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Objectives Background Materials and Methods Results Discussion To develop an automated verification workflow for transfusion compatibility testing (TCT) based on the AUTO10‐A guidelines and blood group serology characteristics and to conduct a simulated validation of the test and subtest results by assessing the appropriateness of the autoverification rules.The accuracy of TCT results is a fundamental prerequisite for ensuring the safety of blood transfusions. However, the verification of these results still requires manual intervention.Five autoverification rules and their standards were determined: agglutination intensity, normal results, logical relationships, delta checks and interlaboratory test comparisons. The established categories and standards for the five rules were retrospectively validated using 13 506 samples (requests) that had been manually verified in our laboratory from January 2020 to June 2023.A total of 66 638 test items were involved in the autoverification, with 3844 items violating the verification rules, resulting in a pass rate of 96.10%. Considering individual test items, four tests had a pass rate of more than 90% in both the test item result table and the test subitem result table. However, there were significant differences in the pass rates between different tests. The same conclusion can be drawn when the unit is requests. The different standards set for the agglutination intensity and the delta check in the ABO typing testing subitems showed significant differences in pass rates.The incorporation of manually verified results into the automated verification simulation indicated that the five rules established in this study have good applicability, and appropriate standards can lead to reasonable pass rates. [ABSTRACT FROM AUTHOR]

Objective To determine the value of quality assessment system in supervising standard clinical blood use and improving the quality of clinical blood transfusion medical records. Methods The clinical blood transfusion records of Children′s Hospital, Zhejiang University School of Medical every quarter from January 2019 to December 2022 were selected and extracted for evaluation by 5% to 10% for the current season. These blood transfusion medical records were scored and graded A(≥90 points)/B(80-89 points)/C(

Objective To establish a rare blood group information supply platform in Shaanxi Province. Methods The rare blood group information supply platform consists of sample registration, result registration, donor files and inventory blood. The blood donation codes of voluntary blood donors were recorded for blood typing, and the antigen identification results of each blood group system were registered, all stored in the rare blood type information supply platform. When receiving an application for unusual or rare blood type missing multiple conventional antigens or a certain high-frequency antigen, the corresponding antigen negative blood donors and their blood status (in stock or not) were queried from the donor profile module of the platform, and the inventory of blood of rare blood type was monitored dynamically. Results The results showed that 5.060% (273/5 398) of rare Rh phenotype donors, 1.540‰ (51/33 010) of donors lacking multiple regular antigens, and 13 O-type donors lacking high-frequency antigens were recorded in the rare blood type information supply platform. Among them, 0.019‰ (3/158 484) of Jk(a-b-) phenotype, 0.436‰ (2/4 586) of Di(a+b-) phenotype, and 4.030‰ (8/1 983) of Fy (a-b+) phenotype were stored in the blood bank for rare blood type. Conclusion The establishment of rare blood group information supply platform can meet the urgent demand for blood of rare blood types in clinical practice and ensure the safety of blood transfusion.

Objective To observe the distribution of the unexpected antibodies in order to study the safety and strategies in 1 779 cases of clinical blood transfusion. Methods A total of 1 779 patients with unexpected antibodies were enrolled from transfusion candidates in various hospitals in Xi′an during a 10-year period(from 2012 to 2022.5). Results The unexpected antibodies were detected in 926(52.05%) of 1779 samples. The detected antibodies were mainly from 8 blood group systems and their distributions were as follows: Rh antibodies in 69.76%(646/926), Kidd in 2.59%(24/926), Lewis in 4.21%(39/926), MNS in 12.53%(116/926), P in 0.43%(4/926), Diego in 0.65%(6/926), Duffy in 0.54%(5/926), I in 0.97%(9/926), Rh+ MNS in 1.30%(12/926), Rh+ Lewis in 0.65%(6/926), Rh+ Kidd in 3.24%(30/926), Rh+ Diego in 1.51%(14/926), Rh+ Duffy in 0.86%(8/926), MNS+ Diego in 0.11%(1/926), Rh+ MNS+ Kidd in 0.22%(2/926), Rh+ Lewis+ Kidd in 0.22%(2/926), Rh+ Kidd+ P in 0.11%(1/926), Rh+ Kidd+ Diego in 0.11%(1/926). Conclusion According to the distribution of unexpected antibodies in Xi′an, antibodies from Rh system, were the most common ones.First, the production of unexpected antibodies can be effectively reduced by establishing Rh compatible blood transfusion. Secondly, antibody screen cells containing low-frequency antigens, such as Mur, Dia and Wra, should be reasonably selected to prevent missing detection of anti-low frequency antigen antibodies in Xi′an. Furthermore, the genotyping technology of rare blood group should be promoted and a rare blood group red blood cell bank be established to optimize the blood inventory and ensure the safety of blood transfusion.

