Administration Of Transfusions Research Articles

Implementation of a Standardized Red Blood Cell Transfusion Policy in a Level IV Neonatal Intensive Care Unit: A Quality Improvement Project.

Within the neonatal intensive care unit (NICU), infants frequently receive packed red blood cell (PRBC) transfusions. Although medically necessary, potential negative long- and short-term outcomes exist following PRBC transfusions in very low birth-weight (VLBW) infants (<1500g). Synthesis of the literature demonstrates that the use of a restrictive PRBC transfusion policy can lead to a decreased number of transfusions administered with no increase in long-term neurodevelopmental outcomes. Blood transfusions have also been linked to the diagnosis of necrotizing enterocolitis (NEC) or intraventricular hemorrhage (IVH) in VLBW infants. For this quality improvement project, a restrictive PRBC transfusion policy was implemented in a level IV NICU to promote consistent care and evaluate changes in PRBC administration. The data were collected both pre- and post-policy implementation including: the number of blood transfusions, diagnosis of NEC, and diagnosis of IVH among infants <1500g. The data showed no significant change in the number of PRBC transfusions administered. Likewise, few infants were diagnosed with NEC or IVH during this same time period with minimal change between pre- and post-policy implementation data. Following policy implementation, there was a significant improvement in communication among providers regarding transfusion ordering and the inclusion of hematocrit thresholds in daily progress notes. This unintended outcome has helped to promote sustainability and enhance patient care within the NICU where this policy was implemented. Continued data collection may be beneficial in indicating whether a standardized PRBC transfusion policy will impact the administration of transfusions and diagnosis of NEC or IVH.

Clinical benefits of parenteral iron carboxymaltose in patients with colorectal cancer: a retrospective observational study

Background. The high incidence of anemia in colorectal cancer and its severe consequences for patients determine the need for timely diagnosis and correction of this condition. At the same time, it is extremely important to choose a method for correcting anemia, allowing to achieve maximum efficiency and safety. Aim. To evaluate perioperative methods for correcting iron deficiency anemia in patients with colorectal cancer based on a comparative analysis of the clinical results of intravenous administration of iron carboxymaltose and transfusion of blood components. Materials and methods. The results of treatment of 594 patients with colorectal cancer operated on in 2022 at the department of surgical treatment methods No. 3 (abdominal oncology No. 1) of the Volgograd Regional Clinical Oncology Dispensary were studied. Stratification of patients into groups was carried out using the method of pseudo-randomization by sex and age to eliminate confounding errors. After pseudo-randomization in a 1:1 ratio, the sample of patients with anemia was divided into 2 groups (main group – 124 patients, in whose treatment blood-saving techniques and parenteral administration of iron carboxymaltose were used, and control group – 124 patients, for treatment of anemia in which transfusions of blood components were used). In 98 (39.5%) cases hemicolectomies were performed, in 88 (35.5%) – anterior resections of the rectum, in 36 (14.5%) – resections of the sigmoid colon, in 18 (7.3%) – extirpations of the rectum, in 8 (3.2%) – resection of the transverse colon, 217 (87.5%) operations were performed through laparotomy access, 31 (12.5%) using minimally invasive technologies. Results. The frequency of postoperative complications of grade III–V according to Clavien–Dindo score in the main group (4.8%, 6/124) was statistically significantly lower compared to the control group (14.5%, 18/124) [χ2=6.643; p=0.01]. Postoperative mortality in the main group was 0.8% (1/124), in the control group – 5.6% (7/124) [χ2=4.65; p=0.032]. Conclusion. The use of blood-saving technologies with parenteral administration of iron carboxymaltose in patients with colorectal cancer leads to a reduction in the number of postoperative complications and the level of postoperative mortality.

