Plasma transfusion, whether FFP, plasma 24, thawed plasma, or any variation on this theme, continues to increase in the U.S. The 2009 National Blood Collection & Utilization Survey Report documented 5.7 million units of plasma produced and close to 4.5 million units transfused. This was an increase of roughly 400, 000 units from 2006.1
Recently, I have had several queries and personal communications regarding a perceived increase in RBC transfusions for patients with end-stage renal disease (ESRD) on dialysis. The literature is replete with articles surrounding the management of anemia in this patient population, particularly involving the use of erythropoietin-stimulating agents (ESAs). The literature is limited, however, when it comes to clear guidelines for transfusion. In fact, transfusion is most often discouraged in this population if, in particular, the patient is awaiting a transplant where alloimmunization must be avoided. Continue reading
As Blood Utilization Committees work to implement standardized transfusion order forms that encourage clinically appropriate transfusions, I am seeing that it is often nurses who are filling out the forms (whether on paper or electronically) after the physician writes the order on a blank form. Nurses and BUC’s need to recognize the potential legal implications of this practice. Continue reading
10. Hovav, et al. Transfusion. 1999;39:277-281
Transfusion has been a mainstay of patient care for years. It is identified as the #1 procedure performed in hospitals.1 The development and ultimate use of specific blood components has provided ways to tailor transfusion therapy to the patient’s clinical needs. Processing and storage of blood components, although allowing for more targeted and diverse therapy, also may have its attendant downside. Transfusion, of course, is certainly life-saving in many instances, however recent attention and scientific literature have highlighted the increased risk-to-benefit ratio associated with transfusion. The so-called “storage lesion” may play a part in some transfusion-associated adverse events.
Transfusion support for the obstetric patient is complex and demands a significant understanding of the peri-partum physiology, bleeding risk assessment and knowledge of other useful mechanical, pharmacological, and surgical interventions. Variability in obstetric transfusion practice mirrors that seen in general medical and surgical practices. Even the definition of what constitutes “significant hemorrhage” is plagued by the underlying difficulty in estimating blood loss and risk stratification. Continue reading
Last fall The Joint Commission (TJC) published sentinel event data from 2004 through the first 3 quarters of 2011.1 While TJC cautions that this data is not epidemiologically meaningful because the events are for the most part voluntarily self-reported and represent only a small portion of actual events, TJC encourages us to recognize that information from these reports and resulting root cause analyses are an important source of information for “lessons learned” that can help prevent similar adverse events from occurring. During the first 3 quarters of last year, TJC reviewed 14 transfusion-related sentinel events taking the total to 92 investigated “hemolytic transfusion reactions involving administration of blood or blood products having major blood group incompatibilities” since 2004. What lessons are these events teaching us? Continue reading
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Last’s week’s Journal of the American Medical Association included a clinical crossroads case study on autologous predonation (1). The scenario was a relatively healthy, non-anemic woman (“Mrs. C”) who was scheduled for elective knee replacement surgery and was asking for advice on blood avoidance options. Her specific concerns were voiced as: “Personally, I do not want anyone else’s blood. I believe I should give my own blood for safety reasons. I read the paper a lot and watch the news, and you hear so much about infectious diseases. That’s my concern; I have never had an infectious disease in my life and at this age, I don’t think I want to get one.”(1) From her standpoint, she logically inquired about options such as predonating her own blood prior to surgery or using a directed donor. Continue reading
Iron deficiency is common – very common. Estimates of the prevalence of iron deficiency in the U.S. vary depending on the age of the population studied and co-morbidities. In the National Health and Nutrition Examination Survey (NHANES III) iron deficiency was present in 1-2% of adults (1). Continue reading
by Dr. Carolyn Burns, Medical Director, Transfusion Services, Strategic Healthcare Group LLC
The July supplement to Transfusion, the Journal of Blood Services Management, contains an excellent and quite provocative article surrounding the knowledge of the Food and Drug Administration (FDA) reportable deviations. [1]
For those outside the highly regulated world of the blood donor center or hospital transfusion service, the FDA biologic product deviations (BPDs) are likely unfamiliar. Continue reading
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In honor of National Nurses Week Strategic Healthcare Group would like to recognize nursing’s vital role in blood management and transfusion safety. Continue reading
