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Biomedical subjects

J Georgsen

Publications and source records attributed to J Georgsen.

At least 19 recordsLinked to original sources

Monitoring transfusion practice--a computerized procedure.

As the description of transfusion practice over time requires the handling of massive amounts of data, and because the majority of records have until now been paper-based, little is known about the epidemiology of blood transfusion. Furthermore, most previous studies have collected data manually from patient records or from computerized registers created solely for study purposes. We describe a procedure for monitoring transfusion practices based exclusively upon the collection of data from the existing computerized registers. During the calendar years 1997 and 1998, more than 750 000 data records were collected from the blood transfusion registers, diagnosis and procedure registers, and clinical biochemistry registers at two university hospitals. Linking of the data required a unique and consistent identification of all data records. This was made possible by the national Personal Identification Number. In this way more than 98% of all transfusions could be identified and approximately 95% (77 950) could be connected to a principal diagnosis. The described procedure creates new opportunities for studies of transfusion practices both on a large scale and in richness of detail, and we propose to establish a network where transfusion practices data are available and comparable for individual departments, hospitals, whole regions, and possibly nations.

Blood Transfusion↗

[Blood donors at the county of Funen. Status based on more than five years of experience, 1995-2000].

INTRODUCTION: The Danish blood donor organisation is considered to be one of the best organised in the world. At the same time, Denmark has very high numbers of blood donations and blood transfusions, compared to the number of inhabitants. In recent years, pressure has been put on the donor organisation, owing to a decline in the number of donors and because new treatment modalities and other initiatives take blood transfusion for granted. MATERIAL AND METHODS: Information from the electronic databases of the County of Funen Transfusion Service on all blood donors in the county and its donor organisations from 1995 to September 2000 was extracted and analysed. RESULTS: In September 2000, the County of Funen had 21,087 active blood donors organised in eight bodies, i.e. 4% of the inhabitants. There are significant differences between these bodies, but common to all is a relative lack of donors between the age of 18 and 35 years. Each year about 10% of the donors withdraw, which is equal to 14,127 donors in the period analysed. This withdrawal is only partly balanced by 7820 new donors, with the result that the total number of donors in the county is declining by an average of 1100 donors a year. DISCUSSION: Several possibilities for action are proposed, for instance intensive recruitment campaigns, mobile blood drawing units, a change in the opening hours of blood banks, optimisation of the stocks, but, above all, the possibilities of reducing the amount of blood needed for transfusion. The Funen as well as the Danish health authorities must realise that blood for transfusion is no longer in unlimited supply, but in the future will be a rather restricted good.

Adolescent↗

Leukocyte-depletion of blood components does not significantly reduce the risk of infectious complications. Results of a double-blinded, randomized study.

Allogeneic blood transfusions are claimed to be an independent risk factor for postoperative infections in open colorectal surgery due to immunomodulation. Leukocyte-depletion of erythrocyte suspensions has been shown in some open randomized studies to reduce the rate of postoperative infection to levels observed in nontransfused patients. Using a double-blinded, randomized design, we studied the postoperative infection rate in patients undergoing open colorectal surgery transfused with either leukocyte-depleted erythrocyte suspensions (LD-SAGM) or non-leukocyte-depleted erythrocyte suspensions (SAGM). Unselected patients (n 279) were allocated to receive LD-SAGM (n 139) or SAGM (n 140) if transfusion was indicated. Forty-five percent were transfused, yielding 48 patients in the LD-SAGM group and 64 in the SAGM group. Thirteen patients were excluded because they received one type of transfusion in spite of randomization to the other type. No significant differences in the rates of postoperative infections (P=0.5250) or postoperative complications (P=0.1779) were seen between the two transfused groups. Infection rates were 45% and 38% in the transfused groups and 21% and 23% in the nontransfused groups. No significant difference between the transfused groups was seen on any single infectious event, mortality rate, or duration of hospitalization. Leukocyte-depletion of erythrocyte suspensions transfused to patients undergoing open colorectal surgery does not reduce postoperative infection rates.

Aged↗

Outbreak of Hepatitis B among injecting drug users in Denmark.

BACKGROUND: The incidence of hepatitis B is low in Denmark, but injecting drug users (IDUs) remains a high-risk group for this infection. OBJECTIVES: The aim of the study was to describe a hepatitis B outbreak among IDUs by comparing existing registers. Additionally, we wanted to analyze the genetic variation of the hepatitis B virus involved in the outbreak. STUDY DESIGN: In the County of Funen, registers of laboratory diagnosis, hospital records and reports from clinicians to the Medical Officer of Health (MOH) were compared between 1992 and 1998. HBsAg positive sera recovered from the epidemic were sequenced and compared to known HBV strains. RESULTS: We identified 648 cases of hepatitis B of which 51% (332) were acute infections. The laboratory database identified 96% (319/332) of these, 45% (150/332) were admitted to hospital and 38% (127/332) were reported to public health. By capture-recapture analysis based on MOH reports and hospital records the estimated total number of acute cases were 334 (95% C.I. 283-385). We sequenced 75 HBsAg positive samples and identified two very similar strains of genotype D (serotype ayw3) among IDUs involved in the outbreak. CONCLUSIONS: The current surveillance system did not detect the majority of acute hepatitis B cases in County of Funen. We suggest laboratory-based surveillance of hepatitis B to be implemented at a national level as this may identify new outbreaks faster and more complete than the current surveillance system.

