Hemotherapy Service Research Articles

PREVALENCE OF HIV INFECTION, SYPHILIS, AND SYPHILIS/HIV COINFECTION IN BLOOD DONORS FROM A BLOOD BANK OF PORTO ALEGRE, SOUTHERN BRAZIL

Introduction: Hemotherapy consists of therapeutic treatments performed through blood transfusion. Clinical and serological screening of donors is an essential strategy to avoid transmission of infectious agents in blood transfusion. Objectives: Toassess the seroprevalence of HIV infection, syphilis and syphilis/HIV coinfection in blood donors from a blood bank in Porto Alegre from 2014 to 2016. Methods: Retrospective analysis of all blood donors registered on a software for managing hemotherapy services (Hemodot) of the Blood Bank in the Marques Pereira Laboratory, Porto Alegre / RS, from 2014 to 2016. Results: Of the 28,173 users of the hemotherapy service during the study period, 198 (0.70%) were positive for syphilis, HIV infection, or syphilis/HIV co infection. The prevalence of positive results for syphilis was 0.3%, 0.57% and 0.70% in 2014, 2015 and 2016, respectively, and for HIV infection was 0.18%, 0.14%, and 0.16% for the same period. However, the prevalence of syphilis/HIV coinfection was not statistically significant. Conclusions: The prevalence of syphilis increased significantly from 2014 to 2016. Hovever, this did not occur with HIV infection or with coinfection. This finding may reflect the requirement of the nucleic acid technique (NAT) for HIV screening in blood banks, a procedure that has been increasing transfusion safety and reducing the window period. Further studies may shed new light on the combined use of serological tests and NAT assays in blood banks to diagnose HIV cases and syphilis/HIV coinfection. Key Words: Coinfection; transfusion safety; hemocenter; infectious disease; syphilis; HIV

A Vigilância Sanitária no controle de riscos potenciais em serviços de hemoterapia no Brasil

RESUMO O artigo descreve a situação sanitária dos serviços de hemoterapia avaliados pela Vigilância Sanitária em 2011 e 2012 por meio do Método de Avaliação de Risco Potencial de Serviços de Hemoterapia (MARPSH), classificando-os em cinco categorias: Baixo, Médio-Baixo, Médio, Médio-Alto e Alto. Dos 560 avaliados, houve acréscimo de 9% nos classificados como de baixo risco e queda de 6% entre os de alto. Os principais problemas foram encontrados na região Norte, em agências transfusionais e serviços públicos. Destacaram-se não conformidades relacionadas à gestão da qualidade, de pessoal e de equipamentos. Apesar das melhorias observadas, notaram-se serviços críticos com comprometimento à segurança e à eficácia dos produtos e serviços.

Uma abordagem situacional dos serviços de hemoterapia da cidade de Porto Alegre/RS

The Hemotherapy Production System (HEMOPROD) is a set of elaborate spreadsheets, according to RDC/Anvisa no. 149/2001, containing production data Hemotherapy Services sent monthly to the Municipal Sanitary Surveillance. It includes the service identification data, sorting, collecting, tests, blood products production and transfusion reactions. This is a documentary study of HEMOPROD spreadsheets in order to know the data of Hemotherapy Services of Porto Alegre, RS, in the years 2013 and 2014 were made measurements and descriptive analysis of absolute and relative frequencies. The data showed that the predominant profile of blood donors in the state capital is man, above 29 years, donor and replacement first. It is necessary to sensitize and attract other donor profiles, such as women and young people under 29 years. The donor loyalty is one way to ensure the maintenance of blood products stocks and increase security in the transfusion process.

Elderly blood donor: the influence of this profile in the hemotherapy service

A better quality of life and the perspective of a long, productive life are factors that can contribute to maintaining the stocks of blood products. The aim of this study is to evaluate the blood donation of the elderly at a private haemotherapy service. This is a cross-sectional, descriptive investigation conducted at a private haemotherapy service in Natal/RN, Brazil, during July and September 2015 with a sample of 86 elderly individuals. All the elderly individuals donated blood to meet the needs of one patient. Most of the donors were retirees, with a high level of schooling, married and residing near the site of the donation. New blood donations were difficult to obtain, which was attributed to communication via telemarketing and personal comorbidities. The low number of elderly donors can be attributed to misinformation as to the current maximum age limit for donations, comorbidities and the communication/marketing strategy used to attract participants.

