Bloodlines - BBTS | Home · The breaking news in my last column was that the BBTS has been successful in its bid to host the 2015 Regional Congress of the ISBT in London. Jonathan

BloodlinesIssue No.106 November 2012

BBTS Annual Conference 2012: full coverage

Page 19Poster

Prize

Winners

Page 16Special

Interest

Reports

T H E S O C I E T Y ’ S N E W S L E T T E R

Page 8BBTS

Award

Winners

and CPDnews

Biotest UK Ltd28 Monkspath Business Park, Highlands Road,

Shirley, Solihull, West Midlands B90 4NZ

Telephone: 0121-733-3393 Fax: 0121-733-3066

www.biotestuk.com e-mail: [email protected]

4 Society NewsEditorial

Council Meeting Report

Guide to submitting articles

Call for Communication Committee Members

Council Members update

8 Annual Conference 2012Conference Award Winners

Annual Conference goes to my hometown

Junior Bursaries

Princess of Wales Award

Hospital Transfusion SIG

Paediatric SIG

Blood Bank Technology SIG

CPD NewsGuidelines for pre-transfusion

SHOT or not?

15 Annual Conference 2012Components SIG

Red Cell SIG

Poster Prize Winners

24 ArticlesPatient Blood Management

ISBT Congress

27 Trade News & EventsNEQAS Meeting

The deadline for copy to be submitted for the next edition of the newsletter (107)is Friday 11 January 2013.

con t en t s

I usually start this column with a comment

about the weather - last time I was

looking forward to ‘basking in the

sunshine in Harrogate’! It turned out to

be the wettest September on record, with

floods making it difficult to travel and

actually preventing some delegates from

attending the conference. I’ll keep my

thoughts about the impending winter

weather to myself!

Rain aside, the annual conference was

everything it was meant to be – well-attended,

educational, interesting and fun. The initial

informal comments and formal feedback from

delegates back this up, and I thank the

exhibitors, speakers, chairs, Kate Pendry and her

team of abstract reviewers and poster judges,

Cath Riley and the office team, Jane Keidan and

the rest of the organising committee and the

delegates for making it such a success.

Congratulations to the junior bursary winners -

it was good to meet you all and see you

attending lectures and participating in the

education and case-study sessions, whilst still

making the most of the social opportunities!

I hope that you remain part of the BBTS, and

consider joining one of the SIGs or the

Communications Committee. I know that for

most of you, it was your first conference and

I look forward to reading your feedback which

is published in this edition of Bloodlines.

It was also my pleasure to welcome Martin

Bruce as President Elect, and Marie McQuade

and Dan Palmer as new council members. They

have already thrown themselves wholeheartedly

into council meetings, and Dan has agreed to

join the Professional Affairs and Education

Committee (PAEC), whilst Marie will be joining

the Communications Committee.

Of course, the conference followed on from

a hugely successful summer in the UK. The

Olympics and Paralympics were equally

awesome and more than lived up to my

expectations. The atmosphere in the country,

particularly in London, was amazing, with nearly

everyone watching and talking about the

Games. There were thankfully no serious

T H R E E

PRES IDENT ’ S c o l umn

We would like to thank all the advertisers in this edition of Bloodlines.If you are interested in advertising in future editions, which is distributed to over 450 delegates please contact the BBTS Office: Enterprise House,

Manchester Science Park, Lloyd Street North, Manchester M15 6SE. Tel: 0161 232 7999 or email: [email protected]

Disclaimer - The Publisher, British Blood Transfusion Society cannot be held responsible for errors or any consequences arising from the use of information containedin this journal; the views and opinions expressed do not necessarily reflect those of the Publisher, British Blood Transfusion Society and Editor, neither does the publication

of advertisements constitute an endorsement by the Publisher, British Blood Transfusion and Editor of the products advertised.

Clare Milkins

untoward incidents, but the contingency

planning undertaken by NHSBT was not wasted.

The breaking news in my last column was that

the BBTS has been successful in its bid to host

the 2015 Regional Congress of the ISBT in

London. Jonathan Wallis and I presented the bid

to the Board of Directors at the ISBT meeting

in Cancun and you can read a short report of

the congress, elsewhere in this edition. This is

a really exciting prospect for the BBTS and will

be a great opportunity for UK transfusion staff

to attend an international congress.

We have recently seen the launch of the new

Academy for Healthcare Science (AHCS). This UK

wide organisation aims to provide a single voice

for healthcare scientists and is going to be

hugely important in terms of their registration

and regulation; the AHCS is already planning a

means of assessing equivalence between

current qualifications and the outcomes of the

MSC training programmes. The BBTS has

nominated representatives for two of the

Professional Themed Groups, namely Blood

Sciences and Infection Sciences, so we are in

a good position to influence developments.

