Mathematics and transfusion medicine - Blood Transfusion

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Liumbruno GM et al.43) Use of blood products for elective surgery in 43 Europeanhospitals. The Sanguis Study Group. Transfus Med 1994;4: 251-68.44) Holand L, Sarode R. Should plasma be transfusedprophylactically before invasive procedures? Curr OpinHematol 2006; 13: 447-51.45) Gajic O, Dzik WH, Toy P. Fresh frozen plasma and platelettransfusion for non bleeding patients in the intensive careunit: benefit or harm? Crit Care Med 2006; 34 (5 Suppl):S170-3.46) Holland LL, Brooks JP, Toward rational fresh frozen plasmatransfusion. Am J Clin Pathol 2006; 126: 133-9.47) Triulzi DJ. The art of plasma transfusion therapy [editorial].Transfusion 2006; 46: 1268-70.48) Adel-Wahab OI, Healy B, Dzick WH. Effect of fresh frozenplasma transfusion on prothrombin time and bleeding inpatients with mild coagulation abnormalities. Transfusion2006; 46: 1279-85.49) Segal JB, Dzick WH; Transfusion Medicine/HemostasisClinical Trials Network. Paucity of studies to support thatabnormal coagulation test results predict bleeding in the settingof invasive procedures: an evidence-based review.Transfusion 2005; 45: 1413-25.50) Holland LL, Foster TM, Marlar RA, et al. Fresh frozenplasma is ineffective for correcting minimally elevatedinternational normalized ratios [letter]. Transfusion 2005;45: 1234-5.51) Dara SI, Rana R, Afessa B, et al. Fresh frozen plasmatransfusion in critically ill medical patients with coagulopathy.Crit Care Med 2005; 33: 2667-71.52) Wallis JP, Dzik S. Is fresh frozen plasma overtransfused inthe United States? [letter]. Transfusion 2004; 44: 1674-5.53) Dzick W, Rao A. Why do physicians request fresh frozenplasma? [letter]. Transfusion 2004; 44: 1393-4.54) Stanworth SJ, Brunskill SJ, Hyde CJ, et al. Is fresh frozenplasma clinically effective? A systematic review of randomisedcontrolled trials. Br J Haematol 2004; 126: 139-52.55) Zimmermann M, Büscher M, Linhardt C, et al. A survey ofblood component use in a German university hospital.Transfusion 1997; 37: 1075-83.56) Titlestad K, Kristensen T, Jorgensen J, et al. Monitoringtransfusion practice – a computerized procedure. TransfusMed 2002; 12: 25-34.57) Titlestad K, Georgsen J, Jorgensen J, et al. Monitoringtransfusion practices at two university hospitals. Vox Sang2001; 80: 40-7.58) Santagostino E, Mancuso ME, Morfini M, et al. Solvent/detergent plasma for prevention of bleeding in recessivelyinherited coagulation disorders: dosing, pharmacokinetics andclinical efficacy. Haematologica 2006; 91: 634-9.59) Chowdhury P, Saayman UP, Paulus U, et al. Efficacy ofstandard dose and 30 ml/kg fresh frozen plasma in correctinglaboratory parameters of haemostasis in critically ill patients.Br J Haematol 2004; 125: 69-73.60) Casati G. Clinical governance: an ethical appeal or amanagement programme? [editorial]. Blood Transfus 2006;4: 251-64.61) Dzick WH. The NHLBI Clinical Trials Network intransfusion medicine and hemostasis: an overview. J ClinApher 2006; 21: 57-9.Received: 24 April 2007 – Revision accepted: 4 June 2007Correspondence: Dr. Giancarlo Maria Liumbruno,Viale Italia, 19 – 57126 Livorno, Italye-mail: giancarlo@liumbruno.it84Blood Transfus 2007; 5: 75-84 DOI 10.2450/2007.0015-07075-84_Liumbruno.p65 8405/07/2007, 11.01
Plasma derivatives and strategies for reaching self-sufficiencyin Liguria: the role of the Transfusion Medicine Serviceof the Gaslini InstituteLaura Bocciardo 1 , Marina Martinengo 1 , Diego Ardenghi 1 , Tullia Emanueli 2 ,Enrica Oliva 3 , Gino Tripodi 11Servizio di Immunoematologia e Medicina Trasfusionale, Istituto Giannina Gaslini,Genova2Servizio di Farmacia, Istituto Giannina Gaslini, Genova3CRCC Liguria, Genova, ItalyORIGINAL ARTICLEBackground. Since 2002, Liguria has been part of the Interregional Agreement on Plasma Derivatives(AIP) stipulated among some Regions of north Italy with the aim of contributing to self-sufficiency of theinterregional system through exchanges between the facilities lacking products and those with an excess.In Liguria , the management of plasma derivates is entrusted to the Regional Centre for Co-ordination andCompensation (CRCC) which, with strategies of compensation, tries to guarantee that the needs forplasma derivates are covered in the hospitals in its territory.The Services of Immunohaematology and Transfusion Medicine (SIMT) have a goal of increasing theproduction of plasma in order to participate actively in achieving regional self-sufficiency.Methods. The SIMT of the G. Gaslini Institute introduced some strategies aimed at reaching this goal.The increase in the number of donations made with a cell separator, the introduction of multicomponentdonations of plasma and platelets and the collection of high concentration platelet concentrates led to aconsiderable increase category A plasma sent for fractioning. Finally, the implementation of shared guidelineson the use of blood components enabled the clinical use of the plasma collected to be kept under control.Results and conclusions. The analysis of the trends of consumption of the most widely used plasmaderivatives showed an increase in the overall demands, which can be attributed to the paediatric focus ofour hospital and to its highly specialised wards.On the basis of the industrial technical yield, it was possible to calculate the theoretical coverage of therequirements for plasma: this highlighted a better theoretical coverage for albumin but a shortfall ofintravenous immunoglobulins. The amount of plasma necessary to meet the theoretical needs was calculatedfor each plasma derivative, revealing that the derivative requiring the greatest volume of plasma is intravenousimmunoglobulins. This finding confirms the change in the “driving product”: it is now the consumption ofintravenous immunoglobulins that determines the amount of plasma that is sent for industrial processing.Key words: plasma production; blood derivatives.IntroductionSince 2002, the Region of Liguria has been part of anInterregional Agreement on Plasma Derivatives (AIP) 1stipulated in 1998 among some Regions of north Italy(Veneto, Abruzzo, Emilia Romagna, Friuli Venezia Giulia)and the Autonomous Provinces of Trento and Bolzano,and subsequently joined by Valle d'Aosta, Tuscany,Basilicata and Umbria.Veneto, as the leading Region, manages the processingof plasma and the production of blood derivatives of allthe Regions belonging to the AIP, through the RegionalCo-ordination for Transfusion Activities (CRAT).It stipulates a single interregional agreement with thepharmaceutical industry.The Region of Veneto is also in charge of thedistribution of therapeutic blood derivatives to the otherBlood Transfus 2007; 5: xx-xx DOI 10.2450/2007.0033-06© SIMTI Servizi Srl85085-92_bocciardi.p65 8505/07/2007, 11.20
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