Long time blood-transfusion trend in a European general hospital.
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ABSTRACT:
SUBMITTER: Enko D
PROVIDER: S-EPMC7527503 | biostudies-literature | 2020
REPOSITORIES: biostudies-literature
Publications
Long time blood-transfusion trend in a European general hospital.
Enko Dietmar D Herrmann Markus M Baranyi Andreas A Schnedl Wolfgang J WJ Halwachs-Baumann Gabriele G
EXCLI journal 20200619
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Project description:Gene expression microarrays have made a profound impact in biomedical research. The diversity of platforms and analytical methods has made comparison of data from multiple platforms very challenging. In this study, we describe a framework for comparisons across platforms and laboratories. We have attempted to include nearly all the available commercial and “in-house” platforms. Using probe sequences matched at the exon level improved consistency of measurements across the different microarray platforms compared to annotation-based matches. Generally, consistency was good for highly expressed genes, and variable for genes with lower expression values as confirmed by QRT-PCR. Concordance of measurements was higher between laboratories on the same platform than across platforms. We demonstrate that, after stringent pre-processing, commercial arrays were more consistent than “in-house” arrays, and by most measures, one-dye platforms were more consistent than two-dye platforms. Keywords: cross platform microarrays
2006-06-01 | GSE4833 | GEO
Project description:OBJECTIVES:To study the rational use of the blood components in pediatric and neonatal wards. METHODS:It was a retrospective study conducted by department of pediatrics of a tertiary care centre in western part of India. The patients were included from the pediatric ward, pediatric surgery ward, neonatal intensive care unit (NICU), pediatric intensive care unit (PICU) over a period of three months. All the patients below 12 y of age receiving blood components, admitted in general pediatric wards, pediatric intensive care unit, neonatal intensive care unit and pediatric surgery ward were included in the study. Each transfusion episode was assessed as per predetermined guidelines. RESULTS:Of the total 336 episodes of blood component transfusions, 244 episodes were appropriate and 92 episodes were inappropriate. Among these, platelets had highest inappropriate (36.84%) episodes followed by fresh frozen plasma (FFP) (28.95%) and packed red blood cell transfusions (PRBC) (21.21%). Majority inappropriate transfusions were seen in intensive care settings. CONCLUSIONS:Almost one-third of blood component transfusions (FFP, platelets and PRBC) were given without any definitive indication. Judicious use of various blood products by following recommended guidelines may help in decreasing the inappropriate use of blood components.
| S-EPMC7223979 | biostudies-literature
Project description:There is good evidence that 50% or more of red blood cell (RBC) transfusions are unnecessary. To curtail inappropriate RBC transfusions at our hospital, real-time clinical decision support was implemented in our electronic medical record (EMR) that alerts clinicians to the patient's most recent pretransfusion hemoglobin value upon order entry and provides Best Practice Advisory. This is a soft pop-up alert which is activated when the hemoglobin exceeds 7 g/dL. The ordering clinician can either honor (by cancelling the order) or override the alert. We studied the impact of the alert on blood utilization during a 3-month period (November 2016 to January 2017). For patients who were transfused despite the alert, a retrospective review of the medical chart was performed to determine whether or not the transfusion was clinically indicated. During the study period, 178 of the 895 RBC transfusion orders (20%) triggered the alert. After excluding duplicates, 144 orders were included in our analysis. Most of these orders (124/144, 86%) were carried out despite the alert. According to our chart review, 48% of the alert transfusions could be considered inappropriate, with hemodynamically stable, asymptomatic anemia being the leading indication. Of clinical services, orthopedic surgery had the highest rate of overriding the alert with no clinical justification (70%). The number of RBC transfusions dropped from 313.5 units per month (preintervention period) to 293.2 units per month (postintervention period)-a 6.5% decrease. Real-time clinical decision support may reduce the number of inappropriate RBC transfusions in a community hospital setting, though in our study, the decrease in blood utilization (6.5%) did not reach statistical significance.
