Safe Transfusion Practice Research Articles

Patient blood management and the Covid-19 Pandemic: An institutional study

Introduction: The COVID-19 pandemic in India is part of the worldwide pandemic of coronavirus disease 2019 (COVID-19). Despite no convincing evidence that this virus can be transfusion-transmitted, the absolute disruption we have seen in everyday life has dramatically reduced the amount of blood donations. Applying the Patient Blood Management (PBM) method is very useful. It is the scientific use of safe and effective medical and surgical techniques designed to prevent anemia and decrease bleeding to improve patient outcomes. PBM conserves a precious community resource, reduces unnecessary hospital and patient care costs, improves patient safety by minimizing exposure to blood, can reduce the risk of hospital-acquired complications and infections, and increases the consumer interest in safety. Efforts to correct anemia in the general population, as well as the imple­mentation of safe blood drive protocols, must be in place to mitigate the risk of viral exposure. This study aimed to assess the indications and requirements of blood and blood products in Covid-19 cases and to develop safe transfusion practices concerning PBM during the Covid-19 pandemic. Methods: This observational study was done in the Blood Bank RLJ Hospital Department of Pathology attached to Sri Devaraj Urs Medical College & Hospital. The records of all COVID-19 positive patient's including their history, blood and blood component utilization from the medical record section, as well as the blood bank and requisition forms sent to a laboratory for investigation and collected over a duration of 6 months (March 2020 to August 2020). Results: Out of 200 COVID-19 positive cases analyzed, only 70 (35%) patients received a blood transfusion, in which 64.28 % (45) patients received single unit PRBCs because of severe anemia and pregnancy-related anemia. Additionally, 25.7% (18) patients received a platelet transfusion because of underlying comorbidities, and 10% (7) received FFP. In all COVID-19 positive patients, we observed a raised ESR. A few patients had raised PT and APTT levels. Patients with mild and moderate anemia presented with microcytic hypochromic anemia and normocytic normochromic anemia. We adopted the Cleveland clinic blood management for low hemoglobin to avoid unnecessary blood transfusions. Conclusion: PBM was found to be an important interventional tool to meet the shortage of blood during the COVID-19 pandemic successfully. An evidence-based emergency blood management plan and flexible regulatory policy should be ready to deal with any disaster and to respond quickly in the case of a blood shortage. While pandemics may reduce the blood supply, our study demonstrated that hospitalized COVID-19 patients had a low level of blood usage. Future studies examining the impact of patient factors may help to further elucidate the mechanisms affecting blood utilization in hospitalized COVID-19 populations.

A review of electronic medical records and safe transfusion practice for guideline development

Electronic medical records (EMRs) are often composed of multiple interlinking systems, each serving a particular task, including transfusion ordering and administration. Transfusion may not be prioritized when developing or implementing electronic platforms. Uniform guidelines may assist information technology (IT) developers, institutions and healthcare workforces to progress with shared goals. A narrative review of current clinical guidance, benefits and risks of electronic systems for clinical transfusion practice was combined with feedback from experienced transfusion practitioners. There is opportunity to improve the safety, quality and efficiency of transfusion practice, particularly through decision support and better identification procedures, by incorporating transfusion practice into EMRs. However, these benefits should not be assumed, as poorly designed processes within the electronic systems and the critically important electronic-human process interfaces may increase risk while creating the impression of safety. Guidelines should enable healthcare and IT industries to work constructively together so that each implementation provides assurance of safe practice.

Seroprevalence of Transfusion Transmitted Infections among Multiple Transfused Patients in Indian Scenario: Step for Safe Transfusion Practices

