Prevalencia de marcadores infecciosos en donantes de sangre. Complejo Hospitalario Universitario Ruíz y Páez

Introducción: La infección transmitida por transfusión (ITT) es producto de la inoculación directa de un agente infeccioso específico desde la unidad de sangre al huésped susceptible. Los marcadores serológicos positivos responden a características epidemiológicas no detectadas en miembros de la población aparentemente saludable. Objetivo general: Determinar la prevalencia de marcadores infecciosos y las características sociodemográficas en unidades sanguíneas procesadas de donantes que asisten al banco de sangre del Complejo Hospitalario Universitario "Ruíz y Páez" de Ciudad Bolívar - Estado Bolívar, período junio 2019 - junio 2022. Metodología: Se trató de un estudio de tipo descriptivo, retrospectivo, no experimental. El universo estuvo conformado por 13 016 unidades sanguíneas, 414 muestras fueron reactivas, que reportaron un total de 434 serologías positivas. Resultados: Se apreció una prevalencia global de 3,34 % para cualquier ITT; el marcador infeccioso más frecuente fue sífilis con el 60,83 % y una prevalencia de 2,03 %. Tomando en cuenta las características sociodemográficas predominantes: género masculino, 65,94 %; grupo etario 38-47 años, 28,74 %; ocupación obrera, 24,88 %; provenientes de Ciudad Bolívar, 84,06 %. Las muestras con coinfección representaron un 4,58 %, siendo la combinación VIH+Sífilis la más frecuente 1,45 %. El año 2021 destacó con 35,25 % serologías positivas. Conclusiones: La prevalencia de marcadores infecciosos se considera no despreciable. Se debe reforzar la prevención y cura de las enfermedades infecciosas trasmisibles en miembros de la población aparentemente saludable, así como también redirigir las estrategias en el manejo de seguridad transfusional.

Introduction: Transfusion-transmitted infection (ITT) is the direct inoculation of a specific infectious agent from the blood unit to the susceptible host. Positive serological markers respond to epidemiological characteristics not detected in members of the apparently healthy population. General objective: Determine the prevalence of infection markers and sociodemographic characteristics in processed blood units of donors attending the blood bank of the "Ruíz y Páez" University Hospital Complex in Ciudad Bolívar - Bolivar State, period June 2019 - June 2022. Methodology: This was a descriptive, retrospective, nonexperimental study. The universe consisted of 13 016 blood units, 414 samples were reactive, which reported a total of 434 positive serologies. Results: An overall prevalence of 3.34 % was found for any ITT; the most frequent infection markers were syphilis with 60.83% and a prevalence of 2.03 %. Taking into account the predominant sociodemographic characteristics: male gender, 65.94 %; age group 38-47 years, 28.74 %; labor occupation, 24.88 %; from Ciudad Bolivar, 84.06 %. The samples with coinfection represented 4.58 %, being the combination HIV+Syphilis the most frequent 1.45 %. Year 2021 stood out with 35.25 % positive serologies. Conclusions: The prevalence of infection markers is considered not negligible. The prevention and cure of communicable infectious diseases in members of the apparently healthy population should be strengthened, as well as redirecting strategies in transfusion safety management.

The monitoring of adverse reactions to blood donation: a multi-center analysis / 中国输血杂志

【Objective】 To investigate the establishment of multi-center haemovigilance (HV) and the monitoring of adverse reactions to blood donation (ARBD), in order to provide basis for the management of blood donors. 【Methods】 The operation of HV was investigated by questionnaire. The total number of blood donations (including plateletpheresis) and ARBD cases occurred in each blood center from 2014 to 2018 were analyzed. 【Results】 Among the 24 blood centers in this survey, only nine got HV operated. The incidence of ARBD of 19 blood centers that fulfilled the questionnaire was in the range of (0.003~1.151) %. The change trend of number and incidence of ARBD cases were indeterminate. 【Conclusion】 Most blood centers did not got HV established. The incidence of ARBD varied greatly and was indeterminate. The application of HV should be further improved to strengthen ARBD management.

Regional hemovigilance system for adverse reactions to blood donation / 中国输血杂志

【Objective】 To establish a regional hemovigilance system of adverse reactions to blood donation(ARBD) and to evaluate its operation effect. 【Methods】 A regional monitoring working group was established to improve the ARBD monitoring system in two phases [phase-ⅠJanuary-June, 2019 and phase-Ⅱ July-December, 2019). The suitability of monitoring standards and reporting approaches, as well as the running effect of this system were evaluated by comparing the accuracy of ARBD classification and severity grading, timely report processing and the contents of reports submitted in two phases. The incidence of ARBD and the number of different types of ARBD cases in the two phases were analyzed to compare the monitoring effect. 【Results】 7 and 17 blood banks joined the regional working groups in phase-Ⅰand phase-Ⅱ, respectively. In phase-Ⅰ, 565 cases of ARBD were reported, 72.04%(407/565)of them was accurately sorted and 80.95%(34/42)were timely reported. Over 99% of reports covered such monitoring items as blood donors′ gender, type of blood donation, place of blood donation, organization mode of blood donation, symptom of ARBD, type, severity grading and other related factors, and less than 20% of reports recorded the details concerning the treatment following ARBD. In phase-Ⅱ, 1098 cases of ARBD were reported, 94.54%(1 038/1 098)of them was accurately sorted and 96.08%(98/102)were timely reported. Over 97% of reports covered the monitoring items mentioned above, still less than 30%, though elevated in comparison with phase-Ⅰ, of reports recorded the details concerning the treatment following ARBD, and less than 20% tracked the ARBD. The overall incidence of ARBD reported was 0.87%, while 0.93%(1 098/118 565)in phase-Ⅱ and 0.77%(565/73 267)in phase-Ⅰ, with statistically significant differences (P<0.01). 【Conclusion】 The regional monitoring system for ARBD in Chongqing, with Blood Safety Hemovigilance Guidelines(T/CSBT 001-2019)as the standard and the Blood Safety Monitoring Management Information System as the reporting approach, has been basically established through two phases of development, and the reporting contents need to be further managed at specific levels.

