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Wang J, Deng LF, Zhang Q, He L. TSR: A User-Friendly R Shiny Application for Assessment of Optimal Blood Product Selection in ABO-Incompatible Hematopoietic Stem Cell Transplantation. Curr Med Sci 2023; 43:716-722. [PMID: 37273128 DOI: 10.1007/s11596-023-2754-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/06/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Patients undergoing hematopoietic stem cell transplant (HSCT) need frequent transfusions, until their red blood cells (RBCs) and platelets start to recover. The safe transfusion for patients who receive ABO-incompatible HSCT is essential to the transplant process. To date, there is no user-friendly tool to choose the right blood product for transfusion treatment, despite the number of guidelines and expert advice on the subject. METHODS R/shiny is a powerful programming language for clinical data analysis and visualization. It can create interactive web applications that work in real-time. The web application named TSR was built using R programming, simplifying blood transfusion practice for ABO-incompatible HSCT with a one-click solution. RESULTS The TSR is divided into four main tabs. The home tab provides an overview of the application, while RBC, plasma and platelet transfusion tabs offer tailored suggestions for blood product selection in each category. Unlike traditional methods that rely on treatment guidelines and specialist consensus, TSR leverages the power of the R/Shiny interface to extract critical content based on user-specified parameters, providing an innovative approach to improve transfusion support. CONCLUSION The present study highlights that the TSR enables real-time analysis, and promotes transfusion practice by offering a unique and efficient one-key output for blood product selection to ABO-incompatible HSCT. TSR has the potential to become a widely-utilized tool for transfusion services, providing a reliable and user-friendly solution that enhances transfusion safety in clinical practice.
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Affiliation(s)
- Juan Wang
- Department of Blood Transfusion, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Lin-Feng Deng
- Department of Blood Transfusion, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Quan Zhang
- Department of Laboratory Medicine, Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan, 430015, China
| | - Lei He
- Department of Blood Transfusion, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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2
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Teawtrakul N, Songdej D, Hantaweepant C, Tantiworawit A, Lauhasurayotin S, Torcharus K, Sripornsawan P, Sutcharitchan P, Surapolchai P, Komvilaisak P, Saengboon S, Pongtanakul B, Charoenkwan P. Red blood cell alloimmunization and other transfusion-related complications in patients with transfusion-dependent thalassemia: A multi-center study in Thailand. Transfusion 2022; 62:2039-2047. [PMID: 35986658 PMCID: PMC9560980 DOI: 10.1111/trf.17068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/07/2022] [Accepted: 07/18/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Thalassemia is a common genetic disease in Southeast Asia. Red blood cell (RBC) transfusion is an essential treatment for severe forms of thalassemia. We performed a study to demonstrate RBC alloimmunization and other transfusion-related complications in patients with transfusion-dependent thalassemia (TDT). STUDY DESIGN AND METHODS A multi-center web-based registry of TDT was conducted in eight medical centers across Thailand. Thalassemia information, transfusion therapy, and transfusion-related complications were collected. Factors associated with each complication were demonstrated using the logistic regression analysis. RESULTS Of 1000 patients recruited for the study, 449 were males (44.9%). The mean age was 23.9 ± 15.4 years. The majority of patients, 738 (73.8%) had hemoglobin E/beta-thalassemia. In the study, 421 transfusion-related complications were reported from 357 patients (35.7%). Alloimmunization was the most common complication which was found in 156 patients (15.6%) with 284 positive antibody tests. The most frequent antibodies against RBC were anti-E (80/284, 28.2%) followed by anti-Mia (45/284, 15.8%) and anti-c (32/284, 11.3%). Age ≥3 years at initial blood transfusion, splenomegaly, higher frequencies, and volumes of transfusion were significant factors associated with alloimmunization. None of the patients had to terminate blood transfusion due to multiple alloantibodies. Other commonly seen complications were allergic reactions (130, 13.0%), autoimmune hemolytic anemia (70, 7.0%) and febrile non-hemolytic transfusion reaction (54, 5.4%). CONCLUSIONS Transfusion-related complications, especially alloimmunization, were common among Thai patients with TDT. Extended RBC antigen-matching for the Rh system and Mia should be implemented to prevent the development of alloantibodies in multi-transfused patients.
