Labor de la enfermería española de hemovigilancia / The work of spanish haemovigilance nurses

Fundamentos: La finalidad de la Hemovigilancia es la prevención de eventos adversos relacionados con las transfusiones sanguíneas. Los informes de Hemovigilancia más recientes inciden en la tasa elevada de errores a la cabecera del paciente. La presencia de enfermeras de Hemovigilancia redunda en la prevención de los errores y el aumento de la seguridad transfusional. El objetivo de esta publicación es poner en conocimiento la labor de las enfermeras hemovigilantes.Métodos: Revisión bibliográfica sobre aspectos relacionados con las intervenciones de enfermería de Hemovigilancia a nivel nacional e internacional.Resultados: La presencia hospitalaria de enfermeras de Hemovigilancia está relacionada con la reducción de eventos no deseables y transforma las notificaciones en mayoritariamente casi-incidentes, su existencia favorece el incremento de registros de notificaciones y el seguimiento de trazabilidad en cada caso. Es capaz de detectar áreas de mejora al conocer todo el circuito transfusional y su figura permite el apoyo al resto de enfermeras asistenciales, especialmente en unidades con mayor tasa de incidencias.Conclusiones: La presencia de enfermeras de Hemovigilancia como figura experta dentro de una institución favorece el uso y consumo óptimo de hemocomponentes, incrementando así la seguridad y la sostenibilidad transfusional. (AU)

Fundamentals: The purpose of haemovigilance is the prevention of adverse events related to blood transfusions. Recent haemovigilance reports highlight the high rate of errors at the bedside. The presence of haemovigilance nurses has the potential to prevent errors and increase transfusion safety. The aim of this publication is to raise awareness of the work of Haemovigilance nurses.Methods: Literature review on national and international aspects of haemovigilance nursing interventions.Results: The presence of haemovigilance nurses in hospitals is related to the reduction of undesirable events and transforms notifications into near-misses, their existence favours the increase in notification records and the monitoring of traceability in each case. They are capable of detecting areas for improvement as they are familiar with the entire transfusion circuit and their role enables support to be given to the rest of the care nurses, especially in units with a higher rate of incidents.Conclusions: The presence of Haemovigilance nurses as an expert figure within an institution favours the optimal use and consumption of haemocomponents, thus increasing transfusion safety and sustainability. (AU)

Screening Blood Donors for HIV, HCV, and HBV at the American Red Cross: 10-Year Trends in Prevalence, Incidence, and Residual Risk, 2007 to 2016.

Prevalence, incidence and residual risk of HIV, HCV and HBV are critical indicators of the safety of the blood supply. The American Red Cross routinely monitors these markers. Herein the results of testing over 58 million donations from 2007 to 2016 are reported. The prevalence and incidence of these infections has declined or remained essentially stable over the 7.5 to 10-year period. In 2015 to 2016, the prevalence of HIV, HCV and HBV were respectively: 1.65, 11.47 and 5.85 per hundred thousand (pht) donations with a significant decrease over the 10-year study only for HCV. Weighted incidence rates for all positives were 1.98 pht person years (py) for HIV, 2.20 pht py for HCV and 1.25 pht py for HBV. Estimates of residual risk using these incidence rates were: HIV, 1:2.3 million; HCV, 1:2.6 million; and HBV, 1:1.5 million donations, reflecting very low risk to recipients. There have been increases in the safety of the blood supply compared to prior published estimates. Demographic factors were shown to be associated with variations in infection prevalence and incidence. Continuing changes in the structure of the donor population or changes in policy could impact these measures of safety.

Serological screening in donors in Mexico: advances and technology / Tamizaje serológico en donadores de México: avances y tecnología

The residual risk of transfusion-related infections has decreased dramatically in countries that have routinely implemented serological screening. Most of the donation in Mexico is from replacement practice, a risk factor for positive serology. In Mexico, the altruistic donation is only 2.7%. The heterogeneity of technical factors, regional factors and internal policies of each center influences the variability of data on the prevalence of positive screening, as well as the prevalence of confirmed cases. The main advantage of nucleic acid technology is the detection of donors in the period of serological window or occult infections, being occult hepatitis reports in Mexican donors from 1 to 3.4%. The limitation of available technology, the scope of the clinic and perspectives, invites us to improve technology and health policies in the interest of transfusion safety.

