[Study of the satisfaction of the quantitative and qualitative needs of labile blood products' recipients in non self-sufficient transfusion area]. / Étude de la satisfaction des besoins quantitatifs et qualitatifs des receveurs de produits sanguins labiles en région transfusionnelle non autosuffisante.

This retrospective study over 4 years, in a non-self-sufficient transfusion region, analyses the qualitative and quantitative needs of recipients of blood components in the phenotypic characteristics red cell specific. If the quantitative needs were still covered with the national solidarity, is not less that a qualitative improvement of supply remains to achieve and requires a collective effort of each of the links in the regional transfusion chain.

[Identification of alloantibodies and their associations: balance sheet of a year at the Auvergne-Loire French Blood Establishment]. / Identification d'allo-anticorps et leurs associations : bilan d'une année à l'Établissement français du sang Auvergne-Loire.

OBJECTIVES: Some alloantibodies and their combinations can lead to delays or even an impasse in a transfusion, owing to the necessity of finding compatible red blood cell concentrates. The aim of this study was to determine the specificities of the most common alloantibodies, as well as the most common combinations of alloantibodies. METHODS AND MATERIALS: A retrospective study analysed erythrocyte alloantibodies identified in 2008 in the immunohematology laboratories at the Auvergne-Loire French Blood Establishment. The following data were studied: frequency, specificities of the alloantibodies, date of discovery, and patient age and sex. RESULTS: One thousand eight hundred and fifteen alloantibodies were identified in 1575 patients (median age: 63.5years, female/male ratio: 3.03). The most common alloantibodies were directed against the following antigens: RH3/E (18.7%), KEL1/K (17.3%), RH1/D (16.4%), MNS1/M (9.4%), FY1/Fya (6.9%), RH2/C (6.1%), KEL3/Kpa (4.7%), JK1/Jka (4.3%) and RH4/c (4.1%). In 13.1% of patients, at least two alloantibodies were identified. The pairs most frequently combined were anti-RH1/RH2, anti-RH3/RH4 and anti-RH3/KEL1. CONCLUSION: Specific associations of paired alloantibodies were identified. The main combinations provide indications on the choice of red cell concentrates in the inventory for a given patient. The data collected in our study show that when an antibody is identified, it is recommended for subsequent transfusion episodes to respect the phenotype RH 1-5 (D, C, E, c, e) and KEL1 (K) of the patient, and if possible antigens JK1 (Jka) and FY1 (Fya), and to a lesser extent MNS3 (S). Detailed knowledge of the immunological mechanisms leading to the formation of these alloantibodies and their combinations would allow better prevention of erythrocyte alloimmunization.

[Evaluation of continuous education in transfusion for professionals in medical blood banks]. / Évaluation d'une formation en transfusion sanguine à destination des personnels des dépôts de sang.

PURPOSE OF THE STUDY: Like every actor in transfusion, staff members practising within blood banks of healthcare establishments have to follow a specific initial training and must frequently update their knowledge in blood transfusion. METHODS: To address this need from these professionals, the Établissement français du sang Auvergne-Loire set up training sessions which content regularly evolved according to regulation recommendations. Every cycle consists in a total of 35hours of training, divided in five one-day modules. The comparison of the evaluation questionnaires offered at the beginning and at the end of each day allowed to measure the benefits provided by every module and to compare progress according to the number of modules previously followed. The analysis of satisfaction surveys contributed to improving the education towards a high level of satisfaction of every participant. RESULTS CONCLUSION: At the end of its third year of existence, the 35hours education programme permitted to achieve a better level of training for all the staffs and the evolution towards an on-site continuing education format seems to better correspond to the personnel's expectations.

[Analysis of a severe septic transfusion reaction with standard platelet concentrate]. / Analyse d'un incident bactérien grave transmis par transfusion d'un concentré plaquettaire.

We recently observed a near fatal case of transfusion-transmitted infection with standard platelet concentrate. Streptococcus dysgalactiae subspecies equisimilis was isolated both from donor, residual component container and cultures of the patient's blood. This should question the usefulness of systematic bacterial detection in platelet concentrates, however a lethal accident has occurred recently which escaped bacterial detection. This observation calls for implementation of pathogen inactivation procedures for platelets concentrates.

