Blood Bank Information System Research Articles

Donors with repeated blood product discards for filtration problems, clots or hemolysis: Causes and follow-up.

Sanquin donor medicine department is informed when donations or their components are rejected. This can occur isolated or frequently. It is undesirable because the donations cannot be used and there may be an underlying medical cause. Based on regional approaches, a uniform procedure was developed. Information about whole blood, plasma- plateletpheresis donations from which one or more components were rejected for filtration time (>2 h), hemolysis or clots were extracted from blood bank information system. After rejection of two successive components or donations or total ≥3 the donor is contacted. Depending on the medical history and investigation by the family doctor, the donor carrier is re-evaluated. We looked for the causes of the discarded products and performed a survey among blood services regarding polices with discarded products. One or more components from 1742 of about 2.2 million successful donations (0.08%) were rejected. The highest percentage of rejection was seen in plateletpheresis (1.5%), all for clots. No underlying medical causes were found. 24 whole blood donors were found to have sickle cell trait (SCT) and were permanently deferred. The policies for follow-up after discarded products or acceptance of SCT donors vary between the 16 blood banks. Six organizations do not follow-up donors and seven accept SCT for blood or plasma donation. Informing donors with repeated discarded products avoids the non-use of donations. Causes of repeated discarded products can be found by follow-up of donors. The results of the survey indicate a large discrepancy in policies applied worldwide.

Association between ABO blood groups and SARS-CoV-2 infection in blood donors of Puglia region

This is an observational multicentric cross-sectional study aiming at assessing the association between ABO blood groups and SARS-CoV-2 seroprevalence among the blood donors in Puglia region. Data on ABO and Rh blood groups and demographic characteristics were obtained from Blood Bank Information System. All donors were screened for SARS-CoV-2 IgG antibodies. Comparison of seroprevalence among blood groups and the association between the recorded variables and seroprevalence were evaluated. A total of 35,709 donors from 22 centers were included, with a seroprevalence of 6.8%. The distribution of ABO phenotypes was blood type O (46.8%), A (34.0%), B (14.7%), and AB (4.5%). Among the 2416 donors reactive for SARS-CoV-2 IgG, the prevalent phenotype was blood type O (43.1%), followed by A (37.7%), B (14.2%), and AB (5%). The seroprevalence of phenotype A and AB was 7.5%, followed by B (6.5%) and O (6.2%). According to the adjusted analysis, there was an increase in seroprevalence in groups A and AB, compared to group O, and an increase in males compared to females. A possible effect modification was observed after stratifying for sex (p = 0.0515). A significantly lower prevalence of blood type O was found compared to A and AB, whereas no association was observed between Rh factor and seroprevalence. We hypothesized that the A antigen present in blood type A and AB can play a role in the binding of SARS-CoV-2 to ACE2 receptors, resulting in an increased risk of infection. Furthermore, natural anti-A/anti-B antibodies produced in group O could block viral adhesion to cells and explain a lower risk of infection.

A US-Wide Red Blood Cell Alloantibody Exchange Can Decrease Mortality and Produce Cost Savings in the Care of Alloimmunized Patients with Sickle Cell Disease