Determining the true incidence of acute transfusion reactions: Active surveillance at a specialized liver center

ABSTRACT Background: Blood transfusion is a life-saving procedure, but may cause adverse transfusion reactions (TRs). The reporting of TRs is often missed due to various reasons. The aim of this study was to determine the incidence of unreported acute TRs through active surveillance and to compare it with the incidence of passively reported TRs. Methods: This prospective observational study was done over a period of four months at a tertiary care hospital. A total of 500 consecutive transfusion episodes (TEs) in patients who had received blood component transfusions in the intensive care units were included in the study. Comprehensive data were collected from the blood bank records, patient records and through interviews with the attending clinical staff. The TEs were defined as all blood components issued to a single patient in 24 h. Results: The overall incidence of TRs was 1.8 % (9 cases), with 0.4 % (2 cases) being reported passively, while 1.4 % (7 cases) were identified during active surveillance. The transfusion-associated cardiac overload (TACO) had the highest incidence of 1.2 % (6 cases) in active surveillance. A single case of acute hemolytic transfusion reaction was also observed during active surveillance. The passively reported TRs were one allergic reaction and one febrile non-hemolytic transfusion reaction. Conclusion: Active surveillance of TRs provided an insight into the true incidence of TRs, which is higher when compared with the passively reported TRs. The TACO was found to have the highest incidence and not a single case was reported. There is a need to improve awareness regarding TR reporting.

Knowledge, attitude and practices about hemovigilance among practitioners: a cross-sectional study

Abstract: Transfusion by blood and blood products forms an important part of treatment. But this is not free from transfusion reactions which may be in the form of fever, rashes, shivering, anaphylaxis or even death. Hemovigilance is a programme of reporting such events.Materials and Methods: The present study was conducted in a tertiary care hospital of Jammu, (J& K). Permission was taken from Institutional Ethics Committee, Govt. Medical College, Jammu. A pretested questionnaire was prepared and circulated among practitioners. They were given time of 15 minutes to fill that questionnaire. After 15 minutes, the filled questionnaire were collected and were analysed. The data was presented in tabulated form.Results: Total 50 practitioners were included in the study. All the practitioners had knowledge about transfusion reactions. Only 10% of the practitioners had knowledge that transfusion reactions can be prevented, 40% of the practitioners had knowledge about hemovigilance programme and had an idea that transfusion reactions can be reported. But only 10% of the practitioners knew where to report and who can report, 6% knew how to report. Only 48% of the practitioners thought that transfusion reactions should be reported, 70% of the practitioners thought that transfusion reactions can be dangerous. 40% of practitioners told that seminars/CMEs should be planned. 80% of practitioners had encountered transfusion reactions, but only 2% had documented the same. 10% of the practitioners had attended seminars, CMEs. Many reasons were quoted for not reporting transfusion reactions.Conclusion: Overall, most of the practitioners have a positive attitude towards transfusion reaction reporting but knowledge regarding the haemovigilance concept is poor and the majority of them never reported such reaction. Hence, our study demands increased awareness and continued training to strengthen the haemovigilance system.

Trypanosoma cruzi infection in transfusion medicine

ABSTRACT Introduction: Infection by Trypanosoma cruzi is challenging to blood bank supplies in terms of accurate diagnosis, mostly due to its clinical complexity. Infected individuals may remain asymptomatic for years, albeit they may have circulating parasites potentially transferable to eventual receptors of a transfusion. Objective: Although risk donors are systematically excluded through a survey, an important residual risk for transmission remains, evidencing the need to implement additional actions for the detection of T. cruzi in blood banks. Method: A review of the scientific literature is presented with the objective of identifying relevant publications on this subject. Results: We discuss the diagnostic considerations of this chronic infection on transfusion medicine and some recent advances in the processing of blood and derivatives units. Conclusion: Finally, recommendations are made on how the transmission of T. cruzi can be avoided through the implementation of better diagnostic and pathogen control measures at blood banks.

A donor hemovigilance study: evaluation of adverse reactions to blood donors at tertiary care teaching hospital

Background: Donor hemovigilance is an important aspect of the hemovigilance system and contributes to decrease the blood donor’s complications and improving blood donor safety and functioning of blood bank. Reporting of adverse reactions associated with blood donations has been covered under National blood donor vigilance programme. This study was carried out to estimate the adverse events in blood donors and to promote their safety.Methods: The study was conducted over a period of 6 months, from 1st January 2017 to 30th June 2017 after getting approval from institutional ethics committee at tertiary care teaching hospital. Prior informed consent was obtained and donor confidentiality was ensured. The donors were observed for adverse event during or after donation. For delayed reactions, donors were requested to contact the researcher or designated departmental staff. Data was collected in case record form. Data entry was done in excel 2013 and appropriate Statistical test (chi square) was applied.Results: During study period total 7970 donors were registered, out of which 53.27% donors have donated their blood in blood camps and 46.72% have in blood bank. Incidence of donor reactions was 1.54%. Incidence of adverse reaction was higher at blood camps (58.53%). Authors found highest number of cases of mild vaso vagal type reactions (53%). Other types of reactions observed were painful arm, hematoma, delayed bleeding, tingling and moderate type of vaso vagal reaction.Conclusions: Authors did not find any major serious events like convulsion, thrombophlebitis or arterial puncture during study period. It considers that safety of donors was maintained.

