Mie Topholm Bruun

Patient Blood Management in Europe: surveys on top indications for red blood cell use and Patient Blood Management organization and activities in seven European university hospitals.

Patient Blood Management (PBM) in Europe is a working group of the European Blood Alliance with the initial objective to identify the starting position of the participating hospitals regarding PBM for benchmarking purposes, and to derive good practices in PBM from the experience and expertise in the participating teams with the further aim of implementing and strengthening these practices in the participating hospitals.

Prevalence of restless legs syndrome and associated factors in an otherwise healthy population: results from the Danish Blood Donor Study

OBJECTIVE Restless legs syndrome (RLS) is a neurological sensorimotor disorder characterized by uncomfortable sensations in the legs. RLS often occurs as a comorbid condition. Besides an increased risk of iron deficiency, blood donors are considered to be generally healthy. Blood donors are therefore an ideal population for studying factors associated with RLS occurrence, herein the role of iron. It is suggested that RLS is linked to sex, age, low socioeconomic status, unhealthy lifestyle, and iron deficiency. The objective of this study is therefore to estimate the RLS prevalence and identify associated biological, sociodemographic, economic, and lifestyle factors in a population of blood donors. METHODS A total of 13,448 blood donors enrolled in the Danish Blood Donor Study from May 2015 to May 2016. RLS cases were identified using the validated Cambridge-Hopkins RLS-questionnaire. Logistic regression models were applied to assess the relationship between RLS and data on socially related factors collected using questionnaires and population registers. RESULTS In this study, 7.2% women and 4.5% men were classified with RLS. RLS was associated with: female sex, high age, smoking, frequent alcohol consumption, and low education. RLS-related symptoms were associated with obesity, parity and donation intensity three years prior to inclusion among women. RLS was not related to: reduced plasma ferritin, employment status, and income. CONCLUSIONS RLS is a frequent disorder in otherwise healthy individuals. The associations discovered in this study can be utilized in preventing or reducing RLS symptoms.

Digital questionnaire platform in the Danish Blood Donor Study

OBJECTIVES The Danish Blood Donor Study (DBDS) is a prospective, population-based study and biobank. Since 2010, 100,000 Danish blood donors have been included in the study. Prior to July 2015 all participating donors had to complete a paper-based questionnaire. Here we describe the establishment of a digital tablet-based questionnaire platform implemented in blood bank sites across Denmark. METHODS The digital questionnaire was developed using the open source survey software tool LimeSurvey. The participants accesses the questionnaire online with a standard SSL encrypted HTTP connection using their personal civil registration numbers. The questionnaire is placed at a front-end web server and a collection server retrieves the completed questionnaires. Data from blood samples, register data, genetic data and verification of signed informed consent are then transferred to and merged with the questionnaire data in the DBDS database. RESULTS The digital platform enables personalized questionnaires, presenting only questions relevant to the specific donor by hiding unneeded follow-up questions on screening question results. New versions of questionnaires are immediately available at all blood collection facilities when new projects are initiated. CONCLUSION The digital platform is a faster, cost-effective and more flexible solution to collect valid data from participating donors compared to paper-based questionnaires. The overall system can be used around the world by the use of Internet connection, but the level of security depends on the sensitivity of the data to be collected.

Socio-demographic characteristics of Danish blood donors

Background Blood transfusion is an essential component of a modern healthcare system. Because knowledge about blood donor demography may inform the design of strategies for donor recruitment and retention, we used nationwide registers to characterize the entire population of blood donors in Denmark in 2010. Methods The study population comprised all Danes in the age range eligible for blood donation (N = 3,236,753) at the end of 2010. From the Scandinavian Donations and Transfusions (SCANDAT) register, we identified 174,523 persons who donated blood in Danish blood banks at least once in 2010. The association between sociodemographic characteristics and blood donor prevalence was examined using regression models. Results The overall prevalence of blood donation was 5.4% among both women and men. The age-specific prevalence of blood donation peaked at 25 years of age (6.8%) for women and 30 years of age (5.7%) for men. Children of any age were associated with lower prevalence of blood donation among women, while the opposite was seen for men. Middle to high income groups, but not the highest income group, had fourfold higher donor prevalence than the lowest income group (6.7% compared to 1.7%). The prevalence of blood donation was considerably lower among men living with their parents (2.9%) or alone (3.9%) than among men cohabitating with a woman (6.2%). Summary Social marginalization, as indicated by low income and being a male living without a woman, was associated with lower prevalence of blood donation. However, individuals with very high incomes and women with children were underrepresented in the Danish blood donor population.

Patient blood management knowledge and practice among clinicians from seven European university hospitals: A multicentre survey

The aim of this survey was to evaluate the knowledge about Patient Blood Management (PBM) principles and practices amongst clinicians working in seven European hospitals participating in a European Blood Alliance (EBA) project.