Objective To observe and analyze the detection results of blood type unexpected antibody and its risk factors in inpatients, so as to provide reference for promoting the safety of clinical blood transfusion. Methods Clinical data of 22 800 inpatients were collected retrospectively and unexpected antibody screening was performed by microcolumn gel method and saline method. According to the screening results, the inpatients were divided into positive group (n = 62) and negative group (n = 22 738). Clinical data of the two groups were collected and analized by univariate analysis, and specificity identification of unexpected antibody was performed in the positive group. The specific distribution characteristics of antibody were statistically analyzed, and the risk factors of unexpected antibody were analyzed by binary logistic regression. Results Among the 22 800 inpatients, the yield rate of unexpected antibody was 0.27% (62/22 800), with Rh, MNS, Lewis, Kidd blood group antibody, mixed antibody, autoantibodies and others accounted for 40.32% (25/62), 14.52% (9/62), 6.45%(4/62), 1.61%(1/62), 20.97%(13/62), 6.45%(4/62) and 9.68%(6/62), respectively. Univariate analysis showed that there were significant differences in gender, age, pregnancy history, blood transfusion history, blood transfusion frequency and disease type between the positive group and the negative group by chi-square test (χ2 = 11.142, 6.994, 12.453, 4.762, 5.493, 92.381, all P0.05 ) . Binary logistic regression analysis showed that female, age >60 years old, with history of blood transfusion, number of blood transfusion >3 times, history of pregnancy, solid tumor and blood diseases, severe internal medical diseases were independent risk factors for unexpected antibody(P

Platelets transfusion is one of the most important methods to prevent and treat hemorrhagic diseases.At present, the vitro storage of platelets with gentle agitation at (22±2)℃ is short and susceptible to bacterial contamination, which greatly affects the availability and safety of clinical platelets transfusion.Studies at home and abroad have shown that storage at 4°C could prolong the preservation period of platelets.However, refrigeration may aggravate platelets storage lesion (PSL) and accelerate the clearance mechanism after transfusion, which seriously restricts the clinical application of refrigerated platelets.This paper reviews the research advances in PSL caused by 4℃ storage and the clearance mechanism after transfusion.

Background: Universal serological screening in endemic areas is essential for preventing Chagas disease transmission by transfusions, while in non-endemic areas, screening is provided only to donors exposed to the infection risk. In this respect, in order to ensure high and uniform standards of quality and safety of blood components, the Italian National Blood Centre conducted a survey to detect information on management of donors at risk of Chagas disease and on the current transfusion risk. Methods: The National Blood Centre conducted a survey on preventive measures for Chagas disease in the years 2020–2021. Results: Survey results are broadly representative of the national situation; out of 24,269 tested donors, only 15 donors were confirmed positive (0.4 out of 100,000 donors). This rate is lower than the number of positive donors (72/100,000) for transfusion transmissible infections (HIV, HBV, HCV, and T. pallidum) in the same period. Furthermore, the number of T. cruzi positive blood donors is lower than the T. cruzi positive subjects in the general population. Conclusions: In Italy, T. cruzi infection transfusion risk may be considered still very low, and this is confirmed by the absence of documented transfusion transmission. [ABSTRACT FROM AUTHOR]

Objective To analyze the safety of homotypic transfusion in military donors with negative unexpected antibody. Methods Blood samples (4 mL/person)of eligible military blood donors from November 2018 to October 2019 in our hospital (also working as forces blood station) were conducted for RBC antigen typing, unexpected antibody screening, direct antiglobulin test and cross-match test using microcolumn gel technology, and the compatibility of homotype blood samples was statistical analyzed. Results A total of 1 577 samples from eligible military blood donors were collected, including A RhD (+ ), B RhD (+ ), O RhD (+ ) and AB RhD (+ ), accounting for 31.39% (495/1 577), 34.37% (542/1 577), 24.10% (380/1 577) and 10.15% (160/1 577), respectively. Six samples presenting positive unexpected antibodies (0.38%, 6/1 577) were screened out, and a total of 7 141 cross-matching tests were performed on 1 571 unexpected antibody negative samples, including A RhD (+ ) [37.36% (2 668/7 141)], B RhD (+ ) [34.81% (2 486/7 141)], O RhD (+ ) [17.71% (1265/7 141)] and AB RhD (+ ) [10.11% (722/7 141)]. There was only 1 case of incompatible cross-matching presented between other donors and clinical patients, and the direct antiglobulin test was 1+ , therefore suspended red blood cells of the donor were scrapped. Conclusion There was high compatibility and good security of homotype transfusion of military blood donors with negative unexpected antibody.

Objective To investigate the distribution characteristics of Rh blood group antigens and Rh phenotypes among hospitalized patients in Chongqing and explore the significance of Rh phenotyping in ensuring the clinical safety of blood transfusion. Methods We examined Rh (D, C, c, E, e) antigens and ABO blood types in 157 927 hospitalized patients in Chongqing using micro-column gel test, and analyzed the distributions of Rh antigens and phenotypes in relation to ABO blood types, gender, and age of the patients and in different departments. Results Among the 157 927 inpatients, 157 407 were RhD-positive (including 14 cases of D variants) and 520 were RhD-negative, and Rh phenotype distribution differed significantly between the 2 groups. The main phenotypes were CCDee (48.45%) and CcDEe (33.04%) in the RhD-positive patients, and were ccdee (43.27%) and Ccdee (36.54%) in RhD-negative patients. Among the Rh antigens, D antigen was the most common (99.67%), followed by e (94.07%), C (90.97%), c (51.02%) and E (42.50%). No significant differences were found in Rh phenotype distribution among the RhD-positive patients with different ABO blood types or genders or among the patients from different departments of the hospital (all P>0.05). Significant differences were found in Rh phenotype distribution among RhD-positive patients in different age groups (P < 0.05). Conclusion CCDee and CcDEe are the predominant Rh phenotypes in hospitalized patients in Chongqing. The distribution of Rh phenotypes differ significantly among patients with different RhD blood types and in different age groups, and are not associated with ABO blood types, gender or departments where the patients receive care. The establishment of a Rh phenotype database for Rh antigen matching can help to reduce the occurrence of unexpected Rh antibodies and improve the safety of blood transfusion therapy.

