Background

Previous studies have shown the usefulness of combining information from different data sources to identify and analyse variations in transfusion practices. Good knowledge of the conditions leading to blood use is a fundamental requirement for the assessment of the appropriateness of blood transfusion.

Materials and methods

In this study we combined blood transfusion data obtained from the Blood Bank information system with patients’ data from the Hospital Discharge Database, based on the ICD9 classification system, from 1,827 surgical procedures performed in seven different orthopaedic divisions in the Ravenna area between January and December 2009. Hip and knee replacement surgery (primary or revision) and operations following femoral fractures (partial hip replacement and reduction with internal fixation) were considered. For a subgroup of patients clinical and transfusion data were also combined with haemoglobin values obtained from the laboratory information system.

Results

Of the 1,827 surgical procedures, 1,038 (56.8%) were followed by transfusion of red cells. The likelihood of receiving a transfusion varied depending on the patient’s sex (49% for males, 60% for females), age, and on the surgical procedure, being higher for interventions following femoral fractures and for revisions of hip replacement: about 70% of patients undergoing these interventions required transfusion. A large variability in transfusion rates was observed between the seven divisions, which was only partially explained by the different types of surgery (post-traumatic or elective) performed by any of them: relevant variations were also observed for the same type of intervention.

Discussion

Combining information from different data sources could be a time-sparing way to gain useful information about transfusion practices, so contributing to optimising blood usage.

Background

After years of surpluses in numerous blood components in the province of Ravenna, there is now evidence that the increased use of such products is leading to an ever less abundant self-sufficiency. The concern about the possible loss of self-sufficiency, in a province in which the population of donors does not seem to be adequate to compensate for transfusion domands, led us to verify consumption and future prospects in greater detail.

Materials and methods

In order to plan future transfusion needs, past consumption was analysed dividing the population into several age groups. This historical use of blood products was projected into the scenario of the population in years to come to estimate needs and their increases over time.

Results

The use of transfusion products is very different in different age groups, increasing notably with age. Age factor was identified as the most important factor determining blood product consumption.

Discussion

It will, therefore, be the aging of the population that causes an increase in blood product requirements. Projections from the Italian Institute of Statistics considering age groups of the population up to 2051 enable predictions of transfusion needs, in the absence of drastic interventions on the appropriateness of transfusion practices. Considering that the public and private hospitals of Ravenna predominantly admit subjects from its own territory, these predictions appear realistic, provided that new reasons for consumption are not introduced.

Introduction

The aim of the survey described in this article was to determine decisional and strategic factors useful for redefining minimum structural, technological and organisational requisites for transfusion structures, as well as for the production of guidelines for accreditation of transfusion structures by the National Blood Centre.

Materials and methods

A structured questionnaire containing 65 questions was sent to all Transfusion Services in Italy. The questions covered: management of the quality system, accreditation, conformity with professional standards, structural and technological requisites, as well as potential to supply transfusion medicine-related health care services. All the questionnaires returned underwent statistical analysis.

Results

Replies were received from 64.7% of the Transfusion Services. Thirty-nine percent of these had an ISO 9001 certificate, with marked differences according to geographical location; location-related differences were also present for responses to other questions and were confirmed by multivariate statistical analysis. Over half of the Transfusion Services (53.6%) had blood donation sites run by donor associations. The statistical analysis revealed only one statistically significant difference between these donation sites: those connected to certified Transfusion Services were more likely themselves to have ISO 9001 certification than those connected to services who did not have such certification.

Conclusions

The data collected in this survey are representative of the Italian national transfusion system. A re-definition of the authorisation and accreditation requisites for transfusion activities must take into account European and national legislation when determining these requisites in order to facilitate their effective applicability, promote their efficient fulfilment and enhance the development of homogeneous and transparent quality systems.

Background

The system of accreditation of Italian transfusion structures (Transfusion Services and blood donation centres, these latter being managed by voluntary associations) guarantees the National Health Service that the service provided to citizens, patients and donors who use these structures, is correctly authorised, meets further, additional requisites relative to the quality of health care, and that these are documented and controlled during a formal audit.

Materials and Methods

We present here the experience gained, in the period 2007–2009, by the Transfusion Service of the local health authority of Ravenna and of the AVIS blood donation centres in the Province of Ravenna (Italy). These blood donation centres are managed in the context of a stipulated arrangement in which agreement was reached concerning not only the purposes, but also the quality requirements of the blood product collection, the operative methods, and the indicators and surveillance of non-conformities, in order to monitor and improve the blood supply system in the province.

Results

Our data show that, over time, there was a improvement in the distribution of collection of whole blood across the days of the week and better training of staff, as demonstrated by a reduction in non-conformities. Analysis of the data encouraged the identification of a new organisation with computerisation of the blood donation centres and their progressive merging.

Conclusions

There are numerous, precise legislative and technical indications to guarantee the quality of performances in transfusion medicine, from the collection of blood to its allocation. These indications constitute a qualified basis for the development of accreditation models whose final validation is the duty of specifically designated regional and national institutions.

The procedure for obtaining accreditation, planned and carried out uniformly by the Transfusion Service and the voluntary association’s donation centres was an occasion for professional staff to improve the quality of the services delivered. Collectively, these aspects have increased transparency and improved the system of blood supply in the province of Ravenna.

Background

The Chikungunya virus (CHIKV) is transmitted by Aedes mosquitoes and recently caused a massive epidemic on La Réunion Island, in the Indian Ocean. Between July and September 2007 it caused the first autochthonous epidemic outbreak in Europe, in the Region of Emilia-Romagna in the north-east of Italy.

Materials and Methods

After the first reports of an unusually high number of patients with a febrile illness of unknown origin in two contiguous villages, an outbreak investigation was carried out to identify the primary source of infection, the modes of transmission and the dynamics of the epidemic. An active surveillance system was also implemented. Laboratory diagnosis was performed through serology and polymerase chain reaction (PCR) analysis. Blood donation was discontinued in the areas involved from September to October 2007 and specific precautionary blood safety and self-sufficiency measures were adopted by the regional health and blood authorities and the National Blood Centre. An estimate method to early assess the risk of viraemic blood donations by asymptomatic donors was developed, as a tool for "pragmatic" risk assessment and management, aiming at providing a reliable order of magnitude of the mean risk of CHIKV transmission through blood transfusion.

Results

Two hundred and seventeen cases of CHIKV infection were identified between 4th July and 28th September. The disease was fairly mild in most of the cases. The precautionary measures adopted in the blood system caused a considerable reduction of the collection of blood components and of the delivery of plasma to the pharmaceutical industry for contract manufacturing. The estimated risk of CHIKV transmission through blood transfusion peaked in the third week of August.

Conclusion

A CHIKV epidemic poses considerable problems for public health authorities, who not only need good routine programmes of vector control and epidemiological surveillance but also local and national emergency plans to sustain the blood supply, so as to promptly deal with the potentially severe effects of an epidemic outbreak, especially when affected areas locally require a significant blood inventory and at the same time represent a critical resource for other areas depending on external supplies of blood components.