Vox Sanguinis最新文献

Background and objectives: Transfusion-associated bacterial sepsis poses a significant risk to patient safety. This study aimed to determine the rate of bacterial contamination of whole blood (WB) collected at the Cape Coast Teaching Hospital (CCTH) as a quality control and quality assurance activity.

Materials and methods: One-hundred and three WB units collected between January and April of 2018 were screened for bacterial contamination. Bacteria isolated from positive cultures were identified and subjected to antimicrobial testing. WB recipients were followed up for clinical symptoms.

Results: Of the 103 WB units tested, 33 (32%) were contaminated with bacteria. Gram-positive organisms accounted for 67% of the isolates, including coagulase-negative Staphylococcus, Staphylococcus aureus and Bacillus spp., while Gram-negative bacteria comprised 33% of the isolates, with Citrobacter freundii, Serratia marcescens, Escherichia coli and Providencia stuartii being identified. Resistance to antibiotics varied between species. No septic transfusion events were reported involving WB units tested in this study.

Conclusion: The high percentage of contaminated WB units collected at the CCTH provided evidence-based data for the implementation of improved donor skin disinfection processes and the use of blood diversion pouches in 2019. These approaches allowed CCTH to comply with Ghanaian regulatory entities.

Background and objectives: In low- and middle-income countries (LMICs), information on the efficacy of communication interventions promoting blood donation is very scarce. The present review aimed to identify specific communication interventions and their efficacy for increasing blood donation in LMICs.

Materials and methods: The databases searched were PubMed, Scopus, PsycINFO, Web of Science, CINAHL, ProQuest, AJOL and CAB Abstracts. Grey literature sources included the websites of African Society of Blood Transfusion, International Society of Blood Transfusion and World Health Organization. The outcomes of interest were donation attempt or actual blood donations.

Results: A total of 16 studies including nine randomized controlled trials (RCTs) were included in the review. The communication interventions included social media and mass media, such as radio and television, as platforms for promoting blood donation, and newspaper articles or advertisements as an incentive for donor recruitment. Mobile text messages were used either alone or in combination with phone calls, and other interventions such as meetings and brochures. Only three of the 16 studies specifically targeted behavioural science theories, and none of the 16 studies used any implementation science framework. For some communication interventions, there was evidence of statistically significant increases in donations, but the quality of the studies was weak.

Conclusion: The efficacy of communication interventions for promoting blood donations in LMICs remains limited due to few rigorous studies. More rigorous, theory-based studies on the use of communication interventions to increase blood donation in LMICs, especially in sub-Saharan Africa where no prior RCT were identified, are needed.

Background and objectives: The COVID-19 pandemic caused significant disruptions to the blood service in Japan. Stay-at-home policies in schools, organizations and companies made it challenging to access potential blood donors, leading to a substantial decline in blood donation rates. This study aimed to examine the profile of blood donors during the pandemic and compare it with that in the pre-pandemic period.

Materials and methods: Blood donors who contributed to the Japanese Red Cross Blood Services between April 2018 and March 2021 were evaluated based on age, gender, occupation, donation site, height, body weight (BW) and donation status (first-time [FT] or repeat). Factors influencing the return of FT donors who contributed before and during the pandemic were also explored.

Results: During the initial phase of the pandemic, a significant decrease in blood donations was observed, particularly in Tokyo. Despite intermittent drops, the required blood volume was ultimately collected. Donations by both female and male repeat donors increased, although the number of male repeat donors decreased, with only female repeat donors experiencing an absolute increase. Before the pandemic, younger age, 200-mL donation, higher body mass index and fixed donation sites were significantly associated with FT donor returns. During the pandemic, higher age (for males) and 400-mL donation (for females) emerged as significant factors. With changes in donor profiles during the pandemic, there was a noticeable shift in the characteristics of FT donors who returned for a subsequent donation within the following year, particularly in terms of age and blood donation volume.

Conclusion: Despite the challenges, the required blood volume was successfully collected, thanks to increased donations from repeat blood donors. Recruiting and retaining committed donors is essential for maintaining sustainable blood services, especially during crisis situations.

