Red blood cell transfusion in a tertiary Haitian hospital's emergency department: patient characteristics and availability challenges.

BACKGROUND: Red blood cell (RBC) transfusions are essential for many patients admitted to emergency departments (ED). However, accessibility to red cell transfusions is often limited, especially in low-income countries such as Haiti. This article aims to determine the proportion of patients requiring emergency transfusion, transfused patients' characteristics, as well as the response rate and timeliness of blood product delivery for requests made. METHODS: A retrospective study was conducted among all patients with RBC transfusion indications from January to June 2022 at the ED of Mirebalais Teaching Hospital. The parameters studied included transfusion indications, pre-transfusion hemoglobin levels, and delay from prescription to transfusion. RESULTS: During the study period, 3993 patients received treatment in the ED. The proportion of patients requiring RBCs was 7.69%, including 145 males and 117 females, with a median age of 43 [30-56] years. Only 21.7% of these patients received a transfusion. The average pre-transfusion hemoglobin level was 4.75 ± 1.68 g/dL. The most common transfusion's indications were infection/sepsis (36.74%), trauma (23.48%), and cancer (21.57%). The median time delay from prescription to transfusion was 2.37 [0.97-4.93] days. The study identified significant associations between RBC transfusion probability and patient factors like hemoglobin levels, patient disposition, urgency of RBC request, and length of stay. CONCLUSION: RBC transfusion requests are frequent in the ED of Mirebalais Teaching Hospital, with a relatively high transfusion delay. Further studies on the relevance of RBC requests and ways to reduce delay from prescription to transfusion would be beneficial to improve this situation.

Transfusion practices in cirrhotic patients at a tertiary liver care center from Northern India

Abstract Introduction: Transfusion in cirrhotic patients remains a challenge due to the absence of evidence-based guidelines. Our study aimed to determine the indication of transfusion and the associated transfusion thresholds in cirrhotic patients. Methods: This retrospective observational study was conducted in the Department of Transfusion Medicine at a tertiary care liver center from October 2018 to March 2019. The blood bank and patient records of cirrhotic patients admitted during the study period were retrieved and analyzed to determine the current transfusion practice. Results: A total of 992 cirrhotic patients were included in the study. Blood components were transfused to 402 (40.5%) patients. Sixty-nine (17.2%) patients were transfused to control/treat active bleeding, while 333 (82.8%) were transfused prophylactically. Packed red blood cells (65.4%) was the most commonly transfused blood component, followed by fresh frozen plasma (35.6%), among patients receiving transfusions (therapeutic & prophylactic). The mean pre-transfusion thresholds for: (i) packed red blood cell transfusion: hemoglobin less than 7 g/dL; (ii) fresh frozen plasma transfusion: international normalized ratio over 2.6; (iii) platelet concentrate transfusion: platelet count less than 40,700/µL, and; (iv) cryoprecipitate transfusion: fibrinogen less than 110 mg/dL. The average length of stay of the study population was 5 days (3-9. Conclusion: To conclude, 40.5% of our hospitalized cirrhotic patients were transfused, with the majority of the transfusions being prophylactic (82.8%). Separate guidelines are required for this patient population, as these patients have an altered hemostasis which responds differently to the transfusion of blood components.

Transfusion practices in cirrhotic patients at a tertiary liver care center from Northern India.

INTRODUCTION: Transfusion in cirrhotic patients remains a challenge due to the absence of evidence-based guidelines. Our study aimed to determine the indication of transfusion and the associated transfusion thresholds in cirrhotic patients. METHODS: This retrospective observational study was conducted in the Department of Transfusion Medicine at a tertiary care liver center from October 2018 to March 2019. The blood bank and patient records of cirrhotic patients admitted during the study period were retrieved and analyzed to determine the current transfusion practice. RESULTS: A total of 992 cirrhotic patients were included in the study. Blood components were transfused to 402 (40.5%) patients. Sixty-nine (17.2%) patients were transfused to control/treat active bleeding, while 333 (82.8%) were transfused prophylactically. Packed red blood cells (65.4%) was the most commonly transfused blood component, followed by fresh frozen plasma (35.6%), among patients receiving transfusions (therapeutic & prophylactic). The mean pre-transfusion thresholds for: (i) packed red blood cell transfusion: hemoglobin less than 7g/dL; (ii) fresh frozen plasma transfusion: international normalized ratio over 2.6; (iii) platelet concentrate transfusion: platelet count less than 40,700/µL, and; (iv) cryoprecipitate transfusion: fibrinogen less than 110mg/dL. The average length of stay of the study population was 5 days (3-9). CONCLUSION: To conclude, 40.5% of our hospitalized cirrhotic patients were transfused, with the majority of the transfusions being prophylactic (82.8%). Separate guidelines are required for this patient population, as these patients have an altered hemostasis which responds differently to the transfusion of blood components.