PERFIL SOCIODEMOGRÁFICO E EPIDEMIOLÓGICO DE CANDIDATOS DE A DOAÇÃO DE SANGUE

Introdução: Um dos desafios das instituições de saúde é conservar a captação de sangue, uma vez que os doadores representam apenas 1,8% da população brasileira. É de fundamental importância o papel do profissional de enfermagem na conscientização, na captação e na triagem de doadores voluntários. Objetivos: Identificar a representação epidemiológica dos pretendentes à oferta de sangue do Hemocentro de uma unidade hospitalar no Sul de Minas Gerais. Material e Métodos: Estudo retrospectivo e descritivo, com abordagem quantitativa. A coleta foi executada da apreciação do Hemocentro no ano de 2011, com uma amostra de 2.680 candidatos. Foi utilizado o instrumento do próprio Sistema que contém as Fichas de Triagem do Candidato a Doador de Sangue. Para a análise dos dados, fez-se a tabulação no Microsoft Excel Windows 7 Ultimate®, 2011, e a elaboração de tabelas e gráficos com valores absolutos e percentuais. Resultados: Observou-se que 82% candidatos foram aptos e 18%, inaptos, prevalecendo o sexo masculino, entre 18 a 29 anos e doadores de repetição. Diante do perfil dos doadores desta pesquisa, vale ressaltar a importância da elaboração de campanhas educacionais quanto à doação de sangue, a fim de diminuir o número de inaptos, melhorando a qualidade dos candidatos. Conclusão: Os achados demonstram a importância de campanhas que conscientizem os indivíduos sobre as características ideais para quem pretenda a oferecer sangue, para que, assim, ocorra um aumento de sujeitos aptos.

6: Utility of VerifyNow for Point-of-Care Identification of Aspirin and Clopidogrel Effects and Prediction of Bleeding Risk Prior to Emergency Cardiac Surgery

Objectives: Patients with cardiovascular disease frequently take aspirin or clopidogrel, which may place them at risk for bleeding during surgical procedures. The coagulation-based hemotherapy (CBH) service is a clinical pathology consultation service that provides intraoperative management of coagulopathy and transfusion support based on predefined algorithms for patients undergoing major cardiac surgery with cardiopulmonary bypass. Patients frequently present to our service in emergency situations without complete medication histories. The gold standard …

How do we manage cardiopulmonary bypass coagulopathy?

Patients who undergo cardiopulmonary bypass (CPB) are at risk for coagulopathy. Suboptimal turnaround time (TAT) of laboratory coagulation testing results in empiric administration of blood products to treat massive bleeding. We describe our initiative in establishing the coagulation-based hemotherapy (CBH) service, a clinical pathology consultation service that uses rapid TAT coagulation testing and provides comprehensive assessment of bleeding in patients undergoing CPB. A transfusion algorithm that treats the underlying cause of coagulopathy was developed. The coagulation testing menu includes all aspects of coagulopathy with close proximity of the laboratory to the operating room to allow for rapid test results. The hemotherapy pathologist monitors laboratory results at several stages in surgery and uses a comprehensive algorithm to monitor a patient's hemostasis. The optimal number and type of blood products are selected when the patient is taken off CPB. The CBH service was consulted for 44 ventricular assist device implants, 30 heart transplants, and 31 other cardiovascular surgeries from May 2012 through November 2013. The TAT for laboratory tests was 15 minutes for complete blood count, antithrombin, and coagulation panel and 30 minutes for VerifyNow and thromboelastography, in comparison to 45 to 60 minutes in normal settings. The transfusion algorithms were used with optimal administration of blood components with preliminary data suggestive of reduced blood product usage and better patient outcomes. We described the successful introduction of a novel pathology consultation service that uses a rapid TAT coagulation testing menu with transfusion algorithms for improved management of CPB patients.

Mobile computing platform with decision support modules for hemotherapy.

