Blood Transfusion Service Research Articles

Analysis of Blood Utilization Practices and Quality Indicators in a South Indian Teaching Hospital in Puducherry, India

Abstract Introduction: The transfusion of donated blood is the mainstay of treatment for medical or surgical conditions. It is the primary responsibility of blood transfusion services to provide a safe, sufficient, and timely supply of blood products. It is recommended to conduct regular audits to know usage trends. This study aims to analyze the utilization pattern and quality indicators of transfusion services. Materials and Methods: This is a retrospective study conducted in the blood center of a tertiary care teaching hospital in Puducherry, India. We collected and analyzed data on the request and utilization of blood and its products from January 2023 to December 2023. The department-wise utilization of blood and its components, crossmatch to transfusion ratio (C: T ratio), transfusion probability (T%), and transfusion index (TI), were calculated. Results: Packed red blood cells (PRBCs) were the most utilized blood product. The intensive care unit ward received the highest blood supply, followed by obstetrics/gynecology and orthopedics. Patients with anemia, followed by surgery and pregnancy, required a majority of PRBCs. The CT ratio, TI, and TP% were 2.7%, 0.42%, and 0.37%, respectively. Conclusions: The overall transfusion indicators, namely C/T ratio, TI, and TP, were near optimal compared to standard values. However, the majority of the cross-matched blood remained unused. It is crucial to conduct a periodic review of the blood component usage in a hospital.

Exploring barriers and facilitators to blood donation in secondary schools in Malawi.

Despite the Malawi Blood Transfusion Service (MBTS) increasing the amount of blood collected since its inception in 2004, Malawi remains with a 27% deficit in required blood supplies nationally. We sought to understand the facilitators and barriers to blood donation among secondary school students in Malawi. We utilised a qualitative exploratory design, with a sample of 135 participants purposefully selected from 16 secondary schools across Malawi. Data collection methods included in-depth interviews with 20 participants (inclusive of first-time and repeat donors, lapsed and non-donors), 20 key informant interviews (including community leaders, policy-level stakeholders and MBTS staff), and 16 focus group discussions involving 95 participants (community stakeholders and all donor categories). We used the consolidated framework for implementation research (CFIR) to assess barriers and facilitators of blood donation, focusing only on four CFIR domains: internal and external factors; the implementation process and individual characteristics influencing blood donation. Blood donation among students are facilitated by altruism, incentives including milestone awards, knowledge, motivation, transport, peer pressure and individual health status. Common barriers cited included: negative experiences with the blood donation process, fear, unsupported environment, poor incentives, privacy issues and the donation activities starting late than scheduled. While there have been efforts to motivate students to donate blood, significant barriers to blood donation still exist. Intensifying education and awareness campaigns may help dispel misconceptions and fears surrounding donation experiences and blood usage. Also, continuing with the provision of appropriate incentives including milestone awards may also encourage students.

Five year follow -up of a university initiated national voluntary non remunerated blood donation programme in a developing country.

International bodies continue to recommend blood services based on voluntary non remunerated blood donation as an essential prerequisite for blood safety and adequacy. Trinidad and Tobago is a multi-ethnic, multi-religious, high income developing country with a long history of family replacement and remunerated blood donation. Delivery of blood services is fragmented across five autonomous Regional Health Authorities and policy is established by the National Blood Transfusion Service in the Ministry of Health. A voluntary non remunerated blood donor programme initiated by The University of the West Indies at one blood donation centre collected 1.8 % of the annual donations in its first three years and was accepted for national extension in 2018. The COVID-19 pandemic delayed implementation of this plan. The programme to achieve exclusive voluntary non remunerated donation nationally was launched by the Ministry of Health on World Blood Donor Day, June 14th 2022. Knowledge, attitude and practices surveys were done to gather information for communication and interventional strategies. Voluntary non remunerated blood donation was linked to restructuring of blood transfusion services across all Regional Health Authorities. Fifteen surveys identified misconceptions, knowledge gaps and socially acceptable methods of intervention. Voluntary non remunerated donations accounted for 10.8 % of the national collection in the first full year of implementation (p < 0.05). A voluntary non remunerated blood donation programme based on research, education and action has been successfully extended nationally.

Safety and efficacy of a novel mini-pool intravenous immunoglobulin therapy in children with primary immunodeficiency.

