Transfusion Ratio Research Articles

Systematic reviews on platelet transfusions: Is there unnecessary duplication of effort? A scoping review.

Platelet transfusions are used across multiple patient populations to prevent and correct bleeding. This scoping review aimed to map the currently available systematic reviews (SRs) and evidence-based guidelines in the field of platelet transfusion. A systematic literature search was conducted in seven databases for SRs on effectiveness (including dose and timing, transfusion trigger and ratio to other blood products), production modalities and decision support related to platelet transfusion. The following data were charted: methodological features of the SR, population, concept and context features, outcomes reported, study design and number of studies included. Results were synthesized in interactive evidence maps. We identified 110 SRs. The majority focused on clinical effectiveness, including prophylactic or therapeutic transfusions compared to no platelet transfusion (34 SRs), prophylactic compared to therapeutic-only transfusion (8 SRs), dose, timing (11 SRs) and threshold for platelet transfusion (15 SRs) and the ratio of platelet transfusion to other blood products in massive transfusion (14 SRs). Furthermore, we included 34 SRs on decision support, of which 26 evaluated viscoelastic testing. Finally, we identified 22 SRs on platelet production modalities, including derivation (4 SRs), pathogen inactivation (6 SRs), leucodepletion (4 SRs) and ABO/human leucocyte antigen matching (5 SRs). The SRs were mapped according to concept and clinical context. An interactive evidence map of SRs and evidence-based guidelines in the field of platelet transfusion has been developed and identified multiple reviews. This work serves as a tool for researchers looking for evidence gaps, thereby both supporting research and avoiding unnecessary duplication.

Comprehensive analysis of coagulation factor delivery strategies in a cohort of trauma patients

PurposeThe 5th edition of The European recommendations for the management of major bleeding and coagulopathy following trauma leaves room for various coagulation factor administration strategies. The present study examines these strategies reporting prevalence and timing of administration, quantity dispensed, and transfusion ratios in French trauma centers and their compliance with recommendations alongside associated mortality data. MethodsAll adult patients, admitted directly to participating centers between 2011 and 2019, were extracted from a trauma registry. Two subpopulations were studied: severe hemorrhage (SH) and massive transfusion (MT) groups. ResultsA total of 19,396 patients were included, among whom 8.4% (1630) experienced SH and 3% (579) received MT. Within the first 24 hours, 10% received fresh frozen plasma (FFP), rising to 93% and 99% in the subgroups of patients experiencing SH and MT respectively. Only, 8% received fibrinogen concentrate (FC), increasing to 75% and 92% in subgroups SH and MT respectively. Co-administration of FFP and FC became the dominant strategy with 68% of patients at 6 h and 72% at 24 h in SH subgroup. In unadjusted data, mortality was systematically lower in groups that complied with recommendations, a lower mortality than expected was mostly observed in contrast to non-compliant subgroups. The per-patient compliance to studied recommendations was 21% and 22% in SH and MT subgroups. ConclusionThe main hemostatic strategy for major bleeding combined the administration of both FFP and FC, favoring an early additional supply of fibrinogen. Compliance with the recommendations was low in SH and MT subgroups.

Blood Lost: A Retrospective Review of Blood Wastage from a Massive Transfusion Protocol in a Tertiary Paediatric Hospital.

The paediatric massive transfusion protocol (MTP) is activated in the paediatric population for both trauma and non-trauma related indications. While it helps to improve the efficiency and efficacy of the delivery of blood products, it can also result in increased wastage. We aimed to evaluate the wastage rates from our paediatric MTP activations from 2013 to 2018. As part of an audit, we retrospectively reviewed the records of the paediatric patients who had MTP activations. We collected the following data: reason for MTP activation, weight of patient, number of cycles of MTP required, blood products used, blood products wasted, deviation from our institution's recommended MTP blood product ratio, and reason for wastage. We had 26 paediatric MTP activations within the audit period. There was an overall wastage rate of 1.5%, with wastage occurring in 3 out of 26 patients. The reason for all wastage was demise of the patient. Most patients' transfusion ratios deviated from our institution's MTP protocol. Our wastage rates are low likely because of clear MTP activation guidelines and a flexible MTP workflow.

