Blood Component Utilization Research Articles

A comprehensive approach to continuous quality improvement of massive transfusion by developing key performance indicators.

To develop key performance indicators (KPI) for use in quality assessment of our institutional goal-directed massive transfusion (GDMT). A team comprising our transfusion and emergency medicine departments carried out a cross-sectional data analysis of GDMT in adult patients from January 2021 to December 2022. The study was rooted in the Define, Measure, Analyse, Improve, Control (DMAIC) approach. Features of KPIs were (a) importance, (b) scientific soundness and (c) feasibility. Study parameters were defined and analysed using measures of central tendencies and benchmark comparison. Ninety-two massive transfusion events occurred and 1405 blood components were used. Trauma was the leading cause, followed by postpartum haemorrhage and upper gastrointestinal bleeding. Appropriate GDMT activation was observed only in 43.47% of events. The turnaround time (TAT) was within the benchmark in 85.8% of events with an average of 16 ± 10 min. The average utilization of blood components was 20.5 (interquartile range [IQR] = 11.3) in the appropriate group and 5.5 (IQR = 4.25) in the inappropriate group with a wastage rate of 3.5%. Duration of activation was 6.19 ± 4.59 h, and the adherence to thromboelastography was 66.3%. Overall mortality was 45.65%, and the average duration of hospital stay was 6.1 ± 5.9 days. The KPIs developed were easy to capture, and the analysis provided a comprehensive approach to the quality improvement of the GDMT protocol.

Utilization of blood and blood components in the department of clinical hematology of a tertiary care hospital: A prospective hospital-based study

Background: To have proper utilization of blood and its components adherence to established guidelines is essential. Hence, periodic review of blood components is necessary to improve transfusion practices and decrease the inappropriateness of blood components. Aims and Objectives: Our study aims to assess the utilization and appropriateness of blood and blood components in the Department of Clinical Hematology SKIMS, Soura, Srinagar. Materials and Methods: This prospective observational study was conducted in the Department of Blood Transfusion and Immunohematology, SKIMS, Soura, Srinagar, over a period of 1 year from August 2020 to July 2021 on patients admitted in Clinical Hematology requiring transfusion therapy. The number of all blood and blood component units supplied over a period of 1 year was assessed. The usage of different types of blood component was recorded and correlated with the patient’s diagnosis and indications for transfusion. Results: A total of 250 patients were transfused with 2099 blood and blood components, among them 64.32% (1350) units were used appropriately and 35.68% (749) units were used inappropriately. Transfusions of packed red blood cells were found to be inappropriate in patients with asymptomatic chronic anemia with Hemoglobin >7 g/dL. Fresh frozen plasma was given inappropriately in cases of bleeding without derangement of coagulation tests. Inappropriate use of platelets was seen in patients who had received platelets prophylactically with platelet count above 10,000/μL. Conclusion: Proper implementation of guidelines for the use of various blood components would help reduce their inappropriateness.

The assessment of collection and utilization of blood and blood components in Zanzibar

Background: Assessment of blood and blood components requisition and utilization is essential for better planning and improvement of transfusion services to meet requests and demands. The main aim of this study is to assess the collection and utilization of blood and blood components in Zanzibar National Blood Transfusion Services (ZNBTS). Method: It is a retrospective study in which data relating to the collection and usage of blood and its components from January 2021 to December 2021 at ZNBTS was collected and analyzed. Results: A total of 16,388 units of blood were collected from January to December 2021. 21,265 units of blood components were generated from 8,585(55.0%) units of Whole Blood (WB), while the remaining 7,030 (45.0%) units were issued as WB. In Unguja, there was a significant increase in the use of Packed Red Blood Cells (PRBC) 10,177 (61.3%), followed by WB 3,759 (22.6%), Fresh Frozen Plasma (FFP) 1, 562 (9.4%) and Platelets (PLT) 10 (0.06%) respectively. In Pemba, the use of WB was high (n = 1,526; 69.8%), followed by PRBC 878 (3.6%) and FFP 68(0.4%). The monthly mean blood request was 2,975 units (WB 460 and Blood components 1,028). Blood collection was above ZNBTS annual target of 16,000 units but blood and blood components request was met only by 50%. Conclusion: There is a gradual shift in clinical practice from the traditional use of WB to the use of PRBC and other blood components. For the appropriate use of blood and blood components, Transfusion Medicine training among Medical Students and junior clinicians is strongly recommended.