Intravenous polyvalent immunoglobulins (IVIG) for prophylaxis in patients with primary immunodeficiency disorders (PIDs) exposes them to life-threatening infections and debilitating diseases. To improve access to IVIG in lower middle-income countries, the WHO recommends a stepwise approach for the local production of purified and virus-inactivated plasma immunoglobulins by national blood transfusion services using new technologies and medical devices. One new technology relies on single-use sterile medical devices for the purification of plasma immunoglobulin G (IgG), as well as lipid-enveloped virus inactivation from mini-pools of recovered plasma separated from whole blood (mini-pool IVIG [MP-IVIG]). This study aimed to compare the safety and efficacy of MP-IVIG to standard IVIG (STD-IVIG). In this prospective crossover clinical study, we investigated the safety and efficacy of MP-IVIG for STD-IVIG preparations as a replacement therapy in a cohort of 21 paediatric patients with PID. Both MP-IVIG and STD-IVIG were effective in reducing the frequency of severe bacterial infections and hospital admissions in patients with PID. Mild side effects have been observed in seven patients (6.2%) with PID who received MP-IVIG and five patients (5.3%) who received STD-IVIG. No moderate or severe side effects or haemolytic transfusion reactions were reported. The mortality rates were also comparable and were not related to the study products. MP-IVIG presented no safety issues and was as effective as STD-IVIG in IgG replacement in patients with PID. Due to the small numbers, the results have to be addressed with caution.

Gene Frequency and Prevalence of ABO and Rh D Blood Group Systems among Libyan Donors and Patients of Jabal Nafusa Region, Libya

The ABO and Rh D/d blood group systems have significant medical and genetic importance. In Libya, several studies had been conducted on the distribution of the ABO and Rh D/d blood group systems in different regions of the country. However, there are many regions in Libya that have not yet been studied. Therefore, the aim of this study was to determine the gene frequency and prevalence of ABO and Rh D/d blood group systems among Libyan donors and patients of Jabal Nafusa region in Zintan, Alrujban, and Jadu cities north western of Libya; in addition to Tripoli city. This was a retrospective study that included only Libyans attending the Central Blood Bank in Zintan, Alrujban Clinic in Alrujban, Jadu Medical Analysis Laboratory in Jadu, and Al-Khadra Hospital in Tripoli. The ABO grouping and the Rh typing was done by the standard slide method using commercial blood grouping anti-A, anti-B and anti-D. Data was analyzed using descriptive statistics and Hardy–Weinberg equilibrium law. The overall results of this study show that the most prevalent ABO blood group was O (33.68%), followed by A (26.27%), B (21.31%), and AB (18.74%); which cluster into three categories: O&gt;A&gt;B&gt;AB (Zintan and Alrujban cluster), A&gt;O&gt;B&gt;AB (Tripoli cluster), O&gt;AB&gt;B&gt;A (Jadu cluster). The highest prevalence of A+ (29.35%), B+ (19.73%) and A- (8.74%), B- (9.47%) was found in Tripoli and Jadu, respectively. Jadu had the highest prevalence of AB+ (14.86%) and AB- (11.37%). The highest percentage of O+ (46.92%) and Rh D+ (91.64%), O- (12.97%) and Rh d- (42.56%) was observed in Zintan and Jadu, respectively. The occurrence of considerable percentages of O- and AB- blood groups in Jadu indicated significant medical implications for healthcare blood transfusion services. The gene frequency of ABO and Rh D for A, B, O, D+, and d- alleles respectively are: 0.1795, 0.1025, 0.7180, 0.7109, and 0.2891 in Zintan; 0.2013, 0.0762, 0.7225, 0.5817, and 0.4183 in Alrujban; 0.1860, 0.1892, 0.6248, 0.3476, and 0.6525 in Jadu; 0.2693, 0.1885, 0.5422, 0.5660, and 0.4340 in Tripoli. Significant difference in ABO and Rh D allele frequencies was found in Jadu, which indicated that Jadu’s population is not in Hardy–Weinberg equilibrium. This is the first study that documents the gene frequency for ABO and Rh D alleles and their prevalence of Jabal Nafusa region in Libya. The data in this study are of great importance to blood banks, blood transfusion services, genetics and anthropological studies in Libya.