Anterior lumbar spinal fusion surgery associated with lower risk of stroke, pneumonia, and infection compared to posterior lumbar spinal fusion surgery

BackgroundPrior studies, comparing anterior and posterior approaches to lumbar fusion surgery, found similar fusion rates and clinical outcomes, but are limited by sample size. Further evaluation of the postoperative complications of each approach is necessary. MethodsThe MSpine database by PearlDiver was queried using ICD-9, ICD-10, and CPT codes to identify patients who had undergone single-level anterior or posterior lumbar interbody fusion surgery. Readmission rates, ileus, lower extremity DVT, infection, pneumonia, and stroke were used to compare post-operative complications of an anterior vs. posterior approach. Results112,023 patients were included in this study, with 38,529 (34.4%) in the anterior group (ALIF/LLIF) and 73,494 (65.6%) in the posterior group (PLIF/TLIF). At both 30 and 90-days postoperative, patients undergoing an anterior approach to lumbar interbody fusion had a higher odds ratio of lower extremity DVT (30-day OR: 1.19, 90-day OR: 1.16; P<0.05) and ileus complication (30-day OR: 1.87, P= <.05; 90-day OR: 1.81, P<.05). At both 30 and 90-days postoperative, patients undergoing a posterior approach had a higher odds ratio of stroke (30-day: OR: 0.79, 90-day OR: 0.87; P<0.05), transfusion (30-day OR: 0.66, 90-day OR: 0.69; P<.05), infection (30-day OR: 0.88, 90-day OR: 0.91; P <.05), and pneumonia (30-day OR: 0.85, 90-day OR: 0.90; P<.05). There was no statistically significant difference in myocardial infarction or pulmonary embolism between both approaches at 30 and 90-days postoperative. ConclusionsAnterior and posterior approaches for lumbar interbody fusion were associated with differences in postoperative complications at 30 and 90-days. The complication profiles associated with each approach can inform surgeon treatment decisions based on patient profiles.

Increased Severity of Anemia Is Associated with Postoperative Complications following a Adult Spinal Deformity Surgery.

Anemia is a modifiable risk factor for postoperative complications following surgery. This study aimed to determine the impact of preoperative anemia severity on 30-day postoperative complications following adult spinal deformity (ASD) surgery. Adults undergoing spinal fusion for ASD from 2012 to 2018 were identified in the National Surgical Quality Improvement Program database. Patients were substratified into 3 cohorts-non-anemia, mild anemia, and moderate-to-severe anemia-based on World Health Organization definitions. We assessed 30-day wound, cardiac, pulmonary, renal, and thromboembolic complications, as well as sepsis, mortality, postoperative transfusions, extended length of stay, and reoperation. Bivariate analyses and multivariable logistic regression were performed. Of 2173 patients, 1694 (78%) had no anemia, 307 (14%) had mild anemia, and 172 (8%) had moderate or severe anemia. Following adjustments, patients with mild anemia were more likely to have postoperative blood transfusions (odds ratio [OR] 1.80, P<0.001) and extended length of stay (OR 1.43, P<0.001). Patients with moderate-to-severe anemia were at increased risk of organ space infection (OR 3.27, P=0.028), death (OR 13.15, P=0.001), postoperative blood transfusion (OR 2.81, P<0.001), and extended length of stay (OR 3.02, P<0.001). We found a stepwise and approximately two-fold increase in the odds ratio of postoperative transfusion and length of stay with increasing severity of anemia. Moderate-to-severe anemia was associated with increased odds of death and organ space infection. Patients with moderate-to-severe anemia should be medically optimized before ASD surgery.

Blood reservation and utilisation practice for Caesarean section in Ilorin, Nigeria.

