A prospective survey of blood products transferred with patients during inter-hospital transfers in the East of England.

OBJECTIVES: A prospective survey was undertaken of blood products transferred with patients during inter-hospital transfers by ambulance in the East of England (population six million) BACKGROUND: There is little published information on the number and fate of blood products transferred with patients during inter-hospital transfers, although there are concerns about quality assurance and traceability of these blood products. Recent national guidance has been issued, but adherence to this guidance is uncertain. METHODS: A 6-month survey was undertaken of all inter-hospital transfers of blood products with patients within the East of England using routine data captured by established transfer of blood documentation. RESULTS: There were 45 transfer episodes of which 44 involved the transfer of red blood cells. In total, 148 units of red blood cells were transferred, of which 6% were transfused en route, 3% transfused at the destination hospital, 35% were wasted and for 18% the fate could not be established. The remainder were transferred into the blood stock of the destination hospital. CONCLUSION: The small proportion of blood products that were transfused raises questions about the necessity of the transfer of blood products with some patients particularly considering the higher percentage of wasted or untraced products. When transfers occur, there should be better communication between hospital transfusion laboratories assisted by adherence to national and regionally agreed policies.

Headache in systemic lupus erythematosus: a controlled study.

Intractable headaches, the so-called 'lupus headaches', have been long thought of as a common and characteristic manifestation of systemic lupus erythematosus (SLE). Seventy-eight patients with SLE, including 10 patients with definite central nervous system (CNS) involvement, and 89 healthy individuals matched for age, sex and socioeconomic status, were studied by a specific questionnaire addressing the characteristics and type of headache. Clinical features of SLE, neurological manifestations and treatment, disease severity and autoantibody profiles were correlated to the presence of headache. One year prevalence of headache was similar between patients (32%) and otherwise healthy individuals (30%). No significant differences regarding frequency, family history of headache and need for analgesic medication were observed. Headache refractory to analgesic treatment, but responsive to corticosteroid regimen, was recorded in only one patient. Clinical and serological features of SLE, including Raynaud's phenomenon and the presence of anticardiolipin antibodies, were not significantly different between headache sufferers and non-sufferers. In the majority of patients reporting headache, anxiety and/or depression co-existed. Episodic tension headache was the most frequent type, while migraine was traced in a quarter of headache sufferers. Neither the presence nor the clinical type of headache was related to, or predictive of, the development of seizures or psychosis. These results indicate that headache is not specifically related to SLE expression or severity, and suggest that accepting the presence even of a severe headache as a neurological manifestation of SLE in the absence of seizures or overt psychosis may result in overestimation of the disease status.