Hemovigilance: knowledge, attitude and practice among postgraduates and interns of a tertiary care hospital

Background: Adverse reactions due to transfusion of blood and blood products should be reported for the betterment of patients health and to minimize such effects in the future. A Program was initiated to report and reduce incidence of adverse reactions to blood products which is hemovigilance program of India. Aim was to evaluate the knowledge, attitude and practice of haemovigilance among postgraduates and interns. Methods: This was a cross-sectional questionnaire-based study conducted among 159 participants of a tertiary care hospital for a period of 1 month. Results: Results obtained were analysed using descriptive and qualitative statistics. About 83.6% of the participants were aware about the concept of Haemovigilance. Only 23 out of the 159 had reported transfusion reactions in the past but the attitude towards this concept was satisfactory. Conclusions: Overall the participants had a less satisfactory overview of this concept and hence educational interventions can aid in serving the purpose.

Correlation between heart rate variability and psychological evaluation before blood donation / 中国输血杂志

【Objective】 To investigate the correlation between heart rate variability (HRV) and the degree of nervousness before blood donation. 【Methods】 The psychological state of 253 blood donors before blood donation was assessed by the self-rating anxiety scale (SAS) and the degree of nervousness and their HRV were measured. The correlation between the SAS score, the degree of nervousness and the HRV parameters was analyzed, and the differences were compared among different types of donors by multivariate linear regression. 【Results】 A total of 247 blood donors were included in the study. Five HRV parameters in blood donors aged 18-24 were higher than in those aged 25 years and above(all P<0.05), and the anxiety level was higher in female donors(SAS score 41-46) than in males(SAS score 35-43)(P<0.001); the pre-donation SAS score was consistent with the assessment of the tension level (r=0.970, P<0.001); the pre-donation tension level and the SAS score were all significantly negatively correlated with VLF in HRV parameters(r=0.179, P=0.005), and the associations were independent of confounders such as age, body mass index and gender (P<0.05). 【Conclusion】 Compared with SAS and tension assessment, HRV is more objective, and can be used as one of the tests for assessing the tension level of blood donors. The inclusion of HRV in the routine screening of blood donors deserves further study for its application in assessing the anxiety level of blood donors before blood donation, identifying people prone to blood donation-related vasovagal reaction (DRVR), preventing and reducing the risk of DRVR, and improving the safety of blood donation.

Overview on haemovigilance about delayed transfusions in the UK and blood shortage in the USA / 中国输血杂志

Serious hazards of transfusion(SHOT)in the United Kingdom has been received reporting of the adverse events of delayed transfusion for more than ten years. Hemovigilance Module Surveillance Protocol in Biovigilance Component in National Healthcare Safety Network in the United States updated the incident codes to include under-transfusion with the creation of a new process code: no blood (NB) and four incident codes in October 2022. This review introduces the monitoring practice of delayed transfusion/under-transfusion in the UK and the USA, makes a suggestion to incorporate delayed transfusion/under-transfusion due to blood shortage into the national health standard on the classification of transfusion reactions and haemovigilance protocol in China, and to do a national survey as well, therefore the real world data and evidences would be obtained and used for further policy making.

Blood transfusion adverse event management system: construction and application / 中国输血杂志

【Objective】 To establish a blood transfusion adverse event management system and apply it to adverse events management, so as to enhance the ability to identify and process reports as well as prevent adverse events. 【Methods】 According to the errors during the whole process of blood transfusion, the management information system of blood transfusion adverse events was established, and the data of adverse transfusion reactions and adverse transfusion events from 2020 to 2022 were collected according to the system requirements. The system monitoring data and statistical analysis were used to analyze the causes of errors in each link of blood transfusion, sort the incidence of each department, focus on supervising the departments with high frequency of adverse events, and propose effective rectification. 【Results】 The management system counted 51 cases of adverse reactions. The incidence of adverse reactions of plasma (43.1 %, 22/51) was higher than that of red blood cells (39.2 %, 20/51), and the number of allergic reactions was slightly higher than that of febrile non-hemolytic transfusion reaction. Among the 628 cases of adverse transfusion events, blood transport, inbound and storage (TS-A) errors accounted for the highest proportion of 46.2% (290/628), 20.9% (131/628) in post-transfusion disposal and evaluation (TS-G) and 15.8% (99/628) in pre-transfusion evaluation and transfusion application (TS-B). TS-A12 accounted for 63.8 % (185/290) in TS-A errors, which was mainly due to plasma leakage caused by extrusion during transport and the expiration of red blood cells caused by insufficient blood inventory management. TS-B errors mainly focus on the failure to fully assess the bleeding tendency of patients before surgical system surgery, resulting in no or insufficient preoperative blood preparation. Most of the TS-G errors were unqualified medical record. 【Conclusion】 Blood transfusion adverse event management system can help to identify and prevent the occurrence or recurrence of adverse events, formulate targeted rectification and preventive measures, and improve the haemovigilance ability.

