The relationship between ABO blood group and cardiovascular disease: results from the Cardiorisk program.

BACKGROUND: The ABO blood group exerts a profound influence on hemostasis, and it has hence been associated with the development of thrombotic cardiovascular adverse events. In this study, we evaluated the relationship between the ABO blood group and the risk of cardiovascular disease assessed with the Cardiorisk score. METHODS: All blood donors aged between 35 and 65 years were enrolled in the Cardiorisk program, which included the assessment of 8 variables (sex, age, total cholesterol, high-density lipoprotein (HDL) cholesterol, plasma glucose, arterial blood pressure, anti-hypertensive therapy and smoking) which were used to generate a score. Individuals with a resulting score ≥20, considered at high cardiovascular risk, underwent additional instrumental tests (chest X-ray, stress electrocardiogram and Doppler ultrasound of supra-aortic trunks) and were closely clinically monitored. RESULTS: Between January 2005 and December 2015, 289 blood donors with Cardiorisk ≥20 were identified, 249 of whom were included in the study with at least 2 years of follow-up. Among these, 36 (14.5%) had instrumental abnormality tests and developed adverse cardiovascular events (10 acute coronary syndrome, 2 cerebral ischemia, 3 cardiac arrhythmia, 8 stenosis of supra-aortic trunks or iliac arteries) during a median follow-up of 5.3 years. In this group of 249 high risk individuals, a statistically significant association (P=0.02) was found between the non-O blood type and the risk of developing subclinical or clinical cardiovascular events (odds ratio, 3.3; 95% CI, 1.1-10.1; P=0.033). CONCLUSIONS: The results of this study underline the both key role of ABO blood group for the risk of developing arterial thrombotic events and the need for including such unmodifiable variable on the scores assessing the thrombotic risk.

Quality of transfusion products in blood banking.

The primary goal in transfusion medicine and cellular therapies is to promote high standards of quality and produce ever safer and more efficacious products. The establishment of a transfusion service quality management system, which includes several organizational structures, responsibilities, policies, processes, procedures, and resources, is now mandatory and widely regulated worldwide. In this review, we summarize the current knowledge on the quality system in transfusion medicine as applied to the production of blood components, including red blood cells, platelets, and fresh frozen plasma.

Patients' positive identification systems.

BACKGROUND: Blood safety must be maintained throughout the whole transfusion chain to prevent the transfusion of incorrect blood components. The estimated risk of an incorrect transfusion is in the order of 1 per 10,000 units of blood. Although several kinds of errors contribute to "wrong blood" events, 70% of errors occur in clinical areas with the most common being due to failure of the pre-transfusion bedside checking procedure. MATERIALS AND METHODS: Several methods are available to reduce such errors. The I-TRAC Plus system by Immucor consists of an identification bracelet which is a bar-coded wristband and a handheld portable computer that identifies patients and blood bags by a scanner and prints the information through a portable printer. The labels attached on the blood order forms and on the sample tubes are read and recorded in the blood bank's informatics system (EmoNet INSIEL). Labels showing the bar-code of the assigned number, which includes the ID number of the patient, the ID number of the unit and a code identifying the kind of product and use (allogeneic or autologous), are generated and applied to the blood components. The transfusions are administered after checking the unit and the patient's wristband using the scanner of a portable PC. RESULTS: In 5 years a total of 71,400 units of blood components were transfused to 15,430 patients using the I-TRAC Plus system. The system prevented 12 cases of mis-identification of patients (5 in 2003, 0 in 2004, 1 in 2005, 1 in 2006 and 5 in 2007). CONCLUSIONS: In 2003 we introduced the use of a bar-code matching system between a patient's wristband and the blood bag to avoid mistakes at the bedside. In 5 years the system provided benefits by avoiding errors in the identification of patients, thus preventing "wrong blood" transfusions.

Transfusion management using a remote-controlled, automated blood storage.

BACKGROUND: Generally, the safety of transfusion terapies for patients depends in part on the distribution of the blood products. The prevention of adverse events can be aided by technological means, which, besides improving the traceability of the process, make errors less likely. In this context, the latest frontier in automation and computerisation is the remote-controlled, automated refrigerator for blood storage. MATERIALS AND METHODS: Computer cross-matching is an efficient and safe method for assigning blood components, based on Information Technology applied to typing and screening. This method can be extended to the management of an automated blood refrigerator, the programme of which is interfaced with the Transfusion Service's information system. The connection we made in our Service between EmoNet and Hemosafe enables real-time, remote-controlled management of the following aspects of blood component distribution: a) release of autologous and allogeneic units already allocated to a patient, b) release of available units, which can be allocated by remote-control to known patients, in the presence of a valid computer cross-match, c) release of O-negative units of blood for emergencies. RESULTS: Our system combines an information database, which enables computer cross-matching, with an automated refrigerator for blood storage with controlled access managed remotely by the Transfusion Service. The effectiveness and safety of the system were validated during the 4 months of its routine use in the Transfusion Service's outpatient department. CONCLUSIONS: The safety and efficiency of the distribution of blood products can and must be increased by the use of technological innovations. With the EmoNet/Hemosafe system, the responsibility for the remote-controlled distribution of red blood cell concentrates remains with the chief of the Transfusion Services, through the use of automated computer procedures and supported by continuous training of technicians and nursing staff.

Strategies for the transfusion of subjects with complex red cell immunisation: the Bank of rare blood donors of the Region of Lombardy.

INTRODUCTION: Selecting units of rare blood for transfusion to patients with complex immunisation is one of the most critical processes of a Transfusion Centre. In January 2005 the 'Rare Blood Components Bank - Reference Centre of the Region of Lombardy' w as established with the following goals: 1) identifying regional rare blood donors; 2) creating a regional registry of rare donors; 3) organising a regional bank of liquid and frozen rare blood units; 4) setting up a regional Immunohaematology Reference Laboratory (IRL) to type donors and resolve complex cases. METHODS: The key elements in establishing the Bank were periodic meetings organised by the directors and representatives of the regional Departments of Transfusion Medicine and Haematology (DTMH) and the institution of three working groups (informatics, regulations, finance). RESULTS: The regional IRL was set up, the relevant operating procedures were distributed region-wide, software features were defined and later validated upon activation, and the funds assigned were allocated to various cost items. The number and characteristics of the donors to be typed were identified and 14 regional DTMHs started to send samples. Overall, 20,714 donors were typed, for a total of 258,003 typings, and 2,880 rare donors were identified. Of these, 97% were rare donors because of combinations of antigens (2,139 negative for the S antigen and 659 negative for the s antigen) and 3% (n=82) because they were negative for high-frequency antigens. In the first 2 years of activity, the IRL carried out investigations of 140 complex cases referred from other Centres and distributed 2,024 units with rare phenotypes to 142 patients. CONCLUSIONS: The main goal achieved in the first 24 months from the start of the project was to set up a regional network able to meet the transfusion needs of patients with complex immunisation.