Blood components requests at an orthopedic hospital: a critical survey

Abstract Introduction The correct completion of the blood components request form is the starting point to ensure good transfusion care. Many guidelines have been developed to search for hemoglobin values that trigger the need for transfusion and show the importance of Patient Blood Management, a scientific evidence-based approach in processes where transfusion is a possibility, such as in elective surgeries. Objective The cross-sectional study aimed to analyze the transfusion requests at a complex orthopedic hospital over a one-year period. Method The completion quality was classified as Good, Regular, Bad or Very Bad, according to the information given by the physician. Transfusion medicine professionals analyzed the transfusion indication reported on the request form and classified it as Correct, Not based on Patient Blood Management (PBM), in accordance or not with the institutional Maximum Surgical Blood Order Schedule, Impossible to evaluate due to lack of information on the form, and Incorrect. Results The study categorized the completion quality of 2011 requests as Good (8.80%), Regular (9.30%), Bad (72.75%) and Very Bad (9.15%). Analysis of the indications revealed that 54.90% of the requests were in accordance with the current blood transfusion recommendations, and on 23.12% of the forms this field had not been filled out. Conclusion The majority of blood components (63%) requests are in tune with current blood transfusion recommendations, despite the great number of incorrectly completed forms; nevertheless, it is mandatory to reach much better appropriateness rates.

Seroprevalence of IgG and IgM anti-SARS-CoV-2 among voluntary blood donors in Rio de Janeiro, Brazil

Background: In Brazil, mathematical models for derivingestimates and projections of COVID-19 cases have been developed without data on asymptomatic SARS-CoV-2 infection. We estimated the seroprevalence of antibodies to SARS-CoV-2 among blood donors in the State of Rio de Janeiro. Methods: Data were collected on 2,857 blood donors from April 14 to 27, 2020. We report the crude prevalence of antibodies to SARS-CoV-2, the weighted prevalence by the total state population, and adjusted prevalence estimates for test sensitivity and specificity. To establish the correlates of SARS-CoV-2 prevalence, we used logistic regression models. The analysis included period and site of blood collection, sociodemographic characteristics, and place of residence. Results: The proportion of SARS-Cov-2 positive tests without any adjustment was 4.0% (95% CI 3.3-4.7%), and the weighted prevalence was 3.8% (95% CI 3.1-4.5%). Further adjustment by test sensitivity and specificity produced lower estimates, 3.6% (95% CI 2.7-4.4%) and 3.3% (95% CI 2.6-4.1%), respectively. The variable most significantly associated with the crude prevalence was the period of blood collection: the later the period, the higher the prevalence. Regarding socio-demographic characteristics, the younger the blood donors, the higher the prevalence, and the lower the educational level, the higher the odds of a positive SARS-Cov-2 antibody. Similar results were found for the weighted prevalence. Discussion: Although our findings resulted from a convenience sample, they match some basic premises: the increasing trend over time, since the epidemic curve in the state is still on the rise; the higher prevalence among the youngest who are more likely to circulate; and the higher prevalence among the less educated as they have more difficulties in following the social distancing recommendations. Despite the study limitations, it is possible to infer that protective levels of natural herd immunity to SARS-CoV-2 are far from being reached in Rio de Janeiro. (AU)

Seroprevalence of anti-SARS-CoV-2 among blood donors in Rio de Janeiro, Brazil

ABSTRACT OBJECTIVE To estimate the seroprevalence of antibodies to SARS-CoV-2 among blood donors in the state of Rio de Janeiro, Brazil. METHODS Data were collected on 2,857 blood donors from April 14 to 27, 2020. This study reports crude prevalence of antibodies to SARS-CoV-2, population weighted prevalence for the state, and prevalence adjusted for test sensitivity and specificity. Logistic regression models were used to establish the correlates of SARS-CoV-2 prevalence. For the analysis, we considered collection period and site, sociodemographic characteristics, and place of residence. RESULTS The proportion of positive tests for SARS-Cov-2, without any adjustment, was 4.0% (95%CI 3.3-4.7%), and the weighted prevalence was 3.8% (95%CI 3.1-4.5%). We found lower estimates after adjusting for test sensitivity and specificity: 3.6% (95%CI 2.7-4.4%) for the non-weighted prevalence, and 3.3% (95%CI 2.6-4.1%) for the weighted prevalence. Collection period was the variable most significantly associated with crude prevalence: the later the period, the higher the prevalence. Regarding sociodemographic characteristics, the younger the blood donor, the higher the prevalence, and the lower the education level, the higher the odds of testing positive for SARS-Cov-2 antibody. We found similar results for weighted prevalence. CONCLUSIONS Our findings comply with some basic premises: the increasing trend over time, as the epidemic curve in the state is still on the rise; and the higher prevalence among both the youngest, for moving around more than older age groups, and the less educated, for encountering more difficulties in following social distancing recommendations. Despite the study limitations, we may infer that Rio de Janeiro is far from reaching the required levels of herd immunity against SARS-CoV-2.

Cenário mundial do fracionamento industrial de plasma e da produção de hemoderivados / World scenario of industrial plasma fractioning and blood derivates production

A produção de hemoderivados no mundo se iniciou nos anos 40, depois que o químico americano Edwin Cohn desenvolveu uma técnica de precipitação das proteínas plasmáticas pelo álcool. Desde então, a indústria tem passado por diversas fases, das quaisa primeira foi o boom da produção de albumina em pequenos laboratórios. Depois, surgiram os fatores de coagulação liofilizados para o tratamento da hemofilia e as imunoglo-bulinas intravenosas. O aparecimento da AIDS e a comprovação de que ela era transmitida pelos hemoderivados, nos anos 80, trouxeram no seu bojo uma transformação radical, com a introdução de métodos de inativação viral e a obrigação de a indústria cumprir compadrões de qualidade cada vez mais rígidos. O surgimento dos fatores de coagulação recombinantes modificou preços e estratégia dos centros de fracionamento de plasma, hoje focados principalmente na produção de imunoglobulina. A tendência da indústria de hemoderivados tem sido o de consolidações e fusões, criando grandes grupos econômicos que controlam o setor e que dependem cada vez mais do plasma em centros de doação remunerada, disseminados nos Estados Unidos. O Brasil entrou recentemente para o rol dos países com indústrias de hemoderivados, com a criação da Hemobrás, empresa estatalpertencente ao governo federal, cujo objetivo central é aproveitar o plasma disponível no país e reduzir a dependência externa por hemoderivados.

The hemoderivative production started in the 1940s, after the American chemistEdwin Cohn developed a alcohol–based plasmatic–protein precipitation technique. Since then, industry has gone through many phases, being the boom of albumin production in small labs the first one. After that, lyophilized coagulation factors appeared for the treatment of hemophilia and intravenous immunoglobulin. AIDS appearing and the verification that it was transmitted by hemoderivatives, in the 1980s, made present a radical transformation that introduced viral inactivation methods and the industry’s obligation of complying with higher quality standards. The appearance of recombinant coagulation factors modified both prices and strategies of plasma fractionation centers, focused nowadays in imunnoglobulin production. Hemoderivative industry is following a consolidation and fusion tendency, creating big economical groupswhich control the sector and depend more and more on plasma from paid donation center, popular in The United States. Brazil has recently entered to the list of countries with hemoderivative industries after the creation of Hemobrás, whose main goal is to use the plasma available in the country to reduce the dependance on imported hemoderivatives.