Blood Product Management Research Articles

Centralized quality control inspections for blood bags and leukocyte reduction at the Japanese Red Cross Society

The Japanese Red Cross is now emphasizing an intense quality control procedure for testing blood bags and for leukocyte counts in blood components. The inspections and tests are described and the effects and significance these have on blood product management of the supply of safe blood are presented.

Supply chain management of blood products: A literature review

This paper presents a review of the literature on inventory and supply chain management of blood products. First, we identify different perspectives on approaches to classifying the existing material. Each perspective is presented as a table in which the classification is displayed. The classification choices are exemplified through the citation of key references or by expounding the features of the perspective. The main contribution of this review is to facilitate the tracing of published work in relevant fields of interest, as well as identifying trends and indicating which areas should be subject to future research.

Anesthesia care for liver transplantation

Intraoperative transfusion practices for liver transplantation have evolved dramatically since the first transplants of the 1960s. It is important for today's clinicians to be current in their understanding of how transplant patients should be managed with regard to their coagulation profile, volume status, and general hemodynamic state. The anesthesia team is presented with the unique task of manipulating this tenuous balance in a rapid and precise manner when managing patients undergoing liver transplantation. Although significant progress has been made in reducing blood product administration, it is still common to encounter large volume blood loss in these cases. Increasingly, clinicians are challenged to justify transfusion practices with a stronger evidentiary base. The current state of the literature for transfusion guidelines and blood product management in this particular patient subset will be discussed, as well as a variety of means (both pharmacologic and otherwise) used to reduce the need for transfusion. The aim was to review the latest evidence on these topics, as well as to highlight areas that need further clarification regarding their role in the optimal care of these patients.

Technology as applied to patient safety: an overview

Patient safety is a tough problem: tough in cultural, technical, clinical and psychological terms and because of its massive scale and heterogeneity.1 Healthcare encompasses many diverse areas: the mostly routine, but sometimes highly unpredictable and hazardous world of surgery, primary care and rehabilitation where patients have established relationships with their doctors over many years, the nature of probability in preventive medicine, some highly organised and ultrasafe processes such as the management of blood products and the inherently unpredictable, constantly changing environment of emergency medicine. In all these areas, error and harm to patients are real possibilities and frequent actualities, although the nature of the harm, its causes, consequences and likely methods of prevention will differ widely according to context.2 It is important to note that an increasing awareness of medical injuries has been paralleled by the rise in technology, and the increasing complexity it causes. The number of different medications for blood pressure, the various approaches and techniques for hip surgery and the multitude of blood tests for diagnosis of infections, all provide infinitely more opportunities for things to go wrong. This is not to say that the patient safety problem is caused by technology, but rather that technology has led to a complex and confusing environment within medicine that requires support systems in order for human beings to provide the correct treatments. Many industries have made significant advances in safety through the adoption of technology.3 Manufacturing has engaged in the reduction of human personnel through deployment of machine-based systems to produce high-quality goods. In aviation, there has been explicit acknowledgement of the potential for human error and a conscious effort to reduce error through the considered use of technology and automation.4 However, these examples are quite different. The aviation paradigm has been translated to medicine, …

Femoral neck fragility fractures: An audit of perioperative blood product management

Femoral neck fragility fractures: An audit of perioperative blood product management

644: Different Intra-Operative Extracorporeal Circulatory Support Techniques in Lung Transplantation Surgery Lead to Significant Differences in Blood Product Management

644: Different Intra-Operative Extracorporeal Circulatory Support Techniques in Lung Transplantation Surgery Lead to Significant Differences in Blood Product Management

Management of Coagulopathy in the Patients With Multiple Injuries: Results From an International Survey of Clinical Practice

