1. REQUESTS OF APHARESIS PLATELET CONCENTRATES IN THE TUNISIAN NATIONAL CENTER OF BLOOD TRANSFUSION ASMA RYM BEN ROMDHANE MAY 2012

2. 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

3. M ATERIALS & 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.

4. RESULTS

5. 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

6. NON CONFORMITIES RATE

7. R ATE OF PLATLET & APC TRANSFUSION

8. ? 17 142/µL [2000-40 000/μL] [3000-43 000/μL]

9. APC CONSUMPTION

10. APC CONSUMPTION IN THE PUBLIC SECTOR

11. 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

12. 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. »

13. WEIGHT PLATLET COUNT

14. 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

15. 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

16. COMPARISON Audit 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%

17. COMMENTS 82% Prophylactic APC Transfusion Excessive use of a valuable and Expensive product Improve APC Availability Better compliance with NG : An APC better use

18. R ECOMMENDATIONS & 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

19. THANK YOU FOR YOUR ATTENTION