Unveiling transfusions: Analyzing blood product utilization patterns in a leading tertiary care center in Madhya Pradesh, India

Background: Blood transfusions play a pivotal role in medical care, saving millions of lives annually. The timely provision of safe blood is critical in various clinical scenarios, necessitating a careful balance between supply and demand. Despite advanced blood banking facilities globally, challenges persist in ensuring appropriate blood component utilization, prompting a need for clinical audits and optimization strategies. Aims and Objectives: This study aims to analyze the patterns of blood product utilization in a tertiary care hospital in Madhya Pradesh over 1 year, focusing on transfusion requests, cross-match-to-transfusion (C/T) ratios, transfusion indices (TIs), and indications for transfusions. Materials and Methods: A retrospective study was conducted at Shyam Shah Medical College from January 01, 2023, to December 31, 2023. Data from transfusion and cross-match requests in various departments were collected. C/T ratios, TI, and non-usage probability were computed to assess blood utilization efficiency. Results: Out of 16,682 cross-matched units, 71.93% were transfused. The overall C/T ratio was 1.39. The department of medicine demonstrated the most efficient blood usage with a C/T ratio of 1.16. Obstetrics and gynecology had the highest TI (1.06), while surgery had the lowest (0.71). Indications for transfusion included anemia (29.9%), pre-operative (17.2%), intraoperative (21.8%), and post-operative (31.1%). Conclusion: This study provides valuable insights into blood utilization patterns, offering a foundation for refining transfusion practices and enhancing the efficiency of blood management in the studied tertiary care hospital.

Prevalence and pattern of blood and blood component utilization at the Kenyatta National Hospital maternity unit in 2022-2023: A cross-sectional study

Background: Blood and blood component transfusion plays a pivotal lifesaving role. Adequate amounts significantly reduce maternal morbidity and mortality. This study aimed to assess the prevalence and pattern of blood and blood component utilization among women managed at the Kenyatta National Hospital (KNH) maternity unit in 2022-2023. Methods: This was a cross-sectional study targeting women admitted to the KNH maternity unit. Participants were recruited through consecutive sampling. A data abstraction chart was used for data collection. The study variables included proportions of patients who required blood or blood components, indications for transfusion, number of units availed against those requested, and outcomes of the participants. To determine the prevalence of transfusion, the proportion of participants who received blood or blood components was calculated over the admissions. To determine the percentage per indication for transfusion, a particular indication was calculated over the total number of indications and expressed in percentages, and the need was calculated as the total need per blood request generated. Continuous data were analyzed for mean and standard deviation. Frequencies and percentages were calculated for variables with categorical data. Results: Among 5567 admissions, 344 participants who needed blood and blood components were sampled over 7 months from October 2022. This represented a prevalence of 6.2%. Of this prevalence, cesarean deliveries made up 3%, SVD 1.4%, and miscarriages accounted for 0.5% among others. Postpartum hemorrhage was the most common indication (34.5%), with 65.4% of participants having their need for blood/blood components met. The deficit in blood units ordered was 12.4%. The majority (98%) were discharged home. While mortality was recorded at 2%. Conclusion: The prevalence of blood/blood components transfusion was 6.2%. Postpartum hemorrhage remains the most common indication for blood transfusion. The need for blood and its components remains unmet both for the number of units and the type of component.

Tailoring transfusion strategy using thromboelastogram in goal-directed massive transfusion: Impact on transfusion requirements and clinical outcomes.