We will keep you up to date with progress.

It’s a bit early, but good luck with the Christmas

shopping!

@BritishBloodTS

‘British Blood Transfusion Society’

Clare Milkins, BBTS President


F O U R

SOC I E TY n ews

I hope this edition of Bloodlinescontains something new, innovativeand interesting for everyone.Remember also to follow BBTS onFacebook and Twitter for photos fromthe annual conference and otherlatest news.

In this edition of Bloodlines we report onthe success of the conference in Harrogateduring which our president elect - MartinBruce - was welcomed into office. For thoseof you who do not know Martin I managedto capture a photo of us together which

Editorial by Jennifer Duguid

appears at the start of this column.Martin has been a driving force fortransfusion in Scotland and it is interestingto note that during his term of office thevote on Scotland’s devolution and fullindependence will take place, whether thiswill affect BBTS membership criteria issomething that will need considering.

The BBTS Communications Committee,which is responsible, among other things,for planning the themes and topics forBloodlines also welcomed a new memberMarie McQuade. We look forward to Mariehelping us in our communication work butwe are still seeking further members for thecommittee, especially from younger BBTSmembers - perhaps some of our juniorbursary winners would like to join us?Please get in touch with the BBTS office ifyou would like to do so.

The Royal College of Pathologists celebratedit’s 50th anniversary on 21 June this yearand I’m sure many of you are involved inactivities during this National Pathology

Year. We would love to have reports fromthose of you who are running events.Please send in articles and pictures. As partof the colleges’ 50 year celebrations, a listentitled “the history of pathology in 50objects” can be viewed on the collegewebsite www.rcpath.com. So far they havereached object 40, several already listedrelate directly to transfusion science. BBTSmembers helped to contribute to this list.It would be nice to receive commentsregarding objects already listed andsuggestions for additions so please sendyour ideas to Bloodlines. As usual Bloodlinesalso welcomes articles from all members ontopics of interest to those who work in thetransfusion world so please contribute ifyou feel you can. If you are not surewhether your contribution is appropriateplease contact Louise Warburton at theBBTS office who will be only too pleased toadvise and help you.

Jennifer DuguidBloodlines Editor


The October council meetingwas held in Birmingham. Thepresident welcomed the newcouncil members Martin Bruce(President Elect), Marie McQuadeand Dan Palmer.

The minutes, action log and businessplan log were all reviewed.Discussion focussed on:

• Consideration will be given to piloting free student membershipfor those engaged as full time students on BioMedical Sciencecourses. Further discussion will be held with a university and anattempt to pilot this will be made

• CPD on-line is almost ready and will be piloted. A publicitycampaign will be developed and it is hoped to launch thisin January

• One of the council members is preparing information oncurrent R&D being undertaken in the UK which will then be

available for members to view on the BBTS website

• Much discussion was had on Modernising Scientific Careers.The chair of PAEC is setting up a working group to identify thesociety’s role in this. It was noted the society had put forward two representatives for the Academy for Healthcare Science one for blood sciences and another for infection sciences

• The society is continuing to have talks with the University ofManchester with regard to accreditation for the current examsrun by the BBTS.

Under the Pathology Harmony scheme it will be important thatBBTS is represented when the work of this group focuses on bloodtransfusion. Several areas would require consideration namelyquantitation, titres and Kleihauers.

The honorary secretary’s report focused on the following:a. Future proofing the society for roles e.g. Treasurer, Secretary,

examiners, Bloodlines editor and othersb. Identify and update society documents to give them a more

modern flavour

Joan Jones - Honorary Secretary

@BritishBloodTS


Jennifer Duguid and Martin Bruce

SOC I E TY n ews

F I V E

c. Strengthening the Nursing Sub-Committee. It had been considered this would be a stand- alone group but followingdiscussion it was agreed they should sit within the remitof PAEC

The honorary treasurer reported that the strategic financial plansand balancing the books showed improvement and he was pleasedwith progress to date. A meeting had been held with WileyBlackwell and the current model of sharing profits is to bereviewed. It has been agreed that NATA will now be able to publishin Transfusion Medicine and there is interest from Scandinavia whoalso do not have their own journal. Council also discussed thatfinancial support may be required in the next two years to fund thesociety’s approach to Modernising Scientific Careers. Council wasin agreement that it would make good business sense to spendmonies developing the right benefits and assistance for ourmembers.

