Abstract
Background
In Italy, as in many developed countries, a decline in blood component (BC) consumption, especially red blood cells (RBC), has been described, but not studied at a national level. We, therefore, designed a nationwide survey to determine the main features of BC recipients and obtain a picture of the clinical use of BC for the first time in Italy, in order to understand BC demands better and identify specific fields in which to apply Patient Blood Management (PBM).
Material and methods
A nationwide survey of all Italian Blood Establishments working as Hospital Blood Banks (HBB) was performed. Data were collected through an online report form recording information on the number and geographic area of the responding HBB, year of birth and sex of the BC recipients, and clinical indications for every unit of RBC, platelets and plasma transfused in a 24-hour period.
Results
On the survey date, 153/237 (64.5%) of the HBB returned 4,356 forms, reporting 7,523 transfusions. The median and mean ages of the recipients were 73 (range, 0–106) and 67.5 years, respectively; 33.0% were >80 years old and 64.9% >65 years old, with no relevant differences between males and females. Overall, 6,309 RBC units were transfused to 3,850 recipients, 66.7% of them for a medical indication and 32.4% for a surgical indication. The commonest medical indication was acquired, non-cancer-related anaemia and more than 30% of the transfusions occurred in the Emergency Department. Five hundred and sixty platelet transfusions were given to 520 recipients, 62.7% of them for prophylaxis and 28.6% for bleeding before or during an invasive procedure or surgery or for thrombocytopenia. One hundred and ninety-four patients received 654 units of plasma, 71.1% of which were for therapeutic purposes in bleeding patients.
Discussion
We collected a picture of blood transfusion epidemiology in Italy. The data suggest that future PBM plans should be focused on medical anaemia especially in the setting of Emergency Departments.
Keywords: blood donors, Italy, epidemiology, blood component transfusion, surveys and questionnaires
INTRODUCTION
In recent years, the use of blood has decreased overall in many developed countries, thanks to the implementation of Patient Blood Management (PBM) programmes, adherence to guidelines encouraging restrictive transfusion thresholds, and advances in technology and surgical techniques1–5. Nevertheless, demographic changes are a threat to the balance of blood demand and supply in blood services, because both blood consumption and donation patterns vary according to age, as has been shown in different countries6–8. The decrease in younger age groups implies a reduction in the population eligible to donate blood, while the increase in the elderly population leads to a high demand for blood for older patients who are undergoing a growing number of complex therapeutic procedures, such as haematopoietic stem cell transplantation, cardiovascular surgery and solid organ transplantation9,10. In order to gain a broad perspective of the clinical use of blood and determine the main characteristics of recipients, many countries have carried out specific surveys11–13. In the USA, Shehata et al. found that, despite a reduction in the mean number of red blood cell (RBC) units administered, there has been an increase in the proportion of patients admitted to hospital who are transfused. They also found that most RBC units are given to patients in general internal medicine and haematology-oncology services11. In both France12 and the UK13, most patients are transfused in a medical context and the median age of transfusion recipients is over 65 years. A decline in blood component (BC) consumption, especially RBC, has been described in Italy too15,16, but studies investigating whether this decline involves all recipients and occurs for both medical and surgical indications have not yet been done at a national level, and only occasionally performed at a local level17.
The concept of PBM was introduced as a tool to pursue the objective of national BC self-sufficiency18, and PBM recommendations were implemented in Italy by law in 201519. These recommendations suggested that PBM protocols be applied for all adult patients who are candidates for elective major surgery20,21.
In Italy, blood transfusion and transfusion medicine are recognised as essential activities of the National Health Service. Healthcare services, including blood and BC collection, processing, testing, storage and distribution as well as all transfusion medicine activities, are delivered by regional health services within a federalist legislative framework. The National Blood Centre (Centro Nazionale Sangue; CNS) is the competent authority in Italy for blood and BC. Regional health authorities inspect, authorise and accredit blood establishments (BE), according to regional, national and European legislation. In each of the 21 Italian regions, a regional blood centre is established by law. The regional blood centres coordinate the related local networks of BE, complying with national regulations and self-sufficiency, quality and safety plans. BE, which are mostly hospital-based, are responsible for collecting, processing, testing, storing and distributing blood and BC. Most of them also work as hospital blood banks (HBB), issuing BC to hospital inpatients, under the management of the hospital itself, with complete traceability from the donor to the patient, including haemovigilance. In 2019 the Italian population was 59,641,488 inhabitants22, while the number of RBC transfusions per 1,000 inhabitants was 40.6, as stated in the 2020 self-sufficiency national plan23.
With the purpose of determining the main characteristics of BC recipients, acquire a broader perspective of national usage of BC, and to identify specific fields of PBM application, we conducted a national survey of BC use in all Italian BE working as HBB.
MATERIALS AND METHODS
All HBB in Italy were invited to participate in a survey of BC use by all patients who received a transfusion of RBC, platelet or fresh-frozen plasma (FFP) on a specific day. The numbers of RBC, platelet and FFP units transfused in Italy per year and per day were considered with respect to the number of BC transfused in one reference year. At the moment of the study, the most recently available national data were those referred to the year 201715, which was therefore chosen as the reference year. The national data came from annual reports by the Italian National Blood Centre (CNS). The CNS coordinates the National Blood Information System (Sistema Informativo dei Servizi TRAsfusionali; SISTRA) which collects the data related to the activities of the Italian Blood System. Daily BC use in 2017 was calculated as the total of BC transfused in 2017 divided by 365 days.
Participation per geographic area of the country (North-West, North-East, Centre, South, and Islands, based on the Nomenclature of Territorial Units for Statistics [NUTS])24 was also investigated as the percentage of BC transfusions occurring in HBB participating in the study vs the number not participating in the survey.
Participants entered data electronically, using an online survey data collection sheet (Online Supplementary Content, Figure S1) which was a one-page pre-printed report form. The information collected was year of birth and sex of the BC recipient, and clinical indication, for every unit of RBC, platelets, and FFP transfused on Wednesday, 10th of April 2019. This date was selected as representative of an “ordinary” day; Saturday and Sunday were excluded because elective surgical procedures are not performed on these days.
The age of the patient receiving each unit was expressed as 2019 minus birth year. RBC, platelet and FFP are intended as therapeutic adult and neonatal units. FFP includes, as specified in Italian Blood System data15, recovered plasma, source plasma, source plasma from multiple apheresis and pharmaceutical inactivated plasma. The clinical indication was specified for every adult or neonatal unit of RBC, platelets and FFP transfused on the survey day. The categories of clinical indications were based on the Italian Guideline of clinical use of blood25 and other national studies12,13. The analyses were performed on both the recipients and the BC.