Perioperative Transfusion Practices in Adults Having Noncardiac Surgery

Surgical patients are often transfused to manage bleeding and anemia. Best practices for red blood cell (RBC) transfusion administration in patient having noncardiac surgery remains controversial and a robust evaluation and description of perioperative transfusion practices is lacking. We characterized perioperative hemoglobin concentrations and transfusion practices from the prospective VISION cohort which included 39,222 patients aged ≥45 years who had inpatient noncardiac surgery. Variations in transfusion practices were analyzed using hierarchical mixed models, and associations with mortality and complications were evaluated using a nested frailty survival model. Within the cohort, 16.1% (n = 6296) were given perioperative RBC transfusions, with the fraction declining from 20% to 13% over the 6-year study period. The proportion of patients transfused varied by surgery type from 6.4% for low-risk operations (i.e., minor surgery) to 31.5% for orthopedic surgeries. Variations were largely associated with patient hemoglobin concentrations, but also with center (range: 3.7%-27.3%) and country (0.4%-25.3%). Even after adjusting for baseline hemoglobin, comorbidities and type of surgery, both center and country were significant sources of variation in transfusion practices. Among transfused participants, 60.4% (n = 3728/6170) had at least 1 hemoglobin concentration ≤80g/L and 86.0% (n = 5305/6170) had at least 1 hemoglobin concentration ≤90g/L, suggesting that relatively restrictive transfusion strategies were used in most. The proportion of patients receiving at least 1 RBC transfusion declined from 20% to 13% over 6 years. However, there was considerable unexplained variation in transfusion practices.

Establishing a Benchmark for Iatrogenic Hemodilution and Blood Transfusion in Long-Segment Spine Fusion Surgery.

Single-center retrospective cohort study. To identify risk factors for transfusion during long-segment thoracolumbar fusion surgery and benchmark cutoffs that could be used by the operative team to guide the use of transfusion. Perioperative transfusion for patients undergoing long-segment thoracolumbar fusion surgery is common. To date, no standardized intra- and perioperative management of transfusion administration has been defined. Patients who underwent thoracolumbar fusion surgeries of 8 or more levels between 2015 and 2020 were identified. Patient demographics, surgical details, anesthesia and critical care records, and laboratory data were compared between patients who received intraoperative and postoperative blood transfusions and those who did not. Univariate and multivariate propensity-matched analyses were performed to identify independent predictors for blood transfusion, and ordinal analysis was performed to identify possible benchmark cutoffs. Among 233 patients identified who underwent long-segment fusions, 133 (57.1%) received a blood transfusion. Multivariate propensity-matched logistic regression showed that intravenous (IV) fluid volume was an independent predictor for transfusion (transfusion group 8051mL vs. non-transfusion group 5070mL, P<0.01). Patients who received ≥4L total IV fluids were more likely to undergo transfusion than those who received <4L (93.2% vs. 50.7%, P<0.01). Those receiving total IV fluids at a rate ≥60mL/Kg (OR 10.45; 95% CI: 2.62-41.72, P<0.01) or intraoperative IV fluids at a rate ≥9mL/Kg/hr (OR 4.46; 95% CI: 1.39-14.32, P<0.01) were more likely to require transfusions. IV fluid administration is an independent predictor for blood transfusion after long-segment fusion surgery. Limiting IV fluid administration may prevent iatrogenic hemodilution and decrease transfusion rates. These data can be used to create perioperative protocols with the goal of decreasing transfusion rates when not indicated and allowing earlier administration when indicated.

Amniotic fluid embolism rescued using venoarterial extracorporeal membrane oxygenation without initial anticoagulation: A case report and literature review.

