Implementation of a patient blood management program based on a low-income country-adapted clinical decision support system

ABSTRACT Introduction: Patient blood management (PBM) programs are associated with better patient outcomes, a reduced number of transfusions and cost-savings The Clinical Decision Support (CDS) systems are valuable tools in this process, but their availability is limited in developing countries This study assesses the feasibility and effectiveness of an adapted CDS system for low-income countries. Methods: This was a prospective study of the PBM program implementation, in a 200-bed tertiary hospital, between February 2019 and May 2020. Outcome measures were red blood cell (RBC), fresh frozen plasma (FFP) and platelet unit transfusions, the transfusion of a single unit of red blood cells and an RBC adequacy index (RAI). Results: Comparing the post-PBM program era with the pre-PBM system era, there was a decrease in red blood cell transfusions (p = 0.05), with an increase in single unit red blood cell transfusions (p = 0.005) and RAI (p < 0.001). Conclusions: The PBM programs, including electronic transfusion guidelines with pre-transfusion medical auditing, was associated with improved transfusion practices and reduced product acquisition-related costs.

Medidas de distanciamento social e demandas para reorganização dos serviços hemoterápicos no contexto da Covid-19 / Social distancing measures and demands for the reorganization of hemotherapy services in the context of Covid-19

Resumo O artigo tem por objetivo discutir as consequências das medidas de distanciamento social sobre a disponibilidade de sangue e a organização dos serviços hemoterápicos no início da pandemia de Covid-19 no Brasil. A partir do acesso às notícias publicadas no mês de abril de 2020 nos sites das Hemorredes estaduais do país e organizadas em matriz Excel, foram elaborados quadros-síntese e descrição de resultados. A situação crítica de abastecimento de sangue, em especial para alguns tipos sanguíneos, foi constatada em muitos estados, devido à circulação do novo coronavírus. A adoção de medidas de distanciamento social e a manutenção das demandas por transfusão para tratamentos, urgência e emergência, requereram a implantação e a implementação de estratégias e ações para reorganização dos serviços. Medidas de proteção foram incorporadas, fluxos alterados e rotinas estabelecidas. Este estudo evidencia o quanto a situação epidemiológica da Covid-19 e as medidas necessárias para o seu controle influenciaram sobre a situação dos estoques e disponibilidade de sangue, e, demandaram, mudanças na organização dos serviços hemoterápicos a fim de assegurar a proteção, mitigar os riscos de propagação do vírus e garantir o suprimento de sangue para o atendimento às necessidades do sistema de saúde.

Abstract The article aims to discuss the consequences of social distancing measures on the availability of blood and organization of blood therapy services at the beginning of the Covid-19 pandemic in Brazil. News published in April 2020 on the websites of the country's state Blood Service Networks were consulted and organized in an Excel spreadsheet, presented in summary charts, and descriptions of results were prepared. A critical situation of blood supply, especially of some blood types, has been observed in many states. This situation is influenced by the circulation of the new coronavirus. The adoption of social distancing measures associated with unchanged transfusion demands for outpatient, urgency and emergency care required the implementation of strategies and actions for the reorganization of the services. Protection measures were incorporated, flows were changed and new routines were established. This study shows the extent to which the epidemiological situation of Covid-19 and the necessary measures for its control influenced the stocks and availability of blood. Changes in the organization of blood therapy services were fundamental in order to ensure protection, mitigate the risks of spreading the virus, and ensure the blood supply to meet the needs of the health system.

Utilisation of emergency blood in a cohort of South African emergency centres with no direct access to a blood bank

Introduction: The transfusion of emergency blood is an essential part of haemostatic resuscitation. Locally, where direct access to a blood bank is limited, emergency blood is stored within emergency centres. It was previously suggested that stored blood provides inadequate volumes compared to what is needed. Minimal data are available regarding indications for emergency blood usage. We aimed to describe the utilisation of emergency blood in selected Cape Town emergency centres. Materials and methods :A cross-sectional study was carried out at three secondary level emergency centres (no blood bank), and one tertiary centre (with a blood bank). Data from emergency blood recipients were recorded over a three-month study period. Indications for transfusion, number of units and location of transfusion were recorded. Indications and usage location were described in numbers and proportions. Results : A total of 329 emergency blood units were transfused to 210 patients. Trauma accounted for 39% (n = 81) of cases and other surgical conditions for 22% (n = 47), particularly upper gastrointestinal 11% (n = 24) and perioperative bleeding 8% (n = 16). Medical conditions accounted for 15% (n = 31), with anaemia 13% (n = 27), the most prevalent indication. Gynaecological conditions accounted for 15% (n = 32), mostly ectopic pregnancy 8% (n = 17). The majority of emergency blood, 77% (n = 253) were used in the emergency centres or operating theatres, 6% (n = 21).Conclusion :Trauma remains a major indication for emergency blood transfusion in this setting. This study questions the use of emergency blood for certain non-urgent diagnoses (i.e. anaemia). Given the scarcity of this resource and limitations to access, appropriate use of emergency blood needs to be better defined locally. Ongoing monitoring of the indications for which emergency blood is used, improved transfusion stewardship and better systems to access emergency blood should be a priority in this setting