Regarding recipient data, the number of patients transfused, median and mean recipient age across all units used, the male-to-female ratios at all ages, the distribution of recipients by sex and age group, the number of BC transfused to males and to females, and the percentage of RBC, platelets and FFP transfused to males and females by 5-year age group were calculated.
Concerning BC data, the RBC, platelet and FFP units transfused for the main clinical indications were calculated. All platelet units are expressed as “therapeutic platelet dose”. An “adult platelet dose”, meaning ≥2×1011 platelets, is conventionally composed of five single units of whole blood-derived buffy coats. Each unit of apheresis platelets is equal to an “adult platelet dose”; paediatric platelet dose is conventionally composed of one single unit of whole blood-derived buffy coats15. The mean number of units transfused per patient was determined for RBC and platelets, but not for FFP because the specific dose, calculated as mL/kg, was not available. The clinical indications for RBC transfusion were first divided by broad category (surgical and medical). The following indications were considered as surgical: cardiothoracic surgery, gastrointestinal (oesophageal, gastric, colorectal, hepatic, pancreatic) surgery, orthopaedics and trauma, urology, vascular surgery, neurosurgery, obstetric and gynaecological surgery, and otolaryngology. Medical indications included anaemia (acquired non-oncological, neonatal/foetal, post-operative, oncological and onco-haematological, in solid organ transplantation, thalassaemia and haemoglobinopathies, not defined), gastrointestinal bleeding, and haemorrhage. For the main indications for RBC, platelet, and FFP transfusions, the most frequent sites in which the transfusions were administered were specified, as percentages of total transfusions.
All data were first managed with the software programme Excel, v. 14.1.0 (Microsoft Inc., Redmond, WA, USA). Data quality control and analyses were performed using the STATA software package (Stata, version 11.2; StataCorp, College Station, TX, USA).
RESULTS
Participation and data
Of the 237 HBB invited to participate, 153 (64.5%) returned 4,356 reports.
The total number of BC transfused in all HBB in the reference year 2017 was 3,022,813 (2,473,714 RBC, 259,036 platelets, 290,063 FFP). The BC transfused in 2017 in HBB that participated in the survey and returned reports were 2,358,393, representing, when compared to the BC transfused in Italy in the same year, 78% of transfusions. Online Supplementary Content, Figure S2 shows the number of BC transfused in HBB participating and not participating in the survey in the reference year (2017) and illustrates geographical variations among NUTS: North-West, 73.2%; North-East, 100%; Centre, 71.1%; South, 67.5%; and the Islands (79%).
The mean number of BC transfused in a day in 2017 was 8,282, while the number of BC transfused on the 2019 survey date in HBB from which reports were received was 7,523, equivalent to 90.8% of the mean number of BC transfused in a day in 2017.
Characteristics of the blood component recipients
On the day chosen for the survey, 4,356 patients were transfused of whom 2,096 were women (48.1%), and 2,254 were men (51.7%). Data on gender were missing for six patients.
The BC recipients’ median and mean ages were 73 (range, 0–106) and 67.5 years, respectively. There were 1,437 recipients aged more than 80 years old, who accounted for 33.0% of all recipients. Almost two-thirds of patients (2,826; 64.9%) were aged more than 65 years, whereas 132 (3%) were younger than 15 years. The male-to-female ratio for all ages was 1.08.
The distribution of recipients by sex and by 5-year age group is shown in Figure 1. There were no relevant differences between the proportions of males and females, except in the age band from 30 to 54 years and over 90 in which the mean male-to-female ratio was 0.7 and 0.5, respectively. The percentage distribution of RBC transfusions given to males and females, by 5-year age group (Figure 2), has a shape similar to that of recipient distribution by age group, probably because RBC are the most frequently transfused BC; the percentages of platelets and FFP transfused to males and females, by 5-year age group (Online Supplementary Content, Figures S3 and S4) did not seem to show particular trends among age bands, possibly because of the small numbers of transfusions in the period surveyed (24 hours).
Figure 1.
The distribution of blood component recipients by sex and 5-year age group
Figure 2.
The percentage of red blood cell units transfused to males and females, by 5-year age group
A total of 3,953 BC were transfused to males (52.5%) and 3,560 to females (47.3%), while the recipients’ sex was not specified for 10 (0.4%) BC. With regard to the distribution of BC use according to sex, males received 3,254 (82.3%) RBC, 320 (8.1%) platelet and 379 (9.6%) FFP transfusions, while females received 3,045 (85,5%) RBC, 240 (6.7%) platelet and 275 (7.7%) FFP transfusions.
Use of blood components
Each of the 4,356 reports provided data from a patient who was prescribed one or several BC which were transfused into them on the survey day. Table I summarises the BC received by the 4,356 patients.
Table I.
Blood components received by the patients on the survey date
| Blood components | Patients (n=4,356) | |
|---|---|---|
| N | % | |
| Red blood cells only | 3,670 | 84.3% |
| Plasma only | 111 | 2.6% |
| Platelets only | 387 | 8.9% |
| Red blood cells and plasma | 55 | 1.3% |
| Red blood cells and platelets | 105 | 2.4% |
| Plasma and platelets | 8 | 0.2% |
| Red blood cells, plasma and platelets | 20 | 0.5% |
Among the patients who received at least one RBC unit, 50.0% were transfused with only one unit and 41.5% with two units (cumulative percentage, 92.49%). Among recipients of platelets or FFP, 93.8% received one platelet unit, while one unit of FFP was transfused to 24.7% of patients and two units of FFP to 27.8% (cumulative percentage, 52.6%). Regarding FFP transfusions, among patients in the year bands over 15 years, i.e., adult patients, 19.9% received only one FFP unit and 29.9% received two (cumulative percentage, 49.85%).
On the day of the survey, 6,309 RBC units were transfused to 3,850 recipients, 66.7% of them for a medical indication and 32.4% for a surgical indication. The number of RBC units transfused, the number of recipients, and the mean number of RBC transfused per recipient for medical and surgical indications are shown in Table II.
Table II.
