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SUMMARY Objectives: To describe the methodology to estimate the total cost of administration of a single unit of red blood cells (RBC) in adults with beta thalassaemia major in an Australian specialist haemoglobinopathy centre. Background: Beta thalassaemia major is a genetic disorder of haemoglobin associated with multiple end‐organ complications and typically requiring lifelong RBC transfusion therapy. New therapeutic agents are becoming available based on advances in understanding of the disorder and its consequences. Assessment of the true total cost of transfusion, incorporating both product and activity costs, is required in order to evaluate the benefits and costs of these new therapies. Methods: We describe the bottom‐up, time‐driven, activity‐based costing methodology used to develop process maps to provide a step‐by‐step outline of the entire transfusion pathway. Detailed flowcharts for each process are described. Direct observations and timing of the process maps document all activities, resources, staff, equipment and consumables in detail. The analysis will include costs associated with performing these processes, including resources and consumables. Sensitivity analyses will be performed to determine the impact of different staffing levels, timings and probabilities associated with performing different tasks. Results: Thirty‐one process maps have been developed, with over 600 individual activities requiring multiple timings. These will be used for future detailed cost analyses. Conclusions: Detailed process maps using bottom‐up, time‐driven, activity‐based costing for determining the cost of RBC transfusion in thalassaemia major have been developed. These could be adapted for wider use to understand and compare the costs and complexities of transfusion in other settings. [ABSTRACT FROM AUTHOR]

SUMMARY: Massive transfusion or major haemorrhage protocols have been widely adopted in the treatment of critically bleeding patients. Following evidence that higher ratios of transfused plasma and platelets to red blood cells may offer survival benefits in military trauma patients, these ratios are now commonly incorporated into massive transfusion protocols. They more closely resemble the effects of whole blood transfusion, which in the second half of last century was largely replaced by individual blood component transfusion based on laboratory‐guided indicators. However, high‐quality evidence to guide transfusion support for critically bleeding patients across the range of bleeding contexts is lacking, including for both trauma and non‐trauma patients. More data on major haemorrhage support and clinical outcomes are needed to inform guidelines and practice. [ABSTRACT FROM AUTHOR]

SUMMARY Objectives To evaluate the use of routinely collected data to determine the cause(s) of critical bleeding in patients who receive massive transfusion (MT). Background Routinely collected data are increasingly being used to describe and evaluate transfusion practice. Materials/methods Chart reviews were undertaken on 10 randomly selected MT patients at 48 hospitals across Australia and New Zealand to determine the cause(s) of critical bleeding. Diagnosis-related group (DRG) and International Classification of Diseases (ICD) codes were extracted separately and used to assign each patient a cause of critical bleeding. These were compared against chart review using percentage agreement and kappa statistics. Results A total of 427 MT patients were included with complete ICD and DRG data for 427 (100%) and 396 (93%), respectively. Good overall agreement was found between chart review and ICD codes (78·3%; κ = 0·74, 95% CI 0·70-0·79) and only fair overall agreement with DRG (51%; κ = 0·45, 95% CI 0·40-0·50). Both ICD and DRG were sensitive and accurate for classifying obstetric haemorrhage patients (98% sensitivity and κ > 0·94). However, compared with the ICD algorithm, DRGs were less sensitive and accurate in classifying bleeding as a result of gastrointestinal haemorrhage (74% vs 8%; κ = 0·75 vs 0·1), trauma (92% vs 62%; κ = 0·78 vs 0·67), cardiac (80% vs 57%; κ = 0·79 vs 0·60) and vascular surgery (64% vs 56%; κ = 0·69 vs 0·65). Conclusion Algorithms using ICD codes can determine the cause of critical bleeding in patients requiring MT with good to excellent agreement with clinical history. DRG are less suitable to determine critical bleeding causes. [ABSTRACT FROM AUTHOR]

Changing population demographics have important implications for the ability of transfusion services to meet the transfusion requirements of minority groups. In Western countries, differences in red-blood-cell ( RBC) antigens between predominantly Caucasian blood donors and recipients from different demographic backgrounds may result in higher RBC alloimmunization rates, particularly in those who are chronically transfused, and can make it more difficult to source compatible blood. Ensuring blood donors are representative of the general population is particularly relevant for patients of African descent, who have a number of important blood group differences from Caucasians. However, there are challenges in ensuring a representative donor population, especially when the national population is very multicultural. Research in African migrants and refugees living in Australia has identified blood donation knowledge, misconceptions about blood donation from experiences prior to migration, and perceptions or experiences of discrimination within the host country as important determinants of blood donation. Therefore, promotion of knowledge and awareness of blood donation and blood and health service processes should be considered to assist with the recruitment of migrant donors. [ABSTRACT FROM AUTHOR]