Transfusion Clinique et Biologique最新文献

Background

Rare genetic diseases are an important global public health problem. At present there are defined approximately 8120 genetic diseases in 15,465 epidemiological datasets and 70% of them start in childhood. Hematopoiesis is the production of all cellular components of blood and continues throughout life.

Objective

This study aims to present prevalence of hematopoietic rare genetic diseases recorden in Turkey.

Methods

The population of study consist of 84.680.273 people who received healthcare from the Turkish National Health Service (49.9% female, 50.1% male). TNHS collects and records electronic data which relates with illness or health information of Turkish population since 2018. All healthcare facilities utilize the Personal Electronic Health Record System (PHR), aligning with standards outlined in the Turkish National Health Data Dictionary and the Health Coding Reference Server (HCRS) established by the Ministry of Health in 2007. The data dictionary comprises essential packages such as patient application and examination records.

Results

Diagnosed female population (53.04%) were higher than male (46.96%). Data shows that most of the people with rare genetic diseases were diagnosed in Marmara Region. The overall prevalence of Hematopoietic Rare Genetic Diseases higher in the years of 2021 and 2022.

Conclusion

The prevalence increased gradually from 2018 to 2022. The consanguinity marriage seems to be the main problem which resulted higher rate of rare genetic diseases in Türkiye.

Transfusion therapy is an indispensable form of treatment, and an important element of the public health system. Due to its origin, blood’s clinical use is associated with various risks that may cause adverse reactions and events. Progress in quality and safety of blood components has eliminated numerous risks, especially those of infectious origin. However, some risks cannot be predicted, while others cannot always be prevented.

Globalisation and climate change constantly favour the spread of infectious agents. Against this, epidemiology plays a central role in ensuring the safety of transfusion treatment, by continuous surveillance and timely identification of risks, and in the development of routine and additional tests as measures for risk mitigation. As a quantitative discipline based on research methods, epidemiology is a method of reasoning; it relies on the generation and testing of hypotheses; it utilises other scientific resources, particularly in the field of blood donation and blood transfusion, thus having many applications. The main focus falls on transfusion-transmissible infections, and on environmental or occupational diseases, injuries, disabilities and death causes at large.

The practice of epidemiology relies on a systematic approach and measurement of disease frequencies. Surveillance is a key element, involving continuously gathering, analysing, and evaluating data regarding diseases, morbidity and mortality, and disseminating the conclusions of the analyses to relevant competent authorities; in this way, action is taken for disease prevention and control. Surveillance systems also provide an important tool for risk assessment, a method to assess and characterise the critical parameters in the functionality of equipment, systems or processes of using scientific data in order to estimate the magnitude of any health effect that derives from decisions of policy makers.

Epidemiological surveillance, particularly for the incidence of adverse reactions and adverse events associated with blood transfusion at the national and international levels, has demonstrated the importance of multidisciplinary cooperation between blood and public health services.

Objectives

To evaluate the return of blood components across different hospital areas, reasons for the same and suggest preventive strategies which might reduce out of controlled temperature storage (CTS) blood logistics and wastage.

Material and methods

A retrospective audit was carried out in the department of Transfusion Medicine from January 2019 to December 2022. Data related to returned blood components was compiled using departmental records and blood centre software entries.

Results

A total of 218 instances of returned components were noted and the total number of components returned were 442 (0.4% of all issued components) (38.4% (170) packed red blood cells, 16.2% (72) single donor cryoprecipitate concentrate, 19.6% (87) platelet concentrate and 25.5% (113) fresh frozen plasma). Components were returned back within 30 mins in only 27% (59/218) of all instances . Wards followed by high dependency units/intensive care units were noted to have the highest number of instances (86 (39.4%) and 69 (31.6%) respectively) with emergency department having the least,comprising 19 instances (8.7%). 77.9% (170/218) instances were observed for routine transfusion requests and 44.5% (97/218) of all instances could have been prevented by an appropriate clinical status assessment of the patient.

Conclusion

Stakeholders such as clinicians, transfusion laboratory professional and nursing staff must take consolidated efforts to eliminate wastage of blood components. Instances of returned blood components can be targeted by the hospital quality team as a quality improvement project.

Objectives

To determine whether prophylactic intra-operative allogenic or autologous transfusion could prevent postoperative anemia and additional transfusion comparing to the control group without receiving any prophylactic intervention in unilateral total knee arthroplasty.

Materials and methods

This study included 711 patients who underwent unilateral TKA. They were divided into four groups: allogeneic transfusion group (group AL), autologous transfusion group (group AT), tranexamic acid group (group TA), and control group (group C). The primary outcome was rate of postoperative allogeneic blood transfusions. Secondary outcomes were postoperative hemoglobin and hematocrit levels, postoperative bleeding amount.

Results

Groups AT and AL did not exhibit a significant reduction in postoperative allogenic blood transfusion rate compared to group C (28/108 vs. 20/108, p = 0.21 and 37/159 vs. 34/159, p = 0.78 respectively). However, group TA demonstrated a significantly lower rate of postoperative allogenic blood transfusions than group C (22/125 vs. 3/125, p = 0.0001). Postoperative hemoglobin and hematocrit levels were statistically higher in group TA than in group C. However, those levels in group AT and AL did not differ significantly from those of group C.

Conclusion

Intra-operative prophylactic transfusions did not decrease postoperative anemia or additional postoperative transfusion compared to the control group in patients undergoing total knee arthroplasty. However, the group receiving tranexamic acid showed lower transfusion rate and higher levels of hemoglobin and hematocrit.

Despite their use in life-saving treatment, blood and blood products can cause life-threatening complications. To administer blood transfusion safely, national guidelines and protocols should be consulted in healthcare organizations. In Türkiye, there are guides and regulations published by the Ministry of Health. With the definition of hemovigilance in the regulations; training in clinical use of blood and transfusion practice fields is now mandatory. This study presents data from a survey designed to assess transfusion knowledge levels of clinical departments for the purpose of planning our training programs.

A two-part survey was conducted on 110 nurses from various departments. Questions included sociodemographic attributes, department they worked in, employment duration, knowledge level on transfusion practices. Statistical analysis was performed.

Of the nurses that participated; 52.7% were above 40 years old, 15.5% were 31–40 years old and 31.8% were below 30 years old. For education; 84.5% of the nurses were graduates or postgraduates. For work experience; 64.5% were working in internal medicine departments, 58.2% had been working as a nurse for 10 or more years while 85.5% worked in the same department for less than 5 years. It was determined that the nurses should know more about transfusion.

Beginner nurses in the intense care unit were found to have lower levels of transfusion practice knowledge, from this it was deduced additional training should be scheduled for beginner nurses with low transfusion knowledge. In addition to theoretical instructions, one-on-one training on operation controls and “observation and guidance” style practical training should be implemented. Theoretical and practical topics with inadequate knowledge should be instructed in finer detail to increase the knowledge level in these subjects.