Single-unit Transfusions Research Articles

Ferroptosis regulates hemolysis in stored murine and human red blood cells.

Red blood cell (RBC) metabolism regulates hemolysis during aging in vivo and in the blood bank. However, the genetic underpinnings of RBC metabolic heterogeneity and extravascular hemolysis at population scale are incompletely understood. Based on the breeding of 8 founder strains with extreme genetic diversity, the Jackson laboratory diversity outbred population can capture the impact of genetic heterogeneity in like fashion to population-based studies. RBCs from 350 outbred mice, either fresh or stored for 7 days, were tested for post-transfusion recovery, as well as metabolomics and lipidomics analyses. Metabolite and lipid Quantitative Trait Loci (QTL) mapped >400 gene-metabolite associations, which we collated into an online interactive portal. Relevant to RBC storage, we identified a QTL hotspot on chromosome 1, mapping on the region coding for the ferrireductase Steap3, a transcriptional target to p53. Steap3 regulated post-transfusion recovery, contributing to a ferroptosis-like process of lipid peroxidation, as validated via genetic manipulation in mice. Translational validation of murine findings in humans, STEAP3 polymorphisms were associated with RBC iron content, lipid peroxidation and in vitro hemolysis in 13,091 blood donors from the Recipient Epidemiology and Donor Evaluation Study. QTL analyses in humans identified a network of gene products (FADS1/2, EPHX2, LPCAT3, SLC22A16, G6PD, ELOVL, PLA2G6) associated with lower levels of oxylipins. These polymorphisms were prevalent in donors of African descent and were linked to allele frequency of hemolysis-linked polymorphisms for Steap3 or p53. These genetic variants were also associated with lower hemoglobin increments in thousands of single-unit transfusion recipients from the vein-to-vein database.

Single vs. Double-Unit Transfusion In Patients With Hematological Disorders Undergoing Chemotherapy Or Stem Cell Transplantation: A Systematic Review And Meta-Analysis

There is no consensus to support the single unit-transfusion policy (1-RBC) over the double-unit transfusion policy (2-RBC) in patients with hematological disorders undergoing chemotherapy or stem cell transplantation. We searched PubMed, Embase, and Cochrane Library. Risk ratios (RR) and mean differences (MD) were pooled. Statistical analysis was performed using Review Manager and R software. Heterogeneity was assessed using I2 statistics. Hemoglobin (Hb) levels at discharge (MD -0.41 g/dL; 95% CI -0.53, -0.29 g/dL; p<0.01) and total RBC units used per admission (MD -0.82 units; 95% CI -1.60, -0.05 units; p=0.04) were significantly lower in patients who received 1-RBC, while length of hospital stay (MD 0.05 days; 95% CI -0.29, 0.39 days; p=0.89), severe bleeding (RR 1.52; 95% CI 0.85, 2.71; p=0.16) and mortality (RR 0.89; 95% CI 0.52, 1.53; p=0.69) showed no significant difference between groups. In patients with hematological disorders undergoing chemotherapy or stem cell transplantation, 1-RBC is associated with lower Hb levels at discharge and a reduction in the total number of RBC units used per admission, with no significant difference in terms of length of hospital stay, severe bleeding risk, transfusion-related adverse events and mortality.

Reducing Unnecessary Transfusions of RBCs in Inpatients Admitted Across Niagara Health Community Hospitals.

Blood products are scarce resources. Audits on the use of red blood cells (RBCs) in tertiary centers have repeatedly highlighted inappropriate use. Earlier retrospective audit at our local community hospitals has demonstrated that only 85% and 54% of all requests met Choosing Wisely Canada guidelines for pre-transfusion hemoglobin (Hb) of 80 g/L or less and single unit, respectively.We sought to improve RBC utilization by 15% over a period of 12 months (meeting Choosing Wisely Canada criteria of pre-transfusion Hb ≤80g/L by >80% and single-unit transfusion by >65%). Following repeated PDSA (Plan-Do-Study-Act) cycles, we implemented educational strategies, prospective transfusion medicine (TM) technologist-led screening of orders, and an RBC order set. The 3-month median percentages of appropriate RBC use for pre-transfusion Hb and single unit (September-November 2021) across all 3 hospitals were 90% and 71%, respectively. Overall, the rate of appropriate RBCs based on pre-transfusion Hb remained above target (>80%), with minimal improvement across all hospitals (median percentage at pre- and post-technologist screening periods of 87% and 90%, respectively). The median percentage of appropriate RBCs based on single-unit transfusion orders has improved across all Niagara Health hospitals with sustained targets (3-month median percentage at pre- and post-technologist screening and most recent time periods of 54%, 56%, and 71%, respectively). We have taken a collaborative, multifaceted approach to optimizing utilization of RBCs across the Niagara Health hospitals. The rates of appropriate RBC use were comparable with the provincial and national accreditation benchmark standards. In particular, the TM technologist-led screening was effective in producing sustained improvement with respect to single-unit transfusion. One of the balancing outcomes was increasing workload on technologists. Local and provincial efforts are needed to facilitate recruitment and retention of laboratory technologists, especially in community hospitals.

