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2.
PLoS One ; 15(2): e0229312, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32084232

RESUMO

Regression testing is crucial in ensuring that modifications made did not introduce any adverse effect on the software being modified. However, regression testing suffers from execution cost and time consumption problems. Test case prioritization (TCP) is one of the techniques used to overcome these issues by re-ordering test cases based on their priorities. Model-based TCP (MB-TCP) is an approach in TCP where the software models are manipulated to perform prioritization. The issue with MB-TCP is that most of the existing approaches do not provide satisfactory faults detection capability. Besides, their granularity of test selection criteria is not very good and this can affect prioritization effectiveness. This study proposes an MB-TCP approach that can improve the faults detection performance of regression testing. It combines the implementation of two existing approaches from the literature while incorporating an additional ordering criterion to boost prioritization efficacy. A detailed empirical study is conducted with the aim to evaluate and compare the performance of the proposed approach with the selected existing approaches from the literature using the average of the percentage of faults detected (APFD) metric. Three web applications were used as the objects of study to obtain the required test suites that contained the tests to be prioritized. From the result obtained, the proposed approach yields the highest APFD values over other existing approaches which are 91%, 86% and 91% respectively for the three web applications. These higher APFD values signify that the proposed approach is very effective in revealing faults early during testing. They also show that the proposed approach can improve the faults detection performance of regression testing.


Assuntos
Condução de Veículo/normas , Bancos de Sangue/normas , Joias/normas , Modelos Teóricos , Software/normas , Administração Hospitalar , Humanos , Sistemas On-Line
3.
Vox Sang ; 114(8): 808-815, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31625182

RESUMO

BACKGROUND AND OBJECTIVES: Smokers currently have no defined restrictions for blood donation. However, cigarette smoke contains toxic substances such as carbon monoxide (CO) and trace elements that can affect the packed red blood cells (PRBCs) quality and safety of transfusion. This study evaluated the effects of smoking on the concentration of essential and trace elements and on carboxyhemoglobin (COHb) levels in PRBCs from smoker donors. MATERIALS AND METHODS: A matched case-control study was conducted to compare COHb levels, determined by the CO-oximetry method, and levels of trace (Cd, Pb, Cr, Ni, As and Hg) and essential (Ca, Mg, Cu, Fe, Mn, Mo, Se and Zn) elements evaluated by inductively coupled plasma mass spectrometry, in PRBCs from smoker (n = 36) and non-smoker (n = 36) donors at Hospital de Clínicas de Porto Alegre, Brazil. RESULTS: Mean COHb level was 14 times higher in the PRBCs obtained from smoker donors (5·9 [4·0-9·1] vs. 0·4 [0·2-0·8]%). Cadmium (1·0 [1·0-1·8] µg/l vs. undetectable) and lead (27 [21-36] vs. 19 [14-26] µg/l) levels were significantly higher in the PRBCs from smokers. Moreover, except for molybdenum, levels of all essential elements were lower in smoker PRBCs. CONCLUSION: The PRBCs donated by smokers contain toxic elements that are probably not safe for transfusion in children. Our results might support changes in the current guidelines of blood banks to improve the transfusion safety through inclusion of inquiry about smoking in the clinical screening, labelling and reserve PRBCs from smoker donors for adults or less critical recipients.


Assuntos
Doadores de Sangue/estatística & dados numéricos , Fumantes/estatística & dados numéricos , Fumar/sangue , Oligoelementos/sangue , Reação Transfusional/epidemiologia , Adulto , Bancos de Sangue/normas , Estudos de Casos e Controles , Eritrócitos/química , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fumar/epidemiologia
4.
Vox Sang ; 114(8): 783-794, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31637738