| S-EPMC6164780 | biostudies-other
Project description:BackgroundSevere anemia in children is a major public health problem in sub-Saharan Africa. In this study we describe clinical and operational aspects of blood transfusion in children admitted to Coast Provincial General Hospital, Kenya.Study design and methodsThis was an observational study where over a 2-year period, demographic and laboratory data were collected on all children for whom the hospital blood bank received a transfusion request. Clinical data were obtained by retrospective review of case notes over the first year.ResultsThere were 2789 requests for blood for children (median age, 1.8 years; interquartile range [IQR], 0.6-6.6 years); 70% (1950) of the samples were crossmatched with 85% (1663/1950) issued. Ninety percent (1505/1663) were presumed transfused. Median time from laboratory receipt of request to collection of blood was 3.6 hours (IQR, 1.4-12.8 hr). Case notes of 590 children were reviewed and median pretransfusion hemoglobin level was 6.0 g/dL (IQR, 4.2-9.1 g/dL). Ninety-four percent (186) were transfused "appropriately" while 52% (120) were transfused "inappropriately." There was significant disagreement between the clinical and laboratory diagnosis of severe anemia (exact McNemar's test; p < 0.0001). Antimalarials were prescribed for 65% (259) of children who received blood transfusions but only 41% (106) of these had a positive blood film.ConclusionIn this setting, clinicians often order blood based on the clinical impression of "severe anemia." This has implications for laboratory workload and the blood supply itself. However, the majority of children with severe anemia were appropriately transfused. The use of antimalarials with blood transfusions irrespective of blood film results is common practice.
| S-EPMC5111588 | biostudies-literature
Project description:ImportanceRed blood cell (RBC) transfusions are frequently administered to preterm infants born before 32 weeks of gestation in the neonatal intensive care unit (NICU). Two randomized clinical trials (Effects of Transfusion Thresholds on Neurocognitive Outcomes of Extremely Low-Birth-Weight Infants [ETTNO] and Transfusion of Prematures [TOP]) found that liberal RBC transfusion thresholds are nonsuperior to restrictive thresholds, but the extent to which these results have been integrated into clinical practice since publication in 2020 is unknown.ObjectiveTo describe neonatal RBC transfusion practice in Europe.Design, setting, and participantsThis international prospective observational cohort study collected data between September 1, 2022, and August 31, 2023, with a 6-week observation period per center, from 64 NICUs in 22 European countries. Participants included 1143 preterm infants born before 32 weeks of gestation.ExposureAdmission to the NICU.Main outcomes and measuresStudy outcome measures included RBC transfusion prevalence rates, cumulative incidence, indications, pretransfusion hemoglobin (Hb) levels, volumes, and transfusion rates, Hb increment, and adverse effects of RBC transfusion.ResultsA total of 1143 preterm infants were included (641 male [56.1%]; median gestational age at birth, 28 weeks plus 2 days [IQR, 26 weeks plus 2 days to 30 weeks plus 2 days]; median birth weight, 1030 [IQR, 780-1350] g), of whom 396 received 1 or more RBC transfusions, totaling 903 transfusions. Overall RBC transfusion prevalence rate during postnatal days 1 to 28 was 3.4 transfusion days per 100 admission days, with considerable variation across countries, only partly explained by patient mix. By day 28, 36.5% (95% CI, 31.6%-41.5%) of infants had received at least 1 transfusion. Most transfusions were given based on a defined Hb threshold (748 [82.8%]). Hemoglobin levels before transfusions indicated for threshold were below the restrictive thresholds set by ETTNO in 324 of 729 transfusions (44.4%) and TOP in 265 of 729 (36.4%). Conversely, they were between restrictive and liberal thresholds in 352 (48.3%) and 409 (56.1%) transfusions, respectively, and above liberal thresholds in 53 (7.3%) and 55 (7.5%) transfusions, respectively. Most transfusions given based on threshold had volumes of 15 mL/kg (470 of 738 [63.7%]) and were administered over 3 hours (400 of 738 [54.2%]), but there was substantial variation in dose and duration.Conclusions and relevanceIn this cohort study of very preterm infants, most transfusions indicated for threshold were given for pretransfusion Hb levels above restrictive transfusion thresholds evaluated in recent trials. These results underline the need to optimize practices and for implementation research to support uptake of evidence.