We compared the overall clinical outcome in formula-based protocol (1:1:1) and thromboelastogram (TEG)-guided goal-based massive transfusion (MT) in the resuscitation of patients with hemorrhagic shock. This was a retro-prospective case-control study conducted over a period of 2 years among the patients who received MT using a 1:1:1 fixed ratio protocol (controls, Group A) and goal-based protocol (cases, Group B) guided through TEG. Patients were matched for the type and severity of the clinical conditions. Utilization of blood components, clinical outcomes, transfusion-related complications, and total mortality rates were compared between the groups. There were 113 patients in the formula-based group and 109 patients in the goal-based transfusion group who were matched for injury severity scores. The total blood components utilized were 1867 and 1560, respectively, with a 17.7% reduction associated with the use of TEG. Patients were divided into normal, hypo, and hypercoagulable based on TEG, and a higher transfusion rate was associated with hypocoagulable TEG (942 vs. 610). The prothrombin time, activated partial thromboplastin time, R time, and K time had a significant positive correlation with the need to transfuse more than 20 blood components, whereas platelet count, base excess, alpha angle, MA, and CI had a negative correlation (r = 0.268, P < 0.001). At the end of goal-directed transfusion, 75% of the patients were free of transfusion support (vs. 65.4%) and only 6.9% of the patients had coagulopathy (vs. 31.8%) compared to formula-based resuscitation with a 10% reduction in mortality. TEG-guided goal-based approach helped to reduce blood component utilization with a reduced incidence of coagulopathy at the end of the MT while improving patient survival.

Blood donation practices, processing and utilisation of blood components in government tertiary hospitals in Nigeria: a multicentre cooperative study.

Timely access to safe blood and blood components is still a challenge in Nigeria. This study aimed to determine blood donation practices, processing and utilization of blood components across government tertiary hospitals (THs) in Nigeria. This was a descriptive cross-sectional study done in Nigeria in June-July 2020. Data were analysed with SPSS version 21.0. Data were collected from 50 THs. The majority (68%) of the THs lack facilities for blood component preparation and only 18% and 32% provide cryoprecipitate and platelet concentrate, respectively. Whole blood was most commonly requested (57.04%). All facilities tested blood for HIV, HBV and HCV, but the majority (23 [46%]) employed rapid screening tests alone and nucleic acid testing was not available in any hospitals. The manual method was the most common method of compatibility testing in 90% (45/50) and none of the THs routinely perform extended red cell typing. The average time to process routine, emergency and uncross-matched requests were a mean of 109.58±79.76min (range 45.00-360.00), 41.62±25.23 (10.00-240.00) and 11.09±4.92 (2.00-20.00), respectively. Facilities for blood component preparation were not widely available. Concerned government authorities should provide facilities for blood component preparation.

Impact of early and empirical cryoprecipitate administration on the transfusion requirements in trauma patients with hemorrhagic shock

Abstract BACKGROUND: Fibrinogen is the earliest coagulation factor falling to the critical levels in severely bleeding trauma patients. Early fibrinogen supplementation in these patients has been recommended to improve the patient outcomes. However, its role in reducing the overall transfusion requirement remains equivocal. AIMS: This study aimed to evaluate the effect of early cryoprecipitate (CRYO) administration on the transfusion requirement and the coagulation assays in trauma patients with hemorrhagic shock. SETTINGS AND DESIGN: An interventional study was conducted in two phases at level I trauma center. During the 1st phase (Group I), patients received blood components in accordance with current practices, whereas in the 2nd phase (Group II), patients received an additional CRYO (pool of 6 units) empirically within 90 min of admission. METHODS: Demographics, clinical, injury characteristics, transfusion requirements, blood counts, and coagulation assays were assessed for both the study groups. STATISTICAL ANALYSIS: The comparative analysis was done for blood component utilization and coagulations assays (prothrombin time, activated partial thromboplastin time, and fibrinogen levels) in both study groups. RESULTS AND CONCLUSIONS: A total of 50 patients in Group I and 51 patients in Group II were recruited. Demographics, clinical, injury characteristics, and laboratory investigations were comparable, except for heart rate, blood pressure, and injury scores. Significant reductions in red blood cell and platelet transfusions were observed, whereas the fresh-frozen plasma transfusions remained unaffected. The results of coagulation assays at 18–24 h were similar for both groups. Although no significant differences in fibrinogen levels were observed despite CRYO administration, decreased requirement for transfusions indicated an improved hemostasis in CRYO group.

