Blood components have been in use in clinical practice for many decades now. In spite of fairly clear guidelines regarding their use, inappropriate prescriptions for components are still rampant. We undertook this work to assess the appropriateness of fresh frozen plasma (FFP) transfusions in our hospital. A prospective audit of 504 transfusion orders for 1761 FFP units was conducted over a 6-month period which was followed by a re-audit of 294 FFP prescriptions for 961 units. In the initial audit, we identified 304 (60.3%) prescriptions which were inappropriate according to the British Committee for Standardization in Hematology (BCSH) guidelines. The re-audit performed after an educational campaign among clinicians showed a reduction in inappropriate requests by 26.6%. The specific areas of misuse were FFP transfusions in patients with hypoproteinaemic states (40.5%), anaemia (36.5%), bleeding without coagulation factor deficiency (10.2%) and volume depletion (9.2%). A significant 50.3% of requests in the initial audit and 38.4% in the re-audit were for single- or two-unit transfusions, which were subtherapeutic. FFP transfusions carry the same risks to the patients as any other blood component. Prescribers of these transfusions need to be aware of the clinical setting where their use is appropriate. Local hospital transfusion committees can play a vital role in overseeing transfusion practices to ensure optimal use of blood/component therapy.
Oral anticoagulation therapy is affected by the drug used, intensity of anticoagulation, physician's experience, patient compliance, laboratory testing and patient education. Patient education is a key factor in optimal anticoagulation and safety in patients on oral anticoagulant therapy. This study was done to assess the knowledge of patients regarding oral anticoagulant therapy in the outpatient setting. This prospective study was done over 2 months in 101 patients on outpatient oral anticoagulant therapy. A 20-point questionnaire on various aspects of oral anticoagulation therapy was administered to assess their knowledge. The answers were graded on a scale of 0-1. Scores were then added up to quantify the knowledge status in each patient. Descriptive statistics and Student's t test was used to analyse the data. The mean knowledge score among patients was 9.4/18 (52.2 %). More than half (52.8 %) of the patients had a score of <9. More than half (54.4 %) of the patients had adequate knowledge-(>80 % score-5.5/7) about the critical (must know) questions regarding OAT. Patients with age ≥60 years had lower mean scores compared to those <60 years of age (p = 0.028). Illiteracy was also associated (p < 0.0001) with poor scores. There are significant lacunae in the knowledge about oral anticoagulation among patients on outpatient treatment. Older age and illiteracy were associated with poor knowledge among patients. More emphasis needs to be given to the vital aspect of patient education to make this therapy safer for patients.
Worldwide, most hematology laboratories have now changed over from the labor intensive manual methods of testing to 3-or 5-part differential automated hematology analyzers. Although laboratory personnel and hematopathologists handling the automated data are familiar with the basic interpretation and benefits of numerical data, the seemingly complex graphical representation of the red cell data in the form of histograms and cytograms is often ignored. At times, these can provide vital information that may not even be apparent in the automated numerical data. 1 Characteristic red cell cytogram patterns indicative of common hematological conditions are being presented in this paper.
Materials and MethodsThis study presents a compilation of characteristic red cell cytograms generated by Advia-120 (Siemens Healthcare Diagnostics, Deerfield, IL), 2 a 5-part differential system (Technicon H1 series) used in the hematology laboratory of a tertiary care teaching institution. The cytograms have been compiled over a 2-year period from blood samples (approximately 200 per day) received for routine complete blood counts (CBC) in the laboratory. Approximately 140,000 cytograms have been analyzed during the study period. Single test requests were not run through the Advia-120 and were done manually. Dipotassium ethylenediaminetetra-aceticacid (EDTA) blood was used for testing and the tubes for sample collection were prepared in-house.
AbstractBackground: Graphical data output from automated hematology analyzers, especially those related to red blood cells, have been traditionally ignored in favor of the more frequently used numerical values. This study presents characteristic red cell cytograms generated by Advia-120, a 5-part automated hematology analyzer, as seen in common hematological conditions.
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