Most blood units routinely cross-matched for patients undergoing Caesarean section (CS) in Nigeria are not used for transfusion. Over-ordering increases blood wastage, blood bank running costs, surgery costs and waiting times. A one-year review of all CS performed in the University of Ilorin Teaching Hospital (UITH), Nigeria, was thus conducted to evaluate blood reservation and utilisation practice. Efficiency of blood utilisation was evaluated using a cross-match to transfusion (C/T) ratio, transfusion probability (TP) and transfusion index (TI). The overall C/T ratio, TP and blood wastage were, respectively, 3.1, 24.6%, and 68%, indicative of inefficient blood utilisation. Establishing a Maximal Surgical Blood Order Schedule (MSBOS), which estimates the units of blood required for specific CS indications, is recommended to minimise blood over-ordering. Blood grouping alone should be done for patients at low risk for transfusion. For moderate risk patients, blood type and screen without cross-matching should be done, reserving cross-matching for high-risk patients.

Balanced Blood Product Transfusion during Adult Liver Transplantation

Background: Orthotopic liver transplant (LT) is often associated with massive blood loss and significant transfusion requirements. Recent recommendations for resuscitation strategy in massive bleeding include the transfusion of balanced blood products, fresh frozen plasma (FFP), platelets, packed red blood cells (PRBC), and restricted use of crystalloids. Objectives: To evaluate whether the intraoperative transfusion ratio of fresh frozen plasma to packed red blood cell units (FFP: PRBC ≤1:1 versus &gt;1:1) plays a positive role in reducing PRBC transfusion in LT. Methods: This is a retrospective study of 84 liver transplant recipients who received at least one PRBC unit during the surgery. The patients were grouped into those who received intraoperative FFP: PRBC ratio ≤1:1 (low ratio) versus the ratio&gt;1:1 (high ratio). Selected perioperative variables were compared between the two groups. Results: Patients in the low-ratio versus high-ratio group had lower intraoperative requirements for PRBC (P&lt;0.001). Importantly, in the high-ratio group, the mean postoperative PRBC transfused units were 1.76 times that of the low-ratio group (incidence rate ratio [IRR], 1.76; 95% CI=1.07-2.90). There was a significant difference between the two groups in preoperative body mass index (P=0.047), hemoglobin (P=0.005), and surgical time (P=0.071); moreover, all the variables were higher in the high-ratio group. After adjusting the variables, postoperative PRBC consumption in the low-ratio group was 43% less than that in the high-ratio group (P=0.007). Conclusion: The intraoperative low-ratio transfusion was associated with a reduced need for total PRBC transfusion in LT.

Analysis of Blood Request Form and Blood Utilization Pattern in a Tertiary Care Specialized Hospital

Background: The growing demands for blood products are vital resources to health care facilities. If requested blood is not transfused, this causes blood wastage. Minimal utilization of requested blood squanders technical time, reagent and imposes extra expenses on patients. This study was conducted to evaluate blood requisition and utilization pattern in a tertiary care hospital. Methods: This retrospective study was conductedin the transfusion medicine dept. of a tertiary care specialized hospital from1 January 2017 to 31 December 2020. Blood request forms were reviewed and blood utilization indices were computed from blood bank registries. Blood utilization was calculated determining cross match to transfusion ratio (C:T), transfusion probability (%T), transfusion index (TI) and non-utilization pattern i.e. wastage. Results: A total of 9,841 recipients were requested to prepare cross match. A total of 13,965 units of blood were cross matched and among these 10316 units were transfused to 9,291 recipients. The overall C:T, %T, and TI were 1.35, 94.41% and 1.05 respectively. The wastage implying in this study was 26.13%. Conclusion: The overallblood utilization was encouraging, but excessive cross matching with minimal transfusion practice was observed implying wastage of blood. Blood transfusion services should adopt blood conserving policies. Bangladesh J Medicine 2022; 33: 259-262

