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3.
Vox Sang ; 115(6): 536-542, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32384164
8.
Transfusion ; 60(5): 897-907, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32319687

RESUMO

In the United States, postpartum hemorrhage (PPH) accounts for 4.6% of all maternal deaths and is responsible for major peripartum medical and surgical morbidity. Therefore, a national health priority is to ensure that women who experience severe PPH receive timely, appropriate, and effective treatment. In this article, we describe our system-wide approach for the planning and delivery of women with suspected placenta accreta spectrum disorder, a condition associated with life-threatening blood loss at the time of delivery. We also highlight current evidence related to transfusion decision making and hemostatic monitoring during active postpartum bleeding. Specifically, we describe how we activate and use the massive transfusion protocol to obtain sufficient volumes and types of blood products. We also describe how we use viscoelastic monitoring (thromboelastography) and standard laboratory tests to assess the maternal coagulation profile. Finally, we review the findings of recent studies examining the potential efficacy of tranexamic acid and fibrinogen concentrate as adjuncts for PPH prevention and treatment. We describe how we have incorporated these drugs into PPH treatment protocols at our institution.


Assuntos
Hemorragia Pós-Parto/terapia , Testes de Coagulação Sanguínea , Transfusão de Sangue/métodos , Transfusão de Sangue/normas , Feminino , Hemostáticos/uso terapêutico , Humanos , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Período Pós-Parto , Gravidez , Fatores de Risco , Índice de Gravidade de Doença , Tromboelastografia
10.
Transfusion ; 60(4): 786-798, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32104927

RESUMO

BACKGROUND: Blood transfusion is a lifesaving intervention for millions of recipients worldwide every year. Storing blood makes this possible but also promotes a series of alterations to the metabolism of the stored erythrocyte. It is unclear whether the metabolic storage lesion is correlated with clinically relevant outcomes and whether strategies aimed at improving the metabolic quality of stored units, such as hypoxic storage, ultimately improve performance in the transfused recipient. STUDY DESIGN AND METHODS: Twelve healthy donor volunteers were recruited in a two-arm cross-sectional study, in which each subject donated 2 units to be stored under standard (normoxic) or hypoxic conditions (Hemanext technology). End-of-storage measurements of hemolysis and autologous posttransfusion recovery (PTR) were correlated to metabolomics measurements at Days 0, 21, and 42. RESULTS: Hypoxic red blood cells (RBCs) showed superior PTR and comparable hemolysis to donor-paired standard units. Hypoxic storage improved energy and redox metabolism (glycolysis and 2,3-diphosphoglycerate), improved glutathione and methionine homeostasis, decreased purine oxidation and membrane lipid remodeling (free fatty acid levels, unsaturation and hydroxylation, acyl-carnitines). Intra- and extracellular metabolites in these pathways (including some dietary purines) showed significant correlations with PTR and hemolysis, though the degree of correlation was influenced by sulfur dioxide (SO2 ) levels. CONCLUSION: Hypoxic storage improves energy and redox metabolism of stored RBCs, which results in improved posttransfusion recoveries in healthy autologous recipients-a Food and Drug Administration gold standard of stored blood quality. In addition, we identified candidate metabolic predictors of PTR for RBCs stored under standard and hypoxic conditions.


Assuntos
Preservação de Sangue/métodos , Eritrócitos/metabolismo , Hipóxia , Adulto , Doadores de Sangue , Preservação de Sangue/normas , Transfusão de Sangue/normas , Estudos Transversais , Feminino , Voluntários Saudáveis , Hemólise , Humanos , Masculino , Recuperação de Função Fisiológica , Transplante Autólogo
11.
Am Surg ; 86(1): 35-41, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-32077414