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Affiliation(s)
- Nattiya Teawtrakul
- Division of Hematology, Department of Internal Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Duantida Songdej
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chattree Hantaweepant
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Adisak Tantiworawit
- Division of Hematology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand
- Thalassemia and Hematology Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Supanun Lauhasurayotin
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kitti Torcharus
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Pornpun Sripornsawan
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand
| | - Pranee Sutcharitchan
- Division of Hematology, Department of Internal Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Pacharapan Surapolchai
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Patcharee Komvilaisak
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Supawee Saengboon
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Bunchoo Pongtanakul
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pimlak Charoenkwan
- Thalassemia and Hematology Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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3
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Addams J, Arbabi S, Bulger EM, Stansbury LG, Tuott EE, Hess JR. How we built a hospital-based community whole blood program. Transfusion 2022; 62:1699-1705. [PMID: 35815552 DOI: 10.1111/trf.17018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Whole blood (WB) is an attractive product for prehospital treatment of hemorrhagic shock and for initial in-hospital resuscitation of patients likely to require massive transfusion. Neither our regional blood provider nor our hospital blood bank had recent experience collecting or using WB, so we developed a stepwise process to gather experience with WB in clinical practice. METHODS When our Transfusion Committee suggested a WB program, we worked with our regional blood provider to collect cold-stored, leukoreduced, low-titer anti-A, and anti-B group O RhD positive WB (low-titer group O WB [LTOWB]) and worked with our city Fire Department to integrate it into prehospital care. This work required planning, development of protocols, writing software for blood bank and electronic medical records, changes in paramedic scope of practice, public information, training of clinicians, and close clinical follow-up. RESULTS Between June 2019 and December 2021, we received 2269 units of LTOWB and transfused 2220 units; 24 (1%) were wasted, two were withdrawn, and 23 were in stock at the end of that time. Most (89%) were transfused to trauma patients. Usage has grown from 48 to 120 units/month, covers all 5 Fire Districts in the county, and represents about ¼ of all hospital trauma blood product use. CONCLUSIONS Developing a WB program is complex but can be started slowly, including both pre-hospital and hospital elements, and expanded as resources and training progress. The investments of time, effort, and funding involved can potentially improve care, save blood bank and nursing effort, and reduce patient charges.
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Affiliation(s)
- Joel Addams
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Saman Arbabi
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA.,Harborview Injury Prevention Research Center, Harborview Medical Center, Seattle, Washington, USA
| | - Eileen M Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lynn G Stansbury
- Harborview Injury Prevention Research Center, Harborview Medical Center, Seattle, Washington, USA.,Department of Anesthesia and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Erin E Tuott
- Department of Laboratory Medicine and Pathology, 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.,Harborview Injury Prevention Research Center, Harborview Medical Center, Seattle, Washington, USA
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4
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Garban F, Vilotitch A, Tiberghien P, Bosson JL. The impact of pathogen-reduced platelets in acute leukaemia treatment on the total blood product requirement: a subgroup analysis of an EFFIPAP randomised trial. Transfus Med 2022; 32:175-177. [PMID: 35019176 DOI: 10.1111/tme.12848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 12/08/2021] [Accepted: 12/30/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To evaluate the impact of pathogen-reduced (PR) platelet transfusions on blood products requirement for clinical practice. BACKGROUND PR platelets are increasing in use as standard blood products. However, few randomised trials have evaluated their impact on bleeding control or prevention. Furthermore, PR platelets recirculate less than untreated platelets. METHODS A subgroup study of the randomised clinical trial EFFIPAP compared three arms of platelet preparations (PR: P-PRP/PAS, additive solution: P-PAS and plasma P-P arms respectively). The subgroup of acute leukaemia patients, in their chemotherapy induction phase, included 392 patients (133 P-PRP/PAS arm, 132 P-PAS arm and 130 P-P arm). Blood requirements were analysed across over periods of 7 days. RESULTS The number of platelet transfusions per week was significantly higher in the P-PRP/PAS group 2.3 [1.6-3.3] compared to the control groups 1.9 [1.3-2.8] and 2.0 [1.3-3.0] for P-P and P-PAS groups respectively (p < 0.0001). However, the total number of platelets transfused per week was not different. The number of red blood cell concentrates (RBC) transfusion per week did not differ either. CONCLUSION In a homogeneous group of patients, platelet pathogen reduction resulted in an increased number of platelet units transfused per week while having no impact on the total number of platelets transfused or the number of RBC transfusion; resulting to an average requirement of 2 RBC and 2-3 platelets transfusions per week of marrow aplasia.
