La France se démarque par un ratio de mortalité maternelle par hémorragie du postpartum (HPP) élevé.Les objectifs de cette thèse étaient: 1/comparer les caractéristiques épidémiologiques de l'HPP entre la France et le Canada 2/décrire les pratiques d'anesthésie-réanimation dans l'HPP et évaluer leur adéquation par rapport aux recommandations chez les femmes décédées d'HPP et dans une population de femmes avec HPP.Les sources de données utilisées étaient: La base nationale canadienne de données hospitalières sur les séjours des patients, l'essai Pithagore6 et l'Enquête nationale confidentielle sur les morts maternelles.La comparaison du profil épidémiologique de l'HPP entre la France et le Canada montre que l'HPP n'est pas plus fréquente en France. Le recours plus fréquent à des traitements de seconde ligne suggère une incidence plus élevée de l'HPP sévère en France. Dans les décès maternels par HPP, certaines pratiques d'anesthésie-réanimation apparaissent comme inadéquates: le monitorage clinique et la mise en condition des patientes, la surveillance paraclinique, le protocole d'anesthésie générale et la stratégie transfusionnelle. La description en population des pratiques transfusionnelles dans l'HPP montre un recours insuffisant à la transfusion. Inversement des stratégies transfusionnelles dont l'efficacité n'est pas prouvée sont fréquemment appliquées.Ce travail suggère une sévérité importante de l'HPP en France, pouvant expliquer l'importance de la mortalité par HPP. Certaines pratiques d'anesthésie-réanimation apparaissant comme non-optimales pourraient être impliquées dans cette sévérité. L'association entre pratiques et sévérité de l'HPP reste à être étudiée. / In France, the maternal mortality ratio due to postpartum hemorrhage (PPH) is higher than in other high resources countries. This situation remains partially unexplained. The objectives of this PhD thesis were: 1/ to compare PPH epidemiological characteristics between France and Canada, 2/ to describe anesthesia and intensive care practices in PPH and to compare them with guidelines, first in cases of maternal deaths from PPH and secondly in a large population of women with PPH. The data sources were: the Discharge Abstract Database from the Canadian Institute for Health Information, the Pithagore6 trial and the French Confidential Enquiry into Maternal Deaths. The comparison of PPH epidemiological profiles between France and Canada shows that PPH incidence is not higher in France. Second-line treatments in PPH management are more frequently performed, suggesting a higher incidence of severe PPH in France. Among maternal deaths from PPH, some practices in anesthesia and critical care management appear to be inadequate: clinical monitoring and laboratory assessment, protocol for general anesthesia and transfusion strategy. The description on transfusion practices in a large population of women with PPH shows that the use of blood products is not sufficient. Conversely, transfusion strategies with unproved efficacy are frequently used. These results suggest a higher rate of severe PPH in France, that may result in the higher maternal mortality due to PPH. Inadequate practices in anesthesia and critical care could be involved in this severity. But the association between specific components of anesthesia and critical care management and PPH severity remains to be explored