Management of perioperative iron deficiency anemia as part of patient blood management in France: A budget impact model-based analysis based on real world data.

Patient Blood Management (PBM) is defined as a patient-centered, systematic, evidence-based approach to improve patient outcomes by managing and preserving a patient's own blood, while promoting patient safety and empowerment. As a corollary, it also reduces the utilization of allogeneic blood components. However, demonstrating cost-effectiveness depends on the health insurance system considered. This analysis aims to estimate the one-year budget impact of PBM in four elective surgical areas, from French National Health Insurance and hospital perspectives. A budget impact model was developed to estimate the difference in the cost of care between scenarios with and without PBM. The impact of hematopoiesis optimization (first pillar of PBM) was studied throughout the management of preoperative anemia and iron deficiency in four types of surgeries: orthopedic, cardiac & cardiovascular, vascular & thoracic, and urologic & visceral surgery. Estimation of model's parameters was based on data collected in 10 French hospitals, literature, and on data from the French national medico-administrative database. A total of 980,125 patients were modeled for all four therapeutic areas. Results shows that implementation of a PBM program could generate annual savings up to €1079 M from the French National Health Insurance perspective (€1018 M from the hospital perspective), and the sparing of 181,451 red blood cells units per year. The deterministic sensitivity analysis showed that PBM generates savings for both perspectives in most parameters tested. Implementing PBM programs could result in important savings for the health care system in France.

Impact of the COVID-19 Pandemic on Blood Transfusion Service: A case study from Kolkata, India

Background: The emergence of coronavirus disease (COVID-19) has posed a significant threat to public health all over the world and it has been a difficult challenge for blood banks in India to cope with the situation. In this study, the effect of the COVID-19 pandemic on the blood transfusion service of India has been assessed. Method: The present study is conducted in a stand-alone community blood bank situated in the city of Kolkata, India. A comparative evaluation of supply, demand, and utilization of blood components by analysing pre-pandemic and post-pandemic data from 2017 to 2020 has been presented. Result: As no blood donation camp could be organized due to the country-wide lockdown along with restrictions in mobility and large gatherings during the initial period after the outbreak of the pandemic, a significant reduction of 80.35% in blood collection was observed. The demand for the Packed Red Blood Cell was decreased by 75% due to the postponement of elective surgeries and non-urgent clinical interventions. Blood utilization patterns also changed as 40% of the Packed Red Blood Cell was issued to thalassemia patients during this period. Conclusion: Based on the evaluation of blood bank performance under pre-pandemic and post-pandemic conditions, recommendations such as spreading public awareness, maintaining sufficient safety stock, proper training of blood banking staff, communicating with nearby hospitals, donors, and medical professionals have been identified to be helpful to mitigate the adverse effects of extreme situations such as a pandemic.

A study on the usage and wastage of blood components in blood bank of B.P. Koirala Institute of Health Sciences, Dharan

Background: Human blood till date has no substitute. Transfusion of blood and its components is a lifesaving procedure. Hence, optimum utilization and minimum wastage of blood and its components should be strictly monitored. Materials and Methods: This is a prospective study conducted on data collected from the blood bank of B.P. Koirala Institute of Health Sciences, Dharan, Nepal for a duration of 1 year from year 2015 to 2016. The sample size was calculated by using systematic random sampling with every third sampling interval sample collection method. The study included usage and wastage of packed red blood cells, platelet concentrate, fresh frozen plasma, and cryoprecipitate including data on the supply of blood components to different departments, age distribution, gender distribution, and distribution of blood components based on blood groups. Results: A total of 1641 units of blood component were included in the study. A total of 92.9% (1524 units) were used and 7.13% (117 units) were wasted. The renal disorder was the most common cause of blood component utilization. The medicine department utilized the majority of the blood components. The expiry was the most common cause of wastage. Among the wasted blood components, platelet concentrate was the maximum. Conclusion: Blood components are a life-saving resource. It should be evaluated and analyzed properly for utilization in a justifiable manner. The hospital should act in accordance so that maximum blood components are utilized in a safe manner and waste is minimized to the least.