RESUMO

INTRODUCTION: In vitro qualitative differences exist in red cell concentrates (RCCs) units processed from whole blood (WB) depending on the method of processing. Minimal literature exists on differences in processing and variability in quality data. Therefore, we collected information from blood manufacturers worldwide regarding (1) details of WB collection and processing used to produce RCCs and (2) quality parameters and testing as part of routine quality programmes. METHODS: A secure web-based survey was developed, refined after pilot data collection and distributed to blood centres. Descriptive analyses were performed. RESULTS: Data from ten blood centres in nine countries were collected. Six blood centres (60%) processed RCCs using the top-and-top (TAT) method which produces RCCs and plasma, and eight centres (80%) used the bottom-and-top (BAT) which additionally produces buffy coat platelets. Five of the centres used both processing methods; however, four favoured BAT processing. One centre utilized the Reveos automated system exclusively. All centres performed pre-storage leucoreduction. Other parameters demonstrated variability, including active cooling at collection, length of hold before processing, donor haemoglobin limits, acceptable collection weights, collection sets, time to leucoreduction, centrifugation speeds, extraction devices and maximum RCC shelf life. Quality marker testing also differed amongst blood centres. Trends towards higher RCC unit volume, haemolysis and residual leucoctyes were seen in the TAT compared with BAT processing across centres. CONCLUSION: Methods and parameters of WB processing and quality testing of RCCs differ amongst surveyed blood manufacturers. Further studies are needed to assess variations and to potentially improve methods and product quality.


Assuntos
Bancos de Sangue/normas , Preservação de Sangue/normas , Eritrócitos/citologia , Bancos de Sangue/métodos , Preservação de Sangue/métodos , Humanos , Inquéritos e Questionários
5.
Lancet Haematol ; 6(12): e606-e615, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31631023

RESUMO

BACKGROUND: Blood transfusions are an important resource of every health-care system, with often limited supply in low-income and middle-income countries; however, the degree of unmet need for blood transfusions is often unknown. We therefore aimed to estimate the blood transfusion need and supply at national level to determine gaps in transfusion services globally. METHODS: We did a modelling study involving 195 countries and territories. We used blood component preparation data from 2011-13 to estimate blood availability for 180 (92%) of 195 countries from the WHO Global Status Report on Blood Safety and Availability. We calculated disease-specific transfusion needs per prevalent case for 20 causes in the USA using the National (Nationwide) Inpatient Sample dataset between the years 2000 and 2014, and the State Inpatient Databases between 2003 and 2007 from the Healthcare Cost and Utilization Project. Using prevalence estimates for the USA from the Global Burden of Disease (GBD) 2017 study, we estimated the ideal disease specific-transfusion rate as the lowest rate from the years 2000 to 2014. We applied this rate to GBD prevalence results for 195 countries to estimate transfusion needs. Unmet need was the difference between the estimated supply and need. FINDINGS: In 2017, the global blood need was 304 711 244 (95% uncertainty interval [UI] 293 064 637-314 049 479) and the global blood supply was 272 270 243 (268 002 639-276 698 494) blood product units, with a need-to-supply ratio of 1·12 (95% UI 1·07-1·16). Of the 195 countries, 119 (61%) did not have sufficient blood supply to meet their need. Across these 119 countries, the unmet need totalled 102 359 632 (95% UI 93 381 710-111 360 725) blood product units, equal to 1849 (1687-2011) units per 100 000 population globally. Every country in central, eastern, and western sub-Saharan Africa, Oceania, and south Asia had insufficient blood to meet their needs. INTERPRETATION: Our data suggest that the gap between need and supply is large in many low-income and middle-income countries, and reinforce that the WHO target of 10-20 donations per 1000 population is an underestimate for many countries. A continuous expansion and optimisation of national transfusion services and implementation of evidence-based strategies for blood availability is needed globally, as is more government support, financially, structurally, and through establishment of a regulatory oversight to ensure supply, quality, and safety in low-income and middle-income countries. FUNDING: National Institutes of Health.


Assuntos
Bancos de Sangue/provisão & distribução , Transfusão de Sangue , Saúde Global , Acesso aos Serviços de Saúde/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde/estatística & dados numéricos , Bancos de Sangue/economia , Bancos de Sangue/normas , Bancos de Sangue/estatística & dados numéricos , Segurança do Sangue/normas , Segurança do Sangue/estatística & dados numéricos , Transfusão de Sangue/economia , Transfusão de Sangue/normas , Transfusão de Sangue/estatística & dados numéricos , Geografia , Carga Global da Doença , Saúde Global/economia , Saúde Global/normas , Saúde Global/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/normas , Humanos , Modelos Teóricos , Determinação de Necessidades de Cuidados de Saúde/economia , Determinação de Necessidades de Cuidados de Saúde/organização & administração , Determinação de Necessidades de Cuidados de Saúde/normas , Áreas de Pobreza , Prevalência
6.
Biopreserv Biobank ; 17(5): 458-467, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31339743

