Current Practice in FFP Preparation and Use in Greece: A National SurveyAspasia Argyrou1, Serena Valsami2, Abraham Pouliakis3, Maria Gavalaki4, Antonis Aggelidis5, Vasiliki Voulgaridou6, Vasiliki Pliatsika6, Theofanis Adraktas4, Andreas Papachronis4, Chrysoula Alepi7, Vasiliki Giannopoulou7, Panagiotis Siourounis8, Sofia Tsagia8, Georges Martinis9, Eftihia Kontekaki9, Eleftheria Zervou10, Spiridon Koliofotis11, Elias Kyriakou11, Athina Mougiou12, Lempousi Dimitra12, Afrodite Chairopoulou13, Aggeliki Tsakania13, Maria Baka14, Ioanna Apostolidou14, Dimitra Moschandreou15, Anastasia Livada15, Marianna Politou2, Fragoula Roussinou2, Christina Pappa16, Vasiliki Koika16, Niki Vgontza5, Anthippi Gafou1, Ioanna Dendrinou5, Fotini Sakellaridi17, Lampothea Labrianou17, Zafeiria Alexandropoulou18, Vasiliki Sochali19, Kostas Malekas20, Areti Skordilaki21, Georgia Kakava22, Konstantinos Lebesopoulos23, Konstantinos Stamoulis24, Elisavet Grouzi151Agioi Anargyroi Hospital, Department of Blood Transfusion, Athens, Greece
2National and Kapodistrian University of Athens, Aretaieion University Hospital, Medical School, Hematology Laboratory-Blood Bank Department, Athens, Greece
3National and Kapodistrian University of Athens, Attikon University Hospital, Second Department of Pathology, Athens, Greece
4Laiko General Hospital, Department of Blood Transfusion, Athens, Greece
5Konstantopouleio-Neas Ionias General Hospital, Department of Blood Transfusion, Athens, Greece
6AHEPA, University Hospital, Department of Blood Transfusion, Thessaloniki, Greece
7General Hospital Tzaneio, Department of Blood Transfusion, Piraeus, Greece
8Agios Panteleimon General Hospital of Nikaia, Department of Blood Transfusion, Athens, Greece
9University Hospital, Department of Blood Transfusion, Alexandroupolis, Greece
10University Hospital, Department of Blood Transfusion, Ioannina, Greece
11Attikon University Hospital, Laboratory of Hematology and Blood Bank Unit, Athens, Greece
12University Hospital, Blood Transfusion Center, Patras, Greece
13Sismanogleio General Hospital, Department of Blood Transfusion, Athens, Greece
14Thriasio General Hospital, Department of Blood Transfusion, Athens, Greece
15Saint Savvas Oncology Hospital, Department of Blood Transfusion and Clinical Hemostasis, Athens, Greece
16General Hospital, Department of Blood Transfusion, Korinthos, Greece
17General Hospital, Department of Blood Transfusion, Rhodes, Greece
18Asklipieio Voulas General Hospital, Department of Blood Transfusion, Athens, Greece
19General Hospital, Department of Blood Transfusion, Giannitsa, Greece
20General Hospital, Department of Blood Transfusion, Livadia, Greece
21General Hospital, Department of Blood Transfusion, Chania, Greece
22Pammakaristos General Hospital, Department of Blood Transfusion, Athens, Greece
23Amalia Fleming General Hospital, Department of Blood Transfusion, Athens, Greece
24Hellenic National Blood Transfusion Center, Athens, Greece
Objective: Fresh frozen plasma (FFP) transfusion is widely used in modern clinical settings. Practices regarding its use vary due to lack of guidelines from randomized trials. The aim of this study was to assess both the current practices regarding FFP production, use, and wastage and the implementation of quality control (QC), female donor plasma production policies, and use of pharmaceutical hemostatic agents in Greece.
Materials and Methods: The study was conducted during February-April 2018. For the first part of the study, data including FFP transfusion indication, hospital department, diagnosis, FFP units/transfusion episode, ABO compatibility, blood donor’s sex, and reasons for discarding were collected. For the second part, questionnaire data were analyzed.
Results: According to data from 20 Greek hospitals, 12655 FFP units were transfused to 2700 patients during 5069 transfusion episodes in the studied period of time. Most patients were hospitalized in internal medicine, general surgery, and intensive care unit departments. Each patient received on average 4.69 units (2.5 units/episode). Transfusion requests were in accordance with international guidelines in 63.44% of cases and 99.04% of the units were given to ABO-identical patients. Main reasons for discarding included failure to meet quality requirements (30.06%), female donors (22.17%), and other causes (27.26%). Among 96.9% of all transfusion services across the country, 28.26% perform QC according to the directions of the European Directorate for the Quality of Medicines & Health Care and 68.83% discard plasma from female donors. Pharmaceutic hemostatic agents are used in 37.23% of the hospitals.