A transfusão de plaquetas pode ser terapêutica quando indicada para interrupção de sangramento ativo ou profilática com o objetivo de prevenir hemorragias. Os concentrados de plaquetas apresentam um volume menor quando comparado ao sangue fresco total e ao plasma rico em plaquetas elevando a contagem plaquetária rapidamente minimizando, assim, a transfusão de componentes desnecessários e o risco de reações transfusionais o que no entanto podem ocorrer. Em cães, a literatura é escassa em relação à ocorrência de reações transfusionais frente ao emprego de concentrados de plaquetas. Sendo assim, este estudo tem como objetivo documentar a ocorrência de efeitos adversos em relação à administração de concentrados de plaquetas em cães em caráter clínico. Realizou-se a transfusão de concentrados de plaquetas em vinte e oito cães trombocitopênicos com manifestações clínicas de diáteses hemorrágicas ou antes de procedimentos cirúrgicos. Estes hemo componentes foram preparados por centrifugação diferencial seriada do sangue total padronizando-se o fracionamento sanguíneo para cães. Determinou-se um controle de qualidade destes concentrados monitorando-se o pH, níveis de glicose, temperatura de armazenamento, rendimento plaquetário, contaminação bacteriana e swirling. Adotou-se uma proporção de 1 concentrado de plaquetas para cada 10 Kg. Dentre os vinte e oito cães transfundidos, presenciou-se a ocorrência de reações adversas em dez pacientes (35,7%) caracterizadas por manifestações gastrintestinais (6/28), seguidas das alérgicas (5/28) e inflamatórias (2/28). A hipertermia, principal reação relatada em seres humanos, foi constatada apenas em um paciente. O incremento plaquetário observado em 1 e 24 horas foi considerado satisfatório na maioria dos cães transfundidos sendo, em média, de 38.000 e 31.000 plaquetas/µL respectivamente. / Platelet transfusion may be either therapeutic or praphylactic when used to interrupt active bleeding or to avoid it, respectively. Plate1et concentrates have a smaller volume when compared to fresh whole blood and to plate1et-rich plasma. Their use quickly increases plate1et counts and, therefore, minimizes unnecessary transfusion of blood components and subsequent transfusion reactions. Literature is scarce concerning transfusion reactions after the administration of platelet concentrates in dogs. Therefore, the objective of this study was to record c1inical adverse effects after its administration in dogs. Platelet concentrates were administered in twenty-eight thrombocytopenic dogs with c1inical signs of hemorrhage or before surgical procedures. These hemocomponents were prepared by serial differential centrifugation of the whole blood standardizing the whole blood fractionation method to dogs. Quality contraI of platelet concentrates was performed by monitoring pH, glucose, storage temperature, platelet count, bacterial contamination and swirling. The dose administrated was one unit per 10 kg. Transfusion reactions occurred in ten dogs (35.7%), characterized by gastrointestinal manifestations (6/28), followed by allergic (5/28) and inflammatory reactions (2/28). Hyperthermia, the most frequent1y reported reaction in humans, was observed in only one dog. The platelet increment observed 1 and 24 hours post-transfusion was considered satisfactory in the majority of the transfused dogs, being, on the average, 38,000 and 31,000 platelets/ µL, respectively.

Färsk fryst plasma (FFP) är en blodkomponent som utvinns genom separation från helblod. FFP innehåller livsviktiga plasmaproteiner, immunoglobuliner och koagulationsfaktorer. Produkten används främst till patienter med omfattande skador som lett till större blodförlust samt vid större kirurgiska blödningar vid operationer. Enligt riktlinjer stiftade av European Directorate for the quality of Medicines and healtcare (EDQM) bör samtliga plasmaenheter understiga 6,0 × 109/L erytrocyter för att produkten klassificeras som godtagbar för transfusion. Syftet med denna studie var att undersöka om Sysmex XN-550 med applikation ”Body Fluid” (BF) kan tillförlitligt koncentrationsbestämma erytrocyter i FFP och därmed ersätta Bürkerkammare som är den nuvarande metoden för dessa mätningar. För detta ändamål utfördes en undersökning av linjäritet hos instrumentet, en statistisk jämförelse med mätning av 30 prover samt fem upprepade mätningar av en känd koncentration för undersökning av reproducerbarheten. Resultaten visade en tydlig korrelation mellan analyserna med en jämn stegring av värden. Korrelationskoefficienten erhöll ett värde på 0,99. Bland Altmananalys visade att 95% av uppmätta värden förelåg inom konfidensintervallet vilket påvisar en överensstämmelse mellan metoderna med p-värde på 0,98. Mätningarna påvisade p-värden på 0,0005 vid analys av den lägsta koncentrationen (1 × 109/L), 0,5 vid anays av näst högsta koncentrationen (3 × 109/L) samt 0,9 vid analys av den högsta koncentrationen (6 × 109/L). / Fresh frozen plasma (FFP) is a blood component derived from separation of whole blood. FFP contains essential plasma proteins, immunoglobulins and coagulation factors. The product is mainly used for patients with extensive injuries which have led to major blood loss or for major bleeding due to surgical procedures. According to guidelines established by the European Directorate for the quality of Medicines and healtcare (EDQM), all plasma components should have an erythrocyte concentration of less than 6 × 109/L for the product to be classified as acceptable for transfusion. The purpose of this study was to investigate whether Sysmex XN-550 with the application “Body Fluid” (BF) could reliably determine the concentration of erythrocytes in FFP and thus replace the current method of Bürker chamber for these measurements. For this purpose, the linearity of the instruments was studied and a statistical comparison including measurements of 30 samples and five repeated measurements of a known concentration for examination of the reproducibility. The results showed a clear correlation between the analyses with an even increase in value. The correlation coefficient provided a value of 0,99. Bland Altman analysis showed that 95% of the measured values were within the confidence interval, which shows a correlation between the used methods and the calculated p-value was 0.98. The reproducibility measurements revealed a p-value of 0,0005 when measuring the lowest concentration (1 × 109/L), 0,5 when measuring the second to highest concentration (3 × 109/L) and 0,9 when measuring the highest concentration (6 × 109/L).

