Maximum surgical blood ordering schedule for elective surgical procedures in Omdurman teaching hospital, Sudan.

BACKGROUND: The need for blood during a surgical procedure is greater than what blood banks are able to provide. There is an excessive amount of blood being ordered for elective surgeries, surpassing the actual requirements. Only 30% of the cross matched blood is actually used in these surgeries. The accuracy of estimating the transfusion needs before a surgical procedure can be determined by looking at the cross match to transfusion ratio and the transfusion index. "These indicators play a crucial role in developing the maximum surgical blood ordering schedule; in this study, these indicators were tested." AIM OF STUDY: Is to determine the efficiency of blood ordering and transfusion practices for patients undergoing elective surgeries. METHODS: This study is a prospective cross-sectional hospital-based study done at Omdurman Teaching Hospital-Sudan. Conducted for the duration of 6 months period from July to December 2019.The study participants were patients who underwent elective surgical procedures in general surgery and Urology departments as total coverage sample over a period of study duration. Ethical clearance obtained from ethical committee of Sudan Medical Specialization Board. RESULTS: Two hundreds seven patients included in this study, the amount of blood units requested were 443-unit, cross matching for 98.6% (n 437) of units were done. Only 100 unit were Transfused (22,8%). The calculated CT ratio was 4.4, transfusion index was 1.6 and transfusion probability was 29.9%. CONCLUSION: Transfusion probability and transfusion index of the present study were optimal but comparatively higher than the standard guidelines as most of the cross matched blood was not utilized.

Current state of transfusion practices for ABO-incompatible pediatric heart transplant patients in the United States and Canada.

BACKGROUND: ABO compatibility restriction on solid organ transplantation limits organ availability. In an effort to increase organ availability, pediatric ABO-incompatible heart transplants (ABOiHT) are now performed with similar outcomes to ABO-compatible transplants. Transfusion support can be challenging and currently there are no standard guidelines for blood product support, ABO isohemagglutinin (IH) titer cutoffs for transplant eligibility, or therapeutic intervention for these patients. The study aim was to survey current blood bank and antibody reduction practices for pediatric ABOiHT in the United States and Canada. STUDY DESIGN AND METHODS: A Web-based survey was sent to 50 US and Canadian pediatric blood bank directors. Participants were queried regarding pre-, intra-, and postoperative blood product support; ABO IH titer testing; and antibody reduction practices in ABOiHT recipients. RESULTS: We analyzed 21 responses from US and Canadian centers that perform pediatric ABOiHT. There is wide variation in the type of blood products transfused and the modification of these products among respondents in the pre-, intra-, and postoperative settings. The frequency of testing ABO IH titers, implementing therapeutic intervention, and the type of therapeutic intervention also vary greatly among the institutions. CONCLUSION: Transfusion support of children with ABOiHT varies widely among blood banks in the United States and Canada. The choice of blood products and modifications utilized, titer thresholds for organ selection and medical decision points, and antibody reduction strategies are not standardized from center to center. As pediatric ABOiHTs become more common, a better understanding of optimal transfusion support and therapeutic intervention is needed.

Anti-D reagents should be chosen accordingly to the prevalence of D variants in the obstetric population.

BACKGROUND: Resolving ambiguous results of D antigen typing is crucial for appropriate and rational administration of anti-D immunoprophylaxis and transfusion practice in obstetric population. The aim of the study was to establish selection criteria of anti-D reagents for our population. METHODS: A total of 12 689 samples from primiparous women in Split-Dalmatia County, Croatia, were typed for RhD antigen during the period of 5 years. Ambiguous results were submitted to additional serologic investigation and genotyping. RHD genotyping was performed by commercial genotyping kits (Ready Gene weak D ® and Ready gene CDE, Inno-Train, Kronberg, Germany). Relative frequencies and accompanying 95% confidence intervals were used to estimate the prevalence of variants. RESULTS: The prevalence of D variants was 0.42% (95% CI 0.31; 0.53). The most common partial D variant was D Va (RHD*05.05), with the prevalence of 0.08% (95% CI 0.03; 0.13). All weak D variants were weak D types 1, 2 and 3 (RHD*weak D type 1, RHD*weak D type 2, RHD*weak D type 3). Weak D samples were distinguishable from partial D in routine typing due to the difference in reactivity of partial D samples with clones D7B8 and RUM-1. Cell line RUM-1 gives weak or negative reactions with partial DVa category. CONCLUSION: The most common partial D variant in our population is DVa. It is recommended to use cell lines which do not strongly agglutinate DVa variant in routine RhD typing. The appropriate choice of reagents will enable the serology methods to recognize the cases in which RHD genotyping is required.

