Hospital Blood Research Articles

Development of a Risk Assessment Model for Predicting Red Blood Cell Transfusion in Neonatal Patients.

The goal was to develop a risk assessment model for predicting red blood cell (RBC) transfusion in neonatal patients to assist hospital blood supply departments in providing small portions of RBCs to those requiring RBC transfusion on time. Clinical information was collected from 1,201 children admitted to the neonatal unit. Clinical factors associated with predicting RBC transfusion were screened, and prediction models were developed using stepwise and multifactorial logistic regression analyses, followed by the evaluation of prediction models using receiver operating characteristic curves, calibration curves, and decision curve analysis (DCA). Overall, 81 neonatal patients were transfused with RBCs, and the variables of gestational age at birth, age < 1 month, receipt of mechanical ventilation, and infant anemia were included in the final prediction model. The area under the curve of the prediction model was 0.936 (0.921 - 0.949), which was significantly higher than that of the individual indicators of gestational age at birth, age at admission < 1 month, receipt of mechanical ventilation, and infant anemia (p < 0.001). DCA showed a standardized net benefit for the possible risk of infant RBC transfusion at 0.1 - 1.0. We developed a risk assessment model to predict the risk of RBC transfusion in neonatal patients that can effectively assess the risk of RBC transfusion in children.

Estimation of ABO Anti-A and Anti-B Agglutinin Titers among Blood Donors at a Tertiary Care Referral Teaching Hospital Blood Centre in Southern India: A Cross-sectional Study

Introduction: Transfusion of blood Group O and its components with high ABO antibody titers to non O recipients has been shown to cause acute transfusion reactions, especially in platelet transfusions, as platelets contain significant amounts of ABO antigen on their surface as well as Anti-ABO alloisogglutinins in plasma. Aim: To estimate the ABO Anti-A and Anti-B agglutinin titers among blood donors at a tertiary care referral teaching hospital blood centre. Materials and Methods: This cross-sectional observational study was conducted at the Immunohaematology laboratory of the Department of Transfusion Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India, from March 2021 to June 2022. All blood donors presenting to the blood centre were screened for eligibility for blood donation. Donors who fulfilled the eligibility criteria as per the Drugs and Cosmetics Act, 1940, and Rules, 1945 were included. Anti-A and Anti-B titers were determined by the conventional tube method with dilutions of 1 in 2, 1 in 4, 1 in 8, 1 in 16, 1 in 32, 1 in 64, 1 in 128, 1 in 256, 1 in 512, and 1 in 1024. A titer of &lt;64 was considered as a low titer, while a titer of &gt;64 was considered as a high titer. Results: A total of 399 donors were included in the study, with 393 (98.5%) being males and 6 (1.5%) being females. The mean age of the study population was 28.49 years. Among blood group A, the percentage of individuals with an IgM anti-B titer of &lt;64 was 85.44% (88) and &gt;64 was 14.56% (15), whereas in blood group B, IgM anti-A titers of &lt;64 were 65.5% (93) and &gt;64 were 34.5% (49). In blood group O, the percentage of individuals with &lt;64 and &gt;64 titers of IgM anti-A were 52.60% (81) and 47.40% (73), respectively, whereas for anti-B, &lt;64 and &gt;64 titers were 77.92% (120) and 22.08% (34), respectively. Conclusion: It is recommended that a database be maintained in all institutes by estimating antibody titers for every A, B, O blood group donors. Whole blood or platelets from group O donors with IgM Anti-A and Anti-B antibody titers &lt;64 can only be transfused across the ABO barrier. As the majority of group A donors had titers &lt;64, group A platelets may be transfused across the ABO barrier in emergency situations.

Evaluation of fresh frozen plasma usage at Tezpur Medical College and Hospital: A two-year study