RESUMO

A massive transfusion protocol (MTP) was implemented at a Level I trauma center in 2007 for patients with massive blood loss. A goal ratio of plasma to pheresed platelets to packed red blood cells (PRBCs) of 1:1:1 was established. From 2007 to 2014, trauma nurse clinicians (TNCs) administered the MTP during initial resuscitation and anesthesia personnel administered the MTP intraoperatively. In 2015, TNCs began administering the MTP intraoperatively. This study evaluates intraoperative blood product ratios and crystalloid volume administered by anesthesia personnel or TNCs. A retrospective review of trauma registry patients requiring MTP from 2007 to 2017 was performed. Patient data were stratified according to MTP administration by either anesthesia personnel (2007-2015) or TNCs (2015-2017). Ninety-seven patients were included with 54 anesthesia patients and 44 TNC patients. Patients undergoing resuscitation by MTP administered by TNCs received less median crystalloid (3000 mL vs 1500 mL, P < 0.001). The ratio of plasma:PRBC (0.75 vs 0.93, P = 0.027) and platelets:PRBC (0.75 vs 1.04, P = 0.003) was found to be significantly closer to 1:1 for TNC patients. MTP intraoperative blood product administration by TNCs reduced the amount of infused crystalloid and improved adherence to MTP in achieving a 1:1:1 ratio of blood products.


Assuntos
Transfusão de Sangue/normas , Hemorragia/enfermagem , Cuidados Intraoperatórios , Enfermeiras Clínicas , Ressuscitação/enfermagem , Ferimentos e Lesões/cirurgia , Adulto , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Sistema de Registros , Estudos Retrospectivos , Centros de Traumatologia
12.
BMJ Open Qual ; 9(1)2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31986114

RESUMO

BACKGROUND: Transfusion is a common procedure for neonates receiving intensive care management. Recognising a paucity of patient blood management (PBM) programmes in neonates, we aimed to embed blood management and best transfusion principles in the neonatal intensive care unit (NICU) by aligning local policies, providing targeted education and partnering with parents. METHODS: Practice-based evidence for clinical practice improvement (PBE-CPI) methodology was used. Previous hospital accreditation audits were reviewed and a neonate-specific transfusion audit was developed. Audit was performed at baseline and repeated following the intervention period. NICU clinicians received targeted education in obtaining informed consent, prescription and safe administration of blood components during a 'Blood Month' awareness period. A neonate-specific parent handout about transfusion was developed in partnership with parents. A pilot video demonstrating a shared consent discussion was also developed to assist in the consent process. Parents' knowledge, concerns and feedback regarding transfusion practice was sought at baseline (survey) and on project completion (experience trackers). RESULTS: Neonate-specific baseline transfusion audit showed inconsistent consent, monitoring and documentation processes in neonatal transfusions. Post-targeted education audit showed improvement in these parameters. The targeted PBM and transfusion-related education delivered during 'Blood Month' was well-received by staff. Parents' feedback about the NICU transfusion consenting process was consistently positive. NICU medical and nursing clinicians (n=25) surveyed agreed that the parent handout was well set out, easy to understand and recommended that it be used to complement practice. CONCLUSION: PBE-CPI tools aligned with Australian PBM guidelines for clinicians and parents were well-accepted by clinical stakeholders and were associated with practice improvement in PBM awareness and transfusion consent processes. This PBE-CPI project developed NICU-specific consent information, not previously available, by partnering with parents to ensure quality of care in transfusion practice. Adoption of this also helps to meet accreditation for Australian Blood Management Standards. These strategies and tools translate readily into other NICUs to embed and support best PBM and transfusion practice.


Assuntos
Transfusão de Sangue/normas , Prática Clínica Baseada em Evidências/normas , Unidades de Terapia Intensiva Neonatal , Terapia Intensiva Neonatal/normas , Austrália , Pessoal de Saúde/educação , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Consentimento Livre e Esclarecido/normas , Pais/educação , Inquéritos e Questionários
13.
Vox Sang ; 115(1): 60-71, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31709562

