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1. Current Practice in FFP Preparation and Use in Greece: A National Survey

Author

Aspasia Argyrou, Serena Valsami, Abraham Pouliakis, Maria Gavalaki, Antonis Aggelidis, Vasiliki Voulgaridou, Vasiliki Pliatsika, Theofanis Adraktas, Andreas Papachronis, Chrysoula Alepi, Vasiliki Giannopoulou, Panagiotis Siourounis, Sofia Tsagia, Georges Martinis, Eftihia Kontekaki, Eleftheria Zervou, Spiridon Koliofotis, Elias Kyriakou, Athina Mougiou, Lempousi Dimitra, Afrodite Chairopoulou, Aggeliki Tsakania, Maria Baka, Ioanna Apostolidou, Dimitra Moschandreou, Anastasia Livada, Marianna Politou, Fragoula Roussinou, Christina Pappa, Vasiliki Koika, Niki Vgontza, Anthippi Gafou, Ioanna Dendrinou, Fotini Sakellaridi, Lampothea Labrianou, Zafeiria Alexandropoulou, Vasiliki Sochali, Kostas Malekas, Areti Skordilaki, Georgia Kakava, Konstantinos Lebesopoulos, Konstantinos Stamoulis, and Elisavet Grouzi

Subjects
transfusion medicine, acquired coagulopathies, replacement therapies, blood coagulation, Diseases of the blood and blood-forming organs, RC633-647.5
Abstract

Objective: Fresh frozen plasma (FFP) transfusion is widely used in modern clinical settings. Practices regarding its use vary due to lack of guidelines from randomized trials. The aim of this study was to assess both the current practices regarding FFP production, use, and wastage and the implementation of quality control (QC), female donor plasma production policies, and use of pharmaceutical hemostatic agents in Greece. Materials and Methods: The study was conducted during February-April 2018. For the first part of the study, data including FFP transfusion indication, hospital department, diagnosis, FFP units/transfusion episode, ABO compatibility, blood donor's sex, and reasons for discarding were collected. For the second part, questionnaire data were analyzed. Results: According to data from 20 Greek hospitals, 12655 FFP units were transfused to 2700 patients during 5069 transfusion episodes in the studied period of time. Most patients were hospitalized in internal medicine, general surgery, and intensive care unit departments. Each patient received on average 4.69 units (2.5 units/episode). Transfusion requests were in accordance with international guidelines in 63.44% of cases and 99.04% of the units were given to ABO-identical patients. Main reasons for discarding included failure to meet quality requirements (30.06%), female donors (22.17%), and other causes (27.26%). Among 96.9% of all transfusion services across the country, 28.26% perform QC according to the directions of the European Directorate for the Quality of Medicines & Health Care and 68.83% discard plasma from female donors. Pharmaceutic hemostatic agents are used in 37.23% of the hospitals. Conclusion: This is the first national survey regarding FFP production and transfusion in Greece. Staff of internal medicine, general surgery, and ICU departments, where most FFP-transfused patients are hospitalized, should be regularly involved in training on contemporary transfusion guidelines. Upcoming centralization of FFP production and inventory management could help in homogenizing practices regarding FFP use and improve product quality. Strengthening the use of pharmaceutic hemostatic agents could improve patients' management.

Published
2021
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2. Platelets transfusion in Greece: Where, when, why? A national survey

Author

Serena Valsami, Abraham Pouliakis, Maria Gavalaki, Aspasia Argyrou, Evagelia Triantafillou, Evagelia Arvanitopoulou, Fotios Girtovitis, Virginia Voulgaridou, Aggeliki Megalou, Paraskevi Chronopoulou, Andreas Papachronis, George Sakellarakis, Eleftheria Zervou, Christina Batsi, Kalliopi Fountouli, Aggelos Athanasopoulos, Elias Kyriakou, Afrodite Cheropoulou, Anastasia Livada, Konstantinos Lebessopoulos, Maria Papakonstantinou, Anthi Gafou, Despina Katopi, George Martinis, Ioanna Dendrinou, Hrysanthi Katharopoulou, Marianna Politou, Margarita Papadopoulou, Paraskevi Papadopoulou, Ekaterini Manaka, Konstantina Paneta, Chrissoula Alepi, Christos Damaskos, Nikolaos Garmpis, Konstantinos Stamoulis, and Elisavet Grouzi

Subjects
national, platelet, platelet products, platelets transfusion, survey, Diseases of the blood and blood-forming organs, RC633-647.5
Abstract