We describe the development of a mobile computing platform (MCP) with a decision support module (DSM) for patients in our coagulation-based hemotherapy service. The core of our MCP consists of a Microsoft Excel spreadsheet template used to gather and compute data on cardiopulmonary bypass (CPB) patients intraoperatively. The DSM is embedded into the Excel file, where the user would enter in laboratory results, and through our 45 embedded algorithms, recommendations for transfusion products would be displayed in the Excel file. The DSM has helped decrease the time it takes to come to a transfusion recommendation, helps double-check recommendations, and is an excellent tool for teaching. Furthermore, the problems that occur with a paper system have been eliminated, and we are now able to access this information easily and reliably. The development and implementation of our MCP system has greatly increased the productivity and efficiency of our hemotherapy service.

Segurança Transfusional: um método de Vigilância Sanitária para avaliação de riscos potenciais em serviços de hemoterapia

This article describes the method for the evaluation of potential risks in hemotherapy services (MARPSH) applied by the Brazilian Health Surveillance Agency. It allows the identification of potential risks by mapping them for advanced control and modeling the preferences for decision making as a proactive risk management activity. The MARPSH structure is composed by 471 control items, being 50% related to risks for the product, 25% for the patient, 17% for the donor and 8% for the worker. Each identified inadequacy is categorized by its severity, its probability and relatively of a possibility of a hazard. For its analysis, the system adopted two different weights according to the valuation of the items of control and the complexity of the procedures. The relationship betwe-en the score and the maximum score possible results in an index called Proportion of Control (PC), by which the potential risk is classified as Low (PC ≥ 95%), Medium-Low (PC ≤ 80% < 95%), Medium (70% ≤ PC < 80%), Medium-High (60% ≤ PC < 70%) and High (PC < 60%). The use of this method for health surveillance allows monitoring and con-trolling the reduction of risks, hence contributing to the increase of transfusion safety.

The Utilization of NET Promoter System As a Blood Supply Management Strategy

AbstractAbstract 4378 Introduction:Despite the increasing development of medicine there is no safe and practice substitute for blood. However the demand for blood are rising every day, due to increases in the number and complexity of procedures that require transfusions The greatest challenge of the hemotherapy service is to provide the blood supply needed “assuring” the safety of them. To meet the potential needs for adequate blood supplies, it is beneficial to increase the number of blood donors and the blood donation rate, without enhancing the risk of blood transmitted diseases. Many strategies have been used to achieve this goal, but most of than concluded that the results of blood donors satisfaction surveys have poor correlation with blood donation process performance. This problem is present in many other fields of the economy, such as hotels, air transportation and day-to-day industrial needs. In the beggining of the last decade developed a strategy called “Net Promoter Score”, that had the intention to establish a direct correlation between customers loyalty and enterprise/process performance. This methodology was based in several researches that could link the customers consuming behavior and the retaining issues. The survey were made with only one question, that was “Would you recommend this company/service for your family or friends” (The Ultimate Question). The customers could answer in a numeric scale from 0 to 10, where 0 was “No, I wouldn’t” and 10 was “Yes, I would”. From that score the clients were stratified in three groups: 0–6 were called “Detractors”, the ones that would be the bad marketing of the company; 7–8 were called “Passive”, the ones that do not have a strong experience neither good or bad; and those 9–10, that were called “Promoters”, that were the ones that would be the marketing department of the company, and in our case, the ones that would recruit and retain more donors. To calculate the so called “NET Promoter Score” (NPS), the percentage of detractors were subtracted from the promoters. This score were than used prospectively to follow the enterprise performance, and to be the main guide to adjust customer services. When the NPS were used as the “core” of the strategy, and all the others management tools were taken together with it, we could call it the “Net Promoter System”. In this way the score is a tool that can be used to develop the system. Nowadays this methodology is widely used in the industry, commerce and other fields, and since its publication there were many economy activities that no company could optimize its performance without improving its score. There is no published research looking for its use in the Hemotherapy practice, and specifically in blood donor recruitment and retention. The objective of this study was to establish the feasibility of the utilization of the Net Promoter Score in the blood donation area. Methodology:The satisfaction survey were offered to the customers at the end of the blood donation process. The candidates to blood donation were analyzed and divided in the described groups according to the so called ultimate question (Detractor, Passive or Promoter) and the blood donations behavior (Clinical unfit for blood donation, First time donor and Repetition donor). These data were pulled together and were used as a guide to adapt customer relations strategy and blood supply optimization. Results:From may of 2011 until july of 2012, there were six thousand nine hundred and eight one researches available for analysis derived from seven thousand three hundred and thirty candidates for blood donation (95,23%). From those 11,9% were from unfit patients that were unable to donate, 44,2% of first time donors and 43,8% of repetition donors. The groups were analyzed according to the score, and the NPS were than calculated as follow: 97,66% ±1,30 (SD) for First time Donors; 98,66% ± 0,84 (SD) for Repetition donors and 90,80% ±4,42 (SD) for unfit candidates. Conclusion:The development of a tool to optimize the blood management is an on course task. Several methodologies have been trying to establish a strong link between donor satisfactions and blood donation behavior. In this study we concluded that NPS is an effective tool, with high feasibility and great potential impact in process performance. The efficacy of the score, the development of the NET Promoter System and the correlation between its methodology with blood donor recruitment and retention must be study in a prospective trial. Disclosures:No relevant conflicts of interest to declare.