Introduction: Red blood cell (RBC) alloimmunization occurs after exposure to non-self RBC antigens through transfusion or pregnancy. Alloimmunization rates and consequently delayed hemolytic transfusion reaction (DHTR) mortality in patients with sickle cell disease (SCD) is particularly high. Interest in a blood bank information system vendor-based alloantibody exchange in the United States (US) is growing, though cost concerns exist. To investigate the impact of an exchange that enables alloantibody data-sharing across hospitals, we conducted the first disease simulation of allo-immunized patients with SCD to project lifetime cumulative DHTR-specific mortality without an alloantibody exchange (status quo) versus with a US-wide alloantibody exchange. We then additionally performed a cost-effectiveness analysis to identify whether investing in an alloantibody exchange would be cost-effective, cost saving or neither. Methods: We built a Markov simulation of alloimmunized patients with SCD in the US. Transition probabilities for DHTR incidence and DHTR-specific mortality were informed from the largest prospective (n=311) and retrospective (n=220) studies of DHTR incidence in people living with SCD. Age-, gender- and disease-specific background mortality probabilities were employed. Cumulative probability of DHTR was modeled from age 5, with a lifetime horizon. Costs were assessed from the health system perspective and effectiveness was calculated in quality-adjusted life-years (QALY). QALYs were informed by published lifetime simulation of patients living with SCD and matched controls. These were originally derived from a polynomial fit linking Euroqual-5 Dimensions to the visual analog scale for pain in patients with SCD in several studies. Cost-effectiveness was quantified using an incremental cost-effectiveness ratio (ICER), or net monetary benefits (NMB) if the intervention was found to be cost saving, either way incorporating a cost-effectiveness willingness-to-pay threshold of $100,000/QALY, as recommended practice. We assumed a lifetime operating cost of $10 million for an alloantibody exchange, that no patient with diagnosed DHTR has more than one DHTR recurrence, that an exchange would not be able to prevent all DHTRs (as up to 30% are not associated with a new detectable antibody in SCD), and utilized prior estimates for US allo-immunized population prevalence range of 20-44% for people living with SCD. We validated our estimate for DHTR reduction with that of the 10-year experience in the national Dutch Transfusion Register of Irregular Antibodies and Cross-match Problems (TRIX). We then conducted deterministic and probabilistic sensitivity analyses, varying all parameter estimates +/-20% and capturing uncertainty in all parameters simultaneously over 10,000 Monte Carlo simulations. Results: Base-case lifetime simulation comparing the strategies of implementing an alloantibody exchange versus not yields a decrease in cumulative lifetime DHTR-specific mortality (2.4% vs 5.7%, respectively; Figure 1). The absolute peak probability decrease of having a history of incident DHTR and being alive occurs at age 41 (10.6% vs 27.0%; Figure 1). The strategy of alloantibody exchange implementation accrues 22.08 per-person lifetime discounted QALYs [95% credible interval 22.03-22.12] versus 21.72 without [95% CI 21.61-21.82], corresponding to a per-person QALY increase of 0.357 with exchange implementation. The lifetime population benefit for an alloimmunized population living with SCD in the United States is up to 15,710 QALYs gained. Total lifetime costs accrue $1.0 billion with exchange as compared to $2.5 billion without. This yields population-level cost savings of $1.5 billion USD ($34,091 saved per alloimmunized patient registered in the exchange), with an accrued incremental NMB of $3 billion. In probabilistic sensitivity analysis the former is favored in 100% of 10,000 Monte Carlo simulations. Conclusion: By reducing DHTR-specific mortality, an alloantibody exchange is predicted to be a life- and cost-saving investment for alloimmunized people living with SCD. Although this analysis was limited to SCD, the impact of an alloantibody exchange would also bring benefit to patients who are alloimmunized in the context of diagnoses and states beyond SCD, such as myelodysplastic syndrome, thalassemia, autoimmune conditions, and pregnancy. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Prevalence of ABO and RhD blood group phenotypes in the Croatian population and in patients with severe COVID-19 in Croatia.

The aim of this study was to determine the distribution of ABO and RhD blood group phenotypes in the general population in the Republic of Croatia and among hospitalized patients with severe COVID-19. Data on ABO and RhD blood groups of all blood donors in Croatia (who donated blood during the period 2015-2020) and patients and pregnant women tested at the Croatian Institute of Transfusion Medicine during the 2-year period, 2019-2020, were obtained from the e-Delphyn blood bank information system. A total of 614,673 results were analyzed in this group. The other group consisted of 780 COVID-19 patients hospitalized with severe COVID-19. Data are presented as total number and percentages and a comparison of proportions test was performed. The most frequent ABO phenotype in the general population is A (38%), followed by O (37%), B (18%) and AB (7%). RhD positive individuals accounted for 81% of the general population and RhD negative for the other 19%. Among COVID-19 patients, phenotype A was the most frequent (42%), followed by phenotypes O (32%), B (17%) and AB (9%). Thus blood group A was significantly more common among COVID-19 patients than among the general population, whereas blood group O was significantly less frequent. This study provides the first official results of the distribution of ABO and RhD blood group phenotypes in the general population in Croatia. Moreover, this study confirms other researchers' observations about the predominance of the A blood group phenotype among COVID-19 patients.