Introduction: Transfusion Transmitted Infections (TTIs) is a worldwide problem both in past and in the present days. The risk of TTIs is increased due to the constant need to receive blood transfusion in patients requiring multiple transfusions. The problem of TTIs runs parallel to the prevalence of the infections in the blood donor group and to the number of units transfused. Aim: To estimate the current prevalence of blood TTIs in patients requiring multiple units of blood transfusions and to determine their association with age, gender, various disease category and number of units transfused. Materials and Methods: This cross-sectional retrospective study was conducted in the Department of Pathology, RD Gardi Medical College, Ujjain, Madhya Pradesh, India from January 2017 to December 2020. Patients of all the age groups and both gender from Outpatient and Inpatient Department, requiring regular transfusions and having a history of 10 or more units of blood transfusion were enrolled. Serological detection of TTIs was done by Enzyme-Linked Immune Sorbent Assay (ELISA) method. Statistically the results were analysed using Statistical Package for Social Sciences (SPSS) version 19.0. Results: In this study, 480 patients were included of which 293 (61.1%) were males and 187 (38.9%) females. Maximum 195 (40.6%) were children in age group of <1-10 years. A total of 63 (13.12%) patients with Hepatitis C virus, 9 (1.87%) patients with Hepatitis B virus and 2 (0.42%) patients with Human Immunodeficiency Virus (HIV) infection were found at the end of study. Highest seropositivity of TTI was seen in patient who had undergone >400 number of transfusions , thus association was established but no association detected with age and sex of the patients. Majority of TTIs were positive in thalassemia patients 164 (34.17%) followed by patient undergoing haemodialysis 151 (31.45%). Conclusion: The results of this study raise an alarm to the existence of a significant risk of TTIs in our society. There is requirement of advanced and vigilant screening of donors with proper strategies to reduce the breach in safe blood transfusion practices.

Approach for Safe Transfusion Practices during COVID-19 Pandemic: Observation of an Indian Rural Blood Bank

Introduction: Focus of Blood transfusion services is continuous, judicious and well-timed supply of safe Blood. The Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) pandemic has caused the major disruption throughout the world and declaration of nationwide lockdown by Government of India from 25th March 2020 to 31st May 2020 to halt the spread of virus has afflicted the blood bank services enormously. Aim: To keep the focal point on approaches implemented for safe blood transfusion services during Coronavirus Disease2019 (COVID-19) pandemic in rural blood bank and to observe how COVID-19 pandemic has affected blood transfusion services in year 2020 with regards to blood collection, supply and organization of camps as compared to year 2019. Materials and Methods: A retrospective study was done in the Blood Bank in a rural tertiary care hospital in Southern India, from January 2019 to December 2020. Various measures were implemented to increase the donor safety and prevention of spread to community and to increase the number of voluntary donors. Statistical analysis performed using Statistical Package for Social Sciences (SPSS) software version 21.0. All data was entered and tabulated in excel sheet. A two sided t-test was utilized for comparing dual variables and one sided Analysis of Variance (ANOVA) for multiple variables. The p-value <0.05 was considered significant. Results: Mean number of units received during pre-COVID19 year were significantly higher (4468±4127.2) as compared to COVID-19 year 2020 (2282±1856.4) with significant p-value <0.001. Overall utilisation of Packed Red Blood Cell (PRBC) (0.001), Human Platelets (Single Donor Platelets (SDP)/Random Donor platelets (RDP)) p-value 0.003,Fresh Frozen Plasma) FFP (p-value 0.001) was significantly higher in pre-COVID-19 year as compared to COVID-19 year 2020. Total number of camps conducted in pre-COVID-19 year was 41 as compared to 23 in COVID-19 year 2020. Patients deferred for blood donation were much higher in COVID-19 year 2020 (n=400) with maximum (32.5%) under category of self-deferral due to clinical illness as compared to year 2019 (n=200). Conclusion: As a result of our strict and effective implementation of COVID-19 safety protocols , no donor had complained of post donation COVID related symptoms and none of our blood bank staff had developed any COVID-19 related illness. Hence during the COVID-19 pandemic, our blood bank maintained 100% attendance (with staggered duty hours).

Seroprevalence of Blood-borne Viral Infections among Blood Donors in a Tertiary Care Hospital, Kalaburagi District, Karnataka, India