Bleeding is one of the leading causes of preventable death after traumatic injury. Trauma-associated coagulopathy complicates the control of bleeding. The published approaches on the management of this coagulopathy differ significantly. A qualitative international survey of clinical practice among senior physicians responsible for the treatment of patients with multiple injuries (Injury Severity Score > or = 16) was conducted to document common practices, highlight the variabilities, and profile the rationale behind existing clinical practices around the world. Survey results are based on 80 (32%) completed returns, representing 25 countries with 93% of respondents employed by trauma centers and a mean of 20 years clinical experience. There are regional differences in the clinical specialty of physicians responsible for trauma management decisions. Blood loss, temperature, pH, platelets, prothrombin time/INR/activated partial thromboplastin time, and overall clinical assessment, were the most common criteria used to assess coagulopathy. Forty-five percent of respondents claimed to follow a massive transfusion protocol in their institution, 19% reported inconsistent protocol use and 34% do not use a protocol. The management of hypothermia, acidosis, blood products, and adjuvant therapy showed regional as well as institutional variability, and surprisingly few massive transfusion protocols specifically address these issues. The results of this survey may serve to draw attention to the need for a common definition of coagulopathy and standardized clinical protocols to ensure optimal patient care.

Revisiting Blood Transfusion Preparedness: Experience from the Bam Earthquake Response

Blood transfusion plays a critical role in the provision of medical care for disasters due to man-made and natural hazards. Although the short-term increase in blood donations following national disasters is well-documented, some aspects of blood transfusion during disasters remain under study. The 2003 earthquake in Bam, Iran resulted in the death of >29,000 people and injured 23,000. In total, 108,985 blood units were donated, but only 21,347 units (23%) actually were distributed to hospitals around the country. Kerman Province, the site of the disaster, received 1,231 (1.3%) of the donated units in the first four days after the disaster. The Bam experience revealed crucial missteps in the development of a post-event strategy for blood product management, and led to the development of a detailed disaster preparedness and response plan that addresses issues of donation, distribution, communication, transportation, and coordination. The current plan requires the Iranian Blood Transfusion Organization to convene a disaster task force immediately as the main coordinator of all disaster preparedness and response activities.

The use of recombinant activated factor VII in trauma patients: Experience from the Australian and New Zealand haemostasis registry

There is increasing use of rFVIIa (eptagog alpha, Novoseven) in injured patients with critical bleeding. The role of rFVIIa is not defined in this group of patients. Registries provide an opportunity to review the patients, reported response and adverse events for rFVIIa. To determine the pattern of use, reported response and adverse events in patients receiving rFVIIa following injury using the Australian and New Zealand Haemostasis Registry (ANZHR). The ANZHR (commenced May 2005) collects data from 53 hospitals on all patients receiving rFVIIa in those hospitals. Of 695 cases in the registry, 108 patients from 19 hospitals were submitted with a primary trauma diagnosis. Most (88) patients received one 90microg/kg dose of rFVIIa. There was a significant reduction in the use of all blood products following rFVIIa (p<0.001) and rFVIIa was thought to have decreased or stopped bleeding in 59% of cases. There was wide variation in the timing of rFVIIa use. There were two adverse events that were considered possibly linked and a total of three thromboembolic events. Following multivariate analysis, pH provided the best model of response to rFVIIa. Patients with a pH<7.05 were significantly less likely to respond (OR=0.3, 95% CI=0.0-0.3). Only two patients would fit the criteria for the present prospective study of rFVIIA in trauma patients. The best approach to managing critical bleeding in trauma patients is not agreed. The role of rFVIIa will only be clarified if there is a standardised approach to fluid management and transfusion of blood products. The registry allows tracking of current practice, outcomes and adverse events and will complement present phase 2 and 3 trials.

Blood platelet production with breaks: optimization by SDP and simulation

The production and inventory management of blood products at blood banks and hospitals is a problem of general human interest. As a shortage may put lives at risk, shortages are to be kept to a minimum. As the supply is voluntary and costly, any spill of unused blood (products) is also to be minimized. Blood platelets (thrombocytes), which are the most expensive and perishable blood product, have the complication of a limited “shelf life” of only 5–7 days. A general figure in the Western world (the USA and Western Europe) for the spill of blood platelets is in the order of 15–20%. A combined new approach is therefore presented which combines stochastic dynamic programming (SDP) and simulation to provide: (i) Practical simple order-up-to rules that are nearly optimal. (ii) Formal theoretical support. The approach has been applied to a Dutch regional Blood bank. Numerical results show a significant reduction of the figures from: 1% to 1 ‰ for shortages; 20% to 1% for spill. A practical question for blood bank managers that still remains is: “How to anticipate irregular production breaks like at Easter and Christmas?” The present paper therefore will extend the combined SDP–Simulation approach to include such breaks. The main findings are: • Also for these breaks a simple order-up-to rule remains to be nearly optimal. • Also for these breaks the outdating and shortages can be kept less than 1%. • The (stationary) periods with production and the (non-stationary) breaks without can be integrated. The approach thus seems suitable for practical implementation.

