How Do I Forestall Platelet Stockpiling? Experience from a Tertiary Care Center

Background:Among all the blood products, platelets had been reported to have a high rate of outdates due to its unpredictable demand and short shelf life of only 5 days. Researchers have applied techniques of management science and inventory theory to develop a model for inventory management. However, they failed to be implemented due to the variations in the demand and supply and complex computational models.Aims:To analyze the utilization pattern of platelet concentrates and discuss the method of optimal inventory management.Methods:We conducted a prospective observational study on platelet inventory practice at our center from January to December 2014. The number of units to be prepared is decided on daily basis by the transfusion medicine faculty or the resident. The utilization, wastage, expiry and the day’s cover are calculated for the study period. Future requirement is estimated based on the usage in the previous quarter, discard rare, average increase in usage and an additional 1% for managing disasters. Results:During this period a total of 6241 and 5706 units of platelet concentrates were prepared and issued respectively. The wastage rate was 5.1% and expiry rate was 3.5%. The average day’s cover of platelet units at our center was found to be 3 days using average monthly stock available and issued platelets. We observed that holding a stock of 45 units of platelets per day we had a cover for about 3 days for issue. Calculation of future requirement(6309) gave a high prediction when compared to the actual platelets prepared(6241).Conclusions:Understanding and regularly monitoring the inventory, setting up an optimum inventory level, follow of first in first out policy and to have an alternate management plan in times of shortage, like usage of apheresis products are some of the strategies which would benefit in best inventory practices.

Zastosowanie kliniczne świeżo mrożonego osocza w szpitalu referencyjnym w Indiach

Background. Increased utilization of fresh frozen plasma (FFP) over the last decade hascaused a rising trend in its unjustified usage exposing recipients to both infectious and non--infectious hazards. The aim of the study was to observe the pattern of clinical use of plasmaat a tertiary care hospital from India.Material and methods. Prospective analysis of all the requests raised for plasma was carriedout. Indicators namely homogeneity of the requisition forms, patient demographics, indicationsfor transfusion, dosage, pre-transfusion coagulation parameters and adverse events werenoted. Appropriateness was defined based on compliance to both national and internationalstandards. Data was analyzed using SPSS version 20 (IBM, USA).Results. Total nine hundred ninety eight patients (Males: 66%) received 4991 units ofplasma at an average of two episodes per patient. Majority were adults 83.6% (n = 835).Primary users were internal medicine (32%) and plastic surgery (17%) respectively. Mostcommon indication was bleeding with coagulopathy seen in 41% (411/998) patients. Averageplasma volume administered was 456.2 ± 287.4 (17 to 2800) mL per episode. Pre--transfusions INR value was available in only 63.2% (n = 1317) episodes. Overall, 56% (n= 1169) episodes were deemed appropriate. Total 0.28% plasma related adverse reactionswere seen and reported to the national hemovigilance database. Mortality in the study groupwas 7.2%.Conclusion. Existing transfusion practices for plasma use were moderately compliant withthe standards. Commonest indications for inappropriate FFP use were for low protein statesand prophylaxis without any evidence of bleeding.Wstęp. W ciągu ostatniej dekady znacznie zwiększyło się zużycie świeżo mrożonego osocza(fresh frozen plasma, FFP), co spowodowało rosnącą tendencję do nieuzasadnionego stosowaniaFFP, a tym samym narażenie pacjentów na ryzyko związane z zakażeniami i niezakaźnymi powikłaniami. Badanie przeprowadzono w celu zaobserwowania, w jaki sposób stosuje sięFFP w referencyjnym szpitalu w Indiach.Materiał i metody. Przeanalizowano w sposób prospektywny wszystkie przypadki zamówieńosocza. Stosowano jednorodne formularze zamówienia i odnotowano dane demograficznechorych, wskazania do transfuzji, dawkę, parametry krzepliwości krwi przed transfuzją orazzdarzenia niepożądane. Prawidłowe stosowanie definiowano jako zgodność z krajowymi i międzynarodowymistandardami. Do analizy danych użyto oprogramowania SPSS, wersja 20(IBM, Stany Zjednoczone).Wyniki. Ogółem 998 chorym (66% mężczyzn) podano 4991 jednostek osocza, a średnia liczbatransfuzji na pacjenta wynosiła 2. Większość stanowiły osoby dorosłe (83.6%; n = 835).Największą grupę stanowili pacjenci internistyczni (32%) i osoby poddające się zabiegom z zakresuchirurgii plastycznej (17%). Najczęstszym wskazaniem było krwawienie z koagulopatiąobserwowane u 41% (411/998) chorych. Średnia objętość podanego osocza wynosiła 456,2± 287,4 (17 do 2800) ml na transfuzję. Wartość INR przed transfuzją była dostępna tylkow 63,2% (n = 1317) epizodów. Ogółem, 56% (n = 1169) epizodów uznano za prawidłowe.W 0,28% przypadków zaobserwowano działania niepożądane i zgłoszono je do krajowej bazynadzoru hematologicznego. Odnotowano 72 przypadki zgonów (7,2% chorych).Wnioski. Stosowana praktyka dotycząca transfuzji osocza była umiarkowanie zgodna ze standardami.Najczęściej stwierdzanymi nieprawidłowościami było stosowanie FFP w przypadkuniedoborów białkowych i w ramach profilaktyki przy braku jakichkolwiek oznak krwawienia