Saving Blood and Reducing Costs: Updating Blood Transfusion Practice in Lower Limb Arthroplasty

Aim Our aim was to quantify blood transfusion rates in lower limb arthroplasty following the introduction of a multimodal enhanced recovery programme (ERP). We then sought to update the maximum surgical blood ordering schedule (MSBOS) and calculate cost savings achieved. Methods A retrospective cohort study was conducted of all patients who required blood transfusion following primary and revision total hip and knee arthroplasty in 2012 and 2015. A multimodal ERP was introduced in 2015. Cost savings were calculated following the introduction of a new MSBOS. Results During the two-year study period 1467 lower limb arthroplasty procedures were performed. The cross-match to transfusion ratio was 3.6:1 in 2012 and 9.9:1 in 2015. The updated MSBOS resulted in a 46% reduction of cross-matched blood and savings of €54,375 per annum. Conclusion Improved perioperative management in lower limb arthroplasty has reduced blood transfusion rates. Updating blood transfusion practice can result in considerable savings in blood, resources and costs.

Ethnic Variations of Blood Groups in a Medical College of Eastern Nepal.

Background Red blood cells contain antigens in its membrane which are inherited according to Mendelian law. ABO and Rhesus blood group systems are considered the most important blood group systems for clinical procedures, blood transfusion, organ transplantation, anthropological study and medico-legal purposes. Determination of ABO and Rhesus blood groups and its frequency distribution in a multiethnic country like Nepal is important for effective management of blood banks, safe blood transfusion services. The trend of blood groups and its ethnic distributions in the eastern part of Nepal is still unknown. Objective To find the distribution of blood groups among the subjects of different ethnic groups of eastern Nepal. Method A cross-sectional perspective study was carried out among the subjects visited in the laboratory of Nobel Medical College, Biratnagar, Nepal for a period of one year from August 1, 2015 to July 30, 2016. Result The 11,960 subjects were included in the present study, among which 5012 were males and 6948 were females. The study revealed that in ABO system, blood group distribution was 34.80% O, 28.66% A, 27.66% B and 6.89% AB. With regard to Rh blood group system, Rhesus +ve was 96.79% and Rhesus -ve was 3.21%. O blood group dominant ethnic groups were Brahmin, Bhujel, Biswakarma, Shah, Gurung, Marwari, Magar, Mahato, Mandal, Newar, Sanyasi, Tamang, Terai Brahmin and Yadav. Similarly, blood group A dominant ethnic groups were Chhetri, Dhimal, Limbu, Rai and Muslim. Howerver, blood group B was dominant in ethnic groups, namely Biswakarma, Rajput, Satar and Tharu. Conclusion The frequency distribution pattern of ABO blood group was observed as O > A> B > AB and in Rhesus system, Rhesus +ve > Rhesus -ve. Variation in blood groups distribution was observed in various ethnic groups.

Overuse of preoperative laboratory coagulation testing and ABO blood typing: a French national study.

Background: Following publication of guidelines on routine preoperative tests, the French Society of Anaesthesiology and Intensive Care (SFAR), in association with French national public health insurance, conducted a survey to evaluate adherence to guidelines and the economic consequences. Methods: Using the French Hospital Discharge Database and National Health Insurance Information system, tests performed during the 30 days before surgery were analysed for two situations: (1) standard laboratory coagulation tests and ABO blood typing in children able to walk and scheduled for tonsillectomy/adenoidectomy; and (2) ABO blood typing in adults before laparoscopic cholecystectomy, thyroidectomy, lumbar discectomy or breast surgery. Guidelines do not recommend any preoperative tests in these settings. Results: Between 2013 and 2015, a coagulation test was performed in 49% of the 241 017 children who underwent tonsillectomy and 39% of the 133 790 children who underwent adenoidectomy. A similar pattern was observed for ABO blood typing although re-operation rates for bleeding on the first postoperative day were very low (0.12-0.31% for tonsillectomy and 0.01-0.02% for adenoidectomy). Between 2012 and 2015, ABO blood typing was performed in 32-45% of the 1 114 082 patients who underwent one of the four selected procedures. The transfusion rate was very low (0.02-0.31%). The mean cost for the four procedures over the 4 yr period was €5 310 000 (sd €325 000). Conclusions: Standard laboratory coagulation tests and ABO blood typing are still routinely prescribed before surgery and anaesthesia despite current guidelines. This over-prescription represents a high and unnecessary cost, and should therefore be addressed.

