Hospital Blood Transfusion Service Research Articles

Trend in the Seroprevalence of Transfusion Transmissible Infections (TTIs) from 2019 to 2023 at the Blood Transfusion Service of the Buea Regional Hospital, Southwest Region, Cameroon

Background: Transfusion-transmissible infections (TTIs) are of significant public health concern, as they can be transmitted through blood transfusions. Monitoring the trends and prevalence of TTIs is crucial for ensuring the safety of the blood supply and implementing effective preventive measures. This study aimed to analyzed the trend in seroprevalence of TTIs, including HIV, hepatitis B (HBV), hepatitis C (HCV), and syphilis (TPHA), among blood donors in the Buea Regional Hospital (BRH) from 2019 to 2023. Materials and Methods: This retrospective study was conducted using data from the Buea Regional Hospital Blood Transfusion Service. The study population included all blood donors who donated blood from January 2019 to December 2023. Serological testing for TTIs was performed using standard diagnostic methods. The prevalence of each TTI was calculated for each year, and the trends were analyzed using statistical tests and expressed as frequency tables, Chi square, logistic regression. Significance was set at p=0.05. Results: A total of 11,256 donors were tested and 919 (8.12%) blood donors tested positive for at least one TTI agent during the study period. The overall positivity rates were 8.23%, 9.48%, 6.65%, 8.29%, and 8.24% for 2019, 2020, 2021, 2022, and 2023, respectively. The prevalence of individual TTIs showed significant variations, with TPHA being the most prevalent (2.96%), followed by HBV (2.58%), HCV (1.15%), and HIV (1.24%). Socio-demographic factors, such as gender, marital status, occupation, and age, were found to be significantly associated (p<0.001) with the odds of testing positive for a TTI. Conclusion: The trend in the prevalence of TTIs among blood donors in the Buea Health Area was characterized by fluctuations over the five-year period.

Validation of a flow-cytometry-based red blood cell antigen phenotyping method.

Current manual and automated phenotyping methods are based on visual detection of the antigen-antibody interaction. This approach has several limitations including the use of large volumes of patient and reagent red blood cells (RBCs) and antisera to produce a visually detectable reaction. We sought to determine whether the flow cytometry could be developed and validated to perform RBC phenotyping to enable a high-throughput method of phenotyping using comparatively miniscule reagent volumes via fluorescence-based detection of antibody binding. RBC phenotyping by flow cytometry was performed using monoclonal direct typing antisera (human IgM): anti-C, -E, -c, -e, -K, -Jka , -Jkb and indirect typing antisera (human IgG): anti-k, -Fya , -Fyb , -S, -s that are commercially available and currently utilized in our blood transfusion services (BTS) for agglutination-based phenotyping assays. Seventy samples were tested using both flow-cytometry-based-phenotyping and a manual tube standard agglutination assay. For all the antigens tested, 100% concordance was achieved. The flow-cytometry-based method used minimal reagent volume (0.5-1μl per antigen) compared with the volumes required for manual tube standard agglutination (50μl per antigen) CONCLUSION: This study demonstrates the successful validation of flow-cytometry-based RBC phenotyping. Flow cytometry offers many benefits compared to common conventional RBC phenotyping methods including high degrees of automation, quantitative assessment with automated interpretation of results and extremely low volumes of reagents. This method could be used for high-throughput, low-cost phenotyping for both blood suppliers and hospital BTS.

Donor Blood Procurement, Safety, and Clinical Utilization: A Study of Blood Transfusion Services in a Tertiary Care Hospital in Nigeria.

Background Donated blood is an essential component of the management of many diseases, and hospital-based blood banks in Nigeria are saddled with the responsibility of provision of safe blood and coordination of its appropriate utilization for patient care. Objective This study reviewed the extent to which the hospital blood transfusion service ensures adequate safe blood supply and utilization. Materials/Methods. This was a retrospective study of 2 years record of the blood bank service of Alex Ekwueme Federal University Teaching. Methods of donor blood procurement, transfusion transmissible infection status, the pattern of blood, and blood component usage across the hospital's clinical departments were evaluated. Statistical analysis was conducted using IBM SPSS, and data were presented as percentages. Fisher's tests were used to test significance, and p value <0.05 is significant. Results The highest proportion of donors was male family replacement donors aged 26–35 years (3634 (39.68%)) while total voluntary donors were 315 (2.65%). Hepatitis B had the highest seroprevalence 267 (2.22%) among blood-borne diseases screened. National Blood Transfusion Service (NBTS) supplied only 3 (0.03%) of total blood units used. The accident and emergency department had the highest proportion of persons who utilized whole blood; 4568 (99.96%). Conclusion The hospital blood bank relies heavily on family replacement donors with little or no assistance from the National Blood Transfusion Service. Family replacement donors have the highest risk of TTIs, and hepatitis B infection has the highest prevalence. The high cost of blood component therapy increases the need for whole blood.