Utilization of Blood and Blood Components in a Tertiary Care Hospital at Bogura, Bangladesh

Background and Objectives: Blood and blood components should be transfused cautiously due to potential risks of various transfusion reactions. It is very important for clinicians to be aware of these potential risks. Great progress had been made in the 20th century, by introducing blood component therapy. Now the term “Rational use of blood” came forward. Hence, indiscriminate use of whole blood (WB) should be avoided or minimized. The aim of our article is to demonstrate and evaluate the quantity and pattern of components used in our hospital. Materials and Methods: A retrospective study was carried out in the Department of Transfusion Medicine at a Medical College Hospital from July 2021 to December 2021. Transfusion details were obtained from blood bank records for each patient. Data of all the used blood and components were evaluated and analyzed. Results: Among the male recipients, the majority was of the age group &lt;10 and &gt;50 years, whereas among females, the majority were of age 21–30 and then &gt;50 years. The majority of used blood units were WB (76.48%) followed by red cell concentrate (22.23%) and then platelet concentrate (0.94%). Fresh frozen plasma and cryoprecipitate were not used. The majority of WB was used in patients of trauma or fracture (17.57%), followed by pregnancy-related cases (17.23%), malignancy (10.20%), kidney diseases (7.43%), and others. Conclusion: The use of WB was the most predominant in spite of prevailing facilities for component preparation in our hospital. Our physicians should be oriented to consider and utilize the advantages of using blood components.

Assessment of Blood Transfusion Utilization and Patient Outcomes at Yekatit-12 Hospital, Addis Ababa, Ethiopia.

BackgroundThe goal of blood transfusion is to provide a safe, sufficient, and timely supply of blood components to the recipients by ensuring that donation is safe and no harm to the recipient. So the current study was aimed to assess blood transfusion utilization and its outcome in patients at Yekatit-12 Hospital, Addis Ababa, Ethiopia.MethodsA cross-sectional study was conducted from May 01 to July 30, 2021, on 616 individuals who have requested blood transfusion at Yekatit-12 Hospital, Addis Ababa, Ethiopia. Information on blood and blood component utilization was collected by using a checklist. Finally, data were analyzed using SPSS version 21.0, and those variables in which P-value is less than 0.05 were considered statistically clinically significant.ResultsA total of 1540 cross-match units were requested for 616 (53.2% male) patients with a mean age of 43 years. Out of 1540 cross-matched blood units, 1498 units of blood were transfused for 615 individuals with a mean of 2.43 units. The most widely used blood component was whole blood 694 (46.3%) and 1252 (83.6%) of the blood unit were “RH” positive. From a total of 68 (11.1%) none improved reported cases, 48 (10.5%) were those transfused with whole blood transfusion. The proportion of improvement after transfusion according to the service ranged from 83.3.0% to 100% and no post-transfusion reactions were reported. A significant improvement was seen in the hematological profile (hemoglobin, red blood cells, hematocrit, platelets, and white blood cells) findings of the transfused individuals after blood unit transfusion (P < 0.05).ConclusionThe overall utilization rate and improvement status after transfusion were high even if the utilization rate has some limitations. The overall ratios of cross-match to transfusion ratio, transfusion probability, and transfusion index were 1.03, 99.8%, and 0.97, respectively.

