Knowledge, attitudes and practices of resident doctors and interns on safe blood transfusion practices: a survey-based study

ABSTRACT Introduction: The knowledge of clinicians regarding blood transfusion services may impact patient care and transfusion outcome. The wide variation in transfusion practices among clinicians leads to inappropriate blood product usage and jeopardizes patient safety. Hence, this survey study aimed to assess knowledge, attitude and practice among the residents and interns of safe blood transfusion. Methods: The online survey was based on self-administered questionnaires of three sections: 1. Demography; 2. Knowledge, and; 3. Attitude and Practice. One point was assigned for the correct response of each question in every section. The knowledge score was further categorized into three categories, depending on the points obtained. The participants were also divided into four groups, depending on their experience. The Kruskal-Wallis test was applied to determine the difference of knowledge and practice scores in three designated groups of residents and interns. A p-value of less than 0.05 was considered to be significant. Result: A total of 247 residents and interns participated in this study. Thirteen participants had an incomplete response. Out of 234 participants, Senior Residents (SR), Junior Residents (JR), and interns were 70, 96 and 68 participants, respectively. The knowledge scores of interns were significantly low, as compared to SRs and JRs. Practice scores of interns were also significantly low, compared to the JRs. However, most of the residents and interns (85%) were aware of the pre-transfusion testing. Conclusion: Therefore, the mandatory incorporation of the transfusion medicine subject in the undergraduate curriculum can help the young budding doctors to better implement the patient blood management.

Incidence of adverse transfusion reactions in Chinese children: a meta-analysis / 中国输血杂志

【Objective】 To systematically evaluate the incidence of adverse transfusion reactions in Chinese children, so as to provide scientific basis for prevention and early intervention. 【Methods】 Literature databases such as PubMed, EMbase, The Cochrane Library, CNKI, Wanfang and VIP were searched in terms of the incidence of adverse transfusion reactions in Chinese children from January 2000 to December 2022. Two researchers extracted literature data independently according to the inclusion and exclusion criteria and conducted quality evaluation of included studies according to AHRQ quality evaluation scale. Statistical analysis was performed using Stata 14.0 software. 【Results】 A total of 870 literatures were retrieved, and 13 were included in the study, with a total of 181 274 cases with blood transfusion. Meta-analysis showed that the overall incidence of adverse transfusion reactions in Chinese children was 0.79%[95%CI (0.54%, 1.04%)]. The incidence of adverse reactions of red blood cells, platelets and plasma were 0.34%[95%CI (0.15%, 0.54%)], 2.94%[95%CI (1.60%, 4.28%)] and 0.31%[95%CI (0.19%, 0.43%)], respectively. The incidence of fever reaction and anaphylaxis reaction were 0.22%[95%CI (0.13%, 0.31%)] and 0.46%[95%CI (0.30%, 0.61%)] respectively. 【Conclusion】 The overall incidence of adverse transfusion reactions in Chinese children is low, but the incidence of adverse reactions of platelet transfusion is high, which needs further prevention and control.

Application of intelligent information system of transfusion reactions in the supervision and management of transfusion reactions / 中国输血杂志

【Objective】 To analyze the application effect of intelligent information system of transfusion reactions(referred to as the system) in the supervision and management of transfusion reactions. 【Methods】 A retrospective analysis was conducted on the clinical data of a total of 67 914 blood transfusion patients in our hospital from January 2018 to August 2023. The patients were divided into the control group (n =36 367, with conventional transfusion management) and the observation group (n =31 547, with management by the system).The incidence of adverse reactions, the supervision and management scores, reporting time and processing time of adverse reactions, and patient satisfaction with blood transfusion in the two groups was observed. 【Results】 The incidence of transfusion reactions in the observation group and the control group was 0.23% (72/31 547) and 0.24% (86/36 367), with no statistically significant difference (P>0.05). The quality scores of the reporting, registration, processing and supervision, and the total scores of the observation group were higher than those of the control group:(21.46±2.76) vs (17.38±2.74) points, (21.65±2.80) vs (16.98±3.20) points, (22.30±2.42) vs (18.80±3.15) points, (22.85±2.10) vs (18.55 ± 3.06) points, and (90.38±5.96) vs (75.26 ± 6.10) points, with statistically significant difference(P<0.05). The reporting time and processing time of transfusion reactions in the observation group were shorter than those in the control group: (3.26±0.45) vs (7.25±1.26) minutes, (10.38±2.96) vs (20.26±2.10) minutes, with statistically significant differences (P<0.05). The satisfaction rate with blood transfusion of the observation group was 99.95% (31 532/31 547), higher than 99.62% (36 229/36 367) of the control group, with significant difference (P<0.05). 【Conclusion】 The application of the system in the supervision and management of transfusion reactions has achieved ideal results, including improving the quality of monitoring and management, shortening the reporting and processing time of transfusion reactions, and improving patient satisfaction with transfusion, which is worth popularizing.

