Blood donation is an important public health issue globally and locally. Recruitment and retention of blood donors are the biggest challenge for blood donation. The purpose of this systematic review is to identify the motivators and deterrents for blood donation. PubMed, Medline and China Journal Net were searched using (blood donation OR blood donor) AND (motivation OR deterrent) and inclusion and exclusion criteria were applied. Nine studies on motivators or deterrents for blood donation were retrieved. Taking into account the situation in Hong Kong and findings gathered from this systematic review, policy suggestions are made. Limitations of this systematic review are also discussed. This systematic review suggests that more Asian studies should be conducted to inform the culturally pertinent measures in Hong Kong. / published_or_final_version / Public Health / Master / Master of Public Health

Thèse univ.--Méd.--Reims, 1973. N°: N° 203. / Bibliogr. ff. 48-49.

Close to one million red blood cell (RBC) units are transfused annually in Canadian hospitals, with surgical inpatients accounting for up to 44% of transfusions. There is evidence of significant variation in transfusion practice in the operating room (i.e., intraoperative). Although variation is expected based on disease severity and patient preference, inappropriate clinical care due to either under- or over-transfusion likely also contributes to significant variation. Indeed, estimates of unwarranted intraoperative RBC transfusions in the literature range from 19% to 49%, owing partly to a lack of evidence-based consensus on RBC transfusion practice in the OR. Our two systematic reviews have highlighted this gap, demonstrating a lack of evidence from trials or actionable clinical practice guidelines to inform decisions in the OR. Perhaps more importantly, avoidance of blood product exposure is an important patient-prioritized outcome that has yet to be studied empirically in the OR. As such, the observed variation in transfusion practice suggests that transfusion decision-making during surgery represents a clear and important knowledge and evidence gap. Transfusion decision-making in the OR is a complex and dynamic process that we cannot begin to improve without first understanding it. It is influenced by 1) physiologic parameters such as acute blood loss, the effects of general anesthesia, and surgical manipulation. Decision-making is also likely heavily influenced by 2) behavioural factors in the OR (heuristics, team dynamics, institutional culture), for which very little empirical work has been conducted. Finally, the importance of 3) patient input in influencing transfusion decisions is inadequately studied, given the documented disconnect between patient priorities and outcomes used in the medical literature and by clinicians. In this context, the aim of my thesis was to develop an empirical understanding of transfusion decision-making in the OR based on stakeholder perceptions and priorities, informed by an integrated patient engagement process. With this work, I address an important knowledge gap in intraoperative blood transfusion, thereby contributing to efforts to reduce variation in blood transfusion practice in surgery. It is my hope that this work will be influential in informing actionable perioperative tools to optimize blood management including providing both evidence and knowledge gaps for future research.

OBJECTIVE: We aimed to evaluate whether early administration of high plasma to red blood cells ratios influences outcomes in injured patients who received massive transfusion protocol (MTP). METHODS: A retrospective analysis was conducted at the only level 1 national trauma center in Qatar for all adult patients(≥18 years old) who received MTP (≥10 units) of packed red blood cell (PRBC) during the initial 24 h post traumatic injury. Data were analyzed with respect to FFB:PRBC ratio [(high ≥ 1:1.5) (HMTP) vs. (low < 1:1.5) (LMTP)] given at the first 4 h post-injury and also between (>4 and 24 h). Mortality, multiorgan failure (MOF) and infectious complications were studied as well. RESULTS: During the study period, a total of 4864 trauma patients were admitted to the hospital, 1.6 % (n = 77) of them met the inclusion criteria. Both groups were comparable with respect to initial pH, international normalized ratio, injury severity score, revised trauma score and development of infectious complications. However, HMTP was associated with lower crude mortality (41.9 vs. 78.3 %, p = 0.001) and lower rate of MOF (48.4 vs. 87.0 %, p = 0.001). The number of deaths was 3 times higher in LMTP in comparison to HMTP within the first 30 days (36 vs. 13 cases). The majority of deaths occurred within the first 24 h (80.5 % in LMTP and 69 % in HMTP) and particularly within the first 6 h (55 vs. 46 %). CONCLUSIONS: Aggressive attainment of high FFP/PRBC ratios as early as 4 h post-injury can substantially improve outcomes in trauma patients.

published_or_final_version / Microbiology / Master / Master of Medical Sciences

No description available.

No description available.

Background: Blood safety is important to blood transfusion. As men who have sex with men (MSM) are considered to have a higher risk of sexually transmitted infections (STIs) compared to the general population, blood donations from MSM may lead to a higher risk of transfusion-transmitted infections (TTIs). For this reason, many countries have established lifelong deferral policies for MSM blood donors since 1980s. Research have been conducted to evaluate the risks and benefits of relaxing MSM deferral policies from lifelong to a finite period, and countries such as the United Kingdom have implemented such relaxation in recent years. Nevertheless, there remains a lack of risk-benefit analyses on this topic in many countries, especially the developing ones. This review can help such countries to reconsider their MSM deferral policies. Objective: The objectives of this review are (i) to review the current deferral policies of blood donation from MSM implemented in major countries and (ii) to review the major determining factors in the risk-benefit analyses of these countries. Method: PubMed, Google Scholar, and China Journal Net were used for literature search. Only literatures with abstract and/or available full text in English or Chinese were included. The PICOS approach was used for study selection, and 37 articles were finally selected. Surveys, cohort studies, cross-sectional studies reviews, and national reports were included in this systematic review. Result: Countries with permanent/indefinite MSM deferral policy include the United States, Canada, France, Mexico, Germany, Norway, Sweden and China (including Hong Kong). Countries with a finite deferral period include New Zealand (5 years), the United Kingdom (12 months), Australia (12 months), Brazil (12 months), Argentina (12 months), Japan (6 months) and South Africa (6 months). Countries without specific deferral criteria for MSM include Spain, Italy, Poland and Russia. The recent relaxation of deferral policies was based on scientific evidence provided by risk-benefit analyses that evaluated the residual risk of TTIs associated with alternative deferral policies. Major determining factors of risk-benefit analyses include the following: 1. epidemiological characteristics that determine the proportion of MSM among HIV-infected patients; 2. screening technologies that have shortened the window period and improved the early detection of STIs; and 3. non-compliance after relaxation, which determines the increasing risk of TTIs. Conclusion: Majority of countries that have recently relaxed their deferral policies for MSM blood donor reduced the deferral period to 12 or 6 months. Most of the risk-benefit analyses found that relaxation of deferral policies for MSM blood donors would lead to a relatively small increase in the risk of TTIs. Policies aimed at lowering the non-compliance may be an effective way to reduce the residual risk of TTIs from MSM blood donors who are within the window period. / published_or_final_version / Public Health / Master / Master of Public Health

