Blood Banking System Research Articles

Blood transfusions in dogs and cats 2. Practicalities of blood collection and administration

Part 1 of this article, published in the May issue of In Practice (volume 32, pp 184–189), described the properties of different blood products in transfusion medicine and outlined how...

Tracking China's health reform

In response to growing public concerns over widening inequalities in health, the Chinese Government offi cially launched another round of the national health system reform plan in early 2009 with a commitment of ¥850 billion (US$125 billion) for the next 3 years. The proposed reform has ambitious targets, including 90% health insurance coverage by the end of 2010 and universal coverage of essential health-care by 2020. But how will these reforms be monitored? Over the past three decades, China’s health information system has evolved to include national household surveys of health-care use and expenditures, real-time surveillance of communicable diseases, and periodic disease-specifi c prevalence surveys. These health metrics were key factors in the current reforms. With use of the national health service surveys in 1993 and 1998, the Development Research Center concluded in 2002–04 that earlier reforms had not been successful. The proportion of health expenditures covered by the government had dropped from 36% to 15%, funding for prevention had relatively declined, health insurance coverage had collapsed to 13% of rural and 40% of urban residents, and 70% of residents from the poorest regions of the country failed to seek inpatient treatment because of cost. In July, 2005, a newspaper article about the study in the China Youth Daily provoked widespread public discussion and debate that was sustained by a litany of media stories of human and fi nancial health-system failings. China’s blood-banking system, as detailed by Xuerong Yu and colleagues. Production of China’s human resources depends on professional medical education. As described by Dong Xu and colleagues, higher education in China has several purposes: global academic excellence, training professionals to service diverse Chinese populations, and re-engineering the professions to grapple with the onslaught of non-communicable diseases. How China harmonises these diverse aims will determine not only the contributions of its next generation of professionals but also very probably the success and sustainability of its ambitious reforms towards universal health coverage. For these and other studies, more and more Chinese health data are increasingly accessible, as illustrated by the wealth of data on child mortality from the internet in Chinese that was analysed by Rudan and colleagues. As reviewed by Yan Guo and colleagues, the recent round of health reforms will be monitored by key indicators, just as the reforms were stimulated in part by results from earlier health surveys. While it is too early to draw conclusions, China has rapidly expanded medical insurance so that the recent national household healthsurvey found a dramatic turnaround: 87% of urban and rural populations reached by 2008. In view of these developments, it seems likely that China will achieve universal insurance coverage well before 2020, albeit providing only limited benefi ts. The Lancet’s two China collections, in 2008 and 2010, illustrate the deepening engagement of Chinese academics in the global health sciences. The recent appointment of a Lancet Asia editor based in Beijing augers well for the journal’s future publications on health in China. Just as China has much to learn from international science, China also has much to share for the mutual benefi t of the entire global health community.

Avoiding the Swamp of Unmet Expectations

The immediate post-HIV testing world of blood banking was a challenging time.1 Public concerns over blood safety fueled a tremendously powerful dynamic within the community to adopt testing and screening measures to deal with progressively more remote risks of transfusion-transmitted illnesses. Indeed, it was reasonable for patients to expect to receive untainted blood products in our hospitals. The result of this dynamic is now a safety profile for transfusion that begins to approach that of other low-risk activities of daily living, such as driving to the store or flying on a major airline.1,2 The firestorm of discussion and debate over each new risk, test, or screening method during the height of that era created a workable process by which to engage in this discussion, and has made the community keenly aware of the need to monitor for new risks. We are now generally more able to decide how, when, or if we should implement additional testing or screening measures to deal with those risks. That is not to say that this has come without considerable and even continuing controversy, but it has brought both the public and providers together to engage on the matter of expectations.1 The lessons learned from this era in blood banking should be studied and carefully considered as scrutiny of other aspects of medical care, and in particular laboratory testing and its risks (safety issues), come to light. Best practices, whether they are business models, software, or hardware tools, will rapidly become the standard of care, driven by a combination of legal, liability, regulatory, public perception, and payer pressures. Just as there was a race to adopt HIV antigen and then nucleic acid based testing (NAT) in the blood banking industry, there must be a rush to adopt a host of …