Frequency of antigen Dia on the blood donor population of the Hemocenter coordinator of the Hemopa Foundation

ABSTRACT Introduction: Erythrocyte phenotyping is a very important test in the adoption of prophylactic measures to reduce transfusion reactions/alloimmunizations in polytransfused patients. The blood group Diego, in its current, form has 22 antigens, of which 4 are immunogenic, being Dia/Dib and Wra/Wrb, while the others are less expressive. The antigen Dia is of low incidence among whites and blacks, however, it is common in the South American indigenous and Asian Mongolian populations. It is also considered a system of clinical importance for its immunogenicity. Method: The present study aimed to carry out a retrospective and descriptive survey of the frequency of the Dia antigen in the blood donor population at the HEMOPA Foundation Coordinating Blood Center from 12/2018 to 1/2000. The data obtained were from the HEMOPA Foundation SBS Progress and SBS WEB Systems databases. Results: During this period, 941,744 blood bags were collected and, of these, 930 bags were phenotyped for the Dia antigen, of which 842 were negative and 88 (9.7%) positive. The research showed that, among the positive donors for the antigen Dia, 88.6% were brown, 3.4%, black and 8%, white. In the statistical analysis, the frequency observed was higher in browns. Conclusion: In the present investigation, we concluded that our region has a relatively higher frequency of the Dia antigen, when compared to the rest of Brazil, and it occurs more often in browns.

Lesión Pulmonar Aguda Relacionada a Transfusión (TRALI) y dos diagnósticos diferenciales para tener en cuenta: Reporte de caso y revisión de la literatura / Transfusion-Related Acute Lung Injury (TRALI) and Two Differential Diagnoses to Consider: Case Report and Literature Review

Resumen Las complicaciones pulmonares asociadas a la transfusión de hemoderivados son reacciones adversas graves y potencialmente mor tales. La Lesión Pulmonar Aguda Relacionada a Transfusión (TRALI), es una de las más frecuentes y con mayor mortalidad asociada. Es una entidad infradiagnosticada debido a su sintomatología inespecífica, a la ausencia de biomarcadores séricos específicos para su diagnóstico y a que aún la evidencia acerca de sus causas es heterogénea. El objetivo del presente artículo es documentar un caso clínico de TRALI y posteriormente, basados en la literatura actual, consolidar los aspectos fundamentales para la identificación oportuna de esta entidad y de dos diagnósticos diferenciales en el contexto de transfusión de hemoderivados y trauma: la Sobrecarga Circulatoria Asociada a Transfusión (TACO) y el Embolismo graso (EG). Así pues, se expone el caso clínico de una paciente adulto joven quien en el contexto de un politraumatismo requiere transfusión de hemoderivados, desarrollo de cuadro clínico compatible con TRALI; de esta manera, la discusión incluye aspectos epidemiológicos, fisiopatología, hallazgos imagenológicos y diagnóstico. Se logra concluir que es preciso poner a disposición de los profesionales del área de la salud literatura científica que favorezca la identificación de estas patologías con base en criterios clínicos, paraclínicos e imagenológicos, para así mismo, disminuir el riesgo de presentación y la mortalidad asociada.