Red blood cell transfusions
| Indications | N. of RBC transfusions | % | Patients | Units/patient |
|---|---|---|---|---|
| Medical | ||||
| Acquired non-oncological anaemia | 1438 | 22.8 | 971 | 1.5 |
| Oncological anaemia | 996 | 15.8 | 741 | 1.3 |
| Thalassaemia and haemoglobinopathies | 651 | 10.3 | 342 | 1.9 |
| Cancer | 488 | 7.7 | 340 | 1.4 |
| Gastrointestinal bleeding | 449 | 7.1 | 249 | 1.8 |
| Multiple trauma | 79 | 1.3 | 39 | 2.0 |
| Haemorrhage (AUB, haematuria, haemoptysis) | 46 | 0.7 | 19 | 2.4 |
| Undefined anaemia | 46 | 0.7 | 32 | 1.4 |
| Neonatal/foetal anaemia | 17 | 0.3 | 17 | 1.0 |
| Total Medical | 4,210 | 66.7 | 2,750 | 1.7 |
| Surgical | ||||
| Orthopaedics and trauma | 717 | 11.4 | 429 | 1.7 |
| Cardiac surgery | 372 | 5.9 | 168 | 2.2 |
| Gastrointestinal surgery | 290 | 4.6 | 144 | 2.0 |
| Urology | 178 | 2.8 | 89 | 2.0 |
| Obstetric and gynaecological surgery | 145 | 2.3 | 64 | 2.3 |
| Vascular surgery | 136 | 2.2 | 68 | 2.0 |
| Solid organ transplantation | 76 | 1.2 | 28 | 2.7 |
| Neurosurgery | 68 | 1.1 | 38 | 1.8 |
| Thoracic surgery | 28 | 0.4 | 14 | 2.0 |
| Postoperative anaemia | 25 | 0.4 | 16 | 1.6 |
| Otolaryngology | 12 | 0.2 | 9 | 1.3 |
| Total Surgical | 2,047 | 32.4 | 1,067 | 2.0 |
| Not reported | 52 | 0.8 | 33 | 1.6 |
| Total | 6,309 | 3,850 | ||
RBC: red blood cells; AUB: abnormal uterine bleeding.
Among medical indications, the highest number of RBC were transfused for acquired non-oncological and onco-haematological anaemia, then thalassaemia and haemoglobinopathies. The majority of RBC transfusions for acquired non oncological anaemia were administered in Emergency Departments/Intensive Care Units (30.9%) and Medicine services (23.6%), while 42.7% of RBC transfusions for onco-haematological anaemia were in Oncology/Haematology services and 12.7% in HBB. RBC transfusions for thalassaemia and haemoglobinopathies were mainly administered in Day Hospitals (40.9%) and in Oncology/Haematology services (29.8%).
Of the RBC transfused for surgical indications, 11.4% were used in the context of orthopaedics and trauma, with 90% of them being administered in general wards and not in operating theatres, Emergency Departments or Intensive Care Units. Cardiac and gastrointestinal surgery accounted for 5.9% and 4.6%, respectively, of RBC transfusions for surgical indications.
Five hundred and sixty platelet units were transfused to 520 recipients: 62.7% of the units were transfused for prophylactic purposes and 28.6% for bleeding (before or during an invasive procedure or surgery or in thrombocytopenia). Clinical indications were not specified for 8.8% of the units transfused. Of the platelet units transfused for prophylaxis, 64.1% were administered in Oncology/Haematology services. The mean number of platelet units transfused per recipient was uniform among the categories of clinical indications (Table III).
Table III.
Platelet transfusions
| Indications | N. of platelet transfusions | % | Patients | Units/Patient |
|---|---|---|---|---|
| Prophylaxis | 287 | 51.3 | 280 | 1.0 |
| Bleeding during invasive procedures or surgery | 113 | 20.2 | 96 | 1.2 |
| Prophylaxis before invasive procedures or surgery | 64 | 11.4 | 61 | 1.0 |
| Not specified | 49 | 8.8 | 43 | 1.1 |
| Bleeding in thrombocytopenia | 47 | 8.4 | 40 | 1.2 |
| Total | 560 | 520 | 1.1 |
Regarding FFP transfusions, 654 units were transfused to 194 recipients: 464 (71.1%) of them were for therapeutic purposes in 194 bleeding patients; 32.6% of them occurred in General Surgery and 20.6% in Cardiac Surgery. Eighteen FFP transfusions (2.8%) were for prophylaxis in patients with inherited clotting factor deficiency for whom virally inactivated specific clotting factors were not available, 109 (16.6%) were transfused during plasma exchange procedures or neonatal exchange transfusions (Table IV). The mean number of FFP units transfused per recipient was not calculated because the definition of a FFP unit15 comprises more than one standardised product.
Table IV.
Fresh-frozen plasma transfusions*
| Indications | N. of FFP transfusions | % | Patients |
|---|---|---|---|
| Bleeding in surgical procedures/trauma/delivery | 319 | 48.8 | 104 |
| Plasma exchange in TTP | 97 | 14.8 | 10 |
| Bleeding in DIC | 75 | 11.5 | 27 |
| Not specified | 63 | 9.6 | 23 |
| Bleeding in inherited clotting factor deficiency * | 35 | 5.4 | 10 |
| Bleeding in massive transfusion | 35 | 5.4 | 9 |
| Prophylaxis in inherited clotting factor deficiency * | 18 | 2.8 | 9 |
| Neonatal exchange transfusions | 12 | 1.8 | 2 |
| Total | 654 | 194 |
The mean number of FFP units transfused per recipient was not calculated because the definition of a FFP unit15 comprises more than one standardised product.
FFP: fresh-frozen plasma; TTP: thrombotic thrombocytopenic purpura; DIC: disseminated Intravascular coagulation;
Virally inactivated specific clotting factors not available.
DISCUSSION
This study is the first ever conducted on the epidemiology of BC transfusion in Italy at the national level. The survey found that 66.6% of BC recipients are more than 65 years old, with no relevant differences between males and females, as observed in other studies12–14,26, except in the age band from 30 to 54 years old, in which the mean male-to-female ratio was 0.7, perhaps related to obstetric and gynaecological indications for transfusions. Females were also prevalent among BC recipients over 90 years old (male-to-female ratio 0.5), probably in relation to the longer life expectancy of the female population who, in 2018, at 65 years of age had a residual life expectancy of 22.4 years (+0.3), compared to the 19.3 years (+0.2) for men27.
In agreement with previous epidemiologic surveys of blood usage12–14, our study shows that RBC transfusion has been aimed at the elderly, with almost 50% of RBC transfused into patients older than 70 years. As expected, RBC are the most frequently transfused BC: more than 84% of BC recipients received only RBC and 50.0% of them were transfused with only one unit14,24. The transfusion of only one unit could be in line with the use of restrictive transfusion thresholds and the application of the “only one strategy” i.e. in clinically stable inpatients needing RBC transfusions a single-unit blood transfusion policy shall be adopted and further RBC units should only be transfused after a thorough clinical reassessment of the patient 20.