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Affiliation(s)
- Frédéric Garban
- Service d'Hématologie, Centre Hospitalier Universitaire de Grenoble Alpes (Grenoble Alps University Hospital), Grenoble, France.,CNRS, UMR 5525 Translationnal innovation in Medicine and Complexity, Université Grenoble Alpes, La Tronche, France
| | - Antoine Vilotitch
- Cellule d'ingénierie des données, Centre d'Investigation Clinique 1406 - Innovation Technologique, Centre Hospitalier Universitaire de Grenoble Alpes (Grenoble Alps University Hospital), Grenoble, France
| | - Pierre Tiberghien
- Etablissement Français du Sang, La Plaine Saint-Denis, Saint-Denis, France.,INSERM UMR 1098 RIGHT, Université de Franche-Comté, Etablissement Français du Sang, Besançon, France
| | - Jean Luc Bosson
- CNRS, UMR 5525 Translationnal innovation in Medicine and Complexity, Université Grenoble Alpes, La Tronche, France.,Cellule d'ingénierie des données, Centre d'Investigation Clinique 1406 - Innovation Technologique, Centre Hospitalier Universitaire de Grenoble Alpes (Grenoble Alps University Hospital), Grenoble, France
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5
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Adkins BD, Libby TA, Mayberry MM, Brady TW, Halls JB, Corbett SM, Schoeny J, Shields EP, Chowdhury J, Kinsinger-Stickel AN, Wehrli G, Jaeger NR, Robertson MP, Butler KM, Lowson SM, Calland JF, Gorham JD. How did we reform our out of control massive transfusion protocol program? Transfusion 2021; 61:3066-3074. [PMID: 34661301 DOI: 10.1111/trf.16706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/14/2021] [Accepted: 09/21/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The massive transfusion protocol (MTP) is designed to quickly provide blood products at a fixed ratio for the exsanguinating patient. At our academic medical center, the frequency of MTP activation increased over 10-fold between 2008 and 2015, putting inordinate stress on our transfusion service. STUDY DESIGN AND METHODS Gathering a large number of relevant stakeholders, we performed a multidisciplinary root cause analysis (RCA) in response to the acute clinical need to reform our MTP. RESULTS Through the RCA, we identified four principal opportunities for improvement (OFI) associated with our MTP: education, stewardship, process improvement, and communication. Through the deployment of new approaches to each of these OFI, we reduced MTP activations, blood product waste, and transfusion service technologist stress. CONCLUSION The MTP is amenable to improvement, and, although time intensive, the RCA process yields significant favorable effects: improving communication with colleagues, reducing stress within the transfusion service, and improving resource utilization. Activation of the MTP at our institution is now more aligned with its primary purpose: rapidly providing large quantities of blood products to exsanguinating patients.
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Affiliation(s)
- Brian D Adkins
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Theresa A Libby
- Department of Medical Laboratories, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Marlene M Mayberry
- Department of Medical Laboratories, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Thomas W Brady
- Department of Medical Laboratories, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Justin B Halls
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Stephanie Mallow Corbett
- Department of Performance Improvement, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Joseph Schoeny
- Department of Performance Improvement, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Eric P Shields
- Department of Performance Improvement, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jahan Chowdhury
- Department of Medical Laboratories, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Amanda N Kinsinger-Stickel
- Department of Medical Laboratories, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Gay Wehrli
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Nicholas R Jaeger
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Matthew P Robertson
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Kathy M Butler
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Stuart M Lowson
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA.,Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - James Forrest Calland
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - James D Gorham
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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6
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Zhang Y, Wang N, Tian Y. Accurate cisAB typing is essential to ensure the safety of a transfusion: A case of a cisAB01 neurosurgery pediatric patient and family study. Clin Case Rep 2021; 9:e04940. [PMID: 34745614 PMCID: PMC8552311 DOI: 10.1002/ccr3.4940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/11/2021] [Accepted: 09/24/2021] [Indexed: 11/09/2022] Open
Abstract
The rare cisAB subgroups inherited from a single parent are characterized by the activities of dual A and B glycosyltransferases encoded by a gene on one chromosome. The serological complexity of cisAB challenges clinical blood transfusion practice because of misclassification in ABO grouping.
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Affiliation(s)
- Yanan Zhang
- Department of Blood TransfusionBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Nuochuan Wang
- Department of Blood TransfusionBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Yongji Tian
- Department of NeurosurgeryBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
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7
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Vanden Broeck J, Beeckman K, Van Gastel E, De Keersmaecker L, Devos T, Gérard C, Noens L, Putzeys D, Van Poucke K, Haelterman M, Deneys V, Schots R. Improvement of transfusion practice and reduction in red blood cell utilization in Belgian hospitals: Results of a national survey and benchmarking. Vox Sang 2021; 117:259-267. [PMID: 34374093 DOI: 10.1111/vox.13187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/01/2021] [Accepted: 07/08/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Belgian health authorities launched a national platform in 2011 to improve the quality of transfusion practices and blood use in Belgian hospitals. No data were available about the quality of hospital transfusion practice at the national level. MATERIALS AND METHODS Three consecutive national surveys (2012, 2014 and 2016) were performed in all 111 Belgian hospitals to assess the degree of implementation of standards in four process domains related to red blood cell (RBC) transfusion: general quality aspects, ordering of RBC, electronic traceability and reporting of adverse events. The surveys were part of a methodology based on informing, feedback and benchmarking. Responses to questions were analysed semi-quantitatively, and hospitals could score 10 points on each of the domains. RESULTS The proportion of hospitals scoring below 5 per domain decreased from 16%, 70%, 14% and 11% (2012) to 2%, 17%, 1% and 1% (2016), respectively. Similarly, scores above 7.5 increased from 25%, 1%, 23% and 36% (2012) to 64%, 30%, 68% and 81% (2016), respectively. In 2016, overall quality of transfusion practices, including the four pre-specified domains, improved continuously with an average total score (max = 40) increasing from 24.2 to 30.5 (p = 0.0005). In addition, there was a decrease in the number of distributed and transfused RBC per 1000 population between 2011 and 2019 from 47.0 to 36.5 and 43.5 to 36.1, respectively. CONCLUSION These data show that the applied methodology was a powerful tool to improve quality of transfusion practices and to optimize utilization of RBC at the national level.
