Purpose: The Health Insurance Review and Assessment Service (HIRA) in South Korea initiated a quality assessment (QA) program for blood transfusion healthcare services in 2020 to ensure patient safety and appropriate blood use. This study examines the quality of blood transfusion services since the first national QA program for blood transfusion services in Korea. Methods: We analyzed HIRA claims and QA investigation data based on inpatient medical records from all tertiary, general, and primary hospitals between October 2020 and March 2021. The target population was patients aged 18 years and older who received either total knee arthroplasty or red blood cell transfusion. The QA indicators for transfusion healthcare service consisted of four quality indicators and four monitoring indicators. Results: We analyzed the results of QA indicators for transfusion service from the medical records of 189,668 patients from 1,171hospitals and expressed indicators as proportions. The average results for evaluation indicators were as follows: transfusion checklist presence, 64.8%; irregular antibody tests, 61.8%; transfusions in which the hemoglobin levels before transfusion met the transfusion guidelines for patients undergoing total knee arthroplasty, 20.6%, and transfusions in patients undergoing total knee arthroplasty, 59.3%. The average results for monitoring indicators were as follows: transfusion management implementation in medical institutions, 56.9%; preoperative anemia management in anemia patients undergoing total knee arthroplasty, 43.9%; one-unit transfusions, 82.5%; and the transfusion index. Conclusion: The quality of blood transfusion healthcare varied and the assessment revealed that there is scope for improvement. Hospitals require more effective blood transfusion management and this can be facilitated by providing feedback on the QA results about blood transfusion healthcare services to medical institutions, and by disclosing the results to the public.
Lee, Eui Young;Kim, Sung Shin;Park, Ga Young;Lee, Sun Hyang
Clinical and Experimental Pediatrics
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제63권2호
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pp.56-62
/
2020
Background: Red blood cell (RBC) transfusion improves cardiorespiratory status of preterm infants by increasing circulating hemoglobin, improving tissue oxygenation, and reducing cardiac output. However, RBC transfusion itself has also been suggested to negatively affect short-term outcomes such as intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and necrotizing enterocolitis (NEC) in premature infants. Purpose: This study aimed to analyze the relationship between RBC transfusion and short-term outcomes in very low birth weight (VLBW) infants (birth weight, <1,500 g). Methods: We retrospectively reviewed the medical records of VLBW infants admitted to the Soonchunhyang University Bucheon Hospital between October 2010 and December 2017. Infants who died during hospitalization were excluded. The infants were divided into 2 groups according to RBC transfusion status. We investigated the relationship between RBC transfusion and short-term outcomes including BPD, ROP, NEC, and IVH. Results: Of the 250 enrolled VLBW infants, 109 (43.6%) underwent transfusion. Univariate analysis revealed that all short-term outcomes except early-onset sepsis and patent ductus arteriosus were associated with RBC transfusion. In multivariate analysis adjusted for gestational age, birth weight and Apgar score at 1 minute, RBC transfusion was significantly correlated with BPD (odds ratio [OR], 5.42; P<0.001) and NEC (OR, 3.40; P= 0.009). Conclusion: RBC transfusion is significantly associated with adverse clinical outcomes such as NEC and BPD in VLBW infants. Careful consideration of the patient's clinical condition and appropriate guidelines is required before administration of RBC transfusions.
Autologous blood transfusion is a common method of reducing the need for homologous blood transfusion during cardiac operations. Between June 1991 and May 1992, 12 cases [Group I] were experienced autologous blood transfusion using Cell Saver undergoing double valve replacement or redo-valve replacement. Control group [N=12, Group II] was selected to above similar operation during same period. The Cell Saver system [Haemonetics Corp.] was employed for autologous blood transfusion. The blood shed in the operative field before and after cardiopulmonary bypass and remained cardiotomy reservior was aspirated by means of a locally heparinized collecting system. After centrifused salvaged blood, the resulting red cell concentrate reinfused subsequently. The patient receiving autologous blood transfusion required significantly less homologous blood transfusion than their control group. [Group I; 3519 $\pm$ 869, Group II; 4622 $\pm$ 856, Respectively; P=0.005] There were no clinical infections in the autotransfusion group. And there was no apparent intergroup difference of the clinical findings, hematologio datas and coagulation parameters. We conclude the autotransfusion using Cell Saver is effective for reducing of the hom-ologlous blood transfusion in cardiac surgery.