Denmark↗

Hepatitis B core antibodies in Danish blood donors: a surrogate marker of risk behaviour.

BACKGROUND AND OBJECTIVES: The aim of this work was to determine the prevalence of antibodies to hepatitis B core antigen (anti-HBc) among Danish blood donors and to correlate this with risk factors for blood-borne and sexually transmitted diseases. MATERIALS AND METHODS: During a 5-month period, 10 862 consecutive donors in the County of Funen were screened for anti-HBc, and repeat-reactive samples were confirmed by supplementary testing. Information on risk factors was assessed by questionnaire in 585 consecutive anti-HBc-negative blood donors and compared with information obtained from confirmed positive donors. RESULTS: The prevalence of confirmed positive anti-HBc among donors was 0.70% (76/10 862, 95% confidence interval [CI]: 0.55-0.87). One donor was positive for anti-HBc immunoglobulin M (IgM); none tested positive for hepatitis B virus (HBV) DNA. In a logistic regression analysis, age, female gender, tattoos and commercial sexual relations, were independent predictive factors for the presence of anti-HBc. CONCLUSION: Anti-HBc is a surrogate marker for previous risk behaviour in the Danish blood donor population. We suggest that screening for anti-HBc may be used among new donors to supplement interviews on risk behaviour.

Adult↗

Monitoring transfusion practices at two university hospitals.

BACKGROUND AND OBJECTIVES: Considering the clinical importance of blood transfusions, the limited knowledge of transfusion practices is remarkable. New methods are needed to elucidate the observed variation of transfusion practices. MATERIALS AND METHODS: All patients transfused or pretransfusion tested (i.e. at risk for blood transfusion) at two tertiary teaching hospitals during the full years of 1997 and 1998 were included in the study. RESULTS: The observed practices contained substantial variance at the level of hospitals. The contributions to the total variance of the different specialities were highly significant, as was the contribution of hospitals to the variance in plasma and platelet transfusions. Significant interactions between hospitals and specialities were observed in transfusion of red cells, plasma and platelets. CONCLUSION: To our knowledge this is the first survey of this size to combine transfusions, diagnoses and biochemical tests, exclusively based on an existing computerized register. The aim is to establish a basis for comparison of local transfusion practices with other commensurate hospitals and regions at a national (and international) level.

Adolescent↗

Prevalence and incidence of bloodborne viral infections among Danish prisoners.

In order to determine the prevalence and incidence of bloodborne viral infections among prisoners, we conducted a prospective study in a Danish medium security prison for males. The prisoners were offered an interview and blood test for hepatitis and human immunodeficiency virus HIV at inclusion as well as at release from prison or end of study. Of 403 prisoners available 325 (79%) participated in the initial survey and for 142 (44%) a follow-up test was available. 43% (140/325) of the participants were injecting drug users (IDUs) of whom 64% were positive for hepatitis B (HBV) and 87% for hepatitis C (HCV) markers. No cases of HIV or human T lymphotropic virus (HTLV) were found. 32% of all prisoners could transmit HBV and/or HCV by blood contact. 70% of IDUs had shared injecting equipment, and 60% had injected inside prison. Only 2% of IDUs were vaccinated against HBV. Duration of injecting drug use, numbers of imprisonments, and injecting in prison were independently and positively associated with the presence of HBV antibodies among IDUs by logistic regression analysis. The HBV incidence was 16/100 PY (95% CI: 2-56/100 PY) and the HCV incidence 25/100 PY (1-140) among injecting drug users (IDUs). We conclude that IDUs in prison have an incidence of hepatitis B and C 100 times higher than reported in the general Danish population. They should be vaccinated against hepatitis B and new initiatives to stop sharing of injecting equipment in and outside prison is urgently needed.

Adult↗

From serological to computer cross-matching in nine hospitals.

In 1991 it was decided to reorganise the transfusion service of the County of Funen. The aims were to standardise and improve the quality of blood components, laboratory procedures and the transfusion service and to reduce the number of outdated blood units. Part of the efficiency gains was reinvested in a dedicated computer system making it possible--among other things--to change the cross-match procedures from serological to computer cross-matching according to the ABCD-concept. This communication describes how this transition was performed in terms of laboratory techniques, education of personnel as well as implementation of the computer system and indicates the results obtained. The Funen Transfusion Service has by now performed more than 100.000 red cell transfusions based on ABCD-cross-matching and has not encountered any problems. Major results are the significant reductions of cross-match procedures, blood grouping as well as the number of outdated blood components.

Blood Banks↗

[Transfusion service of the county of Funen. Organizational and economical aspects of restructuring].