The executive manager’s report covered:

• As of 31/8/2012 membership was 1541, compared to 1603 on the 31/8/2011; membership levels peak and trough duringthe year with the summer, post membership renewal periodbeing the lowest point, then rising to a high point figure at theend of the membership year.

• Education is continuing to see the Specialist Certificate in Science Practice doing well with excellent numbers sittingthe exams.

• The transfusion practitioners summer meeting was successfully held in June with 75 attendees. The annual conference washeld from 26th to 28th September in Harrogate. We had 475delegates which is our highest figure outside of Glasgow, Manchester and ISBT in recent years.

• In August we distributed the 105th edition of the BBTSnewsletter, Bloodlines, which continued to publicise the annual conference and the one day UK NEQAS event.

Specialist Certificate in Transfusion Science Practice

Transfusion Registered Sat the Passed the Pass rate NumberScience Practice for the exam exam exam % withExam distinction

May 2012 54 50 27 54 8November 2011 51 50 32 64 8Total 105 100 59 59 16

Specialist Certificate in Cell & Tissues Only three people have registered so far for the exam in November2012, these figures were the same last year. This figure has sincerisen to seven.

Cell & Tissue Registered Sat the Passed the Pass rate NumberTransplantation for the exam exam exam % withExam distinction

November 2011 3 2 1 50 0

Updates were given to council from:

• Communications Committee - detailed planning for issue 106of Bloodlines is in progress and will focus on how isolated areas and islands handle the problems of transfusion.

• SMAC chair reported:

• informal feedback is that the programme and socialevents were a success

• numbers for the gala dinner were extremely good

• 110 abstracts submitted and 102 were accepted for poster/oral presentation

• The new category of Clinical Audit received 23 abstracts

• 34 people supported the poster judging and the societythanks both the abstract reviewers and the poster judgesfor all their hard work

The new Mollison award will awarded for the first time in 2013 at the annual conference in Birmingham. This award is open toBBTS members based in the UK who have made a significantcontribution to the practice of clinical transfusion medicine duringthe course of their career. Information will shortly be available onhow BBTS members can nominate a person for this award.

The new council members were assigned to support the following committees:

Marie McQuade - Communications CommitteeDan Palmer - PAEC

There are currently requirements to identify people to represent theBBTS on two external groups and these will be identified shortly:

National Blood Transfusion Committee (BMS)MHRA Blood Consultative Committee

A report was received from Lynne Mannion who represented theBBTS at the Patient Blood Management Seminar.

Joan JonesBBTS Honorary Secretary

@BritishBloodTS


BBTS CPD Online!In order to make recording and submitting your

CPD activities quick and simple, the BBTS has been developing

an online CPD tool for all its members.

With the new BBTS online CPD tool you will be able to:

•Record and update your CPD activity

•Make reflective notes and upload relevant documents

•List your work history and current job role information

•Download your entire record in to an editable format

•Submit your CPD record to BBTS at the touch of a button

This fantastic new member benefit

will be available in the new year, so watch this space!

S I X

SOC I E TY n ews @BritishBloodTS


Fancy having your say about what goes into Bloodlines?

Well now’s your chance! BBTS is looking for new members to

join the Communications Committee.

We’re looking for members from all backgrounds who are

bursting with enthusiasm, creativity and ideas.

You’ll attend four committee meetings a year and be actively

involved in planning news and feature articles for Bloodlines.

Call for Communications Committee Members

Bloodlines: Your Guide To Submitting Articles

Deadlines Deadlines for the next issue are always printed on page 3 ofBloodlines. Please make sure you submit your article on or beforethis date. For editing purposes, it is helpful if you submit yourarticle as early as possible before the deadline.

How to submit Articles should be submitted as a Word file (.doc or .docx). Imagesto be included in the article (photos, charts, etc.) must besubmitted as individual files as a jpeg. Images that are embeddedin a text document or PDF file will not be used. Please labelimages accordingly. Footnotes will not be published.

Bloodlines welcomes articles from members and non-members. If you have an article to submit or wish to discuss an idea for an article please contact Louise Warburton at the BBTS office on0161 226 4587 oremail [email protected]

Word count Bloodlines has a magazine style format. Therefore articles printedmust be within a maximum word count to ensure they remainconcise and engaging. As a guide, an article should be around500 words and must be no more than 1000 words. Exceptionsmay be made if the editor feels the article requires greatercoverage (by making prior agreement with the author).

AcronymsPlease ensure when acronyms are used that the phrase or word iswritten out fully in the first instance.

Editing All articles are subject to editorial approval. The editor reserves theright not to publish articles and to edit articles without obtainingpermission from the author. If you wish to review edited copybefore publication you must indicate this when you first submityour article.