Single-Unit Transfusion Policy in Autologous Hematopoietic Stem Cell Transplantation: Less is Not Worse

Single-unit red blood cell (1-RBC) transfusion policy has shown to effectively reduce transfusion burden while maintaining comparable clinical outcomes in hematological patients compared to the classical double-unit policy. However, its effects specifically after autologous stem cell transplantation (ASCT) have not been previously studied. We aimed to evaluate the impact of the 1-RBC policy on transfusion burden in a homogeneous cohort of patients undergoing ASCT. We retrospectively compared the transfusion requirements and the clinical outcomes of 187 patients transplanted from May 2019 to December 2022 under a 1-RBC policy, with a historical cohort of 153 patients transplanted from January 2016 to April 2019 under a double-unit policy. The 1-RBC policy was associated with a 32% reduction in RBC utilization and lower number of RBC transfusions at day 30 after transplantation (median 2 versus 3 units; P < .0001), with an odds ratio of 0.49 in multivariate analysis (P = .03). However, the number of transfusion episodes remained similar (median of 2 in both arms; P = .34). No significant differences in length of stay, hemoglobin levels at discharge or 30‐day mortality were observed. In conclusion, transitioning to the 1-RBC represents a straightforward action in current practice that significantly reduces blood transfusions in patients undergoing ASCT, without negatively impacting clinical outcomes.

Data-driven education improves patient blood management: A pilot study

Abstract Introduction: We sought to increase the use of a restrictive transfusion protocol through clinician education and a standard approach to Patient Blood Management (PBM) in our gynecologic oncology service. Optimal PBM requires the consistent application of evidence-based, restrictive transfusion guidelines, however the use of restrictive transfusion is understudied in surgical oncology populations. We hypothesized that provider specific education that includes data derived from their own clinical practice would result in improved compliance current evidence-based transfusion guidelines. Methods: We created an educational activity that described evidence-based restrictive transfusion guidelines followed by data showing providers their own clinical transfusion practice where compliance with restrictive guidelines was poor. After the education, a plan to improve compliance was developed and put into place. Comparison of transfusion practices and complication/morbidity rates before and after the education was performed. Results: During the 18 months post-education the number of RBC units transfused decreased from 316 152, a 57% reduction and monthly transfusion events were reduced by 42% from 12 to 7 per month. The percent of transfusions with a pretransfusion hemoglobin less than 7 g/dL increased from 40% to 56%. The percent of transfusions with a hemoglobin less than 8 g/dL increased to 90%. Finally, the use of single unit transfusions increased from 49 to 85%, a major contributor to the reduction in units transfused. Conclusion: We created a service-specific educational intervention that improved compliance with evidence-based restrictive transfusion practice. This intervention improved provider compliance with lower transfusion thresholds and increased the use of single-unit transfusions.

Is it time for the death knell of single-unit plasma?

A plasma transfusion dose should be weight-based (10-20 mL/kg), which equates to three to four units in an average-sized adult; therefore, the transfusion of single units under most circumstances is sub-therapeutic. This retrospective observational study examined the prevalence of single-unit plasma transfusion in adults within a 12-hospital system from 1 January 2018, to 31 December 2019. During the study period, 5791 patients received plasma transfusions. The overall prevalence of single-unit plasma was 17.1% for 988 patients. The majority, 3047 (52.6%), occurred at one hospital, 2132 (36.9%) among five hospitals and 612 (10.7%) at the remaining six hospitals. Cardiac and gastrointestinal (GI)/transplant transfused 2707 (46.8%), combined respiratory, neurological, orthopaedic and congenital/dermatology/other comprised 2133 (36.9%) of the six hospitals that transfused less than 200 patients, four (66.7%) transfused single units above the overall prevalence. In this hospital system, more than one in six patients received a transfusion of a single plasma unit. Six of the 12 hospitals had 89.5% of the patients who were transfused plasma. Six service lines transfused 83.7% of all patients receiving plasma. Hospitals that infrequently transfused plasma were more likely to under-dose.