Acute blood transfusion reaction in a tertiary care hospital in Southern Punjab, Pakistan

Background: Blood transfusion is a lifesaving process but carries many risks. Majority of these had been reduced with better diagnostic and management strategies. But the risk of non-infectious adverse transfusion reactions though reduced but cannot be eliminated. Hemovigilance is the system to monitor such reactions.Methods: The objective of current study was to know the frequency of adverse transfusion reactions and to compare it with local and international data. Retrospective cross-sectional descriptive study was done in Ibn-e- Sina hospital. Adverse transfusion reactions reported to blood bank was analysed according to hospital protocol.Results: Out of 6050 blood transfusions 23 (0.38%) develop adverse transfusion reactions. Febrile nonhemolytic transfusion reaction was the commonest adverse event and whole blood was the component implicated.Conclusions: Adverse transfusion reactions are non-infectious complications of blood transfusion which in spite of all efforts cannot be avoided. Frequency of adverse transfusion reactions in our study was 0.38% and Febrile nonhemolytic transfusion reaction was commonest reported reaction type. Hemovigilance system is necessary to monitor, investigate and control such activities.

Infecciones en donantes de un banco de sangre de medellín-colombia, 2015-2016

Introducción. En Medellín, Colombia, se desconoce la prevalência de las siete infecciones transmisibles en bancos de sangre. Materiales y métodos. Estudio transversal con 25 842 donantes. Se emplearon pruebas de detección con alta validez. Se estimaron frecuencias con sus intervalos de confianza del 95%. Los factores asociados se identificaron con Chi cuadrado de Person, Test exacto de Fisher, razones de odds crudas y ajustados mediante regresión logística. Resultados. La reactividad global fue 3,3% en 2015 y 3,5% en 2016; virus de hepatitis B 1,6%, VHC 0,4%, HTLV 0,2%, T.pallidum 1,1% y T. cruzi 0,1%. La reactividad global y las infecciones virales fueron estadísticamente mayores en hombres, donantes mayores de edad, amas de casa, donantes no repetitivos y de primera vez. Conclusion. Se halló una elevada frecuencia de infecciones que implica grandes pérdidas económicas para el banco y la necesidad de mejorar los procesos de selección. La identificación de grupos con mayor prevalencia permite focalizar esfuerzos educativos e investigativos.

Introduction. In Medellin, Colombia, the prevalence of the seven transmissible infections in blood banks is unknown. Materials and methods. Cross-sectional study with 25 842 donors. High validity detection Tests were applied. Frequencies with their confidence intervals of 95% were estimated. The associated factors were identified through Chi square of Person, Fisher's exact Test, crude odds ratios and adjusted by logistic regression. Results. The global reactivity was 3.3% in 2015 and 3.5% in 2016; hepatitis B virus 1.6%, HCV 0.4%, HTLV 0.2%, T Pallidum 1.1% and T. Cruzi 0.1%. The global reactivity and Viral infections were statistically higher in men, older donors of age, housewives, non-repetitive and first-time donors. Conclusion. It was found a high frequency of infections that imply great economics losses for the bank and the need to improve selection processes. The identification of groups with higher prevalence allows to focus educational and investigative efforts.

Introdução. Em Medellín, Colômbia, é desconhecida a prevalência das sete infecções transmissível em bancos de sangue. Material métodos. Estudo transversal com 25 842 doadores. Testes de detecção foram usados com alta validade. As frequências foram estimadas com intervalos de confiança de 95%. Os fatores associados foram identificados com Qui-quadrado de Person, Teste exato de Fisher, razão de possibilidades e razão de possibilidades ajustada por regressão logística. Resultados. A reatividade global foi de 3,3% em 2015 e de 3,5% em 2016; vírus da hepatite B 1,6%, VHC 0,4%, HTLV 0,2%, T. pallidum 1,1% e T. cruzi 0,1%. A reatividade global e as infecções virais foram estatisticamente maiores em homens, doadores de Idade legal, donas de casa, doadores não repetitivos e doadores de primeira vez. Conclusão. Encontrou-se alta frequência de infecções que implica grandes perdas econômicas para o banco e a necessidade de melhorar os processos de seleção. A identificação de grupos com maior prevalência permite enfocar esforços educacionais e investigativos.

Hemovigilancia de los efectos adversos a la donación de sangre / Hemovigilance of side effects related to blood donation

La donación de sangre es el sustento de los programas que proporcionan la sangre segura para el uso terapéutico, con el fin de preservar la salud y vida humana. Es necesario prestar especial atención a la seguridad y calidad de esta actividad ya que es también un principio ético, cuidar de la salud del que de forma altruista da parte de si para beneficiar a los demás. Aunque la donación es un proceder seguro, en ocasiones pueden presentarse efectos adversos en los donantes, algunos evitables, que pueden repercutir en su salud o afectar el retorno a esta actividad. A inicios de la década de 1990, surgen los programas de hemovigilancia encargados de velar, notificar, investigar y prevenir los efectos adversos de la transfusión y la donación, con el fin de prevenir su recurrencia e incrementar la seguridad y calidad de ambos procederes. Este trabajo realiza una revisión actualizada sobre las reacciones adversas de la donación en el contexto de la hemovigilancia(AU)

Blood donation is the livelihood of all blood programs to provide safe blood transfusion for therapeutic use whit the aim to preserve health and human life. It is necessary to pay attention to the safety and quality of this activity, because is an ethical principle to take care of the health of those who, in an altruist manner, give part of themselves in order to benefit others. Although the donation is a safe procedure, occasionally some side effects in donors may occur, many of them can be avoided, and that could have an echo on the donors' health on effect their return to this activity. At the beginning of the 90ths, decade started the Hemovigilance programs in charge of the vigilance, notification and prevention of transfusion and donation side effects, whit the purpose of preventing its recurrence and increase the safety and quality of both procedures. This work carries out and update revision about of donor's reactions in the Hemovigilance(AU)

Resultados de un programa de hemovigilancia / Results of a haemovigilance program