Introduction: Transfusion of blood and its components is a life- saving manoeuvre but has life threatening hazards as well. Blood Transfusion Service (BTS) is covered by “Drug and Cosmetics Act” and has legal implications. Hence, strict criteriae are followed while selecting a donor, particularly emphasising on Transfusion Transmissible Infections (TTI), which may improve safe transfusion practices. Aim: To study the seroprevalence of Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) among Voluntary Donors (VD) in blood centre, tertiary care hospital, Kalaburagi, Karnataka, India. Materials and Methods: The present study was retrospective observational study done for four consecutive years from 1st January 2017 to 31st December 2020. Data of all donors screened for HIV, HBV and HCV was retrieved from the records of Gulbarga Institute Medical Sciences (GIMS) Blood Centre, GIMS Hospital, Kalaburagi, Karnataka, India. The results were tabulated and analysed using descriptive statistics.. Results: Total blood units taken were 15,466 from VDs. There were 96.8% (14,966/15,466) male and 3.2% (500/15,466) female donors. The overall seropositivity of HBV, HCV and HIV was 1.8%, 0.006% and 0.12%, respectively. The highest seroprevalence of TTI was found to be in the age group of 18-30 years (169 donors; 55.6%) followed by 31-40 years age group (103 donors; 33.9%). Conclusion: This study shows increasing trend for total blood donation. Strict selection and retention of voluntary low-risk blood donors is recommended to improve the blood safety. Use of highly sensitive screening tests like Nucleic Acid Amplification Test (NAAT) technology may be implemented in all blood centres to possibly reduce the incidence of TTI.

A prospective interventional study to assess the impact of a 'structured compact training' on knowledge and skills of safe blood transfusion practices among nurses working in a tertiary care institute.

There is scarce information on the baseline knowledge and practices of nursing officers in relation to administration of blood components. We set out to evaluate the influence of training on their knowledge and skills through Kirkpatrick's levels of Training Evaluation. This interventional cross sectional study of 7months duration conducted in a tertiary care teaching institute involved 200 nursing officers. Hundred were assigned to study/intervention group and 100 were assigned to control/ comparison group by systematic random sampling. Knowledge was tested in different domains-blood components, pre-transfusion checks, transfusion process, post-transfusion process and blood administration practice. The baseline knowledge scores of intervention and control group were similar-15.16 ± 4.11 and 15.02 ± 4.75 (p=0.831). Post-intervention (phase I) after 1 month, the scores improved significantly for domain A, B, C, D and E to 4.3 ± 2.21 (p=0.0001), 3.46 ± 2.15 (p=0.0001), 7.02 ± 3.55 (p=0.0001), 2.51 ± 1.46 (p=0.0012), and 5.86 ± 3.61 (p=0.0018) respectively. In phase II, after 3 months of training, and the scores were significantly better from baseline for all domains except E. For domain A, B, C, D and E, scores were 3.82 ± 2.46 (p=0.0001), 3.53 ± 1.98 (p=0.0001), 7.38 ± 3.87 (p=0.0001), 2.48 ± 1.55 (p=0.0035), and 5.86 ± 3.61 (p=0.95) respectively. Our study showed that baseline scores were low in the nursing officers. No significant difference was found in baseline scores in subject and control population. However, post-intervention, a significant improvement in scores was observed in the study group across all domains.

The First Data of Hemovigilance

Background and Objectives: Hemovigilance is a prime requirement for safe transfusion practice rather it may be the reflection of laboratory performance in a blood bank. This study is the first report of transfusion errors and adverse reactions recorded in Bangladesh. It is a new approach to collect and analyze the data pertaining to issues associated with blood transfusion in the day care. This study is aimed to perceive the frequency of adverse reactions and the errors associated with its barrier. Methods: This cross-sectional observational study was conducted in the daycare unit of the Department of Transfusion Medicine of Bangabandhu Sheikh Mujib Medical University from July 2018 to June 2019. Any error regarding pretransfusion and transfusion procedure and adverse event following transfusion was noted according to departmental standard operating procedure and collected data were analyzed with Microsoft Excel 2016. Results: Of the 10,762 units of blood component selected for the issue to 6995 patients, 66 units were discarded. For various reasons. Out of 10696 units of blood component transfused, a total of 459 (4.29%) transfusion reactions were observed among which 390 (3.6%) were acute and 69 (0.6%) were delayed. Mild allergic (40.5%) and Febrile nonhemolytic (36.4%) were the most common acute reaction whereas alloimmunization (9.4%) and delayed hemolysis (4.1%) were the most observed delayed transfusion reaction. Among the recipient, transfusion reactions were observed slightly more in males (7.5%) than in females (5%) and the most affected age group was 20–29 years. Conclusion: However, it is not always possible to analyze the relevance of all the transfusions and the outcome of the patient. Now, a developing country like Bangladesh has to face and notify the errors and to solve them in parallel.