Conclusion: This is the first national survey regarding FFP production and transfusion in Greece. Staff of internal medicine, general surgery, and ICU departments, where most FFP-transfused patients are hospitalized, should be regularly involved in training on contemporary transfusion guidelines. Upcoming centralization of FFP production and inventory management could help in homogenizing practices regarding FFP use and improve product quality. Strengthening the use of pharmaceutic hemostatic agents could improve patients’ management.
Keywords: Transfusion medicine, Acquired coagulopathies, Replacement therapies, Blood coagulation
Yunanistan’da TDP Hazırlama ve Kullanımında Mevcut Uygulama: Ulusal Bir AnketAspasia Argyrou1, Serena Valsami2, Abraham Pouliakis3, Maria Gavalaki4, Antonis Aggelidis5, Vasiliki Voulgaridou6, Vasiliki Pliatsika6, Theofanis Adraktas4, Andreas Papachronis4, Chrysoula Alepi7, Vasiliki Giannopoulou7, Panagiotis Siourounis8, Sofia Tsagia8, Georges Martinis9, Eftihia Kontekaki9, Eleftheria Zervou10, Spiridon Koliofotis11, Elias Kyriakou11, Athina Mougiou12, Lempousi Dimitra12, Afrodite Chairopoulou13, Aggeliki Tsakania13, Maria Baka14, Ioanna Apostolidou14, Dimitra Moschandreou15, Anastasia Livada15, Marianna Politou2, Fragoula Roussinou2, Christina Pappa16, Vasiliki Koika16, Niki Vgontza5, Anthippi Gafou1, Ioanna Dendrinou5, Fotini Sakellaridi17, Lampothea Labrianou17, Zafeiria Alexandropoulou18, Vasiliki Sochali19, Kostas Malekas20, Areti Skordilaki21, Georgia Kakava22, Konstantinos Lebesopoulos23, Konstantinos Stamoulis24, Elisavet Grouzi151Agioi Anargyroi Hospital, Department of Blood Transfusion, Athens, Greece
2National and Kapodistrian University of Athens, Aretaieion University Hospital, Medical School, Hematology Laboratory-Blood Bank Department, Athens, Greece
3National and Kapodistrian University of Athens, Attikon University Hospital, Second Department of Pathology, Athens, Greece
4Laiko General Hospital, Department of Blood Transfusion, Athens, Greece
5Konstantopouleio-Neas Ionias General Hospital, Department of Blood Transfusion, Athens, Greece
6AHEPA, University Hospital, Department of Blood Transfusion, Thessaloniki, Greece
7General Hospital Tzaneio, Department of Blood Transfusion, Piraeus, Greece
8Agios Panteleimon General Hospital of Nikaia, Department of Blood Transfusion, Athens, Greece
9University Hospital, Department of Blood Transfusion, Alexandroupolis, Greece
10University Hospital, Department of Blood Transfusion, Ioannina, Greece
11Attikon University Hospital, Laboratory of Hematology and Blood Bank Unit, Athens, Greece
12University Hospital, Blood Transfusion Center, Patras, Greece
13Sismanogleio General Hospital, Department of Blood Transfusion, Athens, Greece
14Thriasio General Hospital, Department of Blood Transfusion, Athens, Greece
15Saint Savvas Oncology Hospital, Department of Blood Transfusion and Clinical Hemostasis, Athens, Greece
16General Hospital, Department of Blood Transfusion, Korinthos, Greece
17General Hospital, Department of Blood Transfusion, Rhodes, Greece
18Asklipieio Voulas General Hospital, Department of Blood Transfusion, Athens, Greece
19General Hospital, Department of Blood Transfusion, Giannitsa, Greece
20General Hospital, Department of Blood Transfusion, Livadia, Greece
21General Hospital, Department of Blood Transfusion, Chania, Greece
22Pammakaristos General Hospital, Department of Blood Transfusion, Athens, Greece
23Amalia Fleming General Hospital, Department of Blood Transfusion, Athens, Greece
24Hellenic National Blood Transfusion Center, Athens, Greece
Amaç: Taze donmuş plazma (TDP) transfüzyonu modern klinik ortamlarda yaygın olarak kullanılmaktadır. Kullanım ile ilgili uygulamalar, randomize çalışmalardaki kılavuzların eksikliğinden dolayı değişiklik gösterir. Bu çalışmanın amacı, Yunanistan’da TDP üretimi, kullanımı ve israfına ilişkin hem mevcut uygulamaları hem de kalite kontrolünün uygulanmasını, kadın donör plazma üretim politikalarını ve farmasötik hemostatik ajanların kullanımını değerlendirmekti.