Abstract Pulmonary complications associated with the transfusion of blood products are severe, potentially mortal adverse reactions. The transfusion-related acute lung injury (TRALI) is one of the most common and with higher associated mortality. It is an underdiagnosed entity due to its unspecified symptoms, the absence of diagnosis-specific serum biomarkers and the fact that the evidence about its causes is still heterogeneous. The objective of this article is to document a clinical case of TRALI and then, basing on the current literature, consolidate key aspects for the timely identification of this disease and of two differential diagnoses within the context of transfusion of blood products and trauma: the transfusion-associated circulatory overload (TACO) and fat embolism (FE). So, we pres ent the clinical case of a female young adult patient requiring a transfusion of blood products due to a polytraumatism whose clinical condition is compatible with TRALI; thus, the discussion includes epidemiological aspects, physiopathology, imaging findings and diagnosis. We conclude that it is necessary to provide healthcare professionals with scientific literature that favors the identification of these diseases basing on clinical, paraclinical and imaging criteria so as to reduce the risk of presentation and associated mortality.

The paradox of thrombotic thrombocytopenic purpura and the TACO challenge!

Thrombotic thrombocytopenic purpura (TTP) is a rare medical emergency characterized by the pentad of microangiopathic hemolytic anemia, thrombocytopenia, fever, renal failure, and neurological dysfunction. TTP is an infrequent condition and is a thrombotic microangiopathy. TTP is essentially a clinical diagnosis. As untreated TTP has a high mortality, diagnosis is usually presumptive and prompt treatment with plasma exchange is highly beneficial and reduces mortality significantly. Therapeutic plasma exchange with fresh frozen plasma is the standard treatment of choice for TTP. Transfusion-associated reactions may occur in some patients further complicating the disease picture and prolonging hospital stay and recovery. Transfusion-associated circulatory overload and transfusion-associated acute lung injury are the leading cause of transfusion-related mortality. We present here the diagnostic and therapeutic challenges that we faced with a young male patient who presented with fever, jaundice, and seizures.

Implicaciones clínicas de las quimiocinas y sus receptores en la medicina transfusional y el trasplante / Clinical implications of chemokines and their receptors in transfusion medicine and transplantation

Introducción: Las quimiocinas son proteínas secretadas con tamaño en el rango de 8-10 kDa, con numerosas funciones en la fisiología normal y patológica. El término deriva de las palabras citocinas quimiotácticas, que refleja su importante participación en la quimioatracción de leucocitos. Sin embargo, las evidencias muestran que las quimiocinas tienen muchas otras funciones como la comunicación intercelular, la activación celular y la regulación del ciclo celular. Objetivo: Analizar los conocimientos actuales sobre las quimiocinas y sus receptores, y la significación clínica de estas en la medicina transfusional y el trasplante. Métodos: Se realizó revisión de la literatura, en inglés y español, a través del sitio web PubMed y el motor de búsqueda Google académico de artículos publicados en los últimos 10 años. Se efectuó análisis y resumen de la bibliografía revisada. Análisis y síntesis de la información: La transcripción de la mayoría de los genes de quimiocinas es inducible y se produce en respuesta a estímulos celulares específicos. Las quimiocinas son importantes en la movilización de células progenitoras hematopoyéticas para el trasplante y localización de células progenitoras hematopoyéticas trasplantadas. En los modelos de incompatibilidad ABO, las quimiocinas CXC y CC se producen en niveles elevados. Conclusiones: Muchas son las oportunidades de futuras investigaciones sobre las quimiocinas en la medicina transfusional por la considerable redundancia y superposición en la función biológica de estas moléculas y sus receptores. Son solo una parte de un proceso mucho más grande y complejo dentro de la red de citoquinas y otras moléculas del sistema inmune(AU)

