RESUMO
BACKGROUND: There is a paucity of high-quality data to guide appropriate fresh frozen plasma transfusion with current recommendations based on consensus opinion. The limitations of the product and testing modalities are poorly understood with the rare but potentially serious side effects underappreciated. Combined this has resulted in the widespread misuse of FFP. STUDY DESIGN AND METHODS: Retrospective data capturing FFP transfusion within the 12-month period of April 1, 2022 and March 31, 2023 was entered by Australian health care providers. Appropriate transfusion was assessed by the adjudicators and defined as one in keeping with current recommendations. Descriptive and comparative analyses were performed using SAS Studio version 9.4. RESULTS: During the study period, 935 FFP transfusion episodes were captured. The most frequent indications for FFP were massive hemorrhage 344 (37%), bleeding 141 (15%), and preoperative use 90 (10%). Males received 534 (60%) transfusions. Critical care specialists were the largest users of FFP, prescribing 568 (63%) of transfusions. FFP was used appropriately in 546 (61%) transfusions. However, when massive hemorrhage was excluded only 202 (37%) transfusions were appropriate. Patients with an INR <1.5 received 37% of transfusions. Transfusion associated adverse events were reported in 2% (15) of transfusions including two non-fatal anaphylactic reactions. DISCUSSION: This audit assesses the appropriate use of FFP across all major clinical indications and provides the largest body of evidence of Australian plasma transfusion practices. It highlights the widespread misuse of FFP, which is predominantly guided by consensus recommendations due to a lack of high-quality data.
Assuntos
Transfusão de Sangue , Pessoal de Saúde , Humanos , Hospitais , Serviços de Saúde , Atenção à SaúdeAssuntos
Transfusão de Sangue , Pessoal de Saúde , Humanos , Hospitais , Serviços de Saúde , Atenção à SaúdeRESUMO
BACKGROUND: Administration of RhD immunoglobulin (Ig) is important for RhD negative women throughout pregnancy and postnatally to prevent alloimmunisation and haemolytic disease of the fetus and newborn in subsequent pregnancies. AIMS: The aim of this audit was to understand compliance with the Australian guidelines on RhD Ig prophylaxis in pregnancy. MATERIALS AND METHODS: This was a retrospective audit of RhD negative pregnant women in Victoria, Northern Territory, Australian Capital Territory and Tasmania at maternity services of level 2 or higher care, between July 2017 and June 2018. Medical records were reviewed to identify how many RhD negative women received care compliant with the guidelines covering antibody testing, consent, administration of RhD Ig, and feto-maternal haemorrhage (FMH) quantification. RESULTS AND CONCLUSIONS: Analysis included 939 RhD negative women from 43 health services. Compliance with postnatal RhD Ig was high (98%); however, other practice was poor. Documented consent was obtained and recorded for 585 women (62%). Only 76% of eligible women received RhD Ig at the appropriate dose and time (28 and 34 weeks gestation). Similarly, management of potentially sensitising events was suboptimal with 78% receiving RhD Ig when recommended by guidelines. The results of our audit indicate a need for practice improvement across all aspects of care for women who need to receive RhD Ig. A major focus should be not just educating clinical staff, but also educating women to understand the importance of RhD Ig and the potential impact on subsequent pregnancies in order to improve guideline adherence and reduce risk.
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Guias de Prática Clínica como Assunto , Território da Capital Australiana , Feminino , Humanos , Recém-Nascido , Obstetrícia , Gravidez , Estudos Retrospectivos , Isoimunização Rh/prevenção & controle , Imunoglobulina rho(D) , TasmâniaRESUMO
BACKGROUND: Transfusion Practitioner (TP) is a term that describes activities undertaken by a variety of healthcare professionals who play a key role in supporting safe and appropriate blood management/transfusion care for patients. There is significant variation in staff specialty filling the role. To understand which countries have the TP role, and the variations that exist, an international survey was undertaken in 2017. METHODS: A survey was developed by the TP Forum Steering Committee (TPFSC) with input from the International Society of Blood Transfusion (ISBT) Clinical Transfusion Working Party. The survey was distributed by the ISBT Office to all ISBT members and promoted via newsletters and social media. RESULTS/DISCUSSION: Five hundred and eighty-two responses received from 84 different countries. The TP role exists in 67 countries, 10 countries do not have the TP role, one was unaware of the role, and respondents from six other countries did not answer this question. The most prevalent TP activities reported were policy and procedure development, education, participation in Transfusion Committees and audit activities. Eighty-eight respondents indicated they did not have a TP role, with the main barrier being financial, followed by lack of support for the role. Eight respondents indicated they previously had a TP, and this role was no longer in place due to lack of support for the role, cutbacks and other priorities. CONCLUSION: This survey provides insights as to where and how the TP functions and provides the TPFSC with valuable information to develop tools to support further development of the role.
