Quality controls on cord blood unit contiguous segments: recommendation of the SFGM-TC.

In the attempt to harmonize clinical practices between different French transplantation centers, the French Society of Bone Marrow Transplantation and Cell Therapies (SFGM-TC) set up its fourth annual series of workshops which brought together practitioners from all of its member centers. These workshops took place in September 2013 in Lille. Literature and intra-laboratories studies suggest that attached segment is representative of cord blood unit (CBU). Nevertheless, some discrepancies have been observed when analyzing large data registries. To address these issues, we have listed recommendations to increase the standardization of segment processing and quality control (QC), information on units of measurement and specifications and action to be taken in case of out of specifications QC results on segment.

Validating a blood donation awareness tool created using general practitioner and patient acceptability and preferences.

BACKGROUND: There is a need to develop an awareness raising tool for GPs to reach out their patients in order to increase blood donation. The main objective was to create and validate a tool to raise awareness about blood donation that meets acceptability and preference criteria and is applicable in general practice. MATERIAL AND METHODS: This cross-sectional study was conducted in three phases. 1. Tool creation: A stakeholder meeting co-developed three potential tools to raise awareness about blood donation: a consulting room poster, a waiting room poster and a lapel badge for the doctor. Three GPs pilot-tested each tool for one day during their regular consultations. Then, once the pilot was completed each GP assessed acceptability and preference using a semi-structured interview, and patients were also interviewed. 2. Consensual tool selection: An appropriate tool was selected based on pilot data using nominal group technique and expert review. 3. The tool was validated for its acceptability in practice via a quantitative questionnaire distributed electronically to GPs. RESULTS: The consensual tool selected by the nominal group was a combination of elements from all three tools trialled in the pilot, reported to be non-intrusive and convenient for both GPs and patients. Patient responses indicated a high level of acceptability and indicated a strong preference for self-generated discussion of the topic with their GP. In the validation step, 217 responses to the quantitative questionnaire were received: 74.5% of responses fulfilled the acceptability criteria for using this combined tool in general practice. Furthermore, 93.1% of GPs indicated they would use the tool in the proposed format for the purpose of raising awareness. DISCUSSION: The validation of our blood donation awareness tool for use in general practice justifies its evaluation on a larger scale as part of a wider blood donation awareness campaign.

[Does ethics of donation apply equally to all elements of the human body?] / L'éthique du don s'applique-t-elle de la même façon à tous les éléments du corps humain ?

The therapeutic use of elements and products of the human body has always raised serious questions about the balance to be respected between a duty to protect donors and a compelling therapeutic purpose for a patient. Our body is part of a relationship of otherness, since it embodies the person, a relationship that is sometimes therapeutic, for oneself or for others. As an object of gift, the body requires protection. However, if ethics of donation is based on common axiological and protective elements, the field of donation of human body parts is vast and evolving. Each type of donation has its own specificity and its own references, which requires pragmatism, collective reflection, in which everybody should be able to participate in an informed manner.

[The limits of a principlist approach in the ethics of donation of elements and products of the human body. About some examples]. / Les limites d'une approche principiste dans l'éthique du don d'éléments et produits du corps humain. À propos d'exemples.

Voluntary, non-remunerated donations are fundamental principles with anonymity regarding donations of elements and products of the human body in France. Blood donation was a model to organize donation of organs, hematopoietic stem cell or gamete. These principles, which at first glance appear to be intangible, commonly accepted and transposable between the different types of donation, though reveal singularities regarding to a collective imagination, a biological reality, evolution of society, medicine and science. Through the study of these different principles applied to donated human body parts, this article aims to highlight the ethical limitations of a single principlist approach. The notions of anonymity, consent, voluntariness, non for profit, under their universal aknowledge, reveal variability of interpretation and scope due to the heterogeneous characteristics, implications and purposes between these donations of different elements and the uses made of them.

[Not-for-profit: A report from the fourth annual symposium of ethics held by the National Institute for Blood Transfusion (France)]. / À propos du non-profit : rapport du quatrième symposium annuel d'éthique transfusionnelle de l'Institut national de la transfusion sanguine.

The not-for-profit issue has been debated in November 2016 in Paris; this issue is one of the four canonical pillars of ethical blood donation. It is intimately bound to benevolence though it is distinct, as not-for-profit calls for institutions while benevolence calls for individuals. It is indeed intended that voluntary blood donors do not benefit from their donation and are thus non-remunerated. Not-for-profit is essential since it refers to the public character of blood as a putative public resource aimed at being shared as a tribute of solidarity. A central question however is linked to the capacity- or not -of public sectors to ensure that blood components are universally available, with special mention to plasma derived drugs, without the contribution of the for profit, private sector.

[Human trichostrongyloidosis: case report and microscopic difficulties to identify ankylostomidae eggs]. / Diagnostic microscopique différentiel des oeufs de type Ankylostomidé: à propos d'un cas de trichostrongyloïdose.