RESUMO

The scientific impact of translational biomedical research largely depends on the availability of high-quality biomaterials. However, evidence-based and robust quality indicators (QIs) covering the most relevant preanalytical variations are still lacking. The aim of this study was to identify and validate a QI suitable for assessing time-to-centrifugation (TTC) delays in human liquid biospecimens originating from both healthy and diseased individuals. Serum and plasma samples with varying TTCs were analyzed by liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) in a pilot cohort of healthy individuals to identify a suitable QI candidate. Taurine (TAU), as a TTC QI candidate, was validated in healthy individuals and patients with rheumatologic and cardiologic diseases, considering the (1) preanalytical handling temperature, (2) platelet count, and (3) postcentrifugation delay. For discrimination of high TTC (TTC >60 minutes) from low TTC serum specimens, a probability calculation tool was developed (Triple-T-cutoff-model). TTC-dependent changes in healthy individuals were observed for amino acids, particularly TAU. Validation of the TAU levels in an independent cohort of healthy individuals revealed a time-dependent increase in serum, but not in plasma, for a TTC delay of 30-240 minutes. TAU increases were dependent on the handling temperature and platelet count and volume. By contrast, no changes in TAU concentrations were observed for additional postcentrifugation delays. Validation of TAU and the Triple-T-cutoff-model, in rheumatologic/cardiologic patient collectives, allowed the discrimination of samples with TTC ≤60 min/>60 min with estimated AUROC (area under the receiver operating characteristic curve) values of 89% [78%-100%]/86% [71%-100%] and 91% [79%-100%]/84% [68%-100%], respectively. Considering the preanalytical handling temperature and platelet count and volume, TAU and the Triple-T-cutoff-model represent reliable QIs for TTC >60 minutes in serum samples from healthy individuals and selected rheumatologic/cardiologic patients. However, further studies in larger patient collectives with various diseases are needed to assess the robustness and potential of the QIs presented in this article as biobanking quality assurance/quality control tools to support high-quality biomedical research.


Assuntos
Bancos de Sangue/normas , Cardiopatias/sangue , Doenças Reumáticas/sangue , Taurina/sangue , Adulto , Coleta de Amostras Sanguíneas/métodos , Estudos de Casos e Controles , Cromatografia Líquida , Medicina Baseada em Evidências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Doenças Reumáticas/metabolismo , Soro/química , Espectrometria de Massas em Tandem , Fluxo de Trabalho
7.
Transfus Clin Biol ; 26(3): 155-159, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31255509

RESUMO

INTRODUCTION: Different evaluations conducted on blood safety between 2004 and 2013 in Africa showed some progress in most countries. This paper describes the current status of the availability and access to safe blood in the Region. METHODS: A cross-sectional survey was conducted from January to December 2018. Data were collected through a questionnaire prepared using key indicators of blood safety and analysis was done using Excel 2010 and results were compared to those of the 2013. RESULTS: A total of 2,678 blood centres were reported including 244 (9%) stand-alone and 2,434 (91%) hospital based. Amongst these countries, 90.2% had a blood policy, 60.1% participated in an External Quality Assessment Scheme for Transfusion Transmissible Infections screening, 12% had accredited blood services, 73.2% had national guidelines on clinical use of blood and 78% had a government budget. The total number of blood units collected was 4,899,913 and the average proportion of voluntary blood donations was 71%. Plasma-derived medicinal products were included in the national essential medicines list in 52.6% of countries. The average proportion of units of blood tested for infections was 99.5% for HIV, 92.3% for HBV, 98.9% for HCV, 98.8% for syphilis. The percentage of whole blood separated into blood components was 63.4%. CONCLUSION: Countries in the region continue to improve availability and access to safe blood, but challenges still remain and call for concrete actions required to reach universal access to quality and safe blood for transfusion throughout the region.


Assuntos
Segurança do Sangue , Transfusão de Sangue/estatística & dados numéricos , África/epidemiologia , Bancos de Sangue/normas , Bancos de Sangue/estatística & dados numéricos , Doadores de Sangue/estatística & dados numéricos , Segurança do Sangue/normas , Segurança do Sangue/estatística & dados numéricos , Transfusão de Sangue/normas , Estudos Transversais , Pesquisas sobre Serviços de Saúde , Humanos , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Sífilis/prevenção & controle , Sífilis/transmissão , Reação Transfusional/epidemiologia , Reação Transfusional/prevenção & controle , Viremia/diagnóstico , Viremia/epidemiologia , Viroses/prevenção & controle , Viroses/transmissão , Organização Mundial da Saúde
8.
Medicina (Kaunas) ; 55(6)2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31167466