Amniotic fluid embolism (AFE) is a fatal obstetric condition that often rapidly leads to severe respiratory and circulatory failure. It is complicated by obstetric disseminated intravascular coagulation (DIC) with bleeding tendency; therefore, the introduction of venoarterial extracorporeal membrane oxygenation (VA-ECMO) is challenging. We report the case of a patient with AFE requiring massive blood transfusion, rescued using VA-ECMO without initial anticoagulation. A 39-year-old pregnant patient was admitted with a complaint of abdominal pain. An emergency cesarean section was performed because a sudden decrease in fetal heart rate was detected in addition to DIC with hyperfibrinolysis. Intra- and post-operatively, the patient had a bleeding tendency and required massive blood transfusions. After surgery, the patient developed lethal respiratory and circulatory failure, and VA-ECMO was introduced. Based on the course of the illness and imaging findings, the patient was diagnosed with AFE. By controlling the bleeding tendency with a massive transfusion and tranexamic acid administration, using an antithrombotic ECMO circuit, and delaying the initiation of anticoagulation and anti-DIC medication until the bleeding tendency settled, the patient was managed safely on ECMO without complications. By day 5, both respiration and circulation were stable, and the patient was weaned off VA-ECMO. Mechanical ventilation was discontinued on day 6. Finally, she was discharged home without sequelae. VA-ECMO may be effective to save the lives of patients who have AFE with lethal circulatory and respiratory failure. For safe management without bleeding complications, it is important to start VA-ECMO without initial anticoagulants and to administer anticoagulants and anti-DIC drugs after the bleeding tendency has resolved.

Retrospective evaluation of the prevalence and risk factors associated with red blood cell transfusions in cats with urethral obstruction (2009-2019): 575 cases.

To evaluate the prevalence of red blood cell (RBC) transfusions and factors associated with the need for transfusion in cases of feline urethral obstruction (FUO). Secondarily, to compare survival to discharge in cats receiving an RBC transfusion versus those that did not. Retrospective, multi-institutional study from 2009 to 2019. Four university teaching hospitals. Six hundred twenty-two total occurrences of FUO in 575 cats. None. Medical records were retrospectively reviewed for pertinent information. The overall prevalence of severe anemia (PCV<0.20L/L [<20%]) at presentation was 1.0% (6/622). The prevalence of RBC transfusions during hospitalization was 2.1% (13/622). Cats that received an RBC transfusion weighed significantly less than those that did not (4.9 vs 5.8kg; P=0.034) and had a lower PCV at presentation (0.30L/L [30%] vs 0.41L/L [41%]; P<0.001). Hospitalization time (240 vs 72h) and indwelling urinary catheter time (168 vs 48h) were significantly longer in cats receiving a transfusion compared with those that did not (P<0.001). Creatinine concentrations were not significantly associated with transfusion administration, while BUN was higher in cats receiving a transfusion (15.35mmol/L [43mg/dL] vs. 11.78mmol/L [33mg/dL]; P=0.043). Transfusion rates were significantly higher in cats undergoing perineal urethrostomy (5.5%) compared with those that did not undergo surgery (0.97%; P<0.001). The overall survival to discharge rate was 96%. Cats not receiving an RBC transfusion were significantly more likely to survive to discharge than those that did (odds ratio: 14.7, 95% confidence interval: 1.8-37; P<0.001). FUO is rarely associated with severe anemia and the need for RBC transfusions. In this study, cats receiving an RBC transfusion were less likely to survive to discharge; therefore, requiring a blood transfusion may be associated with a worse prognosis. In addition, the need for surgical intervention was associated with a higher prevalence of RBC transfusions.

Not all operative time is created equal: operative time in relation to 30-day complications in benign laparoscopic hysterectomies

STUDY OBJECTIVE: To assess the relationship between operative time and specific 30-day postoperative complications across different intervals of operation duration in total laparoscopic hysterectomies (TLHs).DESIGN: A retrospective cohort study.SETTING: American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2011 to 2020.PATIENTS: 131,146 TLH cases.INTERVENTIONS: Eligible cases included benign laparoscopic hysterectomies with operative times between 20 and 499 min. We excluded cases involving disseminated cancer, emergency surgery, supracervical approaches, or concomitant procedures.MEASUREMENTS: Multivariable logistic regression analysis was used to evaluate the relationship between specific postoperative complications and operative time. Spline regression was used to analyze differences in the association between postoperative complications and operative time across different tertiles of operative duration.MAIN RESULTS: Multivariable logistic regression analysis demonstrated a significant association between operative time and complication occurrence for each complication type investigated, including unplanned readmission, urinary tract infections, superficial surgical site infections, blood transfusion administration, return to the operating room, and deep organ space infections. Multivariable logistic spline regression demonstrated that operative time contributed more strongly to the odds of a complication for shorter procedures than longer procedures. This relationship was more pronounced for major complications than minor complications.CONCLUSION: Operative time is a stronger risk factor for developing complications for shorter duration procedures than longer procedures. This is especially evident in major complications such as return to the operating room and deep organ space infections. Our results suggest that longer procedure duration may not affect the likelihood of a complication as much as previously thought, and operative times should not be a primary factor in deciding to convert to laparotomy or alter post-operative management.