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Affiliation(s)
- Jana Vanden Broeck
- Department of Hematology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Federal Public Service Health, Food Chain Safety and Environment, Brussels, Belgium
| | - Katrien Beeckman
- Nursing and Midwifery Research Unit, University Hospital Brussels, Brussels, Belgium.,Nursing and Midwifery Research Unit, Faculty of Medicine and Pharmacy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Centre for Research and Innovation in Care, Midwifery Research Education and Policymaking (MIDREP), Verpleeg- en vroedkunde, Universiteit Antwerpen, Antwerp, Belgium
| | | | | | - Timothy Devos
- Department of Hematology, Universitair Ziekenhuis Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - Lucien Noens
- Blood Bank, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Dominique Putzeys
- Department of Nursing, Centre Hospitalier Régional de la Citadelle Liège, Liège, Belgium
| | - Karin Van Poucke
- Clinical Laboratory, Algemeen Ziekenhuis Nikolaas, Sint-Niklaas, Belgium
| | - Margareta Haelterman
- Federal Public Service Health, Food Chain Safety and Environment, Brussels, Belgium
| | - Véronique Deneys
- Blood Bank, Département des Laboratoires Cliniques, Cliniques universitaires Saint-Luc, Université Catholique de Louvain Brussels, Brussels, Belgium
| | - Rik Schots
- Department of Hematology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Tsante A, Papandreadi A, Tsantes AG, Kyriakou E, Douramani P, Loukopoulou E, Gialeraki A, Kokoris SI, Kypraiou A, Poulis A, Kopterides P, Piovani D, Bonovas S, Valsami S, Tsantes AE. Seeking Strategies to Optimize Blood Utilization: The Preliminary Experience with Implementing a Patient Blood Management Program in a Greek Tertiary Hospital. J Clin Med 2021; 10:2141. [PMID: 34063464 DOI: 10.3390/jcm10102141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/03/2021] [Accepted: 05/14/2021] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Our aim was to assess blood utilization after implementation of a patient blood management (PBM) program in a Greek tertiary hospital. METHODS An electronic transfusion request form and a prospective audit of transfusion practice were implemented. After the one-year implementation period, a retrospective review was performed to assess transfusion practice in medical patients. RESULTS Pre-PBM, a total of 9478 RBC units were transfused (mean: 1.75 units per patient) compared with 9289 transfused units (mean: 1.57 units per patient) post-PBM. Regarding the post-PBM period, the mean hemoglobin (Hb) level of the 3099 medical patients without comorbidities transfused was 7.19 ± 0.79 gr/dL. Among them, 2065 (66.6%) had Hb levels >7.0 gr/dL, while 167 (5.3%) had Hb levels >8.0 gr/dL. In addition, 331 (25.3%) of the transfused patients with comorbidities had Hb >8.0 gr/dL. The Hb transfusion thresholds significantly differed across the clinics (p < 0.001), while 21.8% of all medical non-bleeding patients received more than one RBC unit transfusion. CONCLUSION A poor adherence with the restrictive transfusion threshold of 7.0 gr/dL was observed. The adoption of a less strict threshold might be a temporary step to allow physicians to become familiar with the program and be informed on the safety and advantages of the restrictive transfusion strategy.
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9
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Gammon R, Cook S, Trinkle A, Thomas K, Benson K. Acute Hemolytic Transfusion Reaction Due to Pooled Platelets: A Rare but Serious Adverse Event. Lab Med 2020; 52:202-204. [PMID: 32930724 DOI: 10.1093/labmed/lmaa056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A female patient aged 65 years with blood group A with relapsed lymphoma had thrombocytopenia; leukocyte-reduced group O prestorage pooled platelet concentrates (PPLTs) were transfused without adverse events. She was discharged home, but 1.5 hours later she returned with fever and dark urine. Hypotension and tachycardia developed; she was admitted to the intensive care unit. Post-transfusion blood and urine samples were obtained. Serial dilutions from 5 donor testing tubes and a simulated PLT pool were performed and read at immediate spin and IgG. Testing confirmed an acute hemolytic transfusion reaction (AHTR): elevated lactate dehydrogenase (996 U/L; normal range 135 U/L-225 U/L) and undetectable haptoglobin (<10 mg/dL; normal range 30 mg/dL-200 mg/dL) levels. Urinalysis showed dark amber urine but no significant quantity of red blood cells. At 37ºC the simulated pool and donor number 5 had high-titer anti-A. As a precaution, the donor was permanently deferred. Research has shown that PLT-associated AHTR has occurred with apheresis platelets but is very rare with whole blood-derived PLTs.