Doadores de sangue de primeira vez e comportamento de retorno no hemocentro público do Recife

OBJETIVO: Analisar o perfil dos doadores de sangue conforme o período da primeira doação e comportamento de retorno no hemocentro público do Recife. CASUÍSTICA E MÉTODOS: Estudo retrospectivo, com 363 doadores, no qual se utilizou o banco de dados do Sistema de Banco de Sangue (SBS) referente ao período de 01 de janeiro de 1998 a 13 de junho de 2008. Na análise avaliaram-se a mediana do número de doações por sexo, idade e escolaridade, além da associação entre o período da primeira doação e o sexo, idade à primeira doação e fator Rh. Para 261 (excluídos 100 doadores de primeira vez e dois por imprecisão da data do retorno), o comportamento de retorno. RESULTADOS: Aproximadamente 77,1% eram homens, 40,5% entre 25-34 anos de idade, 47,7% haviam completado o segundo grau e 54% doaram espontaneamente. A mediana do número de doações foi maior entre os homens (p=0,000) mais velhos (p=0,000). A participação feminina cresceu no período atual (30,6%) em comparação a 1998-2000 (4,8%), mas o percentual superior dos doadores de primeira vez era referente a homem (p=0,003). Daqueles que doaram cinco ou mais vezes, 43,8% retornaram para próxima doação com intervalo menor que seis meses. Prevaleceu o sexo masculino entre doadores de repetição (p=0,011). CONCLUSÕES: A grande maioria dos doadores de repetição (intervalo de tempo entre as duas últimas doações igual ou inferior a 13 meses) ainda não está próximo do número máximo de doação anual. É fundamental concentrar a atenção neste grupo potencialmente mais receptivo para aumentar efetividade do recrutamento.

Conference Scene: Stem Cells World Congress 2009

The focus of this conference report is to present and highlight some selected topics and emerging trends from this excellent annual conference hosted by Select Biosciences Ltd. at the Wyndham Palm Springs. This conference attracted a worldwide audience of more than 100 delegates representing a number of different areas – basic researchers involved with stem cells, representatives from pharmaceutical, biotechnology and vendor companies, a diverse array of industry participants from the cord blood banking industry as well as stem-cell clinics from around the world. The scope of industry coverage presented at this conference included stem cells in regenerative medicine, pluripotency/induced pluripotent stem cells/epigenetics and biobanking. These categories represented the major themes into which the bulk of the presentations at this conference were organized. By far, the major thrust of this conference was on the application of stem cells for regenerative medicine – in this regard it is important to note that mesenchymal stem cells are the most promising types of adult stem cells for regenerative medicine and cellular therapy. Many presentations at this conference were focused around mesenchymal stem cells for cellular therapy in a number of different disease areas.

Management in Indian blood banking system: True reality

Blood transfusion service is a multibillion dollar profession/ business worldwide. Being Indian blood bank personnel, we may not like to call it as business. But in the real sense, it is a production industry with all the components of business built into it. Still, we will not like to call it a business because of the fear in our minds that our general population or blood donors will be annoyed with us and may not come to donate again. Many a times, we do not clarify to the donor at the time of donation that there is service charge for blood units. As a result, when the donor needs blood, it comes as a rude shock and he makes allegations of the ‘sale’ of blood. At that moment, the situation becomes embarrassing because we hesitate to accept that we follow a cost recovery system which is a part of the business.

Capitalizing hope: the commercial development of umbilical cord blood stem cell banking

The creation of commercial cord blood banks rests on the promise of stem cell based regenerative medicine and marks the capitalization of human tissues within a future-oriented “regime of hope”. This paper will present data from a survey of the international cord blood banking industry and will explore: (a) the way firms seek to commercialize cord blood as a new set of commodities; (b) the expectations and moral economy that are being constructed around this technology; and (c) how firms are acting as mediators of hope in what might be called a “promissory bioeconomy”.