Background: Rational usage of blood components is important to ensure their availability to needy patients and to avoid unnecessary risk. Despite available guidelines, improvement in quality control, and standardization about the use of fresh frozen plasma (FFP), many studies around the world show a high frequency of its inappropriate use. Aims and Objectives: (i) To evaluate the pattern of FFP usage in our hospital and to categorize usage as appropriate or inappropriate based on FFP transfusion guidelines. (ii) To evaluate the effectiveness of FFP transfusion based on pre- and post-transfusion international normalized ratio (INR) values by calculating P-value using a paired t-test. Materials and Methods: This retrospective observational study was done by retrieving requisition forms of all the patients who received FFP transfusion in Tezpur Medical College, Tezpur, Assam, during the period of 2 years (November 01, 2020–October 31, 2022). Patients who received other blood products along with FFP were excluded from this study. Results: 1420 units of FFP were supplied to 850 patients during the study period of which 64% went to males. The most common age group receiving FFP was 30–39 years (28%). The most common indication for FFP was liver disease (33%). Appropriate usage was found in 74% of episodes and inappropriate usage in 26% of episodes. Statistically significant improvement was seen in post-transfusion INR when usage was appropriate (P &lt; 0.001). Conclusion: The study highlighted the pattern of FFP usage in various clinical settings. Regular screening of requisition forms for proper guidelines-based indications, administrative interventions, and meetings of the hospital blood transfusion committee for education and sensitization of medical staff will go a long way in ensuring appropriate usage and good transfusion practice.

LifeStream Monitor: Python-Based Hospital Blood Bank Supervision

LifeStream Monitor: Python-Based Hospital Blood Bank Supervision

Bacterial contaminants in stored blood and blood products at Zomba Central Hospital Blood Bank: assessing the possible risk of post-transfusion sepsis in a resource-limited setting

Bacterial contaminants in stored blood and blood products at Zomba Central Hospital Blood Bank: assessing the possible risk of post-transfusion sepsis in a resource-limited setting

Prevalence of Torque Teno Virus (TTV) in Blood Donor from Baghdad-Iraq

Background: In 1997, Torque Teno virus (TTV) discovered for the first time in Japanese patients who suffer from hepatitis. Then, it is detected in healthy individuals without causing harmful effects. Also, it is a part of our microbiome, with a high rate in all populations. This virus belong to a large viral family called Anelloviridae. Today, there are many suggestions to use TTV as a novel biomarker for medical and environmental purposes.&#x0D; Objective: To determine the rate of TTV infection in Iraqi blood donors. And evaluate any association with demographic and risk factors.&#x0D; Methods: This cross-sectional study conducted on serum samples from 359 participants who attended the blood donation unit of Al-Imammain Al-Kadhimain Medical City Hospital and National Blood Transfusion Center in Baghdad. The study sample consists of 351 males and only 8 females; their mean age is (36.04 ± 9.35 SD). For a period from November 2022 to January 2023. A nested polymerase chain reaction (PCR) was used to detect TTV untranslated region.&#x0D; Results: The TTV virus was detected in 93.9% (337 out of 359) of blood donors. However, no significant association was found between demographic data (sex, age) and risk factors such as history of (medical surgery, tattooing, cupping practice, marital status, multiple sexual partners, animal husbandry , travel history), under line medical condition (diabetes mellitus and hypertension), viral hepatitis co-infection and occupation with TTV infection rate.&#x0D; Conclusion: This study showed a high prevalence of TTV among healthy blood donors with no significant association with demographic data and risk factors. These results support that TTV as a part of the human virobiome and normally found in the majority of populations.

The selection and preparation of red cell components for intrauterine transfusion: A national survey.

The practice regarding the selection and preparation of red blood cells (RBCs) for intrauterine transfusion (IUT) is variable reflecting historical practice and expert opinion rather than evidence-based recommendations. The aim of this survey was to assess Canadian hospital blood bank practice with respect to red cell IUT. A survey was sent to nine hospital laboratories known to perform red cell IUT. Questions regarding component selection, processing, foetal pre-transfusion testing, transfusion administration, documentation and traceability were assessed. The median annual number of IUTs performed in Canada was 109 (interquartile range, 103-118). RBC selection criteria included allogeneic, Cytomegalovirus seronegative, irradiated, fresh units with most sites preferentially providing HbS negative, group O, RhD negative, Kell negative and units lacking the corresponding maternal antibody without extended matching to the maternal phenotype. Red cell processing varied with respect to target haematocrit, use of saline reconstitution (n = 4), use of an automated procedure for red cell concentration (n = 1) and incorporation of a wash step (n = 2). Foetal pre-transfusion testing uniformly included haemoglobin measurement, but additional serologic testing varied. A variety of strategies were used to link the IUT event to the neonate post-delivery, including the creation of a unique foetal blood bank identifier at three sites. This survey reviews current practice and highlights the need for standardized national guidelines regarding the selection and preparation of RBCs for IUT. This study has prompted a re-examination of priorities for RBC selection for IUT and highlighted strategies for transfusion traceability in this unique setting.

