The Effect of the Transfusion Protocol on Transfusion Rates and Short-term Outcomes of Preterm Infants in a Tertiary Neonatal Intensive Care Unit

Background: The aim of this study was to compare the epochs before and after the revision of the transfusion guideline, and determine their effects on transfusion rates and short-term outcomes in preterm infants. Materials and Methods: This retrospective study was conducted to investigate the effect of the new transfusion guideline. Infants who were born <32 weeks of gestation and received red blood cell (RBC) transfusion in their first 6-weeks of life were divided into two epochs according to adopting the new transfusion guideline. The demographic and clinical data of the patients were compared between these two periods. Results: Fifty-six infants were included (Period 1, n=22; Period, n=34). The number of transfusions, total and cumulative volume of the transfusions were similar in the two periods. There was an inverse relationship between the gestational age and the number of transfusions in both periods (r=-0.575, p=0.005, and r=-0.494, p=0.003), and there was an inverse relationship between the birth weight and the number of transfusions in period 2 (r=-0.423, p=0.013). The ratio of total phlebotomy volume to estimated total blood volume was higher in period 2 (p=0.029). There was a direct relationship between the phlebotomy loss and volume of RBC transfused in period 2 (r=0.487, p=0.003). The incidence of morbidities was similar in the two periods. Conclusion: Changing only the transfusion protocol did not decrease the transfusion number. Although transfusion guidelines were adopted rigorously, it seems to be impossible to reduce RBC transfusion rates unless anemia prevention strategies were also in place.

1002 Calcium administration in Major haemorrhage Protocol

Introduction Calcium gluconate is an essential part of the major haemorrhage protocol (MHP). It minimizes the exacerbation of transfusion coagulopathies due to the citrate preservative. As fifty percent of trauma patients present with hypocalcaemia prior to transfusion, the risk is pertinent. Given the importance of the issue, surprisingly current guidelines remain sparse. We analysed the percentage of patients who received calcium and their hypocalcaemia incidence. Method A Retrospective review of red traumas during June to August 2019. The frequency of MHP and the patient’s ionised plasma calcium levels on VBG (1.15-1.26mmol/L) were identified. Our standard stated 100% of MHP should receive calcium. A massive transfusion was defined as 10 red blood cells units in 24 hours or 4 blood products within 30mins. Results 27 red traumas were accepted to audit, MHP was activated in 85%. Out of these 75% received calcium and on average after 6.4 units of blood products. The incidence of ionised hypocalcaemia in all MHP patients was 67%. Conclusions We identified a standard that supplementary calcium should be supplemented in all MHPs. Hypocalcaemia was more frequency than our research stipulated. Improvement needs to be made to meet standards. We recommend incorporation of Calcium gluconate into major haemorrhage pack and transfusion guidelines.

Sickle cell disease and the adherence to guidelines for the use of blood transfusions in Duhok, Kurdistan, Iraq

Background and objective: One of the important health problems in Duhok city, Iraqi Kurdistan Region, is sickle cell disease. Blood transfusion remains a significant therapeutic intervention in patients with sickle cell disease that reduces complications related to vaso-occlusions. This study aimed to assess compliance to guidelines for the use of blood transfusionsin Duhok, Kurdistan, Iraq. Methods: This is a cross-sectional study that included 135 patients with sickle cell disease registered at Jeen center of pediatric hematological diseases in Duhok, Kurdistan, Iraq. Between April 1st and July 31st, 2019, 205 medical visits of sickle cell disease were registered. Every patient was evaluated to record the clinical setting and explanations behind visiting and indications for transfusion. Results: Of 135 patients,65.9% had sickle cell anemia (HbSS disease), 33.3% had sickle beta thalassemia, and one patient (0.7%) had Sickle/D disease. A total of 205 medical visits of sickle cell disease were registered with 84 blood transfusion decisions. The most common indicated guideline reasons for transfusion were symptomatic anemia and acute hemolytic crisis with a drop of hemoglobin >2 g/dl below steady state hemoglobin and severe painful crisis only accounted for 38.1%. Conclusion: In this study of patients with sickle cell disease, most blood transfusions were not indicated according to the transfusion guidelines (British Committee for Standards in Haematology – BCSH, 2017). Keywords: Transfusion guidelines for sickle cell disease (BCSH 2017); Sickle cell disease; Iraq.

The Most Common Causes of Transfusion-Transmitted Diseases among Blood Donors in the Middle Eastern States

The need for blood is essential, but there is no timely access to safe blood for millions of individuals who need a transfusion. Additionally, blood transfusions can also be the fastest and simplest form of checking for the existence of transfusion-transmitted diseases to the recipients. Blood safety concerns are an issue of great concern in Middle Eastern Countries in which the inaccessibility or provision of unsafe blood has an adverse effect on morbidity and mortality in the region. Additionally, many organizations and safety procedures of blood transfusion in this region need to be updated. Articles containing the key phrases Middle Eastern Countries, Blood, blood donor, blood transfusion, transfusion safety, transfusion-transmitted infections, and transfusion guidelines published from 2003 to 2020 in MEDLINE, PubMed, Scopus, and Google Scholar. Therefore, to determine the most prevalent causes of transfusion-transmitted disease among blood donors in the Middle East countries, this literature review was intended for research. Based on the data gathered were potentially related to HBsAg and HCV prevalence in blood donors from most of the middle eastern countries. While no positive cases of either HIV Ag-Ab or syphilis antibodies have been recorded especially among the blood donated from Egypt and Saudi Arabia. Based on recent studies findings, WHO, and the Food and Drug administration transfusion transmission of SARS-CoV-2 to recipients did not occur via blood transfusion. So that, In Middle Eastern countries, transfusion-transmitted infection remains a formidable problem. A similarly wide constellation of economic and operational challenges in the area parallels the diverse array of pathogens; this calls for a systemic solution that, as proposed by the WHO, involves regulatory, structural, and training initiatives.

Storage Time of Filtered Red Blood Cells and Post-Transfusion Complications (Review)

Red blood cells are the most required blood transfusion products worldwide. Safety and efficacy of blood transfusion are still relevant issues. Clarification of the causes and mechanisms of post-transfusion complications requires additional research.Aim of the review is to summarize the data of clinical and research studies on transfusion of red blood cell suspension with various storage times.Material. We selected 76 sources from Web of Science, Scopus, and RSCI databases containing pertinent clinical and scientific research data, as well as blood transfusion guidelines.Results. We reviewed the main stages of preparation and storage of filtered red blood cells, described biochemical and structural alterations occurring during blood storage, summarized clinical data on post-transfusion complications, and analyzed clinical consequences and molecular structure abnormalities of red blood cells in relation to their storage time.Conclusion. During long-term storage, red blood cells undergo significant structural and metabolic changes. The clinical use of relatively «old» red blood cells increases the risk of post-transfusion complications. However, the pathophysiological differences between «young» and «old» erythrocytes remain unclear. Large clinical and molecular research studies may add to our understanding of the complex issues related to blood transfusion.