Perancangan Sistem Informasi Bank Darah Menggunakan Basis Data NoSQL

The existence of a blood exchange transaction process through a system carried out by the community, causing storing and managing data on a large scale is now causing problems in terms of scalability for blood bank managers in Yogyakarta. The process of blood transactions carried out by PMI units and hospitals at any time, makes the structure of relations in the blood banking system more complicated. In fact, every PMI unit and hospital in Yogyakarta requires a real-time data collection and storage process, considering that access to mobility of blood transactions is carried out almost 24 hours a day. Implementing an information system using a non-relational database model, is an alternative in the process of simplifying the relational structure in data relationships, this is because the non-relational database uses a NoSQL database model that provides support for database speed so that it remains optimal. In the research conducted, an information system was created that applied a non-relational database model to a case study of a blood bank information system. Where the NoSQL database is suitable for blood bank systems because it has high performance and is non-relational with real-time data storage and retrieval processes. The research conducted resulted in a blood bank information system that was developed using the Firebase database, where this system can display some data from the database such as viewing blood stocks, hospitals, blood donor events, and other information that is carried out in real time.

Audit of Blood Bank Services with Emphasis on Loss of Workforce

Purpose: The goal of blood bank audit is to continuously improve services to the patients by reducing rework, wastage, and inappropriate care. This can be done by establishing certain quality indicators. The rate of discarded blood and its components due to wastage, expiry, and transfusion-transmitted infection are one of such indicator. Design: Retrospective data on the number of whole blood, components prepared, and discarded were collected from the blood bank information system and analyzed. Results: During the study period, the total number of blood and components prepared were 3922. Out of which, a total of 226 units (5.76%) were discarded. In order to alleviate the shortage of blood, we should do intermittent auditing, quality monitoring, thorough evaluation and training of staff, proper management of the resources, and workforce.

The Epidemiology of Platelet Transfusions: An Analysis of Platelet Use at 12 U.S. Hospitals

