Blood transfusion dynamics in Colombia: Unveiling patterns, reactions and survival rates in multitransfused patients.

BACKGROUND AND OBJECTIVES: There is no consensus on a universally accepted threshold to categorize a patient as multitransfused. In 2019, Colombia established the definition of a multitransfused patient as someone who has received six or more blood components, irrespective of the time frame. This study aims to delineate the characteristics, adverse transfusion reactions (ATRs, definitions according to the International Society of Blood Transfusion [ISBT]) and survival rates in this population. MATERIALS AND METHODS: We performed an analysis from the data of all institutions engaged in blood component transfusions at the national level who notified events to the National Information System of Haemovigilance (SIHEVI-INS), from January 2018 to December 2022. The selection criteria focused on individuals who not only exhibited ATRs but also received six or more blood components. RESULTS: Among the 1,784,428 patients who received 6,637,271 blood components, an average of 3.7 components per patient was noted. Concurrently, 8378 ATRs were reported (12.6 ATRs/10,000 transfused components). Within this cohort, 691 patients met the criteria for multitransfusion. Predominantly women (51.8%), these individuals received between 6 and 14 blood components. Out of the 691 multitransfused individuals who experienced ATR, 541 had an allergic reaction. Conversely, out of the 6479 non-multitransfused individuals who experienced ATR, 3835 had an allergic reaction (odds ratio: 2.49, 95% confidence interval: 2.06-3.0). Notably, 271 multitransfused individuals (39.2%) were documented as deceased, with 76% succumbing within 12 months of encountering their most recent ATR. CONCLUSION: Multitransfused individuals in Colombia, being a high-risk group, exhibit a heightened susceptibility to allergic reactions, surpassing the frequency observed in other transfusion populations. This underscores the necessity for tailored medical care specific to this group.

Role of disruptions in O RhD negative donations in Colombia on increasing maternal mortality ratio from haemorrhage.

OBJECTIVE: The aim of this work was to evaluate the relationship of the maternal mortality ratio due to obstetric haemorrhage (MMROH) with the national blood donations, particularly O RhD negative (Oneg) before and during COVID-19 pandemic. BACKGROUND: The maternal mortality ratio is increasing in Colombia, yet little is known regarding the relationship between blood donations and maternal mortality due to obstetric haemorrhage. MATERIALS AND METHODS: A retrospective cross-sectional study between January 1, 2018, and December 31, 2021, was performed, to assess MMROH compared to the blood donations notified to the Colombian National Haemovigilance System, through non-parametric methods. Because a relationship between blood donations and MMROH was identified, the analysis was expanded from 2009 to 2017. RESULTS: In 2020, Colombia increased the MMROH by 32% compared to 2019 which coincided with the lockdown period to contain COVID-19. An inversed relationship (SumD2 = 631.0; rs = -0.7335; p 0.01) between blood donations, particularly Oneg (SumD2 = 652.0; rs = -0.7912; p 0.002) and MMROH was identified. For the years 2015-2019 and 2021, the annual mean MMROH was 8.5 ± 0.5 per 100 000 live births when the annual mean blood donations was 18.2 ± 0.4 donations per 1000 people and the Oneg was 1.0 ± 0.0 donations per 1000 people. In contrast, the years 2009-2014 and 2020 displayed an annual MMROH of 12.6 ± 0.8, when the annual collection of blood was 16.4 ± 0.8 donations and the Oneg was 0.9 ± 0.0, p < 0.001. CONCLUSION: There was an inverse relationship between blood donation, mainly Oneg, and maternal mortality from obstetric haemorrhage. However, we recognise these deaths could be related to other reasons, especially when they occurred in rural areas with limited access to medical services.

Prevention of multiple whole blood donations by an individual at the same month through the creation of a national Deferred Donor Registry (DDR).

INTRODUCTION: The Colombian National Institute of Health administers the National Information System of Haemovigilance (SIHEVI-INS). Today, SIHEVI-INS constitutes a national blood donor and recipient database, which contains a national deferred donor registry (DDR), allowing blood banks to take acceptance or rejection decisions of a potential donor in real time. The study aimed to determine the rate of people who have made more than one whole blood donation monthly in Colombia, violating the national guideline of intervals between donations (three months for men and four for women), since DDR implementation. METHODS: We detected the unique personal identification number of people who, in 30 calendar days, made more than one whole blood donation at any of the 83 blood banks set up in Colombia. There were three comparison periods: 01/01/2018-08/31/2019 (launch of SIHEVI-INS and first national feedback); 09/01/2019-12/31/2020 (second feedback) and 01/01/2021-09/30/2022 (massive incorporation of web services). RESULTS: For the first period, blood banks accepted 18.0 donations per 1000 people. There was a rate of 28.8 people/10,000 donations who had donated whole blood twice within 30 days. In the second period, there were 17.0 donations/1000 people and a rate of 2.1 people/10,000 donations (OR:14.0 CI95 %:12.2-16.0). For the last period, there were 18.2 donations/1000 people and a rate of 0.9 individuals/10,000 donations (OR:31.3 CI95 %:26.6-36.9, p < 0.001). CONCLUSION: DDR reduced by 31 times the acceptance of blood donors who made more than one whole blood donation in the same month. It was necessary to provide periodic feedback and promote web service implementation to reduce this risky behavior.

