Thesis Loan van Hoeven

Summary

Blood transfusion is an important medical treatment for many and diverse patients groups, saving lives but sometimes also causing adverse transfusion reactions in recipients. There are various known but potentially also not yet recognized factors in donors and blood products that might affect patient outcomes. In order to study various aspects and the interplay between them, the Dutch Transfusion Data warehouse (DTD) was designed, in which data from the national blood bank and a (growing) number of Dutch hospitals are linked.

To validate the quality of these data, a structured stepwise approach was applied addressing external validity (e.g. concordance with external reports, previous studies and expert feedback) and internal validity (e.g. completeness, uniformity and plausibility). In addition, an algorithm was developed to identify –out of all diagnostic and procedural data available– the most likely indication (i.e. reason) for transfusion. The algorithm was evaluated against a gold standard based on expert review of patient records, but should still be validated externally using independent hospital datasets.

Analyses of the data show a substantial decrease in red blood cell use between 1996 and 2005, partly due to a shift from largely surgical to predominantly medical blood use. Analysis and simulations using data on anti-RhD donors between 1994 and 2013 demonstrate the effect various donor recruitment scenarios have on the size and age composition of the anti-RhD donor population.

Continuation and further extension of the DTD will contribute to future research into donor-patient associations and furthermore, allows detailed benchmarking studies to improve transfusion practice.