Gereç ve Yöntem: Çalışma, Şubat-Nisan 2018’de gerçekleştirildi. Çalışmanın ilk bölümü için TDP transfüzyon endikasyonu, hastane bölümü, tanı, TDP üniteleri/transfüzyon sayısı, ABO uyumluluğu, kan vericinin cinsiyeti ve dışlama nedenleri gibi veriler toplandı. İkinci bölüm için anket verileri analiz edildi.
Bulgular: Yirmi Yunan Hastanesi’nden alınan verilere göre, incelenen zaman diliminde 5069 transfüzyon sırasında 12655 TDP ünitesi 2700 hastaya nakledildi. Hastaların çoğu dahiliye, genel cerrahi ve yoğun bakım ünitelerinde yatırıldı. Her hasta ortalama 4,69 ünite (2,5 ünite/transfüzyon) aldı. Olguların %63,44’ünde transfüzyon talepleri uluslararası yönergelere uygun olup, ünitelerin %99,04’ü ABO özdeş hastalara verilmiştir. Dışlamanın temel nedenleri arasında kalite gereksinimlerini karşılamama (%30,06), kadın donörler (%22,17) ve diğer nedenler (%27,26) yer aldı. Ülke çapındaki tüm transfüzyon hizmetlerinin %96,9’u arasında, %28,26’sı Avrupa İlaç ve Sağlık Hizmetleri Kalitesi Direktörlüğü’nün talimatlarına göre kalite kontrol gerçekleştirmekte ve %68,83’ü kadın donörlerden plazmayı dışlamaktadır. Hastanelerin %37,23’ünde farmasötik hemostatik ajanlar kullanılmaktadır.
Sonuç: Bu çalışma, Yunanistan’da TDP üretimi ve transfüzyonu ile ilgili ilk ulusal ankettir. TDP ile transfüzyon yapılan hastaların çoğunun hastaneye kaldırıldığı dahiliye, genel cerrahi ve yoğun bakım ünitesi departmanlarının personeli, çağdaş transfüzyon kılavuzları konusunda düzenli olarak eğitime dahil edilmelidir. TDP üretiminin ve envanter yönetiminin yakında merkezileştirilecek olması, TDP kullanımına ilişkin uygulamaların homojenleştirilmesine ve ürün kalitesinin iyileştirilmesine yardımcı olabilir. Farmasötik hemostatik ajanların kullanımının güçlendirilmesi, hastaların yönetimini iyileştirebilir.
Anahtar Kelimeler: Transfüzyon tıbbı, Edinilmiş koagülapatiler, Yerine koyma tedavileri, Kan pıhtılaşması
Aspasia Argyrou, Serena Valsami, Abraham Pouliakis, Maria Gavalaki, Antonis Aggelidis, Vasiliki Voulgaridou, Vasiliki Pliatsika, Theofanis Adraktas, Andreas Papachronis, Chrysoula Alepi, Vasiliki Giannopoulou, Panagiotis Siourounis, Sofia Tsagia, Georges Martinis, Eftihia Kontekaki, Eleftheria Zervou, Spiridon Koliofotis, Elias Kyriakou, Athina Mougiou, Lempousi Dimitra, Afrodite Chairopoulou, Aggeliki Tsakania, Maria Baka, Ioanna Apostolidou, Dimitra Moschandreou, Anastasia Livada, Marianna Politou, Fragoula Roussinou, Christina Pappa, Vasiliki Koika, Niki Vgontza, Anthippi Gafou, Ioanna Dendrinou, Fotini Sakellaridi, Lampothea Labrianou, Zafeiria Alexandropoulou, Vasiliki Sochali, Kostas Malekas, Areti Skordilaki, Georgia Kakava, Konstantinos Lebesopoulos, Konstantinos Stamoulis, Elisavet Grouzi. Current Practice in FFP Preparation and Use in Greece: A National Survey. Turk J Hematol. 2021; 38(1): 22-32
Corresponding Author: Aspasia Argyrou, Greece |
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