Optimizing the Hospital Blood Bank Stock in Korea: A Comparative Analysis of the Uniform 5-Day Stock Index and a Novel Blood Stock Index.

Maintaining optimal blood inventory levels in hospitals is important to prevent blood shortage and wastage. We aimed to provide an efficient blood inventory management strategy for hospital blood banks nation-wide by comparing the current use of 5-day issuable stock (IS) with Lim's IS as a novel target IS. The average and CV of daily usage (DU) were calculated from information entered into Korea's Blood Management System by 194 participating hospitals in 2019 and 2020. Using these data, Lim's IS was calculated by determining the simulated annual average blood shortage day nearest to 1 for each blood group in each hospital. The 5-day IS (5IS) was estimated by multiplying the average DU in 2018 by five to count the shortage days in 2019. The average DU (0.3-231.3 units) and corresponding CV (0.33-7.14) in the participating hospitals were inversely proportional (r=-0.699 to -0.695). The hypothetical averages of 5IS and Lim's IS were 27.0±41.2 and 24.7±20.8, respectively (P=0.006). The shortage days for 5IS and Lim's IS were 8.9±22.7 and 1.0±1.9, respectively (P<0.001). While 5IS was unacceptable for universal application, Lim's IS remained near one shortage day and is considered more efficient than 5IS. Hospitals should implement indicators that consider DU and its variations. This is the first study to introduce Lim's IS as an indicator of optimal blood inventory, and the data are expected to provide guidance for effective blood inventory management nationwide, particularly during blood shortages.

Enhancing blood safety: the utility of NS-1 antigen capture ELISA for detecting acute dengue infections among blood donors during peak transmission periods and the potential to curtail dengue spread

Background: Dengue fever is a viral disease transmitted by mosquitoes and affects millions of people worldwide. It can also be transmitted through blood transfusions, particularly during peak transmission periods. Methods: This was a cross sectional study which was conducted over a two-month period (June 2022 to July 2022) at a tertiary hospital blood bank. A total of 180 nonrepetitive serum samples were collected from voluntary blood donors and analyzed using the dengue NS-1 Ag Microlisa ELISA kit. Results: Among the 180 samples two samples tested positive for the dengue virus NS-1 antigen using the NS-1 antigen capture ELISA, indicating a prevalence of acute dengue virus infection among blood donors during the peak transmission period of 1.2% (2/180). Conclusions: The use of NS-1 antigen testing was shown to be useful for dengue virus detection. Routine screening of blood donors for dengue virus is not universally implemented in many countries, partly due to the lack of sensitive and specific screening tests. However, the use of serological tests, such as ELISA for dengue antibodies or NS-1 antigen, can effectively detect dengue virus in blood donors. Interventions made during peak transmission periods can help in curtailing the spread of dengue infections.

Frequency and Distribution of ABO and Rhesus (D) Blood group Antigens among Blood Donors at a District Hospital Blood Bank in North Goa

Background: Many blood grouping systems and blood group antigens have been described in the available literature. ABO and Rh grouping systems are the most prevalent amongst these. The prevalence of these varies between different regions and races. The present study was conducted at a District hospital blood centre, to study the frequency and; age and sex distribution of ABO and Rh groups in the study population, in the North District of Goa, to help in managing the blood bank inventory and serve patients better. Methods: The study population included 5438 blood donors (voluntary and replacement). Blood groups were determined by conventional test tube agglutination methods – forward and reverse grouping, using standard antisera. Data obtained from the blood centre records was reported as numbers and percentages, and findings were compared with the available literature. Results: Blood group O was the most prevalent in our study population, followed by A, B and AB. Rh positivity was seen in 93.6% blood donors. Rest all donors were Rh negative. Majority donors belonged to the age group 31-40 years, followed by 21-30 years, with majority (88%) being males. 97% donors were voluntary and 3% were replacement donors. Conclusion: O Positive was the commonest blood group in our study population and AB negative was the least common. Keywords: blood donors, voluntary, replacement, blood groups, ABO group, Rh group, distribution, age, gender.

