[Blood transfusion in neonatology: Study of practical aspects in 2016 in France, excluding acute bleeding or surgical care]. / Réalisation d'une transfusion sanguine en néonatologie : état des lieux des pratiques en 2016 en France ; situations aiguës ou chirurgicales exclues.

BACKGROUND: Blood transfusion is common in neonatology, especially in preterm or low birth weight infants. Recommendations were proposed by the French National Authority of Health (HAS) in 2014 and 2015 for red blood cells and platelet transfusion respectively, but an heterogeneity of practical attitudes persist. The objective of this survey is to evaluate transfusion practices in neonatal intensive care units. METHODS: Investigation of practice of neonatal transfusion was organized among 68 neonatal intensive care unit (level 3) between September 2016 and May 2017, by mailing survey focused on systematic training of nurses, patient identification, immunohematology, information and technical aspects of blood components administration. RESULTS: Twenty-three neonatal intensive care units among the 68s answered the questionnaire. One thousand five hundred sixty seven neonates were transfused and 3382 blood products were administered. The results highlight a consensual attitude concerning the procedures of patient identification, immunohematology tests and blood products administration. However, heterogeneity remains concerning information of the parents or the person with parental authority, immediate and delayed follow-up and devices used for the transfusion. However HAS guidelines (2014 and 2015) appear to be well applied by clinicians for blood products, specifications and calcul of transfused volume based on gestational age and weight.

[Analysis of causes of destruction of labile blood products in health institutions: A multicentric study]. / Analyse des causes de destruction des produits sanguins labiles dans les établissements de santé : une étude multicentrique.

OBJECTIVE: One of the tasks of haemovigilance correspondents in Health Institutions (HI) is to reduce the destruction of labile blood components (LBC). The objective of this study was to analyse in depth, five years after a first multicentric study, the causes of LBC destruction in order to assess the impact of measures taken and to define new ways of improvement. METHODS: Prospective analysis was carried out throughout 2016. For every LBC destroyed, the following elements were reported: type of LBC, transfusion department, cause of destruction analysed according to a decision tree, subsequently classed as avoidable or unavoidable. RESULTS: The study included 15 HI. A total 3058 LBC were destroyed, representing an average 0.90% of issued LBC, and this analysis concerned 2576 LBC. Sixty-seven percent of LBC were issued for surgery, intensive care or emergencies. Forty percent of the causes of destruction were patient-related (death, clinical worsening, adverse effects or abnormal constants prior to delivery). Thirty percent were prescription-related, mainly cases of excessive prescription for different reasons. Eleven percent were linked to organisational issues. The rate of destruction judged avoidable, all causes combined, was 36%. CONCLUSION: Comparison with the precedent study shows improvement, thus revealing the efficacy of implemented measures (single-dose distribution, return procedures back to the site of distribution, training of participants). In order to further reduce this rate of destruction, we suggest to promote storage procedures and, above all, to continue to raise awareness within healthcare teams.

[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.

[Documents and transfusion acts: heterogeneous practices]. / Documents et acte transfusionnel: hétérogénéité des pratiques.

Blood transfusion is currently a delegated medical act in patient care services. Blood transfusion safety depends on the strict respect of processes from the prescription of blood products and required patient immuno-hematology exams to the administration of blood products and follow-up of the patient. We conducted a survey among haemovigilance correspondents to establish the documents needed to practice blood transfusion. Blood products delivery depends on the hospitals local organizations and blood products traceability relies on hospitals levels of computerization. We notice heterogeneous practices. Consequently, an updating of the December 15th 2003 circular relative to the transfusion act seems necessary and could thus lead to blood transfusions homogenous practices.

[Qualitative assessment of labile blood product prescription in Le Havre Hospital]. / Evaluation qualitative de la prescription de produits sanguins labiles au groupe hospitalier du Havre.

This retrospective study assessed the conformity of prescriptions of labile blood products as well as the respect of legal requirements and recommendations concerning red blood cells specifications. This study was carried out in two phases one year apart, so as to be able to compare between them. It consisted in an analysis of the administrative and medical information present on the prescription forms and of the discrepancies between the prescribed product and that which was dispensed. Quality of prescriptions was overall better, but some points needed further improvement. The data moreover showed that some prescriptions of phenotyped and cross-matched red blood cells were incomplete. This did not improve over time. Out of 1000 prescriptions for red blood cells, 216 were altered by the transfusion service dispensing unit. A closer look at these changes showed that 49% were justified by statutory requirements or by local protocols. The discrepancies observed between the prescribed product and that which was dispensed were partly due to a poor understanding by the prescribers of statutory requirements. However they are mostly related to particular circumstances, such as emergencies. Furthermore, the prescribers expected the transfusion center to adapt the product in terms of the clinical context.