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Background and Objectives: E-learning programmes are increasingly offered in transfusion medicine (TM) education. The aim of this study was to explore facilitators and barriers to TM e-learning programmes, including assessment of learning outcomes and measures of effectiveness., Materials and Methods: Participants selected from a prior survey and representing a diverse number of international e-learning programmes were invited to participate. A mixed methodology was employed, combining a survey and individual semi-structured one-on-one interviews. Interview data were analysed inductively to explore programme development, evaluation, and facilitators and barriers to implementation., Results: Fourteen participants representing 13 institutions participated in the survey and 10 were interviewed. The e-learning programmes have been in use for a variable duration between 5 and 16 years. Funding sources varied, including government and institutional support. Learner assessment methods varied and encompassed multiple-choice-questions (n = 12), direct observation (n = 4) and competency assessment (n = 4). Most regional and national blood collection agencies rely on user feedback and short-term learning assessments to evaluate their programmes. Only one respondent indicated an attempt to correlate e-learning with clinical practices. Factors that facilitated programme implementation included support from management and external audits to ensure compliance with regulatory educational and training requirements. Barriers to programme implementation included the allocation of staff time for in-house development, enforcing compliance, keeping educational content up-to-date and gaining access to outcome data for educational providers., Conclusion: There is evidence of considerable diversity in the evaluation of e-learning programmes. Further work is needed to understand the ultimate impact of TM e-learning on transfusion practices and patient outcomes., (© 2024 International Society of Blood Transfusion.)

Background and Objectives: Platelet transfusions are used across multiple patient populations to prevent and correct bleeding. This scoping review aimed to map the currently available systematic reviews (SRs) and evidence-based guidelines in the field of platelet transfusion., Materials and Methods: A systematic literature search was conducted in seven databases for SRs on effectiveness (including dose and timing, transfusion trigger and ratio to other blood products), production modalities and decision support related to platelet transfusion. The following data were charted: methodological features of the SR, population, concept and context features, outcomes reported, study design and number of studies included. Results were synthesized in interactive evidence maps., Results: We identified 110 SRs. The majority focused on clinical effectiveness, including prophylactic or therapeutic transfusions compared to no platelet transfusion (34 SRs), prophylactic compared to therapeutic-only transfusion (8 SRs), dose, timing (11 SRs) and threshold for platelet transfusion (15 SRs) and the ratio of platelet transfusion to other blood products in massive transfusion (14 SRs). Furthermore, we included 34 SRs on decision support, of which 26 evaluated viscoelastic testing. Finally, we identified 22 SRs on platelet production modalities, including derivation (4 SRs), pathogen inactivation (6 SRs), leucodepletion (4 SRs) and ABO/human leucocyte antigen matching (5 SRs). The SRs were mapped according to concept and clinical context., Conclusion: An interactive evidence map of SRs and evidence-based guidelines in the field of platelet transfusion has been developed and identified multiple reviews. This work serves as a tool for researchers looking for evidence gaps, thereby both supporting research and avoiding unnecessary duplication., (© 2022 The Authors. Vox Sanguinis published by John Wiley & Sons Ltd on behalf of International Society of Blood Transfusion.)

Background: There continues to be uncertainty about the optimal approach to documenting bleeding data in platelet transfusion trials, with a desire to apply a common assessment tool across all trials. With this in mind, a consensus bleeding assessment tool (BAT) has been developed by the Biomedical Excellence for Safer Transfusion (BEST) collaborative, based on review of data collection forms used in published randomized trials and following content validation with a range of healthcare professionals at seven haematology centres through BEST members. This study aimed to evaluate reliability and reproducibility of the consensus BAT., Methods: Replicated clinical assessments of bleeding were undertaken by participants with haematological malignancies recruited at four haematology centres in an international, multicentred, observational study. Concordance of repeat assessments was calculated for agreement in site and grade of bleeding observed., Results: Forty patients consented to participate, and 13 trained bleeding assessors collected these data. Bleeding assessments were carried out on 113 separate days. Of all 225 bleeding assessments, 204 were compared for grade concordance, and 160 were compared for site concordance. There was very good grade concordance (83%, 95% confidence interval 74-93%) and good bleeding site concordance (69%, 95% confidence interval 57-79%) in observations of bleeding. Discordance was primarily in relation to assessing skin bleeding., Conclusions: Alongside a structured training programme, levels of concordance for a consensus BAT were high. Researchers using assessment tools for bleeding need to balance comprehensive data collection against potential loss of accuracy for some types of bleeding, such as skin findings., (© 2018 International Society of Blood Transfusion.)

Background and Objectives: Platelet count is used as a prophylactic platelet transfusion trigger, although evidence suggests that it is a poor predictor of bleeding. Thus, alternative tests are required. The primary objective of this study was to compare thromboelastography (TEG) parameters on days with and without bleeding symptoms. The secondary objectives were to investigate the relationship between TEG parameters and haematological variables, fever, C-reactive protein (CRP) and platelet transfusion., Materials and Methods: This is a prospective, observational pilot study of 13 thrombocytopenic, haemato-oncologic patients, over 17 cycles of chemotherapy. Bleeding assessment was performed daily together with a total platelet count (TPC), reticulated platelet per cent (RPP) and count (RPC), haemoglobin, mean platelet volume, white blood cell count (WBC), CRP and temperature. TEG analyses were performed on weekdays., Results: TEG alpha angle was significantly lower on days with World Health Organization (WHO) grade 2 bleeding than on days without bleeding. Haematologic variables, CRP and platelet transfusion the previous day were associated with the outcome of TEG analysis, but fever was not., Conclusion: We found a highly significant correlation between the TEG alpha angle and WHO grade 2 bleeding. This finding suggests that fibrinogen-platelet interactions may affect the bleeding risk in thrombocytopenic patients., (© 2017 International Society of Blood Transfusion.)

