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At least 19 recordsLinked to original sources
PubMed2004

Does a perception of increased blood safety mean increased blood transfusion? An assessment of the risk compensation theory in Canada.

BACKGROUND: The risk compensation theory is a widely used concept in transport economics to analyze driver risk behaviour. This article explores the feasibility of applying the theory in blood transfusion to raise important questions regarding the increased blood safety measures and their possible effects on blood usage (e.g., the appropriateness in transfusion). Further, it presents the findings of a pilot survey of physicians in Canada. DISCUSSION: While studies have attempted to define transfusion appropriateness, this article argues that if the risk compensation theory holds true for transfusion practice, physicians may actually be transfusing more. This may increase the possibility of contracting other unknown risks, such as the variant Creutzfeldt-Jakob Disease (vCJD), as well as increasing the risk of non-infectious transfusion risks, such as transfusion reactions. SUMMARY: A much larger study involving psychosocial assessment of physician decision making process to fully assess physician behaviour within the context of risk compensation theory and transfusion practice in Canada is needed to further explore this area.

Attitude of Health Personnel↗
PubMedDate not supplied

Blood safety.

Since blood is a biologic product, it is unlikely that the risk for transfusion-transmitted infection will ever be reduced to zero. The approach to emerging infections associated with transfusion of blood and blood products includes assessing the transmissibility of the agent by this route; developing effective prevention strategies, including screening tests and donor deferral policies; improving viral and bacterial inactivation procedures; and surveillance for known, as well as emerging and poorly characterized, transfusion-transmitted agents. Vigilance is needed to help ensure proper balance between safety and the availability of blood. Finally, vigilance needs to extend to the developing world, where the basic elements to reduce transfusion-transmitted infections and systems of disease surveillance are often not available.

Biological Products↗
PubMed2004

Challenges in global blood safety.

Availability of safe blood and blood products is a critical component in improving health care and in preventing the transmission of infections. Millions of lives are saved each year through blood transfusion. Yet the quality and safety of blood transfusion is of continuing concern, particularly in developing countries where 82% of the world's population lives. The burden of disease and loss of life resulting from unsafe blood transfusions is devastating for communities in developing countries. WHO has developed tools and mechanisms to assess the situation of blood transfusion services globally. This provides invaluable information on the current status of the global blood supply, identifying problems and prioritizing needs and is useful in monitoring progress and trends. The issues related to the blood safety are discussed and WHO's integrated strategy for blood safety is presented in this article.

Blood Banks↗
PubMed1999

Oversight and monitoring of blood safety in the United States.

The US blood safety vigilance system is composed of a network of interwoven programs, now organized under a formal structure, with the Assistant Secretary of Health and DHHS Blood Safety Committee bearing overall responsibility. It takes advantage of the breadth of expertise and close collaborative relationship of transfusion medicine and infectious disease scientists within and outside of the government. Core elements include an array of ongoing surveillance programs for monitoring established as well as new and emerging infectious agents that may pose a risk to blood safety, and the existence of historical and contemporary repositories of donor and recipient specimens that enable rapid investigation of putative new risks. This report summarizes the historical events that shaped the US blood safety oversight system, reviews the current organization and decision-making processes related to blood safety issues, and highlights key surveillance systems and research programs which monitor the US and global blood supplies for known and potential emerging risks.

Blood Banks↗
PubMed2005

Blood safety begins with safe donations: update among blood donors in Yaounde, Cameroon.

Blood safety continues to be an issue of concern in most countries of the African region. An important contributing factor to blood insecurity is the absence of regular, voluntary and nonremunerated blood donors. An update is provided on blood donors in Yaoundé, Cameroon. Raising the alarm through the dissemination of alarming statistics and continuous sensitization of the community remain strategies for attempting to provide a solution to a long-standing but dangerous problem.

Blood Banks↗
PubMed1989

Screening for hepatitis infectivity among blood donors. A model for blood safety?

The safety of blood and blood products is based on three interdependent activities: selection of safe donors, laboratory testing, and, where applicable, treatment of the product to reduce residual infectivity. Posttransfusion hepatitis has provided both the initial stimulus and the model for these procedures. The procedures have resulted in a progressive increase in the safety of the blood supply, which is continuing, as evidenced by a 50% decrease in the frequency of reported posttransfusion hepatitis over the past two years.

Blood Banks↗
PubMed2004

Comparative analysis of national regulations concerning blood safety across Europe.

