Hemovigilance in Massachusetts and the adoption of statewide hospital blood bank reporting using the National Healthcare Safety Network.

A collaboration that grew over time between local hemovigilance stakeholders and the Massachusetts Department of Public Health (MDPH) resulted in the change from a paper-based method of reporting adverse reactions and monthly transfusion activity for regulatory compliance purposes to statewide adoption of electronic reporting via the National Healthcare Safety Network (NHSN). The NHSN is a web-based surveillance system that offers the capacity to capture transfusion-related adverse events, incidents, and monthly transfusion statistics from participating facilities. Massachusetts' hospital blood banks share the data they enter into NHSN with the MDPH to satisfy reporting requirements.

Transfusion-transmitted Babesia microti identified through hemovigilance.

Background: Babesia microti, the primary cause of human babesiosis in the United States, is an intraerythrocytic parasite endemic to the Northeast and upper Midwest. Published studies indicate that B. microti increasingly poses a blood safety risk.

Analysis of transfusion reactions associated with prestorage-pooled platelet components.

Background: The goal of this study was to assess transfusion reactions arising from prestorage-pooled platelet (PSPP) infusions compared with apheresis single-donor platelets (SDPs) and poststorage-pooled, whole blood-derived random-donor platelets (RDPs).

Study Design And Methods: Over a span of 18 months, transfusion reaction records of patients receiving platelet (PLT) infusions were retrospectively reviewed at two academic, tertiary care hospitals. Chi-square analysis was used for statistical comparisons; significance was a p value of less than 0.

Bacterial contamination of whole-blood-derived platelets: the introduction of sample diversion and prestorage pooling with culture testing in the American Red Cross.

Background: Bacterial sepsis following whole blood-derived platelet (WBP) transfusion has remained a substantial patient risk, primarily due to a lack of practical and effective means to limit or detect bacterial contamination. We describe the risk of reported septic reactions to WBPs and the introduction of prestorage-pooled whole blood-derived platelets (PSPs) collected using initial sample diversion and cultured for bacterial contamination.

Study Design And Methods: Product qualification and quality control (QC) testing with the Acrodose PL system (Pall Medical) were evaluated in four regional blood centers.

Nationwide survey of home transfusion practices.

Background: Limited information exists on home transfusion practices.

Study Design And Methods: In 1995, a survey requesting data for 1994 was sent to 1273 American Association of Blood Banks (AABB) institutional members and 113 non-AABB home health care agencies that provide out-of-hospital transfusions.

Results: Of 943 respondents, 102 provide blood to a home transfusion program, 37 provide blood and run a home transfusion program, and 13 run a home transfusion program only, for a total of 152 (16%) with some involvement in home blood transfusions.

Outcomes assessment of a residency program in laboratory medicine.

During a down-sizing of residency programs at a State University Medical School, hospital based residents' positions were eliminated. It was determined to find out the characteristics of the residents who graduated from the Laboratory Medicine Program, to compare women graduates with men graduates, and to compare IMGs with United States Graduates. An assessment of a 25 year program in laboratory medicine which had graduated 100 residents showed that there was no statistically significant difference by chi 2 analysis in positions (laboratory directors or staff), in certification (American Board of Pathology [and subspecialties], American Board of Medical Microbiology, American Board of Clinical Chemistry) nor in academic appointments (assistant professor to full professor) when the male graduates were compared with the female graduates or when graduates of American medical schools were compared with graduates of foreign medical schools.

Hypotensive reactions: a previously uncharacterized complication of platelet transfusion?

Background: In 1993, the American Association of Blood Banks (AABB) received reports of severe hypotensive reactions associated with platelet transfusions. The question arose as to whether these reports were indicative of a previously uncharacterized platelet transfusion reaction.

Study Design And Methods: To further characterize these reactions, the AABB Transfusion Practices Committee developed a series of three questionnaires.

Transfusion practices in human immunodeficiency virus-infected patients.

Background: The reported immunomodulatory effects of transfusion raise concern about the potential for virus activation and tumor growth in human immunodeficiency virus (HIV)-infected patients. In the absence of "standards" of transfusion practice for such patients, a survey of transfusion policies among institutions specializing in the care of HIV-infected patients was performed to delineate current practices.

Study Design And Methods: A survey developed by the Transfusion Practices Committee of the American Association of Blood Banks was sent to 47 AIDS clinical trial units and 14 regional hemophilia centers in North America.

Prophylactic versus therapeutic platelet transfusion practices in hematology and/or oncology patients.

