Safe Transfusion Practice Research Articles

A Study on Day Care Transfusion Services in Transfusion Medicine Department of a Tertiary Care Hospital

Background: Transfusion of blood components and derivatives in day care unit is an eminent part of management of transfusion dependent patients. Day care transfusion service is an alternative to hospital admission and beneficial for those patients who receive blood more frequently for their survival. Objective: The aim of present study is to assess Transfusion Services provided in a Day Care Unit (DCU) of a tertiary care hospital. Methodology: This study was carried out in DCU of Transfusion Medicine Department, Bangabandhu Sheikh Mujib Medical University, (BSMMU) at Dhaka during January 2014 to December 2014. Data were collected from record registers. Recorded retrospective data were analyzed as percentage and proportion. Results: Total recipients were 718. Among those 424 (59.05%) were male and 294 (40.95%) were female and 562 (78.27%) were between 10 to 40 years. A total of 8587 units of blood components were used during this period. Red Cell Concentrate was most commonly utilized product 6388 (74.39%) followed by Fresh Frozen Plasma (FFP) 1360 (15.83%), Platelet Concentrate 544 (6.33%), Whole blood 260 (3.05%)
 and Cryoprecipitate 35 (0.40%). Transfusion was required more frequently in thalassaemic 365(50.88%) patients. Haemophilia 77(10.72%) and aplastic anaemia patients 49 (6.82%) were next high. The main transfusion reaction observed during transfusion was febrile non-haemolytic reactions. Conclusion: For increasing use of specific blood product and hassle-free transfusion services this kind of day care unit services should be strengthened. Long term study of this kind will help us to develop safe clinical transfusion practice.

Analysis of Blood Donor Deferral in a Tertiary Care Hospital

Introduction: Selection of proper donor according to stringent selection criteria is the prerequisite for safe blood transfusion practice. It is widely known that a large number of blood donors are deferred for different reasons.
 Objective: The aim of present study is to evaluate the incidence and different reasons of blood donor deferral in atertiary care hospital.
 Methodology: This retrospective cross-sectional study was carried out in Transfusion Medicine and Clinical Haematology Department of BIRDEM General Hospital, Dhaka, during the period from July 2016 to June 2017.The blood donor of either sex attending the mentioned department were selected purposively and categorized into four groups according to their age for this study. Donors were selected and deferred by medical officer according to national guideline. Deferred blood donors were recorded in register book and were analyzed retrospectively.
 Results: In current study, 1152 blood donor (8.8%) were deferred attending for allogeneic blood donation during the study period. Out of 13082 registered blood donor 11961were male (91.43%) and 1121 were female (8.57%) and deferral rate was 2.37 times more in female. Majority of the deferred donors (55.38%) were under the age of 40 where 26.82% were in between 40-49 years and 17.8% were in the range of 50 years and above. Age range of highest deferred donors (32.20%) was between 30-39 years. The number of temporary and permanent deferral were 836 (72.57 %) and 316 (27.43%) respectively. Anaemia (33.01%), underweight (21.53%) and hypotension (17.34%) were the most common reason of temporary deferral. Chronic uncontrolled hypertension (42.4%), donors with medication (16.77%) and asthma (15.18%) was the most common cause of permanent deferral.
 Conclusion: The deferral rate was low and most of the deferred donors were young adult. Temporary deferred donors were higher than permanent deferred donors. The most common reasons for temporary deferral were anemia, underweight and hypotension. Permanent deferral causes were chronic uncontrolled hypertension, donors on medication for various reason and asthma. Donors should be informed with a clear message on their deferral status. It is important to determine the rate and causes of donor deferral for the safety of blood transfusion and to guide the recruitment efforts for safe blood transfusion and to avoid the permanent loss of blood donors.
 Northern International Medical College Journal Vol.10 (2) Jan 2019: 373-376

Routine indirect antiglobulin testing of blood donors—a further step toward blood safety: an experience from a tertiary care center in northern India