Donor Time to Death and Kidney Transplant Outcomes in the Setting of a 3-Hour Minimum Wait Policy

Lengthening waiting lists for organ transplant mandates the development of strategies to expand the deceased donor pool. Due to concerns regarding organ viability, most organ donation organizations internationally wait no longer than 1 to 2 hours for potential donation after circulatory death (DCD), possibly underutilizing an important organ source; UK policy mandates a minimum 3-hour wait time. To assess whether time to death (TTD) from withdrawal of life-sustaining treatment (WLST) is associated with kidney transplant outcomes. This population-based cohort study used data from the prospectively maintained UK Transplant Registry from all 23 UK kidney transplant centers from January 1, 2013, to December 31, 2021; follow-up was until the date of data extraction (October 2023). Participants comprised 7183 adult recipients of DCD kidney-alone transplants. Duration of TTD, defined as time from WLST to donor mechanical asystole. Primary outcome was 12-month estimated glomerular filtration rate (eGFR; for the main eGFR model, variables with significant right skew [histogram visual assessment] were analyzed on the log2 scale), with secondary outcomes of delayed graft function and graft survival (censored at death or 5 years). This study included 7183 kidney transplant recipients (median age, 56 years [IQR, 47-64 years]; 4666 men [65.0%]). Median donor age was 55 years (IQR, 44-63 years). Median TTD was 15 minutes (range, 0-407 minutes), with 885 kidneys transplanted from donors with TTD over 1 hour and 303 kidneys transplanted from donors with TTD over 2 hours. Donor TTD was not associated with recipient 12-month eGFR on adjusted linear regression (change per doubling of TTD, -0.25; 95% CI, -0.68 to 0.19; P = .27), nor with delayed graft function (adjusted odds ratio, 1.01; 95% CI, 0.97-1.06; P = .65) or graft survival (adjusted hazard ratio, 1.00; 95% CI, 0.95-1.07; P = .92). These findings were confirmed with restricted cubic spline models (assessing nonlinear associations) and tests of interaction (including normothermic regional perfusion). In contrast, donor asystolic time, cold ischemic time, and reperfusion time were independently associated with outcomes. Compared with a theoretical 1-hour maximum wait time, the UK policy (minimum 3-hour wait time) has been associated with 885 extra DCD transplants compared with 6298 transplants (14.1% increase). In this cohort study of DCD kidney recipients, donor TTD was not associated with posttransplant outcomes, in contrast to subsequent ischemic times. Altering international transplant practice to mandate minimum 3-hour donor wait times could substantially increase numbers of kidney transplants performed without prejudicing outcomes.

HPB SO67 - An audit to improve the perioperative administration of tranexamic acid (TXA) to reduce the need for peri- and post-operative blood transfusion in major HPB resections

Abstract Background NHS Blood and Transplant (NHSBT) triggered an ‘amber alert’ on 12 October 2022, meaning hospitals have been asked to put in place management plans to protect blood stocks. In line with these measures requested by NHSBT, The Royal College of Surgeons of England recommended using tranexamic acid in all adult surgical patients if more than 500ml of blood loss is likely. Results from the recent POISE-3 clinical trial confirm the quality, safety and cost-effectiveness of tranexamic acid in surgery, where more than 500ml of blood loss is anticipated. Method Patients were identified by searching the Sheffield Teaching Hospital (STH) operation note database using the key words: hepatectomy, pancreatectomy, liver resection, PPPD and pancreaticoduodenectomy. Retrospective case note review identified TXA administration, pre and postoperative haemoglobin level and blood transfusion prescription. Results 49 patients undergoing major HPB resection at Sheffield Teaching Hospitals (STH) from October 2022 to March 2023 were identified. Following the addition of a prompt in the WHO timeout pre-op checklist, a further 24 patients were reviewed. The audit compared the number of patients who received TXA, pre- and post-operative haemoglobin levels and incidence of intra- or postoperative blood transfusion (within 30 days) between the two groups. Including a prompt did not increase the likelihood of a pre-operative dose of TXA being administered. Mean change in haemoglobin and the proportion of patients requiring transfusion remained similar between the two groups. Conclusion Incorporating a preoperative prompt in the WHO timeout checklist did not improve adherence to guidelines for TXA administration in major HPB surgery. Future audits should continue monitoring these trends and investigating further strategies to optimise perioperative blood management. However, there are randomised controlled trials comparing TXA with placebo in liver resection and the recent TAC-PD trial showed that perioperative TXA did not reduce blood loss in pancreaticoduodenectomy.