Status of hospital-based blood transfusion services in low-income and middle-income countries: a cross-sectional international survey

ObjectivesBlood transfusion is life-saving for patients experiencing acute blood loss and severe anaemia. In low-income and middle-income countries (LMICs), low blood donation rates and unavailability of whole blood and blood...

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.

Modeling global transfusion medicine education.

Modeling global transfusion medicine education.

Organisational management of hospital blood transfusion services in Nairobi County, Kenya: Evidence of implementation.

BackgroundThe World Health Organization in 2002 recommended implementation of a quality system for national blood programmes to ensure adequate and safe blood products to patients. Key elements of the quality system include organisational management, standards, documentation, training and assessment.ObjectivesThe aim of this study was to describe the extent to which organisational management, which is the first element of a quality system, has been implemented in hospitals in Nairobi County, Kenya.MethodsA descriptive, cross-sectional study design was used. Sixty health workers were selected as respondents from 15 hospitals that provide blood transfusion services in Nairobi County. The data collection period was from June to August 2015 and the data were analysed in 2016.ResultsFaith-based hospitals had the lowest level of organisational management implementation (33.3%), private hospitals had 42.5%, whereas government hospitals had the highest implementation (60%). The extent of implementation was based on performance of the senior management team, overall rated by the respondents at 40.1%, establishment of hospital transfusion committees in nine (60%) of the hospitals and appointment of key staff – quality officers in three (20%) hospitals and blood transfusion specialists in six (40%) hospitals. These key staff were instrumental in steering the quality system and ensuring sound blood transfusion practices.ConclusionThe implementation of quality management systems in hospital blood transfusion services can be improved through commitment from senior management teams, who should provide the necessary resources for employment of key staff and establish and empower hospital transfusion committees to guide the blood transfusion services.

Parvovirus B19 seroprevalence, viral load, and genotype characterization in volunteer blood donors from southern Brazil.

Usually transmitted via respiratory droplets, parvovirus B19 (B19V) can also be acquired by blood transfusion especially because of viral persistence, resistance to blood treatment procedures, and high viral load during the early infection phase. This is particularly problematic in immunocompromised or anemic patients where the infection can have a severe outcome. As B19V DNA was detected in blood donations from South Brazil during a viral metagenomic survey performed by Next-Generation Sequencing, the objective of this retrospective study was to evaluate the seroprevalence, B19V DNA presence and circulating genotypes in a Hospital Blood Transfusion Service in Santa Maria city in South Brazil (Rio Grande do Sul state). Among 480 volunteer blood donors, 53.9% (n = 258 of 479) were anti-B19V IgG-positive, and 9 (1.9%) plasma samples presented B19V DNA. In almost all cases (n = 7 of 9, 77.8%), B19V DNA load was accompanied by the presence of anti-B19V IgG suggesting a persistent infection. The sequencing of the strains demonstrated that all belong to genotype 1 which is the most prevalent worldwide. The analysis of the recipient information of the positive for B19V DNA units revealed no related posttransfusion adverse effects. Our results demonstrate for the first time, B19V seroprevalence, viral load, and genotypes among blood donors from South Brazil and give a light for the circulation and impact of this B19V in this part of the country.

Assessment of transfusion utilization and patient outcomes at the largest referral and university hospital in Addis Ababa, Ethiopia

BackgroundAssessment of blood and blood component utilization is an important tool to reduce inappropriate transfusions and to identify the frequency of blood and blood component utilization. However, in Ethiopia, the regular audit and assessment of transfusion practice is not routinely performed.ObjectiveTo characterize blood transfusion practices and monitor blood expiry and patient improvement status as an outcome at Black Lion Specialized Hospital (BLSH), Addis Ababa, Ethiopia.MethodsA 1‐year hospital‐based audit was conducted to analyse utilization of blood components and patient outcomes at the Black Lion Specialized Hospital blood transfusion service. The study was conducted between October 2010 and January 2011 on data of patients transfused from September 2009 to August 2010. Information on blood and blood component utilization was collected from the blood bank log book on 373 subjects. Data were analysed for descriptive statistics and univariate and multivariate analyses using SPSS version 15.0 (SPSS INC., Chicago, IL, USA).ResultsOf 361 transfused study subjects, 856 units of blood were transfused with the mean of 2·37 units per recipient. Whole blood was most commonly transfused to 307 (85%) patients, and the combination of two blood products was administered to 27 (7·5%) patients. Plasma was transfused only for a single patient (0·3%). For patients who did not clinically improve, 45 (66·2%) were those transfused with whole blood. Significant associations were found between the overall improvement status of patients with the health professional who ordered the transfusion and the type of blood and blood product administered.ConclusionTransfusion of blood components was very low, and there was a high rate of whole blood transfusions. When component therapy was used, the rate of patient improvement status after transfusion was high. Therefore, blood transfusion service programmes in Ethiopia should focus on component transfusion and the need to strengthen guidelines for the appropriate use of blood and blood components as clinical therapy.