The majority of RBC units (66.7%) were transfused to medical patients, while most of the platelet transfusions were for prophylactic purposes and FFP was mainly used for bleeding in patients undergoing surgical procedures, trauma or delivery.
The most frequent indication for RBC transfusion was acquired non-oncological anaemia, an undefined diagnosis; interestingly, 30.9% of transfusions were administered in Emergency Departments or Intensive Care Units and 23.6% in Medicine Departments. Clinically significant anaemia, requiring RBC transfusions, is frequently observed in Emergency Departments where, according to several studies, at least 20% of packed RBC transfusions are administered28–31. Recently, it was shown that 4.6% of anaemic patients referred to Emergency Departments were transfused, the iron balance test was rarely ordered among microcytic patients and that intravenous iron was prescribed for fewer than 10% of eligible patients. The Authors concluded that PBM principles should also be applied in Emergency Departments in order to promote a more appropriate and effective clinical approach to anaemic patients32. The same Authors later confirmed that early intravenous iron administration in the Emergency Department reduces the transfusion of RBC units, hospital admissions, re-transfusions, duration of stay in hospital and costs33. Although not all cases of severe or moderate acquired non-oncological anaemia referred to Emergency Departments should be treated with intravenous iron administration, a quick and effective definition of a highly probable iron deficiency status in patients with stable haemodynamics and few clinical symptoms, could sometime avoid RBC transfusion.
As seen in previous surveys10,12–14 and recently confirmed in a large observational multicentre study34, orthopaedic conditions represent the most frequent indication for RBC transfusion in the surgical setting. In Italy, PBM protocols were promoted nationally in 201519 and regulatory guidelines for the implementation of PBM in candidates for major orthopaedic surgery in adults and elective major surgery were published in 2016- and 2017, respectively20,21, but preliminary data on the clinical use of BC at a national level were not available before this study. The findings of future surveys of the clinical use of blood could be compared with those of the present survey in order to detect developments.
With regard to platelet transfusions, most units were given prophylactically, with the commonest indication for platelet use being prophylaxis in haematological diseases, as found in other studies12,14,35. However, our survey did not collect information on the platelet count before transfusion and a subsequent survey should investigate transfusion thresholds. The large share of platelet usage allocated to prophylaxis of bleeding calls for efforts aimed at optimising this use. Indeed, overall use in prophylaxis in onco-haematological disease could be substantially reduced by lowering the platelet count threshold in selected patients without compromising safety36,37. There are still debates about prophylactic platelet transfusions in thrombocytopenic patients prior to surgery. A Cochrane review found insufficient evidence to recommend the administration of pre-procedure prophylactic platelet transfusions in this situation, with a lack of evidence that transfusion resulted in a reduction in post-operative bleeding or all-cause mortality. These authors hoped for future trials, including those involving major surgery and reporting on bleeding, adverse effects, mortality (as a long-term outcome) after surgery, duration of hospital stay and quality of life measures38.
With regard to FFP, the survey showed that 71.1% of transfusions were for therapeutic use; in fact, plasma is used extensively in the treatment of bleeding patients, even though evidence from randomised controlled trials comparing its effects in this context with those of other therapeutic interventions is still lacking39. On the other hand, investigations about BC therapy with a targeted ratio of packed RBC, platelets, and plasma as a treatment for massive haemorrhage in trauma or pre-hospital administration plasma in traumatic haemorrhagic shock40–42 are still ongoing and may re-evaluate the use of plasma in the setting of trauma.
It is noteworthy that, among recipients who received at least one unit of FFP, 24.7% were transfused with only one unit and 27.8% received two units. Among patients over 15 years old, i.e., adult patients, 19.9% received only one FFP transfusion and 29.9% received two FFP (cumulative percentage, 49.85%). Although the dosage per patient is not known, because the definition of a unit of FFP comprises more than one product15, the data do suggest inadequate doses and, therefore, inappropriate use, as found in other studies on the epidemiology of blood transfusion12. In order to evaluate the appropriateness of plasma transfusions the dose per patient should be determined in future investigations.
Our study has some weaknesses. The sample of units transfused nationally in 24 hours only was limited and may not be adequately representative. Another limitation, again related to the study’s duration, is that it was not possible to determine transfusion requirements associated with a specific pathology, because the management recorded for each patient was only 1 day and hence incomplete. It is, therefore, possible that infrequent conditions and procedures associated with high BC use, such as massive haemorrhages, extracorporeal cardiac pumps, or thrombotic thrombocytopenic purpura, might have been under- or overrepresented in our sample. On the other hand, our study does have several strengths, first of all, the participation was very good: although the response rate of the HBB was 64.5%, we estimated that the activity of responding HBB represented 78% of the yearly national activity (when expressed as number of BC transfused in the reference year), or, more than 90% when expressed as mean number of BC transfused nationally in the day included in this survey; participation was also uniform among Italian geographic areas. Furthermore, the study examined the clinical indications on the transfusion request, which are more likely to provide the real reason for the transfusion.
CONCLUSIONS
Our study is the first ever conducted on the epidemiology of BC transfusion in Italy at the national level. It gives an indication of current transfusion practice in Italy, which could facilitate demand planning by blood services and guide application of PBM initiatives.
The survey provides a snapshot of the epidemiology of blood transfusion in Italy in the year 2019. It would be necessary to repeat this survey in the future to have a dynamic view of BC use and to capture the most relevant trends.
Another future development could be a national web-based blood management application. Based on the clinical indications for the BC used in this survey, a national clinical benchmarking database could be developed with the goal of collecting information on the reason for blood use and linking it with patient-specific data and laboratory results.
Supplementary Information
ACKNOWLEDGEMENTS
We thank Roberta Frisenda (Italian Society of Transfusion Medicine and Immunohaematology, Rome, Italy) who managed and facilitated data exchange between the Authors and the SIMTI group for Clinical use of blood in Italy. We also acknowledge the Italian National Blood Centre (National Institute of Health, Rome, Italy) for providing the data on blood component utilisation in the country.