Goksu, Sema Sezgin;Gunduz, Seyda;Unal, Dilek;Uysal, Mukremin;Arslan, Deniz;Tatli, Ali Murat;Bozcuk, Hakan;Ozdogan, Mustafa;Coskun, Hasan Senol
Asian Pacific Journal of Cancer Prevention
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제15권10호
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pp.4251-4254
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2014
Background: Treatment of anemia is an important issue in the palliative care setting. Blood transfusion is generally used for this purpose in supportive care. However the place of blood transfusion in terminally ill cancer cases is less far established. Objective: We aimed to outline the use of transfusions and to find the impact of blood transfusion on survival in patients with advanced cancer and very near to death. Design: Patients dying in 2010-2011 with advanced cancer were included in the study. We retrospectively collected the data including age, type of cancer, the duration of last hospitalisation, ECOG performance status, Hb levels, transfusion history of erythrocytes and platelets, cause and the amount of transfusion. The anaemic patients who had transfusion at admission were compared with the group who were not transfused. Survival was defined as the time between the admission of last hospitalisation period and death. Results: Three hundred and ninety eight people with solid tumours died in 2010-2011 in our clinic. Ninety percent of the patients had anemia at the time of last hospitalisation. One hundred fifty three patients had erythrocyte transfusion at admission during the last hospitalisation period (38.4%). In the anaemic population the duration of last hospitalisation was longer in patients who had erythrocyte transfusion (15 days vs 8 days, p<0.001). Conclusions: Patients who had blood transfusion at the end of life lived significantly longer than the anaemic patients who were not transfused. This study remarks that blood transfusions should not be withheld from terminal cancer patients in palliative care.
Objective: To explore the influence of different ways of blood transfusion on the expression levels of interleukins (IL) and tumor necrosis factor-${\alpha}$ (TNF-${\alpha}$) inperi-operative patients with esophageal cancer. Materials and Methods: A total of 80 patients with esophageal cancer who underwent radical operations were selected as study patients and randomly divided into an observation group (treated with autologous blood transfusion) and control group (with homologous blood transfusion). Changes of intra-operative indexes and peri-operative blood indexes, from hemoglobin (Hb) and hematocrit value (Hct), to levels of inflammatory factors like interleukins-6 (IL-6), IL-8, IL-10 and tumor necrosis factor-${\alpha}$ (TNF-${\alpha}$) were compared. Results: Operations for patients in both groups were successfully conducted, and no significant differences in mean surgical duration and intra-operative hemorrhage volume, fluid infusion volume and blood transfusion volume were detected (p>0.05). Compared with values before surgery, Hb and Hct levels decreased significantly while white blood cell count (WBC) increased 1, 5 and 7 d after operation (p<0.05, p<0.01). In addition, WBC was apparently higher in observation group than in control group 5 and 7 d after operation (p<0.01). Compared with before surgery, in the observation group, levels of IL-6, IL-8 and IL-10 had no significant differences after operation (P>0.05), but TNF-${\alpha}$ level increased y (p<0.01), whereas in control group, IL-6 level had no significant difference (p>0.05), IL-8 level decreased obviously (p<0.05), IL-10 level increased markedly first and then decreased gradually as time passed but its level remained elevated (p<0.01), and TNF-${\alpha}$ level increased first and then decreased, and there was no significant difference 7 d after operation (p>0.05). Conclusions: Decreased IL-8 and increased IL-10 levels are two important reasons for immunosuppression after homologous blood transfusion, whereas autologous blood transfusion can alleviate this while increasing the TNF-${\alpha}$ level, which also has potential to improve anti-tumor immunity in the human body.