How to safely collect and deliver blood components for transfusion.

There are several steps in the transfusion process that aim to ensure the correct blood component is given to the correct patient at the correct time. Ensuring the correct blood component is collected for the correct patient is crucial to safe transfusion practice and patient safety. This article explains the blood component collection and delivery procedure in the UK and outlines the steps that are necessary to enable nurses to collect blood components safely. Nurses in other countries can access their local guidelines and protocols and review these against the guidelines outlined in this article. How to articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of.

A RETROSPECTIVE STUDY OF BLOOD TRANSFUSION PRACTICES IN A TERTIARY CARE HOSPITAL OF NORTH INDIA.

INTRODUCTION: Blood transfusion is an important concern for the society, as it is life saving for patients with bleeding disorders, accidents, surgeries, inherited/acquired hematological diseases and malignancies. Generally, donors are classied into the following categories: voluntary, family replacement, remunerated or paid donors, and autologous donor. AIMS & OBJECTIVES:To understand the importance of Blood & its safe Transfusion practice in a Teaching Hospital. METHODOLOGY: An Observational study was conducted over a period of 12 months from January 2019 to December 2019 in a 750 –bedded Tertiary Care Hospital of Jammu(UT). OBSERVATIONS: In addition to providing Blood-Transfusion Services to the patients admitted in SMGS Hospital Jammu & Other Associated Hospitals of GMC Jammu, the Blood-Bank is also catering to the needs of Registered Private Nursing Homes & Hospitals of Jammu(UT).This Blood-Bank has exceptionally maintained a record of consuming the whole stock of Blood without wasting even a single pint of blood. DISCUSSION: The Aim of Blood Transfusion Services is to supply good Quality of Blood & its Components to the Patients & avoid any risk to the Donors as well as Recepients. Hence it is extremely essential to institute strict Quality Control Measures RECOMMENDATIONS: Recommended that Upgradation of Blood-Bank is essential to cater with the needs of Additional bed-strength that SMGS Hospital is going to acquire in the coming future.

Seroprevalence of transfusion transmitted infections in healthy blood donors in a tertiary care hospital in Puducherry

Introduction: Blood transfusion is both a life saving measure in many medical and surgical emergencies and a source of transfusion transmitted infections. So a provision for strict criteria in recruitment and deferral of blood donors may improve safe transfusion practice. The aim of the study was to estimate the trend in seroprevalence of TTI s among blood donors of both voluntary and replacement donors at a tertiary care teaching hospital in Puducherry, India. Material and Methods: A retrospective study was performed from January 2010 to December 2019 in a blood bank of a tertiary care hospital. A total of 21147 blood units which were collected from both voluntary and replacement donors during the study period were included. Data was analyzed from blood bank records, pertaining to all donors who were screened for HBs Ag, Hepatitis C virus and HIV by using appropriate methods. Results: Out of 21147 blood donors, 514 were positive for TTI s. The overall prevalence of HIV, HBV, HCV and Syphilis was found to be 0.04%, 1.88%, 0.06% and 0.42% respectively. The highest percentage of prevalence was observed for HBV, followed by syphilis, HCV and HIV. Conclusion: Adhering the strict donor eligibility criteria and high sensitive screening methods with effective counselling can decrease the prevalence of TTI’s and help in preventing further transmission of infections in the community.

Safe Blood Transfusion Practices among Nurses in a Major Referral Center in Ghana.

Errors in transfusion of blood and blood products can lead to preventable morbidity and mortality. Nurses constitute a significant aspect of the transfusion process as they are the last in the chain of getting blood directly to the patient. They must, therefore, be conversant with the current standard of national and international guidelines on blood transfusion and appropriate management of adverse transfusion events. This study assesses the knowledge and practices of blood transfusion safety among nurses at Komfo Anokye Teaching Hospital. A descriptive cross-sectional design was employed, and structured questionnaire (Routine Blood Transfusion Knowledge Questionnaire) was used to collect data from 279 nurses from seven clinical directorates of the hospital. The data were processed with Stata version 14.0. Variables were analyzed using descriptive statistics, and relationships were drawn using inferential statistics. Over 90% of the respondents had a minimum of a diploma in nursing or midwifery, 63% had performed blood transfusion at least 5 times, and 46% had never received any training on blood transfusion. The mean score obtained in all four categories of blood transfusion knowledge assessed was 29, with 54% of the respondents scoring below the mean. The highest overall score on knowledge was 53%. This indicates that nurses had poor knowledge regarding safe blood transfusion practices as stipulated in the clinical guidelines for blood transfusion by Ghana's National Blood Service. There was no statistically significant relationship between training/experience and knowledge of safe blood transfusion practices. Regular and continuous update training and audit are needed to safeguard patient safety during blood transfusion.