Background: Platelet transfusions in the United States are increasing in sharp contrast to the marked decrease in red cell and plasma use. Understanding the epidemiology and clinical practice for patients requiring platelet transfusions, particularly in the non-oncologic setting, is needed to identify clinical needs or significant change in practice. Such information can be used to focus the design of evidence based studies to assess platelet transfusion practice and efficacy to areas of high clinical need.Methods: Patient demographics, laboratory and clinical data were extracted from 2013 - 2015 from blood bank information systems and medical records from 12 REDS-III hospitals (both academic and community) located in four states across the U.S. A patient encounter was defined as any inpatient admission or outpatient visit documented with a unique visit date and discharge date. A transfusion episode was defined as all platelets transfused within an 8 hour interval beginning with the first platelet dose transfused within any encounter. Pre-platelet counts are defined as the nearest count up to 24 hours prior to the first transfusion for inpatients, and up to 48 hours before for outpatients. Post-platelet counts are defined as the first count up to 24 hours after completing the last transfusion for inpatients, and up to 48 hours after for outpatients.Results: A total of 122,298 platelet doses were issued for transfusion: 74,721 (61%) were apheresis platelets; 47,577 (39%) were pooled whole blood derived platelets; 103,759 (85%) were for inpatients, 18,539 (15%) were for outpatients. For inpatient transfusions 54% were issued to the General Ward, 29% to ICU, 12% to OR, 3% to ER. One platelet dose was issued per episode 78% of the time, 2 doses in 17%, 3 doses in 3%, and 4 doses in 1%. ABO donor-recipient identical platelets were transfused 37% of the time. For selected ABO mis-matched transfusions, type O platelets were given to non-type O patients 8%, and non-type O platelets to type O patients 19% of the time. Cardiovascular, Hematology-Oncology and Gastrointestinal were the most common broad diagnostic categories for encounters. The top three primary ICD 9-10 codes for each of these categories were: Cardiovascular: coronary atherosclerosis of the native coronary artery, aortic valve disorder and intracerebral hemorrhage; Hematology-Oncology: acute myeloid leukemia without achieving remission, neutropenia NOS, and multiple myeloma with achieving remission; Gastrointestinal: alcohol cirrhosis of the liver, cirrhosis of the liver NOS and hepatic encephalopathy.For inpatients a platelet count between >20,000/µL and 50,000/µL was the most common pre-transfusion count (28% of all episodes) with similar results for general ward (29%) and ICU patients (35%). In the ED and OR a platelet count >100,000/µL was most common - found in 38% and 37% of all episodes. For outpatient transfusions a count of >10,000/µL to 20,000/µL was most common (25%). For inpatients post-platelet count increment ranged from a median of 12,000/µL to 23,000/µL with progressively larger increments seen with progressively higher starting counts (Table 1). For outpatients post-platelet count increments ranged from 21,000/µL to 27,000/µL (Table 1).Conclusion: The REDS-III data base provides a wealth of information to assess platelet transfusion therapy in the U.S. Transfusion of more than 1 dose of platelets per episode is uncommon. Transfusion of ABO mismatched platelets is a common practice. Cardiovascular and Hematology -Oncology patients are prominent users of platelet products. General Ward and ICU dominate the location for platelet transfusion therapy and have similar transfusion practice patterns. The common pre-transfusion platelet count of 20,000-50,000/µL is surprising (as this exceeds evidence based recommendations for prophylactic transfusions in hematology-oncology patients) with reasons unclear. Platelet count increments were also surprisingly low. These findings, particularly the high pre-transfusion platelet count, the poor platelet increments and the high number ABO mis-matched transfusions, highlight differences in real world versus controlled studies and provide epidemiologic and laboratory data to develop future research to improve platelet transfusion practice. [Display omitted] DisclosuresNess:Terumo BCT: Consultancy.

Inventory management practices in the blood bank of an institute of national importance in India.

Background:The demand and supply gap in blood and components has always existed in healthcare facilities. Blood inventory management is crucial to meet the demand and to minimize wastage. This study explores the blood inventory management practices at the blood bank of an institute of national importance in India.Methods:The technicians of the blood bank were interviewed on the practices they followed on blood inventory management and records were reviewed where required.Results:Simple rule of thumb practices, the experience of staff, training, clear policy on stock keeping and allocation, daily stock review, record-keeping, monthly performance review, automation, adoption of information system, regular communications, and leadership emerged as factors contributing to inventory management.Conclusion:The blood bank follows simple procedures and relies on the experience of its staff to manage its inventory. Rigorous training, strict oldest-unit-first-out (OUFO)/first-in-first-out (FIFO) principle for stock management, stringent allocation policy, diligent record-keeping, daily stock review, and monthly performance reports were identified as the key drivers for inventory management. Other measures like regular preventive maintenance of equipment, robust blood bank information system, communication with stakeholders, and effective leadership were found to contribute indirectly to inventory management practices.

