Intra-operative blood salvage in total hip and knee arthroplasty

Purpose To review records of 371 patients who underwent total hip or knee arthroplasty (THA or TKA) with intra-operative blood salvage to determine the allogeneic blood transfusion rate and the predictors for allogeneic blood transfusion. Methods Records of 155 male and 216 female consecutive patients aged 17 to 95 (mean, 70) years who underwent primary THA or TKA by a single surgeon with the use of intra-operative blood salvage were reviewed. Results The preoperative haemoglobin level was &lt;120 g/dl in 15% of THA patients and 5% of TKA patients; the allogeneic transfusion rate was 24% in THA patients and 12% in TKA patients. Despite routine use of intra-operative blood salvage, only 59% of THA patients and 63% of TKA patients actually received salvaged blood, as a minimum of 200 ml blood loss was required to activate blood salvage. In multivariable analysis, predictors for allogeneic blood transfusion were female gender (adjusted odds ratio [OR]=2.8, p=0.02), age &gt;75 years (adjusted OR=5.9, p&lt;0.001), and preoperative haemoglobin level &lt;120 g/l (adjusted OR=30.1, p&lt;0.001), despite the use of intra-operative blood salvage. Patients who received allogeneic blood transfusion had a longer hospital stay and greater complication rate. Conclusion Intra-operative blood salvage is not effective in preventing allogeneic blood transfusion in patients with a preoperative haemoglobin level &lt;120 g/l. It should be combined with preoperative optimisation of the haemoglobin level or use of tranexamic acid. </jats:sec

Prion diseases are efficiently transmitted by blood transfusion in sheep

The emergence of variant Creutzfeld-Jakob disease, following on from the bovine spongiform encephalopathy (BSE) epidemic, led to concerns about the potential risk of iatrogenic transmission of disease by blood transfusion and the introduction of costly control measures to protect blood supplies. We previously reported preliminary data demonstrating the transmission of BSE and natural scrapie by blood transfusion in sheep. The final results of this experiment, reported here, give unexpectedly high transmission rates by transfusion of 36% for BSE and 43% for scrapie. A proportion of BSE-infected tranfusion recipients (3 of 8) survived for up to 7 years without showing clinical signs of disease. The majority of transmissions resulted from blood collected from donors at more than 50% of the estimated incubation period. The high transmission rates and relatively short and consistent incubation periods in clinically positive recipients suggest that infectivity titers in blood were substantial and/or that blood transfusion is an efficient method of transmission. This experiment has established the value of using sheep as a model for studying transmission of variant Creutzfeld-Jakob disease by blood products in humans. (Blood. 2008; 112: 4739-4745

Blood transfusion knowledge among nurses in Malaysia:a university hospital experience

Blood transfusion is a fundamental and life-saving procedure where the consequence of errors can be fatal. Nurses’ knowledge plays an essential role in ensuring quality and safety in blood transfusion. The objective of this study was to assess blood transfusion-associated knowledge of tertiary hospital nurses on the east coast of Malaysia. This was a cross-sectional study with 200 registered nurses involved in blood transfusion procedures at Hospital Universiti Sains Malaysia. The knowledge of the nurses was evaluated by using the routine blood transfusion knowledge questionnaire based on five parts, and <50%, 50–74%, or ≥75% of the knowledge was considered as poor, moderate, or high, respectively. Based on the scoring system, the overall knowledge of blood transfusion among Malaysian nurses (33.2 ± 8.4 years) was estimated to be 54.9 ± 7.6%. In individual items, the scoring was 81.0%, 45.4%, 49.2%, 63.0%, and 90.0% in knowledge prior to blood transfusion, on pre-transfusion, on post-transfusion, on complications, and on transfusion policy, respectively. The findings of this study indicated that most of the nurses’ overall knowledge of blood transfusion was at a moderate level; therefore, training courses and continuous medical education are warranted to improve knowledge and skills of the nurses to ensure good practices of blood transfusion

Pattern of utilization of blood and blood components in obstetrics at tertiary care hospital

Background: Obstetric emergencies occur suddenly and unexpectedly. Blood transfusion becomes one of the live saving measures in such situations. Severe anaemia due to nutritional deficiency, obstetric haemorrhage either during pregnancy, labour or in postpartum period are the commonest indications for blood transfusion worldwide. Blood bank services play important role in saving lives in obstetric emergencies. Health institutions must carry out internal blood transfusion audits to reassure optimal and judicious use of blood and blood components.Methods: Analysis of 755 Obstetric patients requiring blood transfusion in eighteen months period was done to find out the incidence and indications for blood transfusion at tertiary care hospital.Results: Overall, 5.33% of obstetric admissions required transfusion of blood or its components. Severe anaemia (36.55%), accidental haemorrhage (20.92%), postpartum haemorrhage (8.34%), placenta praevia (5.03%) and caesarean section (10.33%) were the common indications for blood transfusion. In more than 65% cases, two or three unit of blood were transfused. In majority of cases (96%) components were used.Conclusions: Blood transfusion helped to save many lives in the present study. Severe anaemia and obstetric haemorrhage of varied aetiology were the common indications for blood transfusion. Component therapy helped to correct specific deficiency. Voluntary blood donation should be encouraged in the younger generation to keep adequate stock of blood in blood bank for emergency use. Preventive measures like improving dietary iron intake and prophylactic iron therapy will go a long way in reducing the need for blood transfusion in Obstetrics