You’ll also be involved in decision making on other aspects

of BBTS communications including our monthly e-newsletter

Bloodspots and the design and content of our new website.

Remember Bloodlines is your magazine and can only work

with your input. If you’re interested in getting involved

or want to find out more, please email Louise Warburton,

BBTS Communications Officer at:

[email protected]

BBTS MembershipLate Joining Fee

Join now for just £43!

Tell your friends and colleagues!Join online at:

www.bbts.org.uk

S E V E N

SOC I E TY n ews@BritishBloodTS


New council members Martin Bruce, President Elect, September 2012Marie McQuade, elected September 2012 Dan Palmer, elected September 2012

I joined the Scottish National Blood Transfusion Service from schoolin July 1971 as a junior Medical Laboratory Technician. As you willbe aware, things were very different back then. There were noQuality Management Systems or Regulations as we know themtoday; Health and Safety was almost non-existent! The interveningforty one years have flown past, and I feel extremely fortunate tohave enjoyed such a fascinating career and to have been able tocontribute to the development of our specialty.

I joined BBTS as a founder member in 1983 and served on councilfrom 1988-90. Always supportive of the vital role being fulfilled byBBTS, during the 1990’s and 2000’s, I had the good fortune toserve on many UK standard setting committees and was able toinitiate and contribute to the development and delivery of anumber of training and development programmes for staff.

Delivering all of this and staying on top of a very challenging dayjob with the Scottish National Blood Transfusion Service (latterlyDirector of Operations, responsible for the blood supply from donorrecruitment and retention, blood collection, processing, testing anddistribution), meant that active involvement with BBTS was not a

realistic option during that time. However, having recently retiredfrom a career with SNBTS spanning 41 years, I am seeking newchallenges.

A few months before my retirement, it was suggested to me thatmy knowledge and experience would be well suited to deliveringthe role of BBTS President Elect /President. I pondered this carefullyfor a few weeks and concluded that I could indeed make a usefulcontribution to the work of our society.

Suffice to say I was absolutely delighted to be informed at thesociety AGM in Harrogate this September that I had beenconfirmed as President Elect and would take over the Presidency atthe BBTS AGM in Birmingham next year. I consider this to be a hugehonour and I will endeavour to ensure that, in the face of relentlessfinancial pressures within the healthcare system, the BBTS continuesto fulfil its mission. Martin Bruce

Retiring council members Sam Harle-StephensEmma Court

I have enjoyed meeting all of the council members old and new andhave made new friends as a result. It was just like one big happyfamily! When I first joined, what struck me was how driveneveryone was to do as much as they could to keep the councilgoing as I joined at a bad time financially. I was the representativeon the NBTC and met some interesting colleagues there as well andhave learnt a lot.

I think I have gained more experience in the field of bloodtransfusion and want to continue to contribute to meetings I attend. Of course I would ’recommend a friend’ because it wouldbe a valuable and rewarding experience for anyone.Sam Harle-Stephens

Council Members Update

BBTS Council 2012

Martin Bruce, Marie McQuadeand Dan Palmer

ANNUAL c on f e r e n c e @BritishBloodTS


E I G H T

Conference Award Winners

James Blundell AwardDr James AuBuchon Dr AuBuchon is President and Chief Executive of Puget SoundBlood Center, Seattle.

Race and Sanger Award Dr Rebecca GriffithsDr Griffiths is part of the erythropoiesis group ofProfessor Dave Anstee at Filton, Bristol.

Kenneth Goldsmith Award Dr Derek Norfolk Dr Norfolk recently retired as Consultant in Haematology and Transfusion Medicine at Leeds Teaching Hospitals andNHS Blood and Transplant.

Gold AwardJoyce Poole (left) Joyce recently retired as the Reference Manager of theInternational Blood Group Reference Laboratory in Filton, Bristol.

Princess of Wales Memorial Scholarship Mavis Okyere (centre)Mavis is a senior biomedical scientist with the National BloodTransfusion Service in Ghana.

N I N E

ANNUAL c on f e r e n c e@BritishBloodTS


BBTS Annual Conference goes to my hometown!

I was very excited when I realised that the BBTS Annual Conference was being held in my home town ofHarrogate and even more excitedwhen I managed to secureaccommodation at the Majestic Hotel.

The Majestic featured highly in my earlyyears as somewhere my parents and friendswent to dinner dances. The ladies wouldhave on ‘posh’ frocks and the men lookedsmart in their DJ’s – I wanted to go too butwas told I was too young... but when I gotto be a big girl they would take me!Needless to say at the tender age of 9 wemoved away from Yorkshire so I never gotto go, so thank you BBTS for arranging thatI could finally wear a posh frock and dancein the Majestic ballroom!