Introducción: La hemovigilancia es el conjunto de procedimientos de vigilancia que cubre toda la cadena transfusional para el mejoramiento continuo de la seguridad y calidad de la cadena transfusional. Incluye el monitoreo, reporte, investigacion y análisis de los eventos adversos ocasionados por la donación, los procesos y la transfusión, para prevenir su ocurrencia o recurrencia. Objetivo: Mostrar los resultados de la implementación de un programa de hemovigilancia en el municipio de Jovellanos, provincia Matanzas, Cuba. Métodos: Entre enero de 2003 y diciembre de 2015 se implementó en el municipio de Jovellanos, un programa de hemovigilancia como parte del programa territorial iniciado en esa provincia, en igual fecha; para incrementar la seguridad y calidad transfusional. Previamente se realizó un diagnóstico del estado de las donaciones, las transfusiones y sus efectos adversos; de los casi errores, la hemoterapia, del grado de conocimientos en medicina transfusional de los médicos e indicadores de transfusiones; esto último mediante la aplicacion de una encuesta. Se inició un programa de capacitación, se creó el comité de transfusiones, se fortaleció el sistema de gerencia de calidad y la participación de las enfermeras en la transfusión. Resultados : Se elevó el grado de conocimientos en medicina transfusional de los profesionales, se logró la disminución de las reacciones de donantes y receptores; de una tasa en el 2002 de 14 y 63 por mil, respectivamente, a 1,1 y 0 por mil en el 2015; además disminuyó la gravedad de las reacciones. Hubo disminución del porcentaje de pacientes ingresados que fueron transfundidos de 18,5 a 7,3; además, disminuyó el número de transfusiones realizadas en 40,5 por ciento. Conclusiones: El programa es factible y sustentable con los recursos existentes y optimizó significativamente la seguridad y calidad transfusional(AU)

Introduction: Haemovigilance is the set of surveillance procedures that covers the entire transfusion chain for the continuous improvement of the safety and quality of this. It includes monitoring, reporting, research and analysis of adverse events caused by donation, processes and transfusion, to prevent its occurrence or recurrence. Objective: To show the results of the implementation of a haemovigilance program in the municipality of Jovellanos, Matanzas province, Cuba. Methods: Between January 2003 and December 2015, a haemovigilance program was implemented in the municipality of Jovellanos as part of the territorial program initiated in that province, on the same date; to increase transfusional safety and quality. Previously, a diagnosis of the state of donations, transfusions and their adverse effects was made; as well as the quasi-errors, the hemotherapy, the degree of knowledge of the doctors in transfusion medicine and the indicators of transfusions; the latter through the application of a survey. A training program was initiated, the transfusion committee was created, the quality management system and the participation of nurses in transfusion were strengthened. Results: The degree of knowledge of the professionals was increased, in transfusion medicine, the decrease in the reactions of donors and recipients was achieved; from an existing rate in 2002 of 14 and 63 per thousand, respectively, to 1.1 and 0 per thousand in 2015; in addition, the severity of the reactions decreased. There was a decrease in the percentage of admitted patients who were transfused from 18.5 to 7.3. In addition, the number of transfusions performed by 40.5 percent decreased. Conclusions: The program is feasible and sustainable with existing resources and significantly optimized transfusional safety and quality(AU)

Incidence of Adverse Transfusion Reactions from an Institutional Hemovigilance System: A Single Center Study / 대한수혈학회지

BACKGROUND: A hemovigilance system is essential to detect and analyze adverse transfusion reactions to various blood components. A blood bank physician has the role of discriminating the adverse transfusion reactions based on the hemovigilance criteria. This study investigated the incidence of adverse transfusion reactions per transfused case and the incidence of adverse transfusion reactions according to the various blood components in recipients. METHODS: From January 2016 to February 2017, 38,689 blood component units were transfused into 3,768 patients. A total of 11,170 transfused cases were reported. The patients’ signs or symptoms were monitored and reported by nurses using an electronic reporting system. A blood bank physician classified the adverse transfusion reactions according to the Korean hemovigilance reporting definitions. RESULTS: The frequency of all transfusion-related events was 469 according to the nursing record. Out of 469 events, 175 (37.3%) were classified as adverse transfusion reactions. The incidence of a febrile nonhemolytic transfusion reaction according to the blood component was highest for red blood cells (1.3%), followed by a platelets (0.8%) and fresh frozen plasma (0.3%). The incidence of allergic reactions was 1.0% (platelets), 0.8% (fresh frozen plasma), and 0.3% (red blood cells). The incidence of febrile nonhemolytic transfusion reactions was lowered significantly by leukocyte-reduction. CONCLUSION: The incidence of adverse transfusion reactions was 37.3% of the transfusion-related events. Therefore, close monitoring by the blood bank physician is essential for safe transfusion. The use of leukocyte-reduced blood components could reduce the incidence of febrile nonhemolytic transfusion reactions.

Desafios da enfermagem diante das reações transfusionais / Nursing challenges in responding to transfusion reactions / Retos de la enfermería ante las reacciones transfusionales

Objetivo: avaliar o conhecimento da equipe de enfermagem diante das reações transfusionais em um hospital do estado de Pernambuco. Método: pesquisa de caráter descritivo com abordagem quantitativa, realizada na unidade de tratamento intensivo e emergência hospitalar, através da aplicação de questionário semiestruturado em 95 profissionais de enfermagem desses setores, durante o período de janeiro a junho de 2013. Estudo aprovado pelo Comitê de Ética do Hospital da Restauração de Pernambuco, CAEE: 0081.0.102.000-10. Resultados: entre os entrevistados, 93% foram mulheres, 80% com tempo de formação superior a 10 anos, das quais 49% nunca monitoraram transfusões de hemocomponentes ou hemoderivados. Verificou-se que 59% desconhecem o tempo máximo para a infusão do concentrado de hemácias e 76% não sabiam o tempo mínimo para realizar essa infusão. Quanto às reações adversas, 65% afirmaram saber identificá-las e 19% não souberam a conduta que deviam adotar diante de reações transfusionais. Conclusão: é necessária a realização de educação continuada dos profissionais de enfermagem a respeito da prática transfusional.