El riesgo residual de las infecciones relacionadas a la transfusión ha disminuido drásticamente en los países que han implementado rutinariamente el tamizaje serológico. La mayor parte de la donación en México es de reposición, factor de riesgo para serología positiva, y en donde la donación altruista es de apenas 2.7%. La heterogeneidad de factores técnicos, regionales y políticas internas de cada centro influyen en la variabilidad de datos en prevalencia del tamizaje positivo, así como en la prevalencia de casos confirmados. La principal ventaja de la tecnología de ácidos nucleicos es la detección de donadores en periodo de ventana serológico o de infecciones ocultas, con reportes de hepatitis ocultas en donadores de 1-3.4% en México. Las limitantes de la tecnología disponible, el alcance de la clínica y de las perspectivas, nos invita a la mejora tecnológica y de las políticas sanitarias en aras de la seguridad transfusional.

Future of platelet formulations with improved clotting profile: a short review on human safety and efficacy data.

BACKGROUND: Platelet (PLT) transfusion is a widely used therapy in treating or preventing bleeding and hemorrhage in patients with thrombocytopenia or trauma. Compared to the relative ease of PLT transfusion, current practice for PLT storage at room temperature (RT) for up to 5 to 7 days is inefficient, costly, wasteful, and relatively unsafe. STUDY DESIGN AND METHODS: This study was a review of major advances in PLT derivative products with improved hemostatic potential and safety feature. RESULTS: Recent progress in understanding the PLT activation and host clearance mechanisms has led to reassessments of current and new storage conditions that employ refrigeration and/or cryopreservation to overcome storage lesions and significantly extend shelf life of PLTs with reduced risk of pathogen contamination. DISCUSSION: It is anticipated that future PLT preservation involving cold, frozen, and/or pathogen reduction strategies in proper PLT additive solutions will enable longer term and safer PLT storage.

Provider trends in paediatric and adult transfusion reaction reporting.

BACKGROUND AND OBJECTIVES: Passive transfusion reaction reporting systems fail to capture a significant number of reactions, and no data exist on provider reporting trends. The aim of this study was to describe transfusion reaction reporting patterns by adult and paediatric providers. MATERIALS AND METHODS: This is a multihospital study on transfusion reaction reporting over a 7-year period. Reports were categorized according to transfusion location and assigned to either a transfusion reaction or nonreaction group according to Centers for Disease Control imputability guidelines. Included in the reaction group (RXN) were definite, probable or possible reaction categories; with the remainder assigned as nonreactions (NORXN). Rates were calculated per 100,000 components transfused using chi-square comparison. RESULTS: There were 1092 reports generated from 363 437 transfusions; 230 reports from 69 311 paediatric and 862 reports from 294 126 adult treatment areas. The reporting rate per 100 000 components transfused was 332 for paediatric and 293 for adult (P = 0·09). The per 100 000 components transfused rates were as follows: 237 for paediatric and 169 for adult (P < 0·01) in the RXN group; with 95 paediatric and 124 adult rates in the NORXN group (P = 0·04). CONCLUSION: The total number of reports generated by paediatric and adult providers was not significantly different, suggesting that both provider groups engage the passive reporting system equally. However, paediatric providers reported more true reactions compared to adult providers. Robust hemovigilance systems will further the understanding of these trends and may aid in the development of targeted provider education programmes.

[Health safety in France: from the contaminated blood case to the sanitary vigilance reforms.] / La sécurité sanitaire en France : de l'affaire du sang contaminé à la réforme des vigilances.

INTRODUCTION: To understand the policy for the implementation of the overhaul of the vigilance, it was useful to recall the context by revisiting the literature and regulation related to health security and the tragedy of contaminated blood, which was the founding element of the new health institutions. The concept of health security was born with the creation of several national agencies. They have proved their usefulness but remain, however, compartmentalized with a division of competences, in terms of vigilance, distributed between several agencies, in a complex territorial mesh constituting a hindrance to the declaration of undesirable events. METHOD: Review of legal texts and literature, from the crisis of contaminated blood followed by the creation of health safety laws, the creation of health safety agencies to the texts relating to the reform of vigilance. RESULTS: Haemovigilance and the creation of the French Blood Establishment, the sole operator of blood transfusions, have been decisive in reducing transfusion chain accidents and the risks associated with infectious diseases. The merging of several agencies has led to a more comprehensive approach to risk assessment related to exposure to contaminants and more effective protection of the health of populations. At the regional level the management of sanitary vigilance at the ARS is well established and contributes locally to the management of alerts and health crises. DISCUSSION: The sanitary structures put in place have proved their usefulness but that is not enough. The culture of health events reporting that is insufficiently developed is changing with the implementation of the unique national portal for reporting and the development of health democracy. CONCLUSION: In addition, we must constantly prepare ourselves for new or re-emerging threats. The health risk linked to the foreseeable increase in exposure to pollutants and toxic products will be the major challenge for the years to come.

