Hospital Transfusion Committee Research Articles

Clinical Utilisation of Cryoprecipitate at a Tertiary Care Centre in Telangana, India: A Quasi-experimental Study

Introduction: Cryoprecipitate is a slushy product derived from Fresh Frozen Plasma (FFP) through centrifugation at specific temperatures and speeds. It is rich in factor VIII or antihaemorrhagic factor, fibrinogen, and minor amounts of other clotting factors. Cryoprecipitate is primarily used to correct hypofibrinogenaemia or replenish depleted fibrinogen levels. Aim: To examine the appropriate clinical utilisation of cryoprecipitate (cryo) by various departments in the Institute and evaluate the improvement in patients through laboratory tests. Materials and Methods: A single group quasi-experimental study was conducted in the Department of Immunohaematology and Transfusion Medicine (IHBT) at Nizam’s Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India. The duration of the study was over a period of six years, from May 2016 to April 2022.. A total of 486 cases where cryoprecipitate was requested were included in the present study. The results were analysed using Prothrombin Time (PT) and International Normalised Ratio (INR). Percentages and means were used to assess various parameters in this study. All statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version 25.0. Results: The mean age of the study participants was 52.7 years. A total of 486 cases were included over a period of six years, with 3375 cryoprecipitate transfusions performed. The youngest patient was a 9-year-old male, the oldest patient was an 83-year-old male. Most of the cryoprecipitate was appropriately utilised by the Medical Oncology Department (995 cases, 995 units, 20-25 mL per unit-29.48%), while the Cardiology Department had the lowest utilisation (12 cases, 12 units-0.35%). Utilisation by other departments ranged between 45 and 564 cases or units (1.33% to 16.71% per department). The majority of cryoprecipitate units were issued for multiple myeloma and acute leukaemias (new cases and relapse)-28.38% (958 units), while the least were issued for minor surgery and medical cases (29 cases or 29 units- 0.85%). Conclusion: Cryoprecipitate should be used appropriately to achieve desired results and avoid unnecessary transmission. Clinicians, residents, and surgeons should adhere to comprehensive regulatory guidelines for the appropriate usage of cryoprecipitate or any other blood products, as outlined by their hospital transfusion committee.

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.

Adverse Blood Transfusion Reaction Reporting at a Tertiary Care Hospital, Bhutan

Background and Objectives: Even though Blood Transfusion Service is considered as life-saving intervention, it is associated with the occurrence of uneventful reactions from the transfusion of blood and blood units. Bhutan Blood Bank is fragmented with different levels of services provided which leads to varied levels of adverse blood transfusion reaction reported. Study on the hemovigilance system at tertiary care hospital is conducted so as to study the frequency and types of reactions over a period of three years from 1st January 2019 to 31st December 2021. Methods: All ATRs occurring within a period of 3 years were studied according to the Blood Bank standard operating procedure. Adverse transfusion events related to blood and blood units were analyzed and classified on the basis of their clinical features and laboratory tests. Descriptive statistics were used to represent the adverse transfusion reactions. Results: During this period, a total of 19,961 blood and blood components were issued and 120 adverse transfusion events were reported. Most reaction reported were febrile non-hemolytic transfusion reaction, FNHTR (59.2%) followed by allergic reaction (22.5%) occurring predominantly in females (93%). Packed red cells were the common component causing adverse events (83 %) with most observable in Group A (42.5%) blood units. Conclusion: Febrile and allergic reactions are the most common type of reaction reported. Although such reaction type is least harmful but fatal reaction can occur and preventive measures must be taken to avoid such reactions. This preliminary study indicates the importance of having continuous monitoring and quality assessment scheme in addressing the issues of adverse transfusion reaction. Furthermore, establishing a hospital transfusion committee is vital for delivery of safe and efficient blood transfusion services.

The Role of Hospital Transfusion Committee in Ensuring Rational Use of Blood

A Hospital Transfusion Committee (HTC) is a governance body established within the hospital to ensure appropriate blood product use, auditing blood use in the hospital and monitoring and preventing adverse events. The primary goal of HTC is to promote the safe and effective use of blood and components. It is important to educate the end users of blood components to close the gap in medical education pertaining to transfusion medicine. Comprehensive blood utilization review and reporting to management ensures that corrective actions are taken when needed. Meeting is held annually in our setting to discuss practices within the hospital and scope of improvement. HTC provides an active forum for communication between staff directly involved in clinical and laboratory-based patient blood management and blood transfusion activities, to provide solutions, feedback and education in relation to identified problems and to ensure that transfusion practice accords with best practice and aligns with national standards.