Profile of plateletpheresis donations at Sadjito Hospital blood transfusion service, Yogyakarta, Indonesia

Profile of plateletpheresis donations at Sadjito Hospital blood transfusion service, Yogyakarta, Indonesia

The impact of tubal ectopic pregnancy in Papua New Guinea--a retrospective case review.

BackgroundEctopic pregnancy (EP) is an important cause of morbidity and mortality amongst women of reproductive age. Tubal EP is well described in industrialised countries, but less is known about its impact in low-resource countries, in particular in the South Pacific Region.MethodsWe undertook a retrospective review of women with tubal EP treated at a provincial referral hospital in coastal Papua New Guinea over a period of 56 months. Demographic and clinical variables were obtained from patients’ medical records and analysed. The institutional rate of tubal EP was calculated, and diagnosis and management reviewed. Potential risk factors for tubal EP were identified, and delays contributing to increased morbidity described.ResultsA total of 73 women had tubal EP. The institutional rate of tubal EP over the study period was 6.3 per 1,000 deliveries. There were no maternal deaths due to EP. The mean age of women was 31.5+/−5.7 years, 85% were parous, 67% were rural dwellers and 62% had a history of sub-fertility. The most commonly used diagnostic aid was culdocentesis. One third of women had clinical evidence of shock on arrival. All women with tubal EP were managed by open salpingectomy. Tubal rupture was confirmed for 48% of patients and was more common amongst rural dwellers. Forty-three percent of women had macroscopic evidence of pelvic infection. Two-thirds of patients received blood transfusions, and post-operative recovery lasted six days on average. Late presentation, lack of clinical suspicion, and delays with receiving appropriate treatments were observed.ConclusionsTubal EP is a common gynaecological emergency in a referral hospital in coastal PNG, and causes significant morbidity, in particular amongst women residing in rural areas. Sexually transmitted infections are likely to represent the most important risk factor for tubal EP in PNG. Interventions to reduce the morbidity due to tubal EP include the prevention, detection and treatment of sexually transmitted infections, identification and reduction of barriers to prompt presentation, increasing health workers’ awareness of ectopic pregnancy, providing pregnancy test kits to rural health centres, and strengthening hospital blood transfusion services, including facilities for autotransfusion.

Bridging the Knowledge Gap in Management and Operations of Transfusion Medicine

Health care includes supportive services such as laboratory, radiology and blood transfusion. To manage blood supply centres and hospital blood transfusion services, leadership development is paramount. In 2000, a post-academic Master course for Management of Transfusion Medicine (MMTM) was initiated, focused on restricted economy countries. E-learning has become a common approach in teaching and training in many parts of the world. However, there are still limitations of which some are difficult to influence and eliminate, because they are an integral part of less developed societies in different parts of the world. E-learning packages are increasingly being promoted as an effective way of delivering training, but they have still not penetrated the clinical transfusion practice. Most clinicians have little knowledge of the risks and benefits of supportive haemotherapy, illustrating that the importance of adequate knowledge and competence of blood prescribing clinicians is still not well recognized.E-learning has found its way into the field of blood transfusion. However, audits of clinical transfusion practice have consistently demonstrated deficiencies in knowledge and practice that impact on patient safety and in some cases, result in death. This paper focuses on bridging the knowledge gap in management and operations of transfusion medicine from the perspectives of planning, policy and leadership issues.