Blood donation practices, motivators and barriers in the Caribbean: A narrative review.

Adequacy and safety are the twin prerogatives of the blood transfusion service which in turn is an indispensable component of public health delivery; however, many Caribbean countries have inadequate blood supply for the current and projected demands of their health care systems. Understanding blood donor motivators and barriers is crucial to improving the rate of voluntary non-remunerated blood donation (VNRD) to meet World Health Organisation (WHO) targets. The objective of this study was to review current research on the landscape of blood donation practices and attitudes in the Caribbean. We undertook a systematic search of electronic databases through September 2023 to identify studies of blood donation practices, knowledge and attitudes, including motivators and barriers to donation in the English-speaking Caribbean. We identified eight (8) relevant studies of observational study design. VNRD remain relatively uncommon; family replacement or remunerated donations were most common. Barriers to blood donation included lack of a known recipient such as a family member who needed blood, never having been asked to donate, presumed ineligibility to donate, and fear of needles or adverse reactions. Study participants indicated willingness to donate blood if provided more information about the importance of blood donation. There is a paucity of published research regarding blood donor knowledge, motivators and barriers in the Caribbean context. Such research could indicate the necessary interventions for achieving the goals of an adequate and safe blood supply.

Questions on travel and sexual behaviours negatively impact ethnic minority donor recruitment: Effect of negative word-of-mouth and avoidance.

Donor selection questions differentially impacting ethnic minorities can discourage donation directly or via negative word-of-mouth. We explore the differential impact of two blood safety questions relating to (i) sexual contacts linked to areas where human immunodeficiency virus (HIV) rates are high and (ii) travelling to areas where malaria is endemic. Epidemiological data are used to assess infection risk and the need for these questions. We report two studies. Study 1 is a behavioural study on negative word-of-mouth and avoiding donation among ethnic minorities (n = 981 people from National Health Service Blood and Transplant (NHSBT) and the general population: 761 were current donors). Study 2 is an epidemiology study (utilizing NHSBT/UK Health Security Agency (UKHSA) surveillance data on HIV-positive donations across the UK blood services between1996 and 2019) to assess whether the sexual risk question contributes to reducing HIV risk and whether travel deferral was more prevalent among ethnic minorities (2015-2019). Studies 1 and 2 provide complementary evidence on the behavioural impact to support policy implications. A high proportion of people from ethnic minorities were discouraged from donating and expressed negative word-of-mouth. This was mediated by perceived racial discrimination within the UK National Health Service. The number of donors with HIV who the sexual contact question could have deferred was low, with between 8% and 9.3% of people from ethnic minorities deferred on travel compared with 1.7% of White people. Blood services need to consider ways to minimize negative word-of-mouth, remove questions that are no longer justified on evidence and provide justification for those that remain.

The COVID-19 pandemic and blood utilisation in South Africa.

The COVID-19 pandemic, first reported in December 2019, affected every sector of every country worldwide. Health services were the first to experience the direct impact. Blood services were advised to decrease blood utilisation in anticipation of reduced blood collections. The South African National Blood Services (SANBS) saw a substantial decline in blood demand following the institution of strict national lockdown measures, but the impact of the epidemic and various mitigation strategies remained unknown. This retrospective study reviews red blood cell (RBC) utilisation during a 4-year period from 2019 to 2022 in the South African (SA) population, stratified by public and private healthcare sectors. To measure the impact of COVID-19, blood utilisation pre COVID-19 was compared with an acute COVID-19 period and a post-acute period. Each period covered 450 days. Blood utilisation was evaluated against the background of reported COVID-19 cases and national lockdown regulations. With the onset of the COVID-19 pandemic, overall RBC utilisation dropped by ~17%. The initial decline was more pronounced in the public sector. Overall, utilisation recovered to pre-COVID-19 levels in the post-acute COVID-19 period, but at different rates in the public and private sectors. There was a significant change in RBC utilisation during the course of the COVID-19 pandemic, much more pronounced in the public sector, which services 85% of the SA population. During the post-acute COVID-19 period, blood utilisation recovered, but at a much slower rate in the public sector. The COVID-19 pandemic accentuated the differences in blood utilisation patterns between the public and private healthcare sectors in SA, and each sector's resilience in adapting to the challenges of the epidemic.