Introduction: Chemokines are secreted proteins with size in the range of 8-10 kDa, with numerous functions in normal and pathological physiology. The term derives from the words chemotactic cytokines, reflecting its important role in the chemoattraction of leukocytes. However, the evidence shows that chemokines have many other functions such as intercellular communication, cell activation and cell cycle regulation. Objetive: To present current knowledge about chemokines and their receptors, and the clinical significance of these in transfusion medicine and transplantation. Method: A review of the literature was made, in English and Spanish, through the PubMed website and the Google academic search engine of articles published in the last 10 years. An analysis and summary of the revised bibliography was made. Developing: The transcription of most of the chemokine genes is inducible and occurs in response to specific cellular stimuli. Chemokines play an important role in the mobilization of hematopoietic progenitor cells for the transplantation and localization of transplanted hematopoietic progenitor cells. In the ABO incompatibility models, the CXC and CC chemokines are produced at high levels. Conclusions: There are many opportunities for future research on chemokines in transfusion medicine due to their considerable redundancy and superposition in the biological function of these molecules and their receptors. They are just one part of a much larger and more complex process within the network of cytokines and other molecules of the immune system(AU)

Clinical features and transfusion effectiveness of patients with hematological diseases underwent acute transfusion reactions / 中国输血杂志

【Objective】 To demonstrate the real incidence and clinical features of acute transfusion reactions (ATRs) and analyze its association with transfusion effectiveness. 【Methods】 The blood transfusion process of patients in the Hematology Department in our hospital from March 16, 2018 to March 16, 2019 was observed and followed up. The vital signs and clinical features were recorded, the clinical data and relevant laboratory examination results were collected, and the correlation between ATRs, clinical features and transfusion effectiveness was statistically analyzed. 【Results】 A total of 2500 transfusions were observed in the Hematology Department, out of which 138 patients developed 242 ATRs. The overall incidence of ATRs was 9.68% (95% CI, 8.52%~10.94%) and the incidence of ATRs during platelets transfusion was the highest. The clinical features of most ATRs were mild and no fatal consequences occurred. No significant difference was found in the association between transfusion effectiveness with ATRs in platelets and red blood cells transfusion (P>0.05). 【Conclusion】 None of the ATRs observed in this study resulted in serious consequences or had effect on the transfusion effectiveness. The characteristics presented in these reactions may provide certain references for clinical practice.

Clinical characteristics and risk factors of adverse reactions to blood transfusion in Chinese adults based on evidence-based medicine / 中国输血杂志

【Objective】 To evaluate the clinical characteristics and risk factors of adverse transfusion reactions (ATR) in Chinese adults, and to provide evidence-based medical evidence for early prevention. 【Methods】 The controlled trial (CT) of risk factors for ATR in Chinese adults were collected through PubMed, Embase, Cochrane Library, CNKI, CMB, VIP and Wanfang database, and the retrieval time was from the establishment of those databases to January 31, 2021 Literature was selected and extracted by 2 researchers according to inclusion and exclusion criteria. Meta-analysis was performed by RevMan5.3 software. 【Results】 A total of 28 049 patients in 12 literature were included, 1 190 patients were included into the ART group and 26 859 into the non-ART group. Meta-analysis results showed that the incidence of ART was 1.63% (410/24 361), mainly allergic reaction (43.90%, 188/410) and non-hemolytic fever (40%, 164/410). Primary hematologic disease (OR=27.11, 95%CI=21.64~33.96, P 2 (OR=7.06, 95% CI=5.64~8.84, P30 min interval between blood issuing and transfusion (OR=3.40, 95% CI=2.88~4.00, P2, >30 min interval between blood issuing and transfusion, transfusion of plasma and cryoprecipitates, while transfusion of red blood cells/white blood cells/platelets was the protective factor.