Objective: to evaluate nursing teams' knowledge with regard to responding to transfusion reactions at a hospital in Pernambuco State. Method: in this quantitative, descriptive study at hospital intensive care and emergency units, a semi-structured questionnaire was applied to 95 nursing professionals from these sectors, from January to June, 2013. The study was approved by the ethics committee of Restauração de Pernambuco Hospital (CAEE: 0081.0.102.000-10). Results: 93% of interviewees were women, 80% had graduated more than 10 years earlier, 49% had never monitored blood component or blood product transfusions; 59% were found not to know the maximum time for red blood cell concentrate infusion and 76% did not know the minimum time for this infusion. Regarding adverse reactions, 65% claimed to know how to identify them, and 19% did not know how to respond to transfusion reactions. Conclusion: nursing professionals need to receive continuing education in transfusion practice

Objetivo: evaluar el conocimiento del equipo de enfermería ante las reacciones transfusionales en un hospital del Estado de Pernambuco. Método: investigación de carácter descriptivo con enfoque cuantitativo, realizada en la unidad de tratamiento intensivo y urgencias hospitalarias, a través de la aplicación de cuestionario semiestructurado a 95 profesionales de enfermería de esos sectores, durante el período de enero a junio de 2013. Estudio aprobado por el Comité de Ética del Hospital da Restauração de Pernambuco, CAEE: 0081.0.102.000-10. Resultados: entre los entrevistados, el 93% fue de mujeres, el 80% con tiempo de formación superior a 10 años, de las cuales el 49% nunca monitoreó transfusiones de hemocomponentes o hemoderivados. Se verificó que el 59% desconocía el tiempo máximo para la infusión del concentrado de hematíes y el 76% no sabía el tiempo mínimo para realizar esa infusión. En cuanto a las reacciones adversas, el 65% afirmó saber identificarlas y el 19% no sabía la conducta que debían adoptar ante las reacciones transfusionales. Conclusión: es necesario realizar educación continuada de los profesionales de enfermería respecto a la práctica transfusional

A hemovigilância no processo de administração de transfusão de hemocomponente para qualidade e segurança do paciente / Hemovigilance in the blood component transfusion administration process for patient quality and safety

O estudo partiu da premissa que a inserção de uma tecnologia irá auxiliar na produção de informações para conhecimento e educação nos processos que necessitam de acompanhamento, monitoramento e avaliação contínua das ações contribuindo com a implementação da política de formação direcionada. Objetivo geral Desenvolver um instrumento de acompanhamento do processo de administração de transfusão de hemocomponente para mitigação e rastreabilidade de incidentes transfusionais. Metodologia estudo descritivo realizado através de observação sistemática do processo de administração de transfusão de hemocomponente em uma instituição pública federal, localizada no Rio de Janeiro com foco no tratamento e cirurgia das doenças cardiovasculares. O estudo foi realizado conforme resolução n°466 de 2012 do Conselho Nacional de Saúde, submetido à Plataforma Brasil e aprovado pelo Comitê de Ética em Pesquisa (CEP) da UNIRIO sob n° CAAE: 51244015.9.0000.5285 e CEP da instituição em que foi realizada a pesquisa sob o n° CAAE: 51244015.9.3001.5272. Foram observadas, 30 transfusões sanguíneas durante os meses de Junho e Julho de 2016. Resultados o estudo evidenciou que conforme o grau de risco, considerando a probabilidade e a severidade dos itens avaliados, todas as etapas do processo avaliado, apresentou Percentual de Conformidades (PC) baixo, ou seja, menor que 60% classificando-as quanto ao potencial grau de risco em alto risco. Conclusão os resultados apontam que mediante a avaliação das conformidades do processo de administração de transfusão sanguínea, há necessidade de uma gestão de ações de vigilância considerando os riscos inerentes identificados, de maneira proativa a fim de prevenir incidentes e minimizar danos associados à terapia, através da implantação de capacitação e educação permanente relacionada à temática. O instrumento irá auxiliar na rastreabilidade, monitorização e mitigação dos riscos de incidentes transfusionais de forma a garantir a qualidade e segurança de todo o processo

The study started from the premise that the insertion of a technology will help in the production of information for knowledge and education in the processes that need monitoring, monitoring and continuous assessment of the actions contributing to the implementation of the targeted training policy. General Objective To develop an instrument to monitor the blood transfusion administration process for the mitigation and traceability of transfusion incidents. Methodology A descriptive study was carried out through a systematic observation of the process of blood transfusion administration at a federal public institution, located in Rio de Janeiro, focused on the treatment and surgery of cardiovascular diseases. The study was carried out according to resolution n ° 466 of 2012 of the National Health Council, submitted to the Brazil Platform and approved by the Research Ethics Committee (CEP) of UNIRIO under n ° CAAE: 51244015.9.0000.5285 and CEP of the institution in which it was performed the research under CAAE: 51244015.9.3001.5272. Thirty blood transfusions were observed during the months of June and July 2016. Results The study showed that according to the degree of risk, considering the probability and severity of the evaluated items, all stages of the evaluated process presented Percentage of Conformities (PC), that is, less than 60%, classifying them for the potential high-risk degree. Conclusion, the results indicate that by evaluating the conformity of the process of blood transfusion administration, there is a need for a management of surveillance actions considering the inherent risks identified, in a proactive way in order to prevent incidents and minimize damage associated with therapy, through implementation of training and permanent education related to the theme. The instrument will assist in the traceability, monitoring and mitigation of the risks of transfusion incidents in order to guarantee the quality and safety of the entire process

Segurança e intervenção: a assistência de enfermagem em hemotransfusão / Safety and intervention: nursing assistance in blood transfusion / Seguridad e intervención: la asistencia de enfermería en Hemotransfusion

