Implementation of an electronic identification system in the setting of perioperative autologous cell salvage transfusion: Experience at a university hospital.

Perioperative autologous cell salvage (PACS) is one of the effective strategies in patient blood management (PBM). However, mistransfusion, in which the wrong blood is transfused to the wrong patient, of PACS units has been reported. In this study, we implemented a bar code-based electronic identification system (EIS) for blood transfusion in the setting of PACS transfusion. Between February 2009 and December 2020, a total of 12341 surgical patients (9% of whom received surgical interventions) received blood transfusion, among whom 6595 (54 %) received autologous blood transfusion alone, 2877 (23 %) both autologous and allogeneic blood transfusions, and 2869 (23 %) allogeneic blood transfusion alone. Among autologous blood conservation techniques, PACS units were transfused to 7873 patients (83 %) without a single mistransfusion. Rates of overall compliance with the electronic pre-transfusion check at the bedside for all autologous units and PACS units were 98.8 and 98.5 %, respectively. Our observations suggest that a bar code-based EIS can be successfully applied to PACS transfusion, as well as allogeneic blood transfusion in operating rooms.

A survey of nurses to assess transfusion practice at the bedside using an electronic identification system: Experience at a university hospital.

OBJECTIVES: The objective of this study was to assess the performance and recognition of transfusion practice at the bedside by nurses in our hospital, where a barcode-based electronic identification system (EIS) has been used since 2002. BACKGROUND: More than half of the steps in the transfusion chain are dependent on nurses' awareness and skills. METHODS: Our transfusion policy at the bedside includes two-person checking of the patient and two-person signing of the label at the time of collecting blood samples for pre-transfusion testing and two-person blood administration, which generally involved a doctor-nurse pair but sometimes involved two nurses. Anonymous, paper-based questionnaires were sent in January 2018 to 1051 nurses who were working in Juntendo University Hospital, Tokyo, Japan. The questionnaire consisted of three parts: (a) background of respondents, (b) performance of collection of blood samples for pre-transfusion testing and (c) performance of pre-transfusion check procedures at the bedside using an EIS based on a total of 20 questions. RESULTS: There was a good response rate of individual nurses (1006/1051, 96%). Most nurses (>90%) performed two-person checking of the patient and two-person signing of the label at the time of collecting blood samples. Most nurses (>90%) performed two-person blood administration involving a doctor-nurse pair and electronic pre-transfusion check using an EIS before blood administration. CONCLUSIONS: The survey revealed that most nurses complied with our transfusion policy at the bedside, but some nurses did not. Further education/training and continuous support by the transfusion service may be needed for all nurses.

Threshold for optimal administration of plerixafor in autologous peripheral blood stem cell collections through CD34+ cell monitoring based on the experience from two Japanese university hospitals.

Plerixafor was introduced to Japan in 2017 as a stem cell mobilization enhancement reagent, but the threshold for its use remains unclear. In this study, we assessed 57 patients treated with plerixafor (33 patients with multiple myeloma (MM) and 24 with malignant lymphoma (ML) and 152 patients without plerixafor administration. When CD34+ cell pre-counts were between 5.5 and 20 cells/µL in MM or 6 and 21 cells/µL in ML, the CD34+ cell count increased significantly, attaining the highest yield in response to plerixafor (achievement rate by one leukapheresis is 93.3% and 91.7% in MM and ML, at P < .001 and P = .012, respectively). In case the CD34+ cell pre-count was less than 5.5 cells/µL, an increase of at least 7 cells/µL from baseline by plerixafor was the necessary condition to achieve successful collection through a two-time leukapheresis. Monitoring CD34+ cell numbers might improve the collection efficiency and reduce the cost.

Impact of CD34+ pre-counting and plerixafor on autologous peripheral blood stem cell collection in Japanese university hospitals in eight years.

OBJECTIVE: Over the past decade, there have been two major advancements in autologous peripheral blood stem cell (PBSC) collection, namely enumeration of CD 34+ cells for apheresis prediction and use of plerixafor to assist mobilization of PBSC. This study aimed to investigate changes in the efficacy of PBSC collection from two Japanese university hospitals over an eight-year period. STUDY DESIGN AND METHODS: A series of 399 PBSC collection procedures from 239 patients with solid malignant tumors (ST, n = 42), malignant lymphoma (ML, n = 91), multiple myeloma (MM, n = 99), and others (amyloidosis and leukemia, n = 7) from two university hospitals from 2011 to 2018 were retrospectively analyzed. We also analyzed the effects of CD34+ pre-counting and plerixafor administration in improving CD34+ cell yield. RESULTS: Using CD34+ pre-count as a reference, the frequency of apheresis was reduced and the yield of CD34+ cells increased in patients with ST. When administrating plerixafor, especially with a CD34+ pre-count <20/µL, the yield of CD34+ cells was significantly increased in patients with ML (p = 0.02) and MM (p = 0.03). CONCLUSIONS: We verified that CD34+ cell counting and plerixafor administration contributed to effective PBSC collections in our hospitals for the eight-year study period. In patients with ST, CD34+ pre-count threshold for starting apheresis was ≥10/µL. CD34+ pre-count (<20/µL) was useful to select appropriate patients for plerixafor administration among the patients with ML and MM.

Pre-operative autologous blood donation and transfusion-related adverse reactions: A 14-year experience at a university hospital.

