Transfusion medicine: looking to the future
The evolution of transfusion medicine into a clinically oriented discipline emphasising patient care has been accompanied by challenges that need to be faced as specialists look to the future. Emerging issues that affect blood safety and blood supply, such as pathogen inactivation and more stringent donor screening questions, bring new pressures on the availability of an affordable blood supply. Imminent alternatives for management of anaemia, such as oxygen carriers, hold great promise but, if available, will require close oversight. With current estimates of HIV or hepatitis C viral (HCV) transmission approaching one in 2 000 000 units transfused, keeping to a minimum bacterial contamination of platelet products (one in 2000) and errors in transfusion, with its estimated one in 800 000 mortality rate, assume great urgency. Finally, serious difficulties in blood safety and availability for poor, developing countries require innovative strategies and commitment of resources.
Identification and classification of the causes of events in transfusion medicine
BACKGROUND: Transfusion medicine lacks a standard method for the systematic collection and analysis of event reports. Review of event reports from the Food and Drug Administration (FDA) showed a relative paucity of information on event causation. Thus, a causal analysis method was developed as part of a prototype Medical Event Reporting System for Transfusion Medicine (MERS-TM).
STUDY DESIGN AND METHODS: MERS-TM functions within existing quality assurance systems and utilizes descriptive coding and causal classification schemes. The descriptive classification system, based upon current FDA coding, was modified to meet participant needs. The Eindhoven Classification Model (Medical Version) was adopted for causal classification and analysis. Inter-rater reliability for the MERS-TM and among participating organizations was performed with the development group in the United States and with a safety science research group in the Netherlands. The MERS-TM was then tested with events reported by participants.
RESULTS: Data from 503 event reports from two blood centers and two transfusion services are discussed. The data showed multiple causes for events and more latent causes than previously recognized. The distribution of causes was remarkably similar to that in an industrial setting outside of medicine that uses the same classification approach. There was a high degree of inter-rater reliability when the same events were analyzed by quality assurance personnel in different participating organizations. These personnel found the method practical and useful for providing new insights into conditions producing undesired events.
CONCLUSION: A generally applicable and reliable method for identifying and quantifying problems that exist throughout transfusion medicine will be a valuable addition to event reporting activity. By using a common taxonomy, participants can compare their experience with that of others. If proven as readily implementable and useful as shown in initial studies, MERS-TM is a potential standard for transfusion medicine.
Creutzfeldt–Jakob disease and blood transfusion: results of the UK Transfusion Medicine Epidemiological Review study
Background and Objectives This paper reports the results to 1 March 2006 of an ongoing UK study, the Transfusion Medicine Epidemiological Review (TMER), by the National CJD Surveillance Unit (NCJDSU) and the UK Blood Services (UKBS) to determine whether there is any evidence that Creutzfeldt–Jakob disease (CJD), including sporadic CJD (sCJD), familial CJD (fCJD), and variant CJD (vCJD) is transmissible via blood transfusion.
Materials and Methods Sporadic CJD and fCJD cases with a history of blood donation or transfusion are notified to UKBS. All vCJD cases aged > 17 years are notified to UKBS on diagnosis. A search for donation records is instigated and the fate of all donations is identified by lookback. For cases with a history of blood transfusion, hospital and UKBS records are searched to identify blood donors. Details of identified recipients and donors are checked against the NCJDSU register to establish if there are any matches.
Results CJD cases with donation history: 18/31 vCJD, 3/93 sCJD, and 3/5 fCJD cases reported as blood donors were confirmed to have donated labile components transfused to 66, 20, and 11 recipients respectively. Two vCJD recipients have appeared on the NCJDSU register as confirmed and probable vCJD cases. The latter developed symptoms of vCJD 6.5 years and 7.8 years respectively after receiving non-leucodepleted red blood cells (RBCs) from two different donors who developed clinical symptoms approximately 40 and 21 months after donating. A third recipient, given RBC donated by a further vCJD case approximately 18 months before onset of clinical symptoms, had abnormal prion protein in lymphoid tissue at post-mortem (5-years post-transfusion) but had no clinical symptoms of vCJD. CJD cases with history of transfusion: Hospital records for 7/11 vCJD and 7/52 sCJD cases included a history of transfusion of labile blood components donated by 125 and 24 donors respectively. Two recipients who developed vCJD were linked to donors who had already appeared on the NCJDSU register as vCJD cases (see above). No further links were established.