Regulação de sangue no Brasil: contextualização para o aperfeiçoamento / Blood regulation in Brazil: contextualization for improvement

A utilização dos produtos do sangue como medicamentos essenciais e o reconhecimento das dimensões dos riscos transfusionais demandam dos países uma ação regulatória com foco em qualidade e segurança. Nesse campo, os órgãos reguladores têm papel fundamental em imprimir socialmente a garantia de que os componentes do sangue serão produzidos e utilizados de acordo com as normas técnicas vigentes. Assim, na busca para gerenciar os riscos sanitários envolvidos no processamento e uso do sangue, o modelo regulatório brasileiro, baseado na construção de uma política nacional de sangue, sob gestão do Estado, vem passando por aprimoramento conceitual e inovação de seus instrumentos. Com a inserção das boas práticas de fabricação preconizadas pela Organização Munidal da Saúde nas normativas brasileiras, o país avança na visão dos estabelecimentos de sangue como centros produtores de produtos biológicos originados do sangue para fins terapêuticos e fortalece a necessidade de desenvolvimento de mecanismos para a segurança no atendimento a doadores e receptores. O desenvolvimento de uma política nacional de sangue coordenada pelo Estado e a instituição de um sistema nacional de vigilância sanitária com poder fiscalizatório legitimado são elementos essenciais utilizados no Brasil para garantia de sangue em quantidade, qualidade, segurança e em tempo oportuno à população. Este artigo tem por objetivo discutir o contexto atual do modelo regulatório de sangue no Brasil na perspectiva de apontar desafios para o aperfeiçoamento desse modelo.

The use of blood products as essential medicines and the recognition of the high risk associated with blood transfusions require governments to take regulatory action with a focus on quality and safety. In this scenario, regulatory agencies play an essential role in socially advancing the guarantee that blood components will be produced according to current operating rules. Thus, in the effort to manage sanitary risks involved in the processing and use of blood, the Brazilian regulatory model, based on the construction of a national blood policy overseen by the State, has undergone conceptual improvement and review of the tools employed to achieve its goals. With the inclusion of good manufacturing practices as part of the Brazilian norms, as recommended by the World Health Organization, the country has moved forward in its view of blood facilities as manufacturing centers producing blood-derived biologics for therapeutic applications. It has also strengthened the need to develop safety mechanisms for blood donors and recipients. The development of a State-coordinated national blood policy and the institution of a national surveillance system with legitimate power of inspection are essential elements used in Brazil to guarantee the amount, quality, safety, and timeliness of blood supply to the population. The present article aims to discuss the present context of the blood regulatory model in Brazil so as to identify the challenges for improvement of this model.

Resíduos de serviços de saúde em hemocentro: gerenciamento e avaliação do desempenho de tratamento de bolsa de sangue por autoclave / Health service waste in a blood bank: management and performance evaluation of blood bag processing in autoclave174