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Affiliation(s)
- Richard Gammon
- Scientific Medical and Technical Direction, OneBlood, Orlando, Florida
| | - Susan Cook
- Department of Pathology and Laboratory Medicine, Moffitt Cancer Center, Tampa, Florida
| | - Anthony Trinkle
- Immunohematology Reference Laboratory, OneBlood, St. Petersburg, Florida
| | - Korena Thomas
- Scientific Medical and Technical Direction, OneBlood, Orlando, Florida
| | - Kaaron Benson
- Department of Pathology and Laboratory Medicine, Moffitt Cancer Center, Tampa, Florida
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10
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Burchard R, Daginnus A, Soost C, Schmitt J, Graw JA. Gender differences in blood transfusion strategy for patients with hip fractures - a retrospective analysis. Int J Med Sci 2020; 17:620-625. [PMID: 32210711 PMCID: PMC7085213 DOI: 10.7150/ijms.33954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 10/16/2019] [Indexed: 01/28/2023] Open
Abstract
Background: In the last decades, transfusion therapy with allogenic blood has progressively shifted to a more restrictive approach. The current study analyzed the transfusion practice and transfusion-associated factors in a regional trauma center over the course of five years. Methods: Retrospective analysis of all patients undergoing surgery for hip fractures in a level 1 trauma center of an academic teaching hospital from 2010 to 2014 (n=650). The number of transfused packed red blood cells (PRBCs), preoperative Hb concentrations, and intensive care unit (ICU) and hospital length of stay (LOS) were analyzed. A logistic regression analysis was performed to evaluate transfusion and ICU LOS-associated risk factors. (Ethical Review Board approval: 2015-497-f-S). Results: From 2010 to 2014 the average number of PRBCs transfused per patient decreased continuously despite similar preoperative Hb levels. During the same period, ICU LOS increased while hospital LOS decreased. Advanced patient age, preoperative Hb concentrations, surgical complications, and ICU LOS were associated with increased transfusion requirements. Although preoperative Hb levels were lower, females received fewer PRBCs compared to males. Conclusion: Over the course of five years, a restrictive transfusion strategy was implemented within clinical practice in patients undergoing surgery for hip fractures. In parallel, a significant reduction in the hospital LOS and an increased ICU LOS was noted. Whether there is an association between increased ICU LOS and decreasing hospital LOS and whether there is a gender effect on transfusion requirements in patients with surgery for hip fractures should be subject to further research.
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Affiliation(s)
- Rene Burchard
- Department of Statistics an Econometrics, University of Siegen, Siegen, Germany.,Department of Health, University of Witten/Herdecke, Witten, Germany.,Department of Trauma- and Orthopaedic Surgery, Kreisklinikum Siegen, Siegen, Germany
| | - Alina Daginnus
- Department of Trauma- and Orthopaedic Surgery, Kreisklinikum Siegen, Siegen, Germany.,Department of Orthopaedics and Trauma Surgery, University of Marburg, Marburg, Germany
| | - Christian Soost
- Department of Statistics an Econometrics, University of Siegen, Siegen, Germany.,FOM University of Applied Sciences, Essen, Germany
| | - Jan Schmitt
- Department of Orthopaedics and Trauma Surgery, Lahn-Dill-Kliniken, Wetzlar, Germany
| | - Jan Adriaan Graw
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK) Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
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11
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Marcos-Jubilar M, García Erce JA, Martínez-Calle N, Páramo JA, Martínez Virto A, Quintana-Díaz M. Safety and effectiveness of a prothrombin complex concentrate in approved and off-label indications. Transfus Med 2019; 29:268-274. [PMID: 31347218 DOI: 10.1111/tme.12621] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 03/10/2019] [Accepted: 06/30/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To evaluate the effectiveness and safety of prothrombin complex concentrates (PCCs) in approved and off-label indications. BACKGROUND PCCs are approved for the urgent reversal of vitamin K antagonists (VKAs). Data concerning the efficacy, safety and dosing for off-label indications are limited, but they are included in massive bleeding protocols. METHODS This was a retrospective review of cases treated with four-factor PCCs (4F-PCCs) between January 2009 and 2016. Efficacy end-points include: (i) VKA reversal efficacy assessed by international normalised ratio (INR) normalisation (<1·5) and (ii) clinical efficacy as bleeding cessation and/or decreased number of transfused blood components and 24-h mortality in bleeding coagulopathy. The safety end-point is the incidence of thromboembolic events. RESULTS A total of 328 patients were included (51·8% male, median age 78 years old). Indications were as follows: VKA reversal (66·6%), bleeding coagulopathy (30·5%) and direct anticoagulant (DOAC) reversal due to bleeding (2·5%). VKA reversal was effective in 97·1% of patients, and 76·5% demonstrated complete reversal (INR < 1·5); only 34·3% patients needed hemoderivatives. Prior to emergency procedures, PCCs achieved global responses in 83% of patients, with no bleeding complication during intervention. DOAC reversal was effective in 88·9% of patients. Bleeding cessation was associated with the dose administered (P = 0·002). In coagulopathy bleeding, haemorrhage cessation, established by the International Society of Thrombosis and Haemostais (ISTH) definition, occurred in 56·7% of massive bleeding events and in 42·5% of other coagulopathies; 24-h mortality was 30%, mainly related to active bleeding. Ten thrombotic episodes were observed (3·1%). CONCLUSION 4F-PCC was effective as adjuvant treatment with an acceptable safety profile, not only for the emergent reversal of VKAs but also for refractory coagulopathy associated with major bleeding.