Barrettʼs, blood groups and progression to oesophageal cancer

Incidence of oesophageal adenocarcinoma (OAC) is increasing rapidly. OAC arises in columnar-lined oesophagus (CLO), a metaplastic change affecting some patients with gastro-oesophageal reflux disease (GORD). As yet there is no reliable method of identifying those at highest risk. Our earlier observation of an association between OAC and blood group O Rhesus negative, if confirmed, may help identify those at greatest risk. To assess the distribution of blood group and Rhesus D (RhD) factor in patients with GORD compared with the blood donating general population. GORD was categorized as nonerosive reflux (NER), erosive oesophagitis, CLO and OAC. The Rotherham Hospital database holds details of all GORD, CLO and OAC patients seen in the Gastroenterology Unit. Blood group information for patients with GORD was obtained from patients' records and the hospital's blood transfusion service. The blood group distribution in the general population was obtained from the National Blood Transfusion Service. The number of expected to observed patients in each blood group for each subtype was compared. Two thousand six hundred and ten NER, 2813 erosive oesophagitis, 568 CLO and 73 OAC patients had a recorded blood group. For RhD positive patients observed proportions in each blood group were similar to expected. The most striking difference was the marked excess of OAC in blood group O, Rhesus negative (P=0.002). CLO patients with blood group O, RhD negative carry a disproportionately higher risk of developing OAC. The mechanism is unknown but the finding has practical application in guiding risk stratification and intensity of surveillance.

Efficacy of recombinant activated Factor VII in patients with massive uncontrolled bleeding: a retrospective observational analysis

Recombinant activated Factor VII (rFVIIa) is a prohemostatic agent used for treatment of hemophilia patients with inhibiting antibodies. It has also been used in the context of massive uncontrolled blood loss, but the efficacy has not been proven. The aim of this study was to evaluate the effectiveness of rFVIIa in massive uncontrolled blood loss. In this retrospective observational analysis patients were included that had received rFVIIa between April 2004 and January 2008 in the context of bleeding that could not be controlled by conventional transfusion therapy. Data were retrieved from patient files, anesthesia reports, the electronic hospital information system, and the computer files of the hospital blood transfusion service. Baseline demographics, medication data, laboratory data, transfusion data, and surgical data were analyzed. In 32 patients with massive uncontrolled blood loss, a significant reduction in transfusion requirements was observed after infusion of rFVIIa, when comparing the transfusions before and up to 48 hours after infusion of rFVIIa. Mean red blood cell (RBC) transfusions showed a reduction of 20.1 units before rFVIIa to 8.7 after rFVIIa (mean difference, 11.4 units; 95% confidence interval [CI], 6.4-16.5) and fresh-frozen plasma (FFP) transfusions showed a reduction of 19.3 units before rFVIIa to 9.3 after rFVIIa (mean difference, 9.9 units; 95% CI, 4.2-15.6). Fifty-six percent of patients receiving rFVIIa for uncontrolled life-threatening bleeding were alive at discharge from the hospital. This study suggests that rFVIIa may play a role in patients with massive uncontrolled blood loss by reducing the amount of RBC and FFP transfusions and by improving the coagulation variables.

Electronic remote blood issue: a combination of remote blood issue with a system for end‐to‐end electronic control of transfusion to provide a “total solution” for a safe and timely hospital blood transfusion service

The rapid provision of red cell (RBC) units to patients needing blood urgently is an issue of major importance in transfusion medicine. The development of electronic issue (sometimes termed "electronic crossmatch") has facilitated rapid provision of RBC units by avoidance of the serologic crossmatch in eligible patients. A further development is the issue of blood under electronic control at blood refrigerator remote from the blood bank. This study evaluated a system for electronic remote blood issue (ERBI) developed as an enhancement of a system for end-to-end electronic control of hospital transfusion. Practice was evaluated before and after its introduction in cardiac surgery. Before the implementation of ERBI, the median time to deliver urgently required RBC units to the patient was 24 minutes. After its implementation, RBC units were obtained from the nearby blood refrigerator in a median time of 59 seconds (range, 30 sec to 2 min). The study also found that unused requests were reduced significantly from 42 to 20 percent, the number of RBC units issued reduced by 52 percent, the number of issued units that were transfused increased from 40 to 62 percent, and there was a significant reduction in the workload of both blood bank and clinical staff. This study evaluated a combination of remote blood issue with an end-to-end electronically controlled hospital transfusion process, ERBI. ERBI reduced the time to make blood available for surgical patients and improved the efficiency of hospital transfusion.