Critical conversations on patient blood management with clinical colleagues

Although a subspecialty-trained transfusion medicine (TM) physician brings value to the clinical bedside, hospital transfusion service oversight often falls under the responsibility of pathologists primarily focused on surgical pathology. Yet, pathologists who lack TM fellowship training may not be quite as confident in their role as the TM physician in-charge, especially when the need to communicate with another clinician arises. Given that blood is a resource subject to frequent shortages, there is a need for constant monitoring of blood utilization such that those responsible for transfusion service oversight need to handle challenging clinical interactions when transfusion guidelines are breeched. Generally, the average pathologist is more knowledgeable regarding blood component therapy than other clinician. Yet, disagreements concerning patient transfusion management can arise, in spite of established evidence-based hospital transfusion guidelines. Since authoritative fact stating is not likely to be effective in changing the entrenched practices, pathologists must engage in strategies that will develop meaningful working relationships with their clinical colleagues. Such strategies include being a visible part of direct patient care, such as attendance at patient rounds or provision of mini-consultations by phone regarding transfusion management. Inviting clinicians to attend the hospital transfusion committee meetings and scheduling educational grand rounds are also useful strategies. Clinicians may be more receptive to blood conservation during times of shortages if open communication is established, particularly if hospital leadership is involved in urgent crisis messaging to the clinicians and other hospital staff involved in patient care.

Evaluation of Blood Requisition Forms Submitted to Transfusion Medicine Department of a Tertiary Care Hospital in Dhaka, Bangladesh

Introduction: Blood requisition form (BRF) analysis is one of the most efficient and effective approaches to assess and monitor rational use of blood and its product. BRF is the first line of communication between the clinicians and transfusion medicine specialists which helps to recognize and evaluate inappropriate use of blood. This issue is frequently underrated by the clinicians which results in increased risk of inappropriate transfusion. The current study is aimed to examine the pattern of completion of blood requisition forms and to ensure safe blood transfusion. Materials and methods: This cross sectional prospective study was conducted from January 2020 to December 2021, at the Department of Transfusion Medicine, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh. A total of 32,133 blood requisition forms that were submitted during the study period were compiled and reviewed anonymously. The data were analyzed using Microsoft Excel. Results: During the study period, a total of 32,133 Blood requisition forms were analyzed. Only 15.2% of these forms were duly completed. Rest of the forms had one or more important parameters left blank. The most common incomplete BRF items were the clinical history or differential diagnosis of the patient (52.66%), presumed date and time of transfusion (95.19%), previous transfusion history (95.9%), and referring doctor’s name and designation (88%). Blood requests were more for females (52.02%) than males (47.98%) during the period. Requisitions were more for adults (90%) than pediatric patients. Conclusion: The current study provides evidence that the rate of completion of BRFs is not satisfactory. The request forms evaluated were not covering acceptable demographic and clinical data of the patients. Both the Hospital Transfusion Committee (HTC) and the Department of Transfusion Medicine can help to improve and standardize transfusion practice by working together. Sir Salimullah Med Coll J 2022; 30: 142-147

National blood system: current status and prospects. Organization of transfusion care in a medical institution