O estudo nasceu do campo de trabalho com a necessidade de orientação e monitoramento da prática hemoterapia em enfermagem. Objetivo Geral: Elaborar um instrumento como uma lista de verificação para orientar a assistência de enfermagem ao cliente submetido à hemotransfusão. Traçamos como objetivos específicos: Identificar a função da enfermeira que atua na Agência Transfusional; Analisar a conformidade dos conhecimentos da equipe de enfermagem sobre intervenções assistenciais ao cliente em hemoterapia e sobre Hemovigilância; Aprimorar a Lista de Verificação (Checklist) Seguro para a Assistência de Enfermagem ao Cliente Receptor de Hemocomponentes (Produto deste estudo) e Testar o produto. Trata-se de um estudo qualitativo, exploratório e descritivo cujo campo de pesquisa foi um hospital universitário público, no estado do Rio de Janeiro, desenvolvido segundo a metodologia administrativa proposta por Cury (2005): Fase I Diagnóstico da função da enfermeira na Agência Transfusional e o conhecimento específico da equipe de enfermagem. Fase II ­ Elaboração da Lista de Verificação Segura para o Cliente Submetido à Hemotransfusão. Fase III - Teste da Lista de Verificação. Os participantes foram 52 enfermeiros e 79 técnicos de enfermagem atuantes na assistência a clientes submetidos à hemotransfusões. O projeto foi aprovado pelo Comitê de Ética e Pesquisa da UNIRIO sob o nº 463207, CAAE: 52779315.7.0000.5285. Na fase diagnostica ocorrida em maio de 2016, foi identificada a função da enfermeira com base na legislação e elaborados dois fluxogramas de trabalho e foi aplicado o teste de Conhecimento a 131 profissionais. As respostas foram codificadas e analisadas pelo sistema SPSS 21,0 e mostraram que apenas 34,35% dos participantes obtiveram acertos acima de 70%, o que reforça a necessidade de treinamentos e implementação de um instrumento assistencial específico. Fase 2 ­ realizada em junho de 2016. Os resultados da fase diagnóstica permitiram as adequações à Lista de Verificação (Checklist) Seguro para a Assistência de Enfermagem ao Cliente Receptor de Hemocomponentes já existente e em uso no hospital e desenvolvido treinamentos voltados para os 131 profissionais de enfermagem. Na terceira fase foi realizada a testagem da Lista de Verificação (Checklist) Segura para a Assistência de Enfermagem ao Cliente Receptor de Hemocomponente corrigida de acordo com as sugestões dos profissionais de enfermagem que utilizaram o impresso proposto em 40 quarenta transfusões. Conclui-se que é de suma importância ter o enfermeiro na agência transfusional com atuação em todo o processo hemoterápico, visto que o sangue é um transplante de órgão que necessita de cuidados intensivos para garantir a segurança do cliente. O estudo respondeu às questões de pesquisa, e evidenciou que a lista de verificação aproxima a assistência e a evolução de enfermagem na transfusão de hemocomponente de uma sistematização, que reduz riscos e danos ao cliente e possibilita a qualidade assistencial de enfermagem

The study was born from the field of work with the need for guidance and monitoring of hemotherapy practice in nursing. General Objective: To devise an instrument such as a checklist to guide nursing care to the transfused client. We outline specific objectives: Identify the role of the nurse working in the Transfusional Agency; To analyze the conformity of the knowledge of the nursing team about healthcare interventions to the client in hemotherapy and on hemovigilance; Improve the Safe Check List for the Hemotransferred Customer. (Product of this study) and Test the product. This is a qualitative, exploratory and descriptive study whose field of research was a public university hospital, in the state of Rio de Janeiro, developed according to the administrative methodology proposed by Cury (2005): Phase I- Diagnosis of the nurse's role in the Transfusional Agency and the specific knowledge of the nursing team. Phase II - Elaboration of the Safe Check List for the Hemotransfusion Customer. Phase III - Checklist Test. The participants were 52 nurses and 79 nursing technicians working in the care of clients submitted to blood transfusion. The project was approved by the Ethics and Research Committee of UNIRIO under nº 463207, CAAE: 52779315.7.0000.5285. In the diagnostic phase that occurred in May 2016, the nurse's role was identified based on legislation and two workflows were elaborated and the Knowledge test was applied to 131 professionals. The responses were coded and analyzed by the SPSS 21.0 system and showed that only 34.35% of the participants obtained scores above 70%, which reinforces the need for training and implementation of a specific care instrument. Phase 2 - carried out in June 2016. The results of the diagnostic phase allowed for adjustments to the existing Checklist for the Client submitted to Hemotransfusion and in use in the hospital and developed training aimed at the 131 nursing professionals. In the third phase, the testing of the Safe Verification List for the Client submitted to Hemotransfusion was performed, corrected according to the suggestions of the nursing professionals who used the proposed form in 40 transfusions. It is concluded that it is of paramount importance to have the nurse in the transfusional agency with a role in the entire hemotherapy process, since blood is an organ transplant that requires intensive care to ensure client safety. The study answered the research questions and showed that the checklist approximates nursing care and evolution in the transfusion of blood components of a systematization, which reduces risks and damages to the client and enables nursing care quality

