[Is the research of posttransfusional alloantibodies still relevant?] / Est-ce que la réalisation de la recherche d'anticorps antiérythrocytaires post­transfusionnelle est toujours pertinente ?

The decision of November 6th, 2006 defining the principles of best practices recommends that posttransfusional red cell alloantibodies research is performed after one to three months after. In the University hospital of Brest, the haemovigilance unit takes charge of sending the medical prescription within the required time and centralizing the results. We wished to estimate if the realization of this research still remains relevant. METHODS: A prospective analysis was performed in 2015. We evaluated the realization rate, the red cell alloantibodies rate and the recipient adverse reactions with the diagnostic category: alloimmunization (delayed serological transfusion reaction, DSTR). RESULTS: In 2015, 2162 prescriptions were sent to the 3271 transfused patients. One thousand and eighteen red cell alloantibodies research were done, i.e. a return rate of 61%. Among them, 12 alloantibodies appeared (0.9%) within an average of 56 days. Thirty-three other alloantibodies appeared and were discovered most frequently before a new transfusion. In 10 cases, a posttransfusional research was done that was negative. A survey was conducted among GHCOH members to describe the practices in these health institutions. Twelve questionnaires were analysed. Ten institutions performed a posttransfusional alloantibodies research by issuing a prescription at the patient's exit with a return rate between 0.14 and 16%; 1 institution has a centralized organization with a return rate of 68.3%; 1566 red cell alloantibodies research were performed and among them, 24 alloantibodies appeared (1.53%). CONCLUSION: These results indicate that to be effective, the management of this biological test must be centralized. Despite this, the red cell alloantibodies rate remains very low (0.9 and 1.53%) and raises the question of the relevance of this systematic testing after transfusion, which is in any case mandatory before a new transfusion of red blood cells.

[Hospital haemovigilance and adverse events or reactions: who notifies and what?]. / Gestion des évènements indésirables receveurs: le point de vue de l'hémovigilant d'un établissement de santé.

The French haemovigilance system designates a physician in charge of haemovigilance in each hospital. She/he collects the adverse reactions and events reported by medical staff or nurses. In 2010, 7360 (2.42/1000 units) adverse reactions and 518 adverse events (excepted donors) were reported. These results mean that the system is particularly effective in hospitals. This study collected the opinion of physicians in charge of haemovigilance about this organization.

[Post-transfusion hepatitis C. From screening to compensation]. / Hépatites C post-transfusionnelles. Du dépistage à l'indemnisation.

In France, during the last decades preceding the 1990s, 100,000 to 400,000 blood recipients may have been infected by hepatitis C. Since 1990, thanks to advances in transfusion safety, the risk of hepatitis C contamination has become extremely low. Given the natural history of the disease, it can be a long time unnoticed. Thus, even today, a significant part of infected individuals do not know their serological status. Through several periods and several campaigns, we present the various means used for the detection of post-transfusion hepatitis C at the Caen University Hospital. These methods have been introduced as a result of legislation or through arrangements made by the institution. They were made possible through the action of haemovigilance system, monitoring adverse reactions related to blood products and of blood products traceability which helps to realise special researches in case of suspected transfused blood products. In addition to posttransfusion hepatitis C detection, we are discussing available victim ways to be indemnified for the injury suffered by contamination by hepatitis C.

[Perceptions of quality in health sectors and impact on quality assurance]. / Perceptions de la qualité dans le secteur sanitaire et impact sur la démarche qualité.

According to the ordinances dated April, 24.1996, clinics and hospitals should launch an internal accreditation process. There are many organizations which are about to develop a quality improvement process in order to be prepared to such an evaluation. The success of such approach lies on the involvement of the members of the organization concerned. This survey intends to sort out the actors' perceptions of quality, in order to adapt the process development to the internal cultural context. The data collection was realized through thirty pre-oriented interviews with physicians, nurses, administrative managers and private consultants in charge of implementing the quality process in health structures. The recorded interviews were later on analyzed in order to determine meaningful categories of perceptions of quality. The analysis reveals that quality is perceived in different ways. Three categories of perception can be found: Quality related to "a mean to change the organization" Quality as a "tool to control and limit the expenses" Quality as a way "to improve the relationship with the patients". Administrative managers rather consider the quality process as an expense control tool, whereas physicians and consultants perceive it as a mean to change the organization. Nurses rather adopt the quality process as a way to improve the relationship with the patient. The understanding of how the quality concept is perceived by the different personnel categories helps to initiate appropriately the improvement quality process in services.