Contractualisation interne : expérience du service de transfusion et d’immunologie de Rabat

The management by objectives method has become highly used in health management. In this context, the blood transfusion and haemovigilance service has been chosen for a pilot study by the Head Department of the Ibn Sina Hospital in Rabat. This study was conducted from 2009 to 2011, in four steps. The first one consisted in preparing human resources (information and training), identifying the strengths and weaknesses of the service and the identification and classification of the service's users. The second step was the elaboration of the terms of the contract, which helped to determine two main strategic objectives: to strengthen the activities of the service and move towards the “status of reference.” Each strategic objective had been declined in operational objectives, then in actions and the means required for the implementation of each action. The third step was the implementation of each action (service, head department) so as to comply with the terms of the contract as well as to meet the deadlines. Based on assessment committees, the last step consisted in the evaluation process. This evaluation was performed using monitoring indicators and showed that management by objectives enabled the Service to reach the “clinical governance level”, to optimize its human and financial resources and to reach the level of “national laboratory of reference in histocompatibility”. The scope of this paper is to describe the four steps of this pilot study and to explain the usefulness of the management by objectives method in health management.     

住院患者血乳酸和血氨的检测流程优化及质量提升

目的探讨同济大学附属同济医院住院患者乳酸和血氨项目检测结果阳性率高的原因,并制定改进措施,提高乳酸和血氨检测的准确性。方法以乳酸>2.2 mmol/L或血氨>30μmol/L为阳性,分别统计同济大学附属同济医院2019年1—6月门诊、急诊、住院和住院急诊患者样本乳酸及血氨项目的总检测数、检测结果阳性率以及检验流程各节点的耗时。随机收集40份临床样本,分别在样本采集后的15、30、45、60、90、120、180 min检测乳酸和血氨,以15 min检测结果为基准值,分别计算后续时间点检测结果与基准值之间的偏差。制定改进措施并实施后,分别统计乳酸和血氨项目检测结果的阳性率及检测流程各节点耗时的变化。结果2019年1—6月,门诊、急诊、住院急诊和住院患者样本乳酸项目检测结果的阳性率分别为36.87%、50.73%、58.28%、84.44%,血氨项目的阳性率分别为14.68%、13.48%、34.04%、72.67%。门诊、急诊、住院和住院急诊样本从样本采集到上机检测的中位时间分别为35、32、130和83 min。40份临床样本乳酸和血氨项目各时间点检测结果与基准值之间的偏差随时间的延长逐渐增大。检验流程改进后,住院患者样本乳酸和血氨项目检测结果的阳性率分别下降至32.59%、22.65%,住院患者样本从样本采集到上机检测的耗时缩短至43 min。结论改进检验前流程有效缩短了住院患者样本从样本采集到上机检测的耗时,降低了乳酸和血氨项目检测结果的阳性率,提高了准确性。     

潍坊地区无偿献血者HLA抗体和HNA抗体检测情况分析

目的:通过随机抽样检测潍坊地区无偿献血者血清HLA抗体及HNA抗体阳性率,评估在潍坊献血人群中开展HLA及HNA抗体筛查的必要性。方法:随机选取有输血、妊娠、移植等免疫史的无偿献血者208例作为实验组,选取无上述免疫史的无偿献血者168例作为对照组,运用流式荧光微珠法对两组标本进行HLA抗体和HNA抗体检测,运用统计分析方法比较两组献血者HLA抗体和HNA抗体的阳性率。结果:实验组208例献血者中HLA抗体阳性47例(22.60%),HNA抗体阳性4例(1.92%)。对照组168例献血者中HLA抗体阳性1例(0.60%),HNA抗体阳性2例(1.19%)。两组比较HLA抗体阳性率实验组明显高于对照组(P<0.05);HNA抗体阳性率无显著性差异(P>0.05)。结论:有输血、妊娠、移植等免疫史的献血者HLA抗体阳性率高于无相关免疫史的献血者,其所捐献的血液成分有诱导免疫性TRALI发生的高风险。对此类献血者开展HLA抗体筛查,对筛查阳性的相关血液产品进行必要的处理,有利于提高临床输血安全。应增加检测例数进一步了解潍坊地区无偿献血人群HNA抗体携带情况。     