Blood Transfusion Procedure: Assessment of Serbian Intensive Care Nurses' Knowledge.

Many patients require administering one or more blood components during hospitalisation in the Intensive Care Unit (ICU). Therefore, nurses' knowledge of who is responsible for immediately administering blood transfusions, monitoring patients, and identifying and managing transfusion reactions is crucial. This cross-sectional descriptive-analytical study aimed to assess the knowledge of ICU nurses in tertiary healthcare institutions about blood transfusion procedures. The questionnaire about the transfusion procedure was designed and reviewed by experts. The questionnaire consisted of 29 items divided into three domains. The scores on the knowledge test ranged from 10 to 27. Generally, 57.7% of nurses had moderate, 23.4% low, and 18.9% high levels of knowledge about the transfusion procedure. Most nurses answered correctly about refreezing fresh frozen plasma, verifying the transfusion product, and identifying the patient. Of the nurses, 91.0% would recognise mild allergic reactions, and 98.2% knew about the supervision of sedated patients. Nurses showed poor knowledge of the length of usage of the same transfusion system for red blood cells, labelling, and transfusion administration in febrile patients. Nurses with higher education and longer working experience had significantly better outcomes (p = 0.000) on the knowledge test. Continuous education of ICU nurses on safe transfusion usage is recommended.

Intrarectal formalin treatment for haemorrhagic radiation-induced proctopathy: efficacy and safety.

Pelvic radiotherapy is limited by dose-dependent toxicity to surrounding organs. The aim of this prospective study was to evaluate the efficacy and safety of intrarectal formalin treatment for radiotherapy-induced haemorrhagic proctopathy (RHP) at the Royal Marsden Hospital. Adult patients were enrolled. Haemoglobin was evaluated before and after formalin treatment. Antiplatelet and/or anticoagulation treatment and administration of transfusion were recorded. The interval between completion of radiotherapy and the first intrarectal 5% formalin treatment was assessed and the dose of radiotherapy was evaluated. Clinical assessment of the frequency and amount of rectal bleeding (rectal bleeding score 1-6) and endoscopic appearance (grade 0-3) were classified. Complications were recorded. Nineteen patients were enrolled, comprising 13 men (68%) and 6 women. The mean age was 75 ± 9 years. The median time between completion of radiotherapy and the first treatment was 20 months [interquartile range (IQR) 15 months] and the median dose of radiotherapy was 68 Gy (IQR 14 Gy). Thirty-two procedures were performed (average 1.7 per patient). In total, 9/19 (47%) patients were receiving anticoagulation and/or antiplatelet medication and 5/19 (26%) received transfusion prior to treatment. The mean value of serum haemoglobin before the first treatment was 110 ± 18 g/L and afterwards it was 123 ± 16 g/L (p = 0.022). The median rectal bleeding score before the first treatment was 6 (IQR 0) and afterwards 2 (IQR 1-4; p < 0.001), while the median endoscopy score on the day of first treatment was 3 (IQR 0) compared with 1 (IQR 1-2) on the day of the last treatment 1 (p < 0.001). One female patient with a persistent rectal ulcer that eventually healed (18 months of healing) subsequently developed rectovaginal fistula (complication rate 1/19, 5%). Treatment with intrarectal formalin in RHP is effective and safe.

Implementation of a prehospital whole blood program: Lessons learned.