RESUMO

BACKGROUND AND OBJECTIVES: Patient Blood Management (PBM) aims to optimize the care of patients who might need a blood transfusion. The International Consensus Conference on PBM (ICC-PBM) aimed to develop evidence-based recommendations on three topics: preoperative anaemia, red blood cell transfusion thresholds and implementation of PBM programmes. This paper reports how evidence-based methodologies and technologies were used to enhance shared decision-making in formulating recommendations during the ICC-PBM. MATERIALS & METHODS: Systematic reviews on 17 PICO (Population, Intervention, Comparison, Outcomes) questions were conducted by a Scientific Committee (22 international topic experts and one methodologist) according to GRADE (Grades of Recommendation, Assessment, Development and Evaluation) methodology. Evidence-based recommendations were formulated using Consensus Development Conference methodology. RESULTS: We screened 17 607 references and included 145 studies. The overall certainty in the evidence of effect estimates was generally low or very low. During the ICC, plenary sessions (100-200 stakeholders from a range of clinical disciplines and community representatives) were followed by closed sessions where multidisciplinary decision-making panels (>50 experts and patient organizations) formulated recommendations. Two chairs (content-expert and methodologist) moderated each session and two rapporteurs documented the discussions. The Evidence-to-Decision template (GRADEpro software) was used as the central basis in the process of formulating recommendations. CONCLUSION: This ICC-PBM resulted in 10 clinical and 12 research recommendations supported by an international stakeholder group of experts in blood transfusion. Systematic, rigorous and transparent evidence-based methodology in a formal consensus format should be the new standard to evaluate (cost-) effectiveness of medical treatments, such as blood transfusion.


Assuntos
Anemia/terapia , Transfusão de Sangue/normas , Transfusão de Eritrócitos/normas , Humanos
14.
Prehosp Disaster Med ; 35(1): 98-103, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31847923

RESUMO

INTRODUCTION: In October 2017, the American Association of Blood Bankers (AABB; Bethesda, Maryland USA) approved a petition to allow low-titer group O whole blood as a standard product without the need for a waiver. Around that time, a few Texas, USA-based Emergency Medical Services (EMS) systems incorporated whole blood into their ground ambulances. The purpose of this project was to describe the epidemiology of ground ambulance patients that received a prehospital whole blood transfusion. The secondary aim of this project was to report an accounting analysis of these ground ambulance prehospital whole blood programs. METHODS: The dataset came from the Harris County Emergency Service District 48 Fire Department (HCESD 48; Harris County, Texas USA) and San Antonio Fire Department (SAFD; San Antonio, Texas USA) whole blood Quality Assurance/Quality Improvement (QA/QI) databases from September 2017 through December 2018. The primary outcome of this study was the prehospital transfusion indication. The secondary outcome was the projected cost per life saved during the first 10 years of the prehospital whole blood initiative. RESULTS: Of 58 consecutive prehospital whole blood administrations, the team included all 58 cases. Hemorrhagic shock from a non-traumatic etiology accounted for 46.5% (95% CI, 34.3%-59.2%) of prehospital whole blood recipients. In the non-traumatic hemorrhagic shock cohort, gastrointestinal hemorrhage was the underlying etiology of hemorrhagic shock in 66.7% (95% CI, 47.8%-81.4%) of prehospital whole blood transfusion recipients. The projected average cost to save a life in Year 10 was US$5,136.51 for the combined cohort, US$4,512.69 for HCESD 48, and US$5,243.72 for SAFD EMS. CONCLUSION: This retrospective analysis of ground ambulance patients that receive prehospital whole blood transfusion found that non-traumatic etiology accounted for 46.5% (95% CI, 34.3%-59.2%) of prehospital whole blood recipients. Additionally, the accounting analysis suggests that by Year 10 of a ground ambulance whole blood transfusion program, the average cost to save a life will be approximately US$5,136.51.


Assuntos
Ambulâncias/estatística & dados numéricos , Transfusão de Sangue/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde , Choque Hemorrágico/epidemiologia , Adulto , Ambulâncias/normas , Transfusão de Sangue/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Choque Hemorrágico/terapia , Texas/epidemiologia
15.
Pan Afr Med J ; 34: 31, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31762899