Documentation errors in transfusion chain: Challenges and interventions

Background and objectiveThere are several steps in transfusion chain where accurate documentation is critical. This study was conducted to evaluate the frequency of documentation errors during transfusion process and to evaluate the effectiveness of interventions in error-management. Methods /MaterialThis study was conducted at Aga Khan University, Pakistan during 2016–2018. Transcription and bedside documentation errors were identified from in-house computerized system and from medical charts. Raw WBIT rate was calculated for repeat blood samples and adjusted for frequencies of ABO-groups in our population accounting for silent WBIT. Rate of ABO-mismatched red cell transfusions was calculated for the annual totals of red cell transfusions. Chi-square was used for observing relationship among errors of various data sets. ResultsA total of 43 WBIT was identified during 54,219 repeat blood samples where blood group was already defined in blood bank information system. Annual unadjusted and cryptic WBIT rate was consistent at 0.8 and 0.6 per 1000 samples respectively during 2016–2018 (p 0.859). There were 1161 transcription errors (1.1 %) in blood group documentation in 105,064 blood samples received for arranging blood products. ABO-mismatched transfusion rate was 0.9 for 10,000 RBC transfusions in pre- and decreased to 0.4 in post-typing era. Overall, the compliance for completing checklist, correct ABO technique and appropriate ABO-interpretation was 88 %, 40 % and 24 % in the reviewed medical charts. ConclusionsSample labeling errors were not improved through training or counseling. Bedside ABO-typing and checklist prior to blood transfusion can control the ABO-mismatched transfusion if done timely and correctly.

Blood Bank Information System Based on Cloud Computing In Indonesia

In the health industry, the development of technology makes all of its related activities easier and faster. Cloud computing can facilitate controlled distribution of blood by using an information system. The problems that occurs in the distributions of blood at the hospitals in Indonesia are sometimes the distributions are not controlled, so the blood may run out of stock caused by inequality of blood needs, difficulty in finding blood donors, and don’t have an integrated system. The purpose of this study is to propose a connecting system that integrates Indonesian society who can be personal donor to help blood supply availability of UTD PMI using BBIS (Blood Bank Management System) based on cloud computing. The research methodology is collecting data with a systematic literature review and referring to previous studies, related to the current conditions in Indonesia. The result in this study is to propose Blood Bank Information System (BBIS), featured of application, dashboard, module and network architecture.

Electronic remote blood issue supports efficient and timely supply of blood and cost reduction: evidence from five hospitals at different stages of implementation.

This multicenter international study evaluated electronic remote blood issue (ERBI) for blood unit collection in hospitals. Retrospective data were collected from the ERBI software databases and blood bank information systems. Prospective "time-and-motion" data collection methods simulated the delivery of red blood cell units to determine the staff time for each step. The main benefit of ERBI was found in two hospitals where the blood unit was issued and collected at refrigerators remote from the blood bank (closer to the clinical area) compared with the standard process of blood bank issue (BBI) and blood unit collection in the blood bank. There was a reduction in the time for blood to reach patients (2.02 min compared to 8.43 min at one site [p ≤ 0.0001], 1.57 min compared to 6.54 min at the other [p ≤ 0.0001]). However, there was no reduction in time where ERBI was conducted in the blood bank or where a blood unit issued by the standard BBI was collected at remote refrigerators. In the three hospitals where ERBI was conducted at remote refrigerators, there was an improved issue:transfusion ratio (range of 1.02-1.09 for ERBI compared to 1.48-1.58 for BBI) and a reduction in staff time and costs of between $5,000 and $10,000/year. This multicenter international study builds on findings from studies in single hospitals that ERBI at remote refrigerators improves the efficiency of transfusion by reducing the time taken for blood units to reach patients, staff time, and costs.

A study on hospital blood information systems

The blood bank unit is one of the most important and fundamental units in every hospital especially in emergency situations. Lack of access to medical records related to individual’s blood transfusion can postpone blood transfusion when it is essentially needed which can in turn increase patients' risks. Meanwhile, the role of a blood bank information system is crucial in accessing this information, thereby improving the quality of available care. This research was conducted to determine the status of the blood bank information system of the hospitals affiliated to Shahid Beheshti University of Medical Sciences.This descriptive- practical study investigated the blood bank information systems of 11 hospitals affiliated to Shahid Beheshti University of Medical Sciences in 2015. Data collection was performed through observation and interview, using a checklist and questionnaire. The validity of the instrument was determined through content validity and its reliability was confirmed through retesting. Data analysis was conducted using descriptive statistics.All blood bank information systems under investigation were semi-mechanized. It was impossible to send the full reports electronically and to present dynamic reports. The blood bank staff were not aware of the existence and significance of the relevant standards and no specific blood bank software were used.Mechanized blood bank information systems bring about effective communication in various health care organizations. They lead to the application of relevant novel technologies while increasing patients’ safety and satisfaction.