Detection of HIV antigen and cDNA among antibody-negative blood samples in Nigeria

In developing countries as many as 50% of patients for whom a transfusion is indicated are at risk of dying immediately if transfusion is withheld. It is therefore important that blood transfusion is made as safe as possible. This study was designed to assess the safety of blood transfusion in two large blood banks in Ibadan, Nigeria. Aliquots of 250 samples already screened and passed as negative for HIV-1 and -2 were collected from each of the blood banks. Samples were tested for the presence of HIV-1 antigen (ELAVIA Ag I) and the antigen-positive samples tested for the presence of specific HIV-1 antibodies by Western blot (BioRad, France). All antigen-positive samples were also subjected to PCR. HIV-1 antigen was detected in 6 (1.2%) of the 500 samples, of which 4 (0.8%) and 3 (0.6%) were Western blot-indeterminate and PCR-positive, respectively. Transfusion of HIV-contaminated blood may be contributing significantly to the spread of the virus in Nigeria. There is therefore an urgent need for an organized blood-banking system with facilities for more sensitive assays for the detection of HIV in blood to prevent transmission through transfusion.

The tragic history of AIDS in the hemophilia population, 1982-1984.

The tragic history of AIDS in the hemophilia population, 1982-1984.

Improving the safety of the blood supply in Ecuador through external performance evaluation of serological screening of blood donors

Background: The Ecuadorian National Blood System collects approximately 100 000 units of blood per year. Screening for infectiousagents is conducted by 23 autonomous blood services using different methodologies and reagents. Objectives: To evaluate the performanceof serology testing by laboratories of the Ecuadorian National Blood Bank System. Study design: Four proficiency panels were distributed between April 2003 and December 2004 containing samples that were characterized as either reactive or non-reactive for hepatitis B surface antigen (HBsAg), antibodies against hepatitis C virus (HCV), and antibodies against human immunodeficiency virus (HIV). Laboratories were classified according to the volume of blood units processed per year, as small (<5000), medium (5000–12000) and large (>12000). Results: Large and medium blood services consistently obtained better results than small ones. All of the 37 anti-HIVantibody false negative results and all of the 20 HBsAg false negative results were reported by small laboratories. False negative results were associated with the use of rapid tests. Laboratories using rapid tests and certain lots of an enzyme-linked immunosorbent assay (ELISA) failed to detect HCV reactive sera in December 2004. Conclusion: The high number of incorrect results in most small blood services indicates serious weaknesses in blood screening that require urgent corrective action. The National Blood System has implemented on-site audits, training, technical assistance, and increased oversight. The long-term proposal is to centralize blood testing in two large blood centers. The results presented here underline the importance of strengthening the regulatory framework and oversight in Ecuador and highlight the role of external performance evaluation programs for blood safety improvement.

The Use of Hydroxy-Ethyl Starch Sedimentation for Autologous Buffy Coat Preparation

The use of hydroxy-ethyl starch (HES) has been used in the cord blood banking industry for the separation of blood into its individual components. The focus of this study is to examine whether the use of HES is feasible in obtaining a buffy coat for the use in the construction of platelet gels. Blood was collected from seven canines into anticoagulant citrate dextrose at a ratio of 1:8. A sample of whole blood was used to obtain initial cell counts and a base line Thrombelastograph® (TEG®). 6% Hespan was added to the whole blood and allowed to sediment for 60 minutes. Cell counts and TEG®s were performed on the resulting layers: red blood cells (RBCs), buffy coat (BC), and plasma. The results of this study (see Table 1) suggest that the gravity sedimentation of whole blood with HES can significantly reduce the RBCs in the BC and plasma layers while increasing the platelet count in the plasma layer. These data also suggest that HES does not affect the clotting capabilities of the BC and plasma layers.

Virtual Blood Banking: A 7-Year Experience

The operating theater blood transaction system (OTBTS) is a virtual blood banking system that allows computer crossmatch–compatible blood ordering and delivery in the operating theater remote from the hospital blood bank. It was developed and implemented our hospital in 1997 and was expanded in 2002 to include an unmatched blood module that allows ordering and issuing unmatched RBCs for intraoperative transfusion. During the past 7 years, the system has handled 6,333 crossmatch requests for intraoperative transfusion and issued 20,073 units of RBCs, including 100 units of unmatched RBCs (group 72 units; group-identical, 28 units). The OTBTS has proven to be efficient (with a turnaround time for blood ordering and issuing <30 seconds), effective (with a reduced crossmatch/transfusion ratio and blood wastage), and error free (no delay or error in transfusion or postponement of operation). Furthermore, our experience with the unmatched blood module has attested to the safety and efficacy of computer-controlled, online ordering and real-time, on-site delivery of unmatched RBCs for emergency transfusion.