APPENDIX 1
| Authors | Affiliations |
|---|---|
| Raffaele Laricchia | UOC di Medicina Trasfusionale, Ospedale Regionale Miulli, Acquaviva Delle Fonti - Santeramo |
| Cinzia Scipioni | UOSD di Medicina Trasfusionale, Ospedale Santa Maria Regina Degli Angeli, Adria |
| Giorgio Gianotto | UOSD di Medicina Trasfusionale, Ospedale San Lazzaro, Alba |
| Roberto Guaschino, Francesca Pollis | UOC di Medicina Trasfusionale, Ospedale SS. Antonio, Biagio E Cesare Arrigo, Alessandria |
| Gianluca Riganello | UOC di Medicina Trasfusionale, Ospedali Riuniti, Ancona Torrette |
| Luciano Lorusso | UOSVD Immunoematologia e Medicina Trafusionale, Presidio Ospedaliero Andria, Andria |
| Pierluigi Berti | UOC di Immunoematologia e Medicina Trasfusionale - SRC Valle D’Aosta, Presidio Ospedaliero Regionale Umberto Parini, Aosta |
| Roberto Zadi | UOC Medicina Trasfusionale, Ospedale S. Donato, Arezzo |
| Antonio Canzian | UOC di Medicina Trasfusionale, Ospedale Mazzoni, Ascoli Piceno |
| Ilvana T. Scuvera, Fabio Marletto | UOC di Medicina Trasfusionale, Ospedale Cardinal Massaia, Asti |
| Saverio Misso | UOC Servizio di Immunoematologia e Medicina Trasfusionale, Ospedale S. Giuseppe Moscati, Aversa |
| Antonino Raineri | UOSD di Medicina Trasfusionale, CRO Centro di Riferimento Oncologico, Aviano |
| Michele Scelsi | UOC di Medicina Trasfusionale, Ospedale San Paolo, Bari |
| Angelo Ostuni | UOC di Medicina Trasfusionale - SRC Puglia, Ospedale Policlinico-Consorziale, Bari |
| Domenico Visceglie, Maria Sodano | UOC di Medicina Trasfusionale, Ospedale di Venere, Bari Carbonara |
| Eugenio Peres | UOC di Medicina Trasfusionale, Presidio Ospedaliero Dimiccoli, Barletta |
| Corrado Sardella | UOSD di Medicina Trasfusionale, PO Bassano Del Grappa, Asiago, Bassano Del Grappa |
| Giuseppe Pipolo, Emilio Casaburi | UOC di Medicina Trasfusionale, Ospedale S. Maria Della Speranza, Battipaglia |
| Stefano Capelli | UOC E Dipartimento Trasfusionale, Ospedale S. Martino, Belluno |
| Vanda Randi, Matteo Capponi, Marina Verenini | SIMT AMBO - CRS Emilia-Romagna, Ospedale Maggiore Pizzardi, Bologna |
| Vanda Randi, Patrizia Bernardoni, Nicola Venturoli | UOC Trasfusionale e Immunoematologia, Policlinico S. Orsola-Malpighi, Bologna |
| Vanda Randi, Annarita Cenacchi, Veronica Roverini | UOC Medicina Trasfusionale, Istituti Ortopedici Rizzoli, Bologna |
| Cinzia Vecchiato | UOC di Immunoematologia e Trasfusionale - SRC Prov. Aut. Bolzano, Bolzano |
| Giovanni Camisasca, Daniel De Martino | UOC di Medicina Trasfusionale, Ospedale SS. Trinità, Borgomanero |
| Giampaolo Gaiga | UOC di Medicina Trasfusionale, Ospedale Orlandi, Bussolengo |
| Mario Pani, Maria B. Tronci | UOC Medicina Trasfusionale, Ospedale San Michele, Cagliari |
| Salvatore Platania | UOC di Medicina Trasfusionale, PO Gravina e S. Pietro, Caltagirone |
| Mauro Vanzelli | UOSD di Medicina Trasfusionale, Ospedale di Camposampiero, Camposampiero |
| Cristina Tassinari | UOSD Medicina Trasfusionale, Ospedale S. Giacomo Apostolo, Castelfranco Veneto |
| Domenico Filomia | UOSD di Medicina Trasfusionale, PO Ferrrari, Castrovillari |
| Sonia A. Raimondi, Pasquale Amato | UOC Servizio Immunoematologia e Medicina Trasfusionale, Ospedale S’Anna e San Sebastiano, Caserta |
| Francesco Sessa, Orlando Pignalosa | UOC Servizio Immunoematologia e Medicina Trasfusionale, Ospedale S. Leonardo, Castellammare di Stabia |
| Mario Lombardo, Patrizia Italia | UOC di Medicina Trasfusionale, Ospedale Cannizzaro, Catania |
| Santi Sciacca, | UOC Medicina Trasfusionale, PO Garibaldi, Catania |
| Sebastiano Costanzo | UOC di Medicina Trasfusionale, PO Gaspare Rodolico, Catania |
| Adalgisa Brescia, Gabriella Talarico | UOC Medicina Trasfusionale e CRQB, Ospedale Pugliese Ciaccio, Catanzaro |
| Camilla Vezzoli | UOSD Medicina Trasfusionale - DMTE Brescia, Servizio Immunoematologia e Medicina Trasfusionale, Chiari |
| Patrizia di Gregorio, Amalia Procida | UOC di Medicina Trasfusionale, Policlinico Universitario, Chieti |
| Gabriella Mazzaro, Davide Sambo | UOSD Medicina Trasfusionale, Presidio Ospedaliero di Chioggia, Chioggia |
| Elisabetta Agea | USD di Medicina Trasfusionale, Ospedale di Città di Castello, Città di Castello |
| Maria C. Buonanno | UOSD Medicina Trasfusionale - DMTE Varese, Ospedale S. Anna, Como - San Fermo Della Battaglia |
| Mattia Lachin | UOSD Medicina Trasfusionale, Ospedale Civile, Conegliano Veneto |
| Massimiliano Viti, Emanuela Nicotri | UOSD Medicina Trasfusionale - DMTE Cremona, PO Ospedale Maggiore, Crema |
| Massimo Crotti | UOC Medicina Trasfusionale - DMTE Cremona, Istituti Ospitalieri Cremona, Cremona |
| Marco Lorenzi | UOC Interaziendale di Immunoematologia e Medicina Trasfusionale, Ospedale S. Croce, Cuneo |
| Gianluca Gessoni | UOSD Medicina Trasfusionale, Ospedale di Dolo, Dolo-Mirano |
| Francesco Spedale, Biagia Pavone | UOC di Medicina Trasfusionale, Ospedale Umberto I, Enna |