Background. Blood safety is a system of measures to organize equal and timely access of citizens to high-quality and safe components of donated blood in the required quantity, their safe and proper use, as well as the safety of donors and patients.
 Objective. To describe the state and prospects of the development of national blood system.
 Materials and methods. Analysis of available regulatory documents and literature sources.
 Results and discussion. In Ukraine, there is a need to create a sustainable self-sufficient national blood system, which could include both the provision of services by medical institutions and the supervision of their provision. This system should be based on voluntary gratuitous donation. It is also necessary to coordinate and standardize such processes as blood procurement, processing, testing for transfusion-transmission infections, determination of blood group and rhesus, storage, distribution, transportation of blood and its components, monitoring of adverse reactions. The hospital transfusion committee (HTC), the hospital blood bank (HBB) and the transfusion immunological laboratory should be the part of the transfusion service of health care facilities. The functions of HTC are to determine the algorithms for the organization of transfusion care, to establish the rules for the appointment of blood and its components, and to assist in education and training of personnel and more. In turn, the functions of HBB include centralized receiving, accounting, storage and dispensing of blood or its components, control of transportation and storage of blood, introduction of alternative therapeutic transfusion methods, control of clinical efficacy assessment, hemovigilance, control of the records and documents of transfusion assistance. It is recommended to allocate four rooms for HBB: for receiving, storage and distributing blood; for collecting and processing applications; for immunohematological examinations and for the staff. Requirements for the provision of blood transfusion services in a health care facility include the organization of the listed above units, inventory management, guidance on the proper use of blood components, quality management, reporting system, and staff training. The blood centre and health care facility must work together to manage blood supplies. When transporting blood, it is extremely important to adhere to the cold chain from the moment the blood is received from the donor to the transfusion of its components to the recipient. Blood and erythrocyte-containing blood components should be stored at 2-6 °C to prevent hemolysis and microbial contamination. Plasma blood components need to be stored frozen (-30 °C), and platelet-containing – in a thermoshaker at a temperature of 20-24 °C. Depending on the type of preparation, plasma, erythrocyte and platelet preparations may have different clinical efficacy. Before transfusion, the doctor must perform a macroscopic assessment of the suitability of the blood product, determine the blood group and rhesus of the recipient, compare the result with the patient’s medical record, determine the blood group and rhesus of the donor, compare the result with plastic container label, perform blood compatibility tests, perform clinical and biological test. Reports on the serious hazards of transfusion (SHOT) indicate that there are adverse transfusion reactions that cannot be prevented, as well as reactions that can be avoided by improving practice and control, and human-related reactions. An important role in the functioning of the blood system is played by hemovigilance. The advantages of hemovigilance are to identify trends in adverse reactions, to reveal the areas for improvement in transfusion medicine, to stimulate research, to raise awareness of risk factors, and to increase the safety of transfusions for patients.
 Conclusions. 1. In Ukraine there is a need to create a stable self-sufficient national blood system. 2. It is necessary to coordinate and standardize such processes as procurement, processing, testing for transfusion-transmission infections, determination of blood group and rhesus, storage, distribution, transportation of blood and its components, monitoring of adverse reactions. 3. Hemovigilance plays an important role in the functioning of the blood system.

Assessment of the quality of stored blood for transfusion at Mbarara Regional Referral Hospital, Southwestern Uganda.

Aim and objective: To assess the quality of blood stored for transfusion at Mbarara Regional Referral Hospital (MRRH) regarding bacterial contamination, malaria infection, and laboratory audit status.Materials and methods: Whole blood and packed red blood cells at MRRH were critically inspected for visual anomalies, and a portion of this blood was aseptically collected and analyzed for Plasmodium species and bacterial contamination using culture methods. For culture positive samples, drug susceptibility testing (DST) was done using the Kirby–Bauer disc diffusion method. An audit using Stepwise Laboratory quality Improvement Process Towards Accreditation (SLIPTA) quality checklist was conducted. The obtained data were analyzed as frequencies and proportions at 95% confidence interval (CI), and significance levels of relatedness were set at p-values<0.05.Results: Of the 202 samples analyzed, 6 (3%) had bacteria while 3 (1.5%) had Plasmodium falciparum trophozoites. The bacterial isolates were Staphylococcus aureus (N=4, 66.7%); Corynebacterium spp (N=1, 16.7%) and Micrococcus spp (N=1, 16.7%). Staphylococcus aureus showed sensitivity to chloramphenicol, oxacillin, amikacin, and gentamycin. Thirty (14.9%) of these units had visually detectable anomalies, and the laboratory audit score was 53.8%.Conclusion: The quality of some blood stored for transfusion at MRRH was inadequate, and the laboratory quality standard based on SLIPTA was low. Based on this, it is crucial to always insist on aseptic measures at all stages (phlebotomy, processing, transporting, and blood storage) and consider more assessment of the donor risk to minimize transfusion-transmitted malaria. It is plausible to standardize the hospital blood transfusion laboratory and revive hemovigilance by the hospital transfusion committee.

How do hospitals respond to feedback about blood transfusion practice? A multiple case study investigation.

