Association between the plasma-to-red blood cell ratio and survival in geriatric and non-geriatric trauma patients undergoing massive transfusion: a retrospective cohort study

Background The benefits of a high plasma-to-red blood cell (RBC) ratio on the survival of injured patients who receive massive transfusions remain unclear, especially in older patients. We aimed to investigate the interaction of age with the plasma-to-RBC ratio and clinical outcomes of trauma patients. Methods In this retrospective study conducted from 2013 to 2016, trauma patients who received massive transfusions were included. Using a generalized additive model (GAM),we assessed how the plasma-to-RBC ratio and age affected the in-hospital mortality rates. The association of the plasma-to-RBC ratio [low (< 0.5), medium (0.5–1.0), and high (≥ 1.0)] with in-hospital mortality and the incidence of adverse events were assessed for the overall cohort and for patients stratified into non-geriatric (16–64 years) and geriatric (≥ 65 years) groups using logistic regression analyses. Results In total, 13,894 patients were included. The GAM plot of the plasma-to-RBC ratio for in-hospital mortality demonstrated a downward convex unimodal curve for the entire cohort. The low-transfusion ratio group was associated with increased odds of in-hospital mortality in the non-geriatric cohort [odds ratio 1.38, 95% confidence interval (CI) 1.22–1.56]; no association was observed in the geriatric group (odds ratio 0.84, 95% CI 0.62–1.12). An increase in the transfusion ratio was associated with a higher incidence of adverse events in the non-geriatric and geriatric groups. Conclusion The association of the non-geriatric age category and plasma-to-RBC ratio for in-hospital mortality was clearly demonstrated. However, the relationship between the plasma-to-RBC ratio with mortality among geriatric patients remains inconclusive.

Factors Contributing to Red Blood Cells Crossmatch and Transfusion among Obstetrics Patients in a Single Tertiary Hospital

INTRODUCTION: Transfusion of blood and blood components among obstetrics patients is a common practice but they are not without risks. This study aims to determine crossmatch to transfusion ratio (C:T ratio) and to assess the factors that influence red blood cells (RBC) transfusion among obstetrics patients in a single tertiary hospital. MATERIAL AND METHODS: This was a retrospective cohort study of RBC crossmatch requests with data collected from 350 obstetrics patients. The patients were grouped into either received RBC transfusion or did not receive transfusion. Demographics and clinical characteristics were analyzed using descriptive and multivariate analysis. RESULTS: The mean C:T ratio was 3.1. Of 350 patients, 149 (42.6%) patients did receive RBC transfusion. Patients with underlying hemoglobinopathy (75.9%), history of postpartum hemorrhage (63.6%), underwent instrumental assisted delivery (64.3%), and with hemoglobin level of < 70 g/L upon crossmatch requests (90.5%) did receive RBC transfusion. Cesarean section (p=0.011), hemoglobin level < 99 g/L (p<0.001), estimated blood loss > 1000 mL (p<0.001), and symptomatic anemia (p=0.029) were the significant factors associated with RBC transfusion. CONCLUSION: The mean C:T ratio in our study was high. Identifying the factors contributing to RBC transfusion among obstetrics patients are important to reduce unnecessary crossmatch and subsequently improve blood inventory management, and thus further reduce the risks associated with allogeneic transfusion.

