ABSTRACT
PURPOSE OF THE STUDY: Platelet transfusion follows the national guidelines published in 2003 by the AFSSAPS, determining, for instance, indications, transfusion threshold and platelets dose. We wanted to assess how these guidelines are routinely used in our hospital, with a special focus on transfusion threshold and delivered dose. MATERIAL AND METHODS: We conducted a prospective study during 11 months on every platelet transfusion. Our establishment is a medium size structure, devoted to emergency and oncology, without bone marrow transplantation. During this period, 235 products were delivered to 105 patients. Half (52%) were delivered to oncological units, a third to emergency units and the remaining to medical and surgical units. RESULTS: The average dose was 4.3±0.8×10(11) platelets (2.0 to 7.6×10(11) platelets), corresponding to 0.45×10(11) platelets per 7kg. During prophylactic transfusions, the average platelet count was 9.4±5.5G/L ; during curative transfusions (43%), it was 39.0±47.8G/L and finally when platelets were infused during surgery (21%), the average platelet count was 57.8±61.4G/L. CONCLUSION: Globally, with regard to transfusion threshold, guidelines were followed in 71%, and 93% in oncological units. Transfusion efficacy, attested by post-transfusion platelet efficiency was above 20% in 59% of the cases. These data highlight a good respect of the transfusion thresholds in the usual platelets-consuming units, but raise the question of the dose, often under those proposed by the guidelines.
Subject(s)
Guideline Adherence , Platelet Transfusion/standards , Female , Humans , Male , Middle Aged , Practice Guidelines as Topic , Prospective StudiesABSTRACT
Pulmonary oedema after transfusion of blood products may be hydrostatic (transfusion-associated circulatory overload [taco]) or exsudative (transfusion-related acute lung injury [trali]). Both conditions have been recognized as major hazards to transfusion recipients. Risk characterization is necessary to improve safety and to monitor trends in the national blood transfusion system. A collaborative multidisciplinary working group of the French National Hemovigilance Committee has proposed an analysis framework for case definitions and classification. The method relies on internationally used definitions and is adapted to the codification procedures used in the french transfusion incident reports electronic data management.
Subject(s)
Acute Lung Injury/etiology , Pulmonary Edema/etiology , Transfusion Reaction , Acute Lung Injury/classification , Acute Lung Injury/diagnosis , Blood Safety , Blood Volume , Consensus Development Conferences as Topic , Decision Trees , Diagnosis, Differential , Electronic Health Records , France , Humans , Hypertension/etiology , Hypotension/etiology , International Cooperation , Pulmonary Edema/classification , Pulmonary Edema/diagnosis , Respiratory Distress Syndrome/diagnosis , Severity of Illness IndexABSTRACT
The discovery of anaemia raises the question of its aetiology. If many causes can easily be established, some remain without any accurate diagnosis. The mere issue is that their causes can be rare or mechanisms interlinked. A blood film examination by the biologist provides helpful elements to guide the diagnosis, it can be improved if it is orientated by the physician who prescribed it. Two cases of late discovery of haemolytic anaemia, in relation with red cell membrane disorders, are reported. They illustrate the interest of a good collaboration between the physician and the biologist that lead to diagnosis. The first case is about a band-3 protein defect, the second deals with an hereditary dehydrated stomatocytosis.
