Thread by @TransfusionWM

We were excited to run our second @BritSocHaem Transfusion in Practice course today with @BuntyStowe @shshsid @h4yder ! #BSHTIP

@BritSocHaem @BuntyStowe @shshsid @h4yder First we talked about blood donation in the UK. All our blood is donated by altruistic donors, most commonly through whole blood donation but 30-40% platelets are donated by apheresis

@BritSocHaem @BuntyStowe @shshsid @h4yder Donors are assessed prior to donation with the Donor Health Questionnaire and a hb check to ensure the donor is safe to donate and the blood is safe to give to patients.

@BritSocHaem @BuntyStowe @shshsid @h4yder Some testing of the donation is mandatory (e.g. HIV, ABO group) and some is discretionary depending on info given by the donor (e.g. malaria for foreign travel) or the destination of the blood (e.g. CMV for IUT).

@BritSocHaem @BuntyStowe @shshsid @h4yder Due to additional discretionary testing, we have less deferrals now than previously. People can find out if they are eligible to donate here blood.co.uk/who-can-give-b… or the JPAC donor selection guidelines are here transfusionguidelines.org/dsg/wb

@BritSocHaem @BuntyStowe @shshsid @h4yder In the transfusion science session we discussed that the ABO blood group is the most important because antibodies are naturally occurring and are IgM, so can activate complement leading to intravascular haemolysis, DIC, renal failure and death

@BritSocHaem @BuntyStowe @shshsid @h4yder The basic transfusion lab test is the “Group and antibody screen” – forward and reverse groups for ABO, forward D group and then screening for patient antibodies to other blood group antigens

@BritSocHaem @BuntyStowe @shshsid @h4yder For anyone who wants to hear more about ABO and D typing, listen to a podcast I recorded with @swright2909, clinical scientist at NHSBT here blooducation.co.uk/portfolio/sara…

@BritSocHaem @BuntyStowe @shshsid @h4yder @swright2909 PBM is an evidence-based, multidisciplinary approach to optimising the care of patients who might need transfusion. I think of it as not using blood for people who don’t need it so it is there for the people who do. This includes lots of blood and quickly in major haemorrhage.

@BritSocHaem @BuntyStowe @shshsid @h4yder @swright2909 A big part of PBM is identifying and treating reversible anaemia. The 2015 NICE guidelines say (among other things) we should be treating iron deficiency with iron. It’s not rocket science! nice.org.uk/guidance/ng24

@BritSocHaem @BuntyStowe @shshsid @h4yder @swright2909 NICE also cover plasma, platelets, alternatives to transfusion and patient information. For more information about PBM, follow @PBM_NHS

@BritSocHaem @BuntyStowe @shshsid @h4yder @swright2909 @PBM_NHS In the Special Requirements session we discussed that irradiated components are given to reduce the risk of transfusion associated GvHD, usually in patients who have impaired T cell immunity or who are receiving a component close in HLA type to their own.

@BritSocHaem @BuntyStowe @shshsid @h4yder @swright2909 @PBM_NHS .@bbguy does a great podcast on this topic which you can listen to here bbguy.org/2019/07/31/074/

Full BSH guidelines are here b-s-h.org.uk/guidelines/gui… (updated version coming soon!)

@BritSocHaem @BuntyStowe @shshsid @h4yder @swright2909 @PBM_NHS @bbguy We also discussed that patients born after 1st Jan 1996 historically have been recommended to have imported plasma components (Octaplas, methylene blue FFP and cryoprecipitate).

@BritSocHaem @BuntyStowe @shshsid @h4yder @swright2909 @PBM_NHS @bbguy SaBTO revised this advice last year and hospitals are likely to be changing practice soon… watch this space! gov.uk/government/pub…

@BritSocHaem @BuntyStowe @shshsid @h4yder @swright2909 @PBM_NHS @bbguy .@shshsid, medical director of SHOT, gave a brilliant overview of the organisation. SHOT started in the 1990s as one of the earliest haemovigilance organisations in the world. By reviewing when things go wrong we can work to make things better. A no blame culture is paramount.

@BritSocHaem @BuntyStowe @shshsid @h4yder @swright2909 @PBM_NHS @bbguy Register for the SHOT Symposium in July here! shotuk.org/annual-shot-sy…

and read last year’s report here shotuk.org/shot-reports/

@BritSocHaem @BuntyStowe @shshsid @h4yder @swright2909 @PBM_NHS @bbguy Transfusion reactions occur commonly. PAUSE the transfusion, check the details on the bag with the patient and their wristband, and assess the patient.

@BritSocHaem @BuntyStowe @shshsid @h4yder @swright2909 @PBM_NHS @bbguy At the bedside we categorise into mild/moderate/severe to guide what actions are required. Mild reactions are fevers (rise <2 degrees C) or non-urticarial rash, with no other associated features.

@BritSocHaem @BuntyStowe @shshsid @h4yder @swright2909 @PBM_NHS @bbguy For anything more, do a full ABC assessment. For patients becoming very unwell during a transfusion, think ABO incompatibility, anaphylaxis, bacterial contamination and TACO.

@BritSocHaem @BuntyStowe @shshsid @h4yder @swright2909 @PBM_NHS @bbguy BSH guidelines for management of transfusion reactions is here, but look at your local guidelines too
b-s-h.org.uk/guidelines/gui…

@BritSocHaem @BuntyStowe @shshsid @h4yder @swright2909 @PBM_NHS @bbguy The most common thing that goes wrong with transfusion is that someone makes an error. The biggest cause of patient morbidity is TACO. The most dangerous complication of transfusion is TA-GvHD (~95% mortality).

@BritSocHaem @BuntyStowe @shshsid @h4yder @swright2909 @PBM_NHS @bbguy All patients should be consented for transfusion (verbal is fine) and this should be documented in the notes. More information on consent is here hospital.blood.co.uk/patient-servic…, including information on the pivotal Montgomery vs Lanarkshire case.

@BritSocHaem @BuntyStowe @shshsid @h4yder @swright2909 @PBM_NHS @bbguy We hope our delegates enjoyed the course today and we look forward to seeing them online for some Whatsapp tutorials over the coming weeks! #BSHTIP