10 Years of Experience with the First Thawed Plasma Bank in Germany

<b><i>Background:</i></b> Plasma is stored at –30°C, which requires thawing before transfusion, causing a time delay between ordering and issuing of at least 30 min. In case of bleeding emergencies, guidelines strongly recommend a 2:1 transfusion ratio of RBCs and plasma. In addition, each minute delay in issuing of blood products in bleeding emergencies increases the mortality risk. To provide plasma in time in bleeding emergencies, a thawed plasma bank was introduced in 2011. <b><i>Summary:</i></b> The thawed plasma bank of University Medicine Greifswald has provided 18,924 thawed stored plasma units between 2011 and 2020. The workflow in the laboratory as well as in the emergency room, the operating room, and the intensive care unit have been optimized by thawed stored plasma. In case of emergencies, the stress factor for the transfusion medicine laboratory staff has been reduced substantially. The thawed plasma bank allows to transfuse patients with massive transfusion demand at a 2:1 ratio of RBCs and plasma according to guidelines. To reduce storage time, we issue all plasma requests from the thawed plasma bank except for pediatric patients. This results in a median storage time in the thawed plasma bank of 24 h. The “just in time” availability of plasma within the entire hospital based on the thawed plasma bank has reduced precautionary ordering of plasma, and hereby the unnecessary use of plasma. After introduction of the thawed plasma bank, plasma usage decreased substantially by 24% within the first year and by 60% compared to 2019/2020. However, as the overall approach to using blood products has changed over the last 10 years due to the patient blood management initiative, quantification of the effects of the thawed plasma bank in reduction of plasma transfusion is difficult. <b><i>Key Messages:</i></b> (1) A thawed plasma bank for the routine supply of blood products in a large hospital is feasible in Germany. (2) The thawed plasma bank allows to supply RBCs and plasma in a 2:1 ratio in bleeding emergencies. (3) The beneficial logistical effects of the thawed plasma bank are optimal if all plasma requests are supplied from the thawed plasma bank. This results in a median storage time of 24 h for thawed plasma.

A Review of Blood and Blood Products Requisition and Utilization in Post-neonatal Ward of a Tertiary Hospital in South Western Nigeria

Background: Blood and its products ordering is a common practice in paediatrics. The ready availability of blood and blood components has resulted in liberal use. Inappropriate use of blood and blood products exposes patients to the risk of transfusion transmissible diseases and allergic and haemolytic reactions. Objective: To assess blood and blood products requisition and utilization in a post-neonatal ward in a semi-urban tertiary hospital in Nigeria Methods: Retrospective analysis of medical records of all transfused post-neonatal patients during the study period from 1st July 2015 to¬ 31st December 2016 to calculate the cross-match to transfusion ratio, transfusion probability and transfusion index. Results: The units of blood cross-matched were 98 and 90 blood units transfused. The cross-match to transfusion ratio was 1.09 indicative of significant blood usage. The transfusion probability was 100% indicative of significant blood usage. The transfusion index was 1.10 indicative of significant blood utilization. Conclusion: Transfusion of blood and blood products in the post-neonatal ward of our setting meet the standard criteria for quality indicators for blood utilization.

Efficiency of blood utilization and characteristics of patients receiving blood transfusion at an associated hospital in North India

Background: Blood is the liquid connective tissue composed of cells and plasma. It is the most precious and unique gift that one person gives to another. Blood banks are not the manufacturing factories. It can only be available on replacement basis. Periodic review of blood components usage is essential to assess the blood utilization pattern in hospitals. This study was conducted to analyse the efficiency of blood utilization and to minimize the inappropriate use of blood.Methods: A retrospective cross-sectional study was conducted in the department of blood transfusion and immunohematology, government medical college and associated hospital, Rajouri for a period of one year with effect from November 2019 to November 2020. Data was collected using blood bank record. Blood utilization was calculated using crossmatch to transfusion ratio (C/T), transfusion probability (T%) and transfusion index (TI) indices.Results: A total of 974 patients were requested to prepare 1270 crossmatched units. Of these 1141 blood units were transfused for 664 patients. The total donations during that period were 1197. 998 donors were replacement donors and 199 were voluntary non-remunerated blood donors donated at various blood donation camps. The overall values of C/T, T% and TI were 1.1:1, 68.1% and 1.1 respectively.Conclusions: Blood utilization indices show efficient usage of blood. However, a blood ordering policy (MSBOS) must be developed to guide the clinicians regarding blood usage which can decrease overordering of blood thereby reducing unnecessary usage of reagents, manpower and also wastage of blood due to outdating.