RESUMO

Introduction: Unsafe transfusion practices can put millions of people at risk of Transfusion Transmissible Infections (TTIs). In Kenya the current blood transfusion scheme involves screening of blood for HIV, Hepatitis B virus (HBV), Hepatitis C virus (HCV) and syphilis. Malaria is also a blood-borne disease which is not currently screened for. In Kenya blood donor selection criteria were reviewed in 2009. Regular review of effectiveness of donor selection criteria can help reduce TTIs prevalence amongst donors and thus make the blood supply safer. Methods: A cross sectional study was conducted between November 2011 to January 2012 among 594 blood donors in the Regional Blood Transfusion Center Nakuru and Tenwek Mission Hospital. Socio-demographic characteristics and associated risk factors were collected using a standard blood transfusion service questionnaire. Donors were obtained through systematic sampling. Each donor sample was screened, for HIV-1 and HIV-2, HBV, HCV, syphilis and malaria parasites. Results: The overall prevalence of TTIs was 14.1%, which ranged from 0.7% for malaria to 5.6% for HBsAg. Blood donors who were married (P=0.0057), had non-formal or just primary education (P=0.0262), had multiple sexual partners (P=0.0144) and in informal occupation (P=0.0176) were at higher risk of HIV positivity. History of blood transfusion/blood products (P=0.0055), being married (P=0.0053) were high risk factors associated with positive syphilis. Being male (P=0.0479) was a high risk factor to HBV infection. Conclusion: The prevalence of TTIs indicates a need to review the questionnaire and apply it strictly for donor selection. The 0.7% prevalence of malaria, poses a serious health risk to non-immune recipients of transfusion. Malaria should be included among mandatory TTI tests in Kenya.


Assuntos
Doadores de Sangue/estatística & dados numéricos , Transfusão de Sangue/normas , Seleção do Doador/métodos , Reação Transfusional/epidemiologia , Adolescente , Adulto , Segurança do Sangue , Estudos Transversais , Feminino , Humanos , Quênia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores Sexuais , Inquéritos e Questionários , Adulto Jovem
16.
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
17.
Clin Orthop Surg ; 11(3): 265-269, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31475045

RESUMO

Background: Hip fracture surgery (HFS) is often associated with perioperative blood loss, and it frequently necessitates transfusion. However, the hemoglobin (Hb) threshold for transfusion remains controversial in hip fracture patients. We evaluated the usefulness of the restrictive strategy and preoperative intravenous iron supplementation in HFS. Methods: We retrospectively reviewed the medical records of 1,634 patients (> 60 years of age) who underwent HFS between May 2003 and June 2014 and were followed up for 1 year or more after surgery. We used the liberal transfusion strategy until May 2009 to determine the transfusion threshold; afterwards, we switched to the restrictive transfusion strategy. Patients with the restrictive transfusion strategy (restrictive group) received intravenous iron supplementation before surgery. We compared the transfusion rate, morbidity, and mortality of the restrictive group with those of the patients with the liberal transfusion strategy (liberal group). Results: Preoperative intravenous iron supplementation was not associated with any adverse reactions. The transfusion rate was 65.3% (506/775) in the liberal group and 48.2% (414/859) in the restrictive group (p < 0.001). The mean hospital stay was shorter in the restrictive group (21.5 vs. 28.8 days, p < 0.001). There was no significant difference in the postoperative medical complications including myocardial infarction and cerebrovascular event. Mortality at postoperative 30, 60, and 90 days was similar between the two groups. Conclusions: Our blood management protocol involving restrictive strategy combined with preoperative intravenous iron supplementation appears to be effective and safe in HFS of elderly patients.


Assuntos
Anemia/terapia , Transfusão de Sangue/normas , Fraturas do Quadril/cirurgia , Compostos de Ferro/administração & dosagem , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Anemia/etiologia , Perda Sanguínea Cirúrgica , Suplementos Nutricionais , Feminino , Hemoglobinas/análise , Fraturas do Quadril/sangue , Humanos , Masculino , Procedimentos Ortopédicos , Hemorragia Pós-Operatória/terapia , Cuidados Pré-Operatórios , Estudos Retrospectivos
18.
J Trauma Nurs ; 26(5): 234-238, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31503194

RESUMO

Massive transfusion protocols are part of damage control resuscitation for hemorrhaging trauma patients with the goal of returning the patient to hemodynamic stability. It is essential that patients receive blood products immediately and in the proper ratios. At our metropolitan Level 1 trauma center, we identified several challenges to deploying massive transfusion rapidly and within the recommended ratio guidelines. In 2016, we implemented a quality improvement project addressing 4 opportunities: fresh frozen plasma (FFP) bag breakage, plasma options, blood bank equipment, and multidisciplinary policy revision. Implementing packaging and shipping improvements, utilization of new products, and updating protocols have resulted in a 50% decrease in FFP bag breakage rates, a dramatic decrease in time for patients receiving massive transfusion to receive plasma products (mean time 3.5 min), and patients being administered the recommended ratio of blood products.


