HAEMOTHERAPY ANALYSIS: THE TEACHING HOSPITAL OLOMOUC IN 2006

AIMS
Annual evaluation of blood transfusion preparation administration at the University Hospital Olomouc, Czech Republic as a contribution to the European Union haemovigilance system.


METHODS
Analysis of blood transfusion preparations released from the Department of Blood Transfusion of the above university hospital and laboratory examination results in receivers of these products for the year 2006. Total hospital consumption and usage in particular medical disciplines in the hospital were assessed.


RESULTS
Red cell concentrates: in total 14 347 TU (deleucotised in 20.4 %). Departments according to usage: surgery, haematooncology, anaesthesiology and surgery intensive care department, and internal medicine department. Haemoglobin levels were above 100 g/L before blood transfusion administration in 24 % of cases. Platelets: in total 1 712 TU (100 % manufactured by apheresis, 56 % deleucotised). Platelet counts below 20 x 10(9)/L were found in all cases before platelet concentrate administration. Plasma: in total 5 959 TU to 1 297 of patients. Departments according to usage: surgery, anaesthesiology and surgery intensive care department, internal medicine and haematooncology. Two hundred and forty nine cases without coagulation parameter monitoring and 333 (25.67 %) patients with only 1 TU of administered plasma were found.


CONCLUSIONS
The incorrect indications for red cell transfusion preparations were found in eleven patients with haemoglobin levels above 130 g/L. Underdosing in 25.67 % of plasma administrations signifies dubious indications in these cases. Implementation of the haemovigilance system in practice is now mandatory for the Czech Republic after joining the European Union. Therefore more precise data and analysis of questionable cases with further education of staff in clinical departments are essential for the haemovigilance principle to be applied on a hospital basis in the Czech Republic.


INTRODUCTION
The Council of Europe's Recommendation on haemovigilance came into operation after admission of the Czech Republic into the European Union 1,2 .Public notice 411/2004 collection is the valid legislative norm clarifying the rules for blood processing in the Czech Republic 3 .This document determines the obligatory supervision of all activities connected to blood transfusion products and the application of blood derivates aimed to enhance the safety of all processes involved.Integral parts of the haemovigilance system are defi nitions of the criteria for haemotherapy indications and checking their adherence.
Blood donor selection criteria are strict in the processing of blood transfusion components.In all donors the blood count, serological and immunohaematological tests are carried out.The qualitative parameters evaluation according to national standards is continuously provided as well as monitoring of transfusion preparations.The plasma for clinical use is released after a six-month quarantine period and the quality of product storage is ensured 4 .Defi nitions of haemotherapy indication criteria are integral parts of haemovigilance.
Each hospital that uses transfusion preparations has an obligation to constitute a hospital transfusion committee guaranteeing effi cient haemotherapy because criteria for the use of blood components are not currently unifi ed in the Czech Republic.Members of the committee defi ne local hospital guidelines and pursue guideline adherence.Departments of blood transfusion supply the data for haemotherapy analysis.

AIM OF THE STUDY
The target of the study was evaluation of a spectrum of blood transfusion preparations (BTP) and their usage in the University Hospital Olomouc.The University Hospital Olomouc is directly administered by the Ministry of Health and in 2006 the hospital had bed care capacity 1 433 of beds, the number of hospitalised patients 44 191, major surgeries 16 579.Total hospital consumption and usage in particular medicinal disciplines were assessed.

METHOD
Analysis of released blood transfusion preparations and evaluation of laboratory examinations according to the date of their administration: haemoglobin levels in the case of erythrocyte BTP administration and platelet count before platelet concentrate administration, international normalized ratio (INR) in the case of plasma administration.

RESULTS
A total number of 27 931 tests for blood compatibility were provided and 21 638 transfusion units (TU) of transfusion preparations were administered at the University Hospital Olomouc in 2006.Men recipients received 12 439 and women 9 199 of TU.The most frequent consumption of BTP was in the age group from 65 to 69 years (2 870 TU per year), the lowest consumption was in the age category from 10 to 14 years (94 TU per year).24.5 % of patients Hb 91-100 g/l: 15 % of patients Hb above 100 g/l: 24 % of patients Blood count examinations before red cells transfusion preparations administration were provided in all cases.There were funded red cell transfusions in eleven patients with haemoglobin levels above 130 g/L.

Platelets
Platelet concentrates produced by apheresis in 100 % of cases were administered.
Total administered amount 1 712 TU (platelet apheresis 746 TU, platelet apheresis deleucotised 966 of TU i.e. deleucotised 56 %) The platelets count were examined before platelet concentrate administration in all cases.There were platelet count values below 20 x 10 9 /L in all cases.

Plasma
Total administered plasma amount 5 959 TU to 1 297 patients.

CONCLUSIONS
The incorrect indications for red cell transfusion preparations were found in eleven patients with haemoglobin levels above 130 g/L.In 25.67 % of plasma administration there were low dosages (underdosing).This signalizes dubious indication for plasma administration in these cases.Slightly higher plasma/erythrocyte ratios in anaesthesiology and surgery care departments refl ects the infl uence of a few cases with massive plasma consumption.
The quality of hospital haemotherapy is a cross-disciplinary problem.It is possible to infl uence it in two diff erent ways.On the one hand the adherence to conditions of good clinical practice during transfusion preparation production in blood transfusion departments is essential.On the other hand constant evaluation of data targeting haemotherapy gained from particular clinical departments and feedback of the analysis of results in clinical practice are necessary.Both procedures are conditions for haemovigilance application into practice.The aim of these analyses is to protect non-indicated administration of transfusion preparations.