The practice of blood cross-match request and transfusion in surgical patients at Debre Markos comprehensive Specialized Hospital, Debre Markos, Ethiopia, 2021/2022. A prospective study

BackgroundBlood transfusions play a great role to improve oxygen delivery to tissues for indicated surgical patients. Preoperative ordering of blood, especially in elective surgery, is often based on the worst-case assumptions, demanding large quantities of blood or overestimating the anticipated blood loss, of which little is ultimately used. This study aimed to assess the practices of blood requisite and transfusion in surgical patients. MethodAn institutional-based prospective study was conducted from September to February 2021/2022, in Debre Markos comprehensive Specialized Hospital. Socio-demographic data like age, sex, ASA status, type of anesthesia, and type of surgeries were taken preoperatively. The number of cross-matched and transfused data were collected from patient charts throughout the perioperative periods. Efficacy of blood utilization was evaluated using the following indices like cross-match to transfusion ratio (C/T ratio), transfusion probability (%T), and transfusion index (TI); a ratio of 2.5 and below, A value of 30% and above, and values of 0.5 or more respectively were considered indicative of significant blood usage and this study is registered with a research unique identifying number of researchregistry7989 and reported in line with STROCSS 2021 guideline. ResultIn all procedures, among cross-matched blood units 64.1% were unutilized. Depending on the urgency of the procedures about 77.7% of cross-matched blood units were not utilized in elective patients. In emergency procedures, the majority (64.3%) of cross-matched units were transfused. The overall blood transfusion indices result was C/T ratio, %T, and TI was 2.9, 33.5%, and 0.7, respectively. The overall blood transfusion indices for elective and emergency surgery are set respectively as follows C/T ratio (4.6 vs 1.5), %T (22 vs 78.8), and TI (0.4 vs 1.9). Among elective procedures, blood utilization was significant in orthopedic surgery with the value of C/T ratio 1.3, %T 66, and TI 1.4. In the rest of the elective procedures, blood transfusion indices were not significant. ConclusionThe overall blood utilization indices in emergency surgical patients were better than in elective and preoperative grouping, screening, and hold (GSH) is sufficient for elective surgical procedures to decrease wastage of valuable supplies.

Crossmatch to Transfusion Ratio (C/T Ratio) Komponen Darah WB dan PRC di RSUD Kabupaten Brebes

A crossmatch test between patient and donor’s blood must be carried out before blood transfusion. However, not all crossmatched blood will be transfused to the patient. This indicates inappropriate distribution of blood products, blood wastage, inaccessibility of blood for emergency patients, increased costs, and increased workload for staff. Crossmatch to Transfusion Ratio (C/T Ratio) is used as an indicator to determine the efficiency of blood use and can serve as a guide to anticipate excessive blood demand. This study aims to determine C/T Ratio score of blood components WB and PRC in the Brebes Regency Hospital 2021. This research is a descriptive study with a retrospective approach. Sampling was done using total sampling technique. Data was obtained from the blood requests recapitulation book in Brebes Regency Hospital’s Blood Bank 2021. The result showed there were 47 units WB crossmatched and 34 units (72%) transfused. There were 4589 units PRC crossmatched and 4369 units (95%) transfused. The C/T Ratio score of WB is 1.38. The C/T Ratio score of PRC is 1.05. The overall C/T Ratio score is 1.05.

Balanced hemostatic resuscitation for bleeding pediatric trauma patients: A nationwide quantitative analysis of outcomes