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Affiliation(s)
- M Marcos-Jubilar
- Hematology Service, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - N Martínez-Calle
- Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J A Páramo
- Hematology Service, Clínica Universidad de Navarra, Pamplona, Spain
| | - A Martínez Virto
- Emergency Department, Hospital Universitario La Paz, Madrid, Spain
| | - M Quintana-Díaz
- Intensive Medicine, Hospital Universitario La Paz, Madrid, Spain
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12
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Saito-Benz M, Sandle ME, Jackson PB, Berry MJ. Blood transfusion for anaemia of prematurity: Current practice in Australia and New Zealand. J Paediatr Child Health 2019; 55:433-440. [PMID: 30246273 DOI: 10.1111/jpc.14222] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 06/20/2018] [Accepted: 08/19/2018] [Indexed: 12/13/2022]
Abstract
AIM To characterise the current transfusion practice among clinicians in Australasian neonatal units and factors that influence their decision-making. METHODS Members of the Australia and New Zealand Neonatal Network (ANZNN) and practitioners at their local institutions were invited to participate in a 15-question web-based survey between 1 June and 31 July 2016. The survey was designed to assess (i) haemoglobin-based transfusion thresholds; (ii) presence of local guidelines; (iii) preference for a restrictive or liberal transfusion policy; (iv) perceived benefits and risks of transfusion; and (v) use of clinical adjuncts to assist decision-making. RESULTS Overall, 130 participants responded to at least one question. Haemoglobin transfusion thresholds for anaemia of prematurity (AOP) varied significantly from <60 to <120 g/L. Of 103 participants, 36 (35%) reported that they do not have access to local transfusion guidelines. The majority utilise multiple clinical and haematological parameters to guide their decision-making, and approximately half (45/84, 54%) believe that tissue hypoxia detected by near-infrared spectroscopy (NIRS) may better inform transfusion thresholds. Of 102 participants, 51 (50%) support a restrictive rather than liberal transfusion policy. The most commonly reported perceived risks of transfusion for AOP were suppression of endogenous erythropoiesis and increased rates of necrotising enterocolitis. CONCLUSIONS There is a significant variation in transfusion practice in Australasian neonatal units. Quality and safety initiatives may assist with improved consistency of transfusion practice across the ANZNN. However, further research is required to better define optimal transfusion thresholds, quantify potential risks of transfusion and determine clinical utility of newer adjuncts such as NIRS.
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Affiliation(s)
- Maria Saito-Benz
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand.,Neonatal Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand
| | - Meghan E Sandle
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Paul B Jackson
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand.,Neonatal Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand
| | - Mary J Berry
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand.,Neonatal Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand
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13
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Glisch C, Jawa Z, Brener A, Carpenter E, Gottschall J, Treml A, Karafin MS. Evaluation of a two-sample process for prevention of ABO mistransfusions in a high volume academic hospital. BMJ Open Qual 2018; 7:e000270. [PMID: 30057954 PMCID: PMC6059318 DOI: 10.1136/bmjoq-2017-000270] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 06/05/2018] [Accepted: 06/19/2018] [Indexed: 11/17/2022] Open
Abstract
Background Acute haemolytic transfusion reactions due to ABO incompatible blood transfusion remain a leading cause of transfusion-associated morbidity and mortality in the USA. Erroneous patient identification and specimen labelling account for many errors that lead to ABO mistransfusions; these errors are largely preventable. Methods Our hospital requires a two-sample process of ABO/Rh typing prior to transfusion. Both samples must be drawn independently. To prevent simultaneous sample draw, our second sample tube has a unique pink top that is only available from the blood bank and can only be sent to the patient’s floor once the first sample arrives in the lab. We performed an audit of this process from 19 March to 30 July 2014 and 19 March to 30 July 2015. Results We reviewed type and crossmatch orders for 2702 new patients during the audit period and 824 patients (30.5%) required transfusion. All patients evaluated received compatible blood, and no mistransfusions were recorded using this method. Three per cent of testing was performed incorrectly, which safely defaulted to giving type O blood. Conclusions The two-sample protocol used by our institution can decrease the risk of mistransfusion. Our protocol was relatively inexpensive, safe, efficient and practical for adaptation by other hospitals.