Pembangunan dan Implementasi Sistem Informasi Bank Darah di PMI dan RSUD Muntilan Kabupaten Magelang

Blood bank administration in PMI, Magelang Regeency is still managed manually, which prevents hospitals from accessing information on blood stock quickly. Hospitals can access information about blood stock by phone only. Such a manual system could be a problem in delivering an excellent service. Therefore, a solution is required to improve the quality of services delivered by PMI. The use of information technology called Blood Bank Information System (SIBD/Sistem Informasi Bank Darah) is promising to improve the quality of services of the PMI. The SIBD helps the hospital to improve time efficiency in the blood demand process. There were several activities which have been completed, i.e.: 1) Developing SIBD at PMI of Magelang Regency; 2) Improving hardware facilities at PMI of Magelang Regency and RSUD Muntilan, including the procurement of computer hardware, modem, and Internet access for each institution; 3) Training on the use of SIBD for both PMI and hospital staff. The results wrer: 1). SIBD at PMI which is linked to RSUD Muntilan and other hospitals for blood supply information and online order; 2) Blood Bank Administration Database which can improve quality of service; 3) capability of PMI and RSUD Muntilan, Magelang Regency staff in utilizing SIBD to improve services to patients.

Pembangunan dan Implementasi Sistem Informasi Bank Darah di PMI dan RSUD Muntilan Kabupaten Magelang

Blood bank administration in PMI, Magelang Regeency is still managed manually, which prevents hospitals from accessing information on blood stock quickly. Hospitals can access information about blood stock by phone only. Such a manual system could be a problem in delivering an excellent service. Therefore, a solution is required to improve the quality of services delivered by PMI. The use of information technology called Blood Bank Information System (SIBD/Sistem Informasi Bank Darah) is promising to improve the quality of services of the PMI. The SIBD helps the hospital to improve time efficiency in the blood demand process. There were several activities which have been completed, i.e.: 1) Developing SIBD at PMI of Magelang Regency; 2) Improving hardware facilities at PMI of Magelang Regency and RSUD Muntilan, including the procurement of computer hardware, modem, and Internet access for each institution; 3) Training on the use of SIBD for both PMI and hospital staff. The results wrer: 1). SIBD at PMI which is linked to RSUD Muntilan and other hospitals for blood supply information and online order; 2) Blood Bank Administration Database which can improve quality of service; 3) capability of PMI and RSUD Muntilan, Magelang Regency staff in utilizing SIBD to improve services to patients.

Donor registration management using blood bank information system: Added layer to safe blood in developing country

Donor registration management using blood bank information system: Added layer to safe blood in developing country

Positive Coomb's test in newborns; causes and clinical consequences Summary of cases diagnosed in the Blood Bank in the years 2005 to 2012