BackgroundThe administration of balanced component therapy has been associated with improvements in outcomes in adult trauma. There is little to no specific data to guide transfusion ratios in children. The aim of our study is to compare outcomes among different transfusion strategies in pediatric trauma patients. MethodsWe conducted a (2014–2016) retrospective analysis of the Trauma Quality Improvement Program. We selected all pediatric (age < 18) trauma patients who received at least one unit of packed red blood cells (PRBC) and fresh frozen plasma (FFP) within 4 h of admission. Patients were stratified based on their FFP:PRBC transfusion ratio in the first 4 h into: 1:1, 1:2, 1:3, and 1:3+. Primary outcomes were 24-mortality, in-hospital mortality. Secondary outcomes were complications and 24 h PRBC transfusion requirements. Multivariable logistic regression analysis was performed. ResultsA total of 1,233 patients were identified of which 637 received transfusion ratio of 1:1, 365 1:2, 116 1:3, and 115 1:3+. Mean age was 11 ± 6y, 70% were male, ISS was 27 [20–38], and 62% sustained penetrating injuries. Patients in the 1:1 group had the lowest 24 h mortality (14% vs. 18% vs. 22% vs. 24%; p = 0.01) and in-hospital mortality (32% vs. 36% vs. 40% vs. 44%; p = 0.01). No difference was found between the groups in terms of complications (22% vs. 21% vs. 23% vs. 22%; p = 0.96) such as acute respiratory distress syndrome (3.3% vs. 3.6% vs. 0.9% vs. 0%; p = 0.10), and acute kidney injury (3% vs. 2.2% vs. 0.9% vs. 0.9%; p = 0.46). Additionally the 1:1 group had the lowest PRBC transfusion requirements (3[2–7] vs. 5[2–10] vs. 6[3–8] vs. 6[4–10]; p < 0.01). On regression analysis a progressive increase in the mortality adjusted odds ratio was observed as the FFP:PRBC transfusion ratio decreased. ConclusionFFP:PRBC ratios closest to 1 were associated with increased survival in children. The resuscitation of pediatric patients should target a 1:1 ratio of FFP:PRBC. Further studies are needed for the development of massive transfusion protocols for this age group. Level of evidenceLevel IV Study typeTherapeutic/Care Management

Step by step transfusion timeline and its challenges in trauma: A retrospective study in a level one trauma center.

Hemorrhagic shock is the leading cause of preventable early death in trauma patients. Transfusion management is guided by international guidelines promoting early and aggressive transfusion strategies. This study aimed to describe transfusion timelines in a trauma center and to identify key points to performing early and efficient transfusions. This is a monocentric retrospective study of 108 severe trauma patients, transfused within the first 48 h and hospitalized in an intensive care unit between January 2017 and May 2019. One hundred and eight patients were transfused with 1250 labile blood products. Half of these labile blood products were transfused within 3 h of admission and consumed by 26 patients requiring massive transfusion (≥4 red blood cells [RBC] within 1h). Among these, the median delay from patient's admission to labile blood products prescription was -11 min (-34 to -1); from admission to delivery of labile blood products was 1min (-20 to 16); and from admission to first transfusion was 20 min (7-37) for RBC, 26 min (13-38) for plasma, and 72 min (51-103) for platelet concentrates. The anticipated prescription of labile blood products and the use of massive transfusion packs and lyophilized plasma units were associated with earlier achievement of high transfusion ratios. This study provides detailed data on the transfusion timelines and composition, from prescription to initial transfusion. Transfusion anticipation, use of preconditioned transfusion packs including platelets, and lyophilized plasma allow rapid and high-ratio transfusion practices in severe trauma patients.

Economic impact of a machine learning-based strategy for preparation of blood products in brain tumor surgery.

