Knowledge of appropriate blood product use in perioperative patients among clinicians at a tertiary hospital

Background: Blood products are an expensive and scarce resource with inherent risks to patients. The current knowledge of rational blood product use among clinicians in South Africa is unknown.Purpose of research: To describe the level of clinicians' knowledge related to all aspects of the ordering and administration of blood products from the South African Blood Services for peri-operative patients at a tertiary hospital.Method: A self-administered survey was distributed to 210 clinicians of different experience levels from the departments of Anaesthesiology, General Surgery and Trauma, Orthopaedic Surgery and Obstetrics and Gynaecology at the study hospital. The questions related to risks, cost, ordering procedures and transfusion triggers for red cell concentrate (RCC), fresh frozen plasma (FFP) and platelets.Results: A total of 172 (81.90%) surveys were returned. The overall mean for correctly answered questions was 16.76 (±4.58). The breakdown by specialty was: Anaesthesiology 19.98 (±3.84), General Surgery and Trauma 16.28 (±4.05), Orthopaedic Surgery 13.83 (±4.17) and Obstetrics and Gynaecology 15.63 (±3.51). Anaesthesiology performed better than other disciplines (p < 0.001) and consultants out-performed their junior colleagues (p < 0.001). Seventy percent correctly identified triggers for RCC transfusion and 50% for platelets. Administration protocols were correctly defined by 80% for RCC and FFP just over 50% for platelets. Thirty eight percent of respondents deemed infectious and non-infectious risk sufficient to obtain informed consent. Knowledge of costs and ordering was below 30%.Conclusion: Clinician's knowledge of risks, resources, costs and ordering of blood products for perioperative patients is poor. Transfusion triggers and administration protocols had an acceptable correct response rate.

Download Full-text

The Impact of Perioperative Viscoelastic Test Application on Blood Product Usage and Outcome in Cardiac Surgery; Regional Cardiac Surgery Center Experience

Journal of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care Society ◽

10.5222/gkdad.2021.78557 ◽

2021 ◽

Author(s):

Murat Aksun ◽

Saliha Aksun ◽

Mehmet Ali Çoşar ◽

Elif Neziroğlu ◽

Senem Girgin ◽

...

Keyword(s):

Cardiac Surgery ◽

Clinical Experience ◽

Heart Surgery ◽

Blood Product ◽

Open Heart Surgery ◽

Control Group ◽

Open Heart ◽

Blood Products ◽

Product Use ◽

The Impact

Objective: Thromboelastography (TEG) is a diagnostic modality that gives information about coagulation. Despite all blood-preserving precautions in open heart surgery there are blood losses and the use of blood and blood products becomes inevitable. TEG is mostly not available in every center and habits, trends and clinical experience in blood use create the possibility of causing unnecessary use of blood and blood products. In this study, it was aimed to determine the effect of the use of thromboelastography on the use of blood and blood products in cardiac surgery. Methods: Two hundred patients between 18-70 years old who underwent open heart surgery were included in the study. After the cardiopulmonary bypass (CPB), the cases were confirmed to have an Activated Clotting Time (ACT) value in the range of 120-150 sec after protamine administration. In 100 patients in the TEG group, the coagulation status was evaluated with TEG and it was decided how to apply blood and blood product use. Blood and blood product use was applied to 100 patients in the control group based on clinical experience and foresight. The total amount of blood and blood product used, fluid balance, need for inotropics, mechanical ventilator time, complications, duration of intensive care and discharge times were recorded. Results: Use of Fresh Frozen Plasma (FFP) at the after CPB in the TEG group was statistically significantly lower than that of the control group FFP (p<0.05). Postoperative FFP and postoperative platelet use in the study group were statistically significantly lower than in the postoperative FFP and postoperative platelet values of the control group (p <0.05). Conclusion: The use of thromboelastography is a very useful monitoring in terms of reducing FFP use after CPB and reducing FFP and platelet usage in the postoperative period. In this way, the unnecessary use of blood and blood products can be prevented.