Along with a lot of delegates the journey tothe conference was not helped by thefloods, at times I wished we had hired aboat rather than a car, but most peopleseemed to get to Harrogate eventually.Whilst on the journey we kept hearingabout road closures ahead but as we werenot sure if they were going to affect us andnone of us having a good old fashionedmap I did what every respectful daughter

does… phoned her Dad... Yorkshire bornand bred he had all the answers!

My first ‘duty’ when I arrived was to go andmeet the Junior Bursary Award Winnersover drinks and nibbles. It can be verydaunting at your first conference especiallyif you are the only one from your workplaceattending and this informal gatheringallows you to meet other bursaries andcouncil members. It was lovely to see themall chatting to each other by the end of theevening and to recognise them throughoutthe meeting to be able to chat to them andsee how they were getting on.

The first day started with the SpecialInterest Groups (SIGS) which were very wellattended and of a very high standard. This was followed by the first plenarysession in the superb auditorium. Theofficial trade opening and informal eveningfollowed giving delegates chance to catchup with old friends and make new ones.The exhibition hall was a perfect setting forthe trade, lunch and posters and gaveplenty of room to wander round. Therewere also a large number of ‘feedingstations’ (as described to me by onemember of staff!) so the queue at lunchand coffee was never too long.

As usual the standard of lectures anddiversity of subjects were excellent as I havecome to expect, well done to the ScientificMeetings Administration Committee(SMAC) under the new ‘chairship’ of JaneKeiden for pulling together a brilliantprogramme. I was spoilt for choice at mostof the simultaneous sessions as to which toattend. The use of the interactive votingpads for some of the sessions was great –even if Mark Williams got some ABOanswers he was not expecting!

It was the 30th anniversary of the BBTSAnnual Conference and this was celebratedin style with a black tie formal conferencedinner – we certainly all scrub up well!It was an occasion for us all to find out whothe poster prize winners were and to thankretiring council members and welcome thenew ones.

Soon it was time to pack our bags andcheck out of hotels before a final day ofsessions. This was rounded off by tea andcupcakes before saying good bye andheading home, all of us looking forward tomeeting again in Birmingham in 2013.

Jane Murphy, BBTS Council Memberand Communications Committee Chair

Jane outside the Majestic hotel.Jane and her colleagues at the gala dinner; Kelly Kemsley, Nicky Mundy and Andrew Endersby.

Junior Bursaries



T E N

Every year the BBTS welcomes the junior bursary awardees to the annual conference. This year saw 16 junior transfusion staff awarded places to attendthe full conference.

Here’s what some of the recipients had to say about theirtime in Harrogate…

I first heard of the BBTS Junior Bursary through a friend whoworked in a neighbouring laboratory, I never thought whenapplying I would actually be one of the lucky 16 to receive a juniorbursary! Everyone was so friendly; it was a great opportunity tomeet other young professionals such as myself in a relaxedenvironment.Elin Pritchard

As a junior bursary award winner, it was an awesome experience.The warm reception on the first night at The Old Swan hotel wasgreat. The educational session was wonderful, learning in a relaxedand friendly environment and listening to speakers of high intellect.I made some friends for life. The exhibition and poster viewing

sessions were just wonderful. The three days was packed with funand educational sessions.Patrick Bardi

I really enjoyed my time at the BBTS Annual Conference. I was ableto relate to other people within the field of blood transfusion bothat my level and above. I was particularly impressed by how theconference gives blood transfusion great significance within therealm of blood sciences and pathology. It showed me that whena group of professionals are passionate about something, greatachievements can be made to enhance its value. I am very gratefulto have been given this opportunity.Danielle King

I would like to say that it has been a great experience which hadopened my eyes to the advances of the blood transfusion science innot only the UK but also in other countries such as the USA,Netherlands, and France. As a trainee Biomedical Scientist, it hasinspired me and allowed me to give suggestions to my workplaceon things that can definitely be improved. This will hopefullyprovide a more efficient and effective service to patients.Anthony Luong

2012 junior bursaries

E L E V E N

ANNUAL c on f e r e n c e

Princess of Wales Memorial Scholarship

@BritishBloodTS


The BBTS Annual Conference has given me a much wider andin-depth view of transfusion covering almost all aspects. I learntabout everything from transfusion theory to its regulation andusage across the globe. What's more the talks were delivered bythe whole range of professional that are involved at all levels oftransfusion, which helped me to understand what complexprocessing goes into the world of transfusion and just how manyincredibly committed professionals it takes just to deliver a bloodcomponent to a patient!Ruth Dickinson