[Tranfusion counseling]. / Le conseil transfusionnel.

In this article, we present transfusion counseling; its organization, actors, their formations and we deal with factual positions. Transfusion counseling needs better identification, tending to a homogeneous organization between every bloodbank centre.

[Anti-RH1 (anti-D) alloimmunization after transfusion of platelet concentrates from RH :1 donors]. / Allo-immunisation anti-RH1 (anti-D) après transfusion de concentrés plaquettaires issus de donneurs RH :1.

Anti-erythrocyte alloimmunization may occur following the transfusion of platelet concentrates, in response to the presence of residual erythrocytes. Immunization against RH1 (D) antigen is the most frequent, but transfusion of RH1 compatible platelet concentrates is not always possible because of supply constraints. We report here three cases of anti-RH1 (anti-D) alloimmunization in RH :-1 patients after transfusion of platelet concentrates from RH :1 donors. Criteria for selection of platelet concentrates are numerous and difficult to achieve in practice. Respect of RH1 compatibility is not obligatory, but in case of transfusion of RH1 incompatible platelet concentrates, anti-RH1 immunoprophylaxis must be made for RH :-1 women of child-bearing age and without profound immunosuppression, as recommended by Afssaps (Agence française de sécurité sanitaire des produits de santé). These data point out the need to perform post-transfusional screening test for irregular erythrocyte antibodies as part of the transfusion of platelet concentrates.

[Who are the recipients of labile blood products? A multicenter nation-wide study--a "donation day." Blood banks, health facilities]. / Qui sont les receveurs de produits sanguins labiles (PSL)? Une étude nationale multicentrique - un jour donné. Etablissement de transfusion sanguine (ETS) - établissements de santé (ES).

During the years 1994-2001, a progressive decrease of the number of blood units transfused has been reported in France. In contrast, since 2002, there is an increasing number of blood units issuing (+7.6% between 2001 and 2006) and this must be investigated. On behalf of the French Society of Blood Transfusion, the "Recipients" working group promoted a nation wide survey with the support of the regional blood transfusion centres. This survey was aimed at describing the profiles of the transfused patients: socio-demographical patterns, and reasons of the blood transfusion (main and associated diagnoses). A cross-sectional survey was designed. All the patients who received a blood unit during a specific day were considered as the population of the study. They were identified by the regional transfusion centres by means of the "individual issuing form". Survey forms were fully filled for 90% of the patients. It has been considered as a good answer rate. Seven thousand four hundred and twenty-two blood units, delivered to 3450 patients were analyzed. Three groups of pathologies were found as a reason of transfusion: haematology-oncology (52.70% of the prescriptions) with 892 patients (27.8%) for haematological malignancies; surgical procedures (23.99%); intensive care and medicine procedures (21.92%). More than 50% of the recipients are 70 years old and more. This result is explained by the age distribution of inpatients. In a context of lack of donors and consequently difficulties to provide patients with optimal number of blood units, this study is helpful. Variability of blood unit issuings must be detected, analyzed and monitored in real time by the actors of the transfusion process, using computerized dashboards: the blood units provider (in order to adjust the strategy of blood units provision) and the health care establishment as well as care blood components prescribers (reasons of blood transfusion and evaluation of practices).

[Guide for the organisation of ceremonies for delivering pins and certificates of recognition to volunteer blood donors. Etablissement français du sang Auvergne-Loire. Associations pour le don du sang bénévole]. / Guide d'organisation des cérémonies de remises des diplômes et des insignes de reconnaissance en faveur des donneurs de sang bénévoles. Etablissement français du sang Auvergne-Loire. Associations pour le don du sang bénévole.

Award ceremonies constitute an important means of promotion among the blood donor population, and also the general population. They contribute to the development of blood donation loyalty. Even so, their organization must be rigorously and perfectly codified. With this aim, the Etablissement français du sang Auvergne-Loire, in partnership with the departmental representation of the blood donors national federation, worked out a guide for their associations.