| Luigina Romano | UOC Medicina Trasfusionale - DMTE Brescia, Ospedale di Valle Camonica Sede di Esine, Esine |
| Ersilia A. Barbone | UOSD Medicina Trasfusionale, Ospedale di Feltre, Feltre |
| Giuseppina Siracusa | UOC Medicina Trasfusionale, Ospedale Unificato, Fermo |
| Maurizio Govoni | UOC di Medicina Trasfusionale, Arcispedale Sant’Anna, Ferrara - Cona |
| Isio Masini, Antonella Esposito, Lucia Magliaro | UOC di Medicina Trasfusionale, Ospedale San Giovanni di Dio, Firenze |
| Franco Bambi | UOC di Immunoematologia e Medicina Trasfusionale e Lab Terapie Cell, Ospedale Pediatrico Meyer, Firenze |
| Marta Micheli | USD di Medicina Trasfusionale, Ospedale San Giovanni Battina, Foligno |
| Carla Gargiulo | UOC di Medicina Trasfusionale, Ospedale Fabrizio Spaziani, Frosinone |
| Ambrogio Pagani | UOC Medicina Trasfusionale - DMTE Varese, Ospedale Sant’ Antonio Abate di Gallarate, Gallarate |
| Antonio Lodato, Fiorella Barocci | UOC Medicina Trasfusionale - DMTE Garbagnate, Ospedale di Garbagnate Milanese, Garbagnate Milanese |
| Paolo Strada | UOC di Medicina Trasfusionale - SRC Liguria, Ospedale San Martino, Genova |
| Giovanni Imberciadori, Maria P. Campanella | UOC di Medicina Trasfusionale, Ospedali Galliera, Genova |
| Alessandro Correggi | UOC di Medicina Trasfusionale, Ospedale Villa Scassi, Genova |
| Gino Tripodi, Marina Martinengo | UOC di Medicina Trasfusionale, Ospedale G. Gaslini, Genova |
| Maria Giavitto | UOSD di Medicina Trasfusionale, Ospedali Riuniti Gorizia-Monfalcone, Gorizia |
| Carmelo F. Tornabene | UOC di Medicina Trasfusionale, Ospedale Misericordia, Grosseto |
| Vanda Randi, Massimo Bellinazzi, Antonella Padovani | SSD di Medicina Trasfusionale, Ospedale Civile, Imola |
| Clemente Mazzei | Struttura Trasfusionale, Ospedale Civile, Imperia |
| Anna Rughetti | UOC di Medicina Trasfusionale, Presidio Ospedaliero San Salvatore, L’Aquila |
| Paola D’Elia | Struttura Trasfusionale, Presidio Ospedaliero Del Levante Ligure - Ospedale S. Andrea, La Spezia |
| Federico G. Morelli | Struttura Trasfusionale, Presidio Ospedaliero, Lavagna |
| Nicola di Renzo | UOC di Medicina Trasfusionale, Ospedale ‘Vito Fazzi’, Lecce |
| Alessandro Gerosa | UOC Medicina Trasfusionale - DMTE Lecco, Ospedale di Circolo A. Manzoni, Lecco |
| Clemente Corvo | UOSD di Medicina Trasfusionale, PO Legnago, Zevio, Bovolone, Legnago |
| Bruno Brando | UOC Medicina Trasfusionale - DMTE Garbagnate, Ospedale Civile di Legnano, Legnano |
| Salvatore Avena, Francesco Tonelli | UOC di Medicina Trasfusionale, Ospedale Unico Versilia, Lido di Camaiore-Viareggio |
| Ceretelli Silvia | UOC di Medicina Trasfusionale, Presidio Ospedaliero Spedali Riuniti, Livorno |
| Giuseppe Cambiè | UOC Medicina Trasfusionale - DMTE Pavia, Presidio Ospedaliero di Lodi, Lodi |
| Rosaria Bonini, Annalisa Martinucci | UOC Medicina Trasfusionale e Immunoematologia, Ospedale San Luca, Lucca - Loc. San Filippo |
| Massimo Franchini | UOC Medicina Trasfusionale - DMTE Cremona, Ospedale Carlo Poma, Mantova |
| Anna Baldi | UOC Medicina Trasfusionale, Nuovo Ospedale Delle Apuane, Massa |
| Gianfranco Giannella | UOC di Medicina Trasfusionale, PO Madonna Delle Grazie, Matera |
| Giuseppe Pugliese | UOC Medicina Trasfusionale - DMTE Milano Policlinico, Ospedale S.Maria Delle Stelle, Melzo |
| Roberta Fedele | UOC di Medicina Trasfusionale, Ospedale Papardo, Messina |
| Andrea Alonci, Eugenia Quartarone | UOC di Medicina Trasfusionale, Policlinico Universitario, Messina |
| Gianluca Gessoni | UOC di Medicina Trasfusionale - DIMT, Ospedale Dell’Angelo, Mestre |
| Luca Santoleri | UOC Medicina Trasfusionale - DMTE Milano Niguarda, Ospedale San Raffaele, Milano |
| Fernando Ravagnani, Flavio Arienti | UOC Medicina Trasfusionale - DMTE Milano Niguarda, Istituto Nazionale Tumori, Milano |
| Daniele Prati, Alessandra Berzuini | UOC Medicina Trasfusionale - DMTE Milano Policlinico, Ospedale Maggiore Policlinico, Milano |
| Silvano Rossini | UOC Medicina Trasfusionale - DMTE Milano Niguarda, Servizio di Immunoematologia e Medicina Trasfusionale, Milano |
| Giovanni Battista Ceccherelli, Laura Bensi | UOC di Immunoematologia e Medicina Trasfusionale, Policlinico di Modena, Modena |
| Angela M. Iannone, Roberta Bertorelo | UOSVD Immunoematologia e Medicina Trafusionale, Ospedale Don Tonino Bello, Molfetta |
| Lauretta M. Manenti, Mannida Pianese | UOSD Medicina Trasfusionale, Ospedali Riuniti della Valdichiana Senese, Montepulciano |
| Cristina Paci | UOSD Immunoematologia e Medicina Trasfusionale, Ospedale Santa Maria alla Gruccia, Montevarchi-Valdarno |
| Fabio Rossi | UOC Medicina Trasfusionale - DMTE Lecco, Ospedale San Gerardo, Monza |
| Claudio Napoli, Annunziata Sansone, Mariangela Rusciano | UOC Servizio di Immunoematologia e Medicina Trasfusionale, Policlinico II Università, Napoli, Italy |