Assuntos
Transfusão de Sangue/normas , Hemorragia/terapia , Avaliação de Resultados em Cuidados de Saúde , Plasma , Padrões de Prática em Enfermagem/normas , Ferimentos e Lesões/terapia , Colorado , Esquema de Medicação , Hemorragia/enfermagem , Humanos , Ressuscitação/normas , Fatores de Tempo , Centros de Traumatologia , Ferimentos e Lesões/enfermagem
19.
Vox Sang ; 114(8): 853-860, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31489645

RESUMO

BACKGROUND: Management of major gastrointestinal bleeding (GIB) may require massive transfusion (MT), but limited data are available. Upper and lower GIB have different aetiologies, prognosis, bleeding patterns and outcomes. Better understanding of current transfusion management and outcomes in these patients is important. We sought to define and validate an algorithm based on clinical coding data to distinguish critical upper and lower GIB using data from the Australian and New Zealand Massive Transfusion Registry (ANZ-MTR). STUDY DESIGN AND METHODS: Australian and New Zealand Massive Transfusion Registry hospital-source data on adult patients receiving a MT (defined as ≥5 red cell units within 4 h) for any bleeding context were used. An algorithm allocating ICD-10-AM codes into 'probable' or 'possible' causes of GIB was developed and applied to the ANZ-MTR. Source medical records of 69 randomly selected cases were independently reviewed to validate the algorithm. RESULTS: Of 5482 MT cases available from 25 hospitals, 716 (13%) were identified as GIB with 538/716 (75%) categorized 'probable' and 178/716 'possible' GIB. Upper and lower GIB causes of MT were identified for 455/538 (85%) and 76/538 (14%) 'probable' cases, respectively; 7/538 (1·3%) cases had both upper and lower GIB. Allocation by the algorithm into a 'probable' GIB category had a 95·7% (CI: 90-100%) positive predictive value when validated against source medical records. CONCLUSION: An algorithm based on ICD-10-AM codes can be used to accurately categorize patients with luminal GIB as the primary reason for MT, enabling further study of this critically unwell and resource-intensive cohort of patients.


Assuntos
Transfusão de Sangue/normas , Codificação Clínica/métodos , Hemorragia Gastrointestinal/classificação , Sistema de Registros , Adulto , Idoso , Algoritmos , Austrália , Codificação Clínica/normas , Estudos de Coortes , Feminino , Hemorragia Gastrointestinal/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Estudos Retrospectivos
20.
Inquiry ; 56: 46958019870943, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31517552

RESUMO

The aim of this study was to evaluate blood transfusion services (BTS) at the main blood banks (BBs) of the Sana'a Capital. The 4 main BBs at Sana'a Capital were evaluated according to the safe World Health Organization BTS standards. Qualitative and quantitative data were collected using semi-structured questionnaires covering 6 components: activities, quality assurance system (QAS) and training, donation, grouping and compatibility testing, components, and screening for transfusion-transmitted infections (TTIs). An overall mean percent score for BTS was calculated where <60% is considered unsatisfactory, 60% to 79.9% satisfactory, and ≥80% highly satisfactory. The 4 BBs screen for HIV, hepatitis B, and hepatitis C and perform all functions except therapeutic transfusion. While 75% of the staff in BBs had received training in biosafety and half of the staff had received training in Standard Operating Procedures (SOPs), no QAS in place at any of the 4 BBs. The 4 BBs depended on 71% of their transfusions on family donors. Two BBs do not perform reverse grouping and do not keep patient/donor samples for the required minimum 5 days. Only one BB achieved an overall high satisfactory score and one achieved a satisfactory score. Findings highlight the increasing challenges facing BTS in Sana'a Capital especially the lack of therapeutic transfusion, poor QAS, and predominant dependence on the family donors. Therefore, there is a need to develop and train staff on QAS and to increase awareness among public on importance of voluntary donation. A wider scale evaluation of BTS in Sana'a is recommended.


Assuntos
Bancos de Sangue/normas , Transfusão de Sangue/normas , Garantia da Qualidade dos Cuidados de Saúde/normas , Transfusão de Sangue/tendências , Pessoal de Saúde/educação , Humanos , Inquéritos e Questionários , Iêmen
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