RESUMO

Background: Umbilical cord blood (UCB) used to be considered waste material and was discarded at birth. However, cord blood is now considered a rich source of adult stem cells that can be used to treat many conditions and diseases. This study was performed to determine pregnant women's knowledge and attitudes toward cord blood stem cell banking and donation in Lebanon. Methods: A descriptive study was conducted in antenatal clinics in Beirut and data were collected using a questionnaire distributed to pregnant women after provision of informed consent. A total of 244 women responded. Results: Less than half of the women (46%) reported knowledge about cord blood banking. However, participants with university and secondary education had significantly higher odds of considering UCB storage compared to those with primary education (odds ratio (OR) 8.62, 95% confidence interval (CI) 2.74-27.15 and OR 21.23,95% CI 6.55-68.86, respectively). Older pregnant women were less likely to think about UCB stem cells storage (OR 0.92, 95% CI 0.85-0.98). Conclusion: Respondents who had an existing knowledge about UCB stem cells banking in general were more likely to consider storing UCB in blood banks if affordable (45.9%). Therefore, it is necessary to inform pregnant women about stem cell banking so that they can make the appropriate decisions for themselves.


Assuntos
Cordocentese/psicologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Obtenção de Tecidos e Órgãos , Adulto , Análise de Variância , Bancos de Sangue/métodos , Bancos de Sangue/normas , Distribuição de Qui-Quadrado , Cordocentese/métodos , Feminino , Humanos , Líbano/etnologia , Razão de Chances , Gravidez , Gestantes/etnologia , Gestantes/psicologia , Estatísticas não Paramétricas , Inquéritos e Questionários
9.
Diabetes Metab Syndr ; 13(3): 2033-2036, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31235132

RESUMO

BACKGROUND: Hyperlipidemia can be caused by abnormal elevation of lipids and lipoproteins in the blood. This increased can lead to heart disease. Risks which can be controlled include alcohol intake, physical activity, smoking, high blood pressure and genetic factors. Markers of increased cardiovascular risk appear to be lower in regular blood donor compared with single time donors as reflected by significantly lower total cholesterol and LDL levels. And it has been thought that there will be a direct relationship between lower risks of Heart diseases with repeated blood donation. AIM: The aim of the present study is to determine the effect of blood donation on single time and repeat donors by assessing their lipid levels and their family history of heart diseases. MATERIAL & METHODS: This cross-sectional study was carried out on (n = 80) random blood donors from the department of Transfusion Medicine KGMU. RESULTS: A significant correlation was found amongst hyperlipidemic level in single time donor & repeat donors and in donors with family history of heart diseases (p < 0.05). A positive association was found between hyperlipidemia with donor's weight (p < 0.05). CONCLUSION: Screening random donor platelets for hyperlipidemia and correlating the condition with other donor criteria like family history of heart diseases, types of donors, donors weight age and gender will help in making the patients safe as well as the donor deferral criteria more stringent to improve the quality of blood supply and will enable blood bankers to supply safe blood and improve the guidelines for blood safety.


Assuntos
Bancos de Sangue/normas , Doadores de Sangue/provisão & distribução , Segurança do Sangue , Transfusão de Sangue/normas , Seleção do Doador/métodos , Hiperlipidemias/fisiopatologia , Programas de Rastreamento , Adolescente , Adulto , Idoso , Transfusão de Sangue/estatística & dados numéricos , Estudos Transversais , Feminino , Seguimentos , Humanos , Hiperlipidemias/diagnóstico , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
10.
Transfus Med Rev ; 33(2): 84-91, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30930009

RESUMO

Transfusion-transmitted infections (TTIs) can be severe and result in death. Transfusion-transmitted viral pathogen transmission has been substantially reduced, whereas sepsis due to bacterial contamination of platelets and transfusion-transmitted babesiosis may occur more frequently. Quantifying the burden of TTI is important to develop targeted interventions. From January 1, 2010, to December 31, 2016, health care facilities participating in the National Healthcare Safety Network Hemovigilance Module monitored transfusion recipients for evidence of TTI and recorded the total number of units transfused. Facilities use standard criteria to report TTIs. Incidence rates of TTIs, including for bacterial contamination of platelets and transfusion-transmitted babesiosis, are presented. One hundred ninety-five facilities reported 111 TTIs and 7.9 million transfused components to the National Healthcare Safety Network Hemovigilance Module. Of these 111 reports, 54 met inclusion criteria. The most frequently reported pathogens were Babesia spp in RBCs (16/23, 70%) and Staphylococcus aureus in platelets (12/30, 40%). There were 1.95 (26 apheresis, 4 whole blood derived) TTIs per 100 000 transfused platelet units and 0.53 TTI per 100 000 transfused RBC components, compared to 0.68 TTI per 100 000 all transfused components. Bacterial contamination of platelets and transfusion-transmitted babesiosis were the most frequently reported TTIs. Interventions that reduce the burden of bacterial contamination of platelets, particularly collected by apheresis, and Babesia transmission through RBC transfusion would reduce transfusion recipient morbidity and mortality. These analyses demonstrate the value and importance of facility participation in national recipient hemovigilance using standard reporting criteria.


