[Ethical issues in transfusion medicine]. / Dimensions éthiques en transfusion sanguine.

Ethics is on the cross road of off values that are present along the ways of transfusion medicine. This is an important tool to afford opinions as well as debates that always emerge when discussing transfusion medicine. The wording is particularly important; this was one among several others that characterized the soul of Jean-Jacques Lefrère when he opened the doors of the ethical issues of transfusion medicine.

[Ethics and transfusion--seminar report]. / Éthique et transfusion sanguine--Échos d'un séminaire.

This paper brings together the abstracts and proceedings of a seminar held on the topic of "ethics and transfusion", October 15, 2013 at the National Institute of Blood Transfusion, Paris.

[Ethics and blood transfusion]. / Éthique et transfusion sanguine.

Blood donation is an act of solidarity. Most often, this act is done on a volunteer basis and, depending on countries and circumstances, is not remunerated. The increase in need, the always-greater number of deferral criteria, the safety issues and the changes in the structures of our societies are among the many subjects for ethical debates. Taking these into account, the actors of the transfusion must analyze certain parameters: the value of a donation, the meaning of volunteering, the appropriateness of remunerating the act of giving a part of one's self, no longer as a donation or an expression of altruism and solidarity, but as a commercial act regimented by economic laws.

[Blood products transport, pedagogy and application]. / Transport des produits sanguins labiles, une approche pratique et pédagogique.

Transport products blood and samples of human blood is one of the keys of transfusional safety forcing all actors to update their know how and to comply with rigorous rules and high level capabilities requirements. This must lead blood transfusion institutes and medical and biologic laboratories to implement specific process insuring safe transport, preservation and avaibility of the items in accordance with patients' therapic needs. Training and regular valuation of involved actors make necessary to update tools and training methods. E-learning allows a fast and homogeneous learning.

[Interest of transfusion safety e-learning for nurses: assessment after two years]. / Intérêt de l'e-formation pour les infirmières qui transfusent: bilan après deux ans.

In front of increasing organizational difficulties, health institutions opted for a transfusion safety e-learning training. Hindsight of two years, an initial assessment highlights success factors and desirable improvements.

[Ratification of UE 4.4 S4 "simulated blood transfusion": inquiry and answers]. / Validation de l'UE 4.4 S4 "pose de transfusion sanguine en situation simulée:: une enquête et des réponses.

The new training reference guide related to state registered degree has been applied since 31 July 2009. Training and valuation projects developed by nurse training institutes have been amended to comply with learning concept: understanding-action-transfer. Validation of grade 4.4 S4 is part of competence 4 validation "implementation of actions related to diagnostic and therapy". The requirement for all students to ratify simulated transfusion lead teachers to update their knowledge and to be more committed to knowledge acquisition. To complete its work, the research and quality control department of the French Transfusion Company regarding the result of the national 2011 inquiry, proposes in relation with the National Transfusion Institute to provide the professional network with tools and supports making knowledge exchanges and experience sharing easier. The reference transfusional teaching guide updating intended to training institutes is being carried out and considered as a priority.

[Guidelines for blood transfusion teaching to medical laboratory technology students]. / Référentiel d'enseignement de la transfusion sanguine aux étudiants techniciens de laboratoire de biologie médicale.

PURPOSE OF THE STUDY: The new French law about clinical laboratory medicine, the requirements of the ISO/CEI 15189 standard, the numerous abilities expected from the medical laboratory technologists and their involvement in blood bank management has led the working group "Recherche et démarche qualité" of the French Society of Blood Transfusion to initiate an inventory of blood transfusion teaching syllabus for medical laboratory technology students and to propose transfusion medicine teaching guidelines. MATERIAL AND METHODS: Seven worksheets have been established for that purpose including red blood cell antigen typing and antibody screening, blood sampling in immunohaematology, automation, clinical practices, blood products, blood delivery and haemovigilance. RESULTS: These guidelines aim at contributing to the harmonization of transfusion medicine teaching and at providing objective elements to the medical laboratory managers regarding the practical and theoretical skills of theirs collaborators.

[Supplying surgery blocs in red cell concentrates: a collective approach to improve practices]. / Approvisionnement des blocs opératoires en concentrés érythrocytaires: une démarche collective d'amélioration des pratiques.

The need to adapt red blood cells concentrates management in surgery blocs and resuscitation to the changes of the legal framework has lead to a collective approach to improve practices. Gathered by the regional hemovigilance coordinators of the Drass Ile-de-France (regional office of health and social actions), representatives of doctors' ordering transfusions and hemovigilance correspondents of the Assistance publique-Hôpitaux de Paris and representatives of the EFS (French blood establishment) Ile-de-France, together with representatives of the Afssaps (French health products safety agency), have coordinated an assessment of local transfusion practices in surgery blocs and resuscitation that have to be compliant. Each hospital then offered local improvement actions, approved by regional and national instances. We present this original and collective approach of assessing practices leading to offers that both respond to a legal framework and improve blood products flows without damaging transfusion security.

[Training, skill and competences' follow-up]. / Formation, habilitation et suivi des compétences.