Transfusion adverse events in a tertiary hospital from 2016 to 2022: a retrospective analysis / 中国输血杂志

【Objective】 To strengthen the management of transfusion adverse events, so as to reduce the occurrence of medical damage and accidents, and guarantee the safety of blood transfusion. 【Methods】 The adverse events of blood transfusion reported in our hospital from July 2016 to December 2022 were collected, the reasons were tracked, and continuous improvements were made. 【Results】 From 2016 to 2022, a total of 315 transfusion adverse events were reported, including 233(73.97%, 233/315) cases of transfusion reactions and 82(26.03%, 82/315) transfusion adverse events. There were 271 328 transfusion cases in the same period, and the incidence of transfusion reactions was 0.858 7‰(233/271 328). The number of transfusion application was 129 887, and the incidence of transfusion adverse event is 0.631 3‰(82/129 887). Sixty-eigtht(82.93%, 68/82) cases of transfusion adverse events were caused by human factors, while the other 14(17.07%, 14/82) cases were non-human factors. According to the linear regression analysis, we have concluded that the year is a significant indicator for transfusion reaction rates (P0.05). 【Conclusion】 Strengthening the management of reporting adverse events in clinical blood transfusion, monitoring the incidence, analyzing and improving different types of adverse events by management tools can reduce the medical risks of blood transfusion and help to guarantee the safety of clinical blood transfusion.

Analysis on the current monitoring and management of blood donation adverse reaction in Chongqing / 中国输血杂志

【Objective】 To investigate the management of adverse reactions to blood donation(ARBD) in blood services, so as to promote the surveillance of ARBD and improve the quality of blood donation service in Chongqing. 【Methods】 A questionnaire, involving the staff and facilities in blood donation sites as well as the prevention and treatment, the record and report, the following up and data related to ARBD was developed by Chongqing Society of Blood Transfusion in February 2019, and was issued to 18 blood services(1 blood center and its sub-center, 6 central blood stations and 11 hospital blood banks) in the Chongqing via email. The questionnaire was filled in and submitted before March 31 by management personnel participating in the investigation, and the data was collected, collated, revised and analyzed by Excel 2011. 【Results】 A total 19 questionnaires were collected, with the valid rate at 100%(19/19). 78.95%(15/19) of the blood services met the requirements of medical personnel allocation(>6 medical staff) when the number of daily blood collection was more than 60, and 100%(19/19)met the requirements of medical personnel allocation(2 to 6 medical staff) when the number of daily blood collection was less than 60. 89.47%(17/19) of the blood services were equipped with epinephrine hydrochloride, and 84.21%(16/19) with dexamethasone(an anti-allergic drug). There were significant differences in the allocation of other types of drugs. 100.00%(19/19) of the blood services formulated prevention and treatment measures concerning ARBD. In 2019, the incidence of ARBD in Chongqing was reported to be 0.54%(1 958 / 359 871), with the highestas [1.35%(223/16 543)] in subcenters and the lowest [0.32%(179/56 299)] in central blood centers (P<0.05). There was statistical significances in the incidences of ARBD reported by different blood stations(P<0.05). 【Conclusion】 The monitoring and management of ARBD among blood services in Chongqing should be further standardized in terms of staffing allocation, emergency drugs allocation and reporting, so as to gradually realize regional homogenization and ensure blood safety.

Research progresses in donation related vasovagal reaction / 中国输血杂志

Donation related vasovagal reaction(DRVR) is the most common adverse reaction during blood donation. It is very important for blood banks to identify, treat and prevent DRVR accurately. At present, it is generally believed that psychological factors are the first major inducement of DRVR. Applied muscle tension (AMT) and salt supplementation have been proved to be effective interventions for vasovagal response; the identification methods of high-risk groups such as State Trait Anxiety Inventory, Medical Fear Inventory and Blood Donor Response Scale have been relatively mature, but the utilization rate is relatively low in China. In this paper, the main clinical manifestations, pathogenesis, research methods, related factors, management and prevention measures of DRVR, as well as the identification of high-risk groups before blood donation are reviewed.

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.

Research and Analysis Result of Recheck Blood Type in Part of Beijing Blood Bank / 中华医院感染学杂志

OBJECTIVE To investigate the degree of risk of viral prevalence of HBV,HCV and HIV through blood transfusion in Beijing Hospital in China,and to assess the need of a national Haemovigilance System. METHODS Retrospectively,7883 blood bank specimens (collected from 2004 to 2007) were re-examined using 8 indicators (including 5-item Hepatitis B,anti-HCV,anti-HIV and Syphilis) for the prevalence of most common viral infection. RESULTS From the blood bank specimens,the prevalence of HBsAg was 0.88% (69),the anti-HBc positive blood,only the anti-HBc was found in 2.65% of the specimens,while both the anti-HBc and the anti-HBe were found in 2.09% of the specimens. The prevalence of anti-HCV was 0.09% (7). CONCLUSIONS We need to establish the national Haemovigilance System to strengthen the monitoring of the above HbsAg,HBcAb and HCV indicators to prevent the transfusion-transmitted infection. Only in this way can the public confidence in blood safety be improved.