Assuntos
Babesiose/epidemiologia , Segurança do Sangue/normas , Transfusão de Sangue , Reação Transfusional/epidemiologia , Babesia , Babesiose/etiologia , Bancos de Sangue/normas , Remoção de Componentes Sanguíneos/efeitos adversos , Transfusão de Componentes Sanguíneos/efeitos adversos , Humanos , Transfusão de Plaquetas/efeitos adversos , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/etiologia , Staphylococcus aureus , Reação Transfusional/etiologia , Estados Unidos
11.
Transfusion ; 59(S2): 1446-1452, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30980744

RESUMO

The shift toward using a transfusion strategy in a ratio to mimic whole blood (WB) functionality has revitalized WB as a viable option to replace severe blood loss in civilian health care. A military-civilian collaboration has contributed to the reintroduction of WB at Haukeland University Hospital in Bergen, Norway. WB has logistical and hemostatic advantages in both the pre- and in-hospital settings where the goal is a perfectly timed balanced transfusion strategy. In this paper, we describe an event leading to activation of our emergency WB collection strategy for the first time. We evaluate the feasibility of our civilian walking blood bank (WBB) to cover the need of a massive amount of blood in an emergency situation. The challenges are discussed in relation to the different stages of the event with the recommendations for improvement in practice. We conclude that the use of pre-screened donors as a WBB in a civilian setting is feasible. The WBB can provide platelet containing blood components for balanced blood resuscitation in a clinically relevant time frame.


Assuntos
Bancos de Sangue , Doadores de Sangue , Segurança do Sangue , Seleção do Doador , Hospitais Militares , Medicina Militar , Bancos de Sangue/organização & administração , Bancos de Sangue/normas , Segurança do Sangue/métodos , Segurança do Sangue/normas , Seleção do Doador/organização & administração , Seleção do Doador/normas , Feminino , Hospitais Militares/organização & administração , Hospitais Militares/normas , Humanos , Masculino , Medicina Militar/métodos , Medicina Militar/organização & administração , Medicina Militar/normas , Noruega
12.
Transfusion ; 59(S2): 1429-1438, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30980748

RESUMO

BACKGROUND: Despite countless advancements in trauma care a survivability gap still exists in the prehospital setting. Military studies clearly identify hemorrhage as the leading cause of potentially survivable prehospital death. Shifting resuscitation from the hospital to the point of injury has shown great promise in decreasing mortality among the severely injured. MATERIALS AND METHODS: Our regional trauma network (Southwest Texas Regional Advisory Council) developed and implemented a multiphased approach toward facilitating remote damage control resuscitation. This approach required placing low-titer O+ whole blood (LTO+ WB) at helicopter emergency medical service bases, transitioning hospital-based trauma resuscitation from component therapy to the use of whole blood, modifying select ground-based units to carry and administer whole blood at the scene of an accident, and altering the practices of our blood bank to support our new initiative. In addition, we had to provide information and training to an entire large urban emergency medical system regarding changes in policy. RESULTS: Through a thorough, structured program we were able to successfully implement point-of-injury resuscitation with LTO+ WB. Preliminary evaluation of our first 25 patients has shown a marked decrease in mortality compared to our historic rate using component therapy or crystalloid solutions. Additionally, we have had zero transfusion reactions or seroconversions. CONCLUSION: Transfusion at the scene within minutes of injury has the potential to save lives. As our utilization expands to our outlying network we expect to see a continued decrease in mortality among significantly injured trauma patients.