Background: Platelet transfusion is among the most useful therapeutic tools in modern clinical settings which mean that ensuring an adequate supply is of paramount importance. Aim: The aim of our study was to record the use and wastage of platelet concentrates (PCs) in Greece, so as to come up with evidence-based interventions. Methods: The study was conducted during May and June 2015. We evaluated the use of random-donor platelets (RDPs) and single-donor apheresis platelets (SDPs). We analyzed such parameters as hospital department and diagnosis, indication for transfusion, PCs' age at the time of transfusion, and wastage rate. Results: We used data from 21 hospitals across the country. A total of 12,061 RDPs and 1189 SDPs were transfused, with an average of 4.84 (±2.72) and 1.12 (±2.73) units per episode, respectively. Most patients had been admitted to the internal medicine and hematology departments. The transfusions were mostly given prophylactically, usually in cases of acute leukemia, and mostly on the day before expiration. Wastage rate was 16.75% for RPDs and 2.70% for SDPs, primarily because of the expiration of the use-by date. Conclusions: This is the first national survey regarding platelet transfusion in Greece. Since most patients were admitted in internal medicine and hematology departments, we recommend that the staff of the abovementioned departments should undergo training on contemporary transfusion guidelines. Platelet discard rate could further be lowered through the centralization of inventory management along with the extension of the lifetime of PCs by means of emerging technologies.

Published
2020
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3. Red Blood Cell Transfusions in Greece: Results of a Survey of Red Blood Cell Use in 2013

Author

Serena Valsami, Elisavet Grouzi, Abraham Pouliakis, Leontini Fountoulaki - Paparisos, Elias Kyriakou, Maria Gavalaki, Elias Markopoulos, Ekaterini Kontopanou, Ioannis Tsolakis, Argyrios Tsantes, Alexandra Tsoka, Anastasia Livada, Vassiliki Rekari, Niki Vgontza, Dimitra Agoritsa, Marianna Politou, Stavros Nousis, Aspasia Argyrou, Ekaterini Manaka, and Maria Baka, Maria Mouratidou, Stavroula Tsitlakidou, Konstantinos Malekas, Dimitrios Maltezos, Paraskevi Papadopoulou, Vassiliki Pournara, Ageliki Tirogala, Emmanouil Lysikatos, Sousanna Pefani, Konstantinos Stamoulis

Subjects
red blood cell, transfusion practice, blood storage age, Diseases of the blood and blood-forming organs, RC633-647.5
Abstract

Objective: Greece is ranked as the second highest consumer of blood components in Europe. For an effective transfusion system and in order to reduce variability of transfusion practice by implementing evidence-based transfusion guidelines it is necessary to study and monitor blood management strategies. Our study was conducted in order to evaluate the use of red blood cell units (RBC-U) in nationwide scale mapping parameters that contribute to their proper management in Greece. Materials and Methods: The survey was conducted by the Working Committee of Transfusion Medicine&Apheresis of the Hellenic Society of Hematology from January to December 2013. The collected data included the number, ABO/D blood group, patients' department, and storage age of RBC-U transfused. Results: The number of RBC-U evaluated was 103,702 (17.77%) out of 583,457 RBC-U transfused in Greece in 2013. RBC-U transfused by hospital department (mean percentage) was as follows: Surgery 29.34%, Internal Medicine 29.48%, Oncology/Hematology 14.65%, Thalassemia 8.87%, Intensive Care Unit 6.55%, Nephrology 1.78%, Obstetrics/Gynecology 1.46%, Neonatal&Pediatric 0.31%, Private Hospitals 8.57%. RBC-U distribution according to ABO/D blood group was: A: 39.02%, B: 12.41%, AB: 5.16%, O: 43.41%, D+: 87.99%, D-: 12.01%. The majority of RBC-U (62.46%) was transfused in the first 15 days of storage, 25.24% at 16 to 28 days, and 12.28% at 29-42 days. Conclusion: Despite a high intercenter variability in RBC transfusions, surgical and internal medicine patients were the most common groups of patients transfused with an increasing rate for internal medicine patients. The majority of RBC-U were transfused within the first 15 days of storage, which is possibly the consequence of blood supply insufficiency leading to the direct use of fresh blood. Benchmarking transfusion activity may help to decrease the inappropriate use of blood products, reduce the cost of care, and optimize the use of the voluntary donor's gift.