Resíduos de serviços de saúde (RSS) de hemocentros destacam-se por questão de biossegurança. Esta pesquisa de caráter descritivo-exploratório e experimental teve como objetivo realizar um diagnóstico do gerenciamento dos RSS de um hemocentro no Paraná (HPR) e avaliar a eficácia da descontaminação de bolsas de sangue positivas para HIV, HCV e HBV, por autoclave.A investigação constou de duas partes, sendo a primeira referente ao diagnóstico do gerenciamento de RSS, e a segunda, relativa ao estudo experimental com análise da descontaminação de bolsas de sangue por autoclave. Na primeira parte foi realizada análise documental e observações in loco com caracterização e pesagem dos RSS e aplicação de um questionário ao gestor do HPR. A segunda parte ocorreu em quatro etapas: 1ª etapa, em que se realizou teste piloto para ajustes e certificação da autoclave; na 2ª etapa foi processada na autoclave 180 bolsas de sangue com sensores térmicos (ST) fora dos sacos plásticos contendo as bolsas de sangue; na 3ª etapa, processou-se 60 bolsas de sangue com ST dentro dos sacos plásticos; e, na 4ª etapa, analisou-se a presence de material genético nas bolsas de sangue após o tratamento em autoclave, pela técnica do PCR - Polymerase Chain Reaction). O diagnóstico do gerenciamento de RSS revelou 53,7% de resíduos do Grupo D, 22,76% do Grupo A1, 12,47% do Grupo A4, 10,97% do Grupo E, e 0,1% do Grupo B; 40% dos RSS do Grupo D eram recicláveis e os restantes eram resíduo comum. Resíduos dos Grupos A, B e E eram transportados para tratamento terceirizado, feito por autoclave e incineração a 450 km do local de geração. Foram constatadas inadequações na segregação dos resíduos dos Grupos A e D, além de infraestrutura e localização incompatíveis para abrigo externo. Como resultados da segunda parte da investigação, o teste piloto evidenciou aderências entre as bolsas de sangue e necessidade de adaptação de um cesto de inox na extremidade superior (ES) da autoclave, com...

Health Service Waste(HSW) of Blood Banknoted for biosafety issue. This was an descriptive and exploratory wich aimed to perform a diagnosis of WHS management of a blood bank in Paraná (BBPR) and evaluate the effectiveness of decontamination of blood units positive for HIV, HCV and HBV, by autoclave. The research consisted of two parts, the first relating to the diagnosis of WHS management, and the second on the experimental study with analysis of decontamination of blood bags by autoclave. The first part was conducted documentary analysis and in locu observations with characterization and weighing of WHS and a questionnaire to the manager of the BBPR. The stage 2 ocurred in four stages: Stage 1, in which he conducted pilot testing for adjustments and certification of the autoclave, the 2nd stage was processed in the autoclave 180 blood bags with thermal sensors (ST) out of plastic bags containing blood bags; in the stage 3, was processing 60 blood bags with ST inside (STI) of plastic bags, and, in the stage 4, was analyzing the presence of genetic material in blood bags after autoclaving, the technique of Polymerase Chain Reaction (PCR). The diagnosis of managing HSW revealed 53,7 % of residues in Group D, Group A1 22,76 %, 12,47 % of the Group A4, 10,97 % of Group E, and 0,1 % in Group B; 40 % of HSW, in Group D were recycled and the remaining residue were common. The residues of the Groups A, B and E were transported to treatment outsourced, made by autoclaving or incineration at 450 km from the generation site. Were found inadequacies in the residues segregation in Groups A and D, as well as infrastructure and location incompatible for external storage. As results of the second part of the investigation, the pilot test showed adhesions between the blood bags the need of adapting a stainless basket at the upper end (UE) of the autoclave and reordering of bags. The PCR exam of stage 2nd was positive for single bag contaminated with HBV...

Estándares de trabajo para servicios de sangre / Standards is working for blood services

El objetivo de este documento es proporcionar a quienes tienen a su cargo la gerencia de los servicios de sangre una guía para garantizar su calidad y la de los productos que distribuyen. Su contenido puede ser utilizado para la implementación de normas y de buenas prácticas de manufactura por las autoridades de salud, así como para establecer programas voluntarios de acreditación. Es por ello que, a pesar que los estándares están diseñados para ser implementados en los bancos de sangre a nivel individual, su aplicación requiere de un sistema nacional que vele por la calidad técnica, científica y administrativa de los servicios de sangre. A través de este sistema nacional el Gobierno formaliza su compromiso y apoyo a la medicina transfusional, y desarrolla una política y un plan nacional de acción, de financiamiento y evaluación de sus operaciones.

Proceso logístico productivo de un centro de sangre regional: modelamiento y análisis / Logistic and production process in a regional blood center: modeling and analysis

Background: The blood supply chain is a complex system that considers different interconnected elements that have to be synchronized correctly to satisfy in quality and quantity the final patient requirements. Aim: To determine the blood center maximum production capacity, as well as the determination of the necessary changes for a future production capacity expansion. Material and Methods: This work was developed in the Blood Center of Concepción, Chile, operations management tools were applied to model it and to propose improvement alternatives for the production process. The use of simulation is highlighted, which permitted the replication of the center behavior and the evaluation of expansion alternatives. Results: It is possible to absorb a 100 percent increment in blood demand, without making major changes or investments in the production process. Also it was possible to determine the subsequent steps in terms of investments in equipment and human resources for a future expansion of the center coverage. Conclusions: The techniques used to model the production process of the blood center of Concepción, Chile, allowed us to analyze how it operates, to detect "bottle necks", and to support the decision making process for a future expansion of its capacity.