El estudio nació del campo de trabajo con la necesidad de orientación y monitoreo de la práctica hemoterapia en enfermería. Objetivo General: Elaborar un instrumento como una lista de verificación para orientar la asistencia de enfermería al cliente sometido a la hemotransfusión. Trazamos como objetivos específicos: Identificar la función de la enfermera que actúa en la Agencia Transfusional; Analizar la conformidad de los conocimientos del equipo de enfermería sobre intervenciones asistenciales al cliente en hemoterapia y sobre Hemovigilancia; Mejorar la Lista de Verificación (Checklist) Seguro para la Asistencia de Enfermería al Cliente Receptor de Hemocomponentes (Producto de este estudio) y Probar el producto. Se trata de un estudio cualitativo, exploratorio y descriptivo cuyo campo de investigación fue un hospital universitario público, en el estado de Río de Janeiro, desarrollado según la metodología administrativa propuesta por Cury (2005): Fase I - Diagnóstico de la función de la enfermera en la Agencia Transfusional y el conocimiento específico del equipo de enfermería. Fase II - Elaboración de la Lista de Verificación Segura para el Cliente Sometido a la Hemotransfusión. Fase III - Prueba de la Lista de Verificación. Los participantes fueron 52 enfermeros y 79 técnicos de enfermería actuantes en la asistencia a clientes sometidos a las hemotransfusiones. El proyecto fue aprobado por el Comité de Ética e Investigación de UNIRIO bajo el nº 463207, CAAE: 52779315.7.0000.5285. La fase diagnóstica ocurrió en mayo de 2016, fue identificada como una función de enfermería con base en la legislación y elaborado dos fundamentos de trabajo y fue aplicada en el ensayo de Conhecimento a 131 profesionales. Las respuestas fueron codificadas y analizadas por el sistema SPSS 21,0 y muestran que sólo 34,35% de los participantes obtiveram acertos superiores a 70%, que requieren una formación básica y una implementación del instrumento assistencial específico. Fase 2 - realizada en junio de 2016. Resultados de la fase diagnóstica permitida como adecuaciones a la Lista de Verificación (Lista de Verificación) Seguro para una Asistencia de Enfermería al Cliente Receptor de Hemocomponentes ya existente en el uso no hospital y desarrolló entrenamientos voltios para los 131 profesionales De enfermagem Em la fase anterior se realizó una prueba de la Lista de Verificación (Lista de comprobación) Segura para una Asistencia de Enfermería en el Receptor de Hemocomponente. Conclui-se que es de suma importancia para el enfermo en la agencia de transfusión en todo el proceso de hemoterápico, en el cuidado de la salud del paciente. El estudio responde a las preguntas de investigación y muestra que una lista de casos se aproxima a un estudio y una evolución de la enfermería en una transfusión de hemocomponente de una sistematización, que reduce lós riesgos y los daños al cliente y posibilita una calidad asistencial de enfermería

Implementación de un sistema de hemovigilancia en el Hospital de Clínicas de Uruguay / Hemovigilance system implementation at the University Hospital of Uruguay

Introducción: la hemovigilancia es una herramienta para mejorar la calidad de la transfusión sanguínea, centrándose principalmente en la seguridad del paciente. Objetivo: identificar y conocer las características y la frecuencia de las reacciones adversas a la transfusión y desarrollar un sistema de hemovigilancia aplicable en nuestro hospital. Material y método: se realizó un estudio de tipo observacional, descriptivo, longitudinal y prospectivo, realizándose el seguimiento de todos los pacientes transfundidos con hemocomponentes en un Hospital Universitario durante 12 meses en un período de dos años (2014-2015). Se registraron las reacciones adversas a la transfusión, los incidentes y los casi incidentes. Resultados: se registraron en total 58 reacciones adversas a la transfusión, correspondiendo a una tasa de 8,3‰ hemocomponentes transfundidos. Conclusiones: el análisis detallado de las reacciones adversas reveló posibilidades de mejoramiento de los procedimientos y permitió la implementación de medidas correctivas y preventivas. El sistema de hemovigilancia utilizado es simple en su estructura y fácilmente aplicable.

Abstract Introduction: hemovigilance is a tool used to improve the quality of blood transfusion, and it mainly focuses on patients’ safety. Objective: to identify and learn about the characteristics and frequency of transfusion related negative effects and to devise a hemovigilance system to be applied in our hospital. Method: we conducted an observational, descriptive, longitudinal and prospective study, and all patients who received hemocomponents at the university hospital in a two year period (2014-2015) were followed up during 12 months. All reactions related to transfusion, adverse incidents and near misses were recorded. Results: 58 transfusion related adverse reactions were recorded, what represented 8,3‰ of the transfused hemocomponents. Conclusion: the detailed analysis of adverse reactions showed procedures to improve results may be adopted and allowed for the implementation of corrective and preventive measures. The hemovigilance system used is simple in terms of its structure and easy to apply.

Resumo Introdução: a hemovigilância é uma ferramenta para melhorar a qualidade da transfusão sanguínea e busca principalmente a segurança do paciente. Objetivo: identificar e conhecer as características e a frequência das reações adversas à transfusão e desenvolver um sistema de hemovigilância aplicável no nosso hospital. Material e método: foi realizado um estudo observacional, descritivo, longitudinal e prospectivo, com o seguimento de todos os pacientes transfundidos com hemocomponentes no Hospital Universitário durante 12 meses em um período de dois anos (2014-2015). As reações adversas à transfusão, os incidentes e os quase incidentes foram registrados. Resultados: foram registradas 58 reações adversas à transfusão, correspondendo a uma taxa de 8,3‰ hemocomponentes transfundidos. Conclusões: a análise detalhada das reações adversas mostrou possibilidades para o aperfeiçoamento dos procedimentos e permitiu implementar medidas corretivas e preventivas. O sistema de hemovigilância utilizado tem uma estrutura simples e é de fácil aplicação.

Serious Adverse Transfusion Reactions Reported in the National Recipient-Triggered Trace Back System in Korea (2006-2014)

BACKGROUND: Adverse transfusion reactions (ATRs) are clinically relevant to patients with significant morbidity and mortality. This study aimed to review the cases of ATR reported in the recipient-triggered trace back system for a recent nine-year period in Korea. METHODS: Nine-year data obtained from 2006 to 2014 by the trace back system at the Division of Human Blood Safety Surveillance of the Korean Centers for Disease Control (KCDC) were reviewed. The suspected cases were assessed according to six categories: (i) related to, (ii) probably related to, (iii) probably not related to, (iv) not related to transfusion, (v) unable to investigate, and (vi) under investigation. RESULTS: Since 2006, 199 suspected serious ATRs were reported in hospitals and medical institutions in Korea, and these ATRs were reassessed by the division of Human Blood Safety Surveillance of the KCDC. Among the reported 193 cases as transfusion related infections, hepatitis C virus (HCV) infection (135, 67.8%) was reported most frequently, followed by hepatitis B virus (HBV) infection (27, 13.6%), HIV infection (13, 6.5%), syphilis (9, 4.5%), malarial infection (4, 2.0%), other bacterial infections (3, 1.5%), HTLV infection (1, 0.5%), and scrub typhus infection (1, 0.5%), respectively. Of the 199 cases, 13 (6.5%) cases were confirmed as transfusion-related (3 HCV infections, 3 malarial infections, 1 HBV infection, 2 Staphylococcus aureus sepsis, 3 transfusion-related acute lung injuries, and 1 hemolytic transfusion reaction). CONCLUSIONS: This is the first nationwide data regarding serious ATRs in Korea and could contribute to the implementation of an effective hemovigilance system.