Blood transfusion is a very common procedure. Before a blood transfusion it is important to find compatible blood for the patient. If the blood is incompatible with that of the patient a transfusion reaction may occur, which can be mortal. It is also important to avoid alloimmunisation. Alloimmunisation occurs when antibodies are produced against a specific antigen. These antibodies are called irregular antibodies and they can be produced after a transfusion, pregnancy, or transplantation. Alloimmunisation makes it harder to find compatible blood for patients in the future and it is a major concern for patients who require blood transfusions repeatedly. By phenotyping erythrocyte antigens, it is easier to find compatible blood for patients before a blood transfusion. Until now, a manual method has been used for phenotyping erythrocyte antigen at the Sundsvall County hospital and an automatization of this method was desired. For this study, 99 anonymised blood doner tests were used. The erythrocyte antigens M, Jka, Jkb, Fya, Fyb, S and s were phenotyped both manually and automated with ORTHO Vision Analyzer. A Clopper Pearson test was used to evaluate the accordance between the methods. A comparison was also made in regard totime and cost. The results showed a good accordance between the methods. The automated procedure using ORTHO Vision has several advantages over the manual procedure using gel cards. The risk of errors is reduced, there are fewer manual steps, it is faster and the personnel can do other tasks while the instrument is processing the tests.

Charles University Faculty of Pharmacy in Hradec Králové Department of Biological and Medical Sciences Candidate: Bc. Kateřina Nováková Supervisor: RNDr. Gabriela Červená, Ph.D. plk. MUDr. Miloš Bohoněk, Ph.D. Title of diploma thesis: Whole blood - New Blood Component Containing Platelets Background: The aim of this thesis was to evaluate in vitro quality parameters and haemostatic function of leucodepleted WB and their comparison with non-leucodepleted WB. The same way the quality parameters (RBC, PLT, HB and hemolysis) of erythrocyte blood component were measured and compared in day D14, D21, D35 and D42. Methods: WB collected from 30 healthy group A donors was divided into two groups - leucodepleted (LWB), using in-line platelet-sparing filters and collected to a blood bag system IMUFLEX® WB-SP (Terumo BCT, USA) and non-leucodepleted WB (NLWB), colletected to a blood bag system CompoFlex® Single System (Fresenius Kabi, Germany). Both groups were stored at 42řC for 14 days and following parameters were measured in days D0, D1, D3, D5, D10 and D14: WBC, RBC, PLT, HB, hemolysis, pH, TEG, FVIII, TT, PT, aPTT, aggregometry, concentration of PF4 and sCD40L (ELISA). Moreover, in days D0, D7 and D14 was measured the level of expression of platelet activation marker CD62P (P-selectin), CD42b, CD61 by...

