Patient blood management and blood conservation - Complimentary concepts and solutions for blood establishments and clinical services in South Africa and beyond.

Blood transfusions come with risks and high costs, and should be utilized only when clinically indicated. Decisions to transfuse are however not always well informed, and lack of clinician knowledge and education on good clinical transfusion practices contribute to the inappropriate use of blood. Low and middle-income countries in particular take much strain in their efforts to address blood safety challenges, demand-supply imbalances, high blood costs as well as high disease burdens, all of which impact blood usage and blood collections. Patient blood management (PBM), which is a patient-focused approach aimed at improving patient outcomes by preemptively diagnosing and correcting anaemia and limiting blood loss by cell salvage, coagulation optimization and other measures, has become a major approach to addressing many of the challenges mentioned. The associated decrease in the use of blood and blood products may be perceived as being in competition with blood conservation measures, which is the more traditional, but primarily product-focused approach. In this article, we hope to convey the message that PBM and blood conservation should not be seen as competing concepts, but rather complimentary strategies with the common goal of improving patient care. This offers opportunity to improve the culture of transfusion practices with relief to blood establishments and clinical services, not only in South Africa and LMICs, but everywhere. With the COVID-19 pandemic impacting blood supplies worldwide, this is an ideal time to call for educational interventions and awareness as an active strategy to improve transfusion practices, immediately and beyond.

Pediatric resident knowledge of transfusion medicine: Results from the BEST-TEST3 international education needs assessment.

BACKGROUND: Transfusions are a common intervention within pediatrics and require unique considerations to optimize patient care. Poor knowledge of evidence-based transfusion practice can lead to misuse of transfusion therapy and harm. While there have been assessments of transfusion medicine knowledge of physicians caring for adult patients, there is little data regarding pediatricians. STUDY DESIGN AND METHODS: Using a published transfusion medicine knowledge exam for internal medicine physicians as a backbone, pediatric transfusion medicine experts, using an iterative process, developed a pediatric-specific examination. Pilot testing and Rasch analysis, a method used in high-stakes testing, was used to validate the exam. The exam and a previously validated survey on transfusion medicine training, attitudes, and perceived ability were administered to pediatric residents. Analysis consisted of descriptive statistics as well as comparisons of exam scores based on survey responses. RESULTS: 330 pediatric residents from 19 sites in 6 countries participated in the study. The vast majority (91%) of residents had obtained blood product consent. The mean exam score was 37.1% (range 9.5%-71.4%) with no statistical differences based on amount or perceived quality of transfusion medicine education or perceived ability. DISCUSSION: A rigorously validated exam has now been developed that can be used to assess pediatric transfusion medicine knowledge. A large international group of pediatric residents performed poorly on the exam demonstrating a pressing need for improved transfusion medicine education to ensure safe and appropriate administration of blood components to infants and children.

Current state of therapeutic apheresis and cellular therapy education for transfusion medicine fellows in the United States.

BACKGROUND: Numerous conditions are responsive to therapeutic apheresis (TA) and cellular therapy (CT) treatments. Both TA and CT are two broad and diverse knowledge fields within transfusion medicine (TM). We therefore sought to survey all the TM fellowship program directors (PDs) in the United States to examine the current fellow state education in TA and CT. METHODS: A 37-question survey was sent to all PDs to collect details of TA and CT training for TM fellows. RESULTS: Responses from 29/51 (56.9%) surveyed programs were received. Most PDs considered TA and CT training for their fellows more than adequate. Two PDs from programs that did not directly oversee TA and CT services at their training sites stated that their program's training in these two areas were only "slightly adequate" or "moderately inadequate." Detailed analysis of training in TA, cell collection, and CT suggests that trainees from programs with direct oversight of these services had longer training and more learning experiences compared to those in which outside rotations were required. CONCLUSIONS: Transfusion medicine fellowship training in TA and CT varies. Most respondents, and particularly those from programs directly overseeing TA services, reported their fellows were adequately prepared in TA. Cellular therapy collections and laboratory operations, however, are less consistent areas of training despite the rapid expansion of these fields. Our survey suggests that a greater emphasis in CT training is needed.