A retrospective study of Quality Control of Fresh Frozen Plasma (FFP) using Factor VIII levels in Central Blood Transfusion Services Indonesian Red Cross

Background: According to a report from the Ministry of Health of the Republic of Indonesia, there are 470 blood transfusion units in Indonesia (235 units managed by PMI, 220 units managed by the government, four units of health services provinces, nine units of vertical hospital BTUs, two unit’s Indonesian police and army hospital) distributed in 38 provinces. With so many BTUs spread throughout Indonesia, each BTU must have the same quality standards to maintain and improve blood services. Therefore, it is necessary to carry out Quality Control of the blood component products produced. Quality control is critical in safely and effectively processing blood and other components. A quality concept comprises quality control, assurance, and management. The laboratory service should have a quality control system. Quality testing and monitoring of blood components for transfusion have led to manufacturing or development. Factor VIII levels are internal quality control parameters required for quality analysis of Fresh Frozen plasma (FFP). As per international standard guidelines and government national regulations (PMK 91/2015) for quality assurance of FFP, 1% of all the units prepared, or four units per month, are tested for stable coagulation factors, including Factor VIII levels. Objective: This study aims to evaluate factor VIII levels in each units FFP to ensure the availability of high-quality products with maximum therapeutic and minimal risk to recipients. Methods: The retrospective data were collected from Research and Development CBTS Indonesian Red Cross archives from 1 January 2019 to 30 April 2023. Out of total 284 units FFP collected from Blood Transfusion Unit Indonesian Red Cross from Sumatera Island (Lampung Province, Palembang City, Pekanbaru City), DKI Jakarta Province (CBTS IRC), Jawa Barat Province (Depok City, District of Bekasi City, District of Bogor City), Banten Province (Tangerang City, District South of Tangerang City), Government Hospital (Fatmawati Hospital BTU), Army Hospital (RSPAD Gatot Soebroto BTU) were tested Quality Control with semi-automated Sysmex CA50 and automated Sysmex CA620 to determine of factor VIII levels in each unit FFP. Results: A total of 284 units of FFP were tested, and mean factor VIII levels were 1,2 IU/mL with a range of 0,3 IU/mL-5,3 IU/mL, the normal range measure being &gt; 0,7 IU/mL. Only 4,9 % (14/284) FFP units were inappropriate from the standard, while 95,1 % (270/284) FFP units could be accepted criteria standard. Conclusion: We conclude that there are still those below-standard Quality FFP products from blood transfusion units; it is necessary to increase the processing of blood components so that the coagulation factors are maintained. From taking blood collecting, transporting, and shipping, it is required to carry out quality control to produce products that meet national and international standards.

Improved survival prediction for kidney transplant outcomes using artificial intelligence-based models: development of the UK Deceased Donor Kidney Transplant Outcome Prediction (UK-DTOP) Tool

The UK Deceased Donor Kidney Transplant Outcome Prediction (UK-DTOP) Tool, developed using advanced artificial intelligence (AI), significantly enhances the prediction of outcomes for deceased-donor kidney transplants in the UK. This study analyzed data from the UK Transplant Registry (UKTR), including 29,713 transplant cases between 2008 and 2022, to assess the predictive performance of three machine learning models: XGBoost, Random Survival Forest, and Optimal Decision Tree. Among these, XGBoost demonstrated exceptional performance with the highest concordance index of 0.74 and an area under the curve (AUC) consistently above 0.73, indicating robust discriminative ability and calibration. In comparison to the traditional Kidney Donor Risk Index (KDRI), which achieved a lower concordance index of 0.57, the UK-DTOP model marked a significant improvement, underscoring its superior predictive accuracy. The advanced capabilities of the XGBoost model were further highlighted through calibration assessments using the Integrated Brier Score (IBS), showing a score of 0.14, indicative of precise survival probability predictions. Additionally, unsupervised learning via k-means clustering was employed to identify five distinct clusters based on donor and transplant characteristics, uncovering nuanced insights into graft survival outcomes. These clusters were further analyzed using Bayesian Cox regression, which confirmed significant survival outcome variations across the clusters, thereby validating the model’s effectiveness in enhancing risk stratification. The UK-DTOP tool offers a comprehensive decision-support system that significantly refines pre-transplant decision-making. The study’s findings advocate for the adoption of AI-enhanced tools in healthcare systems to optimize organ matching and transplant success, potentially guiding future developments in global transplant practices.