This scientific article emphasizes the importance of a policy for antibody screening of all blood donors as a step to further improve blood safety. We also report the incidence of red blood cell (RBC) alloimmunization in healthy blood donors obtained using a cross-sectional prospective study from September 2017 to January 2019 in the Department of Transfusion Medicine of a tertiary care referral and teaching institute in northern India. The indirect antiglobulin test (IAT) for unexpected RBC antibodies was performed by the conventional tube test with pooled group O RBCs on all donor units irrespective of their D status. Samples with positive IATs were sent to the Immune Hematology Reference Laboratory for further immunohematolo-gy workup, maintaining predefined optimal storage and transport conditions. Of the 10,390 donors studied, 9959 were males and 431 were females. The incidence of unexpected antibodies (antibodies other than those of the ABO blood system) among the blood donors was found to be 0.18 percent (19 of 10,390 with 25 alloantibodies). Of the 19 alloimmunized donors, 16 (84.2%) were male (alloimmunization rate 0.16%, 16 of 9959) and 3 (15.8%) were female (alloimmunization rate 0.69%, 3 of 431) (p = 0.01; chi-square test). In our study, the most frequent alloantibodies identified were of the Lewis blood group system (17 of 25 [68%] in 14 of the 19 alloimmunized donors). The second most common allo-antibodies belonged to the Rh blood group system (4 of 25 [16%] in 3 of the 19 alloimmunized donors), followed by those of the MNS blood group system (3 of 25 [12%] in 2 of 19 alloimmunized donors). Anti-K was found in one donor (1 of 25 [4%]). Based on the results of the study, we recommend that a policy of routinely performing IATs on all donor units, irrespective of their D status, be adopted as an essential component of safe blood transfusion practices.

A practical guide to red blood cell transfusion in children

Abstract Red cell transfusion is common in paediatric practice and indicated in haemorrhagic shock, anaemia and certain inherited haematological diseases. As with other blood products there are risks associated with their administration and improper use. Extensive guidance is available in the UK in order to maintain adequate haemovigilance and safe transfusion practice. This article summarises the rationale behind red cell transfusion and offers a practical guide to clinical decision making in the acute hospital setting.

1260. Seroprevalence of Transfusion–Transmissible Infections (HBV, HCV, HIV, and Syphilis) Among Voluntary Blood Donors in Eastern Regional Blood Center Sri Lanka; A 4 Years Evaluation

BackgroundBlood transfusion can be a lifesaving intervention and it may result in acute or delayed complications and carries the risk of transfusion-transmissible infections such as HIV, hepatitis B and C, syphilis, malaria, etc. as well as hemolysis. Therefore, Blood safety remains a major public health problem in many developing countries owing to inadequacies of national blood transfusion policies and services, appropriate infrastructures, qualified personnel and financial resources. The main aim of this study was to evaluate the sereprevelance of transfusion –transmissible infections such as HBV,HCV,HIV and Syphilis among voluntary blood donors in Eastern Regional blood center on behalf of accessing and recommending safe transfusion in the region.MethodsA retrospective analysis of blood donor data from January 2015 to December 2018 was conducted in Eastern Regional Blood center. Serum samples were screened for hepatitis B surface antigen (HBsAg), antibodies and antigens to hepatitis C virus (HCV), human immunodeficiency virus (HIV) 1 and 2 and Treponema pallidum using commercially available immunochromatic based kits. Relevant confirmatory test for each infective marker were carried out for repeated reactive samples.ResultsDuring this study period ELISA screening testing was performed on 56079 blood donors. At baseline screening testing and confirmatory testing revealed that, 7 HBsAg, 10 anti-HCV, and 03 anti-HIV and 9 Treponema pallidum positive results were detected. The overall prevalence of HBV, HCV, syphilis and HIV were 0.012%, 0.017 0.005% and 0.016%.All blood donor were voluntary nonremunerate.ConclusionThe prevalence of HBV, HCV, syphilis and HIV have not remained a big threat to safe blood transfusion in this region compared with some countries across the globe where the results were very high. Comparing with well-developed services the result are more closed with their findings and therefore, safe transfusion practices are established. The reasons for this results may be complex and low prevalence rate in this population with strict adherence to selection criteria and algorithm of donor screening would be the main reasons of this findings.Disclosures All authors: No reported disclosures.