Virtual Blood Banking

The operating theater blood transaction system (OTBTS) is a virtual blood banking system that allows computer crossmatch-compatible blood ordering and delivery in the operating theater remote from the hospital blood bank. It was developed and implemented in our hospital in 1997 and was expanded in 2002 to include an unmatched blood module that allows ordering and issuing unmatched RBCs for intraoperative transfusion. During the past 7 years, the system has handled 6,333 crossmatch requests for intraoperative transfusion and issued 20,073 units of RBCs, including 100 units of unmatched RBCs (group O, 72 units; group-identical, 28 units). The OTBTS has proven to be efficient (with a turnaround time for blood ordering and issuing < 30 seconds), effective (with a reduced crossmatch/transfusion ratio and blood wastage), and error free (no delay or error in transfusion or postponement of operation). Furthermore, our experience with the unmatched blood module has attested to the safety and efficacy of computer-controlled, online ordering and real-time, on-site delivery of unmatched RBCs for emergency transfusion.

Blood conservation: Why bother?

THAT THE BLOOD SUPPLY is the safest it has ever been is decried in many academic and lay press publications. Hepatitis and human immunodeficiency virus (HIV) transmission have now been almost eliminated from allogeneic stored blood.1–3 The improvement in viral transmission risk has come at a considerable cost. New plagues await the blood-banking industry, and today the country has just survived the scare of West Nile virus infestation of the United States blood supply (1/800–1/4,000 units). In 1 year, a nucleic acid test (NAT) for West Nile virus has been instituted, now rendering the chance of West Nile transmission through the blood supply to a much lower level.4,5 New viruses will always be a menace, and viruses such as cytomegalovirus and transfusion-transmitted virus (TTV) are present in the majority of units transfused.6 However, transfusion medicine is rapidly changing and because hepatitis and HIV have been essentially eliminated from the blood supply, the focus shifted to a number of other crucial and fundamental questions. This supplement to the Journal of Cardiothoracic and Vascular Anesthesia examines some of the issues and encourages methods to conserve banked blood, including perioperative techniques and pharmacotherapies such as aprotinin. This article touches on a number of issues surrounding transfusion, all of which provide the compelling argument that conservation is necessary.

Expensive blood safety technologies: understanding and managing cost and access-to-care issues

With a succession of recent blood safety enhancements driving up blood component costs for their hospital customers, the blood banking industry has called for changes in Medicare inpatient payment policy to narrow the gap between costs and reimbursement. In the specific case of leukoreduction of red blood cells, the interplay of intense cost pressures and the absence of authoritative clinical practice guidelines have created wide hospital-to-hospital disparities in patient access to leukoreduced blood components. This review examines the financial implications of costly nonmandated blood safety-related technologies for US hospitals, using leukoreduced red blood cells as a case example. An approach is offered to (1) standardize clinical practice with respect to the administration of nonmandated blood component innovations, (2) reduce the influence of hospital financial priorities on patient access, and (3) better address medicoeconomic tradeoff concerns.

The regulatory pendulum in transfusion medicine

Blood banking and the manufacture of blood products have been relatively outside the influence of regulatory authorities. Several developments contributed to a revision of this environment. The transmission of acquired immunodeficiency syndrome by blood products changed the perception of blood product safety and also spawned litigation and governmental inquiries. The blood banking industry has embraced, with varying degrees of enthusiasm, the principles of systematic quality management and good manufacturing practice, which has created a substantial subindustry and has contributed to a disproportionate focus on product quality. Conventional market forces have also gradually penetrated the traditional blood economies. The public and political focus has resulted in regulatory and policy efforts being concentrated on inappropriate areas. Several of the safety efforts can be arguably described as cost-ineffective while diverting attention and resources from more important issues. An improved integration into mainstream public health policy and incorporation of objectively measured risks into regulatory policy would do much to enhance the quality of the transfusion system. This can be achieved if regulators themselves are overseen through a process that ensures performance and accountability against objective and predefined standards. A further beneficial outcome from this approach could be the harmonization of blood safety and policy measures, the need for which is being felt increasingly worldwide.