Hematocrits of red blood cell units increase during storage due to changes in mean corpuscular volume, impacting outcomes of red cell exchange procedures

Abstract Introduction Hematocrits of red blood cell (RBC) units are generally not measured by blood centers or transfusion services. Red blood cell exchange (RCE) is commonly used to treat sickle cell disease, and a key parameter needed in RCE is the average hematocrit of RBC units. However, there is no consensus on the average hematocrit to use or how it is affected by storage. The goal of our study is to determine the average hematocrit of RBC units by measuring hematologic parameters RBC units during storage and performing statistical modeling of hematocrit changes over time. Methods We sampled aliquots of leukoreduced RBC units in AS-1 (n=10) using the Terumo TSCD-II Sterile Tubing Welder to sterilely collect ~15mL of RBCs in transfer-pack containers. Aliquots were collected weekly from Day 7 to Day 42 of storage. Complete blood counts were performed using the Sysmex XN-3100 Hematology Analyzer. We statistically modeled changes in RBC units during storage by utilizing Bayesian multilevel linear regression models, allowing for capturing effects at the individual RBC-unit level. Posterior distributions of model parameters were estimated and processed using Stan and the rethinking and rstan packages in R. Posterior distributions are summarized with posterior means and 95%-credible intervals in parentheses. Model selection was done by calculating Akaike weights using the widely applicable information criterion (WAIC) to signify statistical support for each model. Results Multilevel linear regression models of hematologic parameters as a function of storage time were developed. Hematocrits increased with a posterior mean of 1.4% (0.98–1.75%) per week of storage, with posterior mean hematocrits of: 61.9% (60.2–63.6%) on Day 7, 63.9% (61.5–66.4%) on Day 21, and 66.0% (62.8–69.7%) on Day 42. These results indicate that a single average cannot be used for RBC units since hematocrits dramatically increase during storage. Mean corpuscular volume (MCV) increased with a posterior mean of 2.31 fL (1.4–3.71) per week whereas hemoglobin remained stable with a posterior mean increase of 0.008 g/dL (-0.016–0.031) per week. Using these results, we subsequently developed a multilevel regression model of hematocrit as a function of MCV. The model using MCV (WAIC=100.2, weight=100%) was favored over the model using time (WAIC=120.0, weight=0%), suggesting that changes in MCV are driving the increasing hematocrits. Conclusion Our study is the first to leverage Bayesian statistics to carefully quantify the average hematocrits of RBC units during storage time and to demonstrate that increasing hematocrits are caused by changes in MCV. These results indicate that transfusion protocols must consider the age of RBC units for RCE calculations, and provisions (e.g., requiring use of fresh units for RCE) may help minimize the variability in post-exchange testing. Moreover, our findings suggest that transfusion services should regularly measure hematocrits of RBC units in their inventory.

Validating a Pneumatic Tube System for Blood Product Delivery

Abstract Introduction/Objective Timely delivery of blood products can be of utmost importance to providing quality care. We aimed to validate the use of a high-speed pneumatic tube system (PTS) that was already installed at our hospital. By reducing delivery times, patient resuscitation and survivability can be increased. Methods/Case Report We followed the Association for the Advancement of Blood &amp; Biotherapies (AABB) guidelines to validate a PTS in a large tertiary academic medical center. The requirements include: verifying product suitability, ensuring product integrity, temperature monitoring, transportation time measurements, and proper packaging and tracking of product receipt. We validated the transfer of packed red blood cells (PRBC), plasma, platelets, and cryoprecipitate from the central blood transfusion services lab (BTS) to nursing stations in a separate building up to 1500 feet (&amp;gt;1/4 mile) away using a Swisslog Translogic® PTS Inclusion with foam inside the PTS carriers helped reduce bumps during transit and insulated products from heat. Results (if a Case Study enter NA) The mean temperature of the PRBC was 6.6 degrees Celsius and none exceeded the AABB maximum of 10 degrees Celsius. The mean time for blood products transit to the nursing stations was 3 minutes (m) and 33 seconds (s). The median time was 3m 31s, and it ranged from 2m 18s to 5m 38s. The PTS reduced delivery times of blood products by up to 10-12 minutes compared to manual porters. Conclusion Transporting blood products via PTS is an efficient method that reduces the required manpower and leads to better utilization of resources. However, it is essential to validate the PTS system before implementing it operationally.

