Discover and read the best of Twitter Threads about #haemSpRs
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I had a personal request to do a tweetorial for the #haemSpRs on haemovigilance. Here goes. A #blooducation 🧵
Haemovigilance is a systematic surveillance of adverse reactions and adverse events related to transfusion’ with the aim of improving transfusion safety.
transfusionguidelines.org/transfusion-ha…
transfusionguidelines.org/transfusion-ha…
We are very lucky in the UK to have @SHOTHV1, one of the first in the world to collate adverse events relating to transfusion - since the 1990s.
Teaching our incoming haematology doctors today about transfusion in haematology patients. So who needs irradiated blood and why? A #blooducation🧵
All blood in the UK is leucocyte reduced (except granulocytes, but that’s another story). Despite this, a unit of red cells or platelets can have around a million residual white cells, mostly lymphocytes.
(for the #haemSpRs, that’s < 5 x 10^6 leucocytes/unit in > 99 % of units and < 1 x 10^6 leucocytes/unit in > 90% of units, both with 95% statistical confidence)
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Transfusion tips for new #haemSpRs, a thread
As a new ST3 I remember being told to book onto the @NHSBT transfusion course learningcentre.nhsbt.nhs.uk/catalog?pagena… and wondering why I needed to learn about transfusion ... 🙈
It can be difficult to know where to start with transfusion – you can’t go on a ward round to find patients. BUT you do start with lab induction and your helpful #BMSes will show you around.
People often ask me “so what exactly does a transfusion consultant do?” (and often I ask myself the same question!). This week I have…
Seen and spoken to patients with congenital bone marrow disorders, iron deficiency, myeloprofilerative disorders, ITP, secondary polycythemia, autoimmune neutropenia and a variety of abnormal counts
Given advice around blood provision for a patient undergoing bone marrow transplant with a D mismatched donor
Today I did an online tutorial with the West Midlands #haemSpRs. It was good to do some teaching after a bit of a hiatus! We've always done online tutorials on Whatsapp but videoconferencing was a win. #Covidsilverlinings
Follow this thread for a #blooducation #tweetorial
Follow this thread for a #blooducation #tweetorial
We talked about platelet refractoriness and its definition. Strictly this is by a recovery value or corrected count increment based on patient size and volume of platelets transfused, but practically we use the rise in platelet count measured within 24h of transfusion.
This should be checked twice, with ABO matched plt which are =< 3 days old. What increase in platelet count is deemed insufficient?
Just had a call from an anaesthetist. Surgeon wants to take a patient with allogeneic antibodies to theatre for a non urgent procedure; surgeon wants to use the O negs. How would the #haemSpRs respond to that? (Without swearing! 🤣🙈) #blooducation
You have all made me laugh tonight! I think you've all covered the main points and very politely may I say... But still for the benefit of the new #haemSpRs... 1/
O D neg blood is negative for A, B and D antigens, and also for K (if it’s “emergency” blood). But nothing else. Patients may have clinically significant antibodies to a whole host of other blood group antigens which may well be present in O D neg K neg blood. 2/
This January @NHSBT are focussing on recruiting more male donors but why are men so important as blood donors? Which components are specifically made from donations from men and why? @bloodmed challenged me to a tweetorial on this topic, so here it is!
@NHSBT @bloodmed 2/ There are a number of differences between men and women (we’ll focus on those having a direct influence on blood donation here!);
@NHSBT @bloodmed 3/ Men can’t be pregnant. This means they are not at risk of making human leucocyte antibodies, unless they have been transfused; anyone who has had a transfusion since 1980 cannot donate blood in the UK transfusionguidelines.org/dsg/wb/guideli…
Continuing the theme of the fortnight #Onegoal
Most O D neg blood goes to O D neg patients, but 16% is used in emergencies. Hopefully the #haemSpRs know that in this setting it is recommended only be used for people of childbearing potential, and until the blood group is known
Most O D neg blood goes to O D neg patients, but 16% is used in emergencies. Hopefully the #haemSpRs know that in this setting it is recommended only be used for people of childbearing potential, and until the blood group is known
In an emergency, group specific blood can usually be available 15-20 minutes following receipt of the (2nd) sample – depending on local SOPs. Fully cross matched blood should be available within 30-45 mins (providing the antibody screen is negative).