[French haemovigilance from 1994 to nowadays: Evolution and prospects]. / L'hémovigilance française de 1994 à nos jours : évolution et perspectives.

Born in France in 1993, haemovigilance aims at monitoring the blood transfusion chain from the donor to the recipient, receiving labile blood products. It differs from the other vigilances due to its organization and its completeness dealing with the collected information. Prior to the European directive, the French agency created a new gravity level: grade 0, aiming at reporting and analyzing the blood transfusion chain dysfunction. Thus, haemovigilance gradually integrates the management of the risks and is given new missions in hospitals and private hospitals. One of its first actions will be to achieve an a-priori analysis, preventing the risks throughout the blood transfusion chain. Such crosscutting missions will be used to manage the coordination of vigilance and in some cases identity monitoring. Haemovigilance may be a key player in identity monitoring because patients' immunology-hematological data base can make it possible to confirm or deny a patient's identity (misused identity or homonyms). Haemovigilance is going to meet other challenges such as the training of health professionals', the implementation of patients' blood management and the periodic revision of the blood transfusions bulletin. A new crosscutting medical profession appears in some countries: blood transfusion practitioner. It combines vigilance, risk management, support for the therapeutic blood transfusions, health professionals training and the evaluation of practices and results. A final mission would be for haemovigilance to be responsible for medicinal products derived from human blood to allow a better monitoring of plasma transfusions.

[Assessment of transfusion practice: assessing nurses' knowledge in transfusion medicine at Mohamed VI Hematology and Oncology Center of Marrakesh, Morocco]. / Évaluation de la pratique transfusionnelle : enquête au sein du personnel infirmier du centre d'oncologie-hématologie du CHU Mohammed VI de Marrakech, Maroc.

UNLABELLED: Blood transfusion is a complex activity, involving many actors. It is a high-risk activity which could not be controlled without the use of specific methods. Health care workers beliefs and organizational factors are two major issues for the blood transfusion safety. PURPOSE: In our medical center, transfusion medicine care practices were evaluated by testing the nursing staff with a list of questions. We carried out a cross-sectional study. The information was gathered by using an anonymous questionnaire. The latter was developed by foreign teams and adapted to the local context. Forty-two nurses have participated to study. Only 25% have appropriate knowledge and practice with no negative consequences for the patient safety. In our sample, poor knowledge and practice concerned mainly (1) pre-transfusion compatibility check when receiving blood units (30%); (2) delay in preservation of blood unit in the ward (65%); and (3) recognition of abnormal reactions after transfusion (40%). These results showed on which topics the teaching program should emphasize so as to improve the quality of blood transfusion in the medical centers according to legal obligations.

Internal medicine resident knowledge of transfusion medicine: results from the BEST-TEST international education needs assessment.

BACKGROUND: Blood transfusion is the most common hospital procedure performed in the United States. While inadequate physician transfusion medicine knowledge may lead to inappropriate practice, such an educational deficit has not been investigated on an international scale using a validated assessment tool. Identifying specific deficiencies is critical for developing curricula to improve patient care. STUDY DESIGN AND METHODS: Rasch analysis, a method used in high-stakes testing, was used to validate an assessment tool consisting of a 23-question survey and a 20-question examination. The assessment tool was administered to internal medicine residents to determine prior training, attitudes, perceived ability, and actual knowledge related to transfusion medicine. RESULTS: A total of 474 residents at 23 programs in nine countries completed the examination. The overall mean score of correct responses was 45.7% (site range, 32%-56%). The mean score for Postgraduate Year (PGY)1 (43.9%) was significantly lower than for PGY3 (47.1%) and PGY4 (50.6%) residents. Although 89% of residents had participated in obtaining informed consent from a patient for transfusion, residents scored poorly (<25% correct) on questions related to transfusion reactions. The majority of residents (65%) would find additional transfusion medicine training "very" or "extremely" helpful. CONCLUSION: Internationally, internal medicine residents have poor transfusion medicine knowledge and would welcome additional training. The especially limited knowledge of transfusion reactions suggests an initial area for focused training. This study not only represents the largest international assessment of transfusion medicine knowledge, but also serves as a model for rigorous, collaborative research in medical education.

