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
Virtually met with my PBM practitioner and Customer Services Manager at NHSBT to review regional use of blood and recovery plans. O neg is going up disproportionately to recovery in activity and it’s important for us to understand why.
We also brainstormed how we are going to run our RTC educational activities over the next few months (we’ve got a plan; watch this space!)
I also:
Caught up with a couple of the “junior” doctors I supervise to review their progress and ongoing needs. I have some fantastic trainees and it’s been more important than ever during Covid to keep in touch and make sure they are supported.
Investigated an incident of an unnecessary transfusion and liaised with the ward manager and my haematology colleagues to try to understand why it happened, as well as to put in measures to reduce the chance of it happening again
Had a telecom to help plan the Advances in Transfusion Medicine virtual meeting on 26th November. It's looking good! We have extended the abstract deadline to 20th Sept - free registration and publication in Transfusion Medicine up for grabs! rcpath.org/event/advances…
Listened to the latest recording of a @blooduction byte on haemolytic anaemia (we are finally getting there with remote recording and will be releasing some new podcasts soon!)
Been involved with discussions around improving transfusion pathways for bone marrow transplant patients in our recently merged trust
Met with the transfusion practitioners to review transfusion reactions and adverse incidents, deciding on any further investigations, appropriate treatment for the patients and whether they needed to be SHOT/SABRE reported
Met with the transfusion biomedical scientists to discuss interesting and unusual cases. We have a few patients requiring washed and/or HLA selected platelets at the moment so we checked in on them too
Spoke to a cardiac anaesthetist about blood prescriptions on cardiac ITU and ironed out a few issues about their communication between cardiac ITU, cardiac surgery and blood bank. Ahem!
Taught the West Midlands #haemSpRs about platelet refractoriness and platelet provision
Chaired the NHSBT Patient’s Clinical Team telecon where we discussed recovery plans from Covid, convalescent plasma, the impending revised @BritSocHaem guidelines on irradiated blood use, and had brilliant CPD session on fibrinogen vs cryo prepared by one of my colleagues
Interviewed for a new senior biomedical scientist in transfusion
Reviewed the draft paper for our feasibility RCT of red cell thresholds in AML with the @NHSBT_CTU statisticians
Worked on the statistical analysis plan for our granulocyte registry, ProGrES. Thanks to hospitals around the country, we have information on more than 200 patients and are working with @LSHTM to see if we can do anything clever around association and causation. Exciting!
Reviewed an audit one of my excellent middle grades has done looking at whether we should remove the “irradiated flag” on the LIMS for patients who no longer need irradiated blood following BMT. Spoiler alert: the ones who no longer need irradiated components don’t need blood.
Had a discussion with one of our large regional hospitals about normovolaemic haemodilution (NB we don't endorse this routinely)
Went for a walk around theatres with one of my transfusion practitioners so I can visualise how things are changing post Covid. We have SO MANY satellite fridges I cannot get my head round where they are all moving to! 🙈
Worked with the IT team on an automated email to be sent blood bank when daratumumab is prescribed. A #haemSpR's audit showed some “gaps”; we need to be better esp as dara moves up the treatment algorithm and when we have the antiCD47 agents (which are a lot less forgiving)!
Next week I’ll be updating our major haemorrhage protocol following extensive discussions across our newly merged (now enormous and even more complex) trust, reviewing some of the revised content for the @PBM_NHS non medical authorisation of blood course, being on call for...
...NHSBT, delivering more teaching, doing another clinic, and as always fielding a whole host of stuff I never saw coming!
I have had a number of #haemSpRs tell me they think they’d be bored “_just_ doing transfusion” and there are definitely times when I miss being a “real” haematologist, but there are also times when I know I could never do anything else.
Most of all I know how lucky I am to work with so many people in different organisations, different specialities and different professions and they are all awesome. You know who you are!
But also I am excited to spend my weekend with this one! Happy weekend everyone 🥰
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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…
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…