Frequência de anticorpos irregulares identificados em pacientes atendidos em um hemonúcleo no sudoeste do Paraná no ano de 2017 / Frequency of irregular antibodies identified in patients treated at the hemotherapy service in southwest of Paraná in 2017

Quando um indivíduo é exposto a antígenos eritrocitários não próprios, ocorre uma resposta imunológica, que leva à produção de anticorpos irregulares voltados contra esses antígenos. Esse processo é conhecido como aloimunização eritrocitária e acontece em decorrência de transfusões de sangue ou gestações incompatíveis. Na medicina transfusional a pesquisa de anticorpos irregulares é fundamental, pois a falha na detecção de um aloanticorpo pode provocar reações transfusionais, aloimunizações, anemias hemolíticas autoimunes e doença hemolítica perinatal. Este estudo tem por objetivo analisar a frequência de anticorpos irregulares de pacientes atendidos no Hemocentro Regional de Francisco Beltrão, Paraná, no ano de 2017. Os dados foram coletados a partir da revisão de registros em arquivos do Laboratório de Imunohematologia do Hemonúcleo. Foram avaliados dados de 49 protocolos de pacientes que apresentaram dificuldades transfusionais no ano de 2017. Dentre os pesquisados, 37 pacientes (75,5%) apresentaram anticorpos irregulares. Dentre os anticorpos anti-eritrocitários observados neste estudo, evidenciou-se a presença de doze pacientes com anti-D (27,2%), seis pacientes com anti-K (13,6%), quatro pacientes com anti-C (9,0%) e em seis pacientes (13,6%) foi observada a presença de autoanticorpos. Este estudo indica que, nos pacientes transfundidos, os anticorpos mais frequentes foram os aloanticorpos Anti-D do Sistema Rh, provavelmente devido ao seu alto grau de imunogenicidade. A prevalência desses anticorpos é semelhante a vários estudos encontrados na literatura.

When an individual is exposed to not-self red blood cell antigens, an immune response occurs, which leads to the production of irregular antibodies directed against these antigens. This process is known as erythrocyte alloimmunization and occurs as a result of blood transfusions or incompatible pregnancies. In transfusion medicine, the search for irregular antibodies is essential, since failure to detect an alloantibody can cause transfusion reactions, alloimmunizations, autoimmune hemolytic anemias, and perinatal hemolytic disease. This study aims at analyzing the frequency of irregular antibodies of patients seen at the Regional Blood Center of Francisco Beltrão, Paraná, in 2017. The data were collected from the review of records in files of the Immunohematology Laboratory of Hemonúcleo. Data from 49 protocols of patients who had transfusion difficulties in 2017 were evaluated. Among those surveyed, 37 patients (75.5%) had irregular antibodies. Among the anti-erythrocyte antibodies observed in this study, the presence of twelve patients with anti-D (27.2%), six patients with anti-K (13.6%), four patients with anti-C (9.0 %), and in six patients (13.6%) with the presence of autoantibodies were observed. This study indicates that, in transfused patients, the most frequent antibodies were the Rh System Anti-D alloantibodies, probably due to their high degree of immunogenicity. The prevalence of these antibodies is similar to several studies found in the literature.

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.

Blood transfusion needs among obstetric patients in a tertiary care hospital: a prospective observational study

Background: Pregnancy possess a special challenge as immune responses in pregnant and non-pregnant states are different. The objectives of this study were to analyze the various indications for blood and blood component transfusion in obstetric patients. To study the prevalence and indications for blood transfusion among obstetric patients. To evaluate the various risk factors among these women. To study the role of antenatal visits in patients requiring blood transfusionMethods: A prospective observational study will be undertaken over a period of one year from July 2018 to June 2019 in Department of Obstetrics and Gynecology at SSIMS and RC, Davangere. This study was conducted on pregnant women and immediate postpartum patients (up to 7 days after delivery) admitted in Department of Obstetrics and Gynecology and requiring blood and blood component therapy. Statistical analysis will be performed using Chi square test and Student’s t test.Results: During study period out of 5486 patients 543 patients required blood transfusion. The incidence of blood transfusion is 9.89%. The indications for blood and blood product transfusion observed in our study were anemia, obstetric hemorrhage, thrombocytopenia, disseminated intravascular coagulopathy, ruptured ectopic, incomplete abortion, complete abortion and hydatidiform mole. Anemia in pregnancy was the most common indication and was observed in 217 cases (39.96%) followed by postpartum hemorrhage, which was seen in 117 cases (21.54%). The incidence of transfusion reactions was 5.34% in our study.Conclusions: A proper knowledge of blood and blood product transfusion is needed to make it available for people who are actually in need and also to decrease the economic burden. Regular Antenatal checkups should be given more importance in order to maximize the hemoglobin level at the time of delivery and to screen out the high-risk patients. Active management of the third stage of labor is required to minimize the blood loss. Anemia followed by obstetric hemorrhage still persists to be a major cause for blood and blood product transfusion.