Manejo de la anemia perioperatoria en paciente con aloanticuerpos programada para esofagectomía / Management of peri-operative anaemia in a patient with rare alloantibodies scheduled for oesophagectomy

Describimos el manejo de una paciente programada para esofagectomía por neoplasia a la que durante el proceso de reserva de hemoderivados le fueron detectados aloanticuerpos, que prácticamente imposibilitaban la obtención de sangre compatible. El manejo de la anemia perioperatoria («patient blood management») se debe realizar rutinariamente en los pacientes quirúrgicos con riesgo de transfusión. Esta estrategia se ha considerado como una de las medidas a tener en cuenta en la rehabilitación multimodal quirúrgica o programa de recuperación intensificada

A description is presented on the management of a patient with an oesophageal neoplasm scheduled for oesophagectomy. Alloantibodies were detected during a blood components reservation procedure, which made it almost impossible to obtain compatible blood. Peri-operative anaemia management or "Patient Blood Management" should be routinely performed in all patients at transfusion risk. This strategy has been considered as one of the actions to bear in mind in fast-track surgery or enhanced recovery after surgery

Prevalence and Trends of Major Transfusion Transmissible Infections among Blood Donors in Dire Dawa Blood bank, Eastern Ethiopia: Retrospective Study.

BACKGROUND: Acquisition of transfusion transmissible infections in the process of therapeutic blood transfusion is a major global health challenge in transfusion medicine. This study aimed to determine the prevalence and trends of major transfusion transmissible infections among blood donors. METHOD: A retrospective analysis of consecutive blood donors' records covering the period between July 2010 and June 2013 was conducted at Dire Dawa Blood Bank, Eastern Ethiopia. RESULT: A total of 6376 blood donors were tested, out of which 5647(88.57%) were replacement donors and 729(11.43%) were voluntary donors. The majority of them were male, 5430(85.16%), and aged between 18-32 years, 4492(70.45%). A total of 450(7.06%) donors had serological evidence of infection with at least one pathogen. The overall positivity rates of HBV, HIV, HCV and syphilis were 4.67%, 1.24%, 0.96%, and 0.44% respectively. Trends for transfusion-transmissible infections showed a significant decrease from 9.51% in 2010 to 6.95% in 2013 with the least prevalence in 2012 (5.90%) (P = 0.004). The prevalence of transfusion transmissible infections was significantly higher among male blood donors compared to female donors, among the age group of 25-32 years and 33-40 years compared to the age group of 18-24 years old, and among unemployed and private workers compared to students. CONCLUSION: A significant percentage of the blood donors harbor transfusion-transmissible infections. Stringent donor selection using standard methods is highly recommended to ensure the safety of blood for the recipient. Furthermore, efforts on motivating and creating awareness in the community are required to increase voluntary blood donors.

Funding blood safety in the 21st century.

BACKGROUND: Since 2000, there has been an historic increase in international development assistance, including blood safety projects. The result has been increased blood donations and infectious disease screening in many beneficiary countries. A comprehensive examination of international development assistance for blood safety has yet to be completed. STUDY DESIGN AND METHODS: This report examines publicly available information, including donor agency websites and databases and data from the 2008 and 2012 World Health Organization Global Database on Blood Safety. RESULTS: Between 2000 and 2015, from $602.4 million to $2.1 billion in international development assistance was allocated to blood safety programs worldwide, mostly as part of the global response to the human immunodeficiency virus/acquired immunodeficiency syndrome epidemic. The US President's Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis, and Malaria were responsible for the majority of blood safety funding, which peaked in 2010 and declined through 2015. CONCLUSION: Between 2000 and 2015, countries with high burdens of human immunodeficiency virus/acquired immunodeficiency syndrome received funding and technical assistance to improve national laboratories, increase blood component production, and strengthen clinical practice. Global trends in international development assistance at large, including aid for blood safety, suggest that funding will not rebound.

Donor deferral policies for men who have sex with men: past, present and future.

We review the history and evolution of blood donor criteria for men who have sex with men (MSM). Deferral policies in many jurisdictions, including Australia, New Zealand, Canada, the United States, Brazil and many western European countries are based on a period of abstinence from MSM, often of 12 months duration. Several countries (Italy, Spain and Portugal) defer donors based on sexual behaviours considered to be at high risk, regardless of whether the partner is same sex or opposite sex. Compliance is a key determinant in the efficacy of any deferral policy. We summarize research themes and strategies discussed at a January 2017 meeting held in Toronto, Canada, to provide an evidence basis for future policy changes.

Fifteen years of Nucleic Acid Testing in France: Results and lessons.