| Antonio Leonardi, Antonietta D’Ambra | UOC Servizio di Immunoematologia e Medicina Trasfusionale-SRC Campania, Policlinico Universitario, Napoli |
| Rosa Azzaro, Annamaria Diodato | UOSD di Medicina Trasfusionale, Istituto Nazionale Tumori Pascale, Napoli |
| Michele Vacca | UOC Servizio di Immunoematologia e Medicina Trasfusionale, Ospedale Cardarelli, Napoli |
| Domenico Ripaldi | UOC Servizio di Immunoematologia e Medicina Trasfusionale, Ospedale Pausilipon-Santobono, Napoli |
| Gaspare M. Leonardi | UOC Servizio di Immunoematologia e Medicina Trasfusionale, Ospedale San Paolo, Napoli |
| Bruno Zuccarelli, Federico Brighel | UOC Servizio di Immunoematologia e Medicina Trasfusionale, Ospedale Dei Colli, Napoli |
| Cosimo Nocera, Michela De Lucia | UOC Servizio di Immunoematologia e Medicina Trasfusionale, Ospedale Del Mare, Napoli |
| Sergio Giordano | UOC Servizio di Immunoematologia e Medicina Trasfusionale, Ospedale Umberto I, Nocera Inferiore |
| Pierpaolo Bitti | UOC Medicina Trasfusionale, Ospedale San Francesco, Nuoro |
| Pierpaolo Bitti, Marco Cocco | UOSD Medicina Trasfusionale, PO Giovanni Paolo II, Olbia |
| Piero Ottone, Tiziana Beltramo | UOSD di Medicina Trasfusionale, Ospedale S. Luigi Gonzaga, Orbassano |
| Luigi Destefano | UOSD Immunolematologia e Medicina Trasfusionale, Ospedale S. Giovanni di Dio, Orbetello |
| Sergio Rizzo | UOC di Medicina Trasfusionale, Policlinico Giaccone, Palermo |
| Gaetano Lucania | UOC Medicina Trasfusionale, Presidio Ospedaliero V. Cervello, Palermo |
| Rosalia E. Agliastro | UOC di Medicina Trasfusionale, Osp. Civico E Benefratelli, Osp. Pediatrico G. di Cristina, Osp. Oncologico M. Ascoli, Palermo |
| Lorena Zandomeni | UOSD di Medicina Trasfusionale, Ospedale di Jalmicco, Palmanova |
| Giustina De Silvestro | UOC Immunotrasfusionale, Azienda Ospedaliera Università, Padova |
| Alessandro Formentini, Simona Urbani | UOC di Immunoematologia e Medicina Trasfusionale, Ospedale di Parma, Parma |
| Cesare G. Perotti | UOC Medicina Trasfusionale - DMTE Pavia, Policlinico San Matteo, Pavia |
| Mauro Marchesi | UOC di Medicina Trasfusionale - SRC Umbria, Ospedale Policlinico, Perugia |
| Carlo Pazzaglia, Adriana Maiello | UOC Medicina Trasfusionale - Qualità - Accreditameto, Ospedale S. Salvatore, Pesaro |
| Patrizia Accorsi | UOC di Medicina Trasfusionale, Ospedale Civile Dello Spirito Santo, Pescara |
| Francesco Romeo | UOC di Medicina Trasfusionale, Ospedale Guglielmo Da Saliceto, Piacenza |
| Diego Zorzi | UOSD di Medicina Trasfusionale, Ospedale Immacolata Concezione, Piove di Sacco |
| Alessandro Mazzoni | UOC Medicina Trasfusionale e Biologia dei Trapianti - Banca Sangue Cordonale e Tessuti, Ospedale Universitario, Pisa |
| Loretta Leardini | UOSD di Medicina Trasfusionale, Nuovo Ospedale degli Infermi, Ponderano - Biella |
| Andrea Bontadini, Roberto Tassan Toffola | UOC e Dipartimento di Area Vasta di Medicina Trasfusionale, Ospedale Santa Maria degli Angeli, Pordenone |
| Clelia Musto | UOC Medicina Trasfusionale - SRC, Ospedale San Carlo, Potenza |
| Antonio Crocco | UOC di Medicina Trasfusionale, Ospedale Misericordia e Dolce, Prato |
| G.Garozzo, F. Bennardello, A. Guccione, V. Licitra | UOC di Medicina Trasfusionale, Ospedale Civile Maria Paternò Arezzo, Ragusa |
| Daniele Vincenzi | UOC di Medicina Trasfusionale, Ospedale S. Maria Delle Croci, Ravenna |
| Alfonso Trimarchi | UOC di Medicina Trasfusionale e Immunematologia, Ospedale Bianchi - Melacrino - Morelli, Reggio Calabria |
| Roberto Baricchi | UOC di Medicina Trasfusionale e Immunoematologia, Arcispedale Santa Maria Nuova, Reggio Emilia |
| Erminia Gentileschi | UOSD Medicina Trasfusionale, Ospedale San Camillo De Lellis, Rieti |
| Luca Boetti, Laura Benedettini | UOC Medicina Trasfusionale, Ospedale Degli Infermi, Rimini |
| Riccardo Serafini | UOC di Medicina Trasfusionale, Ospedale Sandro Pertini, Roma |
| Rita Marinelli | UOC di Medicina Trasfusionale, Ospedale San Giovanni Dell’Addolorata, Roma |
| Luca Pierelli, Alessandro De Rosa, Antonella Matteocci | UOC di Medicina Trasfusionale, Ospedale San Camillo Forlanini, Roma |
| Gina Zini | UOC di Medicina Trasfusionale, Policlinico Gemelli - Università Cattolica Del Sacro Cuore, Roma |
| Maria A. Stigliano, Guido Mistretta | UOC Medicina Trasfusionale - CLV, Ospedale San Filippo Neri, Roma |
| Marco Della Ventura | UOSD Medicina Trasfusionale, Ospedale S. Giovanni Calibita - FBF, Roma |
| Maria A. Stigliano, Roberto Guido | UOSD Medicina Trasfusionale, Ospedale Santo Spirito - San Filippo Neri, Roma |
| Ada M. D’Addosio, Franca Vaccaro | UOC di Medicina Trasfusionale, Villa San Pietro FBF, Roma |
| Maria R. Cassetta, Tiziana Datturi | UOSD Medicina Trasfusionale, Ospedale S. Eugenio - CTO A. Alesini, Roma |
| Maria C. Tirindelli, Carolina Nobile | UOC Medicina Trasfusionale-Ematologia, Policinico Universitario, Roma |
| Stefania Vaglio, Umberto Paladini | UOC di Medicina Trasfusionale - SRC, Ospedale Sant’Andrea, Roma |