If the antibody screen is positive, group specific can still be issued pending antibody ID; O D neg is no safer in this scenario. Risks of transfusing need to be weighed against risks of not.
I’m spending a lot of time thinking about O D neg this week. R0 is something that often causes difficulties – for #haemSpRs and transfusion labs! So what is R0?
(also tempted to add a poll for how you say it! Will stick to "R oh" personally....)
and we have the correct answer! Capital R = D pos, then 0 means (to my mind) no C or E. R0 = cDe; R1 = CDe; R2 = cDE. r = cde which is of course D neg
#Onegoal Q2 of the day... who has the highest priority to receive D neg red cells? (apologies for shorthand!)
...aaand we have a correct answer! Yes, patients who already have alloimmune anti-D are the highest priority to receive D neg red cells. This includes neonates with passive anti-D from mum #blooducation
D neg children and those with unknown blood groups (M and F) should receive D neg blood, but a known D pos child can receive D pos red cells
For the next 2 weeks @PBM_NHS are focussing on O D neg. I’ve got a few #tweetorials up my sleeve; but why is O D neg so important? Can I convince you to make focussing on saving this #preciousblood your #Onegoal for the fortnight? #blooducation
@PBM_NHS Overall red cell issues are falling but O D neg use is static/rising due to increased survival of trauma patients to hospital and increased complexity of transplantation – this is a good thing! But as a %, O D neg use is going up. 
@PBM_NHS O D neg people comprise 7% of both patient and donor population; O D neg patients need O D neg blood, and other key patient groups too (more on that later), so we are always needing to ask more of our O neg donors than others.
Saturday lunchtime #blooducation tweetorial, inspired by someone who came to see me recently. Let's talk Rh null! (NB written by a clinician, for clinicians…scientists please do chip in!)
The Rh protein comprise Rh D C c E and e. “d” does not exist but is used to denote the absence of D. The C/c and E/e proteins are encoded by the RHCE gene and thus inherited together. Rh associated glycoprotein (RhAG) is required for expression of D and CE.
C/c and E/e are antithetical. Antithetical means a pair of antigens that are coded by different alleles of a single gene It does NOT mean that only one is ever carried on a single RBC.
Stocks of O D neg @NHSBT running low again. Will get worse over the next few weeks (donors on holiday...). Teleconference today discussing how we can reduce use.
Lots of work going on to ensure patient care isn't compromised; the responsibility is everyone's!
Lots of work going on to ensure patient care isn't compromised; the responsibility is everyone's!
@NHSBT And the very recent NBTC guidelines on appropriate use of O D neg is here
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Been out of the loop for a few months but back in touch for one day only! It’s the face to face meeting of the patient facing NHSBT consultants… #mouthful #F2FNHSBT
Shubha Allard reminds us of the JPAC guidelines which are all online #F2FNHSBT
transfusionguidelines.org
transfusionguidelines.org
And the Transfusion Handbook, esp useful for the #haemSpRs and available for free online! #F2FNHSBT
transfusionguidelines.org/transfusion-ha…
transfusionguidelines.org/transfusion-ha…
Busy day with the #BSHTIP delegates today. Lots of small group sessions and interactive Kahoot! voting on more transfusion topics! kahoot.com #blooducation
Anaemia of chronic disease signified by low serum fe, low transferrin saturation and normal or low TIBC. Functional iron deficiency is an important cause of ACD.
Thorough guideline here on FID for the #haemSpRs
b-s-h.org.uk/guidelines/gui…
#blooducation
Thorough guideline here on FID for the #haemSpRs
b-s-h.org.uk/guidelines/gui…
#blooducation
B12 levels can be affected by many things including drugs. With borderline levels think metformin, OCP, pregnancy and repeat level. Intrinsic factor antibodies can help decide on further management #BSHTIP
More info here b-s-h.org.uk/guidelines/gui…
More info here b-s-h.org.uk/guidelines/gui…
First up @shshsid on the journey of blood. Did you know the National Blood Service was established before the NHS? #BSHTIP
<3% people aged 17-70 donate blood and 96% of them are Caucasian. Thankfully more than 3% of our delegates are donors!