Blood Transfusion Requirement and not Preoperative Anaemia is associated with Perioperative Complications following Intracorporeal Robotic Assisted Radical Cystectomy

OBJECTIVES: To assess the prevalence of preoperative anaemia and the impact of preoperative anaemia and blood transfusion requirement on 30- and 90-day complications in a cohort of patients undergoing robotic assisted radical cystectomy with intracorporeal urinary diversion (iRARC). PATIENTS & METHODS: IRARC was performed on 166 patients between June 2011-March 2016. Prospective data was collected for patient demographics, clinical and pathological characteristics, perioperative variables, transfusion requirements and hospital length of stay. Thirty- and 90-day complications were classified according to the modified Memorial Sloan-Kettering Cancer Center Clavian-Dindo system. RESULTS: Preoperative anaemia was common (43.4%) and greatest in patients receiving neoadjuvant chemotherapy (48.6%) (p<0.001). Patients with preoperative anaemia were significantly more likely to have an Ileal conduit (p=0.033), higher cystectomy stage (≥pT3) (p=0.028) and a lower lymph node yield (p=0.031). Preoperative anaemia was not associated with increased perioperative morbidity but was associated with the need for blood transfusion (p=0.001). Blood transfusion was required in 20.4% of patients with intraoperative and postoperative blood transfusion rate was 10.2% and 13.9% respectively. The 30-day all complication rate and 30-day major complication rate was 55.4% and 15.7% respectively while 90-day all complication rate and 90-day major complication rate were 65.7% and 19.3% respectively. Intraoperative blood transfusion was not associated with increased complications but postoperative blood transfusion requirement was independently associated with perioperative morbidity: all 30 day complications (p=0.003), all 90-day complications (p=0.009) and 90-day major complications (p=0.004). CONCLUSION: The presence of preoperative anaemia in patients undergoing iRARC is not associated with increased surgical risk although preoperative anaemic patients were significantly more likely to require blood transfusion. Blood transfusion requirement and specifically postoperative blood transfusion is independently associated with perioperative morbidity and is an important factor for the optimisation of postoperative outcomes

Verensiirron turvallinen toteuttaminen aikuispotilaalle

Opinnäytetyön tarkoitus on kuvata turvallisen verensiirron prosessin toteuttaminen aikuispotilaalle. Työssä haetaan vastausta kysymyksiin, miten toimitaan ennen verensiirtoa, verensiirron aikana sekä verensiirron jälkeen. Tavoitteena on kehittää sekä omaa tietämystään verensiirron toteuttamisesta, että luoda sairaanhoitajaopiskelijoille ja valmistuneille sairaanhoitajille tietokokonaisuus aiheesta. Opinnäytetyö on Laurea ammattikorkeakoulun antama aihe ja toteutettu yhteistyössä Laurea ammattikorkeakoulu Tikkurilan kanssa. Opinnäytetyö on toteutettu kirjallisuuskatsauksen metodeja hyödyntäen ja erityisesti lähdehaku on suoritettu mahdollisimman systemaattisesti. Lähdehaun jälkeen työssä on käytetty yhteensä 13 eri lähdettä, joista 12 on englanninkielisiä. Suomen verensiirtotoimintaa säätelevät erilaiset lait. Suomen Punaisen Ristin Veripalvelu ylläpitää Suomessa tapahtuvaa verensiirtotoimintaa. Veripalvelun toimintaan kuuluu verenluovutuksen järjestäminen, luovutetun veren testaus sekä verivalmisteiden tuotanto ja jakelu sairaaloihin. Verensiirtohoidon tavoitteena on potilaan voinnin parantaminen. Sairaanhoitajan rooli verensiirron toteutuksessa on keskeisessä asemassa, joten sairaanhoitajan tulee varmistaa potilaan turvallisuus koko prosessin aikana. Verensiirron turvallinen toteuttaminen alkaa harkitusta verensiirto päätöksestä, jonka jälkeen selvitetään potilaan veriryhmä ja tutkitaan soveltuvuuskokeen avulla sopiva verivalmiste potilaalle. Sairaanhoitaja tarkistaa verivalmisteen käyttökelpoisuuden ja sen, että valmisteessa olevat tiedot täsmäävät sopivuuskoevastausten sekä potilaan veriryhmän kanssa. Sairaanhoitajan tehtävä on valmistella potilas verensiirtoa varten antamalla potilaalle tietoa verensiirtohoidosta sekä valmistelemalla verensiirtovälineet siirtoa varten. Potilas tunnistetaan ennen verensiirron aloittamista. Verensiirto aloitetaan aina biologisella esikokeella. Potilasta tulee seurata koko verensiirron ajan, jotta pystytään nopeasti havaitsemaan mahdolliset verensiirtoreaktiot.The purpose of this thesis is to describe safe blood transfusion administration for adult patients. The thesis discusses what has to be done before, during and after transfusion. The aim is to develop the author’s own knowledge of blood transfusion administration and also to create information package for nursing students and graduated nurses. The thesis was assigned by and is a collaboration project with Laurea University of Applied Sciences. The thesis was made by applying literature review methods and especially the search for sources was made as systematic as possible. The data consists of 13 different kinds of sources out of which 12 are in English. The Finnish blood transfusion action is controlled by laws. The Finnish Red Cross Blood Service maintains the Finnish blood transfusion activities. The activities of the Blood Service include organising blood donations, testing donated blood and also production and distribution of blood products to hospitals. The aim of the blood transfusion is to improve patients’ well-being. It is important to define patient’s blood group in order to transfer suitable blood product. Nurses play a key role in the administration of blood and it is a nurse’s task to ensure patient safety during the blood transfusion. Safe blood transfusion process begins with a deliberate decision to begin the blood transfusion therapy. After making the decision the patient’s blood group will be defined and the appropriate blood product examined. Nurses have to examine the blood product for its utility and check that the information in the blood product is the same as in the test results and the patient’s blood group. It is the nurses’ task to prepare the patient for blood transfusion by giving the patient information about blood transfusion therapy and prepare blood transfusion equipment for blood transfusion. The patient must be identified before blood transfusion. Blood transfusion is started with a biological preliminary test. The patient must be monitored during the whole blood transfusion process in order to be able to detect possible blood transfusion reactions as fast as possible

