scholarly journals A SARS-CoV-2-pandémia hatása a vérkészítmény-felhasználásra a Pécsi Tudományegyetemen

2021 ◽  
Vol 162 (43) ◽  
pp. 1717-1723
Author(s):  
Sándor Pál ◽  
Barbara Réger ◽  
Tamás Kiss ◽  
Hussain Alizadeh ◽  
András Vereczkei ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Blood Product ◽  
Patient Blood Management ◽  
Blood Products ◽  
Blood Management ◽  
Number Of Patients ◽  
Willingness To Donate ◽  
The Impact

Összefoglaló. Bevezetés: A COVID–19-világjárvány betegellátásra gyakorolt hatása hazánkban is jelentős. A vérellátást nehezítette a járványügyi intézkedések következményeként a véradási események elmaradása, a csökkent véradási hajlandóság, továbbá a nehezen megítélhető vérkészítményigény . A „Patient Blood Management” irányelveinek az orvosi gyakorlatban történő egyre szélesebb körű alkalmazása elősegíti az optimális vérkészítmény-felhasználást a transzfúziók lehetőség szerinti elkerülésével. Célkitűzés és módszer: Vizsgálatunk célja a Pécsi Tudományegyetem Klinikai Központjának Janus Pannonius Klinikai Tömbjében a vérkészítmény-felhasználás változásainak felmérése volt a 2020. év első öt hónapjában. Eredmények: A járványügyi intézkedéseket követő időszakban szignifikánsan csökkent a hospitalizált betegeknek (34,08%), a transzfúziót igénylő betegeknek (39,69%) és a felhasznált vörösvérsejt-készítményeknek (46,41%) a száma, valamint az egy betegre jutó felhasznált vörösvérsejt-koncentrátum átlaga (2,61-ről 1,97-re) is. Közel 30%-os arányban csökkent a felhasznált friss fagyasztott plazma egységeinek és a thrombocytakoncentrátumoknak a száma is. Következtetés: A szigorú korlátozások életbe léptetését követően a nehézségek ellenére sikerült elegendő mennyiségű vérkészítményt biztosítani a betegeknek. Az Országos Vérellátó Szolgálat Pécsi Regionális Vérellátó Központja munkatársainak és a klinikusok erőfeszítéseinek köszönhetően a vérkészítményigény és -kínálat között új egyensúly alakult ki, mely megfelelő ellátást biztosított a feltétlenül szükséges transzfúziók kivitelezéséhez. Orv Hetil. 2021; 162(43): 1717–1723. Summary. Introduction: The impact of COVID–19 pandemic on patient care is pronounced also in Hungary. Blood supply was hindered by the reduction of public blood donation events, the reduced willingness to donate, and the difficult predictability of blood product demand as a result of the epidemiological regulations. The wider application of Patient Blood Management guidelines in the medical practice will promote optimal blood product utilization by avoiding transfusions where possible. Objective and method: The aim of our study was to assess the changes in the usage of blood products in the first five months of 2020 at the Clinical Center of the University of Pécs, Janus Pannonius Clinical Building. Results: In the period following the epidemiological measures, we found reduction in the number of hospitalized patients (34.08%), in the number of patients requiring transfusion (39.69%) and in the number of red blood cell products used (46.41%). The number of transfused red blood cell concentrates per patient was also significantly reduced (from 2.61 to 1.97) in this period. The number of transfused fresh frozen plasma units and platelet concentrates also decreased by approximately 30%. Conclusion: After the implementation of the strict restrictions, despite the difficulties, it was possible to provide patients with sufficient blood products. Due to the efforts of both the Regional Blood Transfusion Center of Pécs of the Hungarian National Blood Transfusion Service and of the clinicians, a new balance was established between the demand and the supply of blood products, which provided adequate care for the necessary transfusions. Orv Hetil. 2021; 162(43): 1717–1723.

scholarly journals Evaluating the Importance of Patient Blood Management During COVID-19 Pandemic

2022 ◽  
Vol 11 (6) ◽  
Author(s):  
Azita Chegini
Keyword(s):  
Blood Transfusion ◽  
Blood Collection ◽  
Patient Blood Management ◽  
Blood Products ◽  
Blood Management ◽  
Platelet Dysfunction ◽  
Timely Manner ◽  
Public Places ◽  
Emergency Procedures ◽  
Number Of Patients

: Due to the COVID-19 pandemic, the demand for blood products may decrease as the health care system shifts toward treating the increased number of patients afflicted with COVID-19 and delaying selective surgeries and emergency procedures. One of the most important problems for blood transfusion services during COVID-19 pandemic is the reduction in the number of donors and a decrease in blood stocks. This happens due to the limitations of attendance of donors in blood centers, lack of awareness, misinformation, fear of being infected while donating blood, and restricting the freedom of blood collection teams to attend public places. Blood transfusion services should be prepared and well-responded in a timely manner. In this regard, appropriate use of blood, diminishing unnecessary transfusions, and implementation of patient blood management (PBM) principles are considered as significant measurements. PBM can help maintain blood supply throughout the crisis and reduce the pressure on blood demand. As a result, blood products can be saved for patients who need it urgently. PBM focuses on the patient, as well as the conditions that make patients transfuse blood, such as blood loss, coagulopathy, platelet dysfunction, and anemia. Thus, the majority of health systems in different countries have made recommendations to the PBM in hospitals.