Of the 40 million donations screened with Nucleic acid testing (NAT) between July 2001 and December 2015 in France, 20 HIV-positive, 13 HCV-positive and 17 HBV (HBV-NAT was initiated in 2005 and extended to the whole country in 2010) donations were discarded thanks to NAT. The main benefit in terms of discarded donations is related to HBV with a yield of 0.88 per million donations, which is 12.5 and 1.8 times higher than for HCV and HIV respectively. The main risk factor found in these donors during the post donation interview was having sex with men for males (n=11, all repeat blood donors), having a partner HCV positive (n=6) or at-risk partner (originated from endemic area or HBV positive) for HBV (n=8) for HIV, HCV and HBV, respectively. Although the mean viral load was high for HIV (5.6 log copies/mL) and HCV (7 log IU/mL), HBV cases show low level of DNA (1.8 log IU/mL) demonstrating the need of a highly sensitive NAT assay. Overall, the clinical benefit for recipients remains those related to the prevention of HIV contaminations since HCV avoided transmissions are extremely rare (only one case in the last 5 years thanks to NAT) and the potential infectivity of HBV-NAT only positive cases is questionable due to the low level of HBV DNA and the presence of anti-HBs in more than a half of DNA positive/HBsAg and anti-HBc negative donors.

[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.

Research Progress of Platelet Transfusion in China.

Platelet products have been increasingly used for more than 50 years. Platelet transfusion is effective for correcting bleeding caused by thrombocytopenia and platelet function defects. In this review, we will outline research on platelet transfusion in China including platelet biosafety, cryopreservation of platelets, the assessment of the effectiveness of platelet transfusion, the causes of platelet transfusion refractoriness including immunization against CD36, and neonatal alloimmune thrombocytopenia.

US Army blood program: 2025 and beyond.

In preparing to support the Army in 2025 and beyond, the Army Blood Program remains actively engaged with the research and advanced development of blood products and medical technology to improve blood safety and efficacy in conjunction with the US Army Medical Research and Materiel Command. National and International Blood Bank authorities have noted that the US Army research and development efforts in providing new blood products and improving blood safety operate on the cutting edge of technology and are transformational for the global blood industry. Over the past 14 years, the Army has transformed how blood support is provided and improved the survival rate of casualties. Almost every product or process developed by or for the military has found an application in treating civilian patients. Conflicts have many unwanted consequences; however, in times of conflict, one positive aspect is the identification of novel solutions to improve the safety and efficacy of the blood supply.

[New viral risks in blood transfusion by 2016]. / Nouveaux risques viraux en transfusion sanguine à l'horizon 2016.

Viral safety remains a major concern in transfusion of blood products. Over years, the control measures applied to blood products were made more and more sophisticated; however, the number of infectious agents, and notably of viruses, that can be transmitted by transfusion is increasing continuously. The aim of this review paper is to actualize that published in the same journal by the same authors in 2011 with more details on some of actual vs virtual viral threats that were identified recently in the field of blood transfusion. The main subjects that are covered successively concern the transmission via transfusion of hepatitis E virus, the frequency of transfusion transmitted arboviruses, transfusion at the time of the Ebola epidemics in West Africa, the debated role of Marseillevirus (giant viruses infecting amoebae and suspected to infect human blood latently), and, finally, the recent report of the identification in blood donors of a new member of the Flaviviridae family. The addition of these new viral risks to those already identified-partially controlled or not-pleads for the urgent need to move forward to considering inactivation of infectious agents in blood products.

Blood donation in China: sustaining efforts and challenges in achieving safety and availability.

China has entered a new phase in blood safety and availability through persistent efforts in the past decades. Based on national data from 2008 to 2012, we present a comprehensive review on the blood services ranging from policy and organization, supply, donors, screening and processing, and clinical use to government response in contemporary China. Current evidence suggests that the Chinese blood industries, after continual efforts in reforms on the legal framework and national management system, have been in a relatively steady but bottleneck stage. Although the blood industries have had an impressive track record on management and resolving problems, such as low availability, limited donors, deficient laboratory tests, shortage of blood products, and unnecessary clinical usage of blood still exist nationwide. While medical technology and services have seen a rapid increase in progress in recent years, they have not coordinated with the development of the national health care system. This article presents an analysis with detailed data, rich contents, and recent response from the Chinese government, allowing readers to appreciate how China, a country with more than 19.13% of the world's population, has long endeavored to improve safety and availability of blood. Meantime, the article sincerely welcomes the guidance on policymaking and technical assistance from the international community. Data in this article do not include those of Hong Kong, Macao, or Taiwan.