Evaluating patient blood management practices using PBM metrics in a tertiary care center

BackgroundPBM metrics play a crucial role in assessing and monitoring the effectiveness of PBM programs in healthcare settings. The present study aimed to assess the indicators to achieve effective enforcement of PBM at a tertiary care referral hospital. Subjects and MethodA prospective observational study was conducted on patients admitted for elective surgery at a tertiary care referral centre. PBM metrics were developed and assessed for various parameters, including documentation, patient evaluation, blood ordering schedule, and appropriateness. Experts in transfusion medicine and haematology checked content validity. Eleven different parameters were analysed, and a score was assigned based on the performance. The outcome was categorized as poor, satisfactory, or good. ResultsThe study included 612 patients meeting the inclusion criteria and recruited from Orthopaedics, General Surgery, OBG, Urology, and ENT departments. All departments completed pre-operative anaemia tests, with General Surgery and Orthopaedics conducting the most red cell transfusions. During the study, all of the blood units were used, and there was no waste. The C/T ratio was greater in the Departments of General Surgery, Urology, and Otorhinolaryngology. Pre-operative anaemia was found in 44.12% of patients, 44 patients had red cell transfusions, with 65% getting single-unit PRBC transfusions. All departments received a PBM score between 17–19, showing adequate PBM but with room for improvement. ConclusionThe current study utilized Patient Blood Management (PBM) metrics to critically assess the existing practices and identify the key gaps and areas for improvement in a tertiary care centre.

Regulation of kynurenine metabolism by blood donor genetics and biology impacts red cell hemolysis in vitro and in vivo

AbstractIn the field of transfusion medicine, the clinical relevance of the metabolic markers of the red blood cell (RBC) storage lesion is incompletely understood. Here, we performed metabolomics of RBC units from 643 donors enrolled in the Recipient Epidemiology and Donor Evaluation Study, REDS RBC Omics. These units were tested on storage days 10, 23, and 42 for a total of 1929 samples and also characterized for end-of-storage hemolytic propensity after oxidative and osmotic insults. Our results indicate that the metabolic markers of the storage lesion poorly correlated with hemolytic propensity. In contrast, kynurenine was not affected by storage duration and was identified as the top predictor of osmotic fragility. RBC kynurenine levels were affected by donor age and body mass index and were reproducible within the same donor across multiple donations from 2 to 12 months apart. To delve into the genetic underpinnings of kynurenine levels in stored RBCs, we thus tested kynurenine levels in stored RBCs on day 42 from 13 091 donors from the REDS RBC Omics study, a population that was also genotyped for 879 000 single nucleotide polymorphisms. Through a metabolite quantitative trait loci analysis, we identified polymorphisms in SLC7A5, ATXN2, and a series of rate-limiting enzymes (eg, kynurenine monooxygenase, indoleamine 2,3-dioxygenase, and tryptophan dioxygenase) in the kynurenine pathway as critical factors affecting RBC kynurenine levels. By interrogating a donor-recipient linkage vein-to-vein database, we then report that SLC7A5 polymorphisms are also associated with changes in hemoglobin and bilirubin levels, suggestive of in vivo hemolysis in 4470 individuals who were critically ill and receiving single-unit transfusions.

Using blood wisely in oncology patients: An institutional experience implementing Choosing Wisely Canada restrictive transfusion practices.