妊娠期高血压疾病患者血清LXRα、SREBP-1c的表达和意义

目的探讨妊娠期高血压疾病患者血清肝X受体α(LXRα)、胆固醇调节元件结合蛋白-1c(SREBP-1c)的表达水平和意义。方法选择2017年2月至2019年8月收治的80例妊娠期高血压疾病患者纳入研究,包括妊娠期高血压组31例、轻度子痫前期组25例、重度子痫前期24例,并选择同期接受产检的60例正常妊娠孕妇作为对照组。比较4组研究对象一般资料、血脂水平、血清LXRα、SREBP-1c蛋白的表达水平。结果 4组研究对象年龄、采血孕周、孕前体质指数(BMI)比较差异无统计学意义(P>0.05)。随着疾病严重程度的增加,患者收缩压(SBP)、舒张压(DBP)、24 h尿蛋白含量、TC、TG、LDL-C水平逐渐升高,HDL-C水平逐渐降低(P<0.01),血清LXRα、SREBP-1c的水平也逐渐升高(P<0.01),组间两两比较差异有统计学意义(P<0.05)。Pearson相关性分析显示,血清LXRα、SREBP-1c与TC、TG、LDL-C均呈正相关关系,与HDL-C呈负相关关系(P<0.01),且血清LXRα和SREBP-1c之间呈正相关关系(r=0.576,P<0.05)。结论 LXRα、SREBP-1c在妊娠期高血压疾病患者中呈明显高表达,且和疾病严重程度密切相关,两者可能是通过调控脂质代谢等途径,参与疾病的发生和发展。     

产后甲状腺危象：一例病例报告并文献回顾

危重孕产妇的救治一直是WHO关注的焦点。甲状腺危象为甲状腺功能亢进的严重并发症,治疗延迟或治疗不当可能会产生严重致命后果。产后甲状腺危象是围生期罕见并发症。本文报告1例成功救治的产后甲状腺危象,并期望通过文献复习,对围生期甲状腺危象早期实施血液净化治疗的有效性、局限性进行系统分析,为有效治疗该并发症提供临床参考。     

Sero-prevalence of SARS-CoV-2 antibodies in blood donors during the third wave of infection in Norway,winter/spring 2021

Cross-sectional studies of the prevalence of anti-SARS-CoV-2 in representative groups are routinely used for surveillance of public health in Norway. The group of blood donors is easily accessible to provide an estimate over the infection prevalence. Repeated testing of returning donors also generates data about the duration of the antibody response following infection and vaccination.The aim of the current study was to provide updated information about the development of the pandemic in the blood donor population, and to estimate the number of asymptomatic donors visiting the blood center, in an effort to evaluate the measures to prevent virus spreading between donors and staff.In the two main blood banks in the Oslo area, all blood donors were offered antibody testing for a period of three months. Almost 12,000 donors were tested, and the mean weekly prevalence of antibody positive donors due to infection was 2.7 % (varied from 2.1 to 4.0 %). The number of donors presenting following vaccination was 810 (6.9 %). An average of 38 % of the infections had been asymptomatic, and 31 % of the antibody-positive donors were unaware of having been infected.In conclusion, the proportion of blood donors seropositive for anti-SARS-CoV-2 in our blood centers was stable whereas the number of vaccinated blood donors rapidly increased. This indicates that the virus spreading in the third wave of infection in the Oslo area mainly happened in groups underrepresented as blood donors. Health care workers prioritized for early vaccination may be overrepresented in the study period.     