Blood Products Wastage in Benghazi Hospitals, Libya: The Rate and Causes

Abstract Introduction/Objective Introduction: Despite the rising demand for blood and blood products, supplies are limited. Limiting blood wastage may compensate for fewer donors. This study examines blood waste in Benghazi. A close look at blood and blood product distribution can reveal areas of frequent wastage and the primary factors contributing of blood waste. This would aid in the development of waste prevention programs and raise awareness of the issue. Physicians, laboratory professionals and nurses can follow blood transfusion guidelines. Objectives: This study aimed to determine the rate of blood products wastage and identify the causes of Wastage in Benghazi hospitals in Libya. Methods/Case Report Materials and Methods: Data for this retrospective study describes the blood components utilization or waste for two years: 2015 and 2016 were obtained from hospital blood bank records of all public and private hospitals that Benghazi central blood bank supply with blood and blood components. Descriptive statistical methods analyzed the data. Results (if a Case Study enter NA) Results: In 2015 and 2016, Benghazi central blood bank supplied hospitals with 73511 units of blood. 35107(47.8%) were transfused. Wasted or discarded 33318(45.4)units. No data was available for 5086 units(6.8%). The most frequently wasted component was PRBCs(87%) followed by platelets(8%) and FFP(6%). The major cause of wastage for PRBCs is over-ordering (70.2%) followed by outdated units(18.5%), Returned after 30 minutes of issue (0.6%), Kept more than 3daysand expired(0.6%) and Issued to other hospitals(10.1%). The main cause of wastage for platelets is over-ordering (89%), and inappropriate ordering is the most common cause of waste of FFP(85%). PRBCs waste was mostly found in the surgical department, mainly obstetric(24%). For platelets, waste was mostly found in the hematology department(32%). for FFP, waste was mostly found in ER(47.1%). Conclusion The main cause of blood and blood component wastage is the unnecessary ordering of blood products. The most blood component discarded is PRBCs. Physicians are the most responsible for blood and blood component wastage. The blood ordering pattern needs to be revised, and the over-ordering of blood and blood component should be minimized. Medical staff must be educated to reduce blood wastage. Every hospital should implement a hospital transfusion committee to develop local guidelines and policies to monitor the rational use of blood and blood component.

Red Blood Cell Aliquoting: Improving O Negative Red Blood Cell Utilization in Neonate and Pediatric Inpatients at UC Davis Medical Center

Abstract Introduction/Objective UC Davis Medical Center (UCDMC) is the Sacramento region’s only level 1 adult and pediatric trauma center. It serves a 65,000 square mile area that includes 6 million residents from 33 counties across Northern and Central California. Nearly 7000 patients are transfused annually at UCDMC. Blood supply restrictions, especially on group O negative red blood cells (RBCs), escalated by the COVID-19 pandemic, posed significant patient safety risk. We sought to mitigate this risk by employing restrictive O negative RBC transfusions as recommended by AABB Choosing Wisely, through ABO matched small volume transfusions in neonate and pediatric patients. Methods/Case Report We conducted monthly audits starting in January 2021 to identify trends in O negative RBC use at UCDMC. We partnered with our blood supplier, American Red Cross (ARC), to modify hospital blood inventory. In 2022, we implemented the RBC aliquoting procedure using AS-3 RBCs to facilitate ABO matched small volume transfusions in neonates and children to conserve O negative blood supply. We reviewed regulatory standards, developed standard operating procedures, performed extensive technical validations, and worked with IT to enhance laboratory information system for product manufacturing, labeling, and traceability. We developed education documents for physicians, other providers, nurses, and transfusion services staff including sustainable competency and training. We conducted audits post implementation to measure goal performance in Q4 of FY22, compared to pre- implementation baseline data from Q1 of FY22. Results (if a Case Study enter NA) N/A Conclusion We achieved 57% reduction in O negative RBC utilization post implementation of the RBC aliquoting procedure in Q4 of FY22. Overall O negative RBC use trend at UCDMC improved with a 58% reduction between January 2021 to December 2022. Subsequent reduction of orders was achieved.We conclude that ABO matched RBC aliquot transfusion in neonates and pediatrics is an effective laboratory practice to reduce O negative RBC usage.

Diabetes mellitus and blood glucose variability increases the 30-day readmission rate after kidney transplantation.