382 Background: Using Blood Wisely is a national Choosing Wisely Canada (CWC) initiative that challenges hospitals to benchmark themselves on evidence-informed restrictive transfusion strategies, with the aim to decrease inappropriate red blood cell (RBC) transfusions in Canada. We previously assessed transfusion practices among oncology patients at BC Cancer Vancouver during a 12-month period. Here we present the results of a second audit, after implementation of quality improvement (QI) interventions. Methods: BC Cancer Vancouver RBC transfusion records were obtained for the periods of October 2019-September 2020 and April 2021-March 2022. The percentage of transfusions that were single-unit or for hemoglobin (Hg) ≤80 g/L were measured to assess adherence to CWC targets of ≥65% and ≥80%, respectively, for these metrics. QI interventions were implemented after the first audit, including staff education (grand rounds presentation, sitewide email bulletin) and direct engagement of ordering physicians by nursing staff. Uni- and multivariate analyses were used to test associations between patient characteristics and transfusion outcomes. Results: Single-unit transfusions increased from 41% in inpatients (49/120) and 12% in outpatients (69/586) in the first audit, to 86% (126/146) in inpatients ( P&lt;0.001) and 34% (170/495) in outpatients ( P&lt;0.001) in the second audit. Transfusions for Hg ≤80 g/L increased from 79% (95/120) in inpatients and 66% (384/586) in outpatients, to 93% (136/146) in inpatients ( P=0.001) and 78% (384/495) in outpatients ( P&lt;0.001). Patient factors associated with restrictive transfusion practices included inpatient status and having a hematological malignancy. Conclusions: In the face of fluctuating RBC shortages, interventions aimed at high-use populations like oncology patients are crucial to reducing transfusion overuse. Through education and prescriber engagement, we successfully reduced the rate of inappropriate RBC transfusions at our institution and achieved the status of a designated Using Blood Wisely Hospital.[Table: see text]

Effects of transfusing older red blood cells and platelets on obstetric patient outcomes: A retrospective cohort study.

To investigate associations between transfusion of blood products close to the end of shelf-life and clinical outcomes in obstetric inpatients. Mortality and morbidity were compared in patients transfused exclusively with red blood cells (RBC) stored for less than 21 days (fresh) versus RBC stored for 35 days or longer (old), and platelets (PLT) stored for 3 days or fewer (fresh) versus 4 days or longer (old) in Queensland, Australia from 2007 to 2013. Multivariable models were used to examine associations between these groups of blood products and clinical end points. There were 3371 patients who received RBC and 280 patients who received PLT of the eligible storage durations. Patients transfused with old RBC received fewer transfusions (2.7 ± 1.8 vs. 2.3 ± 1.0 units; P < 0.001). However, a higher rate of single-unit transfusions was also seen in those patients who exclusively received old RBC (252 [9.3%] vs. 92 [13.7%]; P = 0.003). Comparison of fresh vs. old blood products revealed no differences in the quantities of transfused RBC (9.5 ± 5.9 vs. 9.1 ± 5.2 units; P = 0.680) or PLT (1.5 ± 0.8 vs. 1.4 ± 1.1 units; P = 0.301) as well as the length of hospital stay for RBC (3 [2-5] vs. 3 [2-5] days; P = 0.124) or PLT (5 [4-8] vs. 6 [4-9] days; P = 0.120). Transfusing exclusively older RBC or PLT was not associated with increased morbidity or mortality.

Associations of donor, component, and recipient factors on hemoglobin increments following red blood cell transfusion in very low birth weight infants.

Anemia in very low birth weight (VLBW) infants is common and frequently managed with red blood cell (RBC) transfusions. We utilized a linked vein-to-vein database to assess the role of blood donors and component factors on measures of RBC transfusion effectiveness in VLBW infants. We linked blood donor and component manufacturing data with VLBW infants transfused RBCs between January 1, 2013 and December 31, 2016 in the Recipient Epidemiology Donor Evaluation Study-III (REDS III) database. Using multivariable regression, hemoglobin increments and subsequent transfusion events following single-unit RBC transfusion episodes were examined with consideration of donor, component, and recipient factors. Data on VLBW infants (n = 254) who received one or more single-unit RBC transfusions (n = 567 units) were linked to donor demographic and component manufacturing characteristics for analysis. Reduced post-transfusion hemoglobin increments were associated with RBC units donated by female donors (-0.24 g/dL [95% confidence interval (CI) -0.57, -0.02]; p = .04) and donors <25 years old (-0.57 g/dL [95% CI -1.02, -0.11]; p = .02). For RBC units donated by male donors, reduced donor hemoglobin levels were associated with an increased need for subsequent recipient RBC transfusion (odds ratio 3.0 [95% CI 1.3, 6.7]; p < .01). In contrast, component characteristics, storage duration, and time from irradiation to transfusion were not associated with post-transfusion hemoglobin increments. Donor sex, age, and hemoglobin levels were associated with measures of RBC transfusion effectiveness in VLBW infants. Mechanistic studies are needed to better understand the role of these potential donor factors on other clinical outcomes in VLBW infants.

