Hydrocortisone grossly overused. Glad to see our delegates are not routinely giving "H&P" for transfusion reactions or as a premed... #BSHTIP
Patient becoming unwell during the transfusion - it may be completely unrelated to the transfusion- never assume! #BSHTIP
All specialities have their "thing" they do before ABC for an unwell patient. For us? STOP THE TRANSFUSION! (you can always restart it later if its not been disconnected) #BSHTIP
Top 3 severe acute transfusion reactions: 1. ABO incompatibility 2. anaphylaxis 3. bacterial contamination #BSHTIP
Check the ID of the patient and details on the unit then send back the unit to blood bank for further testing but tell them first! #BSHTIP
Tests to think about in an acute reaction include:
Repeat G&S, DAT
CXR
A/VBG
FBC &coag (inc fgn!) +reticulocytes and blood film
Biochem inc LDH and haptoglobin
Blood cultures
Urine dip #BSHTIP
Nice explanation of the DAT. Such a useful test when used wisely and interpreted appropriately #BSHTIP
Familiarise yourself with your local trust guideline for managing transfusion reactions. Your #haemSpR, consultant or transfusion practitioner is also available for advice 24/7 for acute reactions #BSHTIP
Most transfusion events are associated with errors. The @SHOTHV1 report makes for terrifying bedtime reading but is well worth a read. Good case scenarios to see where mistakes have been made #BSHTIP shotuk.org/shot-reports/
Bacterial contamination is extremely rare thanks to bacterial screening of platelets. Patient harm can be (& has been) prevented by visual inspection of the unit prior to transfusion at the bedside #BSHTIP
TACO often underrecognised. Renal failure, diuretic use, cardiac dysfunction, low weight are all risk factors. Try using this tool from the 2016 SHOT report: #BSHTIP
TRALI is much reduced now we are using plasma from male donors only (previously mostly caused by HLA antibodies). ARDS has many causes - difficult to know if the transfusion was implicated #BSHTIP
• • •
Missing some Tweet in this thread? You can try to
force a refresh
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…