Background and Objectives: Plasma transfusions are a frequent treatment worldwide, but many studies have reported a wide variation in the indications to transfuse. Recently, an international paediatric study also showed wide variation in frequency in the use of plasma transfusions: 25% of the centres transfused plasma to >5% of their patients, whereas another 25% transfused plasma to <1% of their patients. The objective of this study was to explore the factors associated with different plasma transfusion practices in these centres., Materials and Methods: Online survey sent to the local investigators of the 101 participating centres, in February 2016. Four areas were explored: beliefs regarding plasma transfusion, patients' case-mix in each unit, unit's characteristics, and local blood product transfusion policies and processes., Results: The response rate was 82% (83/101). 43% of the respondents believed that plasma transfusions can arrest bleeding, whereas 27% believe that plasma transfusion can prevent bleeding. Centres with the highest plasma transfusion rate were more likely to think that hypovolaemia and mildly abnormal coagulation tests are appropriate indications for plasma transfusions (P = 0·02 and P = 0·04, respectively). Case-mix, centre characteristics or local transfusion services were not identified as significant relevant factors., Conclusion: Factors influencing plasma transfusion practices reflect beliefs about indications and the efficacy of transfusion in the prevention and management of bleeding as well as effects on coagulation tests. Educational and other initiatives to target these beliefs should be the focus of research., (© 2017 International Society of Blood Transfusion.)

Audits of practice and incident reporting, most notably to national haemovigilance schemes, indicate that poor hospital transfusion practice is frequent and occasionally results in catastrophic consequences for patients. Improvements in practice are needed and depend on a combined approach including a better understanding of the causes of errors; a reduction in the complexity of routine procedures taking advantage of new technology systems, which enforce agreed guidelines and policies; the setting and regular monitoring of performance standards for key aspects of the hospital transfusion process, improved organisation of transfusion in hospitals and staff training; and further research on the safe and effective use of blood and alternatives to donor blood. There needs to be a greater recognition that 'transfusion safety' applies to the hospital transfusion process as well as the contents of blood bags and that resources need to be provided for the improvement of transfusion safety and management in hospitals commensurate to their importance., (© 2010 The Author(s). Vox Sanguinis © 2010 International Society of Blood Transfusion.)

Background and Objectives: The aim of this study was to evaluate the collection of daily prospective information about bleeding outcomes in patients with thrombocytopenia, including information obtained by patient self-assessment., Materials and Methods: Consecutive patients with haematological malignancies were enrolled in a study of bleeding data collection during the period of thrombocytopenia. A short educational session and information sheet was designed for self-assessment. Platelet counts and all transfusions were recorded daily. Bleeding scores were translated into World Health Organization (WHO) bleeding grades., Results: Nineteen patients were included in the study. Four-hundred and ten days of thrombocytopenia were eligible for assessment of bleeds. Self-assessment was feasible, as defined by the total proportion of days on which self-assessment was completed (70%, 288 thrombocytopenic days). There was 86% agreement between bleeding data collected by self-assessment and by medical examination using a structured assessment form. Examples of discrepancies included the duration of petechiae/bruises and the reporting of minor bleeding. There was no evidence for an association between patients' morning platelet count and daily WHO bleeding grade. The incidences of WHO grade 1 and grade 2 bleeding on days with platelet counts < or = 10 x 10(9)/l, 11-20 x 10(9)/l, and > 20 x 10(9)/l were similar and did not reveal higher rates of bleeding at lower counts., Conclusions: Patient self-assessment can help to support comprehensive daily prospective monitoring of bleeding, specifically facilitating data collection following hospital discharge. The discrepancies between self-assessment and medical examination highlight the need to develop a validated international assessment tool. The association among platelet count, risk of bleeding and role of prophylactic platelet transfusions needs further evaluation in larger prospective trials.

Background and Objectives: There are few published data on the use of red blood cells (RBC) by specialty in the United Kingdom. The aim of this survey was to identify major specialty users of blood to target for audit of transfusion practice with a view to minimizing inappropriate use and to support planning of blood supply needs for the future., Materials and Methods: Data were collected retrospectively of RBC units transfused at 62 hospitals/trusts in London and southeast England between April 1997 and March 1998., Results: A total of 594 810 transfused RBC units were successfully traced to their respective clinical specialties, representing 91.9% of all RBC units issued to the study hospitals. Of the RBC units transfused, 51.2% were transfused in surgical, 36.0% in medical and 12.8% in "combined" specialties., Conclusions: This large study has accurately documented the clinical disciplines that are significant users of RBCs in our service area. It has heightened general understanding of RBC usage within hospitals. It has also raised questions on future strategies for reducing allogeneic blood transfusion that will be important if anticipated major reductions in blood supply occur in the near future.

Objectives: To analyse information about virological testing of cadaveric tissue donors, including the kits used and the rates of test reactivity., Materials and Methods: Retrospective data were collected using a standardised questionnaire sent to 16 tissue banks in the UK. The rates of repeat reactive screen tests and confirmed positive results for the markers HBsAg, anti-HCV, anti-HIV were analysed in 1,833 cadaver tissue donors tested at 12 tissue banks over one year up to March 1998., Results: There was a wide range of kits in use for virological screen testing of cadaver donors. The rates of repeat reactivity in the screen tests varied from 0 to 42%., Conclusion: The findings have implications for policies based on discard of tissues from donors with repeat reactive results, and raise important safety issues with regards to cadaveric virological testing, as the test systems in use have not been validated for cadaver blood samples., (Copyright 2000 S. Karger AG, Basel.)