Dual strategy testing with electrochemiluminescence and ELISA for sero-prevalence of transfusion transmitted viral infections in blood bank

Introduction: Transfusion transmittable infections (TTI) continue to be a major threat to safe transfusion practices. Blood is one of the major sources of transmission of infectious diseases viz. human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis, malaria, and many other infections in India. Screening assays for the infectious diseases with excellent sensitivity and specificity helps to enhance the safety of the blood transfusions reducing the diagnostic window period as much as possible. Methods: The present study was designed to determine the seroprevalence of Transfusion Transmittable Infections viz., HIV, HCV, and HBV, Syphilis, malaria among the blood donors in blood bank from January 2013-December 2013. In the present study Sera samples were screened for hepatitis B surface antigen (HBsAg), antibodies to HCV, HIV using electrochemiluminescence and to syphilis using Rapid Plasma Reagin test (RPR), and to malaria by peripheral smear respectively. All samples were screened for HIV, HBsAg, HCV, syphilis and malaria. Results: Total 9,400 cases. Of which 51% were voluntary donors and 49% were replacement donors. The overall prevalence of HIV, HbsAg, and HCV were 0.35,1.86, and 0.22 respectively. All the markers tested there was increased prevalence of TTI among the replacement donors as compared to voluntary donors. 2.4% donors had infection of each HIV, HbsAg, and HCV. 0.21% donors had infection of both HIV and HCV. Conclusion: The screening of blood and blood components by dual testing strategy using high sensitivity serological assay like enhanced chemiluminescence technology and NAT helps in detecting the potentially infectious blood units in all phases of infection, which aids in enhancing the safety of blood transfusion and reducing the potential risk of post-transfusion infection.

PF809 ARE NATIONAL GUIDELINES AND MANDATORY TRAINING ENOUGH TO ENSURE SAFE TRANSFUSION PRACTICE?

Background:Errors in administering blood product represent a risk for patient safety. The British Society of Haematology (BSH) published guidelines to promote safe transfusion practice (1). These guidelines states that should be recorded: the unique component donation number and the date, start time and the identification of the person administering the component.The guideline also sets the standard for monitoring the patient during the transfusion with pulse, temperature, respiratory rate and blood pressure at the start of the transfusion, after 15 minutes of the start and within one hour from the end.Transfusion training is mandatory for all health professionals involved in transfusion practice.Aims:The aim of this study was to establish if the guidelines established by BSH are applied in clinical practice across different departments.Methods:We performed a retrospective audit on transfusion documentation and patient monitoring and in a district general hospital. We included transfusion of red packed cells, platelets and fresh frozen plasma.Results:We identified 160 unit transfused (132 RPC, 16 PLTS and 12 FFP). Documentation of donation number and the date, start time and the identification of the person administering the component were complete in 88% of the cases, in 8% of the cases there was no documentation at all (Figure 1A); of the remaining in 80% of the cases was missing the signature of the administering person.Regarding the monitoring of the patient only 25% of the unit transfusions were monitored according to the guidelines, in 33% of the cases there was no documentation of the patient monitoring. The least monitored parameter was respiratory rate; the most frequent missed monitoring point was the one at the end of the transfusion (Figure 1B).Summary/Conclusion:Despite clear guidelines and compulsory training transfusion practice is still poor with more than a tenth of the transfusion being not fully documented in the notes and the number of transfusion episodes lacking adequate patient monitoring information outnumbering the transfusion monitored according to the guidelines (33% vs 25%).imagePerforming an audit across the entire hospital allowed us to identify the departments where transfusion procedures were not applied systematically with the plan to offer target training and re‐audit to improve transfusion practice.