Early blood administration by Emergency Medical Services (EMS) to patients suffering from hemorrhagic shock improves outcomes. Prehospital blood programs represent an invaluable resuscitation capability that directly addresses hemorrhagic shock and mitigates subsequent multiple organ dysfunction syndrome. Prehospital blood programs must be thoughtfully planned, have multiple safeguards, ensure adequate training and credentialing processes, and be responsible stewards of blood resources. According to the 2022 best practices model by Yazer etal, the four key pillars of a successful prehospital program include the following: (1) the rationale for the use and a description of blood products that can be transfused in the prehospital setting, (2) storage of blood products outside the hospital blood bank and how to move them to the patient in the prehospital setting, (3) prehospital transfusion criteria and administration personnel, and (4) documentation of prehospital transfusion and handover to the hospital team. This concepts paper describes our operational experience using these four pillars to make Maryland's inaugural prehospital ground-based low-titer O-positive whole blood program successful. These lessons learned may inform other EMS systems as they establish prehospital blood programs to help improve outcomes and enhance mass casualty response.

Adherence to a restrictive red blood cell transfusion strategy in critically ill patients: An observational study.

Randomized controlled trials relatively consistently show that restrictive red blood cell (RBC) transfusion strategies are safe and associated with similar outcomes compared to liberal transfusion strategies in critically ill patients. Based on these data, the general threshold for RBC transfusion was changed to 70 g/L at a 9-bed tertiary level intensive care unit in September 2020. Implementation measures included lectures, webinars and feedback during clinical practice. The aim of this study was to investigate how implementation of a restrictive transfusion strategy influenced RBC usage, haemoglobin trigger levels and adherence to prescribed trigger levels. In this registry-based, observational study, critically ill adult patients without massive bleeding were included and divided into a pre-cohort, with admissions prior to the change of transfusion strategy, and a post-cohort, with admissions following the change of transfusion strategy. These cohorts were compared regarding key RBC transfusion-related variables. In total 5626 admissions were included in the analyses (pre-cohort n = 4373, post-cohort n = 1253). The median volume (interquartile range, IQR) of RBC transfusions per 100 admission days, in the pre-cohort was 6120 (4110-8110) mL versus 3010 (2890-4970) mL in the post-cohort (p < .001). This corresponds to an estimated median saving of 1128 € per 100 admission days after a restrictive RBC transfusion strategy was implemented. In total, 26% of the admissions in the pre-cohort and 19% in the post-cohort (p < .001) received RBC transfusion(s) during days 0-10. Both median (IQR) prescribed trigger levels (determined by intensivist) and actual haemoglobin trigger levels (i.e., levels prior to actual administration of transfusion) were higher in the pre- versus post-cohort (90 [80-100] vs. 80 [72-90] g/L, p < .001 and 89 [82-96] g/L vs. 83 [79-94], p < .001, respectively). Percentage of days without compliance with the prescribed transfusion trigger was higher in the pre-cohort than in the post-cohort (23% vs. 14%, p < .001). Sensitivity analyses, excluding patients with traumatic brain injury, ischemic heart disease and COVID-19 demonstrated similar results. Implementation of a restrictive transfusion trigger in a critical care setting resulted in lasting decreased RBC transfusion use and costs, decreased prescribed and actual haemoglobin trigger levels and improved adherence to prescribed haemoglobin trigger levels.

Immune gene polymorphisms associated with poor response to platelet transfusion and recombinant factor VII administration in Glanzmann thrombasthenia.

