Hemovigilance: the experience of transfusion reaction reporting in a Teaching Hospital. / Hemovigilância: a experiência da notificação de reações transfusionais em Hospital Universitário.

OBJECTIVE: To describe the occurrence of immediate transfusion reactions received by the Risk Management Department of Hospital São Paulo. METHOD: Cross-sectional and retrospective study which analyzed the notification sheets of transfusion reactions that occurred between May 2002 and December 2016 and were included in the Hemovigilance National System. RESULTS: One thousand five hundred and forty-eight transfusion reaction notification sheets were analyzed, all of which concerned immediate reactions associated with packed red blood cells (72.5%). The most frequently reported reaction was febrile non-hemolytic transfusion reaction, and among severe and moderate cases, allergic reaction was the most common. The most frequently reported signs and symptoms were hyperthermia, sudoresis, chills, and skin lesions. No differences were observed regarding gender and age, and 90.7% of reactions occurred in patients with Rh+ factor. CONCLUSION: This study allowed for a better assessment and understanding of transfusion reactions, which will help to improve the quality of blood circulation and provide greater safety of patients undergoing transfusion therapy.

Segurança e intervenção: a assistência de enfermagem em hemotransfusão / Safety and intervention: nursing assistance in blood transfusion / Seguridad e intervención: la asistencia de enfermería en Hemotransfusion

O estudo nasceu do campo de trabalho com a necessidade de orientação e monitoramento da prática hemoterapia em enfermagem. Objetivo Geral: Elaborar um instrumento como uma lista de verificação para orientar a assistência de enfermagem ao cliente submetido à hemotransfusão. Traçamos como objetivos específicos: Identificar a função da enfermeira que atua na Agência Transfusional; Analisar a conformidade dos conhecimentos da equipe de enfermagem sobre intervenções assistenciais ao cliente em hemoterapia e sobre Hemovigilância; Aprimorar a Lista de Verificação (Checklist) Seguro para a Assistência de Enfermagem ao Cliente Receptor de Hemocomponentes (Produto deste estudo) e Testar o produto. Trata-se de um estudo qualitativo, exploratório e descritivo cujo campo de pesquisa foi um hospital universitário público, no estado do Rio de Janeiro, desenvolvido segundo a metodologia administrativa proposta por Cury (2005): Fase I Diagnóstico da função da enfermeira na Agência Transfusional e o conhecimento específico da equipe de enfermagem. Fase II ­ Elaboração da Lista de Verificação Segura para o Cliente Submetido à Hemotransfusão. Fase III - Teste da Lista de Verificação. Os participantes foram 52 enfermeiros e 79 técnicos de enfermagem atuantes na assistência a clientes submetidos à hemotransfusões. O projeto foi aprovado pelo Comitê de Ética e Pesquisa da UNIRIO sob o nº 463207, CAAE: 52779315.7.0000.5285. Na fase diagnostica ocorrida em maio de 2016, foi identificada a função da enfermeira com base na legislação e elaborados dois fluxogramas de trabalho e foi aplicado o teste de Conhecimento a 131 profissionais. As respostas foram codificadas e analisadas pelo sistema SPSS 21,0 e mostraram que apenas 34,35% dos participantes obtiveram acertos acima de 70%, o que reforça a necessidade de treinamentos e implementação de um instrumento assistencial específico. Fase 2 ­ realizada em junho de 2016. Os resultados da fase diagnóstica permitiram as adequações à Lista de Verificação (Checklist) Seguro para a Assistência de Enfermagem ao Cliente Receptor de Hemocomponentes já existente e em uso no hospital e desenvolvido treinamentos voltados para os 131 profissionais de enfermagem. Na terceira fase foi realizada a testagem da Lista de Verificação (Checklist) Segura para a Assistência de Enfermagem ao Cliente Receptor de Hemocomponente corrigida de acordo com as sugestões dos profissionais de enfermagem que utilizaram o impresso proposto em 40 quarenta transfusões. Conclui-se que é de suma importância ter o enfermeiro na agência transfusional com atuação em todo o processo hemoterápico, visto que o sangue é um transplante de órgão que necessita de cuidados intensivos para garantir a segurança do cliente. O estudo respondeu às questões de pesquisa, e evidenciou que a lista de verificação aproxima a assistência e a evolução de enfermagem na transfusão de hemocomponente de uma sistematização, que reduz riscos e danos ao cliente e possibilita a qualidade assistencial de enfermagem