Changes in blood center red blood cell distributions in the era of patient blood management: the trends for collection (TFC) study

Transfusion ◽  
2016 ◽  
Vol 56 (8) ◽  
pp. 1965-1973 ◽  
Author(s):  
Mark H. Yazer ◽  
Bryon Jackson ◽  
Neil Beckman ◽  
Stuart Chesneau ◽  
Patrick Bowler ◽  
...  
Keyword(s):  
Blood Cell ◽  
Red Blood Cell ◽  
Patient Blood Management ◽  
Blood Management ◽  
Blood Center

scholarly journals Patient Blood Management: Implementation of a Preoperative Anemia Clinic for Elective Orthopedic Surgical Patients

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2547-2547
Author(s):  
Paul Letendre ◽  
Emily Coberly ◽  
Katie Dettenwanger ◽  
Kan Huang
Keyword(s):  
Patient Safety ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Elective Surgery ◽  
Surgical Patients ◽  
Patient Blood Management ◽  
Blood Management ◽  
Preoperative Anemia ◽  
Red Blood Cell Transfusions ◽  
Work Up

Abstract Background: Patient blood management (PBM) programs aim to implement best practices and encourage blood stewardship. Judicious use of red blood cell transfusions improves patient safety, decreases hospital length of stay (LOS) and reduces cost. A 2010 World Health Organization statement asserted "…before surgery every reasonable measure should be taken to optimize the patient's own blood volume, minimize the patient's blood loss and to harness and optimize physiological tolerance of anemia…". A comprehensive PBM program includes a preoperative anemia clinic to facilitate these goals. At our institution, 21% of surgical patients are anemic prior to their elective surgery and these patients consume approximately 67% of our transfused operating room blood. Our aim was to reduce red blood cell transfusions in elective orthopedic surgical patients by 25% and decrease hospital LOS through the implementation of a preoperative anemia clinic. Methods: After enlisting the support of hospital leadership, a preoperative anemia clinic referral/consult order was added the electronic medical record. Appropriate patients for referral were undergoing elective orthopedic surgery and had anemia defined as a Hgb <11.0 g/dl. Additional non-anemic patients with extenuating circumstances such as religious objection to transfusion were also referred. Every effort was made to see patients at least 2 weeks prior to the date of scheduled surgery or within 48 hours if the referral was not placed that far in advance. Work-up of anemia was individualized based on a patient's laboratory abnormality and medical profile. Interventions were targeted at treating the underlying cause of anemia and included but were not limited to parenteral iron, erythropoietin receptor agonists, and vitamin B12 injections. The primary measures assessed were the average LOS from day of surgery to discharge and the number of red blood cell units transfused during that stay. Findings: Early data since implementing our preoperative anemia clinic has demonstrated a reduction in LOS from 5.5 days for anemic patients undergoing elective surgery without a referral versus 3.5 days for those with a referral. A relative decrease in LOS of 36%. Reductions in hospital LOS were observed across the spectrum of all elective surgical procedures. The overall red blood cell transfusion rate in patients without referral versus with referral was 1.5% and 1.2% respectively; and of those requiring a transfusion, the mean red blood cell units transfused in the perioperative period was 2.31 units versus 1.19 units, resulting in a relative reduction of 48%. Additionally, 2 patients were diagnosed with a gastric ulcer and 2 patients with multiple myeloma during work-up and referred appropriately for treatment. Discussion: Expansion of the PBM program at our institution to include a preoperative anemia clinic has led to significant reductions in both red blood cell transfusions and hospital LOS in elective orthopedic surgical patients. Early results indicate a near doubling of our goal of a 25% reduction in red blood cells transfused. This has positively impacted our patients and led to both direct and indirect financial savings at our institution. Given the initial success, we hope to expand our preoperative anemia clinic to include all surgical specialties and streamline workflow. To facilitate growth additional staffing will be required. We have created patient education videos about the benefits of correcting their anemia prior to an elective surgery and hope to further engage primary care practitioners to refer patients earlier in their surgical evaluation. We conclude that the creation of a preoperative anemia clinic at our institution is a valuable resource and has led to a decreased use of red blood cell transfusions, a decreased average hospital LOS, improved patient safety and considerable financial savings. Figure. Figure. Disclosures No relevant conflicts of interest to declare.

scholarly journals Red Blood Cell Transfusion Practices in the Neurointensive Care Unit: A Narrative Review

2019 ◽  
Vol 06 (02) ◽  
pp. 072-079
Author(s):  
Rohini M. Surve ◽  
Sonia Bansal ◽  
Radhakrishnan Muthuchellappan
Keyword(s):  
Blood Transfusion ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Narrative Review ◽  
Neurointensive Care ◽  
Red Blood Cell Transfusion ◽  
Compensatory Mechanism ◽  
Neurointensive Care Unit ◽  
The Impact ◽  
The Brain