Adherencia a las buenas prácticas de transfusión, observada en el personal de enfermería del Hospital Pediátrico Baca Ortiz / Adherence to good transfusion practices, observed in the nursing staff of the Baca Ortiz Pediatric Hospital

Contexto: el personal de enfermería cumple un rol fundamental en el proceso transfusional; el nivel de conocimientos debe ser periódicamente evaluado a fin de garantizar una buena práctica transfusional. Objetivo: evaluar el nivel de conocimientos que posee el personal de enfermería del Hospital Pediátrico Baca Ortiz (HPBO) previo y posterior a la intervención, frente a los procedimientos para solicitud, administración y monitoreo de los componentes sanguíneos. Sujetos y métodos: estudio no-experimental pre y post-evaluatorio en el personal de enfermería del Hospital Pediátrico Baca Ortiz de la ciudad de Quito. Se diseñó y aplicó una encuesta estructurada a los profesionales de enfermería del Hospital Pediátrico Baca Ortiz a través de la cual se evaluaron aspectos técnicos relativos a la práctica transfusional en lo relativo a solicitud, administración y monitoreo de los componentes sanguíneos. Resultados: la intervención se realizó en 176 profesionales, distribuidos en tres grupos de capacitación; se observó un incremento global del 14,27% en el puntaje post-intervención sobre 20 puntos, con una p<0,002, estadísticamente significativa. La pre-intervención demostró un menor porcentaje de respuestas correctas en lo referente a la toma y envío de muestras (45,2%). Al evaluar el impacto de la intervención se observó que en la etapa relativa a "recepción de hemocomponentes en el servicio hospitalario, verificación, condiciones de envío, validación del paciente y administración de la transfusión" paso del 67,7% al 79,06% de respuestas válidas con una diferencia porcentual de 11,3%. El área hospitalaria que mayor impacto tuvo fue consulta externa, desde un 22,2% de respuestas correctas en la etapa de pre-intervención y la de menor impacto fue el área quirúrgica con 14,15%. Conclusión: la pre-intervención evidenció debilidades y puntos de mejora en los conocimientos del personal de enfermería que fueron fortalecidos significativamente por la intervención realizada. La educación continua reviste utilidad y relevancia para mejorar percepciones y prácticas en medicina transfusional (AU)

Context: nurses play a fundamental role in the transfusion process; The level of knowledge should be periodically evaluated in order to guarantee good transfusion practice. Objective: to evaluate the level of knowledge held by the nursing staff of the Baca Ortiz Pediatric Hospital (HPBO) before and after the intervention, as opposed to the procedures for requesting, administering and monitoring the blood components. Subjects and methods: pre and post-evaluation non-experimental study in the nursing staff of the Baca Ortiz Pediatric Hospital in the city of Quito. A structured survey was designed and applied to the nursing professionals of the Baca Ortiz Pediatric Hospital through which technical aspects related to the transfusion practice regarding the application, administration and monitoring of the blood components were evaluated. Results: the intervention was carried out in 176 professionals, divided into three training groups; an overall increase of 14.27% was observed in the post-intervention score over 20 points, with p <0.002, statistically significant. The pre-intervention showed a lower percentage of correct answers regarding the taking and sending of samples (45.2%). When evaluating the impact of the intervention it was observed that in the stage relative to "reception of blood components in the hospital service, verification, delivery conditions, patient validation and administration of the transfusion" step from 67.7% to 79.06% of valid answers with a percentage difference of 11.3%. The hospital area that had the greatest impact was external consultation, from 22.2% of correct responses in the pre-intervention stage and the one with the least impact was the surgical area with 14.15%. Conclusion: the pre-intervention showed weaknesses and points of improvement in the knowledge of the nursing staff that were significantly strengthened by the intervention performed. Continuing education has utility and relevance to improve perceptions and practices in transfusion medicine. (AU)

Anemia and transfusion of red blood cells.

The red cells transfusion is a mainstay in the treatment of anemic patients. These blood transfusions are not without risks. The risk-benefit profile for red cell transfusions to treat anaemia is uncertain, but they may contribute to adverse patient outcomes in some situations. The ability of a patient to tolerate anaemia depends on their clinical condition and the presence of any significant co-morbidity; maintenance of circulating volume is of paramount importance. There is no universal transfusion trigger. Advances in the development and validation of physiological, accessible, practical and reliable markers to guide therapy are expected. To improve patients' outcomes, further study is required to more fully explore the risk of anemia, optimal hemoglobin level, and the risk and efficacy of RBC transfusion. Future clinical investigations with high priority should determine the efficacy of transfusion in those classified as uncertain scenarios. In the absence of data, it is prudent that transfusion is administered with caution in these clinical scenarios.

La transfusión de glóbulos rojos es uno de los pilares en el tratamiento de pacientes anémicos. Las transfusiones de sangre no están libres de riesgo. Aunque es incierta la relación riesgo-beneficio de las transfusiones para tratar la anemia, estas pueden ocasionar resultados adversos de los pacientes en algunas situaciones. La capacidad de un paciente para tolerar la anemia depende de su estado clínico y la presencia de cualquier co-morbilidad significativa; la preservación del volumen circulante es de suma importancia. No existe un indicador automático universal para la transfusión. Se espera que los avances en el desarrollo y validación de marcadores fisiológicos, accesibles, prácticos y confiables permitan guiar la terapia. Para mejorar los resultados de los pacientes, se requieren más estudios que exploren más a fondo el riesgo de la anemia, el nivel de hemoglobina óptima, y el riesgo y la eficacia de la transfusión de glóbulos rojos. Las investigaciones clínicas futuras con alta prioridad deben determinar la eficacia de la transfusión en los clasificados como escenarios inciertos. Ante la falta de datos, es prudente que la transfusión se administre con precaución en estos escenarios clínicos.