| Gabriella Girelli, Gianluca Giovannetti | UOC di Medicina Trasfusionale e Immunoematologia, Policlinico Umberto I, Roma |
| Guido Bussetta | UOC Medicina Trasfusionale Miliatre - SRC Trasfusionale Militare, Ospedale Del Celio, Roma |
| Giuseppina De Rosa | UOC di Medicina Trasfusionale, Ospedale Giovanni Battista Grassi, Roma - Lido di Ostia |
| Cinzia Scipioni | UOC di Medicina Trasfusionale - DIMT, Ospedale Santa Maria Della Misericordia, Rovigo |
| Roberto Piunti | UOSD di Medicina Trasfusionale Materno-Infantile e Traumatologica, Ospedale di San Daniele, San Daniele Del Friuli |
| Francesco Fiorin, Maria P. Simeoni | UOSD Medicina Trasfusionale, PO S. Donà P.Ve, Portogruaro, San Donà di Piave |
| Mariella Canavero | UOSD Medicina Trasusionale, Ospedale Nostra Signora di Bonaria, San Gavino Monreale |
| Lazzaro di Mauro, Michele Prisciandaro | UOC di Medicina Trasfusionale, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo |
| Pietro Polito | UOSD di Medicina Trasfusionale, Ospedale San Vito al Tagliamento, San Vito al Tagliamento |
| Corrado Sardella | USD di Medicina Trasfusionale, Ospedale Alto Vicentino, Santorso |
| Massimiliano Oggiano | UOC Medicina Trasfusionale, Ospedale SS. Annunziata, Sassari |
| Viviana Panunzio, Alba G. D’Agosta | UOC di Medicina Trasfusionale, Ospedale San Paolo, Savona |
| Giannino Cicuto | UOSD di Medicina Trasfusionale, Ospedale Madre Teresa di Calcutta, Schiavonia-Monselice |
| Pasquale Gallerano | UOC Medicina Trasfusionale - CQB - Banca del Cordone - Centro Talassemie, Presidio Ospedaliero Giovanni Paolo II, Sciacca |
| Daniela Spadini, Christina M. Regnery | UOC Medicina Trasfusionale - Racc. Emocomponenti, Ospedale Civile, Senigallia |
| Roberto Dovigo | UOC Medicina Trasfusionale - DMTE Bergamo, Presidio Ospedaliero Bolognini, Seriate |
| Antonio Monguzzi | UOC Medicina Trasfusionale - DMTE Milano Niguarda, Ospedale Cinisello - Sesto S.Giovanni, Sesto San Giovanni |
| Giuseppe Campoccia | UOC Immunoematologia e Medicina Trasfusionale, Policlinico Le Scotte, Siena |
| Paola Lanzini, Daniela Rigamonti | UOC Medicina Trasfusionale - DMTE Lecco, Ospedale Civile di Sondrio, Sondrio |
| Mario Alessi | UOC di Medicina Trasfusionale, PO San Vincenzo, Taormina |
| Emilio M. Serlenga, Giuliano D’Andria | UOC di Medicina Trasfusionale, Ospedale Ss. Annunziata, Taranto |
| Gabriella Lucidi Pressanti, Rosa Balsamo | UOC di Medicina Trasfusionale, Ospedale Civile G. Mazzini, Teramo |
| Augusto Scaccetti | UOC di Medicina Trasfusionale, Ospedale Civile S. Maria, Terni |
| Anna M. Bordiga, Paola Manzini | CPVE - Banca del Sangue e Immunoematologia, Banca del Sangue - Molinette, Torino |
| Osvaldo Giachino | UOC di Medicina Trasfusionale, Ospedale Maria Vittoria - S. Giovanni Bosco, Torino |
| Mauro Pagliarino, Giuseppina Facco | UOSD di Medicina Trasfusionale Materno-Infantile e Traumatologica, OIRM S. Anna - CTO, Torino |
| Giuseppe Semino, Guido Balduzzi | UOC di Medicina Trasfusionale, Ospedale SS Antonio e Margherita, Tortona |
| Renato Messina | UOC di Medicina Trasfusionale, Presidio S. Antonio Abate, Trapani - Erice |
| Attilio F. Cristallo, Paola Boccagni | Servizio di Immunoematologia e Trasfusione Multizonale, Servizio di Immunoematologia e Trasfusionale, Trento-Rovereto |
| Arianna Veronesi, Alessandro Spigariol | UOC di Medicina Trasfusionale – DIMT, Ospedale Cà Foncello, Treviso |
| Monica Barcobello | UOSD di Immunoematologa e Distribuzione, Ospedali Cattinara, Maggiore, Trieste |
| Vincenzo De Angelis, Donatella Londero | UOC e Dipartimento di Medicina Trasfusionale di Area Vasta Udinese, Ospedale S. Maria della Misericordia, Udine |
| Giulio Feola | USD di Medicina Trasfusionale, Ospedale San Luca, Vallo Della Lucania |
| Rosa Chianese | UOC Medicina Trasfusionale - SMTE Varese, Ospedale di Circolo - Fondazione Macchi, Varese |
| Pasquale Colamartino | UOC Medicina Trasfusionale e SRC Abruzzo, Ospedale San Pio Da Pietrelcina, Vasto |
| Maria Cianci | UOSD di Medicina Trasfusionale, Ospedale S. Andrea, Vercelli |
| Giorgio Gandini, Pierluigi Piccoli | UOC di Medicina Trasfusionale, Ospedale Civile Maggiore, Verona |
| Maria G. Pezzali | UOC Medicina Trasfusionale - DMTE Pavia, Ospdale Civile, Vigevano |
| Lucia La Rosa, Angelo Rosana | UOC Medicina Trasfusionale - DMTE Garbagnate, Ospedale di Vimercate, Vimercate |
| Silvia Da Ros, Donatella Meo | UOC di Medicina Trasfusionale, Ospedale Belcolle, Viterbo |
Footnotes
AUTHORSHIP CONTRIBUTIONS
GF, FB, FF and PB designed the study and reviewed the paper. GF wrote the manuscript and, together with CG and CM managed the data and performed the quality control and statistical analyses. The SIMTI group for Clinical use of blood in Italy was responsible for data entry. All the Authors approved the final version of the paper.
The Authors declare no conflicts of interest.
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