Patient blood management and the Covid-19 Pandemic: An institutional study

Introduction: The COVID-19 pandemic in India is part of the worldwide pandemic of coronavirus disease 2019 (COVID-19). Despite no convincing evidence that this virus can be transfusion-transmitted, the absolute disruption we have seen in everyday life has dramatically reduced the amount of blood donations. Applying the Patient Blood Management (PBM) method is very useful. It is the scientific use of safe and effective medical and surgical techniques designed to prevent anemia and decrease bleeding to improve patient outcomes. PBM conserves a precious community resource, reduces unnecessary hospital and patient care costs, improves patient safety by minimizing exposure to blood, can reduce the risk of hospital-acquired complications and infections, and increases the consumer interest in safety. Efforts to correct anemia in the general population, as well as the imple­mentation of safe blood drive protocols, must be in place to mitigate the risk of viral exposure. This study aimed to assess the indications and requirements of blood and blood products in Covid-19 cases and to develop safe transfusion practices concerning PBM during the Covid-19 pandemic. Methods: This observational study was done in the Blood Bank RLJ Hospital Department of Pathology attached to Sri Devaraj Urs Medical College &amp; Hospital. The records of all COVID-19 positive patient's including their history, blood and blood component utilization from the medical record section, as well as the blood bank and requisition forms sent to a laboratory for investigation and collected over a duration of 6 months (March 2020 to August 2020). Results: Out of 200 COVID-19 positive cases analyzed, only 70 (35%) patients received a blood transfusion, in which 64.28 % (45) patients received single unit PRBCs because of severe anemia and pregnancy-related anemia. Additionally, 25.7% (18) patients received a platelet transfusion because of underlying comorbidities, and 10% (7) received FFP. In all COVID-19 positive patients, we observed a raised ESR. A few patients had raised PT and APTT levels. Patients with mild and moderate anemia presented with microcytic hypochromic anemia and normocytic normochromic anemia. We adopted the Cleveland clinic blood management for low hemoglobin to avoid unnecessary blood transfusions. Conclusion: PBM was found to be an important interventional tool to meet the shortage of blood during the COVID-19 pandemic successfully. An evidence-based emergency blood management plan and flexible regulatory policy should be ready to deal with any disaster and to respond quickly in the case of a blood shortage. While pandemics may reduce the blood supply, our study demonstrated that hospitalized COVID-19 patients had a low level of blood usage. Future studies examining the impact of patient factors may help to further elucidate the mechanisms affecting blood utilization in hospitalized COVID-19 populations.

Alterations in blood component utilization in a tertiary care hospital in eastern India in the COVID-19 pandemic.

BACKGROUND:With shortages of blood globally in the COVID-19 pandemic, many hospitals and blood centers have successfully implemented blood conservation strategies and strategies to maintain blood donations and blood inventory. Here, we reported our experience of utilization of blood components for transfusion in the current COVID-19 pandemic and discussed the patient blood management (PBM) methods and importance of judicious blood usage in any pandemic.MATERIALS AND METHODS:The retrospective study of 8 months was divided into pre-COVID and COVID periods. Parameters that included number of blood requisitions, blood components reserved and transfused, clinical speciality wise blood usage in both the periods were analysed. Blood utilization indices were computed using recommended equations.RESULTS:We observed an unusual pattern of blood utilization with significant disruption on blood supply and demand chain in this pandemic. A mean drop of 50.7% blood requisitions was observed in the COVID period. The period observed transfusion of 3608 units of blood components with a mean drop of 49.7% when compared to pre-COVID period. Mean drop of 46.6%, 54.4%, 53.4% and 52.7% were observed in packed red blood cell, fresh frozen plasma, platelet concentrate and cryoprecipitate transfusions in the COVID period. Blood component utilization was significantly reduced in most clinical specialities. The mean cross match to transfusion ratio in the COVID period was 1.28 with a mean increase in transfusion probability and transfusion index by 18.2% and 22.2% respectively.CONCLUSION:Although a constant transfusion support was needed in few clinical specialities throughout the pandemic, strict adherence to PBM protocols and practice of first in, first out method of blood dispensing helped the blood centre to support all patients needing blood transfusion.

