REQUESTS OF APHARESIS PLATELET CONCENTRATES IN THE TUNISIAN NATIONAL

CENTER OF BLOOD TRANSFUSION

ASMA RYM BEN ROMDHANE

MAY 2012

INTRODUCTION

In Tunisia: Legislative recommendations 49/05 Manual of procedures for managing blood and its

components :

National guidelines for platelet component requests

The Aim: Evaluation of platelet requests by determining their compliance to these national guidelines

MATERIALS & METHODS

Prospective study

Extended on 20 days (02/03/12 to 21/03/12)

Every request for platelet transfusion from different public and private institutions in the capital was daily analyzed.

RESULTS

•20 DAYS•140 REQUESTS FOR PLATELET TRANSFUSION 

•135 APC DISTRIBUTED•=> 7,5 + 4 APC/DAY

•63 TRANSFUSED PATIENTS•=>2,14 APC/ PATIENT

• AVRAGE AGE = 38 years [1,25 - 96] •SEX RATIO (M/F) = 2,85

GENERAL FEATURES

0%

50%

100%

DATE OF BIRTH MISS-INGtégorie 1; Série 1; 80.2%

AGE MISSING; Série 1; 34.0%

DATE OF BIRTH/AGE

Missing; Série 1; 14.0%

GENDER MISS-ING; Série 1;

7.0%

WEIGHT MISS-ING; Série 1;

99.0%

DIAGNOSIS MISSING;

Série 1; 4.2%

PLATLET COUNT MISS-ING; Série 1;

51.0%

NON CONFORMITIES RATE

RATE OF PLATLET&

APC TRANSFUSION

Platelet Count 0%

20%

40%

60%

80%

100%

Platelet Count ; Missing;

51%

Platelet Count ; Present;

49%PresentMissing

?

RATE OF PLATLET&

APC TRANSFUSION

0%10%20%30%40%50%60%70%80%90%

100%

PROPHLACTIC TRANSFUSION

CURATIVE TRANSFUSION

INDETERMINED RATE OF PLATLET

82%

18%

51%

14 041/µL

?

17 142/µL[2000-40 000/μL]

[3000-43 000/μL]

APC CONSUMPTION

PUBLIC SECTOR PRIVATE SECTOR0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

PUBLIC SECTOR;

Série 1; 93%

PRIVATE SECTOR;

Série 1; 7%

APC CONSUMPTION IN THE PUBLIC SECTOR

CNGMO AOH OTHERS0%

10%

20%

30%

40%

50%

60%

70%

80%

CNGMO; Série 1; 79%

AOH; Série 1; 16%

OTHERS; Série 1; 5%

COMMENTS

Our results show poor compliance with the current national guidelines.

Clinical information were often missing on the prescription. Some of them were part of legislative requirements or recommendations

CIRCULAR 49/05 FOR BLOOD SAFETY

« Any request for blood or its derivatives will be honored only on written medical prescription. Any request non conform to the model in Annex I will be rejected »

« Toute demande de sang ou de ses dérivés ne sera honorée que sur prescription médicale écrite. Toute demande non conforme au modèle de l’annexe I sera rejetée. »

WEIGHTPLATLET COUNT

COMMENTS

In addition to circular 49/05 recommendations, Manual of procedures for managing blood and its components states that platelet request must include :

The patient’s weight

The platlet count Our study: 99% weight were not 51% platelet count

mentioned

COMMENTS

Reasons explaining this high rate of non-compliance:

Unawareness of the importance of these information in the platelet component prescription

Lack of communication between the hospital transfusion committees / NCBT

A well filled request allows the distributor to deliver the product that best suits the patient’s clinical situation

BEST ADVICE TRANSFUSION

COMPARISONAudit Of The Use Of Platelet Transfusions In The Uk (2007)

Our Study (2011)

Transfused Patient

Institution Number

Period

4421

168

3 Months

63

9

2 Months

Global Non Compliance To The Audit

43% 99%

Diagnosis Missing 7% 4,2%

Platlet Count Missing

Cardiology: 17% 29% Hematology: 32%

Critical care: 21%

51%

Prophylactic Transfusion 57% 82%

COMMENTS

82% Prophylac

tic APC Transfusi

on

Excessive use of a

valuable and

Expensive product

Improve APC

Availability

Better compliance with NG : An APC better use

RECOMMENDATIONS&

CONCLUSION

Guidelines: Written local guidelines, given by hospital transfusion committees, must be available in all clinical specialties where APC are transfused

Communication: Hospital transfusion committees/ NCBT

Education: Training must be provided to physicians

Audit: Hospitals should carry out regular audits of compliance with these guidelines

Improve optimization of APC use

THANK YOU FOR YOUR ATTENTION