Conclusion This study has identified three instances of probable transfusion transmission of vCJD infection, including two confirmed clinical cases and one pre- or sub-clinical infection. This study has not provided evidence, to date, of transmission of sCJD or fCJD by blood transfusion, but data on these forms of diseases are limited.
Evaluation of ‘Wastage Rate’ of Blood and Components – An Important Quality Indicator in Blood Banks
Aims: To evaluate the wastage rate of blood and components in a newly established blood bank of a teaching hospital in West Bengal.
Study Design: Retrospective study.
Place and Duration of Study: Department of Transfusion Medicine, IQ City Medical College and Narayana Multispeciality Hospital, Durgapur between April 2014 and October 2014.
Methodology: The study recorded the discarding of whole blood and component units due to various reasons viz. over-collection and under-collection of blood from donors; RBC contamination of plasma and platelets; blood bag leakages; presence of hemolysis, clots, lipemic appearance, greenish and yellowish (icterus) discoloration; expiry date and seroreactivity for infectious diseases. The wastage rate was calculated thereafter using appropriate formula.
Results: Out of total 1241 blood bags which were collected from donors during the study period, 1176 units were separated into components and rest 65 units were kept as whole blood units. Total 93 (7.49%) blood bags were discarded, of which 27 (2.18%) were whole blood bags and 66 were components. The total number of whole blood units issued during this period was 38 and components issued during this period were 693.
Therefore, the wastage rate of whole blood units and components can be calculated as:
Wastage rate of whole blood = 27/38 x100 = 71%
Wastage rate of components = 66/693 x100 = 9.52%
Conclusion: The rate of discarded blood components or “wastage rate” is one of those indicators and has been listed third among the ten quality indicators recommended by National Accreditation Board for Hospitals and Health Care providers. It is important to monitor this parameter for judicious management of blood bank inventory.
Use of Staphylococcal Protein-A and Streptococcal Protein-G for Detection of Red Blood Cells (RBC) Antibodies and Comparison with Other Techniques
Background: Detection of red blood cells antibodies is important for the diagnosis of autoimmune hemolytic anemia, hemolytic disease of newborn, pre-transfusion testing and other problems. The aim of this study was to use Staphylococcal protein A (SpA) and Streptococcal protein G (SpG) as reagents in immunological tests for detecting red blood cells (RBC) antibodies and to compare the method with other techniques.
Study Design & Methods: Sera from 60 patients, comprising forty-four anti-D positive sera from pregnant women and 16 from healthy controls were, used for the study. The anti-globulin gel test and the standard Coombs’ test were used to determine RBC antibodies in these sera and the result were compared with that of protein A and protein G tests.
Results: With various degree of agglutination all 4 techniques detected the presence of RBC antibodies (anti-D) in the sera from 44 pregnant women, and tested negative for the remaining 16 sera (from healthy controls). The sensitivity and the specificity of the 4 techniques was 100%.
Conclusions: This preliminary study demonstrates that both SpA and SpG tests can be used for the detection of RBC antibodies and therefore requires more study and testing before they can become useful standard tests in transfusion medicine.
 Goodnough, L.T., Shander, A. and Brecher, M.E., 2003. Transfusion medicine: looking to the future. The Lancet, 361(9352), pp.161-169.
 Kaplan, H., Battles, J.B., Van der Schaaf, T.W., Shea, C.E. and Mercer, S.Q., 1998. Identification and classification of the causes of events in transfusion medicine. Transfusion, 38(11‐12), pp.1071-1081.
 Hewitt, P.E., Llewelyn, C.A., Mackenzie, J. and Will, R.G., 2006. Creutzfeldt–Jakob disease and blood transfusion: results of the UK Transfusion Medicine Epidemiological Review study. Vox sanguinis, 91(3), pp.221-230.
 Roy, A.D. and Pal, A., 2015. Evaluation of ‘Wastage Rate’of Blood and Components–An Important Quality Indicator in Blood Banks. Journal of Advances in Medicine and Medical Research, pp.348-352.
 Vaillant, A.A.J., Akpaka, P.E., McFarlane-Anderson, N. and Smikle, M.P., 2013. Use of Staphylococcal Protein-A and Streptococcal Protein-G for Detection of Red Blood Cells (RBC) Antibodies and Comparison with Other Techniques. Journal of Advances in Medicine and Medical Research, pp.1671-1677.