Poor response to platelet and recombinant factor VII administration is a major problem in patients with Glanzmann Thrombasthenia (GT). The risk factors associated with poor response to treatment in these patients are unknown. Some genetic variations of cytokines may contribute to therapy resistance. We evaluated, for the first time, whether genetic polymorphisms on cytokine genes are related to poor treatment response in GT patients. We enrolled 30 patients with GT (15 resistant and 15 non-resistant) and 100 healthy controls. Gene polymorphisms of IL-10 and TNF-α were analysed using TaqMan Realtime PCR, and IL-1, IL-1R1 and IL-1RN were investigated with the RFLP method. In-silico analyses were performed to predict the potential impact of these polymorphisms. In the resistant group, all patients had a variant of the IL-10 gene at the -1082 position (rs1800896), with a GG genotype that was significantly more frequent than the non-resistant group. Analysis between healthy controls and GT patients revealed a probable correlation between rs3783550, rs3783553, rs3917356 and rs2234463 and GT. The In-silico study indicated that TNF-α rs1800629 and IL-10 rs1800896 polymorphisms result in different allelic expressions which may contribute to poor response to therapy. These findings suggest that polymorphisms in the IL-10 and IL-1 receptor antagonist genes may play a role in poor therapy response in GT patients. In addition, some polymorphisms in IL-1α, IL1-β, IL-1R1 and IL-R antagonists might be involved in the GT progression.

Measuring evidence-based clinical guideline compliance in the paediatric intensive care unit

BackgroundEvidence-based clinical care guidelines improve medical treatment by reducing error, improving outcomes and possibly lowering healthcare costs. While some data exist on individual guideline compliance, no data exist on overall...

Patient-tailored platelet transfusion practices for children supported by extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation (ECMO) serves as cardiopulmonary therapy in critically ill patients with respiratory/heart failure and often necessitates multiple blood product transfusions. The administration of platelet transfusions during ECMO is triggered by the presence or risk of significant bleeding. Most paediatric ECMO programmes follow guidelines that recommend a platelet transfusion threshold of 80-100 × 109/L. To reduce exposure to platelets, we developed a practice to dynamically lower the threshold to ~20 × 109/L. We describe our experience with patient-tailored platelet thresholds and related bleeding outcomes. We retrospectively evaluated our platelet transfusion policy, bleeding complications and patient outcome in 229 ECMO-supported paediatric patients in our unit. We found that more than 97.4% of patients had a platelet count <100 × 109/L at some point during their ECMO course. Platelets were transfused only on 28.5% of ECMO days; and 19.2% of patients never required a platelet transfusion. The median lowest platelet count in children who had bleeding events was 25 × 109/L as compared to 33 × 109/L in children who did not bleed (p < 0.001). Our patients received fewer platelet transfusions and did not require more red blood cell transfusions, nor did they experience more haemorrhagic complications. We have shown that a restrictive, 'patient-tailored' rather than 'goal-directed' platelet transfusion policy is feasible and safe, which can greatly reduce the use of platelet products. Although there was a difference in the lowest platelet counts in children who bled versus those who did not, the median counts were much lower than current recommendations.

Early red blood cell transfusion and the occurrence of intraventricular hemorrhage in very preterm infants

BackgroundPreterm infants are at risk of developing both intraventricular hemorrhage (IVH) and anemia of prematurity. Several studies reported an association between early postnatal red blood cell (RBC) transfusion and IVH, however the timing and causality between these two remains unclear. AimsTo describe the temporal sequence between administration of early RBC transfusion (within the first week of life) and diagnosis of IVH in very preterm infants. Study designRetrospective single center case-series. Subjects132 very preterm infants (<32 weeks' gestation), admitted to a level III neonatal intensive care unit, studied with serial cranial ultrasound (CUS), and diagnosed with any grade of IVH. Outcome measuresNumber and timing of early RBC transfusions in relation to the timing of IVH. ResultsMedian time of IVH diagnosis was 20.5 h after birth (interquartile range [IQR], 6.25–49.00 h). Of those who received an early RBC transfusion (36 %, 47/132), only 15 % (20/132) received it before the IVH diagnosis. Infants with RBC transfusion before IVH more frequently had lower birth weight, received less fequently antenatal steroids, required more often invasive mechanical ventilation and surfactant administration, had more often hypo- and hypercapnia, and received more fluid boluses, NaHCO3, and inotropes compared to the rest. ConclusionsIn the majority of infants, IVH was already present at the time of the first RBC transfusion. Studies including pre- and post RBC transfusion CUS are needed to assess the effect of early RBC transfusions on the development of IVH in preterm neonates.