Transfusion-associated circulatory overload (TACO): Significance of appropriate pre-transfusion risk assessment to prevent fatal health outcomes.

Madam, Transfusion of blood products is a life rescuing medical intermediation; however, associated adverse transfusion reactions are major pitfalls. Transfusion-associated circulatory overload (TACO) is life-threatening pulmonary oedema that develops secondary to volume overload. Underlying precipitating factors include ages >60 years or <3 years, low body mass index (BMI), rapid transfusion rate and pre-existing volume overload conditions such as heart disease, renal failure, lung disease or low albumin levels. Sign and Symptoms include dyspnoea, tachypnoea, tachycardia, hypoxia, raised jugular venous pressure, broad pulse pressure and hypertension, that appears during or either six hours posttransfusion [1]. TACO should be discriminated from transfusion-related acute lung injury (TRALI) by high jugular venous pressure, pulmonary arterial pressure to >18mmHg, hypertension, brain natriuretic peptide levels (>1200pg/ml) and response to diuretics. Management of TACO includes immediate discontinuation of transfusion, diuretics, supplementary oxygen, and assisted ventilation if indicated [2]. Serious Hazards of Transfusion (SHOT) in 2018 reported TACO as the most typical reason for transfusion-related deaths. Over the period of 11 years (2007-2018), overall cases raised from six to one hundred and ten, including the increase in mortality from one to five and one significant morbidity from three to thirty-six cases [3]. Interestingly, timely and appropriate preventive actions can reduce this severe reaction to zero. A precise risk assessment before transfusion is recommended by SHOT for TACO elimination, especially if the patient has underlying risk factors. Preventive strategies in such predisposed patients include reviewing the need for transfusion, deferring the transfusion until issue can be resolved, transfuse according to body weight, measure fluid balance, consider prophylactic diuretic, slow transfusion rate and monitoring vital signs including oxygen saturation. Thus, TACO is a serious but avoidable transfusion reaction. Appropriate assessment prior to transfusion in every patient is important to ensure safe blood transfusion practice. Continuous...

English

The ABO and Rh (D) blood type distributions vary from one ethnic group to another. However, they play an essential part in population genetics studies, blood transfusion practices and certain medico-legal cases. Thus, this study is aimed to assess ABO and Rh (D) blood group distribution patterns among Natural and Computational Science faculty graduating class students in Woldia University and to document a blood group database and creating awareness among blood donors for safe transfusion. To this end, blood samples from 429 (N=560) volunteer students were taken during the period of 1st February 2020 to 28th April 2020 blood donation campaign and observational cross sectional study design was performed. ABO and Rh (D) typing was done by antigen-antibody agglutination test using commercially available and standard anti-sera. Descriptive statistical measures on phenotypic frequency of ABO and Rh (D) blood types were described in simple percentages. The allelic and genotypic frequencies of the ABO and Rh blood groups were estimated using the assumption of Hardy–Weinberg equilibrium. The ABO and Rh (D) blood phenotypes respectively were found to be A (28.20%) > B (25.40%) > AB (24.70%) > O (21.67%) and Rh+ (60.13%) > Rh- (39.86%) and the combined ABO/Rh(D) blood groups were in the order A+ (16.31%) > B+ (15.85%) > O+ (14.21%) > AB+ (13.75%) and A- (11.88%) >AB- (10.95%) > B- (9.55%) > O- (7.45%). The allelic frequencies of IA (P), IB (q), IO(r) respectively were 0.314, 0.2939 and 0.4655. The allelic frequencies for ID = 0.3687 and for Id = 0.6313 were found. A genotypic frequency of IAIO was the most frequent (0.2923) and IBIB was the least frequent (0.0863). Whereas, IDId was most frequent (0.4655) and IDID was the least frequent (0.1359). The observed and expected frequencies of individuals having ABO blood group showed no significant difference (χ2 = 35.4381, df = 3; P < 0.05) and Rh (D) blood phenotypes of individuals were significantly different (χ2 = 0.000011, df = 1; P < 0.05), thus, not fitting Hardy-Weinberg assumptions. The data obtained in the present study could be used as important input for blood bank services to have better blood management and safe blood transfusion practices in different regions of Ethiopia and abroad in the future.   Key words: ABO, allele, blood donors, blood groups, distribution, genotype, Rh (D), Woldia University.