Are Preoperative Serologic Type and Screen Tests Necessary for Primary Total Joint Arthroplasty Patients in Specialty Surgical Hospitals?

BACKGROUND: Blood loss during total joint arthroplasty (TJA) has been a major concern requiring routine preoperative patient type and screen (T&S); however, with the implementation of blood conserving therapy, a marked decrease for perioperative transfusions has been observed. Many TJAs are now being performed in T&S mandated specialty surgical hospitals (SSHs) that lack on-site blood banks; therefore, the purpose of our study was to determine whether T&S (1) is necessary in SSH for TJA patients and (2) identifies patient risk factors associated with perioperative blood transfusion in SSH. METHODS: A retrospective study was conducted on 1034 consecutive primary TJAs performed between 2013 and 2014 at a 12-bed SSH who all received T&S. Patients were matched (1:1) to 964 inpatient TJA patients performed at a university hospital without routine T&S. Data on surgery type, patient demographics, hemoglobin and hematocrit results, and transfusion rates were collected. Multivariate logistic regression identified perioperative transfusion risk factors. RESULTS: Overall transfusion rates for the matched SSH (1.8% [17/964]) and university hospital populations (2.9% [28/964]) were similar (P = .13), with no emergent transfusions. SSH transfusion rates for simultaneous bilateral THA, simultaneous bilateral TKA, unilateral THA, and unilateral TKA were 21.1% (4/19), 3.1% (4/128), 2.7% (12/439), and 0.0% (0/448), respectively. Multivariate logistic regression identified unilateral THA (P ≤ .001), simultaneous bilateral TJA (P = .001), age (P = .05), and abnormal preoperative hemoglobin (P = .02) as significant transfusion risk factors at SSH. CONCLUSION: Due to low transfusion rates and lack of emergency transfusions, we recommend routinely ordering T&S for bilateral THA but not for unilateral TJA patients, at SSHs.

Evaluation of the Effectiveness of Preoperative Blood Ordering Guideline in Elective Spine, Knee Replacement, and Hip Replacement Surgery.

Background: Preoperative blood ordering is necessary in most of the major orthopedic operations. However, over-crossmatching 200 units/day results in technician workload and compromises blood stock for other patients at Siriraj Hospital. Objective: To evaluate the effectiveness of a new blood ordering guideline in spine and arthroplasty surgery at Siriraj Hospital by comparing the quantity of blood ordering between pre-guideline and guideline groups. Material and Method: The guideline was developed from data of 456 patients who underwent spine or arthroplasty surgery between January 2013 and December 2013 at Siriraj Hospital. To evaluate the effectiveness of the guideline, blood order, and use in 89 patients who received specific orthopedic surgical procedures between December 2014 and March 2015 were compared to blood order and use in pre-guideline patients. Results: Five hundred forty five patients were included. Mean age of subjects was 58 years and 71.49% were females. Mean cross-matched units between the pre-guideline group (1.81 units; 95% CI 1.70 to 1.92) and the guideline group (1.34 units; 95% CI 1.13 to 1.55) was significantly different (p<0.001). Conclusion: The blood ordering guideline does increase effectiveness of preoperative blood reservation, reduce unnecessary cost, and does not compromise patient safety. Consistent use and frequent evaluation of this guideline are encouraged.

[ABO and RHD blood types distribution of the patients treated in the Federal Center of Cardiovascular Surgery of Krasnoyarsk].