Effect of Single-Unit Transfusion Guideline on Red Blood Cell Transfusion for Obstetric Patients [ID: 1375663

INTRODUCTION: The American Red Cross recently declared a national blood crisis. We aimed to evaluate the effect of a single-unit transfusion guideline on the transfusion rate. METHODS: An interdisciplinary quality improvement initiative to reduce blood transfusion for postpartum hemorrhage (PPH) was conducted in a tertiary obstetric hospital with approximately 5,000 births annually. Opportunities for improvement were prioritized including antepartum anemia treatment, early recognition and treatment of PPH, and blood stewardship. The baseline period was January 2019 to December 2020. The intervention period was July 2021 to April 2022. We recommended transfusions begin with an order for a single unit of blood (“Start with One”). Plan-do-check-act cycles were initiated. The clinical outcome was units of blood transfused per 1,000 deliveries. Relative risks, t tests, and control charts were used for analysis. The quality improvement project was IRB exempt (HUM00213652). RESULTS: Incidence of PPH decreased between baseline and intervention periods (relative risk 0.83, 95% CI 0.77–0.90). The baseline transfusion rate was 79.3 units of blood per 1,000 births. During the intervention period, this decreased by 32.8% to 53.2 units per 1,000 births (P=.004). Special cause variation was found after introduction of the “Start with One” campaign: 8 consecutive months in the intervention period have been above the mean proportion for single-unit transfusions. CONCLUSION: A single-unit transfusion guideline, as part of a multimodal strategy to reduce PPH, was associated with a significant decrease in red cell transfusion. The current national blood shortage should be a call to action for all obstetric providers to safely reduce the volume of blood transfusions.

Effect of single-unit transfusion in patients treated for haematological disease including acute leukemia: A multicenter randomized controlled clinical trial

BackgroundRetrospective studies in hematological unit have suggested that single red blood cell (1-RBC) unit transfusion policy may reduce the number of RBC used without negative clinical impact. MethodAcute leukemia patients requiring intensive chemotherapy or patients receiving autologous or allogeneic transplantation were randomly assigned to receive either single RBC (1-RBC arm) or double RBC (2-RBC arm) per transfusion with a hemoglobin trigger of 8 g/dL. The primary composite endpoint was the percentage of patients experiencing serious complications, such as a non-hematological adverse event grade ≥ 3 or intensive care admission or death. FindingsA total of 981 and 592 RBC transfusions were required in the 1-RBC arm (n = 125) and the 2-RBC arm (n = 120), respectively. The mean pre-transfusion hemoglobin levels were 7.49 ± 0.83 g/dL in the 1-RBC arm and 7.46 ± 0.67 g/dL in the 2-RBC arm (p = 0.275). The predefined non-inferiority criteria was achieved with 28/125 patients reaching the primary endpoint in the 1-RBC arm (22.4 %) and 28/120 patients in the 2-RBC arm (23.3 %) (Risk difference 0.009; 95 %, Confidence interval [−0.0791 to 0.0978], p = 0.021). The median (IQR) of RBC units transfused per patient was 7 (4–12) in the 1-RBC arm and 8 (4–12) in 2-RBC arm. Hemoglobin levels at discharge were also comparable in both arms. InterpretationThe results of this trial indicate that a single RBC transfusion policy is not inferior to a double RBC transfusion policy for patients receiving a bone marrow transplant or intensive chemotherapy in a hematological intensive care unit. However, the single RBC transfusion policy did not reduce the number of RBC units transfused per stay. FundingThis trial was funded by a grant from the French Ministry of Health

Single-unit vs Multiple-unit Transfusion During Curative Cancer Surgery: A Prospective Observational Study