We present the case of a 53 year old woman living in a rural area and which suffered from gastric pain and high blood eosinophil polymorphonuclear counts for several years. The parasitological stool examination showed Trichostrongylus sp. larvae and eggs. Clinical and biological signs resolved after 2 courses of treatment with albendazole. We also report the microscopic difficulties to identify Ankylostomidae eggs.

[The legal status of blood's therapeutic products and consequences]. / Le statut juridique des produits thérapeutiques issus du sang et ses conséquences.

The first testimonies of humanity show a constant: blood was always surrounded with a sacred fascination. For years, it was not useful to define a legal status for blood, but healthy crisis, medical practices, had led to answer this question in a context of legal protection of human dignity and rights. Actually, the legal frame is moving and to know those statuses is helpful for a better understanding of the changes.

[Position of French transfusion operator in the regulation of territorial care in a changing context]. / L'inscription de l'EFS dans la régulation territoriale de l'offre de soins à l'aune d'enjeux nouveaux.

Since the first law regarding the French transfusion, the public service of blood transfusion has always evolved. Today, different factors are changing: consequences of combination of French laws and European rules, new regulations and required levels of blood products. Moreover, those changes lead us to look at the position of the EFS in his health's territory which is actually changing too. The study of the context and actual laws could draw a first picture of the opportunities available for the EFS to face those new challenges.

[Organization for the coverage of the transfusional needs of patients with hemoglobinopathy at the Établissement français du sang Bretagne]. / Organisation de la prise en charge des besoins transfusionnels des patients atteints d'hémoglobinopathie à l'Établissement français du sang Bretagne.

UNLABELLED: Brittany is a low prevalence region for hemoglobinopathies. Despite of that, the number of patients is increasing each year. In 2013, 140 patients were known at the EFS Bretagne, and medical consultations are growing for 50% each year since 2011. The consequence is an increase of needs of 22% of compatible packed red blood cells. To anticipate the announced progress, various actions were implemented as study groups, creation of a new informatic prescription for red blood cells phenotyping, promotion of donation, transfusion organisation. RESULTS: Fifthty-nine percent of the 400 ABO RH-KELL, FY, JK, MNS 3, 4, red blood cells were realised on the basis of this new informatic prescription, as the 99% of the packed red blood cells identified Fy (a- b-). So, 92% of the compatible transfused packed red blood cells were already in stock when the patients needed them. CONCLUSIONS: In Brittany, that organisation leads to assume qualitative and quantitative transfusion for sickle cell disease in more than 90% of cases, with fast distribution. In the same time promotion of donation is done to increase the diversity of donors.

[Hospitalization in internal medicine of nonagenarians. Study of 150 cases]. / Hospitalisation en médecine interne des nonagénaires. Etude de 150 séjours.

Very elderly patients represent an increasing rate of hospitalized patients in internal medicine unit. Their admission and discharge modes, their morbidity and explaining factors for length of stay are still bad knowned. This prospective study concerns 150 patients stays, over 90, in an internal medicine and geriatric unit. Morbidity is mainly related with a high number of diagnoses (3.4 +/- 1.5). Most of them (2.8 +/- 1.3) are relevant for the hospitalization. The major categories of observed diseases are degenerative dementia, arrhythmias and adverse drug reactions. The main hospitalization mode is the non programmated one. We noted a high rate of death during hospitalization (17%). The main discharge mode is return home (88%). The length of stay among the survivals is significantly correlated (P < .001) with the number of diagnoses, the need for institutionalization and the sex. This pattern explains more than 20% of the variance of the length of stay. The data confirm the specificity of the medical care of very elderly patients. They also suggest that the french model of medicalization of the information system must be adapted to increase its pertinency among very elderly.

Evaluation of CytoDiff™ on cord blood WBC differential.

INTRODUCTION: An umbilical cord blood bank was recently opened in our institution as an alternative source of hematopoietic stem cells. Before inclusion of a cord blood in an international register, a WBC with differential is requested, among others. Currently, the reference method is the microscopic manual count, and we sought to evaluate the routine flow cytometric method (CytoDiff™) as an alternative. METHODS: A total of 161 cord bloods were analyzed between November 2010 and February 2011. WBC differentials were determined for each sample, by (i) the cell counter (DxH800), (ii) a manual review, and (iii) the flow cytometry using the CytoDiff™ antibody cocktail. RESULTS: Correlation coefficients between flow cytometry and microscopic count were satisfying for neutrophils, lymphocytes, and immature granulocytes and acceptable for eosinophils. On the other hand, we found lower correlation coefficient for basophils and monocytes. Monocytes' correlation was better when comparing flow cytometry with cell counter. CONCLUSION: The flow cytometric approach is suitable to realize cord blood WBC differential and allows for the identification of additional cell subsets.