Purpose: Using a propensity analysis, a recent study reported that blood transfusion might not be an independent predictor of mortality in critically ill patients, which contradicted the results of earlier studies. This study aims to reveal whether or not blood transfusion is an independent predictor of mortality in trauma patients. Methods: A total of three hundred fifty consecutive trauma patients who were admitted to our emergency center from January 2004 to October 2005 and who underwent an arterial blood gas analysis and a venous blood analysis were included in this study. Their medical records were collected prospectively and retrospectively. Using a multivariate logistic analysis, data on the total population and on the propensity-score -matched population were retrospectively analyzed for association with mortality. Results: Of the three hundred fifty patients, one hundred twenty-nine (36.9%) received a blood transfusion. These patients were older (mean age: 48 vs. 44 years; p=0.019) and had a higher mortality rate (27.9% vs. 7.7%; p<0.001). In the total population, the multivariate analysis revealed that the Glasgow coma scale score, the systolic blood pressure, bicarbonate, the need for respiratory support, past medical history of heart disease, the amount of blood transfusion for 24 hours, and hemoglobin were associated with mortality. In thirty-seven pairs of patients matched with a propensity score, potassium, new injury severity score, amount of blood transfusion for 24 hours, and pulse rate were associated with mortality in the multivariate analysis. Therefore, blood transfusion was a significant independent predictor of mortality in trauma patients. Conclusion: Blood transfusion was revealed to be a significant independent predictor of mortality in the total population of trauma patients and in the propensity-score-matched population.
헌혈을 중심으로 하는 혈액 관리보다 혈액의 사용을 적절히 관리하는 것이 중요하다. 수혈용 혈액 현황의 관리, 수혈의 적정성에 대한 평가, 수혈 관련 부작용의 발생 감시 및 대응, 그 밖에 수혈관리에 필요한 업무를 수행하는 수혈관리실의 역할을 통해 개선효과를 살펴보았다. 수혈관리실의 개설·운영을 통해 수혈적정성 평가 업무를 효율적으로 관리할 수 있지만 혈액의 적정성 평가에 시간이 소요되고 수혈관리실 전담인력이 모든 혈액의 적정성을 평가하기에는 어려운 단점도 있다. 앞으로 한국형 환자 혈액관리(patient blood management, PBM)를 도입해 의료기관 내 안전하고 적정한 수혈관리 구현을 위한 수혈관리실과 수혈관리위원회를 정착시키고, 인력을 교육해야 하는 의료기관의 참여가 필수적이다.
Background: In this study, we examined the impact of a patient blood management (PBM) program on red blood cell (RBC) transfusion practices in cardiothoracic surgery. Methods: The PBM program had 3 components: monitoring transfusions through an order communication system checklist, educating the medical team about PBM, and providing feedback to ordering physicians on the appropriateness of transfusion. The retrospective analysis examined changes in the hemoglobin levels triggering transfusion and the proportions of appropriate RBC transfusions before, during, and after PBM implementation. Further analysis was focused on patients undergoing cardiac surgery, with outcomes including 30-day mortality, durations of intensive care unit and hospital stays, and rates of pneumonia, sepsis, and wound complications. Results: The study included 2,802 patients admitted for cardiothoracic surgery. After the implementation of PBM, a significant decrease was observed in the hemoglobin threshold for RBC transfusion. This threshold dropped from 8.7 g/dL before PBM to 8.3 g/dL during the PBM education phase and 8.0 g/dL during the PBM feedback period. Additionally, the proportion of appropriate RBC transfusions increased markedly, from 23.9% before PBM to 34.9% and 58.2% during the education and feedback phases, respectively. Among the 381 patients who underwent cardiac surgery, a significant reduction was noted in the length of hospitalization over time (p<0.001). However, other clinical outcomes displayed no significant differences. Conclusion: PBM implementation effectively reduced the hemoglobin threshold for RBC transfusion and increased the rate of appropriate transfusion in cardiothoracic surgery. Although transfusion practices improved, clinical outcomes were comparable to those observed before PBM implementation.