Download Full-text

Identification of Wasted Blood Products at Staten Island University Hospital in 2020 and Institutional Efforts to Reduce Wastage

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqab191.334 ◽

2021 ◽

Vol 156 (Supplement_1) ◽

pp. S156-S157

Author(s):

M Toprak ◽

I M Asuzu ◽

G Morvillo ◽

F Kiran ◽

B Chae ◽

...

Keyword(s):

Shelf Life ◽

Blood Product ◽

Low Cost ◽

Fresh Frozen Plasma ◽

University Hospital ◽

Blood Component ◽

Blood Products ◽

Staten Island ◽

Team Members ◽

Fresh Frozen

Abstract Introduction/Objective Blood products are precious resources obtained from donors who donate with the intention to help people. These blood products however do not always go to the patients, instead sometimes ending up in the waste. It is inevitable to have some degree of the wastage due to limited blood product shelf life, the inherent need to have stock on hand at all times, and the often unpredictable demand of these products. However, it is possible to minimize the wastage of blood products with careful management of inventories, proper documentation, and education1. In this study, we aim to identify the amount and cost of wasted blood products at Staten Island University Hospital in 2020, the reasons behind the wastage, and solutions to reduce the wastage. Methods/Case Report A retrospective statistical analysis of blood product waste data in 2020 was performed manually with Microsoft Excel. Wastage rate and average cost was calculated, the reasons behind the wastage were identified, and low cost interventions to reduce wastage were planned. Results (if a Case Study enter NA) Total number of the wasted blood product is 425 which represents 3.8% of the total inventory at a total cost of $ 97,309.46 which does not include the hours spend by the lab personnel for the wasted products. The most wasted blood component is fresh frozen plasma (FFP) (Table 1). Thawing the frozen blood products (FFP and cryoprecipitate) significantly shortens the shelf life and triggers a lot of wastage through expiration (Table 2). 32.5 % of the wasted products are wasted due to expiration on the shelf (Diagram 1). Other reasons for the wastage includes patient unreadiness, patient refusal, late return of unused products etc. (Graph 1). Conclusion Educating clinical and laboratory team members about the reasons for wasted blood products and strategies to reduce it might significantly reduce the wastage. Appropriate activation and immediate deactivation of massive transfusion protocol (MTP) would be one of the most important aspect of this education. Expired thawed blood product is the largest contributor to wastage, and MTP is the main reason for thawing. Preventing unnecessary MTP activation minimizes over-thawing and therefore minimizes the expiration and wastage. Documentation of the wasted blood product should be improved to better identify the reasons behind wastage.

Download Full-text

Blood product support

Oxford Handbook of Cancer Nursing ◽

10.1093/med/9780198569244.003.0039 ◽

2007 ◽

pp. 501-510

Keyword(s):

Blood Product ◽

Intensive Chemotherapy ◽

Blood Products ◽

Product Use ◽

Remission Rates ◽

Nurses Role ◽

British Committee

Blood products 502 The nurses' role in blood product transfusions 508 The introduction of safe, reliable blood products has enabled the development of intensive chemotherapy programmes for a variety of malignancies. This has led to significantly improved remission rates. It must be remembered however that blood product use is not without risks, and that these are a very expensive resource. The pool of acceptable donors is also diminishing because of more stringent screening. Blood products should only be used in appropriate situations in consultation with national and local guidelines. (See British Committee for Standards in Haematology, BCSH...

Download Full-text

Thromboelastography after Cardiopulmonary Bypass: Does it Save Blood Products?

Kansas Journal of Medicine ◽

10.17161/kjm.vol15.15789 ◽

2022 ◽

Vol 15 (1) ◽

pp. 341-344

Author(s):

Omar Hasan ◽

Robert Tung ◽

Hadley Freeman ◽

Whitney Taylor ◽

Stephen Helmer ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Blood Product ◽