Blood Transfusion Practice in Operating Rooms in Nemazee Hospital in Southern Iran

Background: The requests for blood products in elective surgeries exceed actual use, leading to financial wastage and loss of shelf-life. In this study, we assessed the blood transfusion indices in elective surgeries performed in the operating rooms. Methods: In this cross-sectional study, from January to June 2017, a total of 970 adult patients who underwent elective surgeries in the operating rooms of Nemazee hospital, a general referral hospital in southern Iran, were investigated. Demographic, clinical, and laboratory data, such as hemoglobin (Hb), hematocrit (Hct), platelets, prothrombin time (PT), and partial thromboplastin time (PTT) were gathered from medical records. Blood utilization was evaluated using the following indices: cross-match to transfusion ratio (C/T ratio), transfusion probability (T%), transfusion index (TI), and Maximum Surgical Blood Order Schedule (MSBOS). Results: The overall C/T, T%, and TI ratios were 2.49, 46.6%, and 0.83 for all procedures, and the highest and lowest ratios pertained to the thoracic and cardiac surgeries, respectively. The C/T ratio was ≥2.5 for all surgical procedures except for cardiac surgeries. T% was <30 for thoracic and orthopedics surgeries and ≥30 for other surgical procedures. In all surgical procedures, TI was less than 0.5, except for cardiac surgeries. Also, the MSBOS was about 3 units for cardiac surgeries and ranged from 0.5 to 1 units in other surgeries. Conclusion: The results of this study showed a high quality blood transfusion practice in cardiac surgeries, possibly due to more focus on this critical ward. Assessing difficulties in the process of reservation, utilization, and preparation of standard protocols and policies are required to improve the blood utilization practice in operating rooms.

A location-allocation model for quality-based blood supply chain under IER uncertainty

Providing blood with high quality at the lowest cost and the shortest time is main challenge of blood supply chain management. This paper presents a new model for designing a dynamic and three level blood supply chain incorporating the quality issues. The proposed model intends to locate facilities, and to determine the best strategy for blood allocation by minimizing both cost and time and maximizing the customer satisfaction based on quality of blood delivery. In order to deal with consideration of real world, intricacies such as blood freshness, both separation and apheresis extraction methods, Cross match to Transfusion ratio (C/T) and equipment failure have been involved. Also, Interval Evidential Reasoning (IER) approach is applied to handle the uncertainty of blood product demand. Since the proposed model is NP-hard, MOPSO and NSGAII algorithms are utilized to solve it. Finally, to demonstrate the applicability of the problem some numerical examples are designed in different sizes and the most favorable algorithm is determined using TOPSIS method.

Transfusion Medicine Informatics: Analysis of User Burden from Clinical Decision Support Alerts in Promoting Patient Blood Management

Introduction/Objective To increase efficiency of blood product ordering and delivery processes and improve appropriateness of orders, a major project to implement clinical decision support (CDS) alerts in the electronic medical record (EMR) was undertaken. A design team was assembled including hospital and laboratory medicine information technology and clinical informatics, transfusion services, nursing and clinical services from medical and surgical specialties. Methods Consensus-derived thresholds in hemoglobin/hematocrit, platelet count, INR, and fibrinogen for red blood cell (RBC), platelet, plasma, and cryoprecipitate blood products CDS alerts were determined. Data from the EMR and laboratory information system were queried from the 12-month period before and after implementation and the data was analyzed. Results During the analysis period, 5813 RBC (avg. monthly = 484), 1040 platelet (avg. monthly = 87), 423 plasma (avg. monthly = 35), and 88 cryoprecipitate (avg. monthly = 7) alerts fired. The average time it took for a user to respond was 5.175 seconds. The total amount of time alerts displayed over 12 months was 5813 seconds (~97 minutes of user time) compared to 56503 blood products transfused. Of active CDS alerts, hemoglobin/RBC alerts fired most often with ~1:5 (31141 RBC units) alert to transfusion ratio and 4% of orders canceled (n=231) when viewing the alert, platelet alerts fired with ~1:15 (15385 platelet units) alert to transfusion ratio and 6% orders canceled (n=66), INR/plasma alerts fired with ~1:21 (8793 plasma units) alert to transfusion ratio and 10% orders canceled (n=41), cryoprecipitate alerts fired with ~1:13 (1184 cryoprecipitate units) alert to transfusion ratio and 10% orders canceled (n=9). Overall monthly blood utilization normalized to 1000 patient discharges did not appear to have statistically significant differences comparing pre- versus post-go-live, except a potentially significant increase in monthly plasma usage at one facility with p = 0.34, although possibly due to an outlier single month of heavy usage. Conclusion Clinical decision support alerts can guide provider ordering with minimal user burden. This resulted in increased safety and quality use of the ordering process, although overall blood utilization did not appear to change significantly.