Blood group systems

Blood group systems

Prevalence of Transfusion Transmissible Infections in Beta-Thalassemia Major Patients of Pakistan: A Systematic Review

Introduction: β-thalassemia major (TM) is one of the most prevalent inherited hemoglobinopathies in Pakistan. It has one of the highest prevalence of transfusion-dependent TM patients globally, with an estimated greater than 100,000 active cases. Each year, an estimated 5000-9000 new cases of TM are being diagnosed in the country. Blood transfusions (BT) are essential in the management of severe TM; it is critical to have a safe BT to reduce the risk of transfusion transmissible infections (TTIs). Frequent blood transfusions in these patients increase their risk of acquiring TTIs compared to the general population. In this systematic review, we aimed to identify the prevalence of TTIs in transfusion-dependent β -thalassemia major patients in Pakistan. Methods & Material: We performed a systematic literature search to identify studies related to the TTIs and transfusion-related infections in Pakistan from January 1, 2010, to January 31, 2020. The search was conducted using PubMed and PakMediNet (Largest medical database of Pakistan), with initial search retrieved 981 studies. Among these, 166 studies met the inclusion criteria. After further screening by reviewing the articles for relevance and availability of full-length articles, only 14 studies met the final criteria for qualitative synthesis. Results Analysis of 14 studies (n=3786) showed that the seroprevalence of Hepatitis B virus (HBV) of 3.13% (0.66 % to 7.4%) and Hepatitis C virus (HCV) of 26 % (5.56% to 68.2%). There were only two studies reported HIV seroprevalence of 0 % & 0.5% (n=6). The rate of seropositivity for HBV and HCV was directly related to the number of transfusions, higher ferritin levels, and older age groups. There was an increase in the HCV rate with the increasing age of patients. Thalassemia patients who were older than ten years of age had a greater HCV compared to those who were less than ten years of age, i.e., 22% vs. 8.4%, p:0.005, respectively. The mean age was higher in HCV reactive children than non-reactive children. A comparison of HCV in healthy donors vs. thalassemia patients showed a rate of 1.9% vs. 13.1% for T.M. patients. There was HCV infection rate of 74% in the group with greater than 100 BTs compared to 33 % in a group with fewer than 35 BTs. The rate of HCV increased to 75% for the patients who had more than 100 BTs. The majority of the patients were males (51% to 88%). The seroprevalence of TTIs was higher in males than in females (73.4% vs. 26.6%). On average, a single TM patient is exposed to at least 17 different donors annually, requiring 1-2 transfusions every month. The free BT is accessible only in 1 out of 4 thalassemia centers. The majority of patients either need to bring their donors or are dependent on an external source of financial aid as they could not afford the cost of BT treatment. More than half of thalassemia patients (57.2%) need to contact multiple BT centers to search for required blood products. About 42.1% of parents of TM patients did not know about TTIs, whereas 31.6% of them did not know about the bloodborne transmission of HBV and HCV. The majority of parents of TM children had a low income, with 75% of them having income less than 10,000 Pakistani rupees (PKR) per month. The prevalence of TTIs in TM patients was significantly higher (96% vs. 4%) compared to the patients requiring multiple transfusions due to other causes such as leukemia, aplastic anemia, and thrombocytopenia. Conclusion: Our data highlights that the prevalence of transfusion-transmitted infections, especially HCV, is alarmingly higher (26%) in the TM population than in the general population. This is because of a lack of resources, inadequate safety measures, and a fragmented blood transfusion system. These findings warrant the urgent need for better public health measures, safe blood transfusion practices, voluntary remunerated blood-based transfusions, and universal quality-assured donor screening. Without these positive interventions, the current transfusion system can lead to a further worsening of the situation. Large prospective multi-centered clinical trials are required to understand better the high prevalence of TTIs in patients with TM. Disclosures Anwer: Incyte, Seattle Genetics, Acetylon Pharmaceuticals, AbbVie Pharma, Astellas Pharma, Celegene, Millennium Pharmaceuticals.:Honoraria, Research Funding, Speakers Bureau.