Globally, blood donation has been disturbed due to the pandemic. Consequently, the optimization of preoperative blood preparation should be a point of concern. Machine learning (ML) is one of the modern approaches that have been applied by physicians to help decision-making. The main objective of this study was to identify the cost differences of the ML-based strategy compared with other strategies in preoperative blood products preparation. A secondary objective was to compare the effectiveness indexes of blood products preparation among strategies. The study utilized a retrospective cohort design conducted on brain tumor patients who had undergone surgery between January 2014 and December 2021. Overall data were divided into two cohorts. The first cohort was used for the development and deployment of the ML-based web application, while validation, comparison of the effectiveness indexes, and economic evaluation were performed using the second cohort. Therefore, the effectiveness indexes of blood preparation and cost difference were compared among the ML-based strategy, clinical trial-based strategy, and routine-based strategy. Over a 2-year period, the crossmatch to transfusion (C/T) ratio, transfusion probability (Tp), and transfusion index (Ti) of the ML-based strategy were 1.10, 57.0%, and 1.62, respectively, while the routine-based strategy had a C/T ratio of 4.67%, Tp of 27.9%%, and Ti of 0.79. The overall costs of blood products preparation among the ML-based strategy, clinical trial-based strategy, and routine-based strategy were 30, 061.56$, 57,313.92$, and 136,292.94$, respectively. From the cost difference between the ML-based strategy and routine-based strategy, we observed cost savings of 92,519.97$ (67.88%) for the 2-year period. The ML-based strategy is one of the most effective strategies to balance the unnecessary workloads at blood banks and reduce the cost of unnecessary blood products preparation from low C/T ratio as well as high Tp and Ti. Further studies should be performed to confirm the generalizability and applicability of the ML-based strategy.

Does the intramedullary femoral canal plug reduce blood loss during total knee arthroplasty?

IntroductionThe benefit of the femoral canal bone plug during total knee arthroplasty (TKA) in reducing blood loss has never been proven. The aim of this meta-analysis was to determine whether the femoral canal bone plug significantly reduces blood loss in primary TKA.MethodAll studies published before December 2021 were searched. The inclusion criteria were randomized controlled trials comparing blood loss between TKA with plugged and unplugged femoral intramedullary canal, respectively. The primary outcome was postoperative hemoglobin reduction.ResultsFive studies with a total of 717 patients (361 in the plugged group, 356 in the unplugged group) met the criteria for inclusion in the meta-analysis. The mean difference in hemoglobin level between the two groups was 0.92 g/dL, with significantly less hemoglobin reduction in the plugged group (95% confidence interval [CI] − 1.64 to − 0.21, p = 0.01). The patients in the plugged group also had a significantly lower risk of receiving a blood transfusion (risk ratio 0.58, 95% CI 0.47–0.73, p < 0.00001).ConclusionsThis meta-analysis demonstrates that using a femoral canal bone plug can significantly reduce blood loss and lower the risk ratio of blood transfusion in patients undergoing TKA.

Low Volume Blood Product Transfusion Patterns And Ratios After Injury

BackgroundThe benefit of a balanced resuscitation in low volume transfusions remains unclear This study is aimed at characterizing blood product ratios in this cohort. MethodsA retrospective analysis (2017–2019) of the ACS TQIP was performed to identify adult trauma patients who received ≥1 unit of packed red blood cells (pRBCs) 4 and 24 h after admission. Blood products received were used to calculate plasma and platelet ratios. ResultsPlasma and platelet ratios were closer to the target 1:1 ratio for ≤4 units pRBCs. Plasma and platelet ratios increased for those receiving ≤10 units pRBCs, demonstrating increasingly unbalanced resuscitation. Transfusion ratios were unbalanced for those receiving ≥5 units pRBC. ConclusionTransfusion ratios were closer to the desired transfusion ratio for low volume blood product resuscitation. In those receiving ≥5 units pRBC, plasma and platelet ratios were not balanced. The optimal transfusion ratio in low volume trauma resuscitation is unknown.

Achieving optimal massive transfusion ratios: The trauma white board, whole blood, and liquid plasma. Real world low-tech solutions for a high stakes issue