Impact of awareness on routine antenatal antibody screening: A prospective study

Introduction: A screening test is performed to detect potential health disorders or diseases in people who do not have any symptoms of disease. The major objective of a screening program is to reduce morbidity, mortality and the disease burden. Antenatal antibody screening in India is mainly focused on the detection of anti-D in RhD-negative mother. Hemolytic disease of the fetus and newborn can also be caused by the antibodies directed against other minor red cell antigens among RhD-positive women. Hence, the study was planned to analyze the influence of creating awareness among clinicians and patients towards implementing the universal antibody screening for pregnant women. Materials and Methods: The obstetricians as well as the patients were made aware of the benefits of the screening test at regular intervals during the study period regarding the universal antenatal antibody screening. Results: During the study period, a total of 2336 samples from antenatal cases were screened for red cell antibodies. A positive outcome was evident by the rise in number of RhD-positive samples received in the laboratory for antenatal antibody screening from 18.2% during the prestudy phase to 72.8% in the second phase of the study after the intervention. Conclusion: In a developing country like India, extra efforts should be put by the transfusion service in collaboration with hospital transfusion committee to sensitize the obstetricians about the need and obvious benefits of performing antibody screening in all antenatal cases

Preponderant use of fresh-frozen plasma in children despite weaker evidence

BACKGROUND: Considering the higher use of fresh-frozen plasma (FFP) in our hospital, we desired to determine the pattern, prevalence, and potential complications of its utilization in new-born and children with the primary aim to observe its effect on the conventional coagulation screening (CCS) parameters. SUBJECTS AND METHODS: Patients' demographics, clinical indications, and pre- and posttransfusion CCS parameters such as the prothrombin time, the international normalized ratio (INR), and partial thromboplastin time were observed over a period of 10 months. Any improvement observed in the laboratory parameters after FFP transfusion was noted. RESULTS: We studied 433 episodes, where 499 FFP units were utilized in 184 patients. Mean age in years was 6 ± 0.16 (new-born to 17). Diagnoses-wise majority had diffuse intravascular coagulation with sepsis 25% (46/184) followed by febrile illness 23% (42/184). Around 46% (84/184) patients had bleeding episodes of which four had known family history of bleeding (three factors IX and one factor XI deficiency). Mean doses of FFP utilized (mL/kg) in children and infants were 12.6 ± 6.3 (n = 297 episodes) and 14.4 ± 6.3 (n = 136 episodes), respectively (P = 0.006). Mean change in INR in the cohort with deranged coagulation parameters against the overtly bleeding cohort was 0.85 versus 0.40 (P = 0.006). CONCLUSION: The study elicits minimal evidence in correcting the coagulation parameters, especially in the infants, whenever FFP was transfused prophylactically. Joint-decision making of the pediatricians and transfusion medicine physician would promote judicious use in children

Acrodermatitis Enteropathica in an adult: a case report

Acrodermatitis enteropathica (ADE) is an uncommon, inherited disorder occurring due to defective Zinc absorption. It can occur as an acquired condition secondary to impaired intestinal absorption in a wide variety of clinical conditions or due to nutritional deficiency. It is clinically characterized by triad of acral dermatitis, alopecia and diarrhoea. The preferential involvement of acral and peri-orificial skin is a feature that is pathognomonic for zinc deficiency. We report a case of ADE in a 22 year old female with no underlying comorbid conditions

