Baltic Sea and Nordic Conference on Blood Donation

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Baltic Sea and Nordic Conference on Blood
Donation 28 31 maj 2004 What is Blood used
for Is it possible to decrease the
consumption Jan Jorgensen The Danish Transfusion
Database Regional Blood Transfusion Centre Aarhus
University Hospital Denmark
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Use of Donated Blood

• Ethical aspects

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Use of Donated Blood

• Donated blood should be used for the treatment of
  patients and handled with the same serious
  respect and ethical standards as
• with which it was donated by the donor

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Use of Donated Blood

• Blood is a gift with no reimbursement
• Given to an unknown patient
• With the intention to help and not to harm

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Use of Donated Blood

• Donation shall be easy and secure for the donor
• Blood shall be handled with respect
• Used with the intension to treat patients

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Use of Donated Blood

• How is it used?

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Use of Donated Blood

• Used for treatment of patients
• Directly Transfused
• Indirectly Not transfused

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Use of Donated Blood

• Direct help to the patient
• Transfusion of single units
• Transfusion of units from a batch
• platelets
• plasma products

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Use of Donated Blood

• Indirect help to the patient
• a few tubes laboratory controls
• several units standards

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Use of Donated Blood

• With the intention to help patients
• Normal values for a new test
• Science

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Use of Donated Blood

• Directly for transfusion
• Indirectly for control of equipment
• With the intension to help patients

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Use of Donated Blood for other purpurses than
transfusion

• No special information when blood is
• used as laboratory quality controls
• Information
• other kinds of use, no identification
• Informed consent (written)
• with identification of donor

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Other Parts of the Donor

• Bone marrow transplantation
• Organ donation
• Scientific experiments

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Other Parts of the Donor

• When a person wishes to donate blood, this does
  not give the hospital the right to ask for
  samples from the rest of the body.

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Use of Donated Blood

• How do we use the blood

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Use of Donated Blood

• Whole blood (not commonly used)
• Blood component therapy

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Use of Donated Blood One unit Several
components

• Red cells
• Platelets Single units
• Pools of three or four buffy coats
• Plasma Single units
• Batch fractionation many kinds
• White cells normally not used

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Use of Donated Blood

• What do we do with all that blood
• The big blood account

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Use of Donated Blood The Blood Account

• Transfused
• Or not transfused
• failures during production
• do not pass quality control
• outdated
• delivered to department gt½ Hour

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Use of Donated BloodAarhus University Hospital

• Produced per year 36.000 units of red cells
• Transfused 94
• Testreagents 1
• Outdated 1
• Discarded (dep.gt½h) 2.4
• Screening 0.2
• Technical problems 0.7
• Other 0.2

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Use of Donated Blood University Hospitals in
Denmark

• Red cell units are used for treatment of
• Cancer 39
• Heart and vessel diseases 20
• Accidents 12
• Gastro-intestinal diseases 11
• Blood diseases 5
• Other 13

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Use of Donated Blood

• Indications for the Transfusion of
• Blood Components

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Use of Donated BloodIndications

• Severe anemia (acute)
• Bleeding and lt25 red cells
• Anemia and symptoms (chronic)
• Heart and lung disease
• Depends on the patient
• Age, diseases, symptoms

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Use of Donated BloodContraindications

• High cellular volume (negative effect)
• Slow circulation
• Deminished oxygene delivery
• Low tissue oxygene concentration
• Low cellular volume (positive effect) (Preoperativ
  e haemodilution)

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Use of Donated Blood

• The Theoretical Indications
• Are They Used In Praxis?

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Use of Donated Blood

• SANGUIS Study Use of Red Cell Units
• retrospective audit of patient files
• 40 patients in each group (20.000)
• elective surgery (6 different kinds)
• 40 university hospitals in Europe

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Use of Donated BloodConclusion of the SANGUIS
study

• The percentage of patients transfused,
• and
• The number of transfused units per pt.
• Depended more on the actual hospital than on the
  size of the bleeding

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Use of Donated BloodConclusion of the SANGUIS
study

• Danish part of the study
• Audit was done in 3 university hospitals
• A total of 1000 files were looked over
• One hospital transfused a higher percentage of
  the patients with a higher number of red cell
  units not dependent on the kind of surgery

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Use of Donated BloodConclusion of the SANGUIS
study

• Tentative explanation of the result
• The use of red cell units for transfusion depends
  more on the traditions and habits of the hospital
  
• than on the patients clinical situation

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Use of Donated BloodThe high number of red cells
used in Denmark

• Red cell units / year /1000 inhabitants
• Dona- Trans- Waste
• tions fusions
• N (2001) 42 39 3
• S (2000) 51 48 3
• DK (2000) 68 63 6

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Use of Donated BloodThe high number of red cells
used in Denmark

• Danish Transfusion Data Base (DTDB)
• Data from 3 other databases
• Blood bank Transfusions
• Patient register Diagnoses, treatment
• Clinical Chemistry Haemoglobin conc.

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Use of Donated BloodThe Danish Transfusion Data
Base

• Hip bone replacement of 2000 patients in 12
  hospitals
• 0-58 of the patients per department were
  transfused
• The differences in percentage between the
  hospitals were significant

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Use of Donated BloodThe Danish Transfusion Data
Base

• Departments with a high percentage of transfused
  patients had also a high percentage of patients
  with
• UHbgt7 mmol/l
• UHb Haemoglobin concentration after the last red
  cell transfusion before discharge

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Use of Donated BloodThe Danish Transfusion Data
Base

• Conclusion
• In spite of a generally accepted common
  transfusion policy in Denmark,
• an audit of the policy actually used in praxis
  shows great differences between Danish hospitals!

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• Why
• We do not know

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