Predictors of direct oral anticoagulant concentrations in the trauma population

IntroductionDirect oral anticoagulant (DOAC) use is becoming more prevalent in patients presenting after trauma. We sought to identify the prevalence and predictors of subtherapeutic and therapeutic DOAC concentrations and hypothesized...

1159 Reducing blood transfusion administration by introducing a structured intravenous iron protocol for maternal postpartum anemia

1159 Reducing blood transfusion administration by introducing a structured intravenous iron protocol for maternal postpartum anemia

Potential of serious games as a competency assessment tool for acute care nurses on the blood transfusion procedure

Background: Blood transfusion is a life-saving treatment that requires comprehensive knowledge and compliance to safety, administration, and management of blood transfusion process. It is a core competency for a registered nurse. Competency assessments are annually conducted as regulatory requirement and for quality assurance within our institution. Prior to using serious games, competency assessment involved an online learning module followed by a face-to-face assessment. This had limitations such as such as limited opportunities, potential lack of standardisation, time, and resources. Aim: The aim of this study was to assess whether serious game for blood transfusion administration could be a valid and reliable nursing competency assessment tool through capturing and analysis of in-game empirical data. Methods: The nursing department from Singapore General Hospital (SGH) developed a serious game for blood transfusion administration. The game modules were developed to match the actual procedure with established learning objectives at each stage. The game’s content validity was assessed by four external subject-matter-experts. Gameplay data of 1093 nurses were tested for construct validity, internal-consistency reliability, and criterion validity of the game. Results: The item-level content validity index (I-CVI) ranged between 0.75 and 1, while the average of the I-CVI scores for all items on the scale (S-CVI/Ave) was 0.99. Six factors and 82 game actions were obtained using principle factor analysis. Most game actions had a communality value (h2) above 0.5. The Inter-factor correlations between the six factors ranged from 0.2 to 0.45. Internal-consistency reliability estimates (α) (together with their 95% CIs) for the stages were greater than 0.75, with an overall of 0.96 for the 82 game actions. Linear association between each predictor and the criterion were below 0.25. Conclusion: Based on the empirical data collated, we conclude that the serious game may be a valid competency assessment tool for nurses in SGH. For future work, we propose to conduct the blood transfusion serious game in other hospitals to further support its validity and reliability as a competency tool for multi-step complex procedural clinical skills.

The selection and preparation of red cell components for intrauterine transfusion: A national survey.

The practice regarding the selection and preparation of red blood cells (RBCs) for intrauterine transfusion (IUT) is variable reflecting historical practice and expert opinion rather than evidence-based recommendations. The aim of this survey was to assess Canadian hospital blood bank practice with respect to red cell IUT. A survey was sent to nine hospital laboratories known to perform red cell IUT. Questions regarding component selection, processing, foetal pre-transfusion testing, transfusion administration, documentation and traceability were assessed. The median annual number of IUTs performed in Canada was 109 (interquartile range, 103-118). RBC selection criteria included allogeneic, Cytomegalovirus seronegative, irradiated, fresh units with most sites preferentially providing HbS negative, group O, RhD negative, Kell negative and units lacking the corresponding maternal antibody without extended matching to the maternal phenotype. Red cell processing varied with respect to target haematocrit, use of saline reconstitution (n = 4), use of an automated procedure for red cell concentration (n = 1) and incorporation of a wash step (n = 2). Foetal pre-transfusion testing uniformly included haemoglobin measurement, but additional serologic testing varied. A variety of strategies were used to link the IUT event to the neonate post-delivery, including the creation of a unique foetal blood bank identifier at three sites. This survey reviews current practice and highlights the need for standardized national guidelines regarding the selection and preparation of RBCs for IUT. This study has prompted a re-examination of priorities for RBC selection for IUT and highlighted strategies for transfusion traceability in this unique setting.