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Transfusão de Sangue , Humanos , Inquéritos e QuestionáriosRESUMO
The Serious Transfusion Incident Reporting program (STIR) commenced haemovigilance in relation to RhD immunoglobulin (Ig) administration in 2015. During two years of reporting, 21 reports relating to RhD Ig administration were received. Thirty-three percent (7/21) were related to omission of RhD Ig, putting women at risk of RhD alloimmunisation and adverse consequences in future pregnancies. A recent case reported to STIR highlights poor communication and misinterpretation of pathology results leading to significant morbidity from haemolysis in the fetus. STIR makes recommendations related to education of staff and communication between clinical and laboratory staff to improve the safety of patient care.
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Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Imunoglobulinas/efeitos adversos , Erros de Medicação , Assistência Perinatal , Isoimunização Rh/epidemiologia , Sistema do Grupo Sanguíneo Rh-Hr , Adulto , Austrália/epidemiologia , Antígenos de Grupos Sanguíneos , Transfusão de Sangue , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Feminino , Transfusão Feto-Materna/tratamento farmacológico , Humanos , Imunoglobulinas/administração & dosagem , Gravidez , Complicações Hematológicas na Gravidez/tratamento farmacológico , Isoimunização Rh/etiologia , Gestão de RiscosRESUMO
Much of the recent work in transfusion practice has shifted to focus on the patient, after efforts over previous decades to ensure the quality and safety of blood products. After the commencement of hemovigilance and transfusion practice improvement programs, the introduction of transfusion practitioners (TP) into health care services and blood centers has continued to increase worldwide. Since this relatively new role was introduced, much work of the TP has focused on patient and staff education, adverse events, transfusion governance, and monitoring of transfusion practices within organizations. The complex nature of the transfusion process makes the TP an integral link in the transfusion chain. Together with hospital transfusion teams and committees, the TP works collaboratively to facilitate the transfusion change management programs and initiatives. Recently, the TP role has evolved to include an emphasis on patient blood management and, to some extent, is shaped by national standards and regulations. These established roles of the TP, together with the ever-changing field of transfusion medicine, provide new opportunities and challenges for a role that is continuing to evolve worldwide.
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Pessoal de Saúde , Medicina Transfusional/tendências , Austrália , Bancos de Sangue/organização & administração , Segurança do Sangue , Transfusão de Sangue/estatística & dados numéricos , Coleta de Dados , Saúde Global , Pessoal de Saúde/educação , Pessoal de Saúde/estatística & dados numéricos , Humanos , Relações Interprofissionais , Auditoria Médica , Assistência Centrada no Paciente , Papel (figurativo) , Medicina Transfusional/educaçãoRESUMO
BACKGROUND: The effectiveness of platelet transfusions to prevent bleeding in patients with hematologic cancers remains unclear. This trial assessed whether a policy of not giving prophylactic platelet transfusions was as effective and safe as a policy of providing prophylaxis. METHODS: We conducted this randomized, open-label, noninferiority trial at 14 centers in the United Kingdom and Australia. Patients were randomly assigned to receive, or not to receive, prophylactic platelet transfusions when morning platelet counts were less than 10×10(9) per liter. Eligible patients were persons 16 years of age or older who were receiving chemotherapy or undergoing stem-cell transplantation and who had or were expected to have thrombocytopenia. The primary end point was bleeding of World Health Organization (WHO) grade 2, 3, or 4 up to 30 days after randomization. RESULTS: A total of 600 patients (301 in the no-prophylaxis group and 299 in the prophylaxis group) underwent randomization between 2006 and 2011. Bleeding of WHO grade 2, 3, or 4 occurred in 151 of 300 patients (50%) in the no-prophylaxis group, as compared with 128 of 298 (43%) in the prophylaxis group (adjusted difference in proportions, 8.4 percentage points; 90% confidence interval, 1.7 to 15.2; P=0.06 for noninferiority). Patients in the no-prophylaxis group had more days with bleeding and a shorter time to the first bleeding episode than did patients in the prophylaxis group. Platelet use was markedly reduced in the no-prophylaxis group. A prespecified subgroup analysis identified similar rates of bleeding in the two study groups among patients undergoing autologous stem-cell transplantation. CONCLUSIONS: The results of our study support the need for the continued use of prophylaxis with platelet transfusion and show the benefit of such prophylaxis for reducing bleeding, as compared with no prophylaxis. A significant number of patients had bleeding despite prophylaxis. (Funded by the National Health Service Blood and Transplant Research and Development Committee and the Australian Red Cross Blood Service; TOPPS Controlled-Trials.com number, ISRCTN08758735.).