National clinical audits play key roles in improving care and driving system-wide change. However, effects of audit and feedback depend upon both reach (e.g. relevant staff receiving the feedback) and response (e.g. staff regulating their behaviour accordingly). This study aimed to investigate which hospital staff initially receive feedback and formulate a response, how feedback is disseminated within hospitals, and how responses are enacted (including barriers and enablers to enactment). Using a multiple case study approach, we purposively sampled four UK hospitals for variation in infrastructure and resources. We conducted semi-structured interviews with staff from transfusion-related roles and observed Hospital Transfusion Committee meetings. Interviews and analysis were based on the Theoretical Domains Framework of behaviour change. We coded interview transcripts into theoretical domains, then inductively identified themes within each domain to identify barriers and enablers. We also analysed data to identify which staff currently receive feedback and how dissemination is managed within the hospital. Members of the hospital’s transfusion team initially received feedback in all cases, and were primarily responsible for disseminating and responding, facilitated through the Hospital Transfusion Committee. At each hospital, key individuals involved in prescribing transfusions reported never having received feedback from a national audit. Whether audits were discussed and actions explicitly agreed in Committee meetings varied between hospitals. Key enablers of action across all cases included clear lines of responsibility and strategies to remind staff about recommendations. Barriers included difficulties disseminating to relevant staff and needing to amend feedback to make it appropriate for local use. Appropriate responses by hospital staff to feedback about blood transfusion practice depend upon supportive infrastructures and role clarity. Hospitals could benefit from support to disseminate feedback systematically, particularly to frontline staff involved in the behaviours being audited, and practical tools to support strategic decision-making (e.g. action-planning around local response to feedback).

Adherence to clinical guidelines for use of blood components at a tertiary hospital in Ghana

Background and objectivesGuidelines for blood transfusions can help to ensure that blood is used appropriately, to avoid wastage and minimize risks, and are particularly important in sub‐Saharan Africa because chronic blood shortages are widespread. This study explored transfusion practices and guideline compliance among clinicians at a tertiary hospital in the Volta region of Ghana.Materials and methodsParticipants in this 3‐month study were clinicians from several hospital departments. The mixed methods study used a questionnaire to assess clinicians’ knowledge of transfusion. Retrospective data from hospital records were used to assess whether each transfusion given during the study period complied with recommendations in the national transfusion guidelines.ResultsAlthough 44/50 clinicians self‐rated their knowledge of transfusion in the questionnaire as good, only two were aware of the national transfusion guidelines, 48% listed incorrect indications for fresh frozen plasma (FFP) and there was considerable variation in haemoglobin thresholds they used to guide transfusion decisions. Of the 313 transfusions of whole blood/packed cells and FFP given during the study, 49% were not in accordance with the guidelines. For the 31 FFP transfusions, under‐dosing was common (87%) and 52% were not in accordance with the guidelines. 46/220 (21%) patients had no cause for anaemia documented during their admission.ConclusionThere is a need to improve awareness of, and compliance with, national guidelines. A multi‐faceted approach including education, guideline dissemination, transfusion audits and oversight from a hospital transfusion committee could contribute to much more effective use of blood components.

EVALUATION OF FUNCTIONING AND STATUS OF IMPLEMENTATION OF HEMOVIGILANCE PROGRAM OF INDIA IN THE BLOOD BANKS OF SOUTHERN KERALA

Objective: The objective of this study is to evaluate the functioning and status of implementation of hemovigilance program of India (HvPI) in the blood banks of southern Kerala.Methods: It was a survey approach to analyze the facilities, working nature, and status of implementation of hemovigilance program by the blood banks located in the three districts of southern Kerala. Both goevrnment and private sector blood banks were subjected to the survey. Standard pro forma was used to collect the data. Collected data were analyzed by percentages and ratios.Results: A total of 40 blood banks were covered in the study. All the blood banks were licensed for handling whole blood. 23 blood banks were licensed for handling blood components. 6 blood banks process 100% blood into components. Majority of blood banks have excellent demand for components. Packed red cells, platelet concentrate, and fresh frozen plasma were the significant components among the prepared components. Majority of the blood banks under the survey had hospital transfusion committee (HTC). 25 blood banks replied as the HvPI is an excellent/good system. However, only 11 blood banks were enrolled in the HvPI. Training programs for the resident doctors and nurses regarding with adverse transfusion reaction and their reporting were not conducted by 17 blood banks.Conclusion: Except very few blood banks, all are need more awareness and training programs. Attention should be given in the area such as underreporting, poor implementation of hemovigilance, only serious reactions reporting, and avoiding minor reactions. Core factor is proper functioning of HTC and awareness programs about hemovigilance system.