The study was born from the field of work with the need for guidance and monitoring of hemotherapy practice in nursing. General Objective: To devise an instrument such as a checklist to guide nursing care to the transfused client. We outline specific objectives: Identify the role of the nurse working in the Transfusional Agency; To analyze the conformity of the knowledge of the nursing team about healthcare interventions to the client in hemotherapy and on hemovigilance; Improve the Safe Check List for the Hemotransferred Customer. (Product of this study) and Test the product. This is a qualitative, exploratory and descriptive study whose field of research was a public university hospital, in the state of Rio de Janeiro, developed according to the administrative methodology proposed by Cury (2005): Phase I- Diagnosis of the nurse's role in the Transfusional Agency and the specific knowledge of the nursing team. Phase II - Elaboration of the Safe Check List for the Hemotransfusion Customer. Phase III - Checklist Test. The participants were 52 nurses and 79 nursing technicians working in the care of clients submitted to blood transfusion. The project was approved by the Ethics and Research Committee of UNIRIO under nº 463207, CAAE: 52779315.7.0000.5285. In the diagnostic phase that occurred in May 2016, the nurse's role was identified based on legislation and two workflows were elaborated and the Knowledge test was applied to 131 professionals. The responses were coded and analyzed by the SPSS 21.0 system and showed that only 34.35% of the participants obtained scores above 70%, which reinforces the need for training and implementation of a specific care instrument. Phase 2 - carried out in June 2016. The results of the diagnostic phase allowed for adjustments to the existing Checklist for the Client submitted to Hemotransfusion and in use in the hospital and developed training aimed at the 131 nursing professionals. In the third phase, the testing of the Safe Verification List for the Client submitted to Hemotransfusion was performed, corrected according to the suggestions of the nursing professionals who used the proposed form in 40 transfusions. It is concluded that it is of paramount importance to have the nurse in the transfusional agency with a role in the entire hemotherapy process, since blood is an organ transplant that requires intensive care to ensure client safety. The study answered the research questions and showed that the checklist approximates nursing care and evolution in the transfusion of blood components of a systematization, which reduces risks and damages to the client and enables nursing care quality