Creación de la red de servicios de medicina transfusional y bancos de sangre del Ministerio de Salud Pública y Asistencia Social, para su regionalización y categorización: acuerdo ministerial No. 529-2011 / Creation of the network of transfusion medicine services and blood banks of the Ministry of Public Health and Social Assistance, for its regionalization and categorization: ministerial agreement No. 529-2011

El objetivo de crear esta red, es la de integrar todos los servicios de la medicina transfusional y los bancos de sangre. En el documento se establecen las funciones de la mencionada red. Incluye las definiciones de los conceptos relacionados al tema principal, además de la infraestructura que deberá tener cada centro, incluidos el equipo y recurso humano y técnico. Enumera la ubicación de los distintos centros de medicina transfusional y los bancos de sangre, destacando como de "referencia" los de los hospitales San Juan de Dios y Roosevelt, los mismos cuentan con los dos bancos principales de sangre del país. Hace la diferencia entre un banco de sangre regional y un centro de trasfusión, detallando igualmente la infraestructura, características, servicios y personal de estos últimos.

Abastecimiento de sangre durante desastres: la experiencia de Chile en 2010 / Blood supply during disasters: the experience of Chile in 2010

Se realizó una revisión de la gestión del abastecimiento y suministro de sangre durante desastres a partir de las experiencias de diversos eventos ocurridos principalmente en la primera década de este siglo, y en particular el terremoto grado 8,8 en la escala de Richter que afectó la zona centro sur de Chile el 27 de febrero de 2010. El objetivo fue proporcionar información que pueda ser útil para mejorar las estrategias y planes de respuesta durante potenciales desastres futuros. La información descriptiva sobre los procedimientos de respuesta se obtuvo mediante entre-vistas, reportes internos y la base de datos del sistema informático del Centro Productivo Regional de Sangre del Maule. Los resultados permiten concluir que para responder de manera eficiente y efectiva a las necesidades de sangre inmediatamente después de un desastre es de importancia clave tener un sistema centralizado de gestión que facilite el abastecimiento y el suministro de sangre y con-tar con personal voluntario competente en salud que esté dispuesto a acudir con celeridad durante estos eventos. Asimismo, se ha observado que durante dichas emergencias se produce un cambio en el perfil de quienes donan sangre. En Chile, por ejemplo, durante las dos semanas siguientes al terremoto la razón hombre/mujer en los donantes se invirtió, con 61,1 por ciento de participación por parte de las mujeres, quienes en la semana previa al evento representaban a solo 37 por ciento.

A review of the management of blood supply and its administration during disasters was conducted based on the experience of several events that occurred primarily from 2000-2010, particularly the earthquake that measured 8.8 on the Richter scale that struck central and southern Chile on 27 February 2010. The objective was to provide information that could be useful in improving response plans and strategies during potential future disasters. The descriptive information on response procedures was obtained from interviews, internal reports, and the computer database from the Maule regional blood production center. The results lead to the conclusion that to respond efficiently and effectively to the need for blood in the immediate wake of a disaster it is essential to have both a centralized management system that facilitates the supply and administration of blood and volunteers with competence in health that are willing to swiftly arrive during these events. A change in the profile of blood donors during such emergencies was also observed. In Chile, for example, during the two weeks after the earthquake, the ratio of male/female donors was reversed. There was 61.1 percent participation by women, whereas in the week before the event women accounted for only 37 percent.

Physical and operational infrastructure of transfusion services of the public blood bank network in the State of Minas Gerais, Brazil, 2007/2008