PERFIL DOS CANDIDATOS INAPTOS PARA DOAÇÃO DE SANGUE NO SERVIÇO DE HEMOTERAPIA DO HOSPITAL SANTO ÂNGELO, RS, BRASIL

The advances in diagnostic methodologies for transmissible blood diseases and the development of clinical screening to select blood donors have left hemotherapy practice safer. Blood donation campaigns attempt to attract higher number of candidates to supply blood demand. The candidate undergoes a clinical screening and a social-epidemiologic interview in order to select a healthy candidate to produce the best blood supplies products achievable. We aimed to study the ineligible blood donors profile through the analysis of 505 files of unfit candidates by clinical screening between 2005 and 2010 at the Hemotherapy Service of Santo Ângelo Hospital - RS. Sixty-two percent of ineligible candidates were male, for males and females the majority had completed high school and were between 18 and 23 years old. The main cause for ineligibility was multiple sex partners, high risk behavior for males, and low hematocrit for females. The awareness of the profile of ineligible candidate shows the importance of information collected in clinical screening, inform the interviewer and, ultimately, leads to a safer hemotherapeutic practice.

Avaliação do Sistema de Vigilância Sanitária do Sangue em âmbito federal, Brasil, 2007

This study evaluated the Sanitary Vigilance System for Blood at federal government level (VIGISAN). This assessment included the following components: managerial system of registration of hemotherapeutic services; external evaluation program of quality of hemotherapy services; hemovigilance system; standardization and inspection of health services for blood and its components. Besides the description and the calculation of efficiency (cost-effectiveness ratio) of VIGISAN, the assessment consisted of two phases based on three methods. VIGISAN had a poorly defined structure, though it operated smoothly and its utility was acceptable for public health. From a total of four defined indicators to evaluate performance, one obtained a satisfactory result. Three out of the seven evaluation attributes achieved positive assessment in this study. The cost-effectiveness ratio was US$ 37,965.16 per activity performed, which resulted in loss of efficiency for the system. This study demonstrates the importance of conducting evaluations of vigilance systems in public health, which should be performed periodically in order to contribute to improvement of the system and thus improve public health in the country.

The Forensic Genetics Laboratory of the University of Barcelona: The evolution of paternity testing cases over the past 35 years