Ensuring the safety of blood and blood products is a vital aspect of healthcare. The potential for transmission of pathogens through blood and blood products makes transfusion safety a significant concern. Despite advancements in testing methodologies, donated blood products still pose a risk for infection transmission. Human parvovirus B19 (B19V) is a small, single-stranded, non-enveloped DNA virus transmissible parenterally by blood transfusion. B19V causes a wide range of clinical manifestations, which is generally harmless in healthy individuals. B19V infection may cause severe complications, such as aplastic crises, as it affects erythrocyte progenitor cells in individuals with increased erythrocyte turnover. Additionally, B19V can be transmitted from pregnant women to their foetus, potentially causing hydrops fetalis and foetal death. The potential for transmission through blood and blood products makes B19V a significant concern for transfusion safety. In response to the growing recognition of B19V's impact on transfusion safety, various international health organisations have introduced guidelines to minimise its transmission through blood and plasma products. However, the implementation of these guidelines varies globally, with some regions, such as India, still lacking formal protocols for B19V monitoring. This review article explores the existing methodologies for screening blood donors for B19V, assesses the associated transfusion risks, and considers the implications for public health and clinical practice. By emphasising advancements in diagnostic techniques and the challenges of their implementation, this article provides a comprehensive overview of efforts to reduce the transmission of B19V through blood transfusions, thereby ensuring safer blood supplies and improved patient outcomes., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kumari et al.)

Background Hip fracture patients often experience surgical site infections (SSIs) as a major infectious complication after undergoing total hip arthroplasty (THA), which can lead to extended hospital stays, increased mortality, and higher healthcare costs. This study aimed to determine the incidence of SSI and identify the risk factors associated with it after THA. Objective This study aimed to explore the correlation between blood transfusion along with other factors and the occurrence of SSIs in postoperative patients who underwent THA for transcervical femoral neck fractures. Methods We conducted a retrospective analysis by reviewing the medical records of patients aged 60-80 years who underwent surgery for hip fractures at the Unidad Médica de Alta Especialidad Hospital de Traumatología y Ortopedia No. 21 in Monterrey, Mexico, between January 2020 and January 2021. We analyzed potential risk factors such as age, sex, transfusion necessity, preoperative hemoglobin levels, history of diabetes mellitus, arterial hypertension, and end-stage chronic disease. Data are presented as numbers and percentages, and statistical analyses were performed using IBM SPSS Statistics for Windows, Version 28.0 (Released 2021; IBM Corp., Armonk, New York, United States). Results The study included 87 patients, of whom 55 (63%) were women with an average age of 73 years. SSIs were identified in 12 (13.8%) patients. Among those with infections, nine (75%) had a history of blood transfusion (p=0.05). Diabetes, hypertension, and chronic kidney disease also increased the risk for infection. There was no association with gender, age, American Society of Anesthesiologists (ASA) risk, and preoperative hemoglobin. Conclusions We found a heightened risk of SSI in patients with a history of blood transfusions, emphasizing the need for careful consideration and monitoring during the perioperative period. Additionally, patients with comorbidities such as diabetes, hypertension, and chronic kidney disease were more susceptible to SSI, underscoring the importance of preoperative assessment and targeted preventive measures. Further research and collaboration are needed to refine strategies for mitigating SSI risk factors and optimizing healthcare resource utilization., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Unidad Médica de Alta Especialidad (UMAE) Hospital de Traumatologia y Ortopedia No. 21 Research Ethics Committee and Local Health Research Committee issued approval R-2021-1903-017. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Arriaga-Cazares et al.)

Objective Through retrospective analysis of the inconsistency of the two blood type identification results of blood samples before and after the implementation of the "comprehensive blood transfusion quality management" in our hospital, the reasons were investigated and analyzed, and improvement measures were proposed to ensure the safety of clinical blood use. Methods We performed a comparative analysis of the 2 blood type identification results of blood samples which were tested in the first three years (January 2015 to December 2017) and the later three years (January 2018 to December 2020) in our hospital after implementation of "Comprehensive Blood Transfusion Quality Management" Results From 2015 to 2020, a total of 12,023 cases of blood type identification were performed twice, and a total of 46 blood samples were identified with inconsistent results. The incidence rate was 0.038%, including 34 cases (0.061%) in the first three years and 12 cases (0.019%) in the later three years (P < 0.05). The related factors were investigated and analyzed. In the first three years after the implementation of "Comprehensive Blood Transfusion Quality Management", the main reason was the wrong identification of patients, and the main responsibility was the nurse. In the later three years after the implementation of "Comprehensive Blood Transfusion Quality Management", the main reason was that patients borrow other people's information, and the main responsibility was the patient. Conclusion The risk of blood transfusion can be effectively reduced by carrying out "Comprehensive Blood Transfusion Quality Management", strictly implementing the operating procedures, and comparing the test results of two blood samples of the same patient's blood type and cross matching. [ABSTRACT FROM AUTHOR]