In October 2001, representatives of 17 European countries (Albania, Bosnia-Herzegovina, Bulgaria, Croatia, Czech Republic, Federal Republic of Yugoslavia, Finland, France, Germany, Greece, Italy, Macedonia, Romania, Slovenia, Spain, Turkey and UK) met in Sarajevo at a course organized by the European School of Transfusion Medicine to discuss their countries' regulations concerning different aspects of the safety of blood transfusion. Results are summarized in tables to facilitate comparisons. Most countries (13/17) have specific transfusion laws and 9/17 have hospital-based systems as opposed to national organizations. Quality assurance is common among investigated countries (14/17). Voluntary associations are responsible for donor promotion in the majority of countries (13/17). Exclusively, voluntary non-remunerated donors are found in 5/17 countries, whereas in the remaining ones, incentives, family replacement and remuneration are mechanisms stimulating blood donation. Medical doctors using official selection criteria are checking donor suitability in virtually all countries, which also perform main microbiological testing. Regulations on good clinical use of blood and derivatives are present in most countries but applied only in some. Although the data presented need to be interpreted with some caution, this preliminary analysis shows that, although some significant differences still exist, the majority of countries studied are moving in the same direction to ensure safety of their blood supply.

Blood Banks↗
PubMed1998

Hepatitis B and blood safety.

The safety of blood and blood products is a global issue. Blood transfusion is an important part of modern medicine, but it is also an efficient route of transmission for a number of infectious agents. Although many countries screen all blood donations for a number of infectious agents, a significant proportion of the world's blood supply is either unscreened or poorly screened, with the resultant risk to recipients of transfusion transmitted infections (TTI). Hepatitis B virus (HBV) is of concern because it is transmitted parenterally, many HBV infections are asymptomatic (and infected individuals may thus unwittingly present as blood donors) and the virus is stable in blood and blood products over long periods. The transmission of HBV is minimized by the screening of donors prior to donation, exclusion of high-risk donors, followed by the in-vitro screening of donations for HBsAg (+anti-HBc in some countries) prior to transfusion. However, even in countries with good quality, active screening programmes, there is still a small residual risk of transmission of HBV from undetected donors with early acute infection, resolving infection, silent infection or infection with atypical virus serology. Unfortunately, as with so many infectious agents, the prevalence of HBV is most often higher in those countries with poorly developed healthcare systems and limited resources. In these countries, the safety of the blood supply is compromised frequently, either because of lack of resources with which to purchase screening assays, or because of acute blood shortages and insufficient time to screen blood prior to transfusion. In such situations it is important to encourage and actively support the introduction of appropriate screening programmes which can be based upon simple assay formats, such as agglutination, rather than the favoured but more complex enzyme immunoassays which are more expensive, require specific equipment and support, and take longer to perform. Such approaches will help reduce greatly the transfusion transmission of HBV.

Blood Banks↗
PubMed2000

Which agents threaten blood safety in the future?

The safety of the blood supply is critical to many parts of modern medicine. In a time when prescriber's and the public's expectations are increasing, it is essential that transfusion services globally ensure the safety of the blood supply. There are, however, many threats to this safety, one being the appearance of new infectious agents. Such agents may be truly 'novel', or may be existing agents, known but not routinely screened for, posing a new or increased threat. However, before an agent is considered to be a true threat to blood safety it must be well characterized, and evidence must be presented that (i) transfusion transmission is a significant route of spread, and (ii) the agent causes significant clinical disease. If either of these criteria are not met, the question has to be asked as to whether the agent is truly a threat to blood safety.

Blood Transfusion↗
PubMed2006

Prevalence of selected viral infections among blood donors deferred for potential risk to blood safety.

BACKGROUND: Health history questions identify blood donors believed to pose a higher risk of transmission of infectious diseases. This study assesses the current impact of some of these questions on blood safety as reflected by infectious disease markers. STUDY DESIGN AND METHODS: Donors who were deferred from donating blood due to health history question(s) were recruited at four different regions of the American Red Cross Blood Services. A blood sample was tested for serologic markers of blood-borne infections as performed for accepted blood donors. RESULTS: Of 497 deferred donors enrolled, 29 donors were deferred for having had "yellow jaundice, liver disease, or hepatitis since the age of 11" (Question 3), 1 of whom had hepatitis C virus antibodies (anti-HCV) and hepatitis B core antigen antibodies (anti-HBc), 2 had anti-HBc, and 1 had anti-HCV (p < 0.05 for both markers). Among 37 donors deferred for having "ever tested positive for hepatitis" (Question 4), 1 had hepatitis B surface antigen and anti-HBc and 3 had anti-HBc (p < 0.05 for both markers). Of 14 donors deferred for "having ever used a needle, even once, to take any illegal or nonprescription drug" (Question 12), 1 had anti-HCV, human T-lymphotropic virus-I antibodies and anti-HBc, 1 had anti-HCV and anti-HBc, and 2 had anti-HCV (p < 0.05 for all three markers). CONCLUSIONS: Blood donors deferred for standard blood donor questions regarding risk of viral hepatitis as well as those with a history of intravenous drug use were more likely to have higher hepatitis marker rates than those who were not deferred. No significant findings were identified for other markers or questions.

Antibodies, Viral↗
PubMed2004

Economic analyses of blood safety and transfusion medicine interventions: a systematic review.