Prevalencia de anticuerpos anti-eritrocitarios en donantes voluntarios de sangre Ecuatorianos / Prevalence of anti-erythrocyte antibodies in Ecuadorian voluntary blood donors / Prevalência de anticorpos anti-eritrocitários em doadores de sangue voluntários equatorianos

El rastreo de anticuerpos anti-eritrocitarios es una de las pruebas pretransfusionales más importantes en medicina transfusional por su aporte en la prevención de reacciones adversas luego de la administración de hemocomponentes. Sin embargo, no todos los bancos de sangre ecuatorianos han incluido esta prueba en sus protocolos de trabajo. Para demostrar su importancia se realizó el presente estudio cuyo propósito fue alertar al sistema nacional de salud sobre la existencia de aloinmunización en la población de donantes de sangre. Se estableció una prevalencia de anticuerpos anti-eritrocitarios del 0,27% y se identificó una mayor frecuencia en el género femenino. Los anticuerpos identificados estuvieron relacionados con los sistemas eritrocitarios Rh (RH), Kell (KEL), Duffy (FY) y Kidd (JK). Una de las limitaciones para la inclusión de esta prueba en los bancos de sangre y servicios de medicina transfusional es el elevado costo de los reactivos y la falta de paneles de células eritrocitarias de composición homocigota y heterocigota para la identificación de anticuerpos anti-eritrocitarios nativos, situación que constituye una oportunidad para que el Ministerio de Salud Pública del Ecuador promueva mejores estrategias para la importación de reactivos, reducción de costos y disponibilidad de paneles de células.

The screening of anti-erythrocyte antibodies is one of the most important pretransfusion tests in transfusion medicine because of its contribution to the prevention of adverse reactions after the administration of blood components, however not all blood banks in Ecuador have included this test in their work protocols. This study has the purpose to alert the national health system about the existence of alloimmunization in the blood donour population. A prevalence of anti-erythrocyte antibodies of 0.27% was established, with a higher frequency being found in the female gender. The identified antibodies are related to the erythrocyte systems Rh (RH), Kell (KEL), Duffy (FY) and Kidd (JK). One of the limitations for the inclusion of this test in blood banks and transfusion medicine services is the excessive cost of serological and gel methodology reagents, and the lack of homozygous and heterozygous erythrocyte cell panels for the identification of native anti-erythrocyte antibodies. That situation constitutes an opportunity for the Ministry of Public Health of Ecuador to promote better strategies for the imports of reagents, cost reduction and availability in the country.

O rastreamento de anticorpos anti-eritrocitários é um dos testes pré-transfusão mais importantes na medicina transfusional pela sua contribuição na prevenção de reações adversas após a administração de componentes sanguíneos. No entanto, nem todos os bancos de sangue do Equador tem incluído esse teste em seus protocolos de trabalho. Para demonstrar a sua importância, foi realizado o presente estudo que teve como objetivo alertar o sistema nacional de saúde sobre a existência de aloimunização na população de doadores de sangue. Foi estabelecida uma prevalência de anticorpos anti-eritrocitários de 0,27%, identificando maior frequência no sexo feminino. Os anticorpos identificados estiveram relacionados com os sistemas eritrocitários Rh (RH), Kell (KEL), Duffy (FY) e Kidd (JK). Uma das limitações para a inclusão destes testes em bancos de sangue e serviços de medicina da transfusão é o alto custo dos reagentes, além da falta de painéis de células eritrocitárias de composição homozigótica e heterozigótica para a identificação de anticorpos anti-eritrocitários nativos, situação que constitui uma oportunidade para que o Ministério da Saúde Pública do Equador promova melhores estratégias para a importação de reagentes, redução de custos e disponibilidade de painéis de células.