An international survey on the role of the hospital transfusion committee.

Hospital transfusion committees (HTCs) can oversee all aspects of transfusion practice at a hospital. This survey sought to identify which quality variables were being reported at HTCs around the world. A working party composed of members of the Biomedical Excellence for Safer Transfusion (BEST) collaborative developed a survey of quality variables that could be potentially presented at HTC meetings. The survey was electronically sent to all BEST members who were encouraged to complete it if they were active on an HTC and to send it to other colleagues with similar experience. An expert panel was convened to determine which quality variables are the most important for review at HTC meetings. There were 121 respondents; the majority were from Europe (52%), Asia (19%), or North America (19%). Most respondents (68%) were at university hospitals. Of the 117 (97%) respondents with an HTC, the committee most often met quarterly (42%) and reviewed transfusion reactions (79%) and risk management-reported events (52%). The HTCs most commonly included transfusion medicine physicians, anesthesiologists, and other physicians who regularly transfuse blood products. Some of the most commonly reported quality variables included number of blood products transfused, wasted, and expired and the number of improperly labeled specimens. The expert panel analysis revealed that some variables that were deemed important were not being frequently reported at HTCs. There is variability in the variables being reported at HTCs around the world with some important variables not frequently reported.

Evaluation of blood requisition and utilization practices at a tertiary care hospital blood bank in Islamabad, Pakistan

Introduction: The significance of appropriate completion of blood request forms (BRFs) is frequently underrated by the clinicians which results in wastage and increased risk of inappropriate therapy. The judicious use of blood components can be assessed by the crossmatch-to-transfusion ratio (C:T), transfusion probability (%T), and transfusion index (TI). The current study assessed the standard of completion of BRFs and blood components utilization at a Tertiary Care Hospital Blood Bank. Materials and Methods: This was a cross-sectional, prospective study conducted at the Department of Blood Transfusion Services, Shaheed Zulfiqar Ali Bhutto Medical University Hospital, Islamabad, from January to April 2016. A total of 5957 BRFs received between January and April 2016 were reviewed. The data were entered in SPSS version 20.0 (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY, USA) and analyzed for completeness, legibility, and blood component utilization through calculation of key indicators including C:T ratio, transfusion probability (%T), and TI. Results: Out of the 5957 request forms reviewed, only 12.7% forms were completed in full. The overall C:T ratio, %T, and TI were 1.52, 65.38, and 0.65, respectively. The same indicators for the Maternal and Child Health Centre (MCHC) were 10.7, 9.32, and 0.09. Conclusion: Incomplete blood transfusion request forms create difficulties for the blood bank staff in comprehending the requests which may compromise patient safety. Similarly, the efficiency of MCHC blood transfusion services is far from optimum. The Hospital Transfusion Committee can play a key role in solving this problem and thus improving the standards of Patient Blood Management.

A retrospective study of transfusion practices in a Tertiary Care Institute.

Background and Aims:Excessive requests for cross matching blood which is more than the blood required for transfusion are usually based on worst case assumptions leading to overestimation of blood usage. We investigated the blood ordering pattern and transfusion practices so as to incorporate a blood ordering schedule for streamlining the use of blood in various hospital departments.Methods:The study was conducted over a period of 19 months in a 350 bedded tertiary teaching hospital. Source of data was blood bank requisition forms and blood bank registers of patients who underwent elective or emergency procedures in the hospital, for which blood was ordered. Data were entered in MS Excel and analysed using SPSS version 20.Results:The blood bank was requested to prepare 10,594 units of blood for 2556 patients. The blood utilised was 16.04% of total cross matched blood, leaving 83.9% of units cross matched but not transfused to patient for whom it was prepared, i.e., wasted. The surgery department had the highest number of units cross matched and transfused. The least number of units cross matched and wasted due to non-transfusion were from the Department of Oncology.Conclusion:The current deficiency of explicit maximum blood order schedule in our hospital is the major factor responsible for high cross match: transfusion ratio. Therefore, a maximal surgical blood order schedule has been suggested to the hospital transfusion committee to implement maximum surgical blood order schedules for selected procedures.

