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.
1. Ask how to do a group and screen and watch a cross match being done
2. Go with the transfusion practitioners investigating a transfusion reaction or adverse event
3. Read you local major haemorrhage guidelines and your major incident plan
As we are currently in the middle of the worst blood shortages of our generation, know your indications for transfusion; NBTC codes are a good start transfusionguidelines.org/uk-transfusion…
And also read the shortage plans (links on the same page; your trust will also have a plan)
Download the 2 NHS transfusion apps: Blood Components
play.google.com/store/apps/det…
and Blood Assist
play.google.com/store/apps/det…

(on all the ususal app providers)
But mostly, ask ask ask. This is all new, no one expects you to know it all.
Welcome to haematology!

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More from @TransfusionWM

Aug 5
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)
nhsbtdbe.blob.core.windows.net/umbraco-assets…
Read 10 tweets
Aug 4
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)
Read 11 tweets
Oct 3, 2020
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…
Read 12 tweets
Oct 3, 2020
Next up @KreuterMD @AShmooklerMD @HermelinMD on transfusion Twitter #AABB20 . So excited for this session!
Concentrating hard on virtual journal clubs; I haven't yet got the hang of this! 🙈
Thank you @AShmooklerMD ; will be looking into Tweet Deck before any more journal clubs!
Read 7 tweets
Oct 3, 2020
Excellent paediatric transfusion session @AABB #AABB2020

First Megan Delaney discussing the role of pathogen inactivation in platelets transfused to children and neonates.
Updating on the recent evidence supporting the safety of both Mirasol and Intercept products, but highlighting that both result in lower post transfusion platelet increments.
Then Marianne Nellis @mnellismd talking on transfusion in paediatric critical care, presenting the work of the TAXI (Transfusion and Anaemia eXpertise Initiative group), culminating in a series of best practice statements and a transfusion decision tree.
ncbi.nlm.nih.gov/pmc/articles/P…
Read 10 tweets
Sep 17, 2020
The two sample, or “group check”, rule has been widely implemented in the UK. It's use increases the chances of identifying a Wrong Blood in Tube (WBIT) and thus preventing ABO incompatible transfusion.
Following a series of WBITs, we became aware of a practice in our hospital whereby junior doctors were taking two transfusion samples at the same time and labelling them with different times.
We undertook a survey to ascertain understanding of the two sample rule and the implications of taking two samples at the same time but labelling them with different times.
Read 17 tweets

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