| S-EPMC11413711 | biostudies-literature
Project description:BackgroundBecause most children and adolescents visit their general practitioner (GP) regularly, general practice is a useful setting in which child and adolescent mental health problems can be identified, treated or referred to specialised care. Measures to strengthen Dutch primary mental health care have stimulated cooperation between primary and secondary mental health care and have led to an increase in the provision of social workers and primary care psychologists. These measures may have affected GPs' roles in child and adolescent mental health care. This study aims to investigate the identification and treatment of child and adolescent mental health problems in general practice over a five-year period (2004-2008).MethodsData of patients aged 0-18 years (N ranging from 37716 to 73432) were derived from electronic medical records of 42-82 Dutch general practices. Time trends in the prevalence of recorded mental health problems, prescriptions for psychotropic medication, and referrals to primary and secondary mental health care were analysed.ResultsIn 2008, 6.6% of children and 7.5% of adolescents were recorded as having mental health problems; 15.2% of these children and 29.4% of these adolescents were prescribed psychotropic medication; 18.9% of these children and 22.9% of these adolescents were referred, mainly to secondary mental health care. Between 2004 and 2008, the percentages of children (chi-square: 22.06; p < 0.001) and adolescents (chi-square: 9.15; p = 0.003) who were diagnosed with mental health problems increased. An increase was also found in the percentage of children who were prescribed psychostimulants (chi-square: 8.29; p = 0.004). Prescriptions for antidepressants decreased over time in both age groups (children: chi-square: 6.80; p = 0.009; adolescents: chi-square: 13.52; p < 0.001). The percentages of children who were referred to primary (chi-square: 6.98; p = 0.008) and secondary mental health care (chi-square: 5.76; p = 0.02) increased over the years, whereas no significant increase was found for adolescents.ConclusionsAlthough GPs' identification of mental health problems and referrals to primary mental health care have increased, most referrals are still made to secondary care. To further strengthen primary mental health care, effective short-term interventions for child and adolescent mental health problems that can be applied in general practice need to be developed.
| S-EPMC3267656 | biostudies-literature
Project description:OBJECTIVES:The primary aim of this scoping review is to describe the current use of pre-hospital transfusion of red blood cells (PHTRBC) and to evaluate criteria used to initiate PHTRBC. The effects on patients' outcomes will be reviewed in Part 2. BACKGROUND:Haemorrhage is a preventable cause of death in trauma patients, and transfusion of red blood cells is increasingly used by Emergency Medical Services (EMS) for damage control resuscitation. However, there are no guidelines and little consensus on when to initiate PHTRBC. METHODS:PubMed and Web of Science were searched through January 2019; 71 articles were included. RESULTS:Transfusion triggers vary widely and involve vital signs, clinical signs of poor tissue perfusion, point of care measurements and pre-hospital ultrasound imaging. In particular, hypotension (most often defined as systolic blood pressure???90?mmHg), tachycardia (most often defined as heart rate???120/min), clinical signs of poor perfusion (eg, prolonged capillary refill time or changes in mental status) and injury type (ie, penetrating wounds) are common pre-hospital transfusion triggers. CONCLUSIONS:PHTRBC is increasingly used by Emergency Medical Services, but guidelines on when to initiate transfusion are lacking. We identified the most commonly used transfusion criteria, and these findings may provide the basis for consensus-based pre-hospital transfusion protocols.
| S-EPMC7317877 | biostudies-literature
Project description:In patients with anemia, there is interest in understanding the impact of red blood cell (RBC) transfusion on patient-reported outcomes such as fatigue. However, data from previous studies are mixed as to whether transfusion improves fatigue. One explanation for this is that prior studies have not examined whether changes in fatigue from transfusion may also affect patient activity levels. This is important because if transfusion reduces fatigue, patients may become more active, which could increase their fatigue. Thus, testing whether transfusion affects patients' fatigability, a measure of fatigue in the context of activity, may be more useful than testing the effect of transfusion on fatigue alone. The objective of this study was to test the effect of transfusion during hospitalization on patients' fatigability 7 days postdischarge. This prospective observational study included hospitalized general medicine patients with hemoglobin levels <10 g/dL. Patient-reported fatigability was collected during hospitalization and by telephone 7 days after discharge. Multivariable linear regression was used to test the association between receipt of a transfusion and fatigability 7 days postdischarge. Among the 350 patients participating, larger reductions in fatigability were observed with more transfused RBCs. Receipt of 1 U of RBCs was associated with a smaller reduction in fatigability, whereas receipt of 2 to 3 U of RBCs was associated with reductions in fatigability nearly 1 standard deviation from baseline and 3 times greater than patients receiving 1 U of RBCs. In hospitalized patients with anemia, receipt of a transfusion is associated with reductions in fatigability 7 days after hospital discharge.