As a newly qualified, multi-disciplined BMS I found the wholeconference such a worthwhile event, with such a wide variety ofinteresting topics and areas covered in the talks and plenarysessions, I found it difficult to choose between which onesto attend. But, it’s not just about the science, the BBTS is a verysociable society and I was made to feel very welcome throughoutthe whole three days. Don’t hesitate to apply for the bursary for2013 if you’re eligible or encourage someone you know whomay benefit. Joseph Saunders

Truly inspiring as junior level staff to take part in the BBTSconference 2012 was quite the eye opener. It was encouraging tohear all the speakers who are specialists in the field of transfusionscience. I am now motivated to now get more involved beyondthe routine NHS bloodbank setting. James Bowden

Applications for junior bursary

places for the 2013 BBTS Annual Conference

will open early next year.

For more information about the junior

bursary scheme please visit:

www.bbts.org.uk

I was offered a placement in the WelshBlood Service to undertake six daystraining from 17 - 25 September 2012.Many thanks to Dr Steve Field whohelped plan my training schedule.

The training was centered on GoodManufacturing Practice (GMP) and Quality.I had the opportunity to discuss, observeand participate in some of the activities ofall departments I visited. I visited the qualitydepartment, patient diagnostic service,processing, automated testing,microbiology, quality assurance anddonor clinic.

Ghana at the moment is in a transitionalstate of moving from a small blood centrewith limited equipment and infrastructureto a new centre. I therefore had theopportunity to experience work in a modernblood centre. I appreciated the essentials ofGMP and Quality.

The staff at the Welsh Blood Service wereaccommodating and helpful. They reallymade me feel like being part of them. I travelled from Wales to Harrogate on 25 September 2012 for the conference.

I thought the programme was very wellplanned and educational. I enjoyed everyone of the lectures I attended.

The exhibitors also had wide range ofproducts and were very helpful. The awardsdinner was splendid. I really felt veryprivileged to be part of it.

I am most grateful to Catherine Riley, BBTSEvents Manager for the support she offeredme before, during and after the conference.

Mavis OkyereSenior Biomedical ScientistNational Blood Transfusion Service,Ghana

Awarded to Mavis Okyere

T W E L V E



Hospital Transfusion Special Interest Group (HoT SIG)

Chair: Ms Hannah Grainger

The theme underlying the HoT SIG atthis year’s BBTS Annual Conferencewas that of medical transfusion. The day began with Dr Kate Pendryand “The appropriate use of red celltransfusion in medical patients: results of the National ComparativeAudit (NCA)”.

In 2005 there was a significant drop in redcell issues due to a change of practice insurgery. A survey of red cell use in the Northof England showed that over three cyclessurgical use fell whilst red cell issues formedical use increased. The three BetterBlood Transfusion Circulars (BBT1,2,3) areseen as positively influencing practice. TheNCA will inform review of BBT3 in terms ofpatient blood management and also aid inthe development of tools for this purpose.

The NCA took place over a week of choicebetween September and November 2011with a 90% participation rate and over9,000 cases audited. The ratio ofhaematology/oncology patients within theaudit was 1:3. Auditors were assisted indetermining appropriateness of transfusionby use of an algorithm that whilst complexwas based on triggers, with caveats. Part 1

of the audit is completed whilst Part 2 isbeing analysed.

The conclusions of Part 1 suggest excessivetransfusion in three key areas; possiblyreversible anaemia (20%), above thresholds(35%) and over transfusion. The secondaudit phase addresses 4,818 cases eligiblefor further investigation. Of those analysedso far, 25% of cases in the possiblyreversible anaemia group could have beenavoided and in the over transfusion groupbody weight is a key factor.

Extrapolation of the data suggests that15% of medical patients are transfusedinappropriately, 5% are for reversibleanaemia. The reasons are because ofsignificant symptoms/signs, inadequateidentification and investigation of anaemia,and pressure to discharge patients. Plans now are to work with the RoyalCollege of Physicians to address this.

Next Dr Derek Norfolk gave an overview onthe “Challenges of long term transfusion”focussing on patients with myelodysplasticsyndrome (MDS). This is predominantlya disease of the elderly and the maincomplications are venous access, ironoverload, red cell allo-immunisation and

impaired quality of life (QoL).Iron overload leads to organ damage,especially cardiac. Whilst chelation therapiesare used, compliance is a problem withsubcutaneous treatment but is improvedwith oral preparations. Red cell allo-immunisation occurs in 30% of patients butconversely 70% don’t develop antibodies.Most commonly Rh and Kell antibodies willdevelop and other antibodies areuncommon in the absence of Rh and Kell.