Embedded Altruism: Blood Collection Regimes and the European Union's Donor Population

Blood donation is often cited as a perfect example of altruism. But blood must be collected as well as donated, and the organizational basis of the blood supply has been largely neglected. This article is a comparative study of blood collection regimes in Europe. Regimes are found to affect donation rates and donor profiles. When the Red Cross collects blood, donation is tied to religious activity and other volunteering, unlike state and blood bank systems. This study argues that collection regimes produce their donor populations by providing differing opportunities for donations. The analysis contributes to an institutional perspective on altruism and highlights the need to attend to the socially embedded nature of altruistic as well as self-interested action.

世界の臍帯血バンクネットワークの現況

世界の臍帯血バンクネットワークの現況

Operating theater blood transaction system. A "virtual" blood transfusion service that brings the blood bank to the operating table.

We describe an operating theater blood transaction system (OTBTS) that is a novel computer software system incorporating electronic crossmatch and the concept of a "self-service" blood banking system in the operating theater. Through this system, the surgeons and the anesthetists can issue blood units for intraoperative transfusion for the patients with a negative antibody screen without the need for a porter service or pneumatic tube system. Since implementation of the OTBTS, the time for obtaining compatible blood for intraoperative transfusion has been reduced from 20 to 30 minutes to around 1 minute. Furthermore, the crossmatch-transfusion ratio was reduced to 1.05. The 23% of patients who required extra blood units (i.e., more than originally anticipated) during surgery further benefited from the system. The blood stock reserved for patients undergoing surgery was reduced by 20%. Therefore, the OTBTS is a system that can greatly enhance the efficiency and safety of intraoperative transfusion and can also save workforce resources.

Effect of the hemoglobin-based oxygen carrier HBOC-201 on laboratory instrumentation: cobas integra, chiron blood gas analyzer 840, Sysmex SE-9000 and BCT.

As part of a clinical trial, we evaluated the effects of the hemoglobin-based oxygen-carrier (HBOC) HBOC-201 (an ultrapurified, stroma-free bovine hemoglobin product, Biopure, Cambridge, MA, USA) on our routine clinical chemistry analyzer (Cobas Integra, F. Hoffmann-La Roche Ltd, Basel, Switzerland ), blood gas analyzer (Chiron 840, Chiron Diagnostics Corporation, East Walpole, MA, USA), routine hemocytometry analyzer (Sysmex SE-9000, TOA Medical Electronics Co Ltd., Kobe, Japan), hemostasis analyzer (BCT, Dade-Behring, Marburg, Germany) and bloodbanking system (Dia-Med-ID Micro Typing System, DiaMed AG, Cressier, Switzerland). The maximum tested concentration of HBOC-201 was 65 g/l. Of the 27 routine clinical chemistry tests challenged with HBOC-201, bilirubin-direct, creatine kinase MB-fraction (CK-MB), creatine kinase (CK), gamma-glutamyltransferase (GGT), magnesium and uric acid were influenced by even low concentrations of HBOC-201. These tests were excluded from use on the plasma of patients treated with HBOC-201. Since the non-availability of the cardiac marker CK-MB may lead to problems in acute situations, we introduced the qualitative Trop T-test (Boehringer Mannheim), which was not influenced. The applicability of another nine tests was limited by the concentration of the HBOC-201 in the patients' plasma. No interference of HBOC-201 in routine hemocytometry, hemostasis-analysis and red-blood cell agglutination detection (blood-bank tests) was observed. Although immediate patient-care was not compromised, routine use of hemoglobin-based oxygen carriers will have a strong impact on logistical management. The development of robust laboratory tests free from the interference of the pigmented oxygen carriers should therefore precede its introduction into routine transfusion medicine.