Background: Universal serological screening in endemic areas is essential for preventing Chagas disease transmission by transfusions, while in non-endemic areas, screening is provided only to donors exposed to the infection risk. In this respect, in order to ensure high and uniform standards of quality and safety of blood components, the Italian National Blood Centre conducted a survey to detect information on management of donors at risk of Chagas disease and on the current transfusion risk. Methods: The National Blood Centre conducted a survey on preventive measures for Chagas disease in the years 2020–2021. Results: Survey results are broadly representative of the national situation; out of 24,269 tested donors, only 15 donors were confirmed positive (0.4 out of 100,000 donors). This rate is lower than the number of positive donors (72/100,000) for transfusion transmissible infections (HIV, HBV, HCV, and T. pallidum) in the same period. Furthermore, the number of T. cruzi positive blood donors is lower than the T. cruzi positive subjects in the general population. Conclusions: In Italy, T. cruzi infection transfusion risk may be considered still very low, and this is confirmed by the absence of documented transfusion transmission.

Background: Despite the advances in screening of blood through nucleic acid testing to improve the blood safety, there are chances that blood will be donated during the “window period.” Careful selection of donors is an important and pragmatic risk management strategy to ensure blood safety. Subjects and Methods: The observational study was undertaken in two parts. In the first part, retrospective data of donors attending blood transfusion services of tertiary care center between 2014 and 2016 were collated and analyzed. In the second part, an online survey was conducted to assess the prevalence and awareness among donors. Results: A total of 32,773 donors reported for blood donation, of which 8974 (27.38%) potential donors were deferred. Deferral incidence due to high-risk behaviors increased in 3 years from 2.84% to 9.85% with majority of donors (99.60%) being males. Fifty-two percent of donors were repeat donors while 48% were first-time donors. In the survey, 90% of centers question donors about high-risk behaviors, 58% of centers specifically question about sex history. Fifty percent of seroreactive donors in the first part of the study and 63% of respondents found that donors give a positive history of high-risk behavior at the time of counseling. Discussion and Conclusion: In view of the need for optimization of cost of health-care services and maintaining highest level of transfusion safety, its time to devise new solutions in dealing with potentially risky sexual behaviors. Efforts are also needed to educate the general population to understand potential risks of high-risk behaviors and to promote the self-deferral or confidential unit exclusion.

Background & objectives: Blood transfusion therapy involves multiple steps to ensure selection of safe blood component for transfusion. This includes testing for infectious markers, full ABO compatibility, free from any clinically significant red cell antibodies and acceptable donor's red cell survival rates without destruction of recipient's red cells. The red cell antibodies present in healthy blood donors can cause severe haemolytic transfusion reaction, especially in massive blood transfusion recipients and paediatric patients. Hence, screening of red cell antibodies in donor blood is important to provide compatible blood products and to avoid haemolytic transfusion reactions in susceptible patient population. This study was planned to assess prevalence, aetiology and type of unexpected red cell antibodies in a large number of whole blood donor population in north India. Methods: This three-year prospective observational study included blood donor samples for antibody screening from January 2015 to December 2017. A total of 166,803 healthy blood donors including 156,128 (93.6%) males and 10,675 (6.4%) females were screened. Results: The prevalence of red cell antibodies was 0.17 per cent in our donor population. Of the total 286 donors with red cell antibodies, 248 (86.7%) had alloantibodies, 30 (10.5%) had autoantibodies and eight donors (2.8%) showed positive antibody screening with inconclusive results. Interpretation & conclusions: Alloimmunization to red cell antigens is a challenging task for current transfusion practices. The antibody screening in blood donors may improve the quality and safety of blood transfusion in the recipients. It also reduces the risk of complications from incompatible blood transfusions. [ABSTRACT FROM AUTHOR]

Background: The occurrence of adverse reactions to blood donation significantly hampers donor retention and negatively impacts on the universal availability of adequate numbers of blood donor units. Objective: To analyze the spectrum and prevalence of adverse reactions in blood donors in a tertiary hospital-based blood bank in Nigeria. Subjects and Methods: The details of 3520 blood donors who presented for donation over a 12 months period were retrieved from the departmental archives for analysis. These included sociodemographic information, type of donor, type and frequency of adverse reactions to blood donation. Data were analyzed using the Statistical Package for Social Sciences version 20.0 (SPSS Inc., Chicago, IL, USA) computer software. Descriptive and inferential statistics were employed to represent the distribution of donor characteristics (as percentages) and compare reaction rates by gender and severity, respectively. Results: The prevalence of adverse reactions to blood donation was (56/3520) 1.60%; this occurred more frequently in male and family replacement donors (55.35% and 100.0%, respectively). The spectrum of donor adverse reactions included anxiety 25 (44.64%), generalized body weakness 11 (19.64%), hematoma 10 (17.86%), fainting 5 (8.93%), and vomiting 5 (8.93%). Vasovagal reactions were the most frequent adverse reaction encountered among the donors (46/56; 82.14%). Conclusion: Vasovagal reactions are common adverse phenomena in our blood donor set; this has implications on transfusion safety and blood donor retention.