Implication of deferral pattern on the donor pool: Study at a Tertiary Care Hospital

Background and Objectives: Donor screening process is one of the most important steps in protecting the safety of blood supply. Donors who do not meet specified criteria are deferred either temporarily or permanently. These criteria are designed to protect both donors and patient safety. Due to the varied rates and reasons for deferrals in the existing literature, we aimed to evaluate the patterns and prevalence of deferrals in our institution. Materials and Methods: This retrospective study was conducted at a Tertiary Care Hospital, Karnataka, Southern India, to evaluate the various reasons for blood donor deferral from January 2011 to January 2014. Demographic data of blood donors was obtained through the blood bank database and secondary measures such as the type of deferral (permanent/temporary, pathogenic/nonpathogenic, and harmful to donor/recipient) were assessed. Results: A total of 54,653 subjects presented to our blood bank during this period out of which 2935 (5.6%) were deferred. The deferral to donor percentage was higher in females (36.54%) than males (3.64%). Low hemoglobin was the major deferral criterion seen in our participants (48.1%) followed by hypertension (16.4%), underweight (8.9%). Low pulse rate and fasting donor were the least prevalent reasons. A total of 36.8% of reasons for deferral were harmful to donors, 88.2% were nonpathogenic, and 98.1% were temporary causes. Conclusion: Variations in donor deferral may be attributed to different donor selection criteria in different regions and centers. Hence, it is important to know the common causes of donor deferral in a region so that measures may be taken to improve the donor pool

Effect of plasma component transfusion on conventional coagulation screening tests

Background: Conventional coagulation screening tests such as Prothrombin time, International normalized ratio (INR) and activated partial thromboplastin time are often used to predict bleeding in various clinical situations. We aimed to observe the effect of Fresh-frozen plasma (FFP) on these parameters. Methods: Patients' demographics, pre- and post-transfusion coagulation parameters were noted to assess the level of correction. The magnitude of improvement in INR was determined using the formula given by Holland and Brooks. Data was analyzed using IBM SPSS Statistics 20. Results: Among 2082 episodes, 4991 units of FFP were transfused at an average of 5 units per patient. Median dose of FFP administered per episode was 10 mL/kg (5.8–13.4). The mean change in INR following transfusion was 8.9% of the pre-transfusion INR and thus considered to be statistically significant. Conclusion: FFP transfusions as a prophylactic measure especially in patients with mildly deranged conventional coagulation screening tests without any empirical evidence of clinical bleeding needs further scrutiny. Reduction in INR following FFP transfusions was better in cohort having higher pre-transfusion INR value (> 3.0)

Evaluation of Clinical Appropriateness of Cryoprecipitate transfusion

Background. Cryoprecipitate (CRYO) is mainly used for management of hypofibrinogenemia during hemorrhage. The historical 1.0 g L−1 threshold of fibrinogen is considered quite inadequate, especially in massive bleeds. Furthermore, the appropriate dose and its impact on plasma fibrinogen levels are unclear. Our aim was to evaluate the appropriateness of CRYO transfusion at our hospital. Material and methods. Retrospective review of indicators namely indications, dosage, pre- -transfusion coagulation parameters and the magnitude of mean plasma fibrinogen increase (Fibinc) to CRYO transfusion were undertaken at a multi-specialty hospital. Appropriateness was defined based on compliance to both national and international guidelines. Results. A total of 400 transfusions were given in 253 patients. Commonest primary indication was hemorrhage (86%) against prophylaxis (14%). Conventionally commonest clinical scenarios were disseminated intravascular coagulation in hemato-oncology [110 episodes (28%)] followed by factor VIII deficiency [92 episodes (23%)] and cardiac surgery [52 episodes (13%)] respectively. Based on indications the overall appropriateness was 92.5%. Pre-transfusion fibrinogen levels were available in 66% (264/400) episodes including 204 events having fibrinogen < 1.0 g L-1. In patients who did not receive plasma components 6 h prior to CRYO, a mean dose of 6.2 units caused a Fibinc of 0.54 (± 0.36) g L−1. Conclusion: The overall Fibinc per unit of CRYO transfused was 0.09 g L-1. We have noted high level of appropriateness towards CRYO transfusion (92.5%) in the present study