Appreciation of the large volume deficits which may occur in surgical or trauma patients due to blood loss has led to vigorous transfusion techniques designed to overt hypovolemic shock and ischemic damage to vital organs which may develop in minutes during the hypovolemic state. In a significant proportion of patients treated with massive rapid blood or fluid transfusion, hypervolemia occurs and life threatening pulmonary edema may develop. Especially, hypervolemia may occur during transfusion for preventing development of the so-called low output syndrome following cardiac surgery. However, the most effective indicator which reveals the adequate level of transfusion is not settled yet. The present study was aimed to compare the effectiveness of the indicators suggested thus far and to determine the most sensitive one. Eight dogs were experimentally studied in terms of left atrial pressure, pulmonary arterial systolic pressure, central venous pressure, mean systemic arterial pressure and heart rate before and after induced hypervolemia with infusion of 600ml heparinized homologous blood. Immediately after induced overtransfusion of the blood, pulmonary arterial systolic pressure increased 75.0%, in omparison with the control before transfusion, left atrial pressure 58.8%, central venous pressure 44.6%, and mean systemic arterial pressure 10.1%, one hour after transfusion, pulmonary arterial systolic pressure 40.0%, left atrial pressure 21.2%, central venous pressure 14.5%, and mean systemic arterial pressure 3.2%, central venous pressure 14.5%, and mean systemic arterial pressure 3.2%, respectively. Heart rate showed no significant change throughout the experiment. These result suggested that the changes of the pulmonary arterial systolic pressure is the most sensitive indicator for detection of hypervolemia during blood transfusion.
Purpose: The purposes of this study are finding the elements for a fast determination of the need for a transfusion to a multiple trauma patient arriving at this clinic in the initial stage establishing objective bases for a doctor in an emergency department to determine the need for a transfusion immediately after a patient has arrived at the emergency department, and providing treatment by considering various factors based on the nine criteria suggested in the emergency room transfusion score (ETS). Methods: This study was conducted on 375 multiple-trauma patients who visited the Chosun University Hospital Emergency Medical Center and activated the Emergency Trauma Team from January 2010 to December 2013. The patients were divided into the transfused group and the non-transfused group by retrospectively analyzing their medical records. Subsequently, the medical records were examined using the nine items suggested by the ETS and the results were analyzed. Results: Three hundred seventy-five patients with multiple traumas visited the Chosun University Hospital Emergency Medical Center and activated the Emergency Trauma Team. Among them, 258 died and 117 recovered and left the hospital. The deceased patients consisted of 182 males and 76 females with an average age 45. Of the 375, 165 were transferred from other hospitals, and 245 were blunt trauma patients. One hundred sixty-nine patients were injured in traffic accidents, and 119 of those 169 who had systolic blood pressure less than 90 mm Hg died. Two hundred twenty-six (60.3%) out of the 375 patients with multiple traumas received an emergency blood transfusion and their average age was 48. The 375 patients consisted of 156 males, 151 who had been transferred from other hospitals, 218 who presented with blunt trauma, 134 who had been injured in traffic accidents, 156 who had a systolic blood pressure less than 90 mm Hg, 134 who scored higher than 9 points on the GCS, and 162 who had a stable pelvic fracture of these 143 died. Conclusion: During this study, 226 (60.3%) out of the patients with multiple traumas received an emergency blood transfusion. After analyzing the results related to emergency blood transfusion by using ETS, we found that an emergency blood transfusion had to be prepared quickly when patients were transferred from other hospitals when the systolic blood pressure was less than 90 mmHg. when abnormalities had been detected by ultrasonography and when the patient presented with a stable pelvic fracture.
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