BackgroundIt is well established that achieving optimal ratios of packed red blood cells (PRBC) to fresh frozen plasma (FFP) to platelet ratios during massive transfusion leads to improved outcomes but is difficult to accomplish. MethodsBetween September 2018 and May 2019 our level 2 trauma center implemented 3 new processes to optimize transfusion ratios during massive transfusion protocol (MTP). Two units of low titer group O whole blood (LTOWB) were added as the first step to our MTP. Second, a dry erase board whiteboard was attached to each fluid warmer for real time recording of transfusions. Last, liquid plasma was incorporated into our MTP. We performed a retrospective review evaluating PRBC:FFP ratios for patients who had the massive transfusion protocol initiated and received 4 or more units of blood. ResultsA total of 50 patients had the massive transfusion protocol initiated and received 4 or more units of PRBCs and/or LTOWB within 4 h of arrival. There were 21 patients evaluated prior to protocol changes and 29 patients after the changes. In the study group mean age, sex, pulse, systolic blood pressure (SBP), and injury severity scale (ISS) on admission were not different. In the pre-protocol (preP) group 90% of patients were blunt trauma and in the post-protocol group (postP) 72% were blunt trauma, p = 0. 22. For the preP group the mean units of PRBCs was 7.6 units and FFP 4.7 units. PostP the mean units of PRBCs was 11.4 units and FFP 10.0 units. PRBC/FFP ratios were 1.7 preP and 1.2 postP, p = 0.0072. ConclusionThe institution of whole blood, use of the trauma white board, and the addition of liquid plasma to our transfusion services have allowed us to approach a 1:1 transfusion ratio during the course of our massive transfusions.

Blood use in elective surgical procedures in a “type A” base hospital

IntroductionBlood orders for surgical patients make up a considerable portion of total blood requests but the majority doesn’t lead to a transfusion. Routine crossmatching and reserving blood for all surgeries can be reduced by establishing a Maximum Surgical Blood Ordering Schedule [MSBOS]. We have analyzed blood utilization in Base Hospital Puttalam and formulated an MSBOS with this study. Material and methodsA total of 2145 surgeries from surgical and gynaecology &amp; obstetric units in the year 2019 was analyzed. Patients who underwent massive transfusions and patients having a pre-operative haemoglobin concentration less than 8.3g/dl or obtained a pre-operative transfusion were excluded considering transfusions to correct preoperative anaemia. The crossmatch to transfusion ratio [C: T], transfusion probability [T%] and transfusion index [TI] was calculated for each surgical procedure. The procedures having a C: T of &gt;3:1 was recommended for group and screen [G&amp;S]. ResultsOf a total of 2145 patients, 90% were females. A total of 1565 units were requested and 1521 units were crossmatched for 2034 patients while only 193 were transfused. Overall indices for the study population are CT ratio of 7.8:1, %T of 10.4% and TI of 0.15. Indices for surgical unit patients are CT ratio of 5:1, %T of 15.2% and TI of 0.29. By using the MSBOS total of 1403 cross matches could have been avoided. ConclusionsBy implementing the MSBOS 92% of cross matches for elective surgeries could have been avoided. The results are on par with the previous studies done at tertiary health care centres.

Assessment of Blood Transfusion Utilization and Patient Outcomes at Yekatit-12 Hospital, Addis Ababa, Ethiopia.

BackgroundThe goal of blood transfusion is to provide a safe, sufficient, and timely supply of blood components to the recipients by ensuring that donation is safe and no harm to the recipient. So the current study was aimed to assess blood transfusion utilization and its outcome in patients at Yekatit-12 Hospital, Addis Ababa, Ethiopia.MethodsA cross-sectional study was conducted from May 01 to July 30, 2021, on 616 individuals who have requested blood transfusion at Yekatit-12 Hospital, Addis Ababa, Ethiopia. Information on blood and blood component utilization was collected by using a checklist. Finally, data were analyzed using SPSS version 21.0, and those variables in which P-value is less than 0.05 were considered statistically clinically significant.ResultsA total of 1540 cross-match units were requested for 616 (53.2% male) patients with a mean age of 43 years. Out of 1540 cross-matched blood units, 1498 units of blood were transfused for 615 individuals with a mean of 2.43 units. The most widely used blood component was whole blood 694 (46.3%) and 1252 (83.6%) of the blood unit were “RH” positive. From a total of 68 (11.1%) none improved reported cases, 48 (10.5%) were those transfused with whole blood transfusion. The proportion of improvement after transfusion according to the service ranged from 83.3.0% to 100% and no post-transfusion reactions were reported. A significant improvement was seen in the hematological profile (hemoglobin, red blood cells, hematocrit, platelets, and white blood cells) findings of the transfused individuals after blood unit transfusion (P < 0.05).ConclusionThe overall utilization rate and improvement status after transfusion were high even if the utilization rate has some limitations. The overall ratios of cross-match to transfusion ratio, transfusion probability, and transfusion index were 1.03, 99.8%, and 0.97, respectively.