Assuntos
Bancos de Sangue , Preservação de Sangue/normas , Transfusão de Sangue/normas , Redes Comunitárias , Serviços Médicos de Emergência , Hemorragia/terapia , Ressuscitação , Centros de Traumatologia , Sistema ABO de Grupos Sanguíneos , Bancos de Sangue/organização & administração , Bancos de Sangue/normas , Redes Comunitárias/organização & administração , Redes Comunitárias/normas , Soluções Cristaloides/administração & dosagem , Serviços Médicos de Emergência/organização & administração , Serviços Médicos de Emergência/normas , Feminino , Hemorragia/mortalidade , Humanos , Masculino , Texas , Centros de Traumatologia/organização & administração , Centros de Traumatologia/normas
13.
Transfusion ; 59(S2): 1453-1458, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30980750

RESUMO

BACKGROUND: Hemorrhage is the leading cause of death on the battlefield. Damage control resuscitation guidelines in the US military recommend whole blood as the preferred resuscitation product. The Armed Services Blood Program (ASBP) has initiated low-titer group O whole blood (LTOWB) production and predeployment donor screening to make whole blood more available to military forces. STUDY DESIGN AND METHODS: ASBP donor centers updated procedures and labeling for LTOWB production. Donors are screened according to US Food and Drug Administration regulations and standard operating procedures. Group O donors are tested for anti-A and anti-B titer levels. Additionally, military personnel notified for pending deployment coordinate with their local ASBP donor center to complete whole blood donor prescreening. The process consists of completing a donor history questionnaire, processing of blood samples for blood group and infectious disease testing, and titer determination for group O personnel. RESULTS: Since March 2016, 7940 LTOWB units have been manufactured at ASBP donor centers and shipped in support of combat operations. Additionally, ASBP donor centers have screened several thousand service members before deployment. From these screenings, the donor low titer rate was 68% and infectious disease reactive test rate was extremely low (≤0.004). CONCLUSION: Whole blood is now the preferred blood product for resuscitation of combat trauma patients. The ASBP partnered with combat forces to screen personnel before deployment. Additionally, LTOWB is manufactured and shipped in support of combat operations. These efforts are expanding the availability of LTOWB for the warfighter.


Assuntos
Sistema ABO de Grupos Sanguíneos , Doadores de Sangue , Transfusão de Sangue/métodos , Medicina Militar , Militares , Ressuscitação/métodos , Bancos de Sangue/organização & administração , Bancos de Sangue/normas , Seleção do Doador/métodos , Seleção do Doador/organização & administração , Seleção do Doador/normas , Feminino , Humanos , Masculino , Medicina Militar/métodos , Medicina Militar/organização & administração , Medicina Militar/normas , Estados Unidos
14.
Vox Sang ; 114(4): 310-316, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30854673

RESUMO

BACKGROUND: In June 2017, Israel lifted the ban on blood donations from men who have sex with men (MSM) and accepts donations if 12 months have passed since the last sexual contact. Recently, the National Blood Services suggested a novel approach that involves acceptance of MSM blood donations without deferral, keeping solely the frozen plasma in quarantine and releasing it for transfusion if a subsequent donation, at least 4 months later, is found negative for transfusion-transmitted agents. In this study, we examined the attitudes and perceptions of MSM to the new Frozen Plasma Quarantine Policy (FPQP). METHOD: A survey was published on gay-oriented websites, collecting anonymous demographic data, history of blood donations and attitudes towards the new policy. RESULTS: We analysed responses from 1233 MSM. Of these, 13·4% had donated blood at least once during the previous year, almost all of them (89·7%) not complying with the current 12-month deferral. Most respondents (64·5%) supported the suggested new approach and would consider donating blood if it were introduced. Of MSM who had donated blood in the previous year, 85% stated they would agree to reveal their sexual practice in the donor health questionnaire (DHQ) in order to be included in the programme, compared with 8·5% under the current 12-month deferral policy. CONCLUSION: The suggested Plasma Quarantine Policy may be more acceptable to MSM than a 12-month deferral and increase their compliance with the blood services policy. This and retesting of donors may increase blood safety.