Blood donor and component management strategies to prevent transfusion-related acute lung injury (TRALI)

Discuss the pros and cons of using donor and blood product-management strategies to prevent transfusion-related acute lung injury (TRALI). A review of the literature was performed. Despite therapeutic advances in pulmonary and critical care medicine, TRALI is now considered to be one of the leading causes of transfusion-associated mortality, and thus determining how to prevent TRALI is extremely important. Donor and product-management strategies to prevent this life-threatening condition have been suggested, but because of gaps in our understanding of TRALI, blood-bankers do not know how beneficial these interventions will be, nor the amount of potential harm-such as decreasing the availability of blood-that could arise if they were implemented. This article discusses the advantages and disadvantages of the various preventive measures that have been described in the literature. Preventing TRALI poses a difficult challenge for blood-banking experts, because it is unknown which measures will be effective in decreasing the incidence of TRALI and which could have significant drawbacks. Only additional research into TRALI prevention will provide the answers on how to best protect patients from this potentially fatal reaction.

Hemosoft: a new software for blood bank and apheresis management

Background: Blood banks (BB) generate large volumes of information relating to patients and blood products sometimes stored indefinitely. Today computers are the main keys used to manage this task. BB information systems are developed mainly to assist BB specialists. Materials and Methods: We developed a new software, Hemosoft, in our blood bank. We have carried out a great deal of research into BB programs around the world in terms of program features. Using the latest technology, Hemosoft has been designed to run on a multi-user platform on the basis of a modular structure, and high security levels. Results: Hemosoft's structural advantages are: (1) its modular structure and client/server architecture reduce initial hardware costs. (2) Relational database structure provides consistent and secure data access, (3) user-friendly graphical interface, (4) according to operational needs, Hemosoft can be expanded and transferred on to different platforms. As a MS Windows ® based program with graphical user interfacing, Hemosoft has all the functions and advantages of windows based applications. Barcode printing is available to ISBT 128 standard. Hemosoft's integrated modules are: blood donation, transfusion, product management, administrative follow-up, apheresis, stock management, staff-management, inter-center communication, statistics, archive, internet and video-conferencing systems, accounts, integration and security. Conclusion: It fulfills international transfusion medicine requirements, legislative measures and guidelines. We believe that Hemosoft is a high quality, competitive program developed to meet international standards. It is our hope that it will enforce transfusion medicine and blood banking nationwide.

A Practice of Anesthesia for Infants and Children, 3rd Edition.

A Practice of Anesthesia for Infants and Children, 3rd Edition.

Blood transfusion strategies for total knee arthroplasty: Minimizing autologous blood wastage, risk of homologous blood transfusion, and transfusion cost

In this nonrandomized study, alternative strategies were suggested to 10 orthopaedic surgeons to minimize autologous blood wastage, the risk of homologous blood transfusion, and cost associated with blood product usage after total knee arthroplasty (TKA). One hundred fifty-five patients with 177 consecutive TKAs over a 2-year period were studied. Group 1 patients had undergone unilateral TKA and did not predonate; 1A patients (n = 19) were drained with a Hemovac, and 1B patients (n = 28) with a postoperative blood recovery system. Group 2 patients (n = 47) predonated one packed red blood cell (pRBC) unit. Group 3 patients (n = 20) predonated 2 pRBC units. Group 4 patients had undergone bilateral sequential TKAs (n = 21) and had predonated 2 pRBC units. Group 5 patients (n = 14) had undergone revision TKA procedures and their blood requirements were individualized. Group 6 patients (n = 6) had preexisting anemia and were excluded from the study. There was no significant difference in total blood loss (909 mL) between groups. Female sex was associated with significantly lower admission hematocrit. Homologous blood was required for 4% of patients in the entire study and the percentage was not statistically different between groups. Twenty-five percent of patients who predonated autologous pRBCs did not use all or some of it. In group 1, the postoperative blood recovery system had a significant effect on reducing postoperative hematocrit drop ( P = .0001), but it was not a significant factor if autologous pRBCs were available. The costs associated with group 1A were significantly less ( P = .0001) compared with the other groups; group 1A had the highest admission hematocrit (43.2). Transfusion with autologous pRBCs was related to lower admission hematocrit rather than to increased postoperative blood loss. An algorithm is presented to provide cost-effective management of blood products after TKA.