The knowledge of blood types frequency in hospital patients helps to plan and perform transfusion therapy at blood donor centers. The distribution of patients' blood by ABO groups and RhD allows to more efficiently organize and use donor blood banks. The risk of a disease is related to genome composition and is inherited with an ABO blood type. Every person should know his (her) ABO blood type and RhD to enable early identification of the first symptoms of an illness. Materials and methods. This work is based on the study of 4831 blood samples from patients treated at the Center of Cardiovascular Surgery in 2013 (2885 (59,7%) men of the mean age 55 years and 1946 (40,3 %) women of the mean age 57 years). Results. Type A blood occurred most frequently (1787 or 37,0% samples) followed by group O (1625 or 33,6% samples). Samples of group B made up 1025 of the total (21,2%), AB blood group was found in 394 samples (8,2%). Conclusion. The blood types distribution of the ABO system in the patients treated at the Center of Cardiovascular Surgery was characterized by the following pattern: A > O > B > AB. Group A was identified in 37,0% of the patients. Its frequency is similar to that in the population of the western part of Russia and Moscow but different from that in the people living in nearby regions. The frequency of RhD system antigens is comparable in all regions of Russia. CcDEe, ccDEe, CcDee, CCDee are considered to be the most widespread phenotypes. The residents of the Krasnoyarsk region and some nearby regions having blood type A apply to the Center of Cardiovascular Surgery with cardiovascular disorders more frequently than those with others ABO blood types.

Blood Requisition and Utilization Practice in Surgical Patients in a Teaching Hospital, Western Nepal.

Background In surgical patients transfusion of blood is often a life-saving measure. Preoperative over-ordering of blood is very common and leads to holding up of the blood bank reserve and wastage of resources. Objective The main objective of this study was to evaluate the practice of cross-match and utilization of blood for general surgeries in a teaching hospital of Nepal, to identify the surgical procedures where type and screen can be introduced and to formulate a maximum surgical blood-order schedule for those procedures where a complete cross-match appears mandatory. Method Three hundred and eighty-eight patients of different general surgical procedures over a period of one year were evaluated. Blood units cross matched and units transfused intra-operative and post-operatively were recorded. Blood utilization was evaluated using the following indices: cross-matched to transfused ratio, transfusion probability and transfusion index. The maximum surgical blood-order schedule was calculated using Mead's criterion. Result Of the 601 blood units arranged for 388 patients, only 108 units were transfused in 81 patients. The cumulative non-utilisation of cross-matched blood was 82%. Based on these data, the maximum surgical blood-order schedule was calculated for seven common surgical procedures where cross-matching was justified. Conclusion Unwarranted cross-matching of blood is done in most procedures, especially cholecystectomies, hernia operations, breast surgeries, skin grafting, thyroidectomies etc. where a group and screen is adequate. Implementation of the recommended maximum surgical blood-order schedule and introduction of type and screen for eligible surgical procedures is a safe, effective and economic solution.

RHD variants in Flanders, Belgium.

BACKGROUND: D antigen variants may be grouped into partial D, weak D, and DEL types. Cumulative phenotype frequencies of these D variants may approach 1% in certain European regions. Unambiguous and quick identification of D variants is of immediate clinical relevance, with implications for transfusion strategy. STUDY DESIGN AND METHODS: A total of 628 samples with ambiguous serologic results from different immunohematology laboratories throughout the Flanders region, Belgium, were genotyped using a commercially available weak D typing approach. After exclusion of detectable weak D types, molecular RHD exon scanning was performed for the remaining samples, and RHD sequencing was performed in two particular cases. RESULTS: Of all samples investigated, 424 (67.5%) were positive for weak D Type 1, 2, or 3, and 22 cases (3.5%) typed weak D Type 4.0/4.1/4.3, 4.2, 5, 11, 15, or 17. Another 49 (7.8%) samples were partial D variants, with a major proportion being category DVI types (n = 27). One RHD(S103P) sample was identified as high-grade partial D, with DIII-like phenotype and anti-D and anti-C immunization. Additionally, a novel DVI Type 3 (A399T) variant was found. Of the remaining 133 samples mainly tested because of ambiguous serologic D typing results due to recent transfusion, 32 (5.1%) were negative for RHD, and 101 (16.1%) were indistinguishable from wild-type RHD and not investigated further. CONCLUSION: Despite the enormous diversity of RHD alleles, first-line weak D genotyping was remarkably informative, allowing for rapid classification of most samples with conspicuous RhD phenotype in Flanders. The clinical implications are discussed.