The reorganization of the transfusion service in the County of Funen during the period from 1990 to 1996 is described. The professional responsibility for the transfusion service was delegated to the county's only department with specialists in transfusion medicine. The responsibility for economy and personnel remained decentralized. Standard operation procedures for collection and production of blood components and for blood group serology were standardized resulting in higher quality. The number of collections were reduced from 47,000 to 35,000 in spite of an unchanged number of transfused units (approx. 31,000 per year). The outdating was reduced from 35 to 2%. A computer system was implemented resulting in rationalized flow of work and the introduction of a computer crossmatch. From 1997, when the computer system will have been paid for, the county and the university hospital will gain DKK 1.6 million and DKK 2.0 million per year respectively as a result of the reorganization.

Blood Banks↗

Detection of irregular red cell antibodies: more than 3 years of experience with a gel technique and pooled screening cells.

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate more than 3 years of experience with a gel technique in combination with pooled screening cells for the detection of irregular red cell antibodies. MATERIALS AND METHODS: Conventional serologic methods were used for blood typing, antibody screening and cross-matching until the end of 1992. We introduced the gel technique as a routine assay for antibody detection and identification in 1993. RESULTS: After the tube technique had been abandoned, the number of false-positive antibody screening tests was reduced by 71%, positive antibody screening tests by 33%, enzyme agglutination by 100% and rouleaux reactions and cold-reacting antibodies by more than 50%. There was a 40% increase in first-time detection of clinically relevant antibodies. We saw no increase in delayed haemolytic transfusion reactions. CONCLUSIONS: For the detection of irregular red cell antibodies, pooled screening cells in combination with a gel technique are at least as efficient and safe as a conventional tube technique with unpooled test cells.

Blood Grouping and Crossmatching↗

[Rational transfusion therapy. A study of transfusion practice and possibilities of optimization in elective coronary bypass surgery].

The objective of the study was to evaluate the effect of intervention on physicians' transfusion behavior in elective coronary artery bypass grafting (CABG). We analyzed transfusion data on 176 patients who underwent primary elective CABG during two periods, either before (phase one, n = 102) or after (phase two, n = 74) intervention. The intervention was based on cooperation with the involved department of cardiac surgery, interviews of the surgeons and anaesthesiologists ordering blood, and concurrent audit of transfusion practice using a blood order form. The proportion af patients receiving allogenic transfusions decreased from 90% in phase one to 58% in phase two and the total use of blood components was reduced from an average of 6.3 units/patient to 2.7 units/patient, p < 0.01. Indications for transfusion documented in the medical record increased from 19% in phase one to 63% in phase two. It is concluded that intervention on physicians' transfusion behavior can improve the transfusion therapy in patients who undergo elective CABG.

Adult↗

[Use of fresh frozen plasma in patient treatment. Indications illustrated by a literature review and a study of practice at a university hospital].

We analyzed transfusion data on all patients transfused with fresh frozen plasma (FFP) during two periods of four weeks, before (phase one) and after (phase two) initiation of information and intervention. Information was based on the results of phase one and on information about appropriate use of FFP. The intervention consisted of introducing a new policy: Clinicians had to justify their prescription of FFP to the physician on duty in the blood bank. During phase one, the usage of FFP was 403 units, which decreased to 229 units during phase two (43% reduction). In both phases an unchanged proportion of FFP units (68%) were preceded by coagulation tests. In phase one, only 90 (22.3%) of the instances had documented coagulopathy by laboratory criteria, whereas in phase two the number was 77 (33.6%). A total of 186 (46.4%) FFP units in phase one were considered inappropriately transfused compared to a total of 89 (38.9%) units in phase two. Indications for transfusion were stated for 80 (19.9%) FFP units during phase one increasing to 114 (49.8%) units during phase two. Through information and intervention we were able to reduce the usage of FFP by 43%. The results reveal a need for quality assurance of the use of transfusions with FFP.

Blood Transfusion↗

[Use of blood products in Denmark in 1993. Regional differences and comparison with other Scandinavian and European countries].

In Denmark approximately 396,000 units of blood were collected during 1993 from among approximately 270,000 voluntary non-renumerated blood donors corresponding to about 76 donations per 100 inhabitants. Almost all units (approx. 99%) were fractionated into blood components in the blood banks. Approximately 16,000 erythrocyte units were rejected due to technical errors or quality control, while around 37,000 erythrocyte units were discarded from stock. Only 190 units were transfused as whole blood. In all 327,108 SAG-M erythrocyte suspensions, 70,971 thrombocyte concentrates, 50,161 units of fresh frozen plasma, FFP, and approximately 1700 kg albumin, 100% were transfused, corresponding to 63, 14 and 10 units and 340 g per 1000 inhabitants. When compared to other Scandinavian and European countries, Denmark has a high consumption of erythrocyte components, FFP and albumin for transfusion. The reason why cannot be clarified by available data, but it is not unlikely that Denmark has a more liberal transfusion policy than the other countries. There are considerable differences within Denmark as regards the clinical use of blood products. Counties/regions with university hospitals and regional and/or national functions tend to have a relatively high consumption. However, no information exists on consumption related to demographic parameters or related to hospitals, departments or diagnoses.

Blood Component Transfusion↗