OBJECTIVE: The objective of this study was to determine the rate of adverse reactions to pre-operative autologous blood donation (PAD) transfusion in a single institution over a 14-year period. STUDY DESIGN AND METHODS: Between January 2003 and December 2016, we investigated adverse reactions to PAD transfusion and compared them with those to allogeneic blood transfusion in Juntendo University Hospital. Adverse reactions were categorized according to the definition proposed by the International Society of Blood Transfusion (ISBT) Working Party on Haemovigilance. RESULTS: A total of 178,014 blood components were transfused during the study period, of which PAD transfusions were 13,653 (8%), whereas allogeneic blood transfusions were 164,361 (92%). The number and rate of adverse reactions to PAD transfusion were 16 and 0.1%, whereas those of allogeneic blood transfusion were 1075 and 0.7%, respectively. The rate of adverse reactions to allogeneic blood transfusions excluding platelet transfusion was 0.3%, being significant (p < 0.01) against PAD transfusion. Among 16 adverse reactions to PAD transfusion, the most common was febrile non-hemolytic transfusion reaction (FNHTR) at 12 (75%), followed by allergic reaction at 4 (25%). The severity of adverse reactions to PAD transfusion was Grade 1 (non-severe) in all cases. With regard to blood component types, 16 adverse reactions involved: 12 cases of whole blood PAD, 2 of frozen PAD, and 2 of autologous fresh-frozen plasma. CONCLUSIONS: Non-severe adverse reactions were observed on PAD transfusion at a rate of 0.1% at our institution.

Implementation of electronic identification system for blood transfusion in the setting of hematopoietic progenitor cell infusion at the bedside.

Hematopoietic progenitor cell (HPC) infusion at the bedside is a critical step in HPC transplantation. In this study, we implemented a bar code-based electronic identification system (EIS) for blood transfusion in the setting of HPC infusion at the bedside. Between July 2003 and December 2014, a total of 518 HPC products were infused to 190 patients without a single misinfusion in the hospital. An overall compliance rate with the electronic pre-infusion check for HPC infusion at the bedside was 100%. Our observations suggest that an EIS can be successfully applied to the infusion of HPC products at the bedside.

Bar code-based pre-transfusion check in pre-operative autologous blood donation.

BACKGROUND: The objective of this study was to demonstrate the feasibility of a bar code-based identification system for the pre-transfusion check at the bedside in the setting of pre-operative autologous blood donation (PABD). MATERIALS AND METHODS: Between July 2003 and December 2008 we determined the compliance rate and causes of failure of electronic bedside checking for PABD transfusion. RESULTS: A total of 5627 (9% of all transfusions) PABD units were administered without a single mistransfusion. The overall rate of compliance with electronic checking was 99%. CONCLUSIONS: The bar code-based identification system was applicable to the pre-transfusion check for PABD transfusion.

Basic and clinical aspects of Clostridium difficile colitis.

Clostridium difficile, a gram-positive anaerobic bacillus dubbed as the difficult clostridium because it resisted early attempts of isolation and culture. After some decades in the darkness, it became famous, when in 1978, a cytotoxin of the C. difficile was found the responsible of the pseudomembranous colitis. We review in this paper aspects of the epidemiology of the C. difficile in health and disease. Also the importance of C. difficile as a cause of nosocomial infections. We review the characteristics of the toxins A and B produced by the pathogenic strains of C. difficile. Finally, clinical aspects of infection with C. difficile in special in the pseudomembranous colitis. The diagnosis, medical therapy, complications and surgical indications are briefly described.

Gastrointestinal stromal tumor of the rectal mesentery.

We report a case of gastrointestinal stromal tumor (GIST) arising from the rectal mesentery. GIST of the large intestine is a rare tumor that accounts for only 0.1% of all colorectal cancers. The patient presented to our hospital with constipation and abdominal distension. Computed tomography (CT) revealed a huge mass in the pelvic cavity, and laparotomy disclosed diffuse peritoneal dissemination from the primary tumor. Radiochemotherapy was commenced, but the patient became too ill to complete it and died of the disease 2 months after surgery. A large high-grade tumor with diffuse dissemination was recognized as an indicator of poor survival in this patient.

Diagnosis and treatment of obturator hernia.

Obturator hernia is a rare type of hernia, but it is a significant cause of intestinal obstruction due to the associated anatomy. Correct diagnosis and treatment of obturator hernia is important, because delay can lead to high mortality. Twelve patients with obturator hernia were managed during a 11-year period, including 11 women and 1 man with a mean age of 82 years. We compared our experience with the previously published data to establish standards for the diagnosis and treatment of this hernia. All 12 patients presented with intestinal obstruction. The median interval from admission to operation was 2 days. The Howship-Romberg sign was positive in 5 patients. A correct diagnosis was made in all 8 patients who underwent pelvic CT scanning. Surgery was performed via an abdominal approach (n = 7) or an inguinal approach (n = 5). The hernial orifice was closed using the uterine fundus (n = 6), a patch (n = 5), and direct suture (n = 1). Mean follow-up time was 33 months, and no recurrence has been detected. The poor physical condition of patients might have led to a delay in diagnosis and treatment. In troubled patients with nonspecific intestinal obstruction, CT scanning is useful for the early diagnosis of obturator hernia. Correct CT diagnosis of obturator hernia allows us to select the inguinal approach combined with patch repair, which is minimally invasive surgery.