Investigation and management of non‐infectious transfusion reactions

Appropriate management of non‐infectious adverse transfusion reactions begins with recognition that a change in clinical status during or following a transfusion may represent an adverse event. Appropriate monitoring of patients during transfusion and explicit training of staff to recognize the signs and symptoms of adverse transfusion reactions is the key to diagnosis and to management. As some reactions may occur in the hours following transfusion, patient education and instruction on reporting relevant symptoms are also important. The typical symptoms that herald the onset of a transfusion‐related adverse event include fever, rash, shock and respiratory distress. Haemoglobinuria may also be a presenting feature. Early signs or symptoms may reflect more than one type of reaction. All transfusionists must be aware of the steps in acute management of a suspected adverse transfusion reaction. For those events that occur while the transfusion is ongoing, stopping the infusion and maintaining the intravenous access are the important first step. Rapid evaluation of the patient's vital signs, a bedside check of the unit and patient identification, as well as assessment of the appearance of the blood component, are early steps. Supportive care based on the patient's signs and symptoms must occur while additional laboratory and clinical investigations are initiated. In most cases of transfusion‐related adverse events, a ‘posttransfusion’ blood sample should be evaluated for the possibility of serological incompatibility. In addition, most moderate and severe reactions would be investigated with a blood count, renal and liver function tests and assessment of urine for haemoglobin. Other specific investigations depend on the presenting features and initial serologic findings. Based on the clinical, laboratory and/or imaging studies, most transfusion‐related adverse events can be classified into one of the categories of acute transfusion reactions. These include acute haemolytic transfusion reactions, febrile non‐haemolytic, allergic, anaphylactoid, septic, circulatory overload, hypotension and transfusion‐related acute lung injury. Transfusion‐associated graft‐versus‐host disease and posttransfusion purpura can be considered in some circumstances and delayed haemolytic transfusion reactions may be seen in the days to week following a transfusion. This diagnostic classification is important in optimizing acute management and may also contribute to decisions about component selection for subsequent transfusion. Reporting of adverse transfusion events is also an important part of management. Reporting to the hospital blood bank assists with diagnosis and decisions regarding future blood component therapy. The hospital transfusion committee may monitor transfusion reaction rates and trends as a quality indicator that can be used to change practices. The blood supplier must be notified of all reactions which may be attributable to a particular donor or donor unit, especially if recall or quarantine of associated blood components may be necessary. Regional or national haemovigilance programmes may require notification and can contribute to changes in standard practices to address common or serious adverse transfusion events and in early recognition of uncommon complications.

Incidence and Causes of Wastage of Blood &amp; Blood Components in a Blood Bank of Tertiary Care Hospital: A Retrospective Study

Abtract Context:There is always a dearth of blood available for transfusion which can be reduced with more efficient utilization of blood or blood components Aims:This study was aimed at finding reasons for discarding blood or blood components and to develop plans to reduce wastage Materials and Methods:This was a retrospective observational study in blood bank unit of tertiary care hospital and included data from records for one year(1 st Jan 2014 to 31 st Dec 2014). Majority of blood donations were subjected to blood components processing. Reason for discarding blood or blood components was observed and results were analysed. Results:Total 11923 blood bags were collected, 11804 were subjected to component preparation. Overall discard rate of whole blood and components was 5.8%. Most common reason for discard was TTI (74.2%), of which HCV formed the majority. Non-utilization due to expiry (17.1%), blood sent for quality control(3.9%) and other causes(leakage, contamination, DCT positivity and no available segment for cross match) constituted 4.8% of the discard rate. Conclusions:Proper utilization of blood is needed with ideally zero percentage wastage. Most common reason for discard of blood/blood products in our study was seropositivity, followed by non-utilization of blood/blood products beyond expiry date. Proper screening of donors, detailed history, issuing blood/components based on FIFO (First in First out) policy and regular audit by hospital transfusion committee will help to reduce wastage.

The use of transfusion quality indicators as a tool for hemovigilance system implementation at a tertiary care center in Saudi Arabia.

Objectives:To report 2-years experience of using transfusion-related quality indicators as a tool in hemovigilance system implementation.Methods:The study was carried out between 2012 and 2013. Blood transfusion service data were prospectively collected at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Donor reactions, transfusion reactions, fresh frozen plasma (FFP) in-date wastage, incidents, and errors pertaining to orders, or requests were collected quarterly and prospectively and forwarded to the Hospital Transfusion Committee (HTC) for review.Results:Donor population consisted of 23,132 donors. One hundred and forty-eight donor reactions were reported, resulting in a rate of 0.6%. Eighty-four transfusion reactions were reported and most were allergic reactions (79.7%). Errors or incidents were reported with approximately 0.3% of the total number of submitted samples/request forms. The FFP in-date wastage was 21.3% of the total FFP wastage. The HTC regularly reviewed the hemovigilance data and reporting; and safety improvements were implemented.Conclusion:The use of quality indicators as a tool for developing and implementing a hemovigilance system provided a better understanding of improvement areas for continuous progress in quality and safety, and is expected to enhance these features along the blood transfusion chain.