Assuntos
Atitude Frente a Saúde , Bancos de Sangue/legislação & jurisprudência , Bancos de Sangue/normas , Doadores de Sangue/psicologia , Segurança do Sangue/normas , Seleção do Doador/normas , Homossexualidade Masculina/psicologia , Adolescente , Adulto , Idoso , Bancos de Sangue/métodos , Transfusão de Sangue , Criopreservação , Seleção do Doador/métodos , Infecções por HIV , Humanos , Internet , Israel , Masculino , Pessoa de Meia-Idade , Comportamento Sexual , Minorias Sexuais e de Gênero , Inquéritos e Questionários , Adulto Jovem
15.
Vox Sang ; 114(4): 317-324, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30883806

RESUMO

BACKGROUND AND OBJECTIVES: The role of pre-donation blood pressure (BP) as independent contributor to post-donation vasovagal reactions (VVRs) is still debated. Differences between a liberal (i.e., inclusion of hypotensive donors) and a restrictive policy (i.e., not accepting hypotensive donors) should be investigated. This study aims to investigate the consequences of a liberal policy in development of VVRs after whole-blood donations. MATERIALS AND METHODS: We compared the incidence of VVRs between 2015 (restrictive policy) and 2016 (liberal policy) and the associated risk factors. We evaluated respectively 22 789 vs. 21 676 blood donations obtained from 18 001 blood donors (12 501 donated in both years). RESULTS: Comparing the results we obtained between 2015 and 2016, donations showed an overlap of the cohorts. Two hundred fifteen VVRs (incidence rate 0·48%) were observed, 104 (0·46%) of which in 2015, and 111 (0·51%) in 2016. A preliminary univariate analysis showed that donors with systolic BP <110 mm Hg had a two-fold risk of VVRs compared to normotensive donors (VVR/donation rate of 0·99% vs. 0·46%; P = 0·001). The subsequent multivariable logistic regression model showed that VVRs were highly associated with weight, site of collection, age and number of donations, excluding a role for systolic and diastolic BP. CONCLUSION: A liberal pre-donation BP policy seems to be safe for blood donors. Our analysis confirms that older donors with higher body-weight who already had donated blood are unlikely to experience VVRs.


Assuntos
Bancos de Sangue/legislação & jurisprudência , Bancos de Sangue/normas , Doadores de Sangue , Pressão Sanguínea , Seleção do Doador/normas , Síncope Vasovagal/etiologia , Síncope Vasovagal/terapia , Adolescente , Adulto , Idoso , Transfusão de Sangue , Seleção do Doador/métodos , Feminino , Humanos , Hipotensão/etiologia , Incidência , Itália , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Sístole , Adulto Jovem
16.
Vox Sang ; 114(4): 340-348, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30838664

RESUMO

BACKGROUND AND OBJECTIVES: Paediatric blood transfusion for severe anaemia in hospitals in sub-Saharan Africa remains common. Yet, reports describing the haematological quality of donor blood or storage duration in routine practice are very limited. Both factors are likely to affect transfusion outcomes. MATERIALS AND METHODS: We undertook three audits examining the distribution of pack types, haematological quality and storage duration of donor blood used in a paediatric clinical trial of blood at four hospitals in Africa (Uganda and Malawi). RESULTS: The overall distribution of whole blood, packed cells (plasma-reduced by centrifugation) and red cell concentrates (RCC) (plasma-reduced by gravity-dependent sedimentation) used in a randomised trial was 40·7% (N = 1215), 22·4% (N = 669) and 36·8% (N = 1099), respectively. The first audit found similar median haematocrits of 57·0% (50·0,74·0), 64·0% (52·0,72·5; P = 0·238 vs. whole blood) and 56·0% (48·0,67·0; P = 0·462) in whole blood, RCC and packed cells, respectively, which resulted from unclear pack labelling by blood transfusion services (BTS). Re-training of the BTS, hospital blood banks and clinical teams led to, in subsequent audits, significant differences in median haematocrit and haemoglobins across the three pack types and values within expected ranges. Median storage duration time was 12 days (IQR: 6, 19) with 18·2% (537/2964) over 21 days in storage. Initially, 9 (2·8%) packs were issued past the recommended duration of storage, dropping to 0·3% (N = 7) in the third audit post-training. CONCLUSION: The study highlights the importance of close interactions and education between BTS and clinical services and the importance of haemovigilance to ensure safe transfusion practice.