Study on Day Care Transfusion Services in Transfusion Medicine Department of a Tertiary Care Hospital

Transfusion of blood components and derivatives in day care unit is an eminent part of management of transfusion dependent patients. Day care transfusion service is an alternative to hospital admission and beneficial for those patients who receive blood more frequently for their survival. The aim of present study is to assess Transfusion Services provided in a Day Care Unit (DCU) of a tertiary care hospital. This study was carried out in DCU of Transfusion Medicine Department, Bangabandhu Sheikh Mujib Medical University, (BSMMU), in Dhaka during January to December 2014. Data were collected from record registers. Recorded retrospective data were analyzed as percentage and proportion. Total recipients were 718. Among those 424 (59.05%) were male and 294 (40.95%) were female and 562 (78.27%) were between 10 to 40 years. A total of 8587 units of blood components were used during this period. Red Cell Concentrate was most commonly utilized product 6388 (74.39%) followed by FFP 1360 (15.83%), Platelet Concentrate 544 (6.33%), Whole blood 260 (3.05%) and Cryoprecipitate 35(0.40%). Transfusion was required more frequently in thalassaemic 365(50.88%) patients. Haemophilia 77(10.72%) and aplastic anaemia patients 49 (6.82%) were next high. The main transfusion reaction observed during transfusion was febrile non-haemolytic reactions. For increasing use of specific blood product and hassle free transfusion services this kind of day care unit services should be strengthened. Long term study of this kind will help us to develop safe clinical transfusion practice.
 Bangladesh Med J. 2019 May; 48 (2): 28-31

Preoperative Laboratory Studies for Pediatric Cardiac Surgery Patients: A Multi-Institutional Perspective.

Preoperative Laboratory Studies for Pediatric Cardiac Surgery Patients: A Multi-Institutional Perspective.

Knowledge of Blood Transfusion Among Nurses.

Health care professionals' knowledge and skills are fundamental to developing and strengthening the quality of blood transfusion procedures. This study evaluated nurses' knowledge about blood transfusion. This descriptive cross-sectional study comprised 171 nurses in medical and surgical units and intensive care units in two hospitals. Data collection was completed in 2 months. Nurses' knowledge of blood transfusion practices was assessed using a questionnaire. Most had obtained a bachelor's degree in nursing, received in-service blood transfusion training, and demonstrated moderate levels of knowledge on the topic. The least known questions related to the changing of blood transfusion sets, the most frequent cause of blood transfusion reactions, and immunological blood transfusion reactions. New graduates or inexperienced nurses, those working in medical units, and those who did not often implement blood transfusions needed more support to improve their knowledge levels (p < .05). Nurses require in-service training to improve their knowledge of safe blood transfusion practices, specifically because blood transfusion sets are the most frequent cause of blood transfusion reactions and adverse reactions associated with blood transfusion. [J Contin Educ Nurs. 2019;50(4):176-182.].

Prevalence of Hepatitis C Virus among blood donors in Blood Bank of Jhalawar Hospital &amp; Medical College Society, Jhalawar Rajasthan

Introduction: Hepatitis C infection continue to be a threat to safe transfusion practices. This study aims to determine the prevalence of Hepa­titis- C virus (HCV) among voluntary and replace­ment blood donors in Blood Bank of Jhalawar Hospital &amp; Medical College Society, Jhalawar, Rajasthan. Material and Methods: A retrospective review of donors record covering the period between Jan 2017 to Dec 2017 at Jhalawar Hospital &amp; Medical College Society, Jhalawar, Rajasthan. The blood collections were taken from the voluntary donors at total 69 blood donation camp and as well as from replacement donors and voluntary donors at blood bank. The blood samples were then obtained by standard procedures of venepuncture. Total 16495 blood donors screened over the period of one year. Antibodies to Hepatitis C virus in serum/plasma is detected by rapid test kit. Results: 34 out of 16495 donor population were positive for Hepatitis C (Prevalence 0.2%). Conclusion: Replacement donors were higher prevalence than the voluntary donors. So, the present study concludes that motivating voluntary blood donors by conducting voluntary blood donation camp is the most effective way of ensuring adequate supplies of safe blood and blood components for transfusion.

Haematological quality and age of donor blood issued for paediatric transfusion to four hospitals in sub-Saharan Africa.