Blood transfusions are contributing to a higher rate of hepatitis C virus (HCV) in Pakistan. Half of all blood transfusions in Pakistan are not screened for hepatitis C, hepatitis B or HIV. Family members donate blood that is likely not tested due to social stigma attached to HCV. Paid donations are also quite common in the country, especially by people who inject drugs (PWID), which increases the population’s exposure to HCV. Most of the population utilizes the private sector for their health needs; this sector has lax regulation due to the lack of oversight by the government or any other regulatory body. In addition, groups who are at most need for blood transfusions, such as hemophiliacs and those with thalassemia, have a higher rate of hepatitis C. This fact reinforces the need for blood transfusion reform in Pakistan, which includes improving oversight, upgrading infrastructure and promoting health literacy through cultural norms, according to the World Health Organization (WHO) recommendations. The lessons learned in Pakistan can be adapted to countries facing similar issues.

Objective: To analyze the results of unqualified blood screening among blood donors in Shaoxing region., Methods: 257 145 blood samples from volunteer blood donors from 2017 to 2021 were tested for HBsAg, HCV, HIV, TP, ALT, HTLV, and NAT. All blood test results were analyzed retrospectively., Results: Over the 5-year period, the average failure rate of the tests for volunteer blood donors was 1.22%. In the descending order from high to low, the positive rates of ALT, HBsAg, NAT, TP, HCV, HIV, HTLV were 0.32%, 0.25%, 0.20%, 0.19%, 0.17%, 0.07%, and 0.01% respecitively. Of these, HBsAg (χ 2 =65.23), ALT (χ 2 =47.32), and HCV (χ 2 =12.73) were significantly different between different years ( P <0.05), but TP (χ 2 =4.19), HIV (χ 2 =7.58), NAT (χ 2 =7.62), and HTLV (χ 2 =6.75) were no significant differences ( P >0.05). And the positivity rates of HBsAg and HCV was a trend of decreasing. By comparing nucleic acid and enzyme immunoassay positive tests, the two methods were found to complement each other. The age and gender distribution difference of the positive population could help to better ensure safe blood recruitment., Conclusion: It is necessary to strengthen blood testing efforts and continuously pay attention to the changing patterns of positive blood-borne diseases in order to improve blood quality and safety.

Aim: The study aimed to investigate the association between the use of serotonergic antidepressants and blood transfusion requirements in orthopedic surgical patients., Methodology: A retrospective follow-up study was conducted at Kota Trauma Hospital, Kota, Rajasthan focusing on patients who underwent orthopedic surgeries between November 2021 through December 2022. Patients were categorized into two groups: users of serotonergic antidepressants and users of other antidepressants (non-selective serotonergic antidepressants). The requirement for blood transfusion for both groups was assessed. Covariate factors, such as medication use and comorbidities (e.g., diabetes mellitus, cardiovascular diseases), were examined to control potential confounding variables., Result: A total of 170 subjects with complete medical records were included in the study. The results presented a significant association between the usage of serotonergic antidepressants and blood transfusion requirements (p=0.001). While no significant differences between the two groups were observed in perioperative hemoglobin levels and fluid infusion, there was a significant difference in blood loss and postoperative drainage., Conclusion: Serotonergic antidepressant usage was correlated with increased blood transfusion requirements in orthopedic surgery patients on antidepressants. The study underscores the importance of considering medication factors in perioperative management and highlights potential implications for patient care strategies., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Iqbal et al.)

Increasing identification of transmissions of emerging infectious diseases (EIDs) by blood transfusion raised the question which of these EIDs poses the highest risk to blood safety. For a number of the EIDs that are perceived to be a threat to blood safety, evidence on actual disease or transmission characteristics is lacking, which might render measures against such EIDs disputable. On the other hand, the fact that we call them 'emerging' implies almost by definition that we are uncertain about at least some of their characteristics. So what is the relative importance of various disease and transmission characteristics, and how are these influenced by the degree of uncertainty associated with their actual values? We identified the likelihood of transmission by blood transfusion, the presence of an asymptomatic phase of infection, prevalence of infection, and the disease impact as the main characteristics of the perceived risk of disease transmission by blood transfusion. A group of experts in the field of infectious diseases and blood transfusion ranked sets of (hypothetical) diseases with varying degrees of uncertainty associated with their disease characteristics, and used probabilistic inversion to obtain probability distributions for the weight of each of these risk characteristics. These distribution weights can be used to rank both existing and newly emerging infectious diseases with (partially) known characteristics. Analyses show that in case there is a lack of data concerning disease characteristics, it is the uncertainty concerning the asymptomatic phase and the disease impact that are the most important drivers of the perceived risk. On the other hand, if disease characteristics are well established, it is the prevalence of infection and the transmissibility of the disease by blood transfusion that will drive the perceived risk. The risk prioritization model derived provides an easy to obtain and rational expert assessment of the relative importance of an (emerging) infectious disease, requiring only a limited amount of information. Such a model might be used to justify a rational and proportional response to an emerging infectious disease, especially in situations where little or no specific information is available. [ABSTRACT FROM AUTHOR]