The acquisition of cytomegalovirus (CMV) infection following blood transfusion has been recognised for over 20 years. Prospective studies in the late 1960's and early 70's demonstrated that this infection was relatively frequent, particularly when patients were multitransfused. In assessing the clinical importance of CMV infection, critical distinctions must be made between infection and significant disease. This is primarily dependent on the immunocompetence of the invaded host. In the child or adult with a normal immune function, CMV infection usually results in asymptomatic seroconversion or is manifested as a mild heterophile-negative mononucleosis syndrome. There is minimal morbidity associated with these infections. Among healthy people the prevalence of CMV acquisition depends on age, socioeconomic conditions and the particular place where the investigations are carried out. In contrast, CMV may be associated with significant morbidity and mortality in immunocompromised patients eg, premature infants, children with immunodeficiency syndromes, patients on chemotherapy and transplant recipients. CMV infections in such patients may be either the result of reactivation of latent virus, since CMV frequently persists in the host after a primary infection or a de novo primary infection. In newborn infants, the role of blood transfusion in causing CMV infection is easier to ascertain, because reactivation of latent CMV is not a complicating factor. Premature infants, receiving blood transfusions (a very common practice) represent a special subpopulation in immunocompromised recipients. Numerous studies have identified 3 particularly high risk groups in this neonatal context: 1. maternal and neonatal seronegativity 2. transfusion of more than 50 mls of blood in toto per infant, particularly when the number of donors is high (&62 4) 3. very low birth weight; usually less than 1500 gms. Moreover these studies have convincingly shown that CMV infection can be significantly reduced by choosing seronegative blood for seronegative infants. However the provision of such blood would pose problems involving significant expense. Seronegative donors would have to be found from the routine donor panels and they would have to be tested prior to every blood donation, because of the possiblity of silent seroconversion. This involves the use of expensive reagents and requires organisational expertise regarding the appropriate timing of tests, keeping adequate stocks of such bloods, etc. Therefore before specific recommendations can be formulated with regard to the use of CMV seronegative blood for controlling CMV infections, it is necessary to study the local circumstances because the prevalence of CMV seronegativity varies in different populations. Moreover, recent studies have shown that the clinical consequences of CMV infection following blood transfusions seems to be diminishing. The reasons for this are not readily identifiable, but may be related to a number of factors, including the volume of blood transfused, the number of donor exposures and importantly a significant change in the make up of the blood donor population. Whatever the reason some centres have concluded, after local studies not to provide CMV screened blood for their sick nursery babies, even for the ones who are at highest risk of CMV infection. In fact a recent nationwide survey run by the American Association of Blood Banks and the College of American Pathologists in 1987 show that as many as 40% of community hospitals and 20% of children's hospitals do not provide blood or blood components with a reduced risk of CMV transmission for their neonates. With such conflicting policies on CMV screening it is therefore all the more important to evaluate the <i>local</i> clinical morbidity and/or mortality in at risk infants, induced by CMV infection via random (CMV unscreened) blood transfusions, which is current practice in our centre. Secondary to the main aims of this work, it was also possible to study: (a) the prevalence of CMV seropositivity amongst the blood donor population in the North East of Scotland and to study in some detail recent CMV infections both serologically and virologically in such donors. (b) the incidence of congenital CMV infection and CMV infection acquired during pregnancy in a select subpopulation of mothers. Since the data on CMV seroprevalence throughout different parts of the UK are scanty, the opportunity was taken to obtain some data on the subject. Although the information is of limited comparable value, the aim was to provide data both on the overall CMV donor carrier rate in different parts of the UK and also on the methodology used to detect it.

Background: Allogeneic transfusion confers a risk to the recipient and the recent introduction of leucocyte depleted blood has increased cost pressure on health resources. Colorectal surgery is a high blood usage field with 43% of all patients in our unit being transfused, over a three year period. Patient perceptions: Despite the risks associated with transfusion, a majority of patients are willing to have an allogeneic transfusion (85%) and think it is safe (89%), which may have implications in the uptake of alternatives available. The effect of bowel preparation Picolax bowel preparation causes significant dehydrating effects which may impair acute normovolaemic haemodilution (ANH). These effects can be minimised by administering intravenous normal saline. Acute normovoiaemic haemodilution (ANH) ANH significantly reduced allogeneic transfusion rate from 39% to 15% in the pilot study, however the controls were historical. No reduction in transfusion rate was seen (29% and 30%) in the prospective randomised controlled trial (n=160). Preoperative haemoglobin, blood loss, age, and transfusion protocol were the key factors influencing transfusion. The effect of ANH on coagulation ANH causes hypocoagulation, and this may explain why the expected red cell saving, as shown by mathematical modelling, was not seen in patients haemodiluted compared with controls.