Published
2017
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4. Red Blood Cell Transfusions in Greece: Results of a Survey of Red Blood Cell Use in 2013

Author

Maria Baka, Paraskevi Papadopoulou, Dimitrios Maltezo, Elisavet Grouzi, Emmanouil Lysikatos, Sousanna Pefani, Elias Markopoulos, Anastasia Livada, Niki Vgontza, Maria Gavalaki, Dimitra Agoritsa, Ageliki Tirogala, Alexandra Tsoka, Argyrios Tsantes, Stavros Nousis, Abraham Pouliakis, Stavroula Tsitlakidou, Serena Valsami, Ioannis Tsolakis, Leontini Fountoulaki-Paparisos, Vassiliki Rekari, Aspasia Argyrou, Ekaterini Kontopanou, Vassiliki Pournara, Marianna Politou, Konstantinos E. Stamoulis, Maria Mouratidou, Konstantinos Malekas, Ekaterini Manaka, and Elias Kyriakou

Subjects
medicine.medical_specialty, lcsh:Internal medicine, Erythrocytes, Blood management, Thalassemia, 030204 cardiovascular system & hematology, ABO Blood-Group System, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Surveys and Questionnaires, Internal medicine, ABO blood group system, medicine, Humans, lcsh:RC31-1245, Hematology, Blood storage age, Greece, business.industry, lcsh:RC633-647.5, Transfusion medicine, lcsh:Diseases of the blood and blood-forming organs, medicine.disease, Intensive care unit, Hospitals, Red blood cell, medicine.anatomical_structure, Apheresis, Emergency medicine, Transfusion practice, Erythrocyte Transfusion, business, Research Article, 030215 immunology
Abstract

Greece is ranked as the second highest consumer of blood components in Europe. For an effective transfusion system and in order to reduce variability of transfusion practice by implementing evidence-based transfusion guidelines it is necessary to study and monitor blood management strategies. Our study was conducted in order to evaluate the use of red blood cell units (RBC-U) in nationwide scale mapping parameters that contribute to their proper management in Greece.The survey was conducted by the Working Committee of Transfusion MedicineApheresis of the Hellenic Society of Hematology from January to December 2013. The collected data included the number, ABO/D blood group, patients' department, and storage age of RBC-U transfused.The number of RBC-U evaluated was 103,702 (17.77%) out of 583,457 RBC-U transfused in Greece in 2013. RBC-U transfused by hospital department (mean percentage) was as follows: Surgery 29.34%, Internal Medicine 29.48%, Oncology/Hematology 14.65%, Thalassemia 8.87%, Intensive Care Unit 6.55%, Nephrology 1.78%, Obstetrics/Gynecology 1.46%, NeonatalPediatric 0.31%, Private Hospitals 8.57%. RBC-U distribution according to ABO/D blood group was: A: 39.02%, B: 12.41%, AB: 5.16%, O: 43.41%, D+: 87.99%, D-: 12.01%. The majority of RBC-U (62.46%) was transfused in the first 15 days of storage, 25.24% at 16 to 28 days, and 12.28% at 29-42 days.Despite a high intercenter variability in RBC transfusions, surgical and internal medicine patients were the most common groups of patients transfused with an increasing rate for internal medicine patients. The majority of RBC-U were transfused within the first 15 days of storage, which is possibly the consequence of blood supply insufficiency leading to the direct use of fresh blood. Benchmarking transfusion activity may help to decrease the inappropriate use of blood products, reduce the cost of care, and optimize the use of the voluntary donor's gift.Amaç: Avrupa’daki kan bileşenlerini en çok tüketen ülkeler arasında Yunanistan ikinci sıradadır. Etkili bir transfüzyon sistemi için ve transfüzyon uygulamasının değişkenliğini azaltmak için kanıta dayalı transfüzyon kılavuzlarını uygulayarak kan yönetimi stratejilerini incelemek ve izlemek gereklidir. Çalışmamız, Yunanistan’da doğru kan transfüzyon yönetimine katkıda bulunmak için, ülke çapında ölçek eşleştirme parametrelerinde eritrosit süspansiyonu (ES) kullanımını değerlendirmek amacıyla yürütülmüştür. Gereç ve Yöntemler: Anket, Ocak-Aralık 2013 tarihleri arasında Hellenic Hematoloji topluluğunun, Transfüzyon Tıbbı ve Aferez Çalışma Komitesi tarafından yürütülmüştür. Toplanan veriler, ABO/D kan grubu, hasta bölümleri ve transfüze edilen ES depolama yaşını içermektedir. Bulgular: 2013 yılında Yunanistan’da transfüzyon yapılan 583,457 ES’nin, ES sayısı 103,702 (%17,77) idi. Hastanedeki bölümlerde transfüze edilen ES (ortalama oran) şöyleydi: Cerrahi %29,34, Dahiliye %29,48, Onkoloji/Hematoloji %14,65, Talasemi %8,87, Yoğun bakım ünitesi %6,55, Nefroloji %1,78, Kadın Hastalıkları ve Doğum %1,46, Yenidoğan ve Çocuk bölümü %0,31, Özel Hastaneler %8,57. ABO/D kan grubuna göre ES dağılımıysa şöyleydi: A: %39,02, B: %12,41, AB: %5,16, O: %43,41, D+: %87,99, D-: %12,01. ES’nin çoğunluğu (%62,46) depolamanın ilk 15 günü, 16 ile 28 günleri arası %25,24’ü ve 29 ile 42 gün arasında ise %12,28’i, transfüze edildi. Sonuç: Eritrosit transfüzyonlarında merkezler arası yüksek değişkenliğe rağmen, en fazla transfüzyon yapılan hasta grubunu cerrahi ve dahili tıp hastaları oluşturmaktaydı, dahili tıp hastalarında transfüzyon oranları daha yüksekti. ES’nin çoğunluğu depolamanın ilk 15 gününde transfüze edildi; bu da muhtemelen kan depolamadaki yetersizliğinin sonucunda taze kan kullanımına yol açtı. Transfüzyon aktivitesinin standartları, kan ürünlerinin uygun olmayan kullanımını azaltmaya, bakım maliyetini düşürmeye ve gönüllü vericilerin hediye kullanımını optimize etmeye yardımcı olabilir.