[Experience with the regionalization of transfusion advice]. / Expérience de régionalisation du conseil transfusionnel.

We represent an organization of transfusionnel advice at a regional level and we develop arguments and stages having allowed us to lead to this choice. This target was reached in two stages, which took place over 3 years. The regional transfusionnel advice leans on three fundamental points: a planned permanent organization, skilled and formed actors as well as adapted tools. Tending to a homogeneous organization between every blood bank center seems to be coherent towards the current configuration of blood donation in France.

[Partnership guide for the good sequence of a blood donation]. / Guide de partenariat pour le bon déroulement d'une collecte de sang.

Blood donation requires a partnership for its organization between Etablissement français du sang and associations. A partnership guide, conceived by and for the operations team in the first rank of which Associations for Altruistic Blood Donation, was worked out to remind or inform conditions necessary for the good sequence of a blood donation. Through this guide, the authors also wanted to clarify the role and the responsibilities of each partner for a better reception of the Candidate for donation. The elaboration of this guide is only a first stage towards an homogenization or even an overhaul of the organization of blood donation.

[Evaluation of continuous education in transfusion for professionals in hospitals and clinics]. / Evaluation d'un enseignement en transfusion sanguine proposé aux professionnels des établissements de santé.

Professional health workers need continuous update of knowledge in blood transfusion practice. To fulfill this expectation, the "Etablissement français du sang (E.F.S) Auvergne-Loire", in cooperation with the Department of Regional Affairs in Health Services in the Auvergne region, has set up a proximity-based and a dedicated continuous education course, for more than three years. The content of this update course was based upon regulatory recommendations. The course is one day long; an evaluation of the course by the teachers as well as an evaluation of the teachers' level after the course is carried out. Each course attendant is given a CD-ROM which comprises all of the presentations of the day, along with relevant law texts. We now report on our experience in teaching 127 individual professionals in eight sessions: 95% gave full appreciation. This experience reached - up to now - 53% of the public and private hospitals with transfusion services in the Auvergne region and the Loire district and 90% of structures having remote blood banks. This experience can easily be extended to other regional E.F.S. settings.

[Transfusion safety and haemovigilance committees]. / Le comité de sécurité transfusionnelle et d'hémovigilance.

Transfusion safety and haemovigilance committees (TSHC) were initially created in the public health care sector. Nowadays, they are also a mandatory committee of private health care institutions. The members of the TSHC, as well as the way the committee is driven and organized, are defined by law. The aim of the committee is focused on the management of transfusion safety and haemovigilance. The TSHC takes part in the improvement of the safety of transfused patients, and monitors the applying of haemovigilance rules. It also handles the training of all staff members involved in the blood transfusion process.

[Evaluation of aa tracking system for labile blood products in the Midi-Pyrenes region]. / Evaluation du système de traçabilité des produits sanguins labiles en région Midi-Pyrénées.

At the request of the regional authority, the system of traceability of blood products in the Midi-Pyrenees area in France was assessed using available documentation, visits and interviews of participants. We studied the time needed to obtain traceability data in the Blood Banks and the reactivity of the system defined as the time needed to carry out a simulated descending transfusional survey. This information allowed us to assess usefulness and cost of the system, its applicability and the timeliness of information, according to the criteria of the Centers for Disease Control. The system is based on a standardized nominative form for the delivery of blood products and specific feedback. For the participants, traceability makes transfusional surveys easier and improves transfusions safety. In two of the 130 hospitals, the system is linked to the "program of medicalization of information systems". In the 2nd semester of 1996, the traceability proportion was 97%. For a given date of distribution, 75% of blood products were traced in 14 days and 83% in a month. The study of reactivity showed that all donations coming from two randomly chosen blood collection sites could be traced in about 2 hours. This first evaluation of a regional system of traceability showed its feasibility and acceptability, based on evaluation criteria of a public health surveillance system. A continuous evaluation process would be necessary to assess the good functioning of the system and to detect and prevent possible deficiencies.