Blood transfusion in the Caribbean: Historical perspective in the context of Trinidad and Tobago.

To compare the historical development of blood transfusion in Britain and a former British West Indian colony. International transfusion bodies recommend national coordination and exclusively voluntary non-remunerated donation as essential pre-requisites for blood safety. These ideals have been achieved in high-income countries including Great Britain, the United States of America and Canada. However, most West Indian countries have fragmented, hospital-based blood services that rely on family replacement and remunerated donors. Comparative historical analysis of blood transfusion service development in Great Britain and Trinidad and Tobago was undertaken to provide insight into their dichotomous development and inform policy decisions to bridge the gap between the two types of transfusion service. The British National Blood Transfusion service was based on voluntary non-remunerated blood donation from its inception but achieved national coordination over 50 years that included a period of regional control during which incoordination contributed to a tainted blood scandal. Failure to establish community voluntary non-remunerated donation in Trinidad and Tobago during the colonial period, before independence in 1962, allowed regionally-controlled family replacement and remunerated blood donation to become entrenched then perpetuated by path dependence. A university-led programme has recently used historically-proven methods, drawing on the experiences of the British National Blood Transfusion Service, to establish a model for developing a voluntary non-remunerated programme. The programme aims to avoid historical pitfalls during its national extension. Historical analysis provided information for introducing voluntary non-remunerated blood donation and planning a nationally-coordinated blood transfusion service.

Frequency of ABO, Rh and Kell Blood Group among Blood Donors in Brazzaville, Republic of the Congo

Introduction: Blood group antigens play an essential role in transfusion safety and in avoiding the risk of alloimmunization. The ABO, Rh and Kell blood group systems are the most clinically important. The aim of this study was to determine the frequency of ABO, Rh and Kell blood groups among blood donors in Brazzaville, Republic of Congo. Methods: This was a cross-sectional study conducted among blood donors in Brazzaville, republic of Congo, from June 2021 to November 2022. The blood samples were tested for ABO, Rh and Kell antigens by standard tube agglutination method. The statistical analysis was done using SPSS version 21.0. Results: A total of 350 participants were included, of which 258(73.7%) of donors were males and 92 (26.3%) females. The antigen frequencies of ABO and Rh(D) blood group system showed that O was the most prevalent blood group 46.8% followed by A (28.9%), B (16.9%), and AB (7.4%). The Rh-positive donors were more prevalent (94.86%) as oppose to the Rh-negative (5.14%). The most common Rh phenotype is the Dccee (64.86%) while the rarest phenotype is the dCcee (0.86%). The prevalence of K and k antigen was 0.9% and 99.1%, respectively. Conclusion: This study determined the phenotypic variability of ABO and Rh blood group antigens with low prevalence of Kell antigen. The extensive phenotypic status of Rh and Kell systems in blood donors is important for the efficient management of blood banks and transfusion services.

Understanding Blood Donation Practices in Gilgit, Pakistan An Anthropological Perspective

Blood is widely recognized as an essential bodily fluid crucial for sustaining life, and blood donation plays a critical role in saving lives. Ensuring access to a safe and sufficient supply of blood and its derivatives and reliable blood transfusion services is indispensable for a strong healthcare system. It is important to note that voluntary non-remunerated blood donors are the most reliable source of safe blood supply. In Pakistan, 70% of donated blood comes from replacement or paid donations, while only 10% comes from voluntary donations. In Gilgit, voluntary blood donation is scarce, and most blood comes from replacements. The respondents display limited understanding of blood transfusion, while they exhibit a positive attitude toward voluntary blood donation despite low participation. This discrepancy is attributed to inadequate awareness and campaigns, as well as prevalent myths and negative perceptions associated with blood and blood donation. Furthermore, sectarian-based segregation, the symbolic relationships between the donor and recipient and the exclusion of female blood donors exacerbate the gap between blood supply and demand. The research emphasises culturally suited solutions and strategies that can help enhance voluntary blood donation in Gilgit.

