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Background: The aim of the study is to present the results and experience in the management of complaints in a transfusion service in order to draw attention to the importance of this segment of quality management and to stimulate publication of other studies on the topic., Materials and Methods: This study is based on data from the Croatian Institute of Transfusion Medicine obtained by analysis of complaints recorded during a 13-year period (1998-2010). The distribution of the types and frequencies of complaints is presented, along with the level of their justifiability and criticality. The dynamics of the complaints is analysed overall and within particular categories. In addition, corrective actions and other factors that may have influenced the trends observed are discussed., Results: During the study period, 817 complaints were received, most of which (40.9%) referred to the positive direct antiglobulin test in red cell concentrates, followed by blood product issuing and distribution (12.9%) and blood product quality (9.4%). Of the 817 complaints, 177 (21.7%) were assessed as serious and 645 (78.9%) as justified based on the testing performed., Conclusion: Data collected by systematic recording and analysis of complaints provide a basis for problem identification, implementation of corrective and preventive actions, and improvement of product and service quality, and, thereby, customer satisfaction.

Background: Continuous and efficient error management, including procedures from error detection to their resolution and prevention, is an important part of quality management in blood establishments. At the Croatian Institute of Transfusion Medicine (CITM), error management has been systematically performed since 2003., Materials and Methods: Data derived from error management at the CITM during an 8-year period (2003-2010) formed the basis of this study. Throughout the study period, errors were reported to the Department of Quality Assurance. In addition to surveys and the necessary corrective activities, errors were analysed and classified according to the Medical Event Reporting System for Transfusion Medicine (MERS-TM)., Results: During the study period, a total of 2,068 errors were recorded, including 1,778 (86.0%) in blood bank activities and 290 (14.0%) in blood transfusion services. As many as 1,744 (84.3%) errors were detected before issue of the product or service. Among the 324 errors identified upon release from the CITM, 163 (50.3%) errors were detected by customers and reported as complaints. In only five cases was an error detected after blood product transfusion however without any harmful consequences for the patients. All errors were, therefore, evaluated as "near miss" and "no harm" events. Fifty-two (2.5%) errors were evaluated as high-risk events. With regards to blood bank activities, the highest proportion of errors occurred in the processes of labelling (27.1%) and blood collection (23.7%). With regards to blood transfusion services, errors related to blood product issuing prevailed (24.5%)., Conclusion: This study shows that comprehensive management of errors, including near miss errors, can generate data on the functioning of transfusion services, which is a precondition for implementation of efficient corrective and preventive actions that will ensure further improvement of the quality and safety of transfusion treatment.

Aim: To assess the association between ABO blood group genotypes and genetic risk factors for thrombosis (FV Leiden, prothrombin G20210A, and methylenetetrahydrofolate reductase C677T mutations) in the Croatian population and to determine whether genetic predisposition to thrombotic risk is higher in non-OO blood group genotypes than in OO blood group genotypes., Methods: The study included 154 patients with thrombosis and 200 asymptomatic blood donors as a control group. Genotyping to 5 common alleles of ABO blood groups was performed by polymerase chain reaction with sequence specific primers (PCR-SSP). FV Leiden was determined by PCR-SSP, while prothrombin and methylenetetrahydrofolate reductase were determined by PCR and restriction fragment length polymorphism (PCR-RFLP)., Results: There was an association between non-OO blood group genotypes and the risk of thrombosis (odds ratio [OR] 2.08, 95% confidence interval [CI], 1.32-3.27). The strongest association with thrombotic risk was recorded for A1B/A2B blood group genotypes (OR, 2.73; 95% CI, 1.10-6.74), followed by BB/O1B/O2B (OR, 2.29; 95% CI, 1.25-4.21) and O1A1/O2A1 (OR, 1.95; 95% CI, 1.15-3.31). FV Leiden increased the risk of thrombosis 31-fold in the group of OO carriers and fourfold in the group of non-OO carriers. There was no significant difference in the risk of thrombosis between OO and non-OO blood groups associated with prothrombin mutation. Non-OO carriers positive for methylenetetrahydrofolate reductase had a 5.7 times greater risk of thrombosis than that recorded in OO carriers negative for methylenetetrahydrofolate reductase., Conclusion: Study results confirmed the association of non-OO blood group genotypes with an increased risk of thrombosis in Croatia.

Pseudothrombocytopenia is a laboratory artefact that can introduce serious problems in diagnosis and treatment in patients with low platelet count. The most common reason for this artefact is in vitro platelet clumping in blood samples collected into ethilenediaminetetraacetic acid (EDTA) anticoagulant. The clumping activity is greater at temperatures less than 37 degrees C, and the EDTA concentrations required for clumping are 20 times below anticoagulant concentrations. In this article we described the case of a female patient with diagnosed EDTA induced pseudothrombocytopenia. The cause of incorrectly low platelet counts was proved by simultaneous analysis in blood samples collected into EDTA anticoagulant and into heparin as a control sample. Absences of incorrectly low platelet count in heparin sample and rapid decrease of platelet count in EDTA sample were noticed. Decrease in platelet count was accompanied by increase in the number of leukocytes, so called pseudoleukocytosis. Careful examination of blood film is necessary to establish correct diagnosis, promptly after the blood collection and approximately two hours later. It is important to verify formation of clumps two hours after the blood collection and also progressive reduction in the platelet count in EDTA sample. By blood assessment conducted in this concern it is possible to avoid severe misinterpretation in such patients.

In order to evaluate the testing proficiency in immunohematological laboratories in Croatia blood samples were prepared and fully examined in the Croatian Institute for Transfusion Medicine and sent to all the transfusion laboratories in the country. The laboratories were asked to perform the following tests: determination of AB0 blood group and Rh phenotype; detection and identification of irregular antibodies and crossmatches between serum and RBCs. All the laboratories (100%) accurately determined AB0 and Rh(D) negative blood groups and crossmatch between compatible serum and RBCs. In 80.65% of the laboratories, Rh(Du) blood group was accurately determined. The incompatibility between serum and Rh(Du) RBCs in crossmatch was detected in 93.55% of the laboratories. 96.77% laboratories correctly detected irregular antibodies. Only 35.48% of the laboratories accurately identified anti-D and anti-C alloantibodies in the serum, 32.26% failed to identify one of the two antibodies and 29.03% of the laboratories detected irregular antibodies but did not identify their specificity. Only 35.48% of the laboratories correctly performed all the tasks.