Knowledge, attitude and practice of haemovigilance amongst healthcare professionals in Nashik, Maharashtra, India

Background: Haemovigilance Programme of India was launched in 2012 with the purpose to identify, analyse and learn the complications related to transfusion and blood donation, in order to avoid such complications in future. Though it is essential to identify the Adverse Transfusion Reactions (ATR) to reduce the incidence and make transfusion easier; there are rare reports available about knowledge, attitude, and practice (KAP) of Healthcare Professionals (HCP) for haemovigilance.Methods: In this cross-sectional study, pre-validated questionnaire designed for assessing the KAP, the possible ways to improve transfusion reaction reporting and causes of underreporting were distributed among 220 Healthcare Professional (HCP) in Nashik, Maharashtra.Results: The response rate of the study was 93%. Amongst them 58% HCP had poor knowledge while only 9% had good knowledge about haemovigilance. According to respondents, training to the HCP, CME’s, making reporting compulsory and launching of a toll-free helpline number will mark a milestone in improving transfusion reaction reporting. Legal liability issue and lack of time & knowledge were the main factors which discouraged them from reporting.Conclusions: Overall, most of HCP in Nashik have a positive attitude towards transfusion reaction reporting but knowledge regarding the haemovigilance concept is poor and the majority of them never reported ATR. Hence, our study demands increased awareness and continued training to strengthen the haemovigilance system, especially ATR reporting.

Clinical analysis of 214 cases of blood transfusion adverse reactions / 重庆医学

Objective To understand the basic situation of blood transfusion adverse reactions to provide a basis for more ra-tionally and safely using blood in clinic.Methods A total of 24 409 cases of blood transfusion in this hospital during 2012?2015 were retrospectively analyzed.The report forms of blood transfusion adverse reactions served as the criterion for conducting the sta-tistics.Results There were 214 case of transfusion adverse reaction in this hospital during these 4 years.The incidence rate was 0. 88%.Among 5 blood components,the adverse reaction occurrence by frozen plasma was maximal,followed by single donor PLT and suspension red blood cells,which by the washed red blood cells was lowest.The blood adverse reactions showed the decreasing trend with the time and increasing trend with the age group increase.The transfusion reactions had no statistical difference between sexes and among blood types(P>0.05).Conclusion Clinical medical units should fully recognize the risk of blood transfusion,set up a standardized blood usage system and strictly implement,strengthen the blood transfusion knowledge training,advocate the au-tologous blood transfusion and clinically scientific,reasonable and safe blood usage.

Delayed Hemolytic Transfusion Reaction with Alloimmunization of Rh Phenotype: A Two-Case Study / 대한수혈학회지

Delayed hemolytic transfusion reaction is difficult to prevent using an unexpected antibody test performed prior to transfusion, and unlike acute hemolytic transfusion reaction, it occurs a few days after blood transfusion. Hence, determining the reason for delayed hemolytic transfusion reaction may be a tim-consuming task for clinicians Here, we report our experience of two cases of delayed hemolytic transfusion reaction as a result of the unexpected antibody production to Rh blood group antigens after transfusion. The first patient with a history of transfusion during admission was identified as having anti-E and anti-C antibodies according to the antibody identification test at the time of re-admission. The second patient who had chronic blood transfusion due to cancer treatment was found to have anti-C antibody. Both patients received transfusion of Rh antigen-compatible RBC units only after unexpected antibody development. However, like both cases, patients receiving continuous blood transfusion should be considered for a routine Rh phenotype test.

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.