Snapshot on physicians’ view on safe blood transfusion in multiply transfused patients in Nigeria

ABSTRACT Background: Multiply transfused patients (MTPs) are often at risk of alloimmunization and other transfusion-associated complications. These complications could be ameliorated through extended blood typing prior to transfusion of blood and blood products. Objective: The aim of this study was to assess the knowledge and practice of safe blood transfusion in MTPs by physicians. Materials and Methods: This was a cross-sectional questionnaire-based study of physicians who attended a scientific conference of the West Africa College of Physicians in Asaba, Delta State. Result: Most of the respondents (68%) managed patients requiring multiple blood transfusions. Forty-seven respondents (68.1%) had a blood transfusion policy for MTPs in their respective centers, and 43 (68.1%) had no transfusion trigger hemoglobin level in their respective health facilities. Respondents who had a blood transfusion policy in their centers had a better knowledge of safe blood transfusion than those that did not, P = 0.008. None of the respondents reported carrying out antibody screening before and after multiply transfusing the patients. Although 100% performed initial screening for transfusion transmissible infections (TTIs), only 11.6% repeated screening for TTIs annually. Conclusion: Practice of safe blood transfusion in MTPs was found to be poor among physicians in Nigeria. Hospitals and training institutions should design ways to update knowledge of physicians on safe blood transfusion especially in MTPs and by so doing optimize safe blood transfusion practices, so as to improve the quality of life of patients.

A Systematic Review of Transfusion-Transmissible Infections Among Blood Donors and Associated Safety Challenges in Pakistan.

The blood transfusion (BT) system in Pakistan is fragmented, demand-driven and depends on weakly regulated transfusion practices. There is a considerable possibility that transfusion-transmissible infections (TTIs) are contributing to the current epidemic of hepatitis B virus (HBV) and hepatitis C virus (HCV) (affecting 7.4% of the general population) in the country. To study this issue, we conducted a systematic review to identify articles related to TTIs and transfusion safety in Pakistan from January 1, 2010 to January 31, 2020. A review of 33 articles met the final criteria for qualitative synthesis. Analysis of these studies showed a cumulative frequency of HBV 2.04%, HCV 2.44%, HIV 0.038%, syphilis 1.1% and malaria 0.11%. The frequency of coinfections among blood donors varied from 0.0099% to 0.35%. The highest number of coinfections were HCV and syphilis, followed by HCV and HBV infections. Syphilis and malaria were tested in only 38% and 46% of all the blood donations in one study. The rate of voluntary non-remunerated donations (VNRDs) was less than 13%, and male donors were 95% to 100% in these studies. There was a significant difference in the frequency of HBV and HCV in VNRDs (0.48%) as compared to replacement donors (RDs) (4.15%). In short, this review shows a high frequency of TTIs, especially HBV, HCV and syphilis in the blood donor population in Pakistan. There is a high dependency on RDs, minimal use of healthy voluntary blood donation practices, inadequate screening of high-risk donors, repeated collections of the blood from RDs, poor quality of screening methods and limited knowledge of donor health. Without standardized safe transfusion practices, there will be an ongoing increase in transmission of TTIs, especially HBV, HCV, syphilis, and HIV leading to a significant adverse public health impact.