Published
2017

5. Excellent long term patient and renal allograft survival after ABO-incompatible kidney transplantation: Experience of one center

Author

Christina Melexopoulou, George Liapis, George Zavos, Maria Gavalaki, Smaragdi Marinaki, Chrysanthi Skalioti, and John Boletis

Subjects
congenital, hereditary, and neonatal diseases and abnormalities, Transplantation, Kidney, medicine.medical_specialty, Everolimus, business.industry, education, Observational Study, medicine.disease, biological factors, humanities, Surgery, surgical procedures, operative, medicine.anatomical_structure, Renal transplant, hemic and lymphatic diseases, ABO blood group system, parasitic diseases, medicine, Renal allograft, business, Kidney transplantation, medicine.drug
Abstract

To investigate the long-term results of ABO-incompatible (ABOi) kidney transplantation in a single center in Greece.Thirty consecutive ABOi kidney transplantations were performed from June 2005 to December 2013. All patients received rituximab one month prior to transplantation. Immunoadsorption therapy was performed for the removal of anti-A/B IgG antibodies until the titer was ≤ 1:16. Additional apheresis sessions were performed post-operatively. Intravenous immunoglobulin and oral immunosuppression consisting of tacrolimus (TAC) in combination with either everolimus or mycophenolate acid was administered. We compared the long term results of our ABOi group to those of a matched group of 30 ABO compatible (ABOc) living kidney recipients with similar baseline characteristics. The ABOc recipients received an immunosuppressive regimen consisting of TAC and mycophenolate acid. All patients in both groups received induction therapy with Basiliximab or Daclizumab, whereas corticosteroids were instituted on the day of surgery. During the follow-up period, indication biopsies were performed and interpreted by an experienced nephropathologist. The parameters we analyzed included the following: Donor/recipient age, gender, blood type, human leukocyte antigen mismatches, panel reactive antibodies, primary cause of renal failure, mean time on dialysis, immunosuppressive regimen, patient survival, graft outcome, incidence of rejections, surgical and infectious complications.The mean follow-up period was 6 years (range 1 to 9 years). A mean of 5.0 ± 3.0 (range 0-14) pre-transplant immunoadsorptions were required in order to reach the target titer. Patient survival in ABOi group in comparison to ABOc group at 1, 3, 5 and 8 years did not differ significantly (100% vs 100%, 96% vs 100%, 92% vs 100% and 92% vs 100%, P = ns). Additionally, graft survival was similar in the two groups at the same time points (100% vs 100%, 96% vs 96%, 92% vs 96% and 81% vs 92%, P = ns). The mean serum creatinine and the estimated glomerular filtration rate by the modification of diet in renal disease formula at 1, 3, 5 and 8 years did not differ significantly between ABOi and ABOc group. None of the patients in the ABOi group developed acute or chronic antibody-mediated rejection evidenced by histological signs. Four patients (13.3%) in the ABOi group and 3 (10%) in the ABOc group experienced acute cellular rejection, which was treated successfully in all cases. Bacterial and viral infections were also similar between the two groups.ABOi kidney transplantation is a safe and effective alternative that enables kidney transplantation in countries with unacceptably long deceased-donor waiting lists.

Published
2015
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