Economic evaluations are increasingly common in blood safety and transfusion medicine. We sought to summarize and review economic evaluations of donated blood interventions conducted in the United States. By using computer database searches, we identified 19 studies that reported both cost and health benefit results, and relative to each other, we rated the quality of their design and reporting. We classified 6 of the studies as having high quality, 10 as having fair quality, and 3 as having poor quality. Several strengths and limitations in economic evaluations of blood safety and transfusion medicine interventions were identified. Four key improvements can increase the quality of literature in this discipline. We believe researchers should (1) provide more explicit detail on cost parameters in each study and the methods used to obtain them; (2) adopt a clear analysis perspective relevant to decision makers that captures all key costs and consequences, such as the societal perspective; (3) use a consistent approach to reporting sensitivity analyses; and (4) place greater reliance on graphical presentation of results including sensitivity analyses because a large amount of information can be conveyed in relatively simple figures, leaving space to discuss the impact of important analysis assumptions and applicability of the results to other settings.

Blood Donors↗
PubMed2004

Expensive blood safety technologies: understanding and managing cost and access-to-care issues.

With a succession of recent blood safety enhancements driving up blood component costs for their hospital customers, the blood banking industry has called for changes in Medicare inpatient payment policy to narrow the gap between costs and reimbursement. In the specific case of leukoreduction of red blood cells, the interplay of intense cost pressures and the absence of authoritative clinical practice guidelines have created wide hospital-to-hospital disparities in patient access to leukoreduced blood components. This review examines the financial implications of costly nonmandated blood safety-related technologies for US hospitals, using leukoreduced red blood cells as a case example. An approach is offered to (1) standardize clinical practice with respect to the administration of nonmandated blood component innovations, (2) reduce the influence of hospital financial priorities on patient access, and (3) better address medicoeconomic tradeoff concerns.

Blood Component Transfusion↗
PubMed1991

Transfusion therapy in cardiac surgery: impact of the Paul Gann Blood Safety Act in California.

The Paul Gann Blood Safety Act became law in California on January 1, 1990, mandating that patients be informed of the risks and alternatives of blood transfusions. To evaluate the impact of this legislation, the authors compared transfusion therapy in patients undergoing cardiac surgery during 1990 to previous years (1986 to 1987 and 1989). Surgical techniques were unchanged. Homologous component usage was 8.7 +/- 0.6 (mean +/- SE) units/patient in 1986 to 1987 (n = 373), 8.2 +/- 0.9 in 1989 (n = 219) and 4.3 +/- 0.6 in 1990 (n = 222), P less than .001 by ANOVA. Erythrocyte transfusions were 3.5 +/- 0.2, 3.2 +/- 0.2, and 2.2 +/- 0.2 units/patient (P less than .001); platelet/plasma usage was 5.2 +/- 0.5, 4.9 +/- 0.7 and 2.1 +/- 0.4 units/patient (P less than .001). The number of patients not requiring transfusions increased from 28 per cent in 1989 (61 of 219) to 47 per cent in 1990 (104 of 222). A slight but significant decrease in cardiopulmonary bypass time and perioperative blood loss occurred. The authors conclude that this legislation stimulated the surgical team to control blood loss during surgery and to avoid the anticipatory use of component transfusions.

Aged↗
PubMed2005

[Paramedical staff knowledge and practice related to the blood transfusion safety].

Blood transfusion is a complex activity, involving many actors. It is a high risk activity which couldn't be controlled without the use of specific methods. Health care workers beliefs and organisational factors are two major issues for the blood transfusion safety. Our study objectives were to describe the paramedical staff's knowledge and practice regarding blood transfusion safety and to identify factors that are related to them. We carried out a cross sectional study. The information was gathered by using a questionnaire. The latter was developed by foreign teams and adapted to the local context. Two outcome measures were used: the knowledge and practice score and the proportion of true answers. The study showed that only 15% of the interviewed persons have had a score less than 30 (scale range from 0 to 100), i.e. only 15% have had appropriate knowledge and practice with no negative consequences for the patient safety. 13.8% of the study population provided right answers related to the biologic exams required before red cells transfusion and 34% for the abnormal reaction circumstances. These results underscores the importance of strategies improving the quality and the safety of blood transfusion, i.e. the continuous medical education, implementing a blood transfusion information system and the use of transfusion practice guidelines.

Adult↗
PubMed2003

Transmissible spongiform encephalopathy update and implications for blood safety.

At this time, the accumulated evidence does not support the implementation of measures targeted against the risk of transfusion transmission of sporadic, familial, or iatrogenic CJD. Evolving information about vCJD, however, suggests that policy makers need to consider implementing measures to protect against exposure to vCJD, if such measures themselves do not lead to decreased blood safety. Surveillance of human TSEs and investigation of the risk of transfusion transmission must continue in order to provide further refinements in blood safety policy.

Blood Banks↗