Background: The occurrence of adverse reactions to blood donation significantly hampers donor retention and negatively impacts on the universal availability of adequate numbers of blood donor units. Objective: To analyze the spectrum and prevalence of adverse reactions in blood donors in a tertiary hospital-based blood bank in Nigeria. Subjects and Methods: The details of 3520 blood donors who presented for donation over a 12 months period were retrieved from the departmental archives for analysis. These included sociodemographic information, type of donor, type and frequency of adverse reactions to blood donation. Data were analyzed using the Statistical Package for Social Sciences version 20.0 (SPSS Inc., Chicago, IL, USA) computer software. Descriptive and inferential statistics were employed to represent the distribution of donor characteristics (as percentages) and compare reaction rates by gender and severity, respectively. Results: The prevalence of adverse reactions to blood donation was (56/3520) 1.60%; this occurred more frequently in male and family replacement donors (55.35% and 100.0%, respectively). The spectrum of donor adverse reactions included anxiety 25 (44.64%), generalized body weakness 11 (19.64%), hematoma 10 (17.86%), fainting 5 (8.93%), and vomiting 5 (8.93%). Vasovagal reactions were the most frequent adverse reaction encountered among the donors (46/56; 82.14%). Conclusion: Vasovagal reactions are common adverse phenomena in our blood donor set; this has implications on transfusion safety and blood donor retention. [ABSTRACT FROM AUTHOR]

Blood transfusions are contributing to a higher rate of hepatitis C virus (HCV) in Pakistan. Half of all blood transfusions in Pakistan are not screened for hepatitis C, hepatitis B or HIV. Family members donate blood that is likely not tested due to social stigma attached to HCV. Paid donations are also quite common in the country, especially by people who inject drugs (PWID), which increases the population's exposure to HCV. Most of the population utilizes the private sector for their health needs; this sector has lax regulation due to the lack of oversight by the government or any other regulatory body. In addition, groups who are at most need for blood transfusions, such as hemophiliacs and those with thalassemia, have a higher rate of hepatitis C. This fact reinforces the need for blood transfusion reform in Pakistan, which includes improving oversight, upgrading infrastructure and promoting health literacy through cultural norms, according to the World Health Organization (WHO) recommendations. The lessons learned in Pakistan can be adapted to countries facing similar issues. [ABSTRACT FROM AUTHOR]

Résumé: La sécurité transfusionnelle concerne toutes les étapes depuis la prescription des examens immuno-hématologiques jusqu’à la réalisation de l’acte transfusionnel. Dans sa décision du 5 novembre 2006 relative aux bonnes pratiques transfusionnelles, l’Afssaps recommande de transfuser les patients pendant les heures ouvrables de l’établissement et de limiter les transfusions la nuit aux seules urgences vitales. Une enquête rétrospective menée au sein de notre établissement a permis d’évaluer la proportion des transfusions réalisées en horaires de garde. L’objectif de cette évaluation des pratiques professionnelles est d’analyser les raisons conduisant à réaliser des transfusions à des horaires tardifs et d’en évaluer la pertinence. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Blood transfusion safety depends on strict compliance with each step of a process beginning with the order for labile blood products and related immunohematologic testing and ending with administration and follow-up of the receiver. This process is governed by stringent regulatory texts and guidelines. Despite precautions, processing errors are still reported. Analysis of incident reports shows that the most common cause involves patient identification and that most errors occur at two levels, i.e. the entry of patient information and management of multiple regulatory crosschecks and record-keeping using different systems. Method: The purpose of this report is to describe the collaborative approach implemented by the Établissement français du Sang Alpes-Méditerranée (EFSAM) and the Assistance publique des Hôpitaux de Marseille (APHM) to secure the blood transfusion process and protect interfaces while simplifying and facilitating exchanges. Results: Close cooperation has had a threefold impact with simplification of administration, improvement of experience feedback, and better management of test ordering. The organization implemented between the two institutions has minimized document redundancy and interfaces between immunohematologic testing and delivery. Collaboration based on experience feedback has improved the level of quality and cost control. Conclusion: In the domain of blood transfusion safety, the threshold of 10−5 has been reached with regard to the risk of ABO errors in the distribution concentrated red cells (CRC). In addition, this collaborative organization has created further opportunity for improvement by deploying new methods to identify simplification measures and by controlling demand and usage. [Copyright &y& Elsevier]

Abstract: Despite the generalization of prevention measures against foetomaternal alloimmunization with anti-D immunoprophylaxis since 1970s, retrospectively 30 years later, its complications (new-born child''s severe haemolytic disease, foetal death by anemia or nuclear icterus by bilirubin encephalopathy) have not disappeared. At the same time, alloimmunizations against antigens other than D increase with no possible prevention. As part of the set up in France of regional files analysing and making an inventory of serious foetomaternal incompatibilities requiring in utero or neonatal transfusion, we felt the need to synthesize current data, biological profiles (early screening of erythrocytic alloimmunization and its follow up during pregnancy, father''s immunohaematologic status, evaluation of in utero immune haemolysis and impact of new non invasive techniques of diagnosis-RH1 foetal genotypage from ADN foetal of RH1 – mothers'' maternal plasma), clinical and paraclinical data (evaluation of foetal haemolysis by echography, recording of foetal movements and foetal cardiac rhythm), therapeutic indicators (in utero foetal transfusions or exsanguinotransfusions, neo and postnatal transfusions or exsanguinotransfusions, induced premature labour, newborn''s intensive continue phototherapy and Rhesus immunoprophylaxis) in order to enable medical and paramedical professionals to carry out the specific supervision of pregnancies with foetomaternal incompatibility, the in utero, neo- and postnatal treatment of child and the efficient therapeutic prevention of anti-D alloimmunization, in a cooperative way. [Copyright &y& Elsevier]