Hospital-based transfusion error tracking from 2005 to 2010: identifying the key errors threatening patient transfusion safety.

BACKGROUND: This report provides a comprehensive analysis of transfusion errors occurring at a large teaching hospital and aims to determine key errors that are threatening transfusion safety, despite implementation of safety measures. STUDY DESIGN AND METHODS: Errors were prospectively identified from 2005 to 2010. Error data were coded on a secure online database called the Transfusion Error Surveillance System. Errors were defined as any deviation from established standard operating procedures. Errors were identified by clinical and laboratory staff. Denominator data for volume of activity were used to calculate rates. RESULTS: A total of 15,134 errors were reported with a median number of 215 errors per month (range, 85-334). Overall, 9083 (60%) errors occurred on the transfusion service and 6051 (40%) on the clinical services. In total, 23 errors resulted in patient harm: 21 of these errors occurred on the clinical services and two in the transfusion service. Of the 23 harm events, 21 involved inappropriate use of blood. Errors with no harm were 657 times more common than events that caused harm. The most common high-severity clinical errors were sample labeling (37.5%) and inappropriate ordering of blood (28.8%). The most common high-severity error in the transfusion service was sample accepted despite not meeting acceptance criteria (18.3%). The cost of product and component loss due to errors was $593,337. CONCLUSION: Errors occurred at every point in the transfusion process, with the greatest potential risk of patient harm resulting from inappropriate ordering of blood products and errors in sample labeling.

Record fragmentation due to transfusion at multiple health care facilities: a risk factor for delayed hemolytic transfusion reactions.

BACKGROUND: Patients transfused at more than one health care facility face safety risks, because their transfusion record is fragmented. Blood group antibodies documented at one facility may be unknown to others. Because many antibodies are evanescent, access to prior antibody records is important for preventing incompatible transfusions and delayed hemolytic reactions. The study goal was to quantify multisite transfusion activity and its impact on antibody record accuracy. STUDY DESIGN AND METHODS: Patients (n = 100) undergoing hospital transfusion testing were surveyed to determine the locations and dates of any prior transfusions. Also, transfusion records were examined to determine whether patients (n = 200) known to be alloimmunized at one hospital had antibody testing done at another nearby hospital and, if so, how often the results were discrepant. RESULTS: Twenty-three percent (23/100) of patients undergoing type-and-screen testing reported receiving transfusions at 24 other facilities. Locations of transfusions that occurred elsewhere were 54.2% (13/24) at eight other in-state hospitals, 12.5% in bordering states, 20.8% in more distant states, and 12.5% during military service. Twenty-one percent (42/200) of patients known to be alloimmunized at one hospital had antibody test results on record at another nearby hospital. Antibody discrepancies were noted in 64.3% (27/42) of cases. The most common discrepancy was the failure of one facility to detect an antibody. CONCLUSION: Multisite transfusions were common. For patients seen at both of two nearby hospitals, antibody records were frequently discrepant. The findings support the need for interfacility sharing of transfusion records, particularly at the regional level.

Unexplained extreme hyperbilirubinemia among neonates in a multihospital healthcare system.

We report a series of neonates who developed a total serum bilirubin (TSB) >20mg/dL during a recent ten-year period in a multihospital healthcare system. The incidence of a TSB >20mg/dL fell after instituting a pre-hospital discharge bilirubin screening program in 2003/2004 (91.3 cases/10,000 births before vs. 72.4/10,000 after), but the incidence has subsequently remained unchanged. No specific cause for the hyperbilirubinemia was identified in 66% of (n=32) cases with a TSB >30 mg/dL or in 76% of (n=112) cases with a TSB 25.0-29.9 mg/dL. We hypothesized that hemolysis was a common contributing mechanism, but our review of hospital records indicated that in most instances these infants were not evaluated sufficiently to test this hypothesis. Records review showed maternal and neonatal blood types and direct antiglobulin testing were performed in >95% cases, but rarely were other tests for hemolysis obtained. In the ten-year period reviewed there were zero instances where erythrocyte morphology from a blood film examination or Heinz body evaluation by a pediatric hematologist or pathologist were performed. In 3% of cases pyruvate kinase was tested, 3% were evaluated by hemoglobin electrophoresis, 3% had a haptoglobin measurement, and 16% were tested for G6PD deficiency. Thus, determining the cause for hyperbilirubinemia in neonates remains a problem at Intermountain Healthcare and, we submit, elsewhere. As a result, the majority of infants with a TSB >25mg/dL have no specific causation identified. We speculate that most of these cases involve hemolysis and that the etiology could be identified if searched for more systematically. With this in mind, we propose a "consistent approach" to evaluating the cause(s) of hyperbilirubinemia among neonates with a TSB >25mg/dL.

