Hemovigilance system implementation at the University Hospital of Uruguay
Abstract
Introduction: hemovigilance is a tool used to improve the quality of blood transfusion, and it mainly focuses on patients’ safety.
Objective: to identify and learn about the characteristics and frequency of transfusion related negative effects and to devise a hemovigilance system to be applied in our hospital.
Method: we conducted an observational, descriptive, longitudinal and prospective study, and all patients who received hemocomponents at the university hospital in a two year period (2014-2015) were followed up during 12 months. All reactions related to transfusion, adverse incidents and near misses were recorded.
Results: 58 transfusion related adverse reactions were recorded, what represented 8,3‰ of the transfused hemocomponents.
Conclusion: the detailed analysis of adverse reactions showed procedures to improve results may be adopted and allowed for the implementation of corrective and preventive measures. The hemovigilance system used is simple in terms of its structure and easy to apply.
References
(1) Leach Bennett J, Blajchman MA, Delage G, Fearon M, Devine D. Proceedings of a consensus conference: risk-based decision making for blood safety. Transfus Med Rev 2011; 25(4):267-92.
(2) Stein J, Besley J, Brook C, Hamill M, Klein E, Krewski D, et al. Risk-based decision-making for blood safety: preliminary report of a consensus conference. Vox Sang 2011; 101(4):277-81.
(3) Dzik WH. Emily Cooley Lecture 2002: transfusion safety in the hospital. Transfusion 2003; 43(9):1190-9.
(4) de Vries RR, Faber JC, Strengers PF; Board of the International Haemovigilance Network. Haemovigilance: an effective tool for improving transfusion practice. Vox Sang 2011; 100(1):60-7.
(5) Muñiz-Díaz E, León G, Torres O. Manual iberoamericano de hemovigilancia. Barcelona: Texto y Color 65, 2015.
(6) 6. Wiersum-Osselton JC, Wood E, Bolton-Maggs PHB, Schipperus MR. Definitions in haemovigilance: guiding principles and current state of development of international reference definitions. ISBT Sci Ser 2014; 9(1):91-7.
(7) Wood EM, Stevenson L, Bielby L, Wiersum-Osselton JC. Haemovigilance: concepts and frameworks. ISBT Sci Ser 2014; 9(1):86-90.
(8) Noel L, Debeir J, Cosson A. The French haemovigilance system. Vox Sang 1998; 74(Suppl 2):441-5.
(9) Uruguay. Ministerio de Salud Pública. Ministerio de relaciones Exteriores. Decreto Nº 385/000 Mercosur. Reglamento Técnico de Medicina Transfusional. Montevideo, 26 de diciembre de 2000.
(10) Uruguay. Presidencia de la República. Decreto Nº 194/986. Creación de la Comisión Permanente para el estudio de reacciones adversas por transfusiones. Montevideo, 8 de abril de 1986.
(11) Faber JC. Haemovigilance: definition and overwied of current hemovigilance systems. Transfus AlternTransfus Med 2003; 5(1):237-45.
(12) Stainsby D. Hemovigilance: not just a register. The impact of transfusion safety iniciative in UK. ISBT Sci Ser. 2007; 2(1):189-93.
(13) International Society of Blood Transfusion. Working party on haemovigilance: proposed standar definitions for surveillance of non infectious adverse transfusion reactions 2013. Amsterdam: IHN, 2013. Disponible en: http://www.isbtweb.org/fileadmin/user_upload/Proposed_definitions_2011_surveillance_non_infectious_adverse_reactions_haemovigilance_incl_TRALI_correction_2013.pdf. Consulta: 16 agosto 2015.
(14) Koh MBC, Alcantara R. Transfusion errors and management. ISBT Sci Ser 2009; 4(2):216-20.
(15) Callum JL, Kaplan HS, Merkley LL, Pinkerton PH, Rabin Fastman B, Romans RA, et al. Reporting of near-miss events for transfusion medicine: improving transfusion safety. Transfusion 2001; 41(10):1204-11.
(16) Asociación Argentina de Hemoterapia e Inmunohematología. Manual técnico: traducción al español de la 17a edición de la American Association of Blood Banks. 17 ed. Buenos Aires: AAHI, 2012.
(17) Bolton-Maggs PH, Cohen H. Serious Hazards of Transfusion (SHOT) haemovigilance and progress is improving transfusion safety. Br J Haematol 2013; 163(3):303-14.
(18) Sousa Neto A Lemos de, Barbosa MH. Incidentes transfusionais imediatos: revisão integrativa da literatura. Acta Paul Enferm 2012; 25(1):146-50.
(19) Chung KW, Harvey A, Basavaraju SV, Kuehnert MJ. How is national recipient hemovigilance conducted in the United States? Transfusion 2015; 55(4):703-7.
(20) Reesink HW, Panzer S, Gonzalez CA, Lena N, Muntaabski P, Gimbatti S, et al. Haemovigilance for the optimal use of blood products in the hospital. Vox Sang 2010; 99(3):278-93.
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