Tertiary Care ◽

Length Of Hospital Stay ◽

Fresh Frozen Plasma ◽

Hospital Length Of Stay ◽

Graft Occlusion ◽

Blood Products ◽

Care Community ◽

Coagulation Tests

Introduction. This study aimed to determine if thromboelastography (TEG) is associated with reduced blood product use and surgical re-intervention following cardiopulmonary bypass (CPB) compared to traditional coagulation tests. Methods. A retrospective review was conducted of 698 patients who underwent CPB at a tertiary-care, community-based, university-affiliated hospital from February 16, 2014 – February 16, 2015 (Period I) and May 16, 2015 - May 16, 2016 (Period II). Traditional coagulation tests guided transfusion during Period I and TEG guided transfusion during Period II. Intraoperative and postoperative administration blood products (red blood cells, fresh frozen plasma, platelets, and cryoprecipitate), reoperation for hemorrhage or graft occlusion, duration of mechanical ventilation, hospital length of stay and mortality were recorded. Results. Use of a TEG-directed algorithm was associated with a 13.5% absolute reduction in percentage of patients requiring blood products intraoperatively (48.2% vs. 34.7%, p <0.001). TEG resulted in a 64.3% and 43.1% reduction in proportion of patients receiving FFP and platelets, respectively, with a 50% reduction in volume of FFP administered (0.3 vs. 0.6 units, p < 0.001). Use of TEG was not observed to significantly decrease postoperative blood product usage or mortality. The median length of hospital stay was reduced by 1 day after TEG guided transfusion was implemented (nine days vs. eight days, p = 0.01). Conclusions. Use of TEG-directed transfusion of blood products following CPB appears to decrease the need for intraoperative transfusions, but the effect on clinical outcomes has yet to be clearly determined.

Download Full-text

Blood Product Use in Recently Diagnosed Persons with Myelodysplastic Syndrome: A Population Study.

Blood ◽

10.1182/blood.v114.22.4849.4849 ◽

2009 ◽

Vol 114 (22) ◽

pp. 4849-4849

Author(s):

Scott D Ramsey ◽

Cara L McDermott ◽

Sara J Beck ◽

Jose A. Lopez ◽

Stephen C Dinwiddie ◽

...

Keyword(s):

Myelodysplastic Syndrome ◽

Blood Product ◽

Puget Sound ◽

Washington State ◽

Red Blood Cell Transfusion ◽

Refractory Anemia ◽

Newly Diagnosed ◽

Blood Products ◽

Product Use ◽

Western Washington

Abstract Abstract 4849 Many patients with myelodysplastic syndrome (MDS) experience cytopenias that require blood product support. The extent to which MDS patients utilize blood products following diagnosis is unknown. The objective of this study was to characterize the use of blood products among recently diagnosed MDS patients in western Washington State. Records from the NCI's Surveillance, Epidemiology, and End Results (SEER) cancer registry for western Washington State were searched for patients diagnosed with MDS between 2001 and 2007. These records were linked to Puget Sound Blood Center (PSBC) database records. The PBSC is the major supplier of blood products for the Washington SEER region. SEER identified a total of 781 newly diagnosed patients during 2001-2007. The average age was 72.84, 76% were over age 65 and 55% were over age 75. Fifty-eight percent were male and 88% were white race. The most common MDS subtypes included refractory anemia (24%) and refractory anemia with excess blasts (21%); 33% had no specified subtype. Three hundred seventy-six patients (48%) received at least one blood product within 12 months of diagnosis; packed red blood cells (RBCs) (n=361 persons) and platelets (n=222 persons) were most commonly transfused. Among those receiving at least one transfusion of RBCs or one transfusion of platelets respectively, patients received an average of 15.40 units of RBCs and 15.37 units of platelets over 12 months from diagnosis; of these patients, the highest quartile used an average of 39.84 RBCs and 33.81 platelets per person. The proportion of MDS patients receiving any RBCs within 12 months of diagnosis increased from 24% in 2001 to 54% in 2007. Platelet use within 12 months of diagnosis increased from 12% of patients in 2001 to 39% in 2007. Among those receiving at least one platelet transfusion or at least one red blood cell transfusion within 12 months of diagnosis the number of products transfused increased over time, from an average of 8.00 platelet units (SD 5.77) and 8.85 units of RBCs (SD 11.21) in 2001 to 14.12 platelet units (SD 20.31) and 15.98 units RBCs (SD 19.35) in 2007 (p<0.0001, p<0.0001, respectively). Approximately half of newly diagnosed MDS patients receive at least one blood product in the first 12 months following diagnosis. Blood product use has increased substantially from 2001 to 2007, in terms of both the proportion of patients receiving them and the number of transfusions per person. Further study is needed to determine the factors leading to more aggressive use of blood products in these patients. Disclosures No relevant conflicts of interest to declare.

