Patient blood management: A solution for South Africa

Thomson, Jackie; Hofmann, Axel; Barrett, C; Beeton, A.; Bellairs, Greg R M; Boretti, L; Coetzee, Mercia; Farmer, Shannon; Gibbs, M; Gombotz, Hans; Hilton, Caroline; Kassianides, Chris; Louw, Vernon; Lundgren, Christina; Mahlangu, Johnny; Noel, Colin B.; Rambiritch, Vanitha; Schneider, François; Verburgh, Estelle; Wessels, P-L; Wessels, Philippus L.; Wise, R; Shander, Aryeh

doi:10.7196/samj.2019.v109i7.13859

Cited by 20 publications

(24 citation statements)

References 71 publications

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“…25 26 These and other guidelines on patient blood management were developed during or after the index study. 27 There were limitations to the study. First, data were abstracted from the clinical records and were thus often missing and subject to the judgment by the nurses who performed the abstraction.…”

Section: Discussionmentioning

confidence: 99%

“…Pertinent to the obstetric population, the Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis in collaboration with the International Federation of Gynaecology and Obstetrics and the European Board and College of Obstetrics and Gynaecology have published recommendations on prenatal iron therapy that could mitigate risk of transfusion . These and other guidelines on patient blood management were developed during or after the index study …”

Section: Discussionmentioning

confidence: 99%

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Antenatal blood transfusion in South Africa: indications and practice in a high‐HIV‐prevalence setting

et al. 2020

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BACKGROUND Globally, data on antenatal blood transfusion practices are scarce. We sought to characterize the epidemiology of antenatal transfusion in South Africa. STUDY DESIGN AND METHODS A cross‐sectional study was conducted of women who were transfused during pregnancy (>48 hr before anticipated delivery) at two hospitals in Durban and Soweto in 2014 to 2015. Medical record data on demographics, obstetric history, anemia, HIV status, and indications for blood transfusion were abstracted. RESULTS The records on a total of 560 transfused pregnant women were evaluated; mean age was 28 years, 98% were of black African ethnicity, and 28% were HIV positive. At time of transfusion, one‐half were in the first trimester. Hemorrhage was noted in 76% of women, most of which was associated with abortion (67%) or ectopic pregnancy (27%). Most women were transfused with red blood cells (RBCs; median, 2 units); 14% of women were transfused with plasma and 2% with platelets. Median pre‐ and posttransfusion hemoglobin levels were 6.9 g/dL and 9.2 g/dL, respectively; the latter differed by hospital (8.7 g/dL vs. 9.5 g/dL; p < 0.01). Hemorrhage was associated with missing HIV status, lower gestational age, and transfusion of 3 or more RBC units (all p < 0.01). In contrast, diagnoses of anemia (Soweto only) were associated with HIV infection, later gestational age, and lower (<3 units) RBC dose (all p < 0.01). CONCLUSION Abortion and ectopic pregnancy with associated hemorrhage were the leading indications for antenatal transfusion and were concentrated in early gestation. By contrast, anemia was associated with HIV infection and transfusion in the third trimester.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Antenatal blood transfusion in South Africa: indications and practice in a high‐HIV‐prevalence setting

et al. 2020

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“…Implementors need to identify the stakeholders in implementing Patient Blood Management and understand what motivates each of them to support, engage, or contribute (25)(26)(27).…”

Section: Guided Implementationmentioning

confidence: 99%

“…However, despite compelling evidence and ongoing WHO policy drive, practical guidance for healthcare providers (HCPs) and national authorities (21,(25)(26)(27) and clinical guidelines and recommendations across numerous specialties and national health systems (22,(28)(29)(30)(31)(32)(33)(34)(35)(36), implementation of Patient Blood Management is far behind the expectations for good and safe clinical practices. Ignoring the cumulative evidence puts life, well-being and safety of millions of hospitalized patients at risk.…”

Section: Introductionmentioning

confidence: 99%

Call to Action – Closing the Gap to Make Patient Blood Management the New Norm(al) as Viewed by Implementors in Diverse Countries