A Retrospective View of Post Renal Transplant Urinary Tract Infections: An Experience of A UK Transplant Centre

Urinary tract infections (UTIs) are prevalent post renal transplant complication. These infections are most common in renal transplant recipient’s contrary to their incidence in general healthy population as shown by previous studies. Though the frequencies of occurrences are different in renal transplant patients. There is general lack of consensus on the risk factors associated with development of UTIs in renal transplant patients as well as effects posed by them and occurrence of mortality in patient group. This retrospective cohort study investigated and included adults’ patients who were operated for renal transplant in a single transplant center in UK from Jan 2014 to December 2023. The number of patients were 604 with two hundred and fifty-nine developed one or more UTIs in 42 months follow-up period. Significant risk factors for post-transplant UTIs were advanced age, female gender, reflux kidney disease, use of azathioprine and cadaveric donor. UTIs did not increase risk for renal graft loss, but were associated with increased mortality (3.5 odds ratio, 95% confidence interval 1.68–7.23). We conclude UTIs may be associated with an increased mortality risk in renal transplant recipients. Prevention of UTIs in high-risk renal transplant patients or those with recurrent UTIs may possibly decrease post-transplant mortality.

Ethical, Psychological and Social Un/certainties in the Face of Deemed Consent for Organ Donation in England.

Deemed consent legislation for deceased organ donation was introduced in England in 2020, and is considered a vital part of the new UK NHS Blood and Transplant's 10-year strategy to increase consent for organ donation. Despite the legislation containing safeguards to protect the public, the introduction of deemed consent creates ethical, psychological and social un/certainties for healthcare professionals in their practice. In this paper, we offer insights into healthcare professionals' perspectives on deemed consent, drawn from interview data with 24 healthcare professionals in an NHS Trust in England, prior to the introduction of the legislation. Whilst participants supported deemed consent in principle, they were concerned that it would present a threat to the nature of donation as a 'gift'; the notion of informed consent (or non-consent); and the autonomy of donors, their relatives, and their own roles as health professionals, posing dilemmas for practice. We argue that healthcare professionals present themselves as guardians of potential (non)donors and thus as having ethics and integrity in their own practice. We draw conclusions around the values and principles that matter to healthcare professionals when contemplating consent in deceased donation which will be useful for organ donation committees and ethics forums.

Evaluating the Crossmatch-to-Transfusion Ratio as a Tool for Analyzing and Optimizing Blood Bank Resource Utilization: A Retrospective Observational Study.

Background Blood transfusion services are crucial for modern medical care, particularly for surgical interventions, chronic diseases, pregnancy complications, and malignancies. There is an increasing demand for blood products in India; hence,optimizing resource utilization in blood banks is essential. This study aims toevaluatethe crossmatch-to-transfusion (C/T) ratio as a tool for analyzing and optimizing the utilization of blood bank resources. The C/T ratioof the various clinical departments will also identify inefficiencies in blood ordering practiceand plan corrective actions. Methods A retrospective observational study was conducted at the Blood Center of Saveetha Medical College and Research Center. Data were collected over a three-month period from November 1, 2023, to January 31, 2024. Information was collected from crossmatch request forms, crossmatch registers, issue registers, and digital medical records. The study included all crossmatch requests received within the study period. The C/Tratio was calculated department-wise, and the departments with high C/T ratios were identified. Results In the study, 1,861 packed red blood cell (RBC) units were crossmatched, of which 797 units were issued. The overall hospital C/T ratio was 2.33, which indicates excessive blood ordering. The Department of Obstetrics and Gynaecology had the highest C/T ratio of 5.14, followed by Oncology (3.09), Urology (2.9), General Surgery (2.26), and Orthopaedics (2.08). These high ratios showed significant overorderingand underutilization of crossmatched blood units. Conclusion This study revealed that the C/T ratio in the hospital exceeded international standards, especially among surgical departments. This indicates a need for optimizing blood ordering practices to reduce unnecessary crossmatches, minimize wastage, and enhance resource management. Implementing strategies to correct the high C/T ratio and regular auditing can improve blood transfusion services and ensure efficient utilization of blood products.