Assessment of Neurocognitive Functioning in Sickle Cell Disease and Thalassemia and the Association with Silent Cerebral Infarcts and Cerebral Hemodynamics and Oxygen Metabolism

Introduction Neurocognitive impairment is a significant problem in patients with sickle cell disease (SCD), affecting various life domains such as academic achievement, career progress, and general life quality. The cause of this impairment is not yet fully understood, however, it has been linked to silent cerebral infarcts (SCIs) and irregularities in blood perfusion and oxygenation, particularly in children with SCD. Previous research has identified cognitive deficits in adults with SCD, but the relationship with SCIs has not been thoroughly explored in this age group. This study aimed to examine the neurocognitive functioning among adult patients with three types of inherited chronic anemia (severe SCD, mild SCD, and thalassemia) and healthy controls. Additionally, we investigated potential associations of neurocognitive performance with cerebral perfusion and oxygenation, and SCIs. Methods This study included 70 severe SCD patients (60 HbSS, 10 HbSβ 0), 22 mild SCD patients (14 HbSC, 8 HbSβ +), 16 thalassemia patients (6 NTDT, 10 TDT), and 29 healthy controls. We assessed neurocognitive functioning through eight tasks divided into seven neurocognitive domains such as attention, processing speed, nonverbal IQ, working memory, verbal learning, visual memory, and fine motor dexterity. Each task score was standardized using published norm data, converted into Z-scores, and used to compute the mean Z-score per domain. SCIs were assessed and segmented using FLAIR MRI scans. Cerebral blood flow (CBF) and oxygen extraction fraction (OEF) were derived using time-encoded pseudo-continuous arterial spin labeling (te-pCASL) and T 2-relaxation-under-spin-tagging (TRUST) techniques, respectively. Cerebral metabolic rate of oxygen (CMRO 2) was calculated from the CBF, OEF and oxygen content (calculated from hemoglobin and arterial saturation). One-sample t-tests or one-sample Wilcoxon-signed rank tests were used to compare the seven neurocognitive domains of each group with normative test data and ANOVA was used to compare these domains between participant groups. Independent-sample t-tests or Mann-Whitney U tests were used to compare the neurocognitive domains between patients with and without SCIs. Lastly, correlation analyses explored the relationships between the neurocognitive domains and SCI volume, CBF, OEF, and CMRO 2. Results In the severe SCD group, only processing speed and fine motor dexterity were significantly impaired after adjusting for multiple comparisons (Table 1 &amp; Figure 1). Mild SCD patients exhibited lower scores in processing speed, working memory, and fine motor dexterity compared to the norms. In contrast, after adjustment for multiple comparisons, thalassemia patients and healthy controls only showed significantly lower scores in fine motor dexterity (Table 1). When comparing groups, SCD patients had significantly slower processing speed compared to thalassemia patients and healthy controls. Surprisingly, SCD patients without SCIs exhibited poorer fine motor dexterity than those with SCIs (p=0.03), while no such associations were identified in other groups. Finally, no associations were found between the neurocognitive domains and SCI volumes, CBF, OEF and CMRO 2. Conclusion Our results show slower processing speed in SCD patients compared to thalassemia patients and healthy controls, aligning with previous studies. However, unlike previous research, we did not find additional neurocognitive deficits in SCD patients. This could be due to variations in patient selection, environmental factors, socioeconomic status, or recent enhancements in SCD treatment approaches, such as the early administration of hydroxyurea and/or blood transfusion. Interestingly, all groups showed diminished fine motor dexterity, potentially due to the ongoing digital transition. A key observation from this study was the lack of association between neurocognitive performance and SCIs, hemodynamics, and oxygen metabolism, suggesting that SCIs and oxygenation might not be the only factors contributing to impaired processing speed. Our results suggest that recent developments in medical treatments could have improved the neurocognitive function of SCD patients residing in Western countries. However, concerning the domain of processing speed, further studies are required to investigate other SCD-related factors that might influence this particular area.