Background and ObjectivesPaediatric blood transfusion for severe anaemia in hospitals in sub‐Saharan Africa remains common. Yet, reports describing the haematological quality of donor blood or storage duration in routine practice are very limited. Both factors are likely to affect transfusion outcomes.Materials and MethodsWe undertook three audits examining the distribution of pack types, haematological quality and storage duration of donor blood used in a paediatric clinical trial of blood at four hospitals in Africa (Uganda and Malawi).ResultsThe overall distribution of whole blood, packed cells (plasma‐reduced by centrifugation) and red cell concentrates (RCC) (plasma‐reduced by gravity‐dependent sedimentation) used in a randomised trial was 40·7% (N = 1215), 22·4% (N = 669) and 36·8% (N = 1099), respectively. The first audit found similar median haematocrits of 57·0% (50·0,74·0), 64·0% (52·0,72·5; P = 0·238 vs. whole blood) and 56·0% (48·0,67·0; P = 0·462) in whole blood, RCC and packed cells, respectively, which resulted from unclear pack labelling by blood transfusion services (BTS). Re‐training of the BTS, hospital blood banks and clinical teams led to, in subsequent audits, significant differences in median haematocrit and haemoglobins across the three pack types and values within expected ranges. Median storage duration time was 12 days (IQR: 6, 19) with 18·2% (537/2964) over 21 days in storage. Initially, 9 (2·8%) packs were issued past the recommended duration of storage, dropping to 0·3% (N = 7) in the third audit post‐training.ConclusionThe study highlights the importance of close interactions and education between BTS and clinical services and the importance of haemovigilance to ensure safe transfusion practice.

Antibody screening and identification in donors and general patients at a tertiary care teaching hospital in Western India.

BACKGROUND AND OBJECTIVES:The aim of the blood transfusion service should be to provide effective blood and blood components, which are as safe as possible and adequate to meet patient's need. To achieve safe blood transfusion practice, many blood transfusion center in India follow routine type and screen protocol for all patient's and donor's blood samples to detect unexpected alloantibodies. The present study is aimed at assessing the frequency and type of unexpected red cell alloantibodies in general patient population and donors at a tertiary care teaching hospital in western India.MATERIALS AND METHODS:In this prospective study, samples of patients as well as blood donors were processed for ABO and Rh “D” grouping as well as antibody screening with three cell screening panel on fully automated immunohematology analyzer. Positive sample in three cell screening panel was further evaluated for identification of specific alloantibody with eleven cell identification panel by column agglutination technique. Results were recorded, and data were analyzed to calculate the frequency of unexpected alloantibody.RESULTS:A total of 74,214 patient samples and 80,173 donor samples were processed for type and screen. Out of which, 512 patients and 11 donors were identified with alloantibody. Most common alloantibody found in the present study is anti-D (0.075%), followed by anti-E (0.041%), anti-c (0.021%), anti-K (0.0205%) in Rh and Kell blood group system.CONCLUSION:Antibody screening and identification of specific alloantibody help in identifying most appropriate blood unit that lacks the corresponding antigen and prevent alloimmunization.

Documentation of the Clinical Blood Transfusion Practice at a Teaching and Referral Hospital in Western Kenya

Blood transfusion is an essential component of modern health care. It can restore normal life expectancy and improve quality of life when used safely. Blood is scarce, costly and its use could be associated. with complications. Good clinical practice, which includes proper documentation, ensures safe and effective transfusion practice. The objective of the study was to analyze the process of documenting the clinical blood transfusion practice at public teaching and referral hospital. A hospital based medical chart review of 384 patients who were transfused from June 2013 to November 2013 was carried out. Systematic random sampling method was used to sample the patient medical charts and a data was collected using a structured data collection. Data was analyzed using frequency tables and is presented in form of text, tables and charts. Approval was obtained from Institutional Research and Ethical Committee of Moi University and the patient’s medical records were de-identified. The median age of the recipients was 31.5 years (IQR 13, 45.8) and the range was 1 day to 89 years. Females comprised 55.2% of the recipients. The indication of the transfusion, pre-transfusion Hb, consent, blood and blood product unit number, start times, duration of transfusion and observations of vital signs were documented in the charts of 91.1%. 99.0%, 0.8%, 73.4%, 43%, 47.1% and 27.6% of all the recipients respectively. It was concluded that there were inadequacies in the documentation of the transfusion process. The strategies of clinical audit and continuing medical education of health workers ought to be applied in order to improve the documentation of the clinical practice of blood transfusion. In addition, studies to establish the reasons for inadequate documentation of the transfusion process should be carried out.