Download Full-text

Knowledge of appropriate blood product use in perioperative patients among clinicians at a tertiary hospital

Health SA Gesondheid ◽

10.1016/j.hsag.2016.06.003 ◽

2016 ◽

Vol 21 ◽

pp. 309-314

Author(s):

Bradley Yudelowitz ◽

Juan Scribante ◽

Helen Perrie ◽

Eddie Oosthuizen

Keyword(s):

Blood Product ◽

Tertiary Hospital ◽

Product Use

Download Full-text

Appropriateness of blood product transfusion in the Obstetrics and Gynaecology (O&G) department of a tertiary hospital in West Africa

Transfusion Medicine ◽

10.1111/tme.12028 ◽

2013 ◽

Vol 23 (3) ◽

pp. 160-166 ◽

Cited By ~ 13

Author(s):

E. N. Osei ◽

A. T. Odoi ◽

S. Owusu-Ofori ◽

J.-P. Allain

Keyword(s):

West Africa ◽

Blood Product ◽

Tertiary Hospital ◽

Blood Product Transfusion ◽

Obstetrics And Gynaecology

Download Full-text

Effect of tranexamic acid administration time on blood product use in urban trauma patients

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxaa074 ◽

2020 ◽

Vol 77 (Supplement_2) ◽

pp. S46-S53 ◽

Cited By ~ 1

Author(s):

Elizabeth Tencza ◽

Andrew J Harrell ◽

Preeyaporn Sarangarm

Keyword(s):

Tranexamic Acid ◽

Blood Product ◽

Trauma Patients ◽

Loading Dose ◽

Blood Products ◽

Ambulance Personnel ◽

Product Usage ◽

Packed Red Blood Cells ◽

Product Use ◽

Acid Administration

Abstract Purpose To evaluate the effect of time to tranexamic acid administration on blood product usage in trauma patients and to assess the potential benefit of initiating a protocol for field administration by ground ambulance personnel. Methods Adult patients with traumatic injuries who received 1 g of tranexamic acid during the period January 2014 through June 2016 were retrospectively identified via review of automated dispensing cabinet and electronic medical record data and cross-referencing with the New Mexico Trauma Registry. Exclusion criteria included tranexamic acid use for nontrauma indications, previous admission for trauma during the study period, and a lack of pertinent information regarding the time, type, or severity of trauma in available records. The primary outcome was blood product use (aggregate of units of platelets, packed red blood cells [pRBCs], and fresh frozen plasma [FFP]) in the first 24 hours of hospital admission. Results The analysis included 107 patient cases, with a median transport time of 20 minutes (range, 7-103 minutes); 73% of reported transport times were less than 30 minutes. All patients received a loading dose of tranexamic acid in the hospital, with the exception of 2 patients who received tranexamic acid in the field. Administration of a tranexamic acid loading dose was documented within 3 hours for 90.7% of patients, with a mean time to administration of 91.9 minutes. A mean (SD) total of 14.8 (16.0) units of blood products (range, 0-91 units) were administered, consisting of a mean (SD) of 8.0 (8.4) units of pRBCs (range, 0-48 units), 5.6 (7.5) units of FFP (range, 0-38 units), and 1.2 (1.7) units of platelets (range, 0-7 units). Time to tranexamic acid administration did not affect blood product usage in the first 24 hours of admission after adjusting for potential confounders. Conclusion Earlier administration of tranexamic acid was not associated with a decrease in use of blood products. This finding, paired with the relatively short ground transport times typical for our institution, makes it unlikely that field administration of tranexamic acid would benefit the evaluated patient population.

Download Full-text