AbstractAnemia is common in neurointensive care unit (NICU) patients and is one of the common causes of systemic insults to the brain. Though the recent literature favors restrictive blood transfusion practices over liberal transfusion to correct anemia in the general ICU, whether a similar practice can be adopted in NICU patients is doubtful due to lack of strong evidence. Impairment of cerebral autoregulation and cardiac function following acute brain injury affects the body's compensatory mechanism to anemia and renders the brain susceptible to anemic hypoxia at different hemoglobin (Hb) thresholds. Hence, red blood cell transfusion (RBCT) practice based on a single Hb threshold value might be inappropriate. On the other hand, allogenic RBCT has its own risks, both in short and in long run, leading to adverse outcomes. Thus, instead of relying only on arbitrary Hb values, a better way to decide the need for RBCT in NICU patients is to target parameters based on systemic and regional cerebral oxygenation. This approach will help us to individualize RBCT practices. In this narrative review, based on the available literature, authors have discussed the impact of anemia and blood transfusion on the immediate and late neurological outcomes and the current role of regional brain monitoring in guiding blood transfusion practices. In the end, authors have tried to update on the current RBCT practices in neurosurgical and neuromedical patients admitted to the NICU.

Blood products and fluid therapy

2021 ◽  
pp. 449-470
Author(s):  
Nicholas Eaddy ◽  
Alexandra Cardinal
Keyword(s):  
Blood Transfusion ◽  
Fluid Therapy ◽  
Coagulation Factor ◽  
Patient Blood Management ◽  
Blood Products ◽  
Blood Management ◽  
Massive Blood Transfusion ◽  
Essential Components ◽  
The Common ◽  
Specific Management

This chapter describes the blood products which are commonly required as part of anaesthetic practice, including red cells, plasma, cryoprecipitate, platelet concentrate, and concentrated coagulation factor preparations. The essential components of patient blood management, aiming to reduce the requirement for transfusion, are described. The principles and practice of massive blood transfusion are described. The specific management of Jehovah’s Witnesses, and other patients who decline blood transfusion, is discussed. The chapter finishes with a discussion of the common intravenous fluid preparations which are used in practice, and how to use them appropriately.

scholarly journals Blood Transfusion in Obstetric Cases

2020 ◽  
pp. 197-200
Author(s):  
Ali Sungkar ◽  
Raymond Surya
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Massive Transfusion ◽  
Patient Blood Management ◽  
Blood Products ◽  
Blood Management ◽  
Transfusion Therapy ◽  
Massive Transfusion Protocol ◽  
Life Threatening ◽  
Transfusion Protocol

Objective: To discuss about blood loss in an obstetric setting, the role of blood transfusion, and patient blood management.Methods: Literature review.Results: Severe anaemia with hemoglobin level less than 7 g/dL or late gestation (more than 34 weeks) and/ or significant symptoms of anaemia, the recommendation is giving only single unit transfusion followed by clinical reassessment for further transfusion. In postpartum hemorrhage (PPH), massive transfusion protocols are commonly used description as large volume of blood products over a brief period to a patient with uncontrolled or severe hemorrhage, transfusion more than 10 RBC units within 24 hours, transfusion more than 4 RBC units in 1 hour with anticipation of continued need for blood, replacement of more than 50% of total blood volume by blood products within 3 hours. All obstetric units have a clear-cut massive transfusion protocol for the initial management of life-threatening PPH, considering early transfusion therapy with RBCs and FFP.Conclusion: Patient blood management aims to maintain hemoglobin concentration, optimize haemostasis, and minimize blood loss in effort to improve patient outcomes. Massive transfusion protocol in management of life-threatening should depend on each obstetric unit.Keywords: blood transfusion, obstetric cases, patient blood management.   Abstrak Tujuan: Untuk mendiskusikan tentang hilang darah dalam obstetric, peran transfusi darah, dan patient blood management.Metode: Kajian pustaka.Hasil: Anemia berat dengan nilai hemoglobin kurang dari 7 g/dL atau kehamilan lanjut (lebih dari 34 minggu) dan/ atau gejala nyata anemia, rekomendasi ialah memberikan satu unit transfusi diikuti dengan penilainan klinis untuk transfusi lebih lanjut. Pada perdarahan postpartum, protokol transfusi massif umum digambarkan sebagai volume darah yang dibutuhkan jumlah banyak dalam periode singkat, transfusi lebih dari 10 sel darah merah dalam 24 jam atau lebih dari 1 jam, penggantian lebih dari 50% total volume darah dalam 3 jam. Seluruh unit obstetric memiliki protokol transfusi massif yang jelas untuk taalaksana awal perdarahan postpartum dengan mempertimbangkan transfusi awal untuk komponen sel darah merah dan FFP.Kesimpulan: Patient blood management bertujuan untuk menjaga konsentrasi hemoglobin, optimalisasi hemostasis, dan minimalisasi hilang darah untuk meningkatkan luaran pasien. Protokol transfusi masfi dalam tatalaksana yang mengancam nyawa sangat bergantung pada setiap unit obstetrik.Kata kunci: kasus obstetri, patient blood management, transfusi darah  

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