Inpatient hyperglycemia is an established independent risk factor among several patient cohorts for hospital readmission. This has not been studied after kidney transplantation. Nearly one-third of patients who have undergone a kidney transplant reportedly experience 30-day readmission. Data on first-time solitary kidney transplantations were retrieved between September 2015 and December 2018. Information was linked to the electronic health records to determine diagnosis of diabetes mellitus and extract glucometric and insulin therapy data. Univariate logistic regression analysis and the XGBoost algorithm were used to predict 30-day readmission. We report the average performance of the models on the testing set on bootstrapped partitions of the data to ensure statistical significance. The cohort included 1036 patients who received kidney transplantation; 224 (22%) experienced 30-day readmission. The machine learning algorithm was able to predict 30-day readmission with an average area under the receiver operator curve (AUC) of 78% with (76.1%, 79.9%) 95% confidence interval (CI). We observed statistically significant differences in the presence of pretransplant diabetes, inpatient-hyperglycemia, inpatient-hypoglycemia, minimum and maximum glucose values among those with higher 30-day readmission rates. The XGBoost model identified the index admission length of stay, presence of hyper- and hypoglycemia, the recipient and donor body mass index (BMI) values, presence of delayed graft function, and African American race as the most predictive risk factors of 30-day readmission. Additionally, significant variations in the therapeutic management of blood glucose by providers were observed. Suboptimal glucose metrics during hospitalization after kidney transplantation are associated with an increased risk for 30-day hospital readmission. Optimizing hospital blood glucose management, a modifiable factor, after kidney transplantation may reduce the risk of 30-day readmission.

Deep Reinforcement Learning for Managing Platelets in a Hospital Blood Bank

Introduction The inventory management of platelets is complicated by their short shelf-life. In many hospitals, ordering policies are set by staff based on their experience rather than through forecasting or mathematical modelling. A data-driven approach may help to reduce wastage while ensuring the right unit is available for the right patient at the right time. Finding optimal policies for managing perishable inventory is known to be computationally challenging due to the large number of “observation states” required to represent the age profile of the stock. Reinforcement learning (RL) is a subfield of machine learning in which agents learn how to solve a sequential decision-making task through interaction with an environment. Deep reinforcement learning (DRL) uses deep neural networks to efficiently learn a policy (a mapping between an observed state and an action) for problems with many observation states. We demonstrate, with both simulated and real-life demand data, that DRL can be used to learn effective platelet replenishment policies for a hospital blood bank. Methods We implemented the platelet replenishment scenario from a recent study (Rajendran &amp; Srinivas, 2020) as an RL environment using the OpenAI gym Python package. Daily demand is stochastic, sampled from day-of-the-week specific Poisson distributions. The reward is the negative cost incurred, comprised of fixed and variable order costs, holding costs, shortage costs and wastage costs. We reimplemented the four heuristic replenishment policies described in that study, with policy parameters fit using stochastic mixed integer linear programming (SMILP), where the ordering decision is based on the total number of units in stock and the order quantity is either fixed or the difference between current stock and a target stock level. We trained DRL policies using two popular methods: Deep Q-Networks (DQN) and Proximal Policy Optimization (PPO) using the RL environment. We compared the performance of these six policies, in addition to the optimal policy found using value iteration (VI) and a policy with perfect foresight, on 1,000 randomly generated evaluation episodes each 365 days long. We repeated the analysis using real demand data obtained from the blood transfusion laboratory at University College London Hospital, a large tertiary level care hospital in the United Kingdom, fitting the policies using daily demand data from 2015 and 2016, and evaluating their performance on data from 2017. Results &amp; Discussion The DRL policies incurred consistently lower mean daily costs on the simulated evaluation episodes than the four policies fit using SMILP. PPO incurred a lower mean daily cost than DQN in 96% of the evaluation episodes and performed near optimally - its mean daily cost was only 0.3% higher than that of the VI policy and 8% higher than the policy with perfect foresight. The best performing heuristic policy fit using SMILP, (s, S), incurred a mean daily cost 1.2% higher than the VI policy. The VI policy could be represented as an (s, S) heuristic policy, with different parameters to those found using SMILP. Therefore, in this case, the advantage of DRL over SMILP appears to be the fact it can efficiently learn from many more example sequences of demand, rather than its ability to represent more complex functions. PPO incurred the lowest mean daily cost on the real demand data from 2017 of the six SMILP and DRL policies, 10% higher than a policy with perfect foresight. Holding costs were the main difference between PPO and the policy with perfect foresight when using both simulated and real demand data. In both experiments PPO achieved mean wastage of 0% and suffered a shortage, which would have required placing an additional rush order, on 3.2% of days with simulated demand data and 2.7% of days with real demand data. Conclusion DRL can be used to learn near-optimal policies for a simplified platelet replenishment task, consistently outperforming a previously reported approach. This suggests it may be a viable method for finding policies that can be applied in practice to improve the management of platelet inventory and reduce wastage. In future work, the ability of DRL to learn how to act in large observation space states will enable consideration of additional aspects of the real problem, such as the fact that not all units arrive fresh and not all requested units are transfused, where existing methods become computationally infeasible or impractical.