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Affiliation(s)
- Chad Glisch
- Internal Medicine, Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Zeeshan Jawa
- Internal Medicine, Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Alina Brener
- Internal Medicine, Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Erica Carpenter
- Internal Medicine, Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Wisconsin Diagnostic Laboratories, Milwaukee, Wisconsin, USA
| | - Jerome Gottschall
- Internal Medicine, Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Medical Sciences Institute, Blood Center of Wisconsin, Milwaukee, Wisconsin, USA
| | - Angela Treml
- Internal Medicine, Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Medical Sciences Institute, Blood Center of Wisconsin, Milwaukee, Wisconsin, USA
| | - Matthew Scott Karafin
- Internal Medicine, Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Medical Sciences Institute, Blood Center of Wisconsin, Milwaukee, Wisconsin, USA
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14
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Larson MC, Karafin MS, Hillery CA, Hogg N. Phosphatidylethanolamine is progressively exposed in RBCs during storage. Transfus Med 2017; 27:136-141. [PMID: 28134466 DOI: 10.1111/tme.12382] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/15/2016] [Accepted: 11/26/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND It is well established that as a blood unit ages, fewer of the unit's red blood cells (RBCs) remain in circulation post-transfusion. The mechanism for clearance is not well defined. Phosphatidylethanolamine (PE) is a phospholipid that is primarily found on the inner leaflet of healthy cells, and is an important ligand for phagocytosis of dead cells when exposed. OBJECTIVES The objective of the present study was to measure the change in PE exposure in donor RBCs over increasing storage ages using the novel PE-specific probe, duramycin. METHODS Five adsol (AS-1) preserved RBC units were sampled weekly for 6 weeks and were labelled with duramycin. The percentage of PE exposed on red cells in each sample was determined using flow cytometry. Surface phosphatidylserine (PS) was evaluated for comparison. RESULTS We found that RBCs in AS-preserved donor units increasingly exposed PE, from less than 1% in freshly processed RBCs, to nearly 20% at 42 days of storage and correlated with increased relative vesiculation or microparticle concentration and release of cell-free haemoglobin. By comparison, only 5% of cells exposed PS at 42 days. CONCLUSION We conclude that exposure of PE in the RBC outer membrane was higher than that of PS during 42 days of storage and correlated significantly with increased vesiculation and release of haemoglobin.
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Affiliation(s)
- M C Larson
- Medical Imaging Department, University of Arizona, Tucson, Arizona, USA
| | - M S Karafin
- Blood Research Institute, Blood Center of Wisconsin, Wisconsin, USA.,Pathology Department, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - C A Hillery
- Pediatric Hematology Oncology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - N Hogg
- Biophysics Department, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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15
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Goss C, Avecilla ST, Garbaini J, Degtyaryova D, Lo D, Chang DY, Cushing M. Can the interval between antibody identifications be increased for alloimmunized patients? Transfusion 2016; 56:334-8. [PMID: 26456540 PMCID: PMC4984843 DOI: 10.1111/trf.13380] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 07/30/2015] [Accepted: 08/14/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND New alloantibody formation is unpredictable in patients who have been previously alloimmunized. Pretransfusion testing is designed to detect these antibodies while antibody identification (ABI) techniques are designed to identify the specificity of the antibody. Pretransfusion testing intervals are prescribed by regulatory and accrediting agencies, intervals for ABI in alloimmunized patients are not. Our institution evaluated the safety of increasing the interval from every 72 hours to 14 days. The current 72-hour interval was chosen at our institution to align with AABB Standard 5.14.3.2, which requires a pretransfusion specimen drawn within 3 days of the scheduled transfusion for potentially immunized patients. STUDY DESIGN AND METHODS Over 2 years, all ABI entries in the laboratory information system were screened. All cases of alloimmunized patients with an additional antibody specificity that developed within 14 days of a previous ABI were reviewed and confirmed by four transfusion medicine physicians. RESULTS Initially, 8948 entries were screened. Thirty patients were identified to have formed 33 newly identified clinically significant alloantibodies within 14 days. After further categorization, only 13 antibodies (0.15% of all ABIs, 0.47% of alloimmunized patients examined) were deemed to be newly formed clinically significant antibodies that would have led to a change in transfusion practice. CONCLUSION Retrospective analysis of ABI results over a 2-year period revealed that 0.47% of previously alloimmunized patients that have samples for pretransfusion testing develop a new clinically significant alloantibody in 14 days or less. While there would be significant resource advantages to increasing the duration between repeat ABI, it does not outweigh the risk of a potential hemolytic transfusion reaction.