The adverse impact on liver transplantation of using positive cytotoxic crossmatch donors.

Because of the liver graft's ability to resist cytotoxic antibody-mediated rejection, it has become dogma that the conventional transplant crossmatch used to avoid hyperacute rejection of other organs is irrelevant to the liver. We examined this hypothesis in a consecutive series of adult primary liver recipients treated with FK506 and low-dose steroids. Twenty-five of 231 (10.8%) patients received a liver from a cytotoxic-positive crossmatch donor (more than 50% of donor T lymphocytes were killed by dithiothreitol-pretreated recipient serum). The outcome was compared with that of 50 negative crossmatch patients who had their transplantations just before and after the crossmatch positive cases. The one-year graft and patient survivals were 56% and 68%, for positive and 82% and 86% for negative crossmatch patients (P = 0.004, P = 0.03, respectively). The difference between patient and first graft survival was accounted for by retransplantation, which was 4 times more frequent in the positive-crossmatch cases. Histologically, failed allografts obtained at the time of retransplantation revealed a spectrum of pathologic findings related to vascular injury. This study showed a higher difficulty of intraoperative blood product management, a degraded prognosis, and a poorer average quality of ultimate graft function when liver transplantation was performed against positive cytotoxic crossmatches. In such patients for whom crossmatch-negative donors may never be found because of the broad extent and intensity of sensitization, special therapeutic strategies perioperatively must be evolved if results are to improve.

Blood product utilization and management in Canada

The utilization of blood for transfusion in Canada has remained at 900,000-950,000 units p.a. for the past six years. Donation has decreased slightly from a peak of 1,200,000 units p.a. in 1989. The use of fresh plasma and cryo-precipitate has decreased while the use of platelets has doubled in the past six years. The increased use of albumen cannot be explained. In Vancouver, all anaesthesia residents take a compulsory transfusion medicine rotation which appears to be successful in rationalizing transfusion practice.

AIDS and the geriatrician.

Ten percent of acquired immune deficiency syndrome (AIDS) cases are in persons over 50 years of age with 25% of these cases in persons over 60, and 4% in persons over 70 years of age. If the present age distribution holds, there will be 27,000 AIDS cases in persons over 50, and 1100 cases in persons over 70 years of age, by 1991. Older persons are more likely to acquire AIDS through blood transfusions than to homosexual exposure or drug abuse. Changes in the management of blood products will benefit older persons. The nearly 1 million elderly homosexual men, who have been sheltered from the virus by their pattern of sexual activity, will face greater risks as the prevalence of the virus and the age of the carriers increases. The underappreciated neurological consequences of human T-cell lymphotrophic virus type III (HTLV-III) infection, subacute encephalitis, vacuolar myelopathy, and psychiatric disorders will be of particular interest to geriatricians who are often consulted to evaluate neurological dysfunction. Geriatricians will need to become familiar with the spectrum of HTLV-III infection and prepared to counsel patients and extended-care facilities.

Hospital blood bank laboratory data processing system.

A data processing system designed to improve the management and usage of blood and blood products has been developed as a pilot for general application throughout the West Midlands Regional Health Authority. The package provides for the routine clerical, patient record, and stock management aspects of a hospital blood bank laboratory. It can be tailored to the individual requirements of different laboratories and may be implemented in a variety of ways on a family of computer systems of differing power and capacity, thus accommodating widely varying workloads and archiving requirements. Bar code readers are included in the system design, and may be used for data input where standard Codabar labels are affixed to blood products by blood transfusion centres. The system has been installed in one hospital laboratory and preliminary results indicate a high degree of acceptability at all levels. Further refinement of the software to meet minor deficiencies and the requirements of the recent DHSS Health Circular BLD/2/13 are currently being specified.