Introduction: Blood transfusions can be lifesaving interventions but have also been linked with increased rates of postoperative complications. It has been shown that even one unit of blood transfused during surgery is associated with increased postoperative complications. There are few studies on the cancer patient population. More information on the adverse effects of transfusing more than one unit of blood, particularly during cancer surgery, would provide a better understanding of the complications associated with increased blood transfusions in cancer patients.Methods: Following USF IRB approval, the medical records of all patients who received a blood transfusion during curative cancer surgery at Moffitt Cancer Center from December 1, 2021 to December 31, 2021 were reviewed to collect data from prospectively enrolled patients. Perioperative data were collected, which included postoperative complications, intensive care unit admission, length of hospital stay, and readmission rates within 30 days.Results: There was a total of 32 patients who received a blood transfusion during curative cancer surgery at Moffitt Cancer Center from December 1, 2021 to December 31, 2021 which made the overall transfusion rate of 5.31%. Of those who received perioperative blood transfusions, 56.3% received more than one unit of blood. There were no significant differences between the groups who received 1 or >1 unit in terms of preoperative demographics, intraoperative data, hospital length of stay, or postoperative complications at 30 days, except intraoperative blood loss.Conclusion: There were no significant differences in outcomes between patients who received only 1 unit of blood vs patients who received >1 unit when cancer patients underwent curative surgery. We found that many patients who received a blood transfusion during curative cancer surgery were preoperatively anemic.

A Retrospective Review of Red Blood Cell Transfusion Practices in a Rural Community Hospital System

Introduction: Anemia is associated with increased length of stay and mortality in hospitalized patients. Red blood cell (RBC) transfusions could be lifesaving intervention and are generally used as a stabilizing measure until underlying etiology of anemia is identified and corrected. However, RBC transfusions have several adverse effects which occasionally could be life-threatening, including transfusion associated infections, immunologic reactions, volume overload, electrolyte imbalances, and iron overload. The decision on RBC transfusions should be based on patient's clinical status and physician's judgment, supported by data from randomized trials. Methods: In efforts to improve RBC transfusion practices in Northern Arizona Healthcare (NAH) facilities, all RBC transfusions between 01/01/2021 and 03/31/2022 were evaluated. Based on randomized clinical trial data, the following RBC transfusion thresholds were considered: Hemoglobin (Hgb) <8 g/dL for hospitalized anemic patients with established cardiovascular disease (CVD) or undergoing surgery, and Hgb <7 g/dL in hemodynamically stable hospitalized patients. Transfusions in pediatric patients, active/suspected blood loss, anemia with hemodynamic instability and massive or recurrent transfusions were excluded from the analysis. For the purpose of this study, RBC transfusion was deemed to be unjustified in cases where only 1 unit of RBC could have been sufficient to raise Hgb level above the specified threshold, however >1 unit was used with no clear justification. Results: A total of 2756 units of RBC transfusions were analyzed in hospitalized patients ages 18-102 years. Three patient groups were identified based on the documented provider justification for RBC transfusions: 1) Hgb <7 g/dL, 2) Hgb <8 g/dL with established CVD or undergoing surgery, 3) "other" who did not meet criteria for the previous groups. In the "other" group, the justification was manually entered by the provider. In the Hgb <7 group, 2004 RBC units were transfused in 1019 patients. Of those, 1440 units were transfused for Hgb level of 6.0-6.9 g/dL in 837 patients, with 273 patients receiving 2-4 units of RBCs when 1 unit could have been sufficient to raise the Hgb level >7 g/dL. Therefore, 303 RBC units were considered unjustified. Also, 83 units were deemed unjustified as they were transfused in 72 patients with pre-transfusion Hgb of ≥7.0 g/dL. In the Hgb <8 group, a total of 711 units were transfused in 500 patients. In the CVD group, 401 units were transfused in 287 patients, of which 260 patients had a Hgb of 7.0-7.9 g/dL. Thirty-four of these patients received 2-3 units when 1 unit was deemed sufficient to increase Hgb >8 (35 unjustified units). Additionally, 5 patients received at least 1 unit of RBC when Hgb was ≥8.0 g/dL (6 unjustified units). In patients undergoing surgery, 213 patients received 310 units. Of those, 150 patients had a Hgb 7.0-7.9 g/dL, 23 of which received >1 units (23 unjustified units). In the group classified as "other", 41 units were transfused in 39 patients. Hgb levels in this group were between 6.7 to 13.3 g/dL. After further evaluation, 18 units transfused in 17 patients were deemed to be unjustified. Discussion: RBC transfusion practices were evaluated in two hospitals in a rural setting in Arizona. From a total of 2756 units, 468 (16.9%) were deemed to be unjustified. The majority of these cases were seen in the Hgb <7 group. This is the first evaluation of RBC transfusion practices at this institution and a stepping stone to implement measures to improve these practices in the future. The next step includes creating an order set module that would not only require providing justification for blood transfusion, but also confirmation of pre-transfusion and desired target Hgb levels. Additionally, it would implement a notification encouraging single unit transfusions when feasible to decrease transfusion associated adverse reactions and cost burden on patients. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Successful Collaboration of a Hospital Based Blood Center and Blood Bank during the Pandemic and Blood Shortage