Double red cells can be donated for rarer blood groups by apheresis- but donors must be >70kg, have hb >140g/L and only donate 2x/year (vs 50kg, 125g/L (women)/135g/L (men) and every 16/12 weeks) #BSHTIP
I enjoy Whatsapp tutorials with the #haemSpRs but was good to see them face to face today... Key facts from today:-
V few patients merit products from IgA deficient donors
Check IgA levels at NHSBT (more sensitive) and for anti IgA abs. Transfusion history is critical. Usually washed products will suffice.
hospital.blood.co.uk/media/29083/in…
Check IgA levels at NHSBT (more sensitive) and for anti IgA abs. Transfusion history is critical. Usually washed products will suffice.
hospital.blood.co.uk/media/29083/in…
For patients with alloabs, can use same approach no matter how unusual
1. is the ab clinically signif (?ATR ?HDN)
2. what % donors are ag neg (can you get ag neg blood??)
3. how much blood loss is expected?
4. optimise the patient pre op! (this should be #1!!)
#blooducation
1. is the ab clinically signif (?ATR ?HDN)
2. what % donors are ag neg (can you get ag neg blood??)
3. how much blood loss is expected?
4. optimise the patient pre op! (this should be #1!!)
#blooducation
Good tutorial w the new #haemSpRs this evening. Pooled plt now in 30% PAS, w fewer allergic reactions than apheresis platelets #blooducation
Apheresis plt req'd for HLA selected, IgA def or IUT/neonatal transfusion. Preferred for pts born post 1996 but not a must #blooducation
HLA sensitisation no different between apheresis v pooled plt. Leucocyte reduction reduces the risk (TRAP study) researchgate.net/profile/Kj_Kao…
Just finished online tutorial w #haemSpRs. Todays learning points: sickle cell anaemia pts need ABO, full Rh& K matched RBCs, HbS neg... 1/2
2/2 .. <7/7 old for exchange, <10/7 for top up. And neg for any previous or current abs #blooducation
TAPS trial gives evidence for top up (if hb <90) or exchange (hb >90) transfusion pre op #blooducation
linkinghub.elsevier.com/retrieve/pii/S…
linkinghub.elsevier.com/retrieve/pii/S…
Next up the NATA plenary session. @TobyRichardsUCL on 'cheap and quick wins in PBM' #bbts2017
@TobyRichardsUCL Either oral or IV iron are useful in pre op setting #bbts2017
Great online tutorial tonight w the #haemSpRs talking re major incident planning. Sadly a reality for all of us. Discussn points were...
… staffing of lab (&clinical teams) to be maintained at 12, 24, 48 hours i.e. don’t front load workforce too much
haem medic in clinical area can help guide product use, ensure appropriate XM and coag samples sent
Last week we had a #haemSpR training day. First up haemolytic anaemia.
Comprehensive BSH guidelines here
b-s-h.org.uk/guidelines/gui…
and here
b-s-h.org.uk/guidelines/gui…
b-s-h.org.uk/guidelines/gui…
and here
b-s-h.org.uk/guidelines/gui…
Can the #haemSpRs tell me what a DAT is and what it means?
Heidi Doughty talking on transfusion challenges in the military. Many civilian lessons to be learnt #F2F2017
Pre hospital transfusion is big. Is this necessary in civilian practice? #F2F2017
.@RePHILL_trial study may provide answers. Currently recruiting in West Mids &elsewhere #F2F2017
Catch up from the BBTS session to follow... now its thrombosis free comms and Laura Green presenting ORANGE #BSH2017
Annual major bleeding rate for pts on oral anticoagulants 1.2-3.6% in trials, almost certainly higher in real life #BSH2017
Warfarin is one of the drugs most frequently wrongly prescribed and dispensed #BSH2017