Characteristics and causes of pre-donation deferrals at a Chinese blood center

ObjectivesThe purpose of this retrospective analysis was to understand the causes and characteristics of the pre-donation deferral, so as to enhance blood safety and improve donor satisfaction.BackgroundBlood transfusion is crucial in managing a variety of different medical and surgical needs. Its benefits are manifold but there are risks for the recipients. Thus some blood donors are deferred from donating when they do not meet certain criteria. An in-depth understanding of the underlying causes of donor deferral will not only improve donor selection but also ensure blood safety and avoid donor complaints.Materials and methodsThis single-center experience was carried out from 26th July 2018 to 25th July 2019 on all whole blood donors in Tianjin, China. Donors’ demographics and information were retrieved; comparisons between deferral data were summarized by the Chi-square test using Statistical Product and Service Solutions (SPSS) application version 22. The difference between groups were considered statistically significant when p < 0.05.ResultsA total of 190,846 participants were included; whereby 119,951 (62.85 %) of participants were first-time blood donors. The pre-donation deferral rate was 9.26 %, and deferral was more likely seen in first-time donors, male donors, and donors of age above 35 years (p < 0.05). Overall, raised alanine aminotransferase (ALT) contributed to 48.46 % of all temporary deferrals, followed by lipaemia (20.71 %). For female donors, low hemoglobin was the leading cause of temporary deferral. Positive hepatitis B surface antigen (Hepatitis B) and syphilis were the two common causes of permanent deferrals, with incidence at 11.65 % and 3.93 %, respectively.ConclusionPre-donation deferral remains a significant problem in China and accounted for 9.26 % of participants in this study. Raised ALT and lipaemia were common temporary deferrals, especially among first-time donors, males, and older donors. Appropriate interventions should be taken to address the blood quality, improve the donor retention strategies in order to secure an adequate and safe blood supply.     

COVID-19 related callback in blood donors; Outcomes in blood donors and patients

Call back as a procedure to report post donation symptoms or illness by donors has been established since 2009 in Iranian Blood Transfusion Organization (IBTO). During the first phase of COVID-19 outbreak, all blood donors were requested to report any respiratory infection symptoms after donation. The study investigated the callback data of COVID-19 in Tehran Blood Center during the first 3 months of the outbreak in Iran. The purpose of this study was to estimate the frequency of post donation COVID-19 related call back reports and determine its implications for blood donors and patients.A telephone interview was conducted with donors who had reported COVID-19 symptoms. Some questions were asked to evaluate donor′s health at the time of blood donation. The donors categorized into three groups: laboratory-confirmed, suspected, and COVID-19 irrelevant based on their answers. In cases that the blood component obtained from a laboratory-confirmed donor had been released, the hospital was notified and asked to follow up the recipient for COVID-19.The results showed 30 donors (0.08 %) had callback related to COVID-19 and 76.63 % of the obtained component was disposed. The results also showed that only one donor had a laboratory-confirmed result with the RBC unit processed from her whole blood released for transfusion. The RBC unit recipient did not show any signs or symptoms of infection during a 46-day follow-up.Concluded that callback system was effective to remove most of the components obtained from the donors who reported to be COVID-19 suspected or confirmed. Moreover, the result did not support virus transmission through blood transfusion.     

Role of anti-allergic agents on attenuating transfusion reactions in adults: A systematic review and meta-analysis

BackgroundAnti-allergic agents (e.g. dexamethasone, chlorpheniramine or promethazine) are commonly administered to patients prior to blood product transfusions. However, the use of these agents is largely experience-based instead of evidence-based. This meta-analysis aimed to explore the evidence behind using anti-allergic agents to attenuate transfusion reactions.Materials and MethodsThe Pubmed, EMBASE, Cochrane Library, Wanfang, Chinese National Knowledge Infrastructure (CNKI), and Chinese Biomedical literature (CMB) databases were all queried for related articles. Data from groups treated with and without anti-allergic agents were collected for meta-analysis using RevMan 5.3. Baseline characteristics and univariate statistics between groups were compared using SPSS 19.0.ResultsEight eligible articles (six case control studies and two randomized controlled trials, all with high risks of bias) were identified (22060 total cases). Administered anti-allergic agents in these studies only included dexamethasone, chlorpheniramine or promethazine. Baseline characteristics showed no significant age or gender differences between treatment or control groups. There were no significant differences between the pooled experimental or control groups (for each of the three medications) in terms of fever, pruritis, rash, airway spasm or overall transfusion reaction rates.ConclusionThere is no evidence that dexamethasone, chlorpheniramine or promethazine can prevent transfusion reactions. Avoiding the arbitrary use of such anti-allergic agents before blood transfusions may potentially avoid needless adverse drug reactions.