Abstract Introduction/Objective At the beginning of the SARS-Co-V2 pandemic, many hospitals implemented mitigating strategies to preserve their blood supply in anticipation of a blood shortage. Our health system, Inova (IHS), which includes 5 hospitals supported by our hospital based blood services, was no different. During the pandemic we experienced a decline in donations and available blood products. In anticipation of this shortage, our institution mobilized the Patient Blood Management (PBM) initiative. A multidisciplinary review of transfusion criteria was performed across the system. This included enforcing single unit red blood cell (RBC) transfusions, partial RBC exchanges for sickle-cell disease, and reduction in plasma replacement volume during plasma exchanges for patients with thrombotic thrombocytopenic purpura (TTP). By implementing these strategies, patient outcomes were not impacted despite the constraints to our blood supply. Methods/Case Report IHS Executive leaders were identified to participate along with key stakeholders in the PBM committee meetings to ensure proper blood utilization for our patients. Clinical guidelines were updated within the physician order sets. Data was compiled with a focus on hemoglobin metrics along with the percentage of single unit transfusions. Collaborating with IHS Apheresis Services and our providers, we developed a strategy to reduce the number of blood products transfused. Results (if a Case Study enter NA) Although there was decline in donor blood collections during the pandemic due to significant concerns of SARS-CO-V2 exposure, the implementation of Patient Blood Management strategies at our institution proved to be beneficial for product management and resource allocation. Although there was a decline in the number of donations (6.5%) we were able to transfuse more patients. Conclusion The SARS-Co-V2 pandemic significantly reduced the blood inventory nationwide. By implementing a robust Patient Blood Management program, we were able to successfully utilize our blood inventory while maintaining transfusion practices that aligned with standards of care. The collaborative efforts between our hospital based blood center and the blood bank led to the optimal use of a reduced blood supply during the pandemic. Incorporating Patient Blood Management principles and safe implementation of novel treatment plans for certain apheresis patient population during the pandemic enabled our system to have more available blood products and care for more patients with improved patient outcomes.

Implementation of a patient blood management in an Italian City Hospital: is it effective in reducing the use of red blood cells?

To evaluate the effect of patient blood management (PBM) since its introduction, we analyzed the need for transfusion and the outcomes in patients undergoing abdominal surgery for different types of tumor pre- and post-PBM. Patients undergoing elective gastric, liver, pancreatic, and colorectal surgery between 2017 and 2020 were included. The implementation of the PBM program was completed on May 1, 2018. The patients were grouped as follows: those who underwent surgery before the implementation of the program (pre-PBM) versus after the implementation (post-PBM). A total of 1302 patients were included in the analysis (445 pre-PBM vs. 857 post-PBM). The number of transfused patients per year decreased significantly after the introduction of PBM. A strong tendency for a decreased incidence of transfusion was evident in gastric and pancreatic surgery and a similar decrease was statistically significant in liver surgery. With regard to gastric surgery, a single-unit transfusion scheme was used more frequently in the post-PBM group (7.7% vs. 55% after PBM; p = 0.049); this was similar in liver surgery (17.6% vs. 58.3% after PBM; p = 0.04). Within the subgroup of patients undergoing liver surgery, a significant reduction in the use of blood transfusion (20.5% vs. 6.7%; p = 0.002) and a decrease in the Hb trigger for transfusion (8.5, 8.2–9.5 vs. 8.2, 7.7–8.4 g/dl; p = 0.039) was reported after the PBM introduction. After the implementation of a PBM protocol, a significant reduction in the number of patients receiving blood transfusion was demonstrated, with a strong tendency to minimize the use of blood products for most types of oncologic surgery.

Passive order auditing associated with reductions in red blood cell utilization: National blood shortage experience.