Platelet additive solution suspended apheresis platelets: A new perspective for safe transfusion practice in patients with liver disease

Introduction: Thrombocytopenia is one of the most common complications in chronic liver disease and perioperative transplant patients requiring multiple units of platelets transfusion. Aim: This study was undertaken to find out the effectiveness of platelet additive solution (PAS) suspended apheresis platelets in such patients and to compare the in vitro quality of PAS suspended, and plasma suspended apheresis platelets. Materials and Methods: This is a prospective study conducted in the Transfusion Medicine Department of multiorgan transplant center in South India from April 2016 to April 2017. AntiA and antiB isoagglutinin titers were analyzed in O group SSP+ suspended apheresis platelet concentrates (PCs) and response of both SSP+ suspended, and plasma suspended apheresis PCs were analyzed in patients by checking the corrected count increment (CCI). Results: Among 200 single donor platelet (SDP) products, 111 (55.5%) were SSP suspended and 89 (44.5%) were plasma suspended. There were no adverse transfusion reactions in SSP+ suspended PCs. Among 24 individuals with paired plasma suspended and SSP+ suspended SDP products, no statistically significant difference was found in CCI at 24 h. There was a statistically significant difference between pre- and post-anti-A and anti-B titers (P

Seroprevalence of transfusion transmissible infections among blood donors in tertiary care centre of GandhiNagar, Gujarat, India

Background:Transfusion transmissible infections (TTI) is a major challenge to the blood transfusion service all over the world. TTI create a significant burden on health care system that continue to be a threat to safe transfusion practices. Safety of blood is a major concern in transfusion therapy. In spite of advancement of technologies and meticulous testing one cannot detect the infections in “Window Phase”.Aims and Objectives:To study the sero-prevalence of TTIs among blood donors andto assess the trend of TTIsamong blood donors from records at the blood bank of our tertiary care hospital. Materials and Methods: The present study was carried out at Blood bank of GMERS Medical College, Gandhinagar, Gujarat, India and includes the analysis of seroprevalence of HIV, HBV, HCV, Syphilis and Malaria in the blood donors during the period of 3 years and 6 months from January 2015 to June 2018. Results: Out of total 13724 blood donors, replacement donors (52.4%) were more in comparison to voluntary donors (47.6%). The seropositivity among the blood donors in our study was 0.29% for HBV, 0.04% for syphilis, 0.03% for HIV and 0.0% for both HCV and malaria. The seroprevalence of HIV and syphilis showed a declining trend while seroprevalence for HBV was increasing trend over 3 years. Conclusion: Voluntary blood donation, increasing awareness about blood donation in general population, selection of repeat, non- remunerated, regular voluntary blood donors and diligent donor selection are most important to increase blood safety and avoid transmission of infectious disease through blood transfusion.

Challenges in Establishing a Transfusion Medicine Service: The Cleveland Clinic Abu Dhabi Experience

Opening a new hospital is a once in a lifetime experience and can be very inspiring for those involved in its activation. However, establishing a safe transfusion practice in a greenfield environment comes with unique challenges and opportunities. To highlight critical activation components such as on-boarding of new personnel, establishing clinical practices, and integrating critical laboratory software. Our staff initially faced challenges in standardizing transfusion medicine clinical practice inside the laboratory. Our efforts were mainly focused on the appropriate use of various transfusion orders, creating comprehensive policies for type and screening, cost effective utilization of blood products, and establishment of the maximum surgical blood order schedule. The transfusion service was launched with 2 information technology programs that separately facilitated steps in the transfusion process, but did not provide centralized access to the entire process. In these circumstances, we partnered with the laboratory information system team to create a series of interfaces that streamlined each system's functionality and implemented the existing infrastructure with upgrades that enable remote location and management of blood products. The transfusion medicine team spent more than a year training and monitoring workflows to avoid individual variations between technologists and to adopt our own standards of practice. Participation in a structured training plan was also necessary between clinical caregivers to know the safe and efficient use of these standards. Although laboratory and clinical staff are knowledgeable in care delivery, it is always a learning experience to establish a new system because of the natural tendency of resorting to previous practices and resistance to new approaches.

