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…

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.

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 ... 🙈

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28 day mortality following haemorrhage is higher in children than adults (unpublished data and substudies from PROPPR and PROMMTT) Observational studies of large numbers of patients but with only very small numbers of paediatric patients suggest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.

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! 🙈

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.

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.

thelancet.com/journals/lance…

Lots of talk about this paper from @TobyRichardsUWA in the last couple of days. My thoughts:

Unselected patients with anaemia, 28/29% medical history IDA, 26/27% had ferritin <100. 20% already on oral iron.

1/ Definition of IDA is ferritin <100 ng/mL which is in line with pre op guidelines but not other settings, where 30 is more commonly used. Would be interested to know outcomes for those with ferritin <30.

2/

Following the first part of my granulocyte tweetorial yesterday, here’s the second instalment...

https://twitter.com/TransfusionWM/status/1290378886027640832

So how do we “make” GTX? Historically they were collected by apheresis from patients with CML(!). These days, most countries collect from healthy donors following dexamethasone and/or GCSF as either directed (e.g. family/friends) or non directed donations...

I was on call for NHSBT last week and have discussed lots of patients for whom we have agreed to transfuse granulocytes (GTX). But what are they, when do we use them and how can you get hold of them? #blooducation I wrote a tweetorial and it was soooo long, so I’ve divided it into chunks (I LOVE granulocytes) 🙈. So, here’s part 1.

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

Recently, blood bank brought to my attention a patient under haematology who was pancytopenic.

Hb 77 g/L
WCC 8.4 x10^9/L
Plt 41 x10^9/L

What is the usual red cell transfusion threshold for patients with haematological malignancy?

#blooducation In the absence of active bleeding or acute coronary syndrome, NICE recommend a transfusion threshold of 70 g/L. Some haematology units use 80 g/L although this is not supported by UK guidance.

nice.org.uk/guidance/ng24/…

Yesterday I met with our fantastic BMSes and MLAs to go over interesting/tricky cases this week. We talked about indications for washed platelets. #blooducation

Washed platelets are indicated in order to reduce risk of Washed platelets are given to patients with a history of recurrent allergic reactions. Allergy is usually to proteins in the plasma element of the platelet unit, so removing the plasma reduces the risk.

Today I did an online tutorial with the West Midlands #haemSpRs. It was good to do some teaching after a bit of a hiatus! We've always done online tutorials on Whatsapp but videoconferencing was a win. #Covidsilverlinings

Follow this thread for a #blooducation #tweetorial We talked about platelet refractoriness and its definition. Strictly this is by a recovery value or corrected count increment based on patient size and volume of platelets transfused, but practically we use the rise in platelet count measured within 24h of transfusion.

This week, NBTC released an updated Red Cell Shortage Plan. Why is it needed and what does it say? Keep reading for some #blooducation @PBM_NHS Blood donation levels are falling consistently due to reduced donor activity. At the moment, blood stocks look good because elective work has ceased in most hospitals and NHSBT are working to increase donations. But it is anticipated soon demand will exceed supply.

Lots of discussions about #covid19 going on. Hoping everyone on Twitter knows the key messages and where to find info, but if not, here are a few links... 1/ Here is a message from @NHSBT today, requesting we are careful with O D neg ordering and only request K neg when needed nhsbtdbe.blob.core.windows.net/umbraco-assets…

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/

We were excited to run our second @BritSocHaem Transfusion in Practice course today with @BuntyStowe @shshsid @h4yder ! #BSHTIP @BritSocHaem @BuntyStowe @shshsid @h4yder First we talked about blood donation in the UK. All our blood is donated by altruistic donors, most commonly through whole blood donation but 30-40% platelets are donated by apheresis

This January @NHSBT are focussing on recruiting more male donors but why are men so important as blood donors? Which components are specifically made from donations from men and why? @bloodmed challenged me to a tweetorial on this topic, so here it is! @NHSBT @bloodmed 2/ There are a number of differences between men and women (we’ll focus on those having a direct influence on blood donation here!);