El estudio nació del campo de trabajo con la necesidad de orientación y monitoreo de la práctica hemoterapia en enfermería. Objetivo General: Elaborar un instrumento como una lista de verificación para orientar la asistencia de enfermería al cliente sometido a la hemotransfusión. Trazamos como objetivos específicos: Identificar la función de la enfermera que actúa en la Agencia Transfusional; Analizar la conformidad de los conocimientos del equipo de enfermería sobre intervenciones asistenciales al cliente en hemoterapia y sobre Hemovigilancia; Mejorar la Lista de Verificación (Checklist) Seguro para la Asistencia de Enfermería al Cliente Receptor de Hemocomponentes (Producto de este estudio) y Probar el producto. Se trata de un estudio cualitativo, exploratorio y descriptivo cuyo campo de investigación fue un hospital universitario público, en el estado de Río de Janeiro, desarrollado según la metodología administrativa propuesta por Cury (2005): Fase I - Diagnóstico de la función de la enfermera en la Agencia Transfusional y el conocimiento específico del equipo de enfermería. Fase II - Elaboración de la Lista de Verificación Segura para el Cliente Sometido a la Hemotransfusión. Fase III - Prueba de la Lista de Verificación. Los participantes fueron 52 enfermeros y 79 técnicos de enfermería actuantes en la asistencia a clientes sometidos a las hemotransfusiones. El proyecto fue aprobado por el Comité de Ética e Investigación de UNIRIO bajo el nº 463207, CAAE: 52779315.7.0000.5285. La fase diagnóstica ocurrió en mayo de 2016, fue identificada como una función de enfermería con base en la legislación y elaborado dos fundamentos de trabajo y fue aplicada en el ensayo de Conhecimento a 131 profesionales. Las respuestas fueron codificadas y analizadas por el sistema SPSS 21,0 y muestran que sólo 34,35% de los participantes obtiveram acertos superiores a 70%, que requieren una formación básica y una implementación del instrumento assistencial específico. Fase 2 - realizada en junio de 2016. Resultados de la fase diagnóstica permitida como adecuaciones a la Lista de Verificación (Lista de Verificación) Seguro para una Asistencia de Enfermería al Cliente Receptor de Hemocomponentes ya existente en el uso no hospital y desarrolló entrenamientos voltios para los 131 profesionales De enfermagem Em la fase anterior se realizó una prueba de la Lista de Verificación (Lista de comprobación) Segura para una Asistencia de Enfermería en el Receptor de Hemocomponente. Conclui-se que es de suma importancia para el enfermo en la agencia de transfusión en todo el proceso de hemoterápico, en el cuidado de la salud del paciente. El estudio responde a las preguntas de investigación y muestra que una lista de casos se aproxima a un estudio y una evolución de la enfermería en una transfusión de hemocomponente de una sistematización, que reduce lós riesgos y los daños al cliente y posibilita una calidad asistencial de enfermería

Analysis of donor deferral at three blood centers in Brazil.

BACKGROUND: The safety of the blood supply is ensured through several procedures from donor selection to testing of donated units. Examination of the donor deferrals at different centers provides insights into the role that deferrals play in transfusion safety. STUDY DESIGN AND METHODS: A cross-sectional descriptive study of prospective allogeneic blood donors at three large blood centers located in São Paulo, Belo Horizonte, and Recife, Brazil, from August 2007 to December 2009 was conducted. Deferrals were grouped into similar categories across the centers, and within each center frequencies out of all presentations were determined. RESULTS: Of 963,519 prospective blood donors at the three centers, 746,653 (77.5%) were accepted and 216,866 (22.5%) were deferred. Belo Horizonte had the highest overall deferral proportion of 27%, followed by Recife (23%) and São Paulo (19%). Females were more likely to be deferred than males (30% vs. 18%, respectively). The three most common deferral reasons were low hematocrit or hemoglobin, medical diagnoses, and higher-risk behavior. CONCLUSION: The types and frequencies of deferral vary substantially among the three blood centers. Factors that may explain the differences include demographic characteristics, the order in which health history and vital signs are taken, the staff training, and the way deferrals are coded by the centers among other policies. The results indicate that blood donor deferral in Brazil has regional aspects that should be considered when national policies are developed.

Prevalence of serologic markers for hepatitis B and C viruses in Brazilian blood donors and incidence and residual risk of transfusion transmission of hepatitis C virus.

BACKGROUND: We evaluate the current prevalence of serologic markers for hepatitis B virus (HBV) and hepatitis C virus (HCV) in blood donors and estimated HCV incidence and residual transfusion-transmitted risk at three large Brazilian blood centers. STUDY DESIGN AND METHODS: Data on whole blood and platelet donations were collected from January through December 2007, analyzed by center; donor type; age; sex; donation status; and serologic results for hepatitis B surface antigen (HBsAg), antibody to hepatitis B core antigen (anti-HBc), and anti-HCV. HBV and HCV prevalence rates were calculated for all first-time donations. HCV incidence was derived including interdonation intervals that preceded first repeat donations given during the study, and HCV residual risk was estimated for transfusions derived from repeat donors. RESULTS: There were 307,354 donations in 2007. Overall prevalence of concordant HBsAg and anti-HBc reactivity was 289 per 100,000 donations and of anti-HCV confirmed reactivity 191 per 100,000 donations. There were significant associations between older age and hepatitis markers, especially for HCV. HCV incidence was 3.11 (95% confidence interval, 0.77-7.03) per 100,000 person-years, and residual risk of HCV window-phase infections was estimated at 5.0 per million units transfused. CONCLUSION: Improvement in donor selection, socioeconomic conditions, and preventive measures, implemented over time, may have helped to decrease prevalence of HBV and HCV, relative to previous reports. Incidence and residual risk of HCV are also diminishing. Ongoing monitoring of HBV and HCV markers among Brazilian blood donors should help guide improved recruitment procedures, donor selection, laboratory screening, and counseling strategies.