An observational study on utilization of blood and blood components in a tertiary care hospital of Kolkata, West Bengal

Background: Blood is essential for human survival though it is a scarce and precious resource. Blood Transfusions also have some risks, like immunomodulation in the recipients, transmission of infectious agents, and may lead to serious adverse reaction. Hence, it is necessary to make an efficient use of blood and blood products. Aims and Objectives: With this background, the present study was carried out at the blood bank of Medical College and Hospital, a tertiary care hospital of West Bengal, India to evaluate the utilization pattern of blood and blood components. Materials and Methods: Facility based, observational, descriptive, and cross-sectional epidemiological study was conducted on the basis of secondary data collected from records of blood bank, medical college, Kolkata, regarding blood and blood component transfusion pattern of patients who were admitted in medical college and hospital and received blood and blood components from blood bank medical college, Kolkata during period from September 1, 2021, to September 15, 2021. Results: Total number of transfusion recipients during the study period was 1339. Total 2621 no of blood and blood components were issued. About 66.84% (895) of all recipients were transfused with single unit of blood or blood component. Packed red blood cells were the maximum utilized blood component. The most common diagnosis for patients requiring blood and blood components was anemia. Conclusion: A large proportion of patients were transfused with single unit of blood or blood component, which might not be beneficial. Training, regular meeting with clinicians and periodic assessment of blood usage are recommended to prevent inappropriate transfusion.

An insight to the internal quality control of blood components separated using the latest whole blood collection and processing systems: Experience from a tertiary care hospital blood transfusion service in Eastern India.

With blood component therapy becoming the standard of care in transfusion medicine globally, the quality control (QC) of these components has become a routine and mandatory program in all blood centers. Extensive utilization of blood components has been observed in our multidisciplinary tertiary care hospital. We use quadruple bag systems and automated component extraction facilities for collection and processing of whole blood (WB). In this study, we analyzed our data relating to QC of all blood components which we prepare and issue for transfusion. The retrospective 5-year study comprised 47,430 WB collections which were separated into blood components using quadruple bags and automated component extraction machine. A total of 90 units of WB were processed into blood components for the machine calibration and validation. Routine use of the system was started once the calibration and validation results were acceptable. At least 1% of each component prepared was subjected to QC as per departmental standard operating procedures. Statistical analysis was done using the SPSS statistical package. The mean volume, hematocrit (Hct), platelet (PLT), and white blood cell (WBC) in 350 and 450 mL WB units were 394.63 mL, 39.43%, 0.93 × 1011, and 3.12 × 109 and 507.75 mL, 40.72%, 1.13 × 1011, and 3.45 × 109, respectively, with mean recovery of PLT and WBC in buffy coat being 95.54% and 68.63% and 97.87% and 74.51%, respectively. As high as 89.91% RBC recovery was noted in the packed red blood cell units which were subjected to QC. QC of random donor platelets was performed in 979 (2.36%) units with acceptable results. The mean fibrinogen and FVIII values were estimated to be 469.17 mg and 217.34 IU (1.07 IU/mL) and 600.21 mg and 273.39 IU (1.11 IU/mL) in fresh frozen plasma units prepared from 350 and 450 mL WB, respectively. A total of 578 (1.62%) units of cryoprecipitate were investigated for QC with favorable results. We conclude that QC data generated in this study will provide invaluable information about the performance of the latest blood collection systems. QC of all blood components under study complied with both national and international standards. We opine that all blood centers should establish a complete QC program and adhere to departmental protocols and manufacturer's instructions for its execution and effective outcome.

The 4-Year Experience with Implementation and Routine Use of Pathogen Reduction in a Brazilian Hospital.

(1) Background: We reviewed the logistics of the implementation of pathogen reduction (PR) using the INTERCEPT Blood System™ for platelets and the experience with routine use and clinical outcomes in the patient population at the Sírio-Libanês Hospital of São Paulo, Brazil. (2) Methods: Platelet concentrate (PC), including pathogen reduced (PR-PC) production, inventory management, discard rates, blood utilization, and clinical outcomes were analyzed over the 40 months before and after PR implementation. Age distribution and wastage rates were compared over the 10 months before and after approval for PR-PC to be stored for up to seven days. (3) Results: A 100% PR-PC inventory was achieved by increasing double apheresis collections and production of double doses using pools of two single apheresis units. Discard rates decreased from 6% to 3% after PR implementation and further decreased to 1.2% after seven-day storage extension for PR-PCs. The blood utilization remained stable, with no increase in component utilization. A significant decrease in adverse transfusion events was observed after the PR implementation. (4) Conclusion: Our experience demonstrates the feasibility for Brazilian blood centers to achieve a 100% PR-PC inventory. All patients at our hospital received PR-PC and showed no increase in blood component utilization and decreased rates of adverse transfusion reactions.