Biological paternity research in Catalonia (north-eastern Spain) began in 1976 when Dr. Castillo, Dr. Gelabert and Dr. Huguet studied the first case at the Department of Forensic and Legal Medicine of the University of Barcelona in cooperation with the Haemostasis and Hemotherapy Service and the Blood Bank of the Hospital Clínic in Barcelona. In the knowledge that each human is genetically unique as a result of genetic polymorphism, blood group antigen typing and other immunological techniques including human histocompatibility leukocyte antigen (HLA) typing became widely used for paternity testing and forensic science application until the end of the 1970s. However, biological tests were not accepted by the courts in Spain until 1981 when the Civil Code was reformed. With the support of Dr. Carracedo from the University of Santiago, in 1982 Dr. Huguet and Dr. Gené, who are still actively researching, set up the Haemogenetic Forensic Laboratory at the University of Barcelona and this area of the Legal Medicine Unit was thus consolidated. It was the first Forensic Genetics Laboratory in Catalonia. The aim of this study is to conduct a retrospective analysis of paternity testing cases over the past 35 years. We report on the social and legal development of the cases analysed, grouped into different periods of time. The results on paternity and non-paternity claims were studied included exclusion and non-exclusion rates. Biomathematical performance values were reported for each methodology stage (number of exclusions, average paternity probability values, population index, etc.).

Competências da enfermeira para a triagem clínica de doadores de sangue

O objetivo desta pesquisa foi identificar competências da enfermeira para a triagem de doadores de sangue, dentre as preconizadas pelo Conselho Internacional de Enfermagem. Tratpu-se-se de um estudo qualitativo do tipo estudo de caso. Foi realizado no Serviço de Hemoterapia Unidade Banco de Sangue de um hospital universitário da cidade de Porto Alegre, RS, Brasil. Foram observadas 25 entrevistas de cinco enfermeiras que trabalhavam no setor. Para a análise das observações foi utilizada a adequação ao padrão. Foram identificadas seis competências da área prática profissional, ética e legal e onze da área provisão e gerenciamento do cuidado. As competências identificadas neste estudo contribuem para o preparo e prática das enfermeiras generalistas na a realização da triagem clínica de doadores de sangue.

Atuação do enfermeiro em serviço de hemoterapia

Blood transfusion is an important support for treatments, transplants, chemotherapies and surgeries. Safety in the transfusion process requires commitment and integration from nursing professionals. The objective of this study was to analyze nurses’ practice at the Hemotherapy Service of a University Hospital. This descriptive exploratory study used a qualitative approach. Semi-structured interviews were performed with thirteen nurses working at that service. Data analysis was performed using the thematic content analysis technique. Results point at nurses work in triage, and in the transfusion team. In triage, nurses show a favorable reception, informing users about issues regarding blood donation. It was found that team work is performed, in which nurses work together to reach a common objective. Nurses feel valued at work and continuing health education is stated as the possibility of continuously learning skills and competences for the process of nursing practice in hemotherapy services.

Controle de esterilidade de produtos de células progenitoras hematopoéticas do sangue periférico

A taxa de contaminação microbiana dos produtos de células progenitoras hematopoéticas do sangue periférico é baixa. Neste estudo pesquisou-se a prevalência de hemoculturas positivas em células progenitoras hematopoéticas do sangue periférico (CPHSP) no Serviço de Hemoterapia do Hospital de Clínicas de Porto Alegre. Do total de 618 coletas realizadas no período de 2000 a 2007, 26 (4,2%) apresentaram contaminação por bactérias. O Staphylococcus coagulase-negativo foi predominantemente isolado nas hemoculturas. A antibioticoterapia pré e pós-infusão foi estabelecida de acordo com o microorganismo e seu antibiograma, sendo que, em cinco das doze infusões contaminadas realizadas, não foram administrados antimicrobianos profilaticamente. Episódios febris foram observados em sete pacientes (58%), enquanto cinco (42%) não apresentaram febre. Das doze infusões contaminadas realizadas, seis (50%) apresentaram hemocultura pós-descongelamento positivas, enquanto as restantes (50%) foram negativas. Isto se deve às propriedades bactericidas do DMSO, de células fagocitose-ativas e de temperaturas muito baixas atingidas na criopreservação. Autores têm relatado sucesso neste procedimento após a infusão desses produtos contaminados com o mínimo de consequências clínicas.