Haemovigilance, an important step in transfusion safety, had been set up by a French law in January 1993. Application of haemovigilance in public hospitals is based on three conditions: reporting of adverse transfusion events, traceability of blood products and prevention of adverse transfusion events. The implementation of haemovigilance follows the rules given in a Ministry order dated January 1994, the first of a series including regulations about patient information, virological follow-up of transfused patients, blood product distribution. Haemovigilance rules are the same for adults as for children, concerning blood product traceability and adverse event reporting. It is much more difficult in other fields such as autologous transfusion and “child-patient” information that depend on their parent advice and should be particularly adapted to the familial context, the type of disease and the treatment. Difficulties arise for completing pre– and post-transfusion, immuno-haematologic and virologic controls. Compliance to protocols, in agreement with blood banks, is necessary. [Copyright &y& Elsevier]

Nucleic Acid Testing (NAT) for HIV-1 and HCV has been introduced in France and became mandatory for all homologous blood donations since July 1st 2001 in addition to serology screening. Previously, a feasibility study led to the selection of 2 technologies : a TMA based assay (Chiron) uses the Procleix HIV-/HCV assay on pools of 8 samples and a PCR based assay from BioMe´rieux-Roche which is a combination of an RNA extraction system (NucliSens, BioMe´rieux) with a fully automated system for nucleic acid amplification and detection (Cobas Amplicor, Roche). This system uses the Cobas Ampliscreen HCV test v.2.0 and the The Cobas Ampliscreen HIV test v1.5, on 24 sample pools. Pooling was required because single-donation testing is not yet feasible, as a result of the limitations in automation available for all current NAT technologies. The two technologies were easily implemented and showed nearly the same detection limit for HCV RNA and HIV-1 RNA. During a one-year period, from July 1st 2001 to June 30, 2002, out of the 2.5 million donations tested, the NAT yield resulted in one HIV-1 RNA positive-antibody negative donation and one HCV RNA positive-antibody negative donation. Two HIV NAT positive-antibody negative donations were missed by minipool NAT because a very low viral load. Moreover, the NAT implementation did not impact on blood component availability, including platelet concentrates. [Copyright &y& Elsevier]

For 20 years, the organization set up to insure the blood transfusion safety has never stopped strengthening. It is based on clinical and epidemiological selection of the blood donation candidates, biologic selection of blood donations and different physico-chemical techniques for pathogens reduction or inactivation in blood products. In France, this organization is optimized by the assertion of the voluntary and non-remunerated character of blood donation registered in the law of January 4th, 1993. The blood donors selection is structured in three successive stages. The first stage is the pre-donation information. The second stage begins with reading and filling out an info-questionnaire which prepare for an interview with a physician. This interview is specially directed to prevention of transfusion-transmitted infections and the prevention of adverse reactions after a 400 to 600 mL collection of whole blood or components. Finally, the third stage is the delivery of a post-donation information which invites the donor to contact the “e´tablissement franc¸ais du sang” (EFS) in case of a new event arisen after the donation or in case of reviewing of its own answers during the medical interview. [Copyright &y& Elsevier]

Abstract: Blood Transfusion Safety is dependent on effectively organised and managed blood services, which have adequate financial resources, skilled manpower, appropriate infrastructure and quality management systems in place. 80% of the world''s population has access to 20% of the supply blood products, of which little is consistently safe. HIV highlighted the importance of blood safety. The lack of effective blood services in low human development index (LHDI), developing countries, has lead to international funding and capacity building for more than three decades. The initial strategies focused on providing HIV testing reagents to prevention transmission, however this only addresses one part of blood safety. Blood safety is not only dependent on preventing HIV transmission. In many populations there are other infectious agents, which have a higher prevalence. Ensuring the correct blood is provided to the patient depends on: well managed services with effective leadership and adequate budgets; capacity building and retention of skilled experienced staff; availability of laboratory equipment, correctly maintained; blood cold chain systems; procedures for tendering, purchasing and ensuring an unbroken supply of reagents and consumables; and quality management systems. Barriers for simplified effective tendering, procurement and contracting require urgent attention and coordination of all funding organisations to ensure an unbroken supply of reagents. [Copyright &y& Elsevier]

Background: The majority of blood transfusion safety strategies recommended by the WHO for resource-poor countries focus mainly on reducing the risk of transfusion-transmitted infections (TTIs). Other technologies such as leucocyte reduction may represent complementary strategies for improving transfusion safety., Objective: To evaluate the role of using leucocyte reduced blood in a resource-poor country., Methods: Pre-storage leucocyte reduced (LR) red blood cells (RBCs) were specially prepared for the Tissue Oxygenation by Transfusion in severe Anaemia and Lactic acidosis (TOTAL) study, at the Uganda Blood Transfusion Services from February 2013 through May 2015. Quality control tests were performed to evaluate the procedure, and the incremental cost of an LR-RBC unit was estimated., Results: A total of 608 RBCs units were leucocyte reduced. Quality control tests were performed on 55 random RBCs units. The median (IQR) residual leucocyte count was 4 (0·5-10) WBC/uL, equivalent to 1·8x106 WBC per unit. The estimated incremental unit cost of leucocyte reduction was $37 USD per LR RBC unit., Conclusion: Leucocyte reduction of blood in a resource-poor country is doable although relatively costly. As such, its value in resource-poor countries should be weighed against other transfusion safety propositions., (© 2020 Dhabangi A et al.)