Hofmann

Spahn

Holtorf

2020

Preprint

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BackgroundMillions of hospitalized patients are anemic. However, anemia is an independent risk factor for adverse outcomes including morbidity and mortality. In combination with blood loss, anemia is the main driver for transfusion, thus adding risk for adverse outcomes. Patient Blood Management (PBM) is a concept to identify and correct anemia and to minimize blood loss. Evidence demonstrates that PBM significantly improves outcomes and safety while reducing cost by macroeconomic magnitudes. Despite its huge potential to improve healthcare systems, PBM is not yet adopted broadly. By gathering the experiences of a diverse group of PBM implementors across countries with different healthcare contexts, we aimed to identify the drivers, barriers, measures, and stakeholders regarding the implementation of PBM. The synthesis of this information should provide a matrix of complementary measures, allowing PBM stakeholders from diverse professional backgrounds to initiate and orchestrate PBM implementation.MethodsSemi-structured interviews were conducted with 1-4 PBM implementors from 12 countries in Asia, Latin America, Australia, Central and Eastern Europe, the Middle East, and Africa. Responses were summarized per country, and key observations extracted. By defining the levels of intervention for PBM implementation and applying the Donabedian Quality Framework, we created and populated a matrix of key measures and outcomes as identified from the interviews.ResultsWe were able to extract a set of structural and procedural PBM implementation measures from interviews with the implementors. We created a matrix addressing six levels of implementation including government, healthcare providers (HCP), funding, research, training/education and patients and identified structural and procedural measures on each level. ConclusionThis matrix helps to decompose the complexity of PBM implementation into concrete measures on each implementation level. It provides guidance for diverse stakeholders to independently initiate and develop strategies to make PBM a national standard of care, thus closing current practice gaps and matching this unmet public health need.

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“…]. Blood donations themselves have also diminished during the pandemic and this further compounds the availability and distribution limitations of blood products internationally [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Drop for drop: A descriptive analysis of blood product usage in a South African tertiary care setting during the Covid-19 pandemic

Shead

2021

African Journal of Emergency Medicine

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Background The Covid-19 pandemic has had a drastic effect on the global community. Blood products are precious resources especially in the African context and this has been especially compounded during the Covid-19 pandemic. Concurrent to this during the Covid-19 level 5 lockdown in South Africa from 26 March – 30 April 2020, a decrease in trauma admissions to state hospitals was noted. The aim of this data collection was to assess whether lowered blood product issuance was seen during the Covid-19 pandemic lockdown. Method Areas at Tygerberg Hospital with trauma patients were identified, namely: the A1W intensive care unit (Surgical ICU), Trauma Front Room (Trauma Admissions), Trauma Resuscitation unit (Trauma Resus Area) and J7(Trauma Ward). Data of blood product issuance (red blood cells and fresh frozen plasma) for these 4 areas was provided by the Western Cape Blood Service for the period 26 March-30 April 2018, 2019 and 2020. This included the stage 5 Covid-19 South African lockdown, as well as Easter for all three years which is traditionally associated with raised trauma admissions. This data was quantitative. Results 201 products were issued in 2018 versus 103 for the same period in 2020 for the 4 trauma areas in Tygerberg Hospital. The surgical ICU received the most products over 3 years with 183 of the product issuances. Discussion As expected there was a significant decrease in blood product (red blood cell and fresh frozen plasma) issuance during the 2020 period which paralleled the lowered trauma numbers. This represented a significant cost saving of over R150 000 despite increased yearly costs for blood products over the same period. This data collection did not consider the reasoning for these blood transfusions or the clinical appropriateness thereof. The author acknowledges the wide variability of transfusion thresholds and protocols within various centres around the world, including Tygerberg and was not seeking to prove commentary on the appropriateness thereof in this research.

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Patient blood management: A solution for South Africa

Cited by 20 publications

References 71 publications

Antenatal blood transfusion in South Africa: indications and practice in a high‐HIV‐prevalence setting

Antenatal blood transfusion in South Africa: indications and practice in a high‐HIV‐prevalence setting

Call to Action – Closing the Gap to Make Patient Blood Management the New Norm(al) as Viewed by Implementors in Diverse Countries

Drop for drop: A descriptive analysis of blood product usage in a South African tertiary care setting during the Covid-19 pandemic

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