Determination of Unnecessary Blood Transfusion by Comprehensive 15-Hospital Record Review.

BACKGROUND: Although unnecessary blood component transfusions are costly and pose substantial patient risks, the extent of unnecessary blood use in a community hospital setting has not been systematically measured. METHODS: A 15-hospital observational analysis was performed using comprehensive retrospective review. Approximately 100 encounters (x¯â€¯= 103.9, standard deviation [SD] ± 7.6) per hospital (6,696 total component transfusion events) were reviewed between 2012 and 2018. Review was performed by two medical directors. Findings were supported by blind intra- and inter-reviewer double review and blind external review by 10 independent reviewers. RESULTS: Patients received an average of 4.3 (± 1.3) units. Only 8.2% (± 6.7) of patient encounters did not receive unnecessary units. Fifty-five percent (54.6% ± 13.5) could have been managed without at least one component type, while 44.6% (± 14.9) could have been managed completely without transfusion. Forty-five percent (45.4% ± 17.0) of red blood cell, 54.9% (± 19.3) of plasma-cryoprecipitate, and 38.0% (± 15.6) of plateletpheresis encounters could likely have been managed without transfusion. Between 2,713 units (40.5%) and 3,306 units (49.4%) were likely unnecessary. In patients who could have been managed without transfusion of at least one component type, unnecessary blood use was associated with a 0.38 (± 0.11)-day increase in length of hospital stay for each additional unnecessary unit received (p < 0.001). CONCLUSION: Substantial unnecessary blood use was identified, all of which was unrecognized by hospitals prior to review. Unnecessary blood use was attributed to overreliance on laboratory transfusion criteria and failure to follow common blood management principles, which resulted in potential harm to patients and avoidable cost.

Blood Banking and Transfusion Medicine Challenges During the COVID-19 Pandemic.

SARS-CoV-2 (also known as COVID-19) has been an unprecedented challenge in many parts of the medical field with blood banking being no exception. COVID-19 has had a distinctly negative effect on our blood collection nationwide forcing blood banks, blood centers, and the US government to adopt new policies to adapt to a decreased blood supply as well as to protect our donors from COVID-19. These policies can be seen distinctly in patient blood management and blood bank operations. We are also faced with developing policies and procedures for a nontraditional therapy, convalescent plasma; its efficacy and safety is still not completely elucidated as of yet.

Regulation of endothelial cell survival and death by the MAP kinase/ERK kinase kinase 3 - glyceraldehyde-3-phosphate dehydrogenase signaling axis.

Endothelial cell injury and death precede atherosclerosis development. Thus, it is important to understand the mechanisms that lead to these early changes in endothelial cells. Although members of the MAP kinase/ERK kinase (MEK) kinase 3 (MEKK3)-MEK5-ERK5 module play an essential role in underpinning endothelial cell survival, how they execute these actions remain poorly understood. Furthermore, there is poor understanding of death-inducing pathways in endothelial cells and it is also unclear whether there are direct interactions between the kinase module and death-inducing pathways. Using immunoprecipitation and liquid chromatography-electrospray ionisation tandem mass spectrometry approaches, we show in human umbilical vein endothelial cells that the MEKK3-MEK5-ERK5 ternary complex contains glyceraldehyde-3-phosphate dehydrogenase (GAPDH), a glycolytic enzyme that can trigger the death of certain cell-types. GAPDH binds directly to MEKK3. Interestingly, serum depletion, a trigger of endothelial cell death, results in a rapid loss of cytosolic MEKK3 and MEKK3-GAPDH interaction. MEKK3 rapidly reappears in the cytosol upon serum replenishment, accompanied by the restoration of MEKK3-GAPDH interaction. During serum starvation or exposure to cytotoxic concentrations of H2O2, GAPDH accumulates in the nucleus. Inhibition of the nuclear accumulation of GAPDH with R-(-)-deprenyl hydrochloride attenuates the degree of cell death. Serum replenishment of serum-starved cells reduces the level of nuclear GAPDH and prevents cell death. Cell-free assays show phosphorylation of GAPDH on four residues by MEKK3. These data not only strongly implicate nuclear GAPDH in causing endothelial cell death but also reveal a potential mechanism for MEKK3 to regulate GAPDH function and hence promote endothelial cell survival.

Frequency that Laboratory Tests Influence Medical Decisions.

BACKGROUND: Among the variables that influence medical decisions, laboratory tests are considered to be among the most important and frequently used. The influence of laboratory tests on medical decisions has been difficult to estimate. The goal of this study was to estimate the number of patient encounters that included a laboratory test. METHODS: We extracted information for 72196 patient encounters from 1-week intervals each quarter of a year from our comprehensive academic medical center electronic medical record. The patients examined represent a comprehensive range of clinical conditions and medical services. We determined for which encounters laboratory and other orders existed. RESULTS: Overall 35% of encounters had 1 or more laboratory tests ordered. However, the percent varied markedly with patient care areas. For inpatient, emergency department, and outpatient populations, 98%, 56%, and 29%, respectively, had 1 or more laboratory tests ordered. CONCLUSIONS: Our observations support that it is not possible to use a single number to categorize the frequency with which laboratory tests occur in patient encounters. Utilization of laboratory tests varied with type of medical service with almost all inpatients, approximately half of emergency department patients, and nearly one-third of outpatients having laboratory tests during their healthcare visit.