Transfusion Ratios and Deficits in Injured Children With Life-Threatening Bleeding.

To assess the impact of plasma and platelet ratios and deficits in injured children with life-threatening bleeding. Secondary analysis of the MAssive Transfusion epidemiology and outcomes In Children study dataset, a prospective observational study of children with life-threatening bleeding events. Twenty-four childrens hospitals in the United States, Canada, and Italy. Injured children 0-17 years old who received greater than 40 mL/kg total blood products over 6 hours or were transfused under activation of massive transfusion protocol. Weight-adjusted blood product volumes received during the bleeding event were recorded. Plasma:RBC ratio (plasma/RBC weight-adjusted volume in mL/kg) and platelet:RBC ratio (platelet/RBC weight-adjusted volume in mL/kg) were analyzed. Plasma deficit was calculated as RBC mL/kg - plasma mL/kg; platelet deficit was calculated as RBC mL/kg - platelet mL/kg. Of 191 patients analyzed, median (interquartile range) age was 10 years (5-15 yr), 61% were male, 61% blunt mechanism, and median (interquartile range) Injury Severity Score was 29 (24-38). After adjusting for Pediatric Risk of Mortality score, cardiac arrest, use of vasoactive medications, and blunt mechanism, a high plasma:RBC ratio (> 1:2) was associated with improved 6-hour survival compared with a low plasma:RBC ratio (odds ratio [95% CI] = 0.12 [0.03-0.52]; p = 0.004). Platelet:RBC ratio was not associated with survival. After adjusting for age, Pediatric Risk of Mortality score, cardiac arrest, and mechanism of injury, 6-hour and 24-hour mortality were increased in children with greater plasma deficits (10% and 20% increased odds of mortality for every 10 mL/kg plasma deficit at 6 hr [p = 0.04] and 24 hr [p = 0.01], respectively); 24-hour mortality was increased in children with greater platelet deficits (10% increased odds of 24-hr mortality for every 10 mL/kg platelet deficit [p = 0.02)]). In injured children, balanced resuscitation may improve early survival according to this hypothesis generating study. Multicenter clinical trials are needed to assess whether clinicians should target ratios and deficits as optimal pediatric hemostatic resuscitation practice.

Blood Ordering and Transfusion Practices: An Insight Toward Better Utility of Blood Products.

BackgroundAn adequate supply of quality blood products is the backbone of any hospital. To maintain it, the utilization and wastage of the products should be closely monitored.ObjectiveTo determine the crossmatch to transfusion (C/T) ratio, transfusion probability (%T), and transfusion index (Ti) of packed red blood cells and to review the use of platelets.Materials and methodsA total of 6,326 hematological patients receiving packed red blood cells were included in the study. The random donor platelets that were prepared during this period were also included to know the actual utilization of platelets.ResultsA total of 26,146 crossmatches were requested for these 6,326 patients in three years. Out of these, 26,024 units were issued and transfused to the patients. The CT ratio of our data was calculated to be 1.00, the transfusion probability was found to be 98.1%, and the transfusion index was computed to be 0.99. For random donor platelets, 37,162 were prepared from whole blood during this period, while 30,971 platelets were transfused to the patients.ConclusionThe overall results of our analysis showed proper utilization of blood products at our institution. The wastage was considered to be minimal.