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Affiliation(s)
- Cheryl Goss
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, New York
| | - Scott T. Avecilla
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Diana Degtyaryova
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, New York
| | - Dian Lo
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, New York
| | | | - Melissa Cushing
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, New York
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16
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Cortés Buelvas A. Anemia and transfusion of red blood cells. Colomb Med (Cali) 2013; 44:236-42. [PMID: 24892241 PMCID: PMC4001991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 11/15/2013] [Accepted: 12/10/2013] [Indexed: 11/21/2022] Open
Abstract
The red cells transfusion is a mainstay in the treatment of anemic patients. These blood transfusions are not without risks. The risk-benefit profile for red cell transfusions to treat anaemia is uncertain, but they may contribute to adverse patient outcomes in some situations. The ability of a patient to tolerate anaemia depends on their clinical condition and the presence of any significant co-morbidity; maintenance of circulating volume is of paramount importance. There is no universal transfusion trigger. Advances in the development and validation of physiological, accessible, practical and reliable markers to guide therapy are expected. To improve patients' outcomes, further study is required to more fully explore the risk of anemia, optimal hemoglobin level, and the risk and efficacy of RBC transfusion. Future clinical investigations with high priority should determine the efficacy of transfusion in those classified as uncertain scenarios. In the absence of data, it is prudent that transfusion is administered with caution in these clinical scenarios.
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17
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Carroll PD, Nankervis CA, Iams J, Kelleher K. Umbilical cord blood as a replacement source for admission complete blood count in premature infants. J Perinatol 2012; 32:97-102. [PMID: 21566570 DOI: 10.1038/jp.2011.60] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We hypothesize that a complete blood count (CBC) with manual differential from umbilical cord blood is equivalent to a CBC with manual differential obtained from the neonate on admission. STUDY DESIGN A CBC and manual differential was performed on 174 paired umbilical cord blood and admission blood samples from infants <35 weeks gestation. Paired t-test and Pearson's correlation coefficient were the primary statistical tools used for data analysis. RESULT Cord and admission blood white blood cell (WBC) count, hemoglobin and platelet count all significantly (P<0.0001) correlated with paired neonatal samples (R=0.82, 0.72, 0.76). Admission blood WBC count fell within the variation of WBC count values from currently accepted neonatal admission blood sources. Cord blood hemoglobin was not clinically different than admission hemoglobin (1.0 g dl(-1)). Cord blood platelet counts were not different from admission blood platelet counts (5800 cells per μl, P=0.23). The immature to total granulocyte ratio was not different between samples (P=0.34). CONCLUSION Umbilical cord blood can be used for admission CBC and differential in premature infants.
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18
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Vlaar AP, In der Maur AL, Binnekade JM, Schultz MJ, Juffermans NP. Determinants of transfusion decisions in a mixed medical-surgical intensive care unit: a prospective cohort study. Blood Transfus 2009; 7:106-10. [PMID: 19503631 DOI: 10.2450/2008.0042-08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Accepted: 11/12/2008] [Indexed: 01/07/2023]
Abstract
BACKGROUND For reasons unknown, a restrictive transfusion policy of red blood cells (RBC) is only gradually being implemented by Intensive Care Unit (ICU) physicians, resulting in a large variation in transfusion practice. Insight into physicians' transfusion decisions may aid efforts to restrict transfusion practice. STUDY DESIGN AND METHODS In a prospective cohort study, transfusion triggers were determined in patients consecutively admitted to an ICU during a 10-week period. Using a questionnaire, the reasons why ICU physicians transfused RBC were evaluated. RESULTS Among 310 admissions, 90 patients (29%) received a RBC transfusion. Eighty-one of these 90 patients were included in this analysis. RBC were transfused at a mean haemoglobin (Hb) level of 7.4+/-1.1 g/dL. Residents transfused RBC at a higher Hb level compared to senior staff (7.7+/-1.0 versus 6.9+/-1.3, respectively; p<0.05). The most important reason for physicians to transfuse RBC was the suspicion of bleeding. Age and coronary ischaemia were the predominant reasons for transfusing RBC in 4% and 12% of cases, respectively. The average order for RBC transfusion was four units. Of each order, 38% of the units were not administered. CONCLUSION RBC transfusion decisions are predominantly based on Hb levels rather than on patients' characteristics. Residents transfuse at a higher Hb level compared to more experienced physicians. The major determinant for physicians to transfuse RBC is bleeding. However, the majority of patients were transfused in the absence of bleeding, and many of these patients received multiple units. The need for RBC may be overestimated, resulting in wasted orders.
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