The suggestion is that if Rh and Kell allo-immunisation can be avoided, otherantibodies will also be avoided. This leads toa recommendation to perform extendedblood group phenotyping beforetransfusion, to routinely select ABO, Rh andKell matched, and to minimise donorexposure.

Transfusion Associated Circulatory Overload(TACO) is increasingly recognised as a majortransfusion hazard in the elderly. The myththat one unit increases Hb by 1g/dl is onlytrue for patients around 70 – 80 Kg.

Transfusion strategies in MDS are associatedwith maintaining QoL. Most patients will betransfused to a target haemoglobin (Hb)derived from surgical or critical carespecialties. Following transfusion the patienttypically feels well for a few days but thenis symptomatic by week 3. The key patientcentred outcomes are fatigue and theimpact on daily life.

A systematic review by Pinchon et al (2009)found 17 studies but these werepredominantly small and underpowered. It did demonstrate however that it ispossible to measure Health Related Qualityof Life (HRQoL) in MDS. Patients have betterHRQoL with a higher mean Hb (10 – 12g/dl)and the more stable the Hb the better theQoL. A ‘one size fits all’ approach totransfusion triggers in MDS is inappropriateand the focus should be on HRQoL.

Dr Dora Foukaneli introduced the topic of“Renal anaemia” summarising the effects of

T H I R T E E N



renal disease on anaemia and the benefits/problems associated with treatment (transfusion, EPO). Not all clinical guidelines forrenal anaemia are in agreement, the target Hb range is 10 – 12g/dl.It is known that 30% of patients for transplant are sensitised bytransfusion and 1% cannot then be transplanted. Practice is notstandardised with regard to use of HLA matched and washedcomponents.

The renal Registry has 50,965 records with 6,648 new patientsbeing added in. The renal registry does not capture information onblood transfusions. The 2011 medical use of blood NCA identifiedthat 4.1% of cases were renal. In November 2012 a survey of Renalcentres will be conducted, not for prevalence of renal anaemia butto survey transfusion practice. The survey will not however be able to address appropriateness. It will collect denominator datarelated to pre-dialysis, peritoneal dialysis and haemodialysis. The survey will be circulated on 1st November and centres will have6 weeks to respond.

The presentations concluded with Dr Manel Rathnayake and her“Experiences in Sri Lanka”. Dr Rathnayake gave a description ofSri Lanka in terms of its size, population increase and bloodtransfusion service. The latter is centrally coordinated (Nationally)

with regional clusters and hospital blood banks being part of thestructure. There is a steady increase in collections and a 100% ofdonations are voluntary. Donations are made through hospitalblood banks or ‘blood camps’ (regional sessions).

Use of blood reflects the same breakdown as the UK with 65% formedical patients. The medical patients distribute to 25% oncology,20% thalassaemia and 20% for anaemia. This latter group is madeup of patients with iron deficiency anaemia, chronic renal and liverdisease and MDS.

The BCSH guidelines are followed for FFP, however, plasma is stillused for warfarin reversal due to limited availability of prothrombincomplex concentrates.

Sri Lanka has an active donor programme with low rates oftransfusion transmitted infection and can serve as a model todeveloping countries. Dr Rathnayake concluded that lessonsfor Sri Lankan transfusion services are to consider better use ofalternatives, ensure competence of staff and to increase theircurrently small haemovigilance scheme.

The next HoT SIG meeting will be held in May 2013 in Birmingham.

Karen Shreeve, Welsh Blood Service

F O U R T E E N



The Paediatric SIG had a very successful meeting with afocus on neonatal transfusion and SHOT issues, attended bya large and interested audience. It followed the tradition ofhaving a local guest chair for the session, on this occasionPaula Bolton-Maggs, an expert in paediatric haematologyand haemostasis, currently Medical Director of SHOT.

Amit Gupta, an Oxford neonatologist presented a fascinatingexploration of current evidence relating to a possible link betweenneonatal necrotising enterocolitis and prior transfusion. As this wasreported to SHOT for the first time last year the review was timelyfor a UK transfusion audience. Clearly prospective studies areneeded in this area.

Ruth Gottstein, a Manchester neonatologist gave a stimulatingoverview of haemolytic disease of the newborn (HDN), illustratingthe practicalities of both intrauterine and exchange transfusions.This was highly educational for those who may not have first-handexperience in clinical management of babies with HDN but whoare frequently involved in aspects of prevention including withanti-D immunoglobulin.