Toxic masculinity in red blood cell units? Testosterone therapy in blood donors revisited.

FDA guidelines limit the use of blood from donors taking testosterone replacement therapy (TRT) to red blood cell (RBC) concentrates, whereas plasma and platelets are discarded. The purpose of this study is to bring awareness to above-average free testosterone concentrations in RBC units from TRT donors. We quantified the concentrations of free (bioavailable; pg/ml) and total (protein bound and free; ng/dl) testosterone in plasma (frozen within 24 h) and supernatants from 42-day stored leukocyte-reduced RBC units from 17 TRT male donors and 17 matched controls (no TRT). Total testosterone concentrations were determined by liquid chromatography with tandem mass spectrometry (LC-MS/MS). Free testosterone concentrations were quantified in the same samples using equilibrium dialysis/LC-MS/MS. Plasma free and total testosterone concentrations in TRT donors were 2.9 and 1.8 times higher than that of controls. Total testosterone concentrations in RBC supernatants were about 30% of that of plasma. In contrast, free testosterone concentrations in RBC supernatants were 80%-100% of that of plasma and were significantly (p=.005) higher in TRT compared with controls (252.3 ± 245.3 vs. 103.4 ± 88.2pg/ml). Supraphysiological free testosterone concentrations (>244 pg/ml) in RBC supernatants were observed in five TRT donors and two control donors. RBC units from TRT donors may contain supraphysiological concentrations of free testosterone. This may be resolved by avoiding blood collections soon after testosterone dosing and by enhanced screening of TRT donors. These data establish a rationale for new studies and reexamination of the current guidelines concerning the utilization of blood components from TRT donors.

Comparison of efficacy of two different doses of tranexamic acid in prevention of post operative blood loss in patients with congenital cyanotic heart disease undergoing cardiac surgery.

Background:The optimal dose of tranexamic acid in minimizing perioperative bleeding is uncertain. We compared efficacy of two different doses of tranexamic acid in reducing post-operative blood loss and its side effects in patients with congenital cyanotic heart disease undergoing cardiac surgery.Settings and Design:Prospective observational study at a pediatric cardiac center in South India.Methods:Consecutive cyanotic patients undergoing cardiac surgery were divided into groups I and II to receive either 10 mg/kg or 25 mg/kg of tranexamic acid administered as triple dose regime after induction, during cardiopulmonary bypass, and after protamine. Post-operative blood loss at 24 hours, blood component utilization, incidence of renal dysfunction and seizures were compared.Results:Totally, 124 patients were recruited, 62 in each group. The pre-operative variables and cardiopulmonary bypass time were comparable. Patients receiving 25 mg/kg had lower post-operative blood loss compared to patients in lower dose group (8.04 ± 8.89 vs 12.41 ± 19.23 ml/kg/24 hours, P = 0.03). There was no difference in the transfused volume of packed red cells (9.21 ± 7.13 ml/kg vs 12.41 ± 9.23 ml/kg, P = 0.712), fresh frozen plasma (13.91 ± 13.38 ml/kg vs 11.02 ± 8.04 ml/kg, P = 0.19), platelets (9.03 ± 6.76 ml/kg vs 10.90 ± 6.9 ml/kg, P = 0.14) or cryoprecipitate (0.66 ± 0.59 ml/kg vs 0.53 ± 0.54 ml/kg, P = 0.5) in group II and I, respectively. Two patients developed renal dysfunction secondary to low cardiac output in lower dose group. There were no seizures.Conclusions:Tranexamic acid administered at a dose of 25 mg/kg as triple dose regime is associated with lower post-operative blood loss compared to a lower dose of 10 mg/kg in cyanotic patients undergoing cardiac surgery without causing major adverse effects.