Audit and education: Role in safe transfusion practice.

BACKGROUND:Auditing and education are the tools for improvement in the transfusion practices. Clinicians are not providing patient's demographic data and medical history to the blood bank that required transfusion. This missing information in blood request forms can lead to transfusion reactions to the patient. So we planned to analyse the blood request forms received at our blood bank and the impact of educational program for the clinicians.METHODS:A total of 6894 blood request forms were received from the month of July 2014 to December 2014 at a blood bank in Amritsar, India. We evaluated for completeness of the blood request form in parameter columns like second identification (CR No. or Father/Husband Name), diagnosis, pre transfusion hematological parameters, quality and quantity of blood component required, history of previous transfusion and adverse transfusion reaction, urgency of transfusion, medical officer name and signature, phlebotomist name and signature etc. A series of CMEs on “Safe Transfusion Practices” were organized for clinicians and hospital staff from 1st August 2014 and improvement in clinicians’ behavior was analysed.RESULTS:A total of 60.83% requests were not filled completely during the study period. Of these 91.42% were in the month of July, which decreased to 48.76% in the month of December 2014 with a total improvement of 42.66%. Incomplete second identification (91.03%) and history of previous transfusion and adverse transfusion reactions (80.21%) were the commonest incomplete fields in the month of July 2014. In the month of December 2014, an improvement in incomplete second identification was observed (12.8%) however phlebotomist signature was still a major incomplete field (45.19%). A statistically significant (p value = 0.004, paired ‘t’ test) improvement in completeness of forms was observed.SUMMARY:Results of medical audit and using those as a basis for developing a highly targeted educational program, can improve the clinicians’ approch towards transfusion practices.

Prediction of Extended Red Blood Cell Phenotype from Exome Next Generation Sequencing Data

Introduction:Accurate typing of patient and donor red blood cell (RBC) antigens is critical for safe transfusion practice. Although blood typing is traditionally accomplished by serology, genotyping methods to predict RBC antigens have proven valuable in a growing number of situations such as recently-transfused patients, scarcity of typing reagents, and indeterminate serologic results. However current RBC genotyping assays address a limited number of blood group genes and associated variants, and may not detect novel genetic changes and certain rare but clinically-significant variants. Next generation sequencing (NGS) technology provides an appealing alternative technology, allowing the user to examine a patient's entire genome or exome in a high-throughput manner. Whereas efforts are underway in multiple fields to apply exome sequencing (ES) for diagnostic, prognostic, and treatment purposes, Transfusion Medicine, with its extensive clinical genomic database, should find ready application from this approach. We describe here the creation of an algorithm to interpret NGS into a predicted extended RBC phenotype, and its application to analyze ES data from 245 participants of the ClinSeq® sequencing cohort.Methods:RyLAN (Red Cell and Lymphocyte Antigen prediction from NGS) was created as an open-source Python application that takes an NGS sorted binary alignment matrix (.bam) file and index as input. The software interacts with a non-relational database that encodes genomic blood group coordinates and phenotype interpretation rules, and yields a predicted extended RBC phenotype and quality parameters. Hard filters for mapping quality, depth, vcf QUAL, and fraction of alternate allele can be modified per individual genomic coordinate. The output is provided as a MongoDB document to facilitate advanced bulk queries and statistical analysis. We employed RyLAN to analyze 245 ES NGS files from the ClinSeq® cohort, using a database of 176 known antigenic, null, and weak blood group single nucleotide variants in 27 blood group genes as input.Results:The cohort consisted of 115 females and 130 males; 89% of participants self-described as white race, non- Hispanic ethnicity. Three percent of participants self-described as Hispanic or Latino, 4% as Asian, 2% with African ancestry, and the remaining as mixed or unknown race. From the total 176 genomic positions analyzed, 160 were not addressed by current commercially-available RBC genotyping platforms. The average read depth for the positions of interest was 78.2, and the average vcf QUAL value was 968. The highest variant nucleotide frequency was observed at the Fya/Fyb and Jka/Jkb loci (275 and 223 total haplotype variant calls, respectively).Among other phenotypes, RyLAN predicted 4 instances of heterozygosity for the KEL*02N.17 allele, 5 heterozygous individuals for the weak FY* X allele, 32 total heterozygous samples for various weak Kidd alleles, 2 homozygous individuals for weak Kidd expression, 1 heterozygosity for Lu6/Lu9, 1 SC:1,2 case, 1 Co(a-b+) predicted phenotype, and a total of 19 RHAG*01.04 and 47 KLF1*BGM12 alleles. Limited areas of the BCAM, KLF1, KEL, FUT7, ERMAP and CR1 genes failed quality filters repeatedly, and careful review indicated that these regions were not captured in the ES libraries. The ACKR1 promoter GATA-binding site variant was present in every sample and predicted all cases of self-reported African ancestry.Conclusions:We describe a new, open-source informatics tool to translate NGS data into a predicted extended RBC phenotype, and demonstrate its application through the analysis of 245 ClinSeq® ES files. Most predicted antigen frequencies were as expected for the ethnic composition of our cohort. We detected a higher frequency of the RHAG p.V270I and KLF1 p.S102P variants than expected, findings that are in agreement with the 1000 Genomes Project and warrant further study. Our analysis also corroborates the relative frequency of the JK*01W.01 allele, and the presence of the JK*01W.03 and JK*01W.04 alleles in the Caucasian population, which can lead to serologic discrepancies in other genotyping platforms. Serologic confirmation of these findings is being conducted. Further study of genomic data across multiple ethnic groups can help refine knowledge of blood group gene polymorphisms and their clinical association. DisclosuresNo relevant conflicts of interest to declare.

