{'fraction_non_alphanumeric': 0.024658506297676068, 'fraction_numerical': 0.005321979776476849, 'mean_word_length': 4.9724576271186445, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
THE 42ND ANNUAL MEETING OF THE AMERICAN ASSOCIATION OF BLOOD BANKS

The 1989 meeting of the American Association of Blood Banks (AABB) took place in New Orleans on 2 1-26 October. Predictably, two major topics at the meeting were medical audit (quality assurance) and transfusion microbiology. Audit appears to be as great a preoccupation in the United States as on this side of the Atlantic. During a one-day workshop ‘Improving transfusion practice: the role of quality assurance’, a number of speakers gave their experiences with the audit of the use of red cells. platelets and fresh frozen plasma. The majority of the audit programmes described were hospital-based, and only one speaker referred to a ‘blood centre’ based scheme. Unfortunately, this experience would not be readily translated to a transfusion centre in England and Wales since the ‘blood centre’ concerned (Puget Sound in Seattle) provides a central laboratory service for 24 hospitals and has a haematologist on 24 h duty to discuss all requests for blood components other than red cells. Two facts were evident throughout this meeting. Firstly, while requests for platelets and fresh frozen plasma can be audited prospectively, a similar approach to red cell transfusions can cause unnecessary delays in patient treatment and is not generally performed. Secondly, the operation of a prospective audit brought very little benefit as measured by the number of requests which were judged inappropriate or unnecessary and therefore not met. Particularly in respect to fresh frozen plasma, some ‘unnecessary’ requests were still met, as the haematologist was unable to persuade the clinician who made the order that transfusion as planned was inappropriate. A small number of requests were amended-and this could be a revision upwards as well as a revision downwards. Thus, audit itself was not avoiding wastage or inappropriate use, but was assuring optimal treatment for the patient. One clear advantage which resulted from the institution of an audit system, in all examples quoted, was education of medical staff. Before setting up any formal audit programme on the use of blood derivatives it is necessary to draw up and agree criteria for transfusion. In most cases, once criteria had been agreed by the hospital transfusion committee inappropriate requests were no longer made, as clinicians were quite clear about the conditions which must be met before blood derivatives would be supplied. In fact, if the established criteria were loose enough, all requests would be met and no formal audit would be invoked! All participants agreed that audit required resourcesboth in the laboratory and from medical staff. In a computerized laboratory, it is very easy, for example, to ’call up’ each day a list of patients who have received transfusion without meeting certain criteria-for example, platelets transfused when the platelet count is greater than a defined level, fresh frozen plasma given without pre-transfusion coagulation tests. The blood bank resident then performs a chart review. It is difficult to see how most U.K. blood transfusion laboratories could easily institute such a system. What should be done with the results of a blood transfusion audit? One could ask how well clinicians would react to a rebuke from the Transfusion Committee about inappropriate transfusions administered to their patients. And how does one reinforce good practices? Positive feedback in the form of letters of congratulations to ‘good performers’? A league system perhaps? And where in the U.K. are the hospital-based transfusion committees which are going to take on the work of drawing up lists of agreed criteria and reviewing individual cases? There is no doubt that audit can lead to positive benefits for the patient. It requires resources and commitment from both staff and management. Much informal audit is already performed in the U.K. but there is far more to be done. Hospital transfusion committees are a first step and we should be making these our immediate goal. The large content of transfusion microbiology at the meeting reflected the year’s experience of anti-HTLV donor screening in the U.S.A.. the interest in the bio-engineered hepatitis C antigen clone and the concern with the assessment of transfusion-infection risks and their prevention. The anti-HCV assay comes at a time when the incidence of post-transfusion hepatitis (PTH) in the U.S.A. in estimated to have decreased markedly. Similarly, in a report from Canada on a prospective study of PTH the incidence had fallen from 9% (at the beginning of the study) to 2% currently. Since ’surrogate’ (alanine aminotransferase and anti-HBc) screening for non-A, non-B hepatitis is not performed in Canadian transfusion centres, this fall is largely ascribed to donor education leading to ‘self-exclusion’ of donors at risk of contracting HIV. Transmission of HCV in homosexual males seems less important than was originally predicted: hence a large component of shared risk with HIV infectivity is likely to be associated with intravenous drug use. Unfortunately no hard data on supplementary testing to confirm positive antiHCV screening results (of special importance in lower prevalence populations such as blood donors), was forthcoming. An important transfusion safety study in California was reported. From late 1984 (prior to anti-HIV screening of blood donations) to early 1985, 200000 donor sera have been stored in a ’repository’ for subsequent anti-HIV (and anti-HTLV) screening. Recipients of the different components of reactive units could then be traced and tested for evidence