Background and objectives: Foetal and neonatal alloimmune thrombocytopenia (FNAIT) results from maternal platelet-directed antibodies and can result in severe intracranial haemorrhage (ICH) in foetuses and newborns. Screening for human platelet antigen-1a (HPA-1a)-directed antibodies during pregnancy could allow timely intervention with antenatal treatment and prevent ICH. We assessed the cost effectiveness of HPA-1a typing and anti-HPA-1a-screening as part of the prenatal screening programme.

Materials and methods: Different HPA-1a screening scenarios were tested in a decision analysis model and assessed for diagnostic, treatment, intervention and lifetime costs and prevention effects compared to the current situation without screening in the Netherlands. Model parameters were based on available data, literature and expert opinions. One-way sensitivity analysis and probabilistic sensitivity analysis were performed.

Results: Adding screening for anti-HPA-1a antibodies to the current antenatal screening programme of the Netherlands will lead to an additional cost of €4.7 million per year and a gain of 226 quality-adjusted life years (QALYs) per year, indicating an incremental cost-effectiveness ratio (ICER) of €20,782 per QALY gained. One-way sensitivity analysis showed that the uncertainty around the incidence of ICH, lifetime costs of disabled children and the probability of having antibody quantitation >3.0 IU/mL at 20 weeks had the highest effect on the ICER.

Conclusion: Antenatal anti-HPA-1a screening might be cost effective. To obtain more knowledge and thereby to improve risk stratification, a pilot screening programme is warranted.

Background and objectives: Intravenous polyvalent immunoglobulins (IVIG) for prophylaxis in patients with primary immunodeficiency disorders (PIDs) exposes them to life-threatening infections and debilitating diseases. To improve access to IVIG in lower middle-income countries, the WHO recommends a stepwise approach for the local production of purified and virus-inactivated plasma immunoglobulins by national blood transfusion services using new technologies and medical devices. One new technology relies on single-use sterile medical devices for the purification of plasma immunoglobulin G (IgG), as well as lipid-enveloped virus inactivation from mini-pools of recovered plasma separated from whole blood (mini-pool IVIG [MP-IVIG]). This study aimed to compare the safety and efficacy of MP-IVIG to standard IVIG (STD-IVIG).

Materials and methods: In this prospective crossover clinical study, we investigated the safety and efficacy of MP-IVIG for STD-IVIG preparations as a replacement therapy in a cohort of 21 paediatric patients with PID.

Results: Both MP-IVIG and STD-IVIG were effective in reducing the frequency of severe bacterial infections and hospital admissions in patients with PID. Mild side effects have been observed in seven patients (6.2%) with PID who received MP-IVIG and five patients (5.3%) who received STD-IVIG. No moderate or severe side effects or haemolytic transfusion reactions were reported. The mortality rates were also comparable and were not related to the study products.

Conclusion: MP-IVIG presented no safety issues and was as effective as STD-IVIG in IgG replacement in patients with PID. Due to the small numbers, the results have to be addressed with caution.

Background and objectives: Wrong blood in tube (WBIT) continues to be a preventable cause of unintended harm to the patient. The literature describing extent of the problem, its consequences and factors leading to WBIT from the perspective of lower middle-income countries (LMICs) is limited. The present study describes WBIT and its outcome in a hospital-based blood centre from an LMIC.

Materials and methods: WBIT events occurring during the study period were analysed to identify the root cause. In addition, they were analysed according to discipline, department and time of sample draw. Root causes were divided and compared with standard operating procedure (SOP) for sample collection for blood requests. All WBIT events were followed and their outcomes analysed.

Results: WBIT events occurred at a rate of 4.8/10,000 blood requests, with a higher rate in urgent requests (5.2/10,000 requests). The average rate of WBIT was higher in surgical disciplines compared to medical and acute care services (6.58 vs. 4.43 vs. 3/10,000 requests). The highest rate of WBIT was observed when requests were received during 8:00 PM-2:00 AM (p = 0.02). Deviations from SOP with contribution from human and organizational elements were identified as the root cause. The consequences ranged from delay in providing blood to acute haemolytic transfusion reactions.

Conclusion: We found that WBITs occurred at a rate comparable to that reported from developed countries. Use of software and automation may reduce the rate of WBIT but not eliminate it completely. Strict adherence to SOPs and continuous training of phlebotomy staff would help reduce it to a minimum. Blood centres need to develop specific strategies with respect to their root causes.