Postgraduate education in transfusion medicine in the absence of formal residency training: assessment of factors needed to develop and sustain a postgraduate diploma program.

BACKGROUND: Quality education in transfusion medicine is key to delivering a safe and cost-effective blood service, yet postgraduate residency programs are lacking in many resource-limited countries and regions. The first formal, accredited, postgraduate training program in transfusion medicine aimed at medical doctors was developed and implemented at the University of the Free State in Bloemfontein, South Africa, in 2008. In the context of high demand and limited resources, ensuring sustainability of postgraduate training programs is essential. STUDY DESIGN AND METHODS: A formal qualitative and semi-quantitative research approach was followed to determine and test the factors considered important in program sustainability, and consisted of a literature survey, followed by semi-structured interviews and a Delphi survey. RESULTS: Fifty-five factors were identified from the semi-structured interviews. During the Delphi survey, consensus was reached on 41 and stability declared on a further 13. These factors formed the basis of a structured model informing the sustainability aspects of a postgraduate program in transfusion medicine. CONCLUSION: Literature on program sustainability in the field of transfusion medicine is very limited. This study identified the key factors essential to the long-term viability of a postgraduate program in transfusion medicine and should find broad applicability in other resource-limited countries and regions. It is envisaged that this will enable such programs to reach a state of self-sufficiency while not being overly reliant on external funding and support.

Autoevaluación en medicina transfusional / Self-assessment in transfusion medicine

Hace 18 años, el Comité Científico de la AAHI, publicaba en el Vol. XX de nuestra Revista una edición especial con un programa de Autoevaluación en Medicina Transfusional. Tuvo tan buena recepción entre los lectores que a lo largo del tiempo fue conocida como la "Revista de las 500 preguntas". La misma fue utilizada por todos los profesionales de la especialidad como instrumento para medir su grado de conocimientos sobre la medicina transfusional, pero fundamentalmente era la última herramienta que utilizaban los médicos para evaluar si estaban en condiciones de aprobar el examen de la especialidad. Durante mi paso por la Comisión Directiva en el año 2004, los miembros del Comité Científico nos habíamos propuesto hacer una nueva edición del programa de autoevaluación, pero sólo habíamos llegado a las 300 preguntas cuando dejé la Secretaría Científica. No era una tarea fácil, porque se requiere de mucha experiencia para confeccionar preguntas por el sistema de elección múltiple. Es así que "las 300" fueron guardadas para otra oportunidad. Y la oportunidad llegó de la mano de los festejos de los 40 años de la AAHI. Esta vez le propuse a la Dra. Mónica Puppo retomar la idea de hacer "otra Revista de las 500 preguntas", evaluar nuevamente las 300 anteriores, dado que algunas ya habían perdido vigencia y llegar a las 500 a partir del contenido de los dos últimos Manuales Técnicos, del Transfusion Medicine Self-Assessment and Review de la AABB y de las Normas Técnicas y Administrativas de la Ley Nacional de Sangre Nº 22990. Es nuestro deseo que esta nueva edición alcance el mismo valor que la anterior porque ello demostraría que entre nuestros asociados persiste el interés en incorporar conocimientos y además, de autoevaluarse. Agradezco a la Dra. Mónica Puppo porque se hizo eco de mi pretensión y trabajó incansablemente para que llegáramos en tiempo y forma a este momento, y ambos debemos agradecer la colaboración de los Dres. Silvina Kuperman...