Assuntos
Anemia/terapia , Bancos de Sangue/normas , Doadores de Sangue , Transfusão de Sangue/métodos , Controle de Qualidade , Anemia/sangue , Criança , Hematócrito , Hematologia/normas , Hemoglobinas , Hospitais , Humanos , Malaui , Pediatria/métodos , Garantia da Qualidade dos Cuidados de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Refrigeração , Reprodutibilidade dos Testes , Manejo de Espécimes , Uganda
17.
Vox Sang ; 114(3): 247-255, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30861146

RESUMO

BACKGROUND AND OBJECTIVES: Blood is a critical resource for responding to mass casualty incidents (MCI). The main framework for transfusion preparedness is the American Association of Blood Bank (AABB) Disaster Operation Handbook. A disaster preparedness plan for co-ordinated blood supply was issued in Italy in 2016. AIM: To assess the level of preparedness of the Transfusion Centers (TS) in the Piedmont region, to evaluate the applicability of AABB checklist and to evaluate the application of the Italian plan. MATERIALS AND METHODS: We surveyed all the Regional Transfusion Centers (TS) using the AABB checklist, addressing 74 priority action items grouped according to 16 preparedness domains. The Italian 2016 plan has been considered the regulatory cut-off and hospitals were stratified based on the type and the TS workload. A principal component analysis (PCA) was conducted to summarize the variance among centres. RESULTS: Twenty-one out of 25 TS agreed to participate. Eighty-one % were at high and 18% were at medium level of preparedness. All but two centres were above the cut-off determined by the Italian law. A significant better preparedness was found in medium size hospitals compared to bigger and smaller hospitals. Other than that, the different TS showed a quite homogeneous distribution of preparedness variance. CONCLUSIONS: This study demonstrated a good level of preparedness in the Piemonte TS, above the Italian law requirements in the majority of TS. The AABB checklist could be used to highlight gaps and needs in the regional TS networks in case of emergency crisis.


Assuntos
Bancos de Sangue/normas , Defesa Civil/normas , Planejamento em Desastres/normas , Incidentes com Feridos em Massa , Bancos de Sangue/estatística & dados numéricos , Defesa Civil/estatística & dados numéricos , Planejamento em Desastres/estatística & dados numéricos , Utilização de Instalações e Serviços , Humanos , Itália , Inquéritos e Questionários
18.
Vox Sang ; 114(4): 394-396, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30820949

RESUMO

Human immuno virus screening assays have improved in sensitivity over the last 20 years and our data demonstrates that there is no evidence of missed HIV positive window period donations since the introduction of pooled HIV NAT screening. Here we recommend that extensive lookback investigations are not routinely required if the most recent negative donation is negative on individual sample HIV PCR testing.


Assuntos
Bancos de Sangue/normas , Doadores de Sangue , Segurança do Sangue/normas , Seleção do Doador/métodos , Infecções por HIV/sangue , Infecções por HIV/diagnóstico , Segurança do Sangue/métodos , Transfusão de Sangue/métodos , Transfusão de Sangue/normas , Inglaterra , Soropositividade para HIV/sangue , Humanos , Técnicas de Amplificação de Ácido Nucleico , Reação em Cadeia da Polimerase , Reprodutibilidade dos Testes , País de Gales
20.
Obstet Gynecol ; 133(3): e249-e253, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30801478

RESUMO

Since the first successful umbilical cord blood transplant in 1988, it has been estimated that more than 35,000 transplants have been performed in children and adults for the correction of inborn errors of metabolism, hematopoietic malignancies, and genetic disorders of the blood and immune system. Two types of banks have emerged for the collection and storage of umbilical cord blood: 1) public banks and 2) private banks. The benefits and limitations of public versus private umbilical cord blood banking should be reviewed with the patient because they serve different purposes. This patient discussion also should include the concept of autologous and allogeneic use of umbilical cord blood. Umbilical cord blood collected from a neonate cannot be used to treat a genetic disease or malignancy in that same individual (autologous transplant) because stored cord blood contains the same genetic variant or premalignant cells that led to the condition being treated. There is no current evidence to support the use of an autologous umbilical cord blood sample in regenerative medicine. Patients should be made aware of the quality control and regulatory organizations that provide oversight for the process of umbilical cord collection and storage. Umbilical cord blood collection should not compromise obstetric or neonatal care or alter routine practice of delayed umbilical cord clamping with the rare exception of medical indications for directed donation. Therefore, it is important to inform patients that the medical condition of the woman or neonate may prevent adequate umbilical cord blood collection. This document is updated with a statement that the routine use of private cord blood banking is not supported by available evidence and that public banking is the recommended method of obtaining cord blood. In addition, the importance of contribution from all ethnicities and races to public banks is highlighted.


Assuntos
Bancos de Sangue/normas , Sangue Fetal , Bancos de Sangue/classificação , Humanos , Recém-Nascido
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