Decreased blood collection during the Coronavirus Disease 2019 (COVID-19) pandemic resulted in long-term red blood cell (RBC) shortages in the United States. In an effort to conserve RBCs, the existing passive alert system for auditing inpatient transfusions was modified to activate at a lower hemoglobin threshold (6.5g/dL instead of 7.0g/dL for stable, nonbleeding inpatients) during a 9-month shortage at an academic medical center. Hemoglobin levels prior to RBC transfusions were compared for inpatients receiving RBC transfusions to determine whether RBC utilization changed during the intervention. This retrospective study compared the number of single-unit RBC transfusions and hemoglobin levels prior to RBC transfusion among inpatients during the 9months of the intervention (Period 2, 06/01/2021-2/28/2022) to the same period of the previous year (Period 1, 06/01/2020-2/28/2021). Overall full unit RBC transfusions to inpatients decreased by 15% from 5182 to 4421. Of all transfusions, 50.3% and 49.8% were single-unit RBC transfusions in Period 1 and Period 2, respectively. The incidence rate difference and incidence rate ratio of single RBC units transfused per 1000 patient days were significantly decreased (p=0.0007). The average pre-transfusion hemoglobin level significantly decreased from 7.18 g/dL to 7.05 g/dL (p=0.0002), largely due to significant decreases in hemoglobin transfusion triggers for adult inpatient ward transfusions. Modification of the passive alert system was associated with significantly decreased RBC utilization during a long-term RBC shortage. Modification of transfusion criteria recommended by passive alerts may be a feasible option to decrease RBC utilization at centers during long-term RBC shortages.

An Audit of Clinical Cases of Dengue Fever and the Usage of Platelets in Such Cases in a Tertiary Care Hospital in Hyderabad

Background and Objectives: Dengue is an acute self-limited systemic viral infection caused by the dengue virus of the family Flaviviridae. The incidence of dengue fever has been increasing for the past few years and dengue has become a global problem. The current data required for further improving the treatment policies are scanty. Our study aims to capture the demographic and clinical characteristics of the patients enrolled in the study, to see any correlation between thrombocytopenia and bleeding tendencies and other transfusion-related parameters. Methods: The study is a prospective cohort study. All seropositive dengue cases were included in the study. A format was prepared for documenting the demographic data, history, clinical characteristics, spectrum of the disease, the laboratory details of the patient (platelet count, prothrombin time, activated partial thromboplastin time, Hematocrit, and indication). All the transfusion requirement data were collected from the blood center registers. Overall mortality in the study group, number of hospital readmissions, and episodes of exacerbation of symptoms was recorded separately. Results: A total of 270 cases were included in the audit who fulfilled the inclusion and exclusion criteria. The median age of the patient pool was 27 (4–66 years range). Twenty-six percent of the cases developed hemorrhages. Eighty-four single-donor platelets (SDPs) and 340 random-donor platelets (RDPs) were used. A mean of 270 ml of products was transfused per patient. The mortality rate was 0.8%. The mean duration of hospitalization was 1 week. In 72% of cases, platelet count was restored in single-unit transfusion. Ninety-nine percent of the product utilization were within the guidelines recommended. Conclusion: A good monthly audit of blood product utilization is a good guide for treatment. Quality control and rational use of SDPs and RDPs are important in sick and thrombocytopenic patients resulting in better clinical outcomes.

The effect of clinician education on blood transfusion practice in obstetrics: completing the audit cycle.

With blood products being alimited and expensive resource within the healthcare system, there is an ever-increasing emphasis on judicial and appropriate use. To evaluate whether implementing contemporary society recommendations on restrictive transfusion policies would reduce inappropriate use of red blood cell transfusions, by evaluating the effect of a staff educational campaign. An audit of peri-partum red cell concentrate (RCC) transfusion practice within a tertiary obstetric unit was undertaken, covering a 1-year period (2015), examining data related to transfusion prescribing practices. Subsequently, an educational programme was held for clinical and laboratory staff which aimed to bring practice in line with society guidelines. A repeat audit covering another 1-year period (2018) was undertaken. The number of RCC units of transfused reduced by 49% between 2015 and 2018 (426 to 218). The number of patients receiving transfusion dropped from 166 in 2018 (1.8% of births) to 119 in 2015 (1.5% of births). Among stable patients who were transfused, the proportion receiving a single unit increased from 6.9 to 53.9%. (p < 0.001). Haematological reassessment between units rose from 13.8 to 80.4% (p < 0.001). Written consent documentation improved (68% in 2018 vs. 38% in 2015) (p < 0.001). The implementation of guidelines has resulted in substantial reduction in RCC transfusions between 2015 and 2018. Fewer women received a blood transfusion, and those who did received fewer units. There is a higher proportion of patients being reassessed between units and receiving single unit transfusions. Recording of consent has improved.