Repository Facility: The Milano Cord Blood Bank

In spite of abundant literature on cryobiology, relatively limited published information is available on specific features of the facilities where biological materials are stored. In this article the repository facility of a large cord blood bank is described. The 122 sq m biostorage area, which is part of the 226 sq m Milano Cord Blood Bank, is located in the basement of a hospital blood transfusion service. The repository area was designed to contain 35 liquid nitrogen (LN) tanks equipped with an automated refilling system. It was constructed according to Italian and French norms and guidelines. The current setting includes the following elements: an outdoor 6000 L reservoir connected to the area through a LN vacuum line, 30 LN tanks, a ventilation system interfaced to six oxygen sensors and a management system based on a programmable logic controller (PLC) linked to commercial proprietary software for continuous and real time monitoring of LN tanks and of the safety parameters of the repository area. T...

A solid phase and microtiter plate hemagglutination method for pretransfusion compatibility testing.

Most hospital blood transfusion services perform routine pretransfusion compatibility tests (ABO/D typings, antibody detection tests and crossmatches) using standard test tube methods. Recently, alternative technologies, including microtiter plate methods, solid phase red cell adherence (SPRCA) assays, gel tests, microbead columns and affinity column assays have become available. While the increased sensitivity of these new serological technologies is an important advantage, cost savings and automated testing are also important benefits. Our hospital's Transfusion Service converted from manual test tube methods for compatibility testing to manual microtiter plate and SPRCA methods and, subsequently, to automated microtiter plate and SPRCA methods. The conversion was facilitated by using commercially-marketed reagent kits and a fully-automated blood typing analyzer. The automated blood typing system was linked electronically to a hand-held combination bar code reader/portable data terminal that enabled positive identification of patients' bar code wrist bands, personal identification badges, and bar code labels on patients' blood samples and blood components. This bar code identification system has been implemented in the hospital's outpatient Infusion Service. Thus, the conversion to microtiter plate and SPRCA assays enhanced transfusion safety not only by increasing the sensitivity of serological testing, but also by standardizing compatibility testing, supporting electronic record keeping, and linking the laboratory analyzer to a bar code identification system.

Clinicians' satisfaction with a hospital blood transfusion service: a marketing analysis of a monopoly supplier.

One of the objectives of the NHS reforms is to improve customer focus within the health service. In a study to assess the quality of customer service provided by the Edinburgh and South East Scotland Blood Transfusion Service a 19 item questionnaire survey of the main clinical users of the service was performed to ascertain their satisfaction, measured on a 5 point anchored scale, with important aspects of the service, including medical consultation, diagnostic services, blood and blood components or products and their delivery, and general satisfaction with the service. Of 122 clinicians in medical and surgical disciplines in five hospitals in Edinburgh, 72 (59%) replied. Fourteen (22%) indicated dissatisfaction with any aspect of the medical consultation service, owing to inadequate follow up of clinical contacts and unsatisfactory routing of incoming calls. Diagnostic services were criticised for the presentation, communication, and interpretation of results. The restricted availability of whole blood, the necessity to order platelets and plasma through the duty blood transfusion service doctor, and the use of a group and screen policy, attracted criticism from a small number of clinicians. Ten of 68 respondents expressed dissatisfaction with delivery of blood and components to the wards and theatres. The findings indicate that the clinicians served by this blood transfusion service are largely satisfied with the service. Changes are being implemented to improve reporting of laboratory results and measures taken to improve liaison with clinicians.

Routine cross-matching is not necessary for a transurethral resection of the prostate.

Two hundred and fifty-five consecutive patients undergoing transurethral prostatectomy were studied prospectively to test a policy of not routinely cross-matching blood. Blood was ordered only for patients with anaemia, a major medical risk factor, a prostate gland estimated to be greater than 60 g, or the presence of red cell alloantibodies. Of the 203 patients who were "grouped and saved" only, 30 (12%) were subsequently cross-matched and 22 (8.5%) transfused. There were no significant problems as a result of the operation of this policy. The value of these pre-operative criteria for cross-matching was confirmed, apart from the clinical estimation of prostatic size. The use of such a policy could be of significant value to the hospital blood transfusion services.

A rational approach to crossmatching blood for elective surgery.

A group-and-screen system was introduced for selected surgical procedures to improve the cost-effectiveness of the hospital blood transfusion service. The mean crossmatch-transfusion ratio for eleven procedures was 11.1 but fell to 3.3 after the change. The overall crossmatch-transfusion ratio in the hospital improved from 2.7 to 2.2 (p less than 0.001) and blood wastage by expiry fell from 12% to 5% (p less than 0.02). The mean age of blood being transfused also improved slightly from 12.3 days to 10.4 days (p less than 0.001). No problems have arisen from the group-and-screen system to date. It has led to improvement in the efficiency and cost-effectiveness of the hospital blood bank and resulted in fresher blood being transfused.