Antibody levels correlate with detection of Trypanosoma cruzi DNA by sensitive polymerase chain reaction assays in seropositive blood donors and possible resolution of infection over time.

BACKGROUND: The clinical significance of anti-Trypanosoma cruzi low-level reactive samples is incompletely understood. Polymerase chain reaction (PCR)-positive rates and antibody levels among seropositive blood donors in three countries are described. STUDY DESIGN AND METHODS: Follow-up samples were collected from T. cruzi-seropositive donors from 2008 through 2010 in the United States (n = 195) and Honduras (n = 58). Also 143 samples from Brazil in 1996 to 2002, originally positive by three serologic assays, were available and paired with contemporary follow-up samples from these donors. All samples were retested with Ortho enzyme-linked immunosorbent assay (ELISA). PCR assays were performed on coded sample panels by two laboratories (Blood Systems Research Institute [BSRI] and American Red Cross Holland Laboratory [ARC]) that amplified kinetoplast minicircle DNA sequences of T. cruzi. RESULTS: PCR testing at BSRI yielded slightly higher overall sensitivity and specificity (33 and 98%) compared with those at the ARC (28 and 94%). Among seropositive donors, PCR-positive rates varied by country (p < 0.0001) for the BSRI laboratory: Brazil (57%), Honduras (32%), and the United States (14%). ELISA signal-to-cutoff ratios (S/CO) were significantly higher for PCR-positive compared to PCR-negative donors (p < 0.05 for all comparisons). Additionally, PCR-negative Brazilian donors exhibited greater frequencies of antibody decline over time versus PCR-positive donors (p = 0.003). CONCLUSION: For all three countries, persistent DNA positivity correlated with higher ELISA S/CO values, suggesting that high-level seroreactivity reflects chronic parasitemia. Significant S/CO declines in 10% of the PCR-negative Brazilian donors may indicate seroreversion after parasite clearance in the absence of treatment.

Positivity of HIV, hepatitis B and hepatitis C in patients enrolled in a confidential self-exclusion system of blood donation: a cross-sectional analytical study / Positividad del VIH, la hepatitis B y hepatitis C en pacientes incluidos en un confidencial sistema de exclusión de la donación de sangre: un estudio transversal analítico

CONTEXT AND OBJECTIVE: Selection of healthy blood donors is essential to ensure blood safety. A confidential self-exclusion (CSE) system was designed so that high-risk donors could confidentially exclude their blood from use in transfusions. This study aimed to compare the demographic characteristics and the results from human immunodeficiency virus (HIV), hepatitis B surface (HBS) and hepatitis C virus (HCV) screening tests on donors who opted to get into and out of CSE. DESIGN AND SETTING: Analytical cross-sectional study on all volunteer donors at Shiraz Blood Transfusion Organization from March 21, 2006, to March 21, 2008. METHODS: The results from the abovementioned tests were compared between donors who opted into and out of CSE. RESULTS: 100,148 donors in 2006 and 104,271 in 2007 gave blood. Among these donors, respectively, 829 (0.82 percent) and 592 (0.57 percent) opted for the CSE. The prevalence of HIV antibodies, HBS antigens and HCV antibodies in CSE donors was significantly higher than in donors who did not choose CSE (p < 0.05). The prevalence of at least one of these three infections among CSE donors was 3.12 percent in 2006 and 3.04 percent in 2007, and was significantly higher than the prevalence among non-CSE donors (0.58 percent and 0.57 percent, respectively). CONCLUSION: Because of the higher prevalence of HBS, HCV and HIV positivity in blood donors who chose the CSE option, offering CSE to blood donors could be a potentially useful method for improving blood safety, since it could increase the detection of infected blood during the window period.