INTRODUCTION: Within the context of transfusion safety, the immunohematological study of donors and recipients of blood products is currently the most fragile link in the transfusion chain of the public blood bank network of Minas Gerais. OBJECTIVE: The objective of this work was to provide a critical and situational overview of the physical and operational infrastructure of the transfusion services in the state. Method: This was an observational cross-sectional, evidence-based study covering 226 transfusion services; only 19 belong to the Hemominas Foundation and 207 are non-Hemominas transfusion services. The investigation involved the application of questionnaires and red cell panel tests. RESULTS: The results revealed considerable non-compliance with the national law and with the norms of Hemominas. These findings were obtained for the two groups studied; however the frequencies were higher among non-Hemominas transfusion services. CONCLUSION: The study provides information about the situation of the physical and operational infrastructure of transfusion services that may be used to help plan effective measures for improvement and serve as the basis for an evaluation of the impact of future interventions regarding the quality, reliability and safety of transfusions. As primordial factors, we propose compliance with the law, qualified personnel and investment in further qualifications, a review of training methods, and more rigorous inspection of transfusion services. As a suggestion, we propose the establishment of an External Quality Control Program in Immunohematology for the entire network of blood banks in the state and the adoption of the methods presented in this study as a tool to monitor transfusion service performance.

INTRODUÇÃO: No contexto da segurança transfusional, o estudo imuno-hematológico do doador e do receptor de hemocomponentes é hoje o elo mais frágil da cadeia transfusional na hemorrede pública de Minas Gerais. OBJETIVO: O objetivo deste trabalho foi traçar panorama crítico e situacional da infraestrutura física e operacional das Agências Transfusionais (ATs) do estado. Método: Estudo observacional transversal, baseado em evidências, abrangeu 226 ATs, sendo 19 próprias da Fundação Hemominas (PH) e 207 não próprias da Hemominas (NPH), com aplicação de questionários e testes de painel de hemácias. RESULTADOS: Os achados do presente estudo mostraram percentuais expressivos de não conformidades com a legislação vigente no país e com as normas estabelecidas pela Hemominas. Estas foram encontradas nos dois grupos estudados, com algumas exceções, apresentando maiores frequências entre as ATs NPH. CONCLUSÃO: O estudo possibilitou o conhecimento da situação da infraestrutura física e operacional das ATs, podendo subsidiar o planejamento de ações efetivas de melhorias, bem como servir de base para avaliar o impacto de futuras intervenções, com vistas à qualidade, confiabilidade e segurança transfusional. Para isto, propôs como fatores primordiais, o cumprimento da legislação vigente, recursos humanos qualificados e investimentos na sua capacitação, revisão das metodologias de treinamento e maior rigor nas verificações e inspeções das ATs. Como sugestão, propõe ainda a criação, pela Hemominas, de Programa de Controle de Qualidade Externo em Imunohematologia para toda hemorrede do estado e adoção da metodologia deste estudo como instrumento de monitoramento da performance das ATs.

Reestructuración del sistema de sangre de las Fuerzas Armadas / Restructuring the blood banks of Argentinian Army

Objetivo. 1. Involucrar a las FFAA de la Argentina en programas de promoción y captación de donantes voluntarios, altruistas y repetitivos. 2. Centralizar el procesamiento de las unidades de sangre obtenidas, generar economía de escala y disminuir los costos para competir. Método. 1.- Comprometer a la jerarquía de las tres FFAA en este proyecto; 2.- Registrar las necesidades transfusionales y los recursos existentes en ellas; 3.- Comparar los costos operativos actuales de los hospitales con los costos del presupuesto operativo y de inicio de un Centro Regional de Hemoterapia; 4.- Realizar trabajo comparativo de la Promoción conjunta de la Donación y de Colectas Móviles y un registro de donantes voluntarios y de promotores; 5.- Crear un Centro Regional de Hemoterapia. Resultado. Creación Centro Regional de Hemoterapia "Héroes de Malvinas". Conclusión. Las actividades propuestas permiten a las FFAA acompañar al Plan Nacional de Sangre, adherir al concepto de responsabilidad social y tomar a los hemocomponentes como recurso estratégico invalorable en momentos de emergencia por conflicto o crisis.

Elegibilidad para la donación de sange: recomendaciones para la educación y la selección de donantes potenciales de sangre / Elegibilidad for the donation of blood: recommendations for the education and the selection of potential donors of sangre

El documento recopila en forma razonada los parámetros y condiciones que deben ser tomados en consideración en la educación y selección de los donantes de sangre, con un nivel de detalle que permitirá su comprensión al personal de los servicios de sangre, a los voluntarios de la comunidad y a los donantes de sangre. Como ilustación de cómo se aplica estos parámetros en varios países, se presentan a modo de ejemplo los criterios de selección de la Asociación Americana de Bancos de sangre, etc. Finalmente, el documento incluye recomendaciones de la OPS para las autoridades nacionales de salud y los programas nacionales de sangre con el propósito de promover un abordaje multidisciplinario y coordinado para la promoción de la salud, de la educación pública.