would be clinically useful.