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/
These antibodies are found, if the patient has any, during the antibody screen (the “screen” part of “group and screen”) and then identified by testing against a panel of donor cells (NB this takes time, and more samples). 3/
Red cell alloantibodies can cause haemolytic transfusion reactions (usually delayed, but still significant). In the stable, non bleeding patient, antigen negative and physically cross matched blood should be given. 4/
As a point of principle I like to tell people suggesting O negs as an option, that they may as well give ABO and D specific blood, as this will be no less safe. That often makes them realise their misunderstanding of what O neg actually is. 5/
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…
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.
This morning I met with the chair and vice chair of the Midlands Regional Transfusion Committee, the Midlands Patient Blood Management Practitioner and the Customer Services Manager. What are their roles and what does the RTC do?
A #blooducation 🧵
RTCs serve to bring together Hospital Transfusion Committees to discuss best practice, implement new guidance and provide educational resources and events. They are run by clinicians and scientists working in hospitals, supported by @NHSBT.
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.
Every doctor starting in a new trust does transfusion training as part of their mandatory training. But why?
50ml ABO incompatible blood can kill a patient. ABO antibodies are naturally occurring (“everyone” has them) and they are IgM; they can activate complement and cause *immediate* intravascular haemolysis, causing release of free haem, endothelial activation, renal failure and DIC.
In most hospitals, blood banks require 2 samples (one may be historic) before releasing group specific (non-O) blood for a patient. This is to increase the chances of identifying a *wrong blood in tube* (pt whose blood's in the tube is not the pt whose details are on the outside)
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.
Excellent session on emergency paediatric transfusion #AABB20. Cyril Jacquot talking on pre hospital transfusion and summarising the literature.
28 day mortality following haemorrhage is higher in children than adults (unpublished data and substudies from PROPPR and PROMMTT)
Observational studies of large numbers of patients but with only very small numbers of paediatric patients suggest that pre hospital blood is not associated with an excess of transfusion reactions and in some studies is thought to have improved survival.
Whole blood, group O, high titre neg, used in paediatrics in Pittsburgh appears to be safe with no haemolysin-mediated haemoylsis in non group O patients (Leeper et al JAMA Pediatrics 2018) ncbi.nlm.nih.gov/pmc/articles/P…