Hemolytic disease of the fetus and newborn (HDFN) is caused by the destruction of fetal red blood cells due to red cell antibodies produced by the mother. HDFN can cause fetal hydrops during pregnancy or neonatal jaundice after birth. Direct Antiglobulin Test (DAT) detects antibodies bound to red cells and is a valuable test aiding in the diagnosis of HDFN. In Iceland DAT is routinely performed on cord blood or newborn blood samples if the mother is Rhesus D negative or has non-A/B red cell alloantibodies. The aim of this study was to investigate the causes and consequences of positive DAT in newborns in Iceland over a period of eight years. The study population was infants diagnosed with a positive DAT in the Blood Bank in Iceland in the years 2005-2012. Relevant data on the blood group and antibody status of mother and child, blood transfusion and DAT results were retrieved from the Blood Bank information system ProSang. Birth records provided information on birth weight, gestational age and phototherapy. Health records from the Children's Hospital provided information on the management and fate of the newborn. Over the study period 383 newborns had a positive DAT result at the Blood Bank. In 73.6% of cases the underlying cause was ABO blood group mismatch between mother and infant, in 20.4% of cases the mother had non-A/B red cell alloantibodies, in 3.9% both of above factors were present, while in 2.1% the cause was unclear. A total of 179 (47.6%) children had neonatal jaundice that required treatment, of which 167 (93.3%) only needed phototherapy. Eight infants required exchange transfusion, five of these had Rhesus antibodies and three ABO blood group mismatch. ABO blood group mismatch between mother and child was the most common cause for a positive DAT in neonates in Iceland in the years 2005-2012. Almost half of the neonates required treatment but usually phototherapy was sufficient. Rarely, blood transfusion or exchange transfusion was necessary in severe cases of ABO blood group mismatch or non-A/B red cell alloantibodies. Coombs test, Direct Antiglobulin Test (DAT), Hemolytic disease of the fetus and newborn (HDFN), ABO blood group mismatch, red cell alloantibodies, neonatal jaundice, exchange transfusion. Correspondence: Anna Margret Halldorsdottir, annamha@landspitali.is.

Improving blood transfusion practice by educational emphasis of the Blood Utilization Committee: Experience of one hospital

AimThe aim of this study was to reduce crossmatch to transfusion ratio through development of a new Blood Utilization Committee. BackgroundBlood utilization hinges on the cooperation between transfusion services, medical staff, nursing and administration. Transfusion committees have attempted to bring about better oversight and bridge the gap between departments but in our institution this did not work until we had a catalyst to drive the effort. The unabashed desire and enthusiasm of one of our cardiac surgeons for self-improvement led to the formation of a new Blood Utilization Committee in October of 2012. Study design and methodsCrossmatch and transfusion data were gathered from our blood bank information system starting with the 4th quarter of 2011 through the 1st quarter of 2013. The crossmatch to transfusion ratio (C:T) was calculated and comparisons were made between the results from before and after the initiation of the committee. ResultsAt the commencement of the committee the initial C:T for the cardiac team was 2.48. We calculated a decrease of the C:T to 1.5 four months after the November 2012 formation of the new committee. The P-value calculated (P<0.0005) proved that the decrease was statistically significant. ConclusionThe initial impulse generated by the cardiothoracic surgery team is now spreading to other DRG groups in our hospital and we are seeing a drop in their C:T as well. Better blood utilization is attainable when the physicians who perform most transfusions lead the charge.

Blood transfusion practice: A survey in Sichuan, China

Objective: To get full knowledge of current conditions and development in the past seven years of clinical transfusion practice in Sichuan, China. Study Design and Methods: This survey was performed by means of a questionnaire which consisted of three parts of questions including basic conditions of blood banks in the hospitals, procedures for clinical blood transfusion and the utilization of different types of blood products. Thirty-five representative hospitals from different geographic locations in Sichuan province participated in this survey. Results: All of the 35 hospitals returned the questionnaires and 33 hospitals (94.3%) answered the questions completely. The blood bank information system began to be used by more hospitals from 2006 (21.21%, 7/33) to 2012 (48.48%, 16/33). Automated grouping and cross-matching systems have not been used in level 2 hospitals and only 3 level 3 hospitals used automated systems in 2012. Still less common were procedures for evaluation of blood order forms for appropriateness (2/33, 6.06%) and evaluation of appropriateness and effect of blood component transfusion (8/33, 24.2%), and all the hospitals having these procedures are level 3 hospitals. The percentage of whole blood usage in the volume of all types of blood products used decreased a lot from 7.45% in 2006 to 0.16% in 2010. Technological instruments for bedside checking are not used by any of the hospitals. Conclusions: The transfusion service degree of the hospitals in Sichuan, China, has developed a lot in the past seven years; however, there are still some problems including whole blood still being used, albeit decreasing; lack of independent blood banks within the hospitals; lack of dedicated personnel for the transfusion services; lack of education; lack of blood bank information systems and automation; lack of screening for appropriateness for blood orders. Thus, the quality control center of clinical blood transfusion (QCCCBT) of Sichuan province should help the transfusion departments to attract more investment in staffing, equipment and information system from the hospitals, enhance the training of transfusion department staffs, and emphasize the supervision of transfusion department's work on directing clinical blood utilization and evaluating clinical transfusion appropriateness.