CONTEXTO Y OBJETIVO: La identificación y selección de donantes de sangre sanos es el primer paso para asegurar la seguridad de la sangre. Este estudio tiene como objetivo comparar las características demográficas y los resultados de los virus de la inmunodeficiencia humana (VIH), la superficie de la hepatitis B (HBS) y viru de la hepatitis C (VHC) las pruebas de cribado en los donantes que optaron por entrar y salir de la libre y confidencial de exclusión. DISEÑO Y EMPLAZAMIENTO: Estudio transversal de todos los donantes voluntarios que acudieron a la Shiraz Blood Transfusion Organization entre el 21 de Marzo del 2006 y el 21 de Marzo del 2008. MÉTODOS: Los resultados de las pruebas antes mencionadas fueron comparados entre los donantes que optaron por entrar y salir de CSE. RESULTADOS: 100.148 donantes en 2006 y 104.271 en 2007 donaron sangre. Entre estos donantes, respectivamente, 829 (0,82 por ciento) y 592 (0,57 por ciento) optaron por el CSE. La prevalencia de anticuerpos contra el VIH, los antígenos HBS y anticuerpos contra el VHC en donantes de CSE fue significativamente mayor que en los donantes que no eligió CSE (P < 0,05). La prevalencia de al menos una de estas tres infecciones entre los donantes CSE fue 3,12 por ciento en 2006 y 3,04 por ciento en 2007, y fue significativamente mayor que la prevalencia entre los donantes no CSE (0,58 por ciento y 0,57 por ciento, respectivamente). CONCLUSIONES: Debido a la mayor prevalencia de BA, el VHC y la infección con VIH en donantes de sangre que eligieron la opción del CSE, ofreciendo CSE para los donantes de sangre podría ser un método potencialmente útil para mejorar la seguridad de la sangre, ya que podría aumentar la detección de sangre infectada durante el período de ventana.

Positivity of HIV, hepatitis B and hepatitis C in patients enrolled in a confidential self-exclusion system of blood donation: a cross-sectional analytical study.

CONTEXT AND OBJECTIVE: Selection of healthy blood donors is essential to ensure blood safety. A confidential self-exclusion (CSE) system was designed so that high-risk donors could confidentially exclude their blood from use in transfusions. This study aimed to compare the demographic characteristics and the results from human immunodeficiency virus (HIV), hepatitis B surface (HBS) and hepatitis C virus (HCV) screening tests on donors who opted to get into and out of CSE. DESIGN AND SETTING: Analytical cross-sectional study on all volunteer donors at Shiraz Blood Transfusion Organization from March 21, 2006, to March 21, 2008. METHODS: The results from the abovementioned tests were compared between donors who opted into and out of CSE. RESULTS: 100,148 donors in 2006 and 104,271 in 2007 gave blood. Among these donors, respectively, 829 (0.82%) and 592 (0.57%) opted for the CSE. The prevalence of HIV antibodies, HBS antigens and HCV antibodies in CSE donors was significantly higher than in donors who did not choose CSE (p < 0.05). The prevalence of at least one of these three infections among CSE donors was 3.12% in 2006 and 3.04% in 2007, and was significantly higher than the prevalence among non-CSE donors (0.58% and 0.57%, respectively). CONCLUSION: Because of the higher prevalence of HBS, HCV and HIV positivity in blood donors who chose the CSE option, offering CSE to blood donors could be a potentially useful method for improving blood safety, since it could increase the detection of infected blood during the window period.