Trali, una amenaza enmascarada: definición, aspectos epidemiológicos y clínicos / Trali, a masked threat: definition, epidemiological and clinical aspects

El daño pulmonar agudo relacionado con la transfusión o TRALI, como más comúnmente se le conoce, por definición no se diferencia de otros tipos de distrés respiratorios, salvo por su origen demostrable y su estrecha relación temporal con la transfusión. Constituye una de las reacciones adversas más peligrosas del uso de productos sanguíneos y sus peculiares características le permiten enmascararse entre los muchos factores que pueden desencadenar un daño pulmonar agudo, especialmente en algunos pacientes que resultan más susceptibles a su desarrollo. El propósito de esta revisión es hacer un recordatorio de su existencia, sobre todo a aquellos médicos que manejan cotidianamente pacientes demandantes de componentes sanguíneos y cuya condición clínica favorece su aparición. Sus principales variables epidemiológicas (ej: incidencia y mortalidad) varían, a veces de manera notable, entre los distintos informes. La heterogeneidad de criterios aun después de la consecución de consensos internacionales para su diagnóstico, dificulta aprovechar al máximo los datos obtenidos de los distintos estudios realizados sobre su comportamiento y ha promovido la aparición de no pocos resultados contradictorios. Su diagnóstico clínico representa un reto al presentarse en medio de contextos clínicos que hacen plantear otras causas para la aparición del distrés respiratorio. Por ello, muchas veces pasa inadvertido o es mal identificado(AU)

Transfusion-related acute lung injury better known as TRALI, has not differences with other kinds of acute respiratory distress, except for its close relation with transfusion. It is considered among the greatest hazards on blood products use. With its peculiar characteristics it mimics within the many factors that may trigger an acute respiratory distress, especially among those patients at high risk for suffering lung damage after transfusion. The main purpose of this review is to make a recall of the existence of TRALI for those physicians who deal with high transfusion-demanding patients or those with conditions which could represent a risk for its development. TRALI´s main epidemiological variables (such as incidence and mortality) show important variations among different investigations. The criteria heterogeneity, even after the consecution of international diagnostic consensus, has made it difficult to take advantage of the data arose from multiple studies about its behavior, promoting the report of not a few contradictory results on worldwide publications. Diagnosing TRALI represents a real challenge for the clinician since it often appears within the context of various possible causes for an acute respiratory distress. This is why TRALI is frequently overlooked or misdiagnosed(AU)

Reações transfusionais em crianças: fatores associados / Blood transfusion reactions in children: associated factors

OBJETIVO: Analisar o perfil das reações transfusionais em crianças e identificar os fatores intervenientes. MÉTODOS: Estudo transversal realizado em um hospital-escola pediátrico terciário da rede pública, envolvendo todas as crianças internadas de janeiro a julho de 2011 (5437), das quais 1.226 foram hemotransfundidas, constituindo, assim, a amostra. Realizado estudo documental dos relatórios do serviço de hemovigilância e das fichas de notificação de reações transfusionais. As variáveis investigadas foram: número e tipo de hemocomponente transfundido, local de transfusão, local da reação, idade, sexo, tipo de hemocomponente envolvido, tipo de incidente e história prévia de politransfusão. Realizada análise descritiva e inferencial, utilizando-se testes estatísticos para estabelecer associação entre as variáveis. RESULTADOS: Verificou-se 57 incidentes transfusionais envolvendo 47 crianças distintas e 72 hemocomponentes, constituindo uma prevalência de reações de 3,8%. Na análise inferencial, pelo teste do Qui-quadrado, as seguintes variáveis apresentaram associação estatisticamente significativa (p < 0,05) com o tipo de reação: faixa etária e tipo de hemocomponente envolvido. Analogamente, a doença de base do paciente associou-se com a história prévia de incidente transfusional e o tipo de hemocomponente. CONCLUSÕES: A prevalência de reações transfusionais em crianças é elevada, e os fatores intervenientes são o tipo de hemocomponente, a faixa etária, comorbidade do paciente e politransfusão, sendo que os dois primeiros associam-se, também, com tipo de reação ocorrida.

OBJECTIVE:To analyze the profile of blood transfusion reactions in children and to identify the involved factors. METHODS: This was a cross-sectional study in a tertiary pediatric teaching hospital from the public healthcare system, involving all children admitted from January to July of 2011 (5,437), of which 1,226 received blood transfusions, constituting the sample. A documental study was performed by analyzing files from the hemovigilance service and notification forms of transfusion reactions. The variables investigated were: number and type of blood components transfused, transfusion site, reaction site, age, gender, type of blood components involved, type of incident, and previous history of multiple transfusions. A descriptive and inferential analysis was performed, using statistical tests to establish the association between the variables. RESULTS: There were 57 transfusion incidents involving 47 children and 72 different blood products, thus constituting a prevalence of reactions of 3.8%. At the inferential analysis, the chi-squared test showed that the following variables were significantly associated (p < 0.05) with the type of reaction: age range and type of blood component. Similarly, the patient's underlying disease was associated with previous history of transfusion incident and type of blood component. CONCLUSIONS: The prevalence of transfusion reactions in children is high, and the intervening factors are: type of blood component, age, patient comorbidity, and multiple transfusions; type of blood component and age are also associated with type of reaction.