TY  - JOUR
A1  - Meybohm, Patrick
A1  - Straub, Niels
A1  - Füllenbach, Christoph
A1  - Judd, Leonie
A1  - Kleinerüschkamp, Adina
A1  - Taeuber, Isabel
A1  - Zacharowski, Kai
A1  - Choorapoikayil, Suma
T1  - Health economics of Patient Blood Management: a cost‐benefit analysis based on a meta‐analysis
JF  - Vox Sanguinis
N2  - Background and Objectives
Patient Blood Management (PBM) is the timely application of evidence‐based medical and surgical concepts designed to improve haemoglobin concentration, optimize haemostasis and minimize blood loss in an effort to improve patient outcomes. The focus of this cost‐benefit analysis is to analyse the economic benefit of widespread implementation of a multimodal PBM programme.

Materials and Methods
Based on a recent meta‐analysis including 17 studies (>235 000 patients) comparing PBM with control care and data from the University Hospital Frankfurt, a cost‐benefit analysis was performed. Outcome data were red blood cell (RBC) transfusion rate, number of transfused RBC units, and length of hospital stay (LOS). Costs were considered for the following three PBM interventions as examples: anaemia management including therapy of iron deficiency, use of cell salvage and tranexamic acid. For sensitivity analysis, a Monte Carlo simulation was performed.

Results
Iron supplementation was applied in 3·1%, cell salvage in 65% and tranexamic acid in 89% of the PBM patients. In total, applying these three PBM interventions costs €129·04 per patient. However, PBM was associated with a reduction in transfusion rate, transfused RBC units per patient, and LOS which yielded to mean savings of €150·64 per patient. Thus, the overall benefit of PBM implementation was €21·60 per patient. In the Monte Carlo simulation, the cost savings on the outcome side exceeded the PBM costs in approximately 2/3 of all repetitions and the total benefit was €1 878 000 in 100·000 simulated patients.

Conclusion
Resources to implement a multimodal PBM concept optimizing patient care and safety can be cost‐effectively.
KW  - Patient Blood Management (PBM)
KW  - haemoglobin concentration
KW  - haemostasis
KW  - blood loss
Y1  - 2020
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-214084
VL  - 115
IS  - 2
SP  - 182
EP  - 188
ER  - 
TY  - JOUR
A1  - Schossee, Nadine
A1  - Veit, Gabriele
A1  - Gittel, Julia
A1  - Viebahn, Johannes
A1  - Niklaus, Marius
A1  - Klingler, Philipp
A1  - Üçeyler, Nurcan
A1  - Klinker, Erdwine
A1  - Kobsar, Anna
A1  - Boeck, Markus
A1  - Koessler, Juergen
T1  - Profile of the single-use, multiple-pass protein A adsorber column in immunoadsorption
JF  - Vox Sanguinis
N2  - Background and Objectives
Immunoadsorptions (IA) are used to remove autoantibodies from the plasma in autoimmune disorders. In this study, we evaluated the effects of a single-use, recombinant staphylococcal protein A-based immunoadsorber on blood composition of the patient.

Materials and Methods
In a cohort of patients with myasthenia gravis or stiff-person syndrome, essential parameters of blood cell count, coagulation, clinical chemistry or plasma proteins and immunoglobulins (Ig) were measured before and after IA (n = 11).

Results
In average, IA reduced the levels of total IgG, IgG1, IgG2 and IgG4 by approximately 60%, the acetylcholine receptor autoantibody levels by more than 70%. IgG3, IgA or IgM were diminished to a lower extent. In contrast to fibrinogen or other coagulation factors, the column markedly removed vitamin K-dependent coagulation factors II, VII, IX and X by approximately 40%–70%. Accordingly, international normalized ratio and activated partial thromboplastin time were increased after IA by 59.1% and 32.7%, respectively. Coagulation tests almost returned to baseline values within 24 h. Blood cell count, electrolytes, total protein or albumin were not essentially affected. No clinical events occurred.

Conclusion
The single-use, multiple-pass protein A adsorber column is highly efficient to remove IgG1, IgG2 and IgG4 or specific acetylcholine receptor autoantibodies from the plasma. Coagulation parameters should be monitored, since the column has the capacity to largely reduce vitamin K-dependent factors.
KW  - plasma
KW  - apheresis technologies
KW  - apheresis-therapeutic
KW  - blood processing
KW  - haemostasis
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-259689
VL  - 117
IS  - 3
ER  -