Pattern of utilization of blood and blood components in obstetrics at a tertiary care center: a cross-sectional study

Background: Blood transfusion is an essential lifesaving component in obstetrics. Extra blood loss in pregnancy can occur due to various gestational disorders and complications during labour and delivery. Reduction in maternal morbidity and mortality has been observed by increased use of comprehensive emergency obstetrics care in which blood transfusion has achieved recognition as one of the important components. In a developing country like India, the need for well maintained and readily available blood and transfusion services becomes paramount to decrease maternal morbidity and mortality. We wanted to determine the clinical characteristics and indication of blood transfusion in obstetrics and also determine any adverse blood transfusion reaction.Methods: This cross-sectional study was conducted in the department of obstetrics and gynaecology, Christian medical college, Ludhiana for a period of eighteen months from 15th October 2018. The study group included all the antenatal and postnatal patients up to 6 weeks postpartum who were admitted in the obstetric unit, requiring blood or component transfusions. Clinical characteristics, indication of blood transfusion and any adverse blood transfusion reaction were recorded.Results: In our study, about 7.84% of obstetric admission required blood and blood components. Most common indication for blood transfusion was anaemia either during antenatal or during postnatal period (33.91%). Majority of the patients were unbooked antenatally (63.91%) and were multiparous (93.91%). 4 or more blood transfusions were given in 28.26% of cases.Conclusions: Blood transfusion is live saving measure in many obstetric patients. Blood transfusion is an essential component of emergency obstetric care and appropriate blood transfusion significantly reduces maternal mortality. Severe anaemia is the most common condition requiring blood transfusion, which may be chronic due to nutritional deficiency or following acute blood loss, followed by postpartum haemorrhage, placental abruption and placenta previa. Availability of transfusion facility and blood products in obstetric care setting in peripheral health centres can reduce need for referral of patients and indirectly reduce the maternal morbidity and mortality

A comparison study on the blood transfusion reaction between the elective and the emergency operation’s patients

Blood transfusion is principally a process of transferring blood or blood components from one individual (the donor) toanother individual (the recipient). Blood transfusion can be either a life saving condition or a life threatening situation dueto the complications happened. Therefore, blood transfusion should be conducted with clear and accurate indication inorder to obtain a condition in which the advantages outweighs the disadvantages. The aim of this study was to evaluatethe differences of the blood transfusion reactions between the patients underwent the emergency surgery with theelective surgery. This was a cross sectional study using data from the medical records from January to December 2009and from the observation on blood transfusion patients from January to May 2010. Data were analyzed using independentt-test, Chi-square test or the logistic regression, with 95% confidence interval (p0.05). In conclusion, blood transfusion reactions happened morefrequently in emergency surgery than elective surgery. The WB also generated transfusion reaction more frequently thanthe PRC. The amount of blood required based on hemoglobin correction formula for most patients was similar to the bloodtransfused.Key words: blood transfusion-type of operation-transfusion reaction - whole blood-haemoboglobin correction formul