Background: Platelet utilization has steadily increased throughout the past three decades. At the same time, there has been very little study of the current transfusion practices.

Study Design And Methods: A survey was conducted of institutional members of the American Association of Blood Banks (hospitals) that were actively involved in the care of pediatric and/or adult hematology and/or oncology patients.

The effect of solvent/detergent-treated plasma on red cells stored in vitro.

Background: The potential use of solvent/detergent-treated plasma (S/D plasma) in transfusion practice raises concerns about the cytolytic effects that any residual solvent and detergent in the virally inactivated blood component might have on units of red cells in vitro, if the two components are mixed during preparation.

Study Design And Methods: S/D plasma was mixed with variously processed units of stored red cells, in vitro, to evaluate the effect the residual solvent and detergent would have on cell membrane integrity. A paired protocol design was used in which half-units of red cells were exposed to S/D plasma (test), and the matched half-units were exposed to either the supernatant additive solution from the original red cell unit or standard fresh-frozen plasma (FFP) (control).

In vitro characteristics of white cell-reduced single-unit platelet concentrates stored in syringes.

Background: Platelet concentrates (PCs) for premature infants may be subjected to filtration, centrifugation, and various storage conditions before transfusion.

Study Design And Methods: As there are few data on the cumulative effect of these procedures on PCs, platelet properties (including biochemical and functional in vitro assays) were evaluated after the processing of single units of PCs through a 1-unit-capacity high-efficiency white cell (WBC)-reduction filter followed by syringe storage at either 22 or 37 degrees C for 6 hours. Two- and 5-day-old PCs, volume-reduced PCs, and prestorage WBC-reduced PCs were evaluated.

Fatal disseminated intravascular coagulation and pulmonary thrombosis following blood transfusion in a patient with severe autoimmune hemolytic anemia and human immunodeficiency virus infection.

Background: Autoimmune hemolytic anemia (AIHA) has rarely been reported in association with human immunodeficiency (HIV) infection and never as a presenting manifestation. Similarly, disseminated intravascular coagulation (DIC) is a very infrequent complication of HIV infection.

Case Report: An unusual patient is described who at the time of presentation with severe AIHA was found to be HIV positive.

Reemergence of the International Normalized Ratio for the standardization of prothrombin time.

A survey of physicians demonstrated that half had knowledge of the International Normalized Ratio (INR) but none used the value for monitoring their patients because it was not available from the Coagulation Laboratory. The Laboratory then provided the INR value at a physician's request. A six month review of prothrombin time (PT) results showed that only the physicians from the Cardiology Clinic and the Hematology Clinic employed the INR for monitoring their patients.

Leukocyte reduction in blood component therapy.

Purpose: To review methods of preventing or minimizing the adverse effects associated with the transfusion of passenger leukocytes present in cellular blood components and to define groups of patients who are at risk for adverse effects.

Data Sources: English-language articles on transfusion medicine.

Study Selection: Original reports describing the pathogenesis of leukocyte-induced adverse effects in transfusion recipients and the influence of leukocyte-reduced blood components on these effects.

Reducing the risk for transfusion-transmitted cytomegalovirus infection.

Objective: To define the groups of patients at risk for transfusion-transmitted cytomegalovirus infection and to define the methods to reduce this risk.

Data Sources: English-language publications on transfusion medicine.

Study Selection And Data Extraction: Studies were selected that described cytomegalovirus infection in transfusion-dependent patients.

In vitro characteristics of volume-reduced platelet concentrate stored in syringes.

For convenience, small volumes of platelet concentrate (PC) intended for neonatal patients are often dispensed in syringes. The PC, however, may remain in the syringe for up to several hours before the actual transfusion. As there are few data on the effect of such syringe storage on PCs, the in vitro syringe storage properties of small volumes of 1- and 5-day-old units, and volume-reduced units of PC were evaluated.

Quality assurance in the intensive care unit--monitoring hematocrit orders.

To provide a quality assurance (QA) study in the intensive care unit (ICU), hematocrit orders were monitored for five months (September 1989-January 1990) in an attempt to determine appropriate practice. Computer prints of all hematocrits (hct) ordered in the ICU were reviewed. Of all patients admitted to the unit in this time (528), 61 percent (319) had hematocrits ordered.

Evaluation of iron status in women identified by copper sulfate screening as ineligible to donate blood.

Assessment of venous hemoglobin (Hb), serum ferritin, and zinc protoporphyrin (ZPP) levels was carried out in women identified by CuSO4 screening as ineligible to donate blood. The correlation of log ferritin with ZPP was relatively poor (r = -0.580) but significant (p greater than 0.