Bancos de sangue de cordão umbilical e placentário para uso familiar, de caráter privado, no Brasil: subsídios técnicos, legais e éticos para uma análise de implementação

Os bancos de sangue de cordão umbilical e placentário foram criados a partir da comprovação de que o sangue de cordão umbilical e placentário (SCUP) é uma fonte rica em células progenitoras hematopoéticas (CPH) e alternativa às células provenientes da medula óssea para transplante, fato que gerou o interesse pelo armazenamento das células nele contidas. A legislação brasileira distingue bancos para uso alogênico não aparentado (públicos) e para uso exclusivamente autólogo (privados). Por sua vez, o armazenamento de SCUP para uso familiar (doação dirigida) pode ser realizado em bancos de sangue de cordão umbilical e placentário públicos, serviços de hemoterapia ou centros de transplante, quando há um membro da família do nascituro com doença diagnosticada e que necessite de transplante de CPH como tratamento. Apesar de a legislação ser clara, a Anvisa tem identificado o interesse sobre a possibilidade da liberação de unidades de SCUP, armazenadas em bancos autólogos, para a utilização de outrem, familiar, além do recém-nascido beneficiário. O objetivo do trabalho visa promover a reflexão sobre uma possível modificação dos parâmetros legais nacionais que regem os bancos de SCUP autólogo, tornando-os bancos com vistas ao uso familiar, por meio da exposição dos principais elementos relacionados ao tema. O estudo analisou os critérios técnico-sanitários legais para regulamentação dos bancos; descreveu as características das CPH de diversas fontes e tipos de doação para transplante; contextualizou a relação com os princípios da Bioética; avanços sobre terapia e pesquisas relativas às CPH; e discutiu possíveis riscos envolvidos no processo.

Human Herpesvirus 8 in Healthy Blood Donors, Argentina

Human Herpesvirus 8 in Healthy Blood Donors, Argentina

Satisfação no trabalho: indicador de qualidade no gerenciamento de recursos humanos em enfermagem

Estudo descritivo que aborda a satisfação no trabalho de enfermeiros gerentes e assistenciais nos Serviços de Hematologia e Hemoterapia de um hospital público da cidade de São Paulo. Objetivou identificar fatores geradores de satisfação no trabalho de enfermeiros gerentes e assistenciais e subsidiar os resultados para a construção de indicadores para avaliação da qualidade do gerenciamento de recursos humanos em Enfermagem. Os componentes do trabalho foram: autonomia, interação, status profissional, requisitos do trabalho, normas organizacionais e remuneração. Participaram do estudo 44 enfermeiros. O instrumento de coleta foi o questionário Índice de Satisfação Profissional (ISP). Concluindo, este estudo permitiu identificar que o grupo assistencial foi o mais satisfeito, com ISP 10,5; o gerencial totalizou 10,0. Quanto à satisfação com a atividade atual, 88,9% dos enfermeiros gerentes disseram estar satisfeitos, assim como 90,9% dos assistenciais. Para os dois grupos, a autonomia foi o componente de maior nível de satisfação profissional.

Risk factors for indications of intraoperative blood transfusion among patients undergoing surgical treatment for colorectal adenocarcinoma

Identification of risk factors for requiring transfusions during surgery for colorectal cancer may lead to preventive actions or alternative measures, towards decreasing the use of blood components in these procedures, and also rationalization of resources use in hemotherapy services. This was a retrospective case-control study using data from 383 patients who were treated surgically for colorectal adenocarcinoma at 'Fundação Pio XII', in Barretos-SP, Brazil, between 1999 and 2003. To recognize significant risk factors for requiring intraoperative blood transfusion in colorectal cancer surgical procedures. Univariate analyses were performed using Fisher's exact test or the chi-squared test for dichotomous variables and Student's t test for continuous variables, followed by multivariate analysis using multiple logistic regression. In the univariate analyses, height (P = 0.06), glycemia (P = 0.05), previous abdominal or pelvic surgery (P = 0.031), abdominoperineal surgery (P<0.001), extended surgery (P<0.001) and intervention with radical intent (P<0.001) were considered significant. In the multivariate analysis using logistic regression, intervention with radical intent (OR = 10.249, P<0.001, 95% CI = 3.071-34.212) and abdominoperineal amputation (OR = 3.096, P = 0.04, 95% CI = 1.445-6.623) were considered to be independently significant. This investigation allows the conclusion that radical intervention and the abdominoperineal procedure in the surgical treatment of colorectal adenocarcinoma are risk factors for requiring intraoperative blood transfusion.