Septic Transfusion Reactions Involving Burkholderia cepacia Complex: A Review.

This review was conducted to assess the global incidence of transfusion-transmitted infections (TTIs) caused by contamination of blood components with the Burkholderia cepacia complex (Bcc). Our search encompassed various specialized databases such as Medline/PubMed, Web of Science, Scopus, Scielo, ScienceDirect, and ClinicalKey. An analysis of the literature revealed a total of eleven reported cases where blood components contaminated with Bcc had been transfused, resulting in sepsis among the affected patients. Of these cases, eight were documented in the literature, while the remaining three occurred within the institution involving the authors of this review. A comparative examination was conducted, considering factors such as primary diagnosis, transfused blood component, time elapsed between transfusion and manifestation of symptoms, administration of antibiotics, and final outcome. Interestingly, regardless of the storage temperature, all blood components were found to be susceptible to Bcc contamination. Furthermore, the cases investigated revealed diverse sources of contamination, and it was observed that all the affected patients had compromised immune systems due to underlying illnesses. Based on these findings, a series of preventive strategies were derived to mitigate and decrease the occurrence of similar cases.

Deferral due to low hemoglobin and predictors of permanence in the blood donation system of repeat female blood donors.

OBJECTIVES: To evaluate the deferral rate due to low hemoglobin (Hb) in repeat female blood donors and identify the factors affecting their permanence in the blood donation system. MATERIALS AND METHODS: 8,368 repeat female blood donors who donated from January 2012 to December 2018 were included. Bivariate analysis and Kaplan-Meier curves were used to identify the covariates possibly associated with developing low Hb, and Cox proportional hazards modeling was used to adjust for all confounders. RESULTS: The global deferral rate due to low Hb was 2.4 %. According to baseline Hb, the frequency of low Hb was 0.7-4.1 %, and it was higher in platelet donors (5.8-9.1 %) than in whole blood donors (1.9 %). The main predictors were baseline Hb (compared to the first quartile; hazard ratio [HR] = 0.487 for the second quartile; 0.234 for the third; and 0.095 for the fourth); change in Hb (HR = 2.689 for a >0.49 g/dL change, compared to smaller changes); the type of donation (compared to whole blood donors, HR = 2.317 for platelet donors); and donation interval (compared to >12.5 month intervals; HR = 2.220 for 8.0-12.5 months; HR = 5.658 for 5.4-8.0 months; and HR = 9.452 for <5.4 months). CONCLUSIONS: In female blood donors at moderate altitude, the probability of developing low Hb increases with a baseline Hb of 13.5-14.0 g/dL, with a change in Hb >0.49 g/dL, in platelet donors, and with donation intervals <12.5 months. These four predictive factors can be used together for early identification of donors at risk of developing low Hb, to institute appropriate measures.

Effect of the first year of COVID-19 pandemic on the collection and use of blood components in Colombia monitored through the national haemovigilance system.

OBJECTIVE: This work aimed to establish the effects of the COVID-19 pandemic on blood collection and blood product usage at the end of the first year. BACKGROUND: The arrival of SARS-CoV-2 to Colombia on March 6, 2020, triggered closure of borders and mandatory lockdown from March 23, 2020. METHODS/MATERIALS: The Colombian National Institute of Health administers the National database of confirmed cases of SARS-CoV-2 and the National Haemovigilance System. We examined positive SARS-CoV-2 cases identified between March 6, 2020, and March 6, 2021, using positive RT-PCR testing (72.8%) or reactive antigen (27.2%). We also analysed accepted and deferred donors' information provided by 100% of blood banks and transfused patients notified by 83% of health care facilities nationwide, between March 1, 2019, to February 28, 2021. RESULTS: Colombia registered 2 273 245 SARS-CoV-2 cases. From these, 60 412 people died from COVID-19 (2.7%) and 2 172 418 individuals recovered (95.6%). There were 11 659 216 SARS-CoV-2 processed samples nationwide. People between the ages of 20 and 39 years concentrated 44.4% of the SARS-CoV-2 cases. There were 773 569 blood donations, mainly from a 20-39-year-old population (60.5%). The pandemic caused a reduction of 155 393 blood donations (16.7%) and 51 823 total deferrals (33.7%). An 18.4% drop in volunteer donors and a 37.3% increase in donations from family/replacements members were observed. There were 399 453 transfused patients and 1 179 895 blood components administered (-8.7% and - 13.9% compared to March 2019-February 2020). CONCLUSION: Mandatory lockdowns in Colombia decreased blood collection and usage, resulting in a reduction of blood components transfused to individual patients.