RHD variants in Polish blood donors routinely typed as D-.

BACKGROUND: Blood donors exhibiting a weak D or DEL phenotypical expression may be mistyped D- by standard serology hence permitting incompatible transfusion to D- recipients. Molecular methods may overcome these technical limits. Our aim was to estimate the frequency of RHD alleles among the apparently D- Polish donor population and to characterize its molecular background. STUDY DESIGN AND METHODS: Plasma pools collected from 31,200 consecutive Polish donors typed as D- were tested by real-time polymerase chain reaction (PCR) for the presence of RHD-specific markers located in Intron 4 and Exons 7 and 10. RHD+ individuals were characterized by PCR or cDNA sequencing and serology. RESULTS: Plasma cross-pool strategy revealed 63 RHD+ donors harboring RHD*01N.03 (n = 17), RHD*15 (n = 12), RHD*11 (n = 7), RHD*DEL8 (n = 3), RHD*01W.2 (n = 3), RHD-CE(10) (n = 3), RHD*01W.3, RHD*01W.9, RHD*01N.05, RHD*01N.07, RHD*01N.23, and RHD(IVS1-29G>C) and two novel alleles, RHD*(767C>G) (n = 3) and RHD*(1029C>A). Among 47 cases available for serology, 27 were shown to express the D antigen CONCLUSION: 1) Plasma cross-pool strategy is a reliable and cost-effective tool for RHD screening. 2) Only 0.2% of D- Polish donors carry some fragments of the RHD gene; all of them were C or E+. 3) Almost 60% of the detected RHD alleles may be potentially immunogenic when transfused to a D- recipient.

Red blood cell alloimmunization in sickle cell disease: prevalence in 2010.

BACKGROUND: Transfusion of red blood cells (RBCs) is frequently required for care of individuals with sickle cell disease (SCD). Alloimmunization rates are high and may be reduced by matching for RBC antigens that can cause alloimmunization. STUDY DESIGN AND METHODS: During the PROACTIVE Feasibility Study, patients with SCD age 2 years or older admitted for pain without acute chest syndrome were enrolled for possible randomization to preventive blood transfusion or standard care. Transfusion and antibody histories were obtained at each site, and antibody screening was done, to assess transfusion burden and alloimmunization prevalence. Participating sites were surveyed regarding antigen matching practice. RESULTS: A total of 237 patients (169 SS, 42 SC, 15 Sß(0) -thalassemia, 11 Sß(+) -thalassemia), 118 males and 119 females, were enrolled. Mean age was 19.3 years (range, 2.0-68.0); there were 122 children and 115 adults. A total of 75.8% had received at least a single transfusion of RBCs before the study. Thirty-four patients (14.4%) had a history of at least one alloantibody and 17 of these had more than one. When surveyed, 19 sites (83% of responders) reported antigen matching to at least include C, E, and K for transfusion of all patients with SCD. CONCLUSION: Though antigen typing before transfusion of people with SCD and providing antigen-negative units is now widely employed by sickle cell centers, the alloimmunization rate remains quite high in contemporary sickle cell populations and may be due in large part to transfusions received at institutions not providing extended matching.

The immunohematologic and patient safety benefits of a centralized transfusion database.