The impact of anemia and blood transfusion on mortality after open abdominal surgery in the elderly

BackgroundMajor abdominal surgery is associated with considerable mortality in the elderly. Anemia has been linked to increased mortality in other types of surgery, such as hip and cardiac surgery. This study aimed to assess the impact of preoperative anemia on mortality in the elderly undergoing major abdominal surgery, and how allogeneic red cell blood transfusion influences mortality in these patients.Materials and methodsWe conducted a single-center, register-based retrospective study on patients, who were aged beyond 60 years and underwent one of 81 open abdominal surgical procedures. Patients operated on during the period from January 1, 2000, to May 31, 2013, were consecutively identified in the Danish National Patient Registry. Plasma hemoglobin was measured within 30 days prior to surgery and the primary endpoint was 30-day postoperative mortality. Information about patient transfusions from the hospital blood bank was available from 1998 to 2010.ResultsA total of 3199 patients were included of whom 85% underwent emergency surgery. The total mortality after 30 days was 20%. The median preoperative hemoglobin value of survivors was 7.7 mmol/L vs 6.9 mmol/L in those who died. The difference in hemoglobin values, between those who survived or died, decreased from the pre- to the post-operative phase. The 30-day postoperative mortality was 28%, 20%, and 12% in patients with a preoperative hemoglobin level in the lower, median, and upper quartile respectively. Transfusion therapy was associated with higher postoperative mortality, except in patients with very low hemoglobin values.ConclusionPreoperative anemia has a clear association with surgically related mortality. The distribution of hemoglobin values in patients with a fatal outcome differs significantly from that of survivors. Red cell transfusion is associated with increased mortality, except in patients with very low hemoglobin values which supports recent guidelines suggesting a restrictive transfusion strategy.

Serum cardiac troponin I levels in adults with sickle cell disease visiting the University College Hospital, Ibadan, Nigeria

Abstract significant association between troponin I level in&#x0D; &#x0D; Recurrent vaso-occlusive crisis and haemolysis normally affect the lifestyle of patients with sickle cell disease. This may occur for a few hours or some weeks, making many of them to require hospital admission and blood transfusion, with inevitable financial implications on care givers. Due to its tissue specificity, cardiac troponin I and T have been claimed to be important in detecting cardiac damage even in the presence of elevated total creatine kinase (CK) and CK-MB that can likely occur in exercise-induced skeletal muscle damage. The significance of cardiac assessment in sickle cell patients was emphasized in a previous report which showed that evidence of mortality related to cardiovascular causes was often encountered during autopsy. This study aimed at accessing serum cardiac Troponin I (cTnI) in adult patients with sickle cell disease at University College Hospital, Ibadan. After written consents were obtained, 131 individuals above 18 years were recruited, 95 of which were sickle cell disease subjects and 36 were non-sickle cell disease controls. Mean age was 35.4years±SD=7.54years with age range of 19 to 56years for the sickle celled subjects and 36.8years±SD=9.11years with age range of 19 to 58 years for controls. Male to female ratio was approximately 2:1 for control and 2.4 :1 for sickle cell subjects. A total of 4(4.2%) sickle cell patients had abnormal troponin I level. There was a significant difference in mean troponin I level between sickle cell subjects and control, but there was no significant association between troponin I and haematological parameters of the sickle cell patients. The likelihood of the sickle cell subjects developing crisis is low, but there was no significant association significant association between troponin I level in sickle cell subjects and their haematological parameters, while there was a significant difference in mean troponin I between Sickle cell subjects and non-Sickle cell controls.

Optimizing Mass Casualty Triage: Using Discrete Event Simulation to Minimize Time to Resuscitation.

