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
Current hb estimation for donors is by CuSO4 but soon @NHSBT will start doing capillary HemoCue for 'at risk' donors (women of child bearing age) #BSHTIP
CuSO4 has low sensitivity and specificity. Remember every bag of blood you prescribe does not have the same amount of hb in it! #BSHTIP
'Manufacture' of blood starts with leucocyte reduction. It is then centrifuged and separated. High volume, (relatively) low tech! Blood centre tours at Filton and Manchester are available hospital.blood.co.uk/media/29262/bl… #BSHTIP
Hepatitis E was on all our minds for a long time in 2015/16. Now all blood components collected by NHSBT are HEV tested and negative #BSHTIP
Discretionary testing helps retain donors and decrease donor deferrals. Travel to certain countries may prompt testing for West Nile virus, malaria, T. Cruzi etc. #BSHTIP
Donors with sickle trait or thalassaemia trait CAN be blood donors as long as hb is high enough. Donated blood will not be used for patients with sickle cell disease though (they have enough HbS already!!) #BSHTIP
Platelets are now routinely sampled for bacterial contamination. Highest risk of bacterial transmission as they are stored at room temp (not in the fridge) #BSHTIP
People born in the UK after 1/1/96 have not been exposed to vCJD in the foodchain and should get imported plasma products - solvent detergent (Octaplas) or methylene blue treated FFP #BSHTIP
Irradiation destroys residual lymphocytes which can cause graft vs host disease in the severely immunocompromised. Full list of who needs irrradiated components is here onlinelibrary.wiley.com/doi/10.1111/j.… #BSHTIP
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…