BACKGROUND: The transfusion medical record is an important tool for providing safe and appropriate blood. However, many patients seek care at more than one hospital and this record is usually not portable. We posited that a centralized transfusion service database (CTS-D) offers benefits through tracking blood types, transfusion requirements, and detecting wrong blood in tube (WBIT). STUDY DESIGN AND METHODS: Records held in the CTS-D from 1997 to 2010 were queried to enumerate those seen at more than one hospital versus one hospital only. Transfusion-related attributes were collected including red blood cell (RBC) antibodies, transfusion requirements, and reactions. WBITs detected due to historical ABO typing were tallied. A review of blood orders that required alteration based on requirements held in the CTS-D was completed. RESULTS: There were 724,584 records; 10.9% of patients had been tested or received blood transfusion at more than one hospital. Of the 63,973 records with RBC alloantibodies, a greater proportion of patients were seen at more than one hospital versus one hospital only (7.11% vs. 3.97%, p < 0.005). Of the 97,687 patient records that required special processing, patients seen at one hospital had a lower rate than those at more than one hospital (12.13% vs. 24.59%, p < 0.005). There were 77 WBITs (0.18 WBITs per 1000 patients). An in-depth review of WBITs found an additional 26.3% (5 of 19) were detected because the current and historical ABO types were from two different hospitals within the CTS. CONCLUSIONS: The CTS-D provides a universal transfusion record that improves patient safety. As health care systems are enlarged, centralization of the transfusion component of the medical record should be considered.

Single-center comparison of gel microcolumn and solid-phase methods for antibody screening.

Our facility changed antibody screening methods from a gel microcolumn-based test (ID-Micro Typing System Gel TEst; Ortho Clinical Diagnostics, Inc., Raritan, NJ) to an automated solid-phase test (Galileo/Capture-R Ready Screen [I and II], Immucor, Inc., Norcross, GA). To determine whether detection rates for commonly encountered clinically significant red blood cell antibodies differed as a consequence of this change, preimplementation and postimplementation antibody identification records were retrospectively reviewed. A statistically significant difference in the percentage of positive screening tests during the gel microcolumn testing period (73,903 total screens, 1.56% confirmed positive) versus the solid0-phase screening period (80,242 total screens, 1.81% confirmed positive; p< 0.0002) was observed . The number of antibodies to K identified was significantly lower with solid phase that with gel (27% decrease; p=0.004). It is unknown whether there is a statistical difference in delayed or hemolytic transfusion reaction rates as this was not evaluated.

Improving blood transfusion practice by regular education in the United Arab Emirates.

BACKGROUND: A cross-match to transfused unit ratio of less than 2.0 is frequently used to assess performance in many hospital blood banks. This brief report was initiated to evaluate the practice at a local hospital and to emphasize the importance of regular educational sessions to improve blood transfusion practice. METHOD: Retrospective data on cross-match : transfused (C : T) ratio of all departments was collected and educational sessions were given to improve practice. Thereafter, a new set of data was collected and change in practice was assessed. RESULTS: Initial data showed total (C : T) ratio of 1.95. After medical staff education, analysis showed clinically significant improvement in blood utilization practice with a (C : T) ratio of 1.60. CONCLUSION: This brief report indicates the importance of regular physician education, the potential role of blood transfusion committee, and the need to implement clear guidelines for blood transfusion.

Incomplete pretransfusion testing leads to surgical delays.

BACKGROUND: The Joint Commission has highlighted the importance of having appropriate and complete pretransfusion testing before surgery begins. The maximum surgical blood ordering schedule (MSBOS) indicates which patients require preoperative transfusion testing. We determined the number of times surgical delays were caused due to the lack of completed pretransfusion testing. STUDY DESIGN AND METHODS: All transfusion events reported through the common medical event reporting system of eight networked hospitals over a 12-month period were evaluated to determine how often patients experienced surgical delays due to not having complete pretransfusion testing. RESULTS: During this 12-month period 12 patients were identified who were either in or en route to the operating room with incomplete pretransfusion testing leading to a delay in providing crossmatched red blood cells (RBCs). In 6 of 12 cases a new antibody was discovered, which required extra time for the provision of crossmatched RBCs, while in 4 of 12 patients the samples were not sent or were lost on the way to the blood bank. In the remaining two patients other parts of the pretransfusion testing process were not followed according to hospital policy. The median surgery start time delay was approximately 12 hours (range, 1-168 hr) in 11 of 12 cases. One patient's case was not aborted when it was discovered that crossmatched RBCs were not immediately available due to newly detected alloantibodies. CONCLUSIONS: We identified three mechanisms by which delays in completing pretransfusion testing in surgical patients occurred. Adherence to the MSBOS and sample collection policies should reduce delays.