Lessons learned from transfusion audits

BackgroundIn times of patient blood management, studies focus on appropriate transfusion strategies to improve patient's outcome. Little is known about the quality assurance in preparation of blood transfusion and thereafter. In the present study, the indication, informed consent, mandatory immunohematology tests and documentation of blood transfusions were evaluated using assessed self-inspection forms approved by the hospital transfusion committee. Materials and Methods47 medical records of transfused patients were retrospectively reviewed by a clinical transfusion audit team in six hospital facilities from 2012 to 2015. Self-inspection forms were used to classify the physicians' documentation of transfusion into 3 groups: adequately, intermediately, and inadequately documented. ResultsAdequate documented records were only found in 5 cases (10.6%), followed by intermediate (51.1%) and inadequate documentation (38.3%). Informed consent was identified most often as inappropriate, and this was a critical point with respect to medico legal aspects. ConclusionContinuous education of physicians defining parameters to be documented is almost essential in daily transfusion medicine routine. The use of a check list with physician's documentation of transfusion is strongly recommended.

Quality indicators for the hospital transfusion chain: a national survey conducted in 100 dutch hospitals.

The 2011 Dutch Blood Transfusion Guideline for hospitals incorporates seven internal quality indicators for evaluation of the hospital transfusion chain. The indicators aim to measure guideline compliance as shown by the instatement of a hospital transfusion committee and transfusion safety officer (structural indicators), observance of transfusion triggers and mandatory traceability of labile blood components (process indicators). Two voluntary online surveys were sent to all Dutch hospitals for operational years 2011 and 2012 to assess compliance with the guideline recommendations. Most hospitals had a hospital transfusion committee and had appointed a transfusion safety officer (TSO). In 2012, only 23% of hospitals complied with the recommended minimum of four annual transfusion committee meetings and 8 h/week for the TSO. Compliance with the recommended pretransfusion haemoglobin threshold for RBC transfusion was achieved by 90% of hospitals in over 80% of transfusions; 58% of hospitals measured the pretransfusion platelet count in over 80% of platelet transfusions and 87% of hospitals complied with the legally mandatory traceability of blood components in over 95% of transfusions. With the current blood transfusion indicators, it is feasible to monitor aspects of the quality of the hospital transfusion chain and blood transfusion practice and to assess guideline compliance. The results from this study suggest that there are opportunities for significant improvement in blood transfusion practice in the Netherlands. These indicators could potentially be used for national and international benchmarking of blood transfusion practice.

How do I implement a more restrictive transfusion trigger of hemoglobin level of 7 g/dL at my hospital?

The red blood cell (RBC) transfusion trigger is a major driver of transfusion practice and affects health care costs and in some instances patient outcomes. Reducing the transfusion threshold will decrease RBC utilization and hospital costs. The hospital transfusion committee, endorsed by the medical staff executive committee, developed an educational program for physicians, nurses, and blood bank staff focusing on the scientific basis for a transfusion trigger of hemoglobin (Hb) of 7 g/dL rather than 8 g/dL as well as a program to discourage the routine 2-unit RBC transfusion. RBC transfusion practice review was performed and those physicians transfusing outside of the new variables were questioned as to the necessity for the transfusion. A total of 4492 RBC units were saved and 662 patients were not transfused over the three fiscal years (FYs), 2010, 2011, and 2012, compared to 2009 baseline. Direct cost savings over 3 years with a transfusion trigger of Hb of 7 g/dL was $943,320. If activity-based costing is used, the savings may have reached as high as $5,314,036. The number of single-unit RBC transfusions increased steadily over the course of the study while the number of 2-unit transfusions remained relatively stable over the three FYs 2010 to 2012. A Hb level of 7 g/dL is the transfusion threshold which is being adopted by many hospitals. Institutional culture change to a Hb level of 7 g/dL can be implemented with the right champion when endorsed by upper echelon medical leadership and hospital administration.