No presenta resumen. / Revisión por pares

No presenta presenta resumen. / Revisión por pares

Ausführliche Analyse über den aktuellen Stand des Universitätsklinikum Leipzig im Umgang mit Erythrozytenkonzentraten (EK). Hinterfragung von Indikation/Transfusionserfolg/Dokumentationserfüllung bei der Transfusion von EKs. Vergleich zwischen unterschiedlichem Alter der EK-Produkte, Transportweg durch das Klinikum hinsichtlich des Transfusionserfolges.:Inhaltsverzeichnis: 1. Abkürzungsverzeichnis 2. Einführung 2.1 Einleitung 2.1.1 Geschichte 2.1.2 Die Blutgruppensysteme 2.1.3 Entwicklung der Transfusionsmedizin 2.1.4 Risiken von Transfusionen 2.1.5 Aktueller Stand der Wissenschaft 2.2 Problemstellung 2.3 Fragestellung 3. Methodik 3.1 Organisationsstruktur des Universitätsklinikums 3.2 Organisatorische Voraussetzungen 3.2.1 Räumlicher Aufbau des Universitätsklinikums 3.2.2 IT-Infrastruktur 3.2.3 Transport von Blutprodukten durch das UKL 3.2.4 Transfusion von Blutprodukten 3.2.5 Rücksendung von Erythrozytenkonzentraten 3.3 Datenerfassung 3.3.1 Erhobene Parameter 3.4 Zeitlicher Verlauf 4. Ergebnisse 4.1 Epidemiologische Daten 4.1.1 Blutgruppenverteilung 4.1.2 Altersverteilung 4.2 Verbrauch von Erythrozytenkonzentraten der Departments 4.3 Verbrauch von Erythrozytenkonzentraten in Abhängigkeit des Patientenalters 4.4 Transfusionstrigger 4.5 Transfusionserfolg 4.6 Einfluss des Präparatealters auf den Transfusionserfolg 4.7 Einfluss von Rohrpostversand auf den Transfusionserfolg 4.8 Transfusionswahrscheinlichkeit einzelner Diagnosen am Beispiel des DOPM 4.9 Dauer zwischen Lieferung und Transfusion 4.10 Mehrfache Versendungen von Präparaten bis zur Transfusion 4.11 Vollständigkeit der Anforderungsscheine 5. Diskussion 5.1 Blutgruppenverteilung transfusionspflichtiger Patienten 5.2 Altersverteilung transfusionspflichtiger Patienten 5.3 Verbleib von angeforderten Präparaten 5.4 Einhaltung der empfohlenen Transfusionstrigger 5.5 Transfusionserfolg 5.6 Einfluss des Präparatealters auf den Transfusionserfolg 5.7 Einfluss des Transportes auf den Transfusionserfolg 5.8 Transfusionswahrscheinlichkeiten im operativen Bereich 5.9 Zeitdauer zwischen Lieferung und Transfusion 5.10 Dokumentation der Anforderungen 5.11 Weitere Optimierungsansätze 5.12 Stärken und Schwächen der Studie 5.13 Unbeantwortete und neue Fragestellungen 6. Zusammenfassung der Arbeit 7. Literaturverzeichnis 8. Abbildungsverzeichnis 9. Tabellenverzeichnis 10. Anlagen 11. Erklärung über die eigenständige Verfassung der Arbeit 12. Lebenslauf 13. Publikationsverzeichnis 14. Danksagungen

Title of Diploma Thesis: Production and use of transfusion products in the District Hospital Trutnov. Aim of the work: The aim was to evaluate the production of transfusion products (TP) in the period 2014-2019 at the Transfusion and Hematology Department (THO) in the District Hospital Trutnov and their use for hemotherapy by individual medical disciplines. Futhermore, to compare the production of TP within the Czech Republic together with selected European countries. The incidence of post-transfusion reactions and other adverse events during the reporting period is also included. Material and methods: The methodological part describes the standard procedures of pre- transfusion examination using the column agglutination method from the company Grifols, S.A., laboratory examination of donors and transfusion products manufactured at the Transfusion Department Trutnov. Conclusion: Despite all the recommendations and efforts to reduce the use of transfusion products, this condition has not been proven both in our department, within the Czech Republic and in Europe. This work recommends deleucotization of transfusion products for the national and European part, unification of procedures for transfusion in a given disease, mandatory introduction of NAT testing to minimize the risk of transmission...

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