Blood transfusion safety is a public health requirement, which is claimed by public health authorities and blood users too. In order to comply with transfusion safety, available national regulatory requirements must be strictly followed (or applied) by blood transfusion workers, caring nurses and physicians. Transfusion's good practices are based on knowledge of the process and the skill in blood transfusion fields. Quality systems, risks management, audits, inspections and certification programs implemented by blood establishments and patients' care services should lead to efficiency. All professionals involved in blood banking and transfusion processes (blood donation, preparation and storage of blood products, transfusion therapy...) must be qualified. They have to follow a program of continued training education. Their competence or ability must also be periodically assessed and documented to let continue and perform tasks safely.

[Transfusion incidents reports of grade zero: a national and descriptive analysis upon two years of practical survey]. / Les incidents transfusionnels de grade zéro: analyse descriptive nationale sur deux ans de pratique.

A grade zero transfusion incident is defined as an inappropriate transfusion of blood component due to one or several failures without immediate clinical or biological consequences for the recipient. Two years after the setting up of the mandatory notification of these incidents, Afssaps haemovigilance unit performed a first descriptive national analysis of the data collected in years 2003 and 2004 at the national level. This analysis was based on one part on computarised e-Fit national database and on the other part on investigation results documents and additional surveys set up by the network professionals. From a quantitative point of view, this study reveals differences in notification as well as in the type of analysis from one region to another. Quantitatively, 45% of grade zero transfusion incidents correspond to attribution errors. The site of origin of grade zero incidents is for almost 73% linked to health establishment, clinical unit or hospital blood bank, and for almost 23% linked to blood establishment. Complete analysis has notably shown that 9% of the incidents are due to errors in blood component prescription. This descriptive analysis, which identifies recurrent failure and critical points originating from non-appropriated transfusions, should constitute the starting point of a reflection aiming at optimising and standardising methods of analysis of grade zero transfusion incidents and at elaborating suggestions to better control critical points.

[French training program for medical students in transfusion medicine. Transfusion Medicine Teachers' College]. / Programme en transfusion des étudiants en médecine. Collège des enseignants en transfusion sanguine.

In France, transfusion medicine training program has been updated. A national committee of professors in transfusion medicine propose a series of 13 items which represent the minimum knowledge that general practitioners should possess. This overview of transfusion medicine is far below the level that specialists should reach and they will need an additional specialized training. Several French universities have set up their own training program which is quite similar to the work of the committee of professors. The following recommendations are not strict guidelines but is a common basis which will be improved in 2005 according to new evidence based transfusion medicine.

Comparison of aerobic standard medium with specific fungal medium for detecting fusarium spp in blood cultures.

In order to compare the performances of a specific fungal medium and a standard aerobic medium for detecting growth of Fusarium spp. in blood, simulated blood cultures were performed. For lower inocula (10(2) and 10(3) cfu/ml taken together), fungal growth was detected significantly earlier using the fungal medium. The mean difference in the time to detection between the two media was 22.33 h at 10(2) cfu/ml, with the maximum difference being achieved for Fusarium verticilloides at 37.05 h. These in vitro test results suggest fungal medium could be useful for obtaining more rapid blood culture results when evaluating patients at risk for invasive infection with Fusarium spp.

[Audit of labile blood product supplies]. / Audit des dépôts de produits sanguins labiles.

An audit of the quality control system is part of an ongoing improvement process. The hospital-based facilities for the transfusion services not involved in collecting and processing donor blood but issuing blood cell products are expected to achieve quality standards. A quality control audit is considered an essential tool to assess and improve deficiencies or deviations for greater effectiveness. A global approach to transfusion processes added to a strict follow-up by all concerned are necessary for the proper management of transfusion practices and the risks involved. Its function is to achieve a certain quality of health, thus requiring confidence and respect. The end result is to ensure blood transfusion safety.

[Immuno-hemolytic transfusion reactions. III. Report of 61 cases]. / Les accidents immuno-hémolytiques transfusionnels. III. Etude de 61 cas.

Blood transfusion is mainly bound to immunological and infectious risks. The immunological risk originates from an incompatibility between the blood of the donor and that of the recipient; this risk remains insufficiently assessed. A multicentre study has been carried out by the French Blood Transfusion Society and the National Institute for Blood Transfusion. Sixty-one accidents due to an erythrocyte incompatibility were found: 26 cases with ABO incompatibility, and 35 cases with alloantibodies of other blood group systems. For the former category of accidents, the most frequent cause was due to a failure in the realization of the bedside ABO check. For the latter, the main problem was the achievement and the interpretation of antibody screening. The long term follow-up shows no chronic after-effects of immunological accidents. For each accident, errors have been identified and analysed. It was proven that they all originate from health care establishments.

[Improvement of transfusion safety in a health care service through the implementation of a quality program]. / Amélioration de la sécurité transfusionnelle dans un établissement de santé par le développement d'une démarche qualité.

The quality policy brings with it an efficient method as well as relevant tools to improve transfusion safety in health care services. This article illustrates the details of the approach through the presentation of a project developed in the East Picardie region throughout several hospitals. It underlines the importance of the choice of a good reference system, of a pertinent method and the necessity of a real project management. Furthermore, the follow-up of the project has enabled us to identify a certain number of success criteria in the steering of the changing process.