| S-EPMC7686894 | biostudies-literature
Project description:BackgroundAnemia is a major cause of global morbidity and mortality, particularly among children. Management of anemia depends on causes and severity of anemia. However blood transfusion is a lifesaving intervention in severe and life-threatening anemia. There are no published data on blood transfusion for anemia in Sudan.MethodsA descriptive study was conducted in Gadarif Hospital in eastern Sudan during 1 August, 2017 to 31 March, 2018. Consecutive children who presented at the emergency room with an indication for blood transfusion were enrolled in the study. A detailed history was gathered from all patients. Physical examinations, including vital signs, were performed. The World Health Organization guidelines for blood transfusion were followed.ResultsDuring the study period, a total of 1800 children were admitted to the emergency pediatric ward in Gadarif Hospital and were assessed for anemia, 513 (28.5%) were anemic and 141 (7.8%) had severe anemia. Three hundred anemic children received blood transfusion. The median (interquartile) of the age of the 300 children who received blood transfusion was 4.2 4.2(2.0-9.0) years. A total of 148 (49.3%) of the children were boys and 151 (50.3%) were younger than 5 years. The diagnoses associated with the order for blood transfusion were sickle cell disease (129, 43.0%), active bleeding (58, 19.3%), malaria (50, 16.7%), visceral leishmaniasis (25, 8.3%), severe acute malnutrition (16, 5.30%), snake bite (11, 3.7%), sepsis (5, 1.7%), and others. Two hundred eighty-five (95.0%) children improved, nine children were discharged against medical advice, and six (2.0%) children died.ConclusionThere is a high burden of anemia in eastern Sudan. Sickle cell disease, malaria, and visceral leishmaniasis are the main causes of anemia in this region. Further research on blood transfusion is needed.
| S-EPMC6890167 | biostudies-literature
Project description:BackgroundEstimating accessibility gaps to essential health interventions helps to allocate and prioritize health resources. Access to blood transfusion represents an important emergency health requirement. Here, we develop geo-spatial models of accessibility and competition to blood transfusion services in Bungoma County, Western Kenya.MethodsHospitals providing blood transfusion services in Bungoma were identified from an up-dated geo-coded facility database. AccessMod was used to define care-seeker's travel times to the nearest blood transfusion service. A spatial accessibility index for each enumeration area (EA) was defined using modelled travel time, population demand, and supply available at the hospital, assuming a uniform risk of emergency occurrence in the county. To identify populations marginalized from transfusion services, the number of people outside 1-h travel time and those residing in EAs with low accessibility indexes were computed at the sub-county level. Competition between the transfusing hospitals was estimated using a spatial competition index which provided a measure of the level of attractiveness of each hospital. To understand whether highly competitive facilities had better capacity for blood transfusion services, a correlation test between the computed competition metric and the blood units received and transfused at the hospital was done.Results15 hospitals in Bungoma county provide transfusion services, however these are unevenly distributed across the sub-counties. Average travel time to a blood transfusion centre in the county was 33 min and 5% of the population resided outside 1-h travel time. Based on the accessibility index, 38% of the EAs were classified to have low accessibility, representing 34% of the population, with one sub-county having the highest marginalized population. The computed competition index showed that hospitals in the urban areas had a spatial competitive advantage over those in rural areas.ConclusionThe modelled spatial accessibility has provided an improved understanding of health care gaps essential for health planning. Hospital competition has been illustrated to have some degree of influence in provision of health services hence should be considered as a significant external factor impacting the delivery, and re-design of available services.
| S-EPMC10041813 | biostudies-literature