Background: Large-scale and long-term studies are not sufficient to determine the efficiency that IT solutions can bring to transfusion safety. Objective: This quality-improvement report describes our continuous efforts to implement and upgrade a bar code–based transfusion management (BCTM) system since 2011 and examines its effectiveness and sustainability in reducing blood transfusion errors, in a 3000-bed tertiary hospital, where more than 60,000 prescriptions of blood transfusion are covered by 2500 nurses each year. Methods: The BCTM system uses barcodes for patient identification, onsite labeling, and blood product verification, through wireless connection to the hospital information systems. Plan-Do-Study-Act (PDSA) cycles were used to improve the process. Process maps before and after implementation of the BCTM system in 2011 were drawn to highlight the changes. The numbers of incorrect labeling or wrong blood in tube incidents that occurred quarterly were plotted on a run chart to monitor the quality changes of each intervention introduced. The annual occurrences of error events from 2011 to 2017 were compared with the mean occurrence of 2008-2010 to determine whether implementation of the BCTM system could effectively reduce the number of errors in 2016 and whether this reduction could persist in 2017. Results: The error rate decreased from 0.03% in 2008-2010 to 0.002% in 2016 (P <.001) and 0.001% in 2017 (P <.001) after implementation of the BTCM system. Only one incorrect labeling incident was noted among the 68,324 samples for blood typing, and no incorrect transfusions occurred among 67,423 transfusion orders in 2017. Conclusions: This report demonstrates that continuous efforts to upgrade the existing process is critical to reduce errors in transfusion therapy, with support from information technology. [ABSTRACT FROM AUTHOR]

Increasing identification of transmissions of emerging infectious diseases (EIDs) by blood transfusion raised the question which of these EIDs poses the highest risk to blood safety. For a number of the EIDs that are perceived to be a threat to blood safety, evidence on actual disease or transmission characteristics is lacking, which might render measures against such EIDs disputable. On the other hand, the fact that we call them "emerging" implies almost by definition that we are uncertain about at least some of their characteristics. So what is the relative importance of various disease and transmission characteristics, and how are these influenced by the degree of uncertainty associated with their actual values? We identified the likelihood of transmission by blood transfusion, the presence of an asymptomatic phase of infection, prevalence of infection, and the disease impact as the main characteristics of the perceived risk of disease transmission by blood transfusion. A group of experts in the field of infectious diseases and blood transfusion ranked sets of (hypothetical) diseases with varying degrees of uncertainty associated with their disease characteristics, and used probabilistic inversion to obtain probability distributions for the weight of each of these risk characteristics. These distribution weights can be used to rank both existing and newly emerging infectious diseases with (partially) known characteristics. Analyses show that in case there is a lack of data concerning disease characteristics, it is the uncertainty concerning the asymptomatic phase and the disease impact that are the most important drivers of the perceived risk. On the other hand, if disease characteristics are well established, it is the prevalence of infection and the transmissibility of the disease by blood transfusion that will drive the perceived risk. The risk prioritization model derived provides an easy to obtain and rational expert assessment of the relative importance of an (emerging) infectious disease, requiring only a limited amount of information. Such a model might be used to justify a rational and proportional response to an emerging infectious disease, especially in situations where little or no specific information is available., (© 2017 Society for Risk Analysis.)

Abstract: Background: Blood transfusions carry risks of untoward reactions, including the transmission of infections, such as hepatitis B and C. Proper blood donor recruitment and selection, and adequate laboratory screening for infectious markers diminish the risk of transfusion-transmitted infections. Objectives: To estimate the potential risk of acquiring transfusion-transmitted infections by hepatitis B or hepatitis C in 24 Caribbean countries during the period of 1996 to 2003. Study design: Official national reports for 1996, 2000–2003 of the yearlynumber of blood donors, screening coverage, and prevalence of serological markers for infectious diseases were used to estimate the risk of patients receiving an HBV- or HCV-positive unit of blood, and of developing an infection after receiving a positive unit. Estimates of number of infections transmitted through transfusion and number of infections prevented by screening of blood were also obtained. Results: During the period analyzed, HBV screening coverage among blood donors was 100% in all countries with the exception of Grenada (0% in 1996) and Saint Lucia (99.5% in 2002). For HCV, only 10 countries reported universal screening in 1996, while 15 did in 2003. The number of countries that did not screen any units for HCV decreased from 11 in 1996 to five in 2003. In general, high prevalence rates of HBV (10–75 per 1000 donors) and HCV (7–19.3 per 1000 donors) markers were found in the majority of countries. We estimated that 235 infections by HCV (1:12471 donations) and two infections by HBV (1:1465373) were transmitted through transfusion because of lack of screening. On the other hand, screening of blood for transfusion prevented 21 005 HCV and 22 100 HBV infections. Conclusions: Blood donor recruitment and coverage of screening for transfusion-transmitted infections, especially HCV, mustbe improved in the Caribbean countries. [Copyright &y& Elsevier]

Blood transfusion safety covers all stages from prescription of immuno-haematological examinations until the completion of the transfusion. According to the 05/11/2006 Afssaps' decision on good transfusion practices, transfusions should not be given at night unless the patient is actively bleeding or has some other urgent clinical need. A retrospective study was used to assess the proportion of transfusions at night. Through this professional practice evaluation, we analyze the reasons leading to perform transfusions at late hours, in order to reduce errors and improve safety for patients., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)