Urban areas in the US are increasingly focused on mass casualty incident (MCI) response. We simulated prehospital triage scenarios and hypothesized that using hospital-based blood product inventories for on-scene triage decisions would minimize time to treatment. Discrete event simulations modeled MCI casualty injury and patient flow after a simulated blast event in Boston, MA. Casualties were divided into moderate (Injury Severity Score 9 to 15) and severe (Injury Severity Score >15) based on injury patterns. Blood product inventories were collected from all hospitals (n = 6). The primary endpoint was the proportion of casualties managed with 1:1:1 balanced resuscitation in a target timeframe (moderate, 3.5 U red blood cells in 6 hours; severe, 10 U red blood cells in 1 hour). Three triage scenarios were compared, including unimpeded casualty movement to proximate hospitals (Nearest), equal distribution among hospitals (Equal), and blood product inventory-based triage (Supply-Guided). Simulated MCIs generated a mean ± SD of 302 ± 7 casualties, including 57 ± 2 moderate and 15 ± 2 severe casualties. Nearest triage resulted in significantly fewer overall casualties treated in the target time (55% vs Equal 86% vs Supply-Guided 91%, p < 0.001). These differences were principally due to fewer moderate casualties treated, but there was no difference among strategies for severe casualties. In this simulation study comparing different triage strategies, including one based on actual blood product inventories, nearest hospital triage was inferior to equal distribution or a Supply-Guided strategy. Disaster response leaders in US urban areas should consider modeling different MCI scenarios and casualty numbers to determine optimal triage strategies for their area given hospital numbers and blood product availability.

Blood Transfusion Request and Utilization: The Trend in a Tertiary Health Care Centre in North Central Nigeria

Background: An effective blood transfusion service is anchored on an adequate supply of safe blood and its components as well as its accessibility and appropriate clinical use. There is a contrast in blood supplies and utilization between the high, middle and low-income countries necessitating the formulation of appropriate modalities to ensure judicious use of blood while minimizing wastage.&#x0D; Aims: This study was aimed at assessing the blood transfusion request trend in our institution and its utilization with the intent of curtailing the wastage of safe blood for transfusion.&#x0D; Study Design: It is a retrospective study.&#x0D; Place and Duration of Study: Jos University Teaching Hospital Blood Bank from January 2022 to December 2022.&#x0D; Methodology: Appropriately filled blood transfusion request forms of the Jos University Teaching Hospital compared with the blood bank In-house records from January 2022 to December 2022 were reviewed. Request dates, requesting Department, Unit or Specialty, indications for request, Number of units requested, and number eventually utilized were used to determine blood transfusion indices which are indicative of efficient and significant blood use.&#x0D; Results: Eight thousand, five hundred forty-eight (8,548) blood transfusion request forms from the blood bank and patients' folders were reviewed and compared with the Blood Bank's in-house records. Requests for blood transfusion for over 460 indications were received from twenty-six (26) departments and units. There was a general Crossmatch: Transfusion ratio (C: T) of 1.7 with a transfusion index (TI) of 1.2 and transfusion probability (TP) of 48.0%.&#x0D; Conclusion: Transfusion requests were characterized by low utilization across departments and units. This calls for the establishment of a transfusion protocol for the determination of blood volume required for every indication so that this limited commodity will be made available and accessible when needed.

Comparative Analysis of Red Blood Cells, White Blood Cells, Platelet Count, and Indices in Type 2 Diabetes Mellitus Patients and Normal Controls: Association and Clinical Implications.

Diabetes mellitus (DM) is a major health burden affecting 537 million adults worldwide, characterized by chronic metabolic disorder and various complications. This case control study aimed to assess the impact of type 2 diabetes mellitus (T2DM), including hyperglycemia levels, on hematological parameters and complete blood count (CBC) derived parameters. A total of 250 known diabetic patients from the Jazan Diabetic Center, Saudi Arabia, between January 2021 and December 2022, along with 175 healthy adult controls were recruited from Jazan Hospital's blood donation center. Demographic characteristics, medical histories, and relevant factors such as gender, age, BMI, treatment, disease duration, and comorbidities were collected with informed consent. The results of the red blood cell (RBC) count, RBC indices, and mean platelet volume showed significant differences between patients and controls, while the white cell (WBC) and platelet count were comparable between the two groups. CBC-derived parameters, especially neutrophil/lymphocyte ratio (NLR), and platelet/neutrophil ratio (PNR) exhibited significant differences. CBC and derived parameters serve as inexpensive tools for T2DM patients monitoring, indicating early blood cell alterations and potential development of anemia. Further studies are needed to explore their role in predicting T2DM pathogenesis and progression, aiming to reduce severe complications, mortality and morbidity.

P‐PB‐13 | Managing Hospital Blood Supply During the Blood Shortage Crisis

P‐PB‐13 | Managing Hospital Blood Supply During the Blood Shortage Crisis