Reacciones transfusionales en el Hospital Docente Provincial “Comandante Faustino Pérez” de la provincia de Matanzas / Transfusion reactions at “Comandante Faustino Pèrez” Provincial University Hospital in the province of Matanzas

A partir del año 2003, en el Hospital Docente Provincial “Comandante Faustino Pérez” se inició el control y análisis de los efectos adversos de la transfusión de sangre, mediante el reporte y estudio de todas las reacciones transfusionales, para conocer su frecuencia, tipo y gravedad, así como su relación con el componente utilizado, los días de extraído y el sexo del receptor. Se reportaron los errores detectados y subsanados antes del proceder. Este estudio se realizó bajo la asesoría y control del Banco de Sangre Provincial “Minerva Duarte”, como parte de la vigilancia sobre los productos sanguíneos y la cadena transfusional, con el objetivo de disminuir los efectos adversos e incrementar la seguridad transfusional. Los datos obtenidos demuestran disminución del número de reacciones adversas, de 52 en el 2002 a 14 en el 2005. Las más frecuentes fueron la febril no hemolítica y las alérgicas; la más grave resultó la contaminación bacteriana. Los errores más frecuentes subsanados antes de la transfusión fueron por equivocación del grupo en la bolsa a transfundir. El componente que más reacciones originó fue el concentrado de hematíes y el sexo femenino fue el que más reacciones presentó. El estudio permitió la adopción de medidas correctivas y preventivas para disminuir las reacciones e incrementar la seguridad transfusional en el centro hospitalario.

From 2003 on, it was started the control and analysis of the adverse effects of blood transfusion at “Comandante Faustino Pérez” Provincial University Hospital by the report and study of all the transfusion reactions in order to know their frequency, type and severity, as well as their relation to the component used, the date of the extraction, and the sex of the recipient. The errors detected and corrected before the procedure were reported. This study was conducted under the counselling and control of “Minerva Duarte” Provincial Blood Bank as part of the vigilance of the blood products and the transfusion chain aimed at reducing the adverse effects and at increasing transfusion safety. The data obtained showed a decrease of the number of adverse reactions from 52, in 2002, to 14, in 2005. The most common reactions were the non-hemolytic febrile reactions and the allergic reactions, whereas the most serious was bacterial contamination. The most frequent amended mistakes before transfusion were those made by the group with the transfusion bag. The packed cells proved to be the component that originated the greatest amount of reactions. Females had more reactions. The study allowed to take corrective and preventive measures to lower the reactions and improve the transfusion safety in the hospital.

Reacciones transfusionales mediadas inmunológicamente / Immunologically mediated transfusional reactions

Son muchas las complicaciones potenciales de la terapia transfusional, pero la mayoría se presentan en pacientes que requieren múltiples transfusiones. Los riesgos asociados con la transfusión de una unidad sanguínea son realmente bajos, pero deben considerarse contra los beneficios que se buscan al ordenarla.Las reacciones transfusionales se pueden clasificar como inmunológicas y no inmunológicas. Muchas de las primeras son causadas por estimulación de los anticuerpos por parte de los antígenos presentes en la transfusión de glóbulos rojos, leucocitos, plaquetas o proteínas del plasma. Esa isoinmunización puede llevar a una reacción futura cuando dichos antígenos sean transfundidos nuevamente al paciente. Entre las posibilidades se incluyen la hemólisis por incompatibilidad; las reacciones febriles o pulmonares causadas por antígenos en las plaquetas o los leucocitos; los fenómenos alérgicos o anafilácticos debidos a anticuerpos que reaccionan con antígenos solubles, generalmente del tipo de proteínas plasmáticas, y otras de menor importancia.

Abstract The potential complications of blood transfusion therapy are multiple but most of them occur only in patients requiring repeated transfusions. Risks associated with transfusion of a single unit of blood are low; however, they must be weighted against the benefits at the time each transfusion is ordered. Transfusion reactions can be classified as either immunologic or non-immunologic. Many immune reactions are caused by stimulation of antibody production by foreign alloantigens present on transfused red cells, leukocytes, platelets, or plasma proteins. Such alloimmunization may lead to future immunologically mediated reactions when transfusions carrying these antigens are administered. These include hemolytic reactions caused by red blood cell incompatibility; febrile or pulmonary reactions caused by leukocytes and platelet antigens; allergic or anaphylactic reactions caused by antibodies reacting with soluble antigens, usually plasma proteins, and other reactions of lesser importance.