Necesidades transfusionales en una unidad de terapia intensiva polivalente de adultos / Transfusion requirements in a polyvalent intensive care unit for adults

Introducción: Las transfusiones sanguíneas son una práctica frecuente en las unidades de terapia intensiva. Objetivo: Determinar las necesidades transfusionales de 382 pacientes hospitalizados en este servicio en estado crítico. Métodos: Se realizó un estudio descriptivo y retrospectivo de los integrantes de esa casuística que se esperaba que no fallecieran en las primeras 24 horas de ingresados en la Unidad de Terapia Intensiva Polivalente del Hospital General Universitario "Vladímir Ilich Lenin" de Holguín, durante el 2010. Las variables clinicoepidemiológicas fueron analizadas mediante las pruebas de Ji al cuadrado y t-Student (á=0,05). Resultados: Del total de la serie, la mayoría eran hombres (51,6 %), la edad media fue de 54±21 años, los fallecimientos constituyeron 35,1 % y la estadía hospitalaria media resultó ser de 7,2±8,4 días. La transfusión con glóbulos rojos se aplicó a 23,3 % y con plasma fresco, plaquetas y crioprecipitado, a 12,6 %; 4,5 y 5,2 %, respectivamente. Se administraron 3,3±3,9 transfusiones por paciente, si bien las de glóbulos rojos y plasma fresco devinieron superiores, así como inferiores los niveles de hemoglobina pretransfusionales en los fallecidos. Entre las principales complicaciones se presentaron las infecciones hospitalarias y la insuficiencia renal aguda, con predominio en los pacientes transfundidos, en los cuales se prolongó la estadía.

Introduction: Blood transfusion is a common practice in intensive care units. Objective: To determine the transfusion need of 382 critically ill patients hospitalized in this service. Methods: A descriptive and retrospective study was carried out in these cases that were not expected to die in the first 24 hours of being admitted to "Vladímir Ilich Lenin" Polyvalent Intensive Care Unit in Holguín during 2010. Clinical epidemiological variables were analyzed by means of the chi-square and Student's t tests (alpha=0.05). Results: Of all the series the majority were men (51.6%), the mean age was 54±21 years, and deaths constituted 35.1% and mean hospital stay was found to be 7.2±8.4 days. Red cell transfusion was applied to 23.3%, and fresh plasma, platelets and cryoprecipitate to 12.6%; 4.5 and 5.2% respectively. Each patient received 3.3±3.9 transfusions, although those of red blood cells and fresh plasma became higher and lower levels of pretransfusion hemoglobin in those who died. Among the major complications were hospital infections and acute renal failure with prevalence in transfused patients, who had longer stays.

A prática transfusional e a formação dos profissionais de saúde / Transfusion practice and the instruction of healthcare professionals

A terapêutica transfusional é uma das mais importantes intervenções da medicina. Sendo a transfusão de sangue um procedimento complexo, não isento de riscos e frequente no Centro de Terapia Intensiva - CTI, torna-se essencial uma atuação profissional competente. O objetivo deste estudo é descrever a formação dos profissionais médicos e de enfermagem que atuam em CTI, relacionada à prática transfusional. A pesquisa foi realizada em um hospital universitário localizado no Triângulo Mineiro. Foi aplicado um instrumento estruturado e confeccionado para conhecer a participação dos profissionais na prática transfusional e qual a sua abordagem no processo de formação. Referem participar do processo transfusional 64 por cento dos profissionais de saúde, os quais se sentem informados sobre o assunto. No entanto, 54 por cento não participaram de atualização, 73 por cento não participaram de programas de capacitação e 89 por cento receberam informação sobre alguns aspectos da transfusão através de aulas teóricas. Considerando os resultados, torna-se necessário rever o processo de formação destes profissionais, bem como dos programas de capacitação sobre medicina transfusional oferecidos pelas instituições.

Transfusion therapy is one of the most important interventions in medicine. However, blood transfusion is a complex proceeding, which is not devoid of risk but as it is common in the Intensive Care Unit (ICU), professional experience is essential. The objective of this study is to describe the level of instruction of medical and nursing professionals who work with transfusions in the Intensive Care Unit. This study was carried out in a University Hospital located in the Triângulo Mineiro region. A structured instrument was developed and applied to discover the professionals' participation in the transfusion practice and their approach to the process of instruction. About 64 percent of healthcare professionals participate in the transfusion process, all of whom felt they were informed about this subject. However, 54 percent did not participate in recycling training courses, 73 percent did not participate in training programs and 89 percent received information on some theoretical aspects of transfusion in classes. In light of the results, it is important to review the education of these professionals, as well as training programs on transfusion medicine offered by institutions.