The Burden of Primary Liver Cancer and Underlying Etiologies From 1990 to 2015 at the Global, Regional, and National Level

ImportanceLiver cancer is among the leading causes of cancer deaths globally. The most common causes for liver cancer include hepatitis B virus (HBV) and hepatitis C virus (HCV) infection and alcohol use.ObjectiveTo report results of the Global Burden of Disease (GBD) 2015 study on primary liver cancer incidence, mortality, and disability-adjusted life-years (DALYs) for 195 countries or territories from 1990 to 2015, and present global, regional, and national estimates on the burden of liver cancer attributable to HBV, HCV, alcohol, and an “other” group that encompasses residual causes.Design, Settings, and ParticipantsMortality was estimated using vital registration and cancer registry data in an ensemble modeling approach. Single-cause mortality estimates were adjusted for all-cause mortality. Incidence was derived from mortality estimates and the mortality-to-incidence ratio. Through a systematic literature review, data on the proportions of liver cancer due to HBV, HCV, alcohol, and other causes were identified. Years of life lost were calculated by multiplying each death by a standard life expectancy. Prevalence was estimated using mortality-to-incidence ratio as surrogate for survival. Total prevalence was divided into 4 sequelae that were multiplied by disability weights to derive years lived with disability (YLDs). DALYs were the sum of years of life lost and YLDs.Main Outcomes and MeasuresLiver cancer mortality, incidence, YLDs, years of life lost, DALYs by etiology, age, sex, country, and year.ResultsThere were 854 000 incident cases of liver cancer and 810 000 deaths globally in 2015, contributing to 20 578 000 DALYs. Cases of incident liver cancer increased by 75% between 1990 and 2015, of which 47% can be explained by changing population age structures, 35% by population growth, and −8% to changing age-specific incidence rates. The male-to-female ratio for age-standardized liver cancer mortality was 2.8. Globally, HBV accounted for 265 000 liver cancer deaths (33%), alcohol for 245 000 (30%), HCV for 167 000 (21%), and other causes for 133 000 (16%) deaths, with substantial variation between countries in the underlying etiologies.Conclusions and RelevanceLiver cancer is among the leading causes of cancer deaths in many countries. Causes of liver cancer differ widely among populations. Our results show that most cases of liver cancer can be prevented through vaccination, antiviral treatment, safe blood transfusion and injection practices, as well as interventions to reduce excessive alcohol use. In line with the Sustainable Development Goals, the identification and elimination of risk factors for liver cancer will be required to achieve a sustained reduction in liver cancer burden. The GBD study can be used to guide these prevention efforts.