Restless legs syndrome is associated with major comorbidities in a population of Danish blood donors

BACKGROUND Restless Legs Syndrome (RLS) is characterized by uncomfortable nocturnal sensations in the legs making sedentary activities and sleep difficult, and is thus linked with psychosocial distress. Due to the symptomatology and neurobiology of RLS (disrupting brain iron and dopamine) it is likely that RLS associates with poorer health-related quality of life (HRQL) and depressive disorder. The objective of this study was to investigate the RLS-HRQL and the RLS-depressive disorder links in a generally healthy population that is not biased by medications. METHODS Complete data, including the Cambridge-Hopkins RLS questionnaire, the 12-item short-form standardized health survey (SF-12), the Major Depression Inventory (MDI), body mass index, smoking status, alcohol consumption, and education were available for 24,707 participants enrolled in the Danish Blood Donor Study from May 1, 2015 to February 1, 2017. Information on quality of sleep was available for all RLS cases. T-tests and multivariable logistic regression models were applied to examine the associations of RLS and MDI scores, and the physical and mental component scores (PCS and MCS) of SF-12, respectively. Analyses were conducted separately for men and women. RESULTS RLS associated with poorer MCS and poorer PCS. Moreover, Participants with RLS were more likely to classify with depressive disorder. Poor quality of sleep was associated with depressive disorder and poorer MCS among RLS cases, and with poorer PCS in female RLS cases. CONCLUSION Thus, we demonstrated that RLS is associated with a significantly lower HRQL and a higher prevalence of depressive disorder among otherwise healthy individuals.

Tools and challenges in creating a biobank in a modern blood bank: experience from the Danish Blood Donor Study (DBDS)

Blood banks are in a unique position to create biobanks and general health studies since existing infrastructure can readily be reemployed. The available tools for creating biobanks include access to potential study participants (blood donors), handling and storage of biological repositories, and collection facilities with experienced staff. The needed tools not readily available are automated high throughput research analysers with data capture possibilities and freezing facilities. Lastly, designated information platforms e.g. a study webpage should be constructed to facilitate information to participants. The challenges encountered when creating a biobank in a blood bank are many. First, motivation for staff members are potentially needed because extra work may be put upon them in order to include blood donors in research biobanks. Second, in order to accommodate future possible health research projects it is recommended to acquire a broad informed consent for these type of studies. A broad informed consent warrants a clear policy on return of research findings to the study participants. Lastly, the collection of outcome variables must be planned. In Denmark national health registries on admission and diseases are of great value for follow‐up data. Otherwise, each subsequent donation after enrollment may serve as a potential way to collect follow‐up data or follow‐up data may be collected through mailed out questionnaires. Experience from the Danish Blood Donor Study (DBDS) has shown the feasibility of establishing a research biobank within a blood bank by using the existing infrastructure.

Impact of apheresis automation on procedure quality and predictability of CD34 cell yield

Success of peripheral blood stem cell (PBSC) collections depends on patient biological parameters and stable apheresis device performance. We investigated product quality and factors influencing main apheresis procedure outcomes including CD34+ collection efficiency (CE), product volume or platelet CE. We also assessed different CD34+ cell yield prediction algorithms. Autologous PBSC collections by Spectra Optia from myeloma and lymphoma patients were analyzed. Complete blood count (CBC) from patient preprocedure and from collected products were assessed. (1) Product yield was calculated, (2) Product CBC was correlated with patient preprocedure variables, and (3) Predictions of CD34+ yields based on (a) product CD34+ cell concentration in samples after two or four chamber flushes or (b) traditional CE2 benchmark, were compared. 62 procedures in 41 patients were analyzed. 84% of all procedures were run without operator intervention. Median CD34+ CE2 was 56.9% (48.8%‐65.2%) and quite stable irrespective of patient conditions, with minor influence from patient white blood cell (WBC) precounts (rs = –.47; P < .001). Platelet loss correlated with WBC precount (rs = .46; P < .001), product volume (rs = .71; P < .0001) and number of chambers collected (rs = .72; P < .0001). CD34+ cell yield was better predicted based on (a) product CD34+ cell concentration from samples after 2 and 4 chamber flushes, respectively (rs = .969; P < .0001 and rs = .9648; P < .0001) than based on (b) CE2 formula (rs = .8262, P < .0001). Spectra Optia provides good quality PBSC products with stable and predictable yield regardless of starting conditions. CD34+ sampling of product after few chamber flushes could be used to predict CD34+ yield.

Patient Blood Management – from local initiatives to European collaborations

Patient blood management (PBM), as defined by the WHO, is a patient‐focused, evidence‐based and systematic approach to optimize the management of patient and transfusion of blood products for quality and effective patient care. It is designed to improve patient outcomes through the safe and rational use of blood and blood products and by minimizing unnecessary exposure to blood products. Important elements of PBM are optimizing haemoglobin concentrations without blood transfusion, minimizing blood loss and managing anaemia, especially by use of evidence‐based transfusion guidelines and pharmacological agents. Local PBM initiatives differ substantially. In one region of Denmark, the majority of PBM initiatives over the last 10 years have been based on provider education and enforcement of national guidelines. Evaluation of the effect of these initiatives indicated that education alone can be an effective and durable method of reducing unnecessary transfusions. To improve implementation and knowledge of PBM, benchmarking of experiences between hospitals and countries seems rational, and several initiatives regarding PBM are being undertaken in Europe. Patient Blood Management in Europe (PaBloE) is a working group of the European Blood Alliance. Its objectives are to derive good practices in PBM and to develop ways to implement these practices. Within this group, several surveys have been performed relating to blood product consumption, implementation of PBM, and knowledge of PBM principles and practices among clinicians. These surveys have shown variation in transfusion rates between the participating hospitals, and variable implementation of PBM activities and monitoring of transfusion practice.