A New Method For Electronic Crossmatch: ABO /Rh Blood Group Confirmation and Antibody Screening Concomitantly With Serologic Crossmatch

Introduction Altough electronic crossmatch (E-XM) is cost effective and reduce laboratory workload, practical difficulties of determining 2 consecutive ABO/Rh in patients, requirement for the verification of the donor ABO group, concerns for errors in patient identification/specimen labeling and lack of reimbursement for performing ABO confirmation testing on a second separately collected specimen could avoid its widespread implementation in some countries. Method Using gel santrifuge method, ABO/Rh grouping and immuno-hematologic tests are done by a fully automatic system and recorded in blood bank information system. For patients and donors who do not have a previous blood group and antibody screen in the system, study steps are: 1. ABO/Rh group is performed with the 1st specimen and recorded 2. Donor blood group and antibody screen are done in the same gel card. 3. A second specimen is required at the time of transfusion request for regular antiglobulin crossmatch and antibody screen. ABO confirmation of patient and donor is done concomitantly in the same card with XM. 4. When 2 or more units are requested, first unit is selected by serologic XM, subsequent units are selected by E-XM from the available donor pool. Donor pool for electronic selection is fed by serologically compatible but undelivered units. Computer system is capable of questioning availability for E-XM eventhough serologic XM is not performed and could show the missing parameters needed for E-XM. Results After 6 months of validation process, between 1.01.2012- 31.07.2013, 36.7% of erythrocytes were reserved by E-XM using this method (table 1). Evaluation of the efficacy of the XM process revealed that 37.5% of the serologically confirmed units were undelivered and those supported the pool for E-XM (table 2). Conclusions 1. This method implements a double specimen system for ABO/Rh verification to ensure the transfusion security and guarantees the selection of at least 1 unit serologically. 2. Reduces work load and cost effective even in centers who are currently using serologic XM. Disclosures: No relevant conflicts of interest to declare.

Root cause analysis of non-infectious transfusion complications and the lessons learnt

Transfusion of blood and blood products can be associated with hazards which may be at times fatal. Timely reporting of transfusion reactions is imperative for root cause analysis and their prevention in future. We retrospectively reviewed the transfusion reactions at our institution during last seven years. The data was retrieved from our computerized blood bank information system and by reviewing the medical charts of patients. The frequency of adverse effects, implicated products, wrong blood transfusion and its outcome were observed. During study period (2006-2012), a total of 393,662 blood or blood products were transfused. There were 458 adverse events with an estimated rate of 1.16 per 1000 blood products administered. During 2011-2012, 121 transfusion reactions were reported of 119,921 transfused units. The most common adverse effects were allergic reactions (70 episodes of 121 or 57.8%) followed by febrile non hemolytic transfusion reactions or FNHTR (43 events of 121 or 35.5%). Transfusion associated dyspnea, circulatory overload and transfusion associated lung injury were less frequent. During the study period, 142,066 red cell units were transfused with nine recognized ABO-mismatch transfusions and two fatalities. The computed incidence of ABO-mismatch transfusion was 1 in 15,785 with a mortality rate of 1 in 71,033 units transfused. Etiology included: errors in final bed side check (n=5), blood bank clerical errors (n=3) and mislabeled tube (n=1). A review of these cases prompted hospital transfusion committee for re-enforcing policies and protocols to minimize accidental ABO incompatible transfusions. We concluded that urticaria and FNHTR are the most frequent transfusion reactions in our setting. ABO mismatched blood transfusions are rare but preventable errors and result mainly from clerical imprecisions.