Knowledge on safe blood transfusion practice of senior staff nurses working in tertiary hospital

Transfusion of blood saves life. An error in blood transfusion, at the same time, takes life. A cross sectional study was carried out for assessing the knowledge and practice on blood transfusion among the senior staff nurses using a structured questionnaire through face to face interview in Dhaka Medical College Hospital (DMCH). Among the about half of the respondents (54.8%)% were in the age group above 40 consisting 97.6% of female where 98% were married. By professional education 79% had Diploma in nursing and midwifery and 16.9% had graduation in nursing. This study revealed that the respondents could mentioned the name of screening tests as HBsAg (65.3%), HIV (58.1%), VDRL (53.2%), HBV (23.4%) and HBC (7.3%). Things to be checked and things to be considered also evaluated among the respondent and found responsive results. This study revealed that among the respondents 57% had moderate knowledge on blood transfusion, 41% good knowledge and only 2% had poor knowledge. There is an association between knowledge level on blood transfusion and year of service. This association is statistically not significant having p value 0.074. Among the respondents almost 48.4% stated transfuse screened blood as a preventive measure to fix problems regarding blood transfusion. Around 5.6% of the respondents mentioned maintaining proper system of blood transfusion as a measure. A few respondents (4.0%) said that difficulties due to blood transfusion can be prevented by controlling blood transfusion related side effects. The nurses practice self-protection of them and patient's protection during blood transfusion. There is needed of proper training on blood transfusion for prevention of complication in the patient as well as for the nurses themselves.
 Asian J. Med. Biol. Res. September 2020, 6(3): 587-593

How to verify patient identity and blood product compatibility using an electronic bedside transfusion system.

Transfusion of an incorrect blood component is an important avoidable serious hazard of transfusion resulting from process errors. Our group and others have taken advantage of new technology and developed electronic transfusion systems for safe transfusion practice in a previous studies. They allow the clinical staff to correctly identify the patient and the blood product at the bedside, ensuring the right blood product is given to the right patient. This video is to demonstrate the process and not to promote any specific product. It is a follow up our previous video clip on electronic remote blood issue in a previous study. The process for correct patient identification originates from the wristband, which contains the patient identification details in a 2D barcode and is printed from the electronic patient record system. These details are associated with the blood sample through using a portable printer to produce a label for the sample tube. The patient details are scanned into the blood bank laboratory information system (LIS) and are then printed on a compatibility label by the LIS, which also contains a 2-dimensional barcode, and is then attached to the blood product. Following an initial visual check of these details by the clinical staff, the electronic bedside system requires that both the patient wristband barcode and the blood product compatibility barcode are scanned. This will electronically verify at the patient's bedside that the right unit is to be given to the right patient. This is the final step in ensuring end-to-end electronic control and safe transfusion practice.

Prevalence of ABO, RhD and other clinically significant Blood Group Antigens among blood donors at tertiary care center, Gwalior

Background: Among all blood group systems and antigens, ABO and D antigens of the Rh blood group system are of primary importance, hence included in routine blood grouping and transfusion. Other blood group systems and antigens that are important in multiparous women, multi-transfused patients and hemolytic disease of newborn are Kell, Rh, Duffy, and Kidd.Aims and Objectives:  To know the pattern of ABO, RhD and other clinically significant major antigens of Rh, Kell, Duffy and Kidd blood group systems as well as evaluation of phenotypes, genotypes and gene frequency of related antigens among blood donors in Gwalior region.Materials and methods: A prospective study was carried out at the Blood Bank from July 2017 to June 2019. During the study period 48500 blood donors were included for ABO and RhD grouping, Out of them 1000 randomly selected donor samples were processed for complete Rh, Kell, Duffy and Kidd blood grouping.Result:  ABO group pattern was; A - 22.56%, B -  36.52%, AB - 9.8% and O -31.12 %, while RhD status was RhD+ 90.99% and RhD- 9.01% . Prevalence of Rh phenotypes was DCCee 43%, DCcee 33%, DCcEe 10%, dccee 6.5%, DccEe 4.5%, Dccee 1%, DCCEe 0.3% and dccEe 0.2%. Kell phenotype was K-k+ 95.5%, K+k+ 4.5%, while K+ k- and K- k- phenotypes were not encountered in this study. Duffy phenotypes were Fya+ Fyb+ 47.5%, Fya+ Fyb- 35%, Fya- Fyb+17% and Fya- Fyb- 0.5%. Kidd phenotype was Jka+ Jkb- 44.5 %, Jka- Jkb- 26.5%, Jka+ Jkb+ 18% and Jka- Jkb+ 11%.Conclusion: Present study is helpful in the transfusion management of multiparous women and multi-transfused patients. Extended blood grouping is the need of future to ensure safe blood transfusion practices.