Finally, Tracey Hall, Transfusion Practitioner at Alder Hey gave anexcellent presentation of her project to introduce an alternativepatient identification system (Mepitac) for situations whereconventional wristbands are not appropriate. Her description of thelogical processes of identifying the solution to the problem of lackof patient identification, its trial introduction and subsequentauditing at 100% compliance provided an inspiring model forothers. She also undertook an interactive session on paediatricspecial requirements, including incorporating the recent SaBTOrecommendations for CMV negative components. The responsesprovided the insight that even a specialist audience struggled tosome extent with the special component needs for children indifferent clinical situations, emphasising the need for continuededucation of all professional groups.

Overall, this was a great session and very well supported bythe delegates.

Dr Helen New, Chair, Paediatrics Special Interest Group

Paediatric SIG Blood Bank Technology SIG

The Blood Bank Technology SIG meeting was held on theWednesday afternoon of the annual conference.

A large audience of approx 150-200 delegates were treated toa varied programme of presentations. These were well received,with very positive feedback following the session.

The session was started by Robert Stamps (NHSBT RCI Sheffield)who outlined how molecular phenotyping of donor red cells wasbeing used for their selection in crossmatching for patients withcomplex serology. Fran Green (IBGL Filton) then presented currentwork on anti-D and Anti-c Quantitation using flow cytometry anddescribed how enzyme treatment of the reagent red cells used hadincreased the sensitivity of the technique, which may allow earlierdetection of rising levels of antibody earlier in pregnancy.

Mark Dunn (Harrogate Hospital) detailed how “Ward OrderComms” is being used effectively within a transfusion laboratorysetting. Kath Philpott (Addenbrookes Hospital) presented two casesof transfusion reaction with no apparent cause that may beattributed to “hyperhaemolysis syndrome”. Sharon Gale (PooleHospital) presented a case study of a child with apparent allo-immune anti-D to which no transfusion related sensitisation couldbe attributed.

I would like to thank the speakers for the enjoyable and informativepresentations and the delegates for their continued support forour SIG.

Please don’t be shy in coming forward with any interesting casestudies or developments in blood bank technology, we are alreadyworking on next year’s programme. You can contact us via theBBTS website.

Steve Tucker, Chair, Blood Bank Technology Special Interest Group

CPDnewsIssue No. 42 November 2012

Continuing Professional Development

Inside this Month’s Issue

Page 2Guidelines for Pre-transfusion

Compatibility procedures

Page 3SHOT or not?

Question and issue 41 answers

As new BCSH guidelines for pre-transfusion compatibility have been issued, I thought we wouldinclude a few ‘questions’ to get everyone reflecting on the changes and impacts the new guidelineswill bring.

We also continue the ‘SHOT or Not’ section, kindly provided by Tony Davies. Answers relating to last issues items are includedand, hopefully, you will see there is a (co-incidental) link between the ‘guideline’ question in this issue and the ‘grouping’question from last issue (which is why I’ve re-printed some of the images, for those who may not have seen last issue).

As ever, if anyone has items or experiences they wish to share, that would be suitable for inclusion in CPD news, we wouldbe most grateful if you would send them to us.

John Eggington

T W O

Continuing Professional Development www.bbts.org.uk

CPD News – Issue 42

Guidelines for pre-transfusion compatibility proceduresin blood transfusion laboratories 2012.

Published ‘on-line’ on 03/10/12 at www.bcshguidelines.com

A few questions to start you thinking. Not all have answers.

1) Since the last version of the guidelines were published what EU directive has come in to force, that specifically

affects blood transfusion laboratories?

2) How has the advice regarding timing of sample collection changed? How will this affect your practices?

3) Specific examples of samples that may give rise to ‘mixed-field’ reactions are given in the guidelines.

Readers are directed to the previous issue of CPD news for an item related to this (answers are presented in this issue).

4) ‘The presence of anti-Jka, anti-Jkb, anti-S, anti-s, anti-Fya and anti-Fyb should be excluded using red cells having homozygous

expression of the relevant antigen.’ How many examples of each phenotype are considered sufficient?

5) It is acceptable to exclude the presence of what antibodies, using validated techniques incorporating enzyme treated cells?

6) When assigning specificity to red cell antibodies detected in patient samples, red cell phenotyping should be performed using

a reagent of the same specificity as the antibody assigned. If this test is positive or ‘mixed-field’ what could this reflect?

7) a) D negative red cells should always be selected for what patients?

b) D positive red cells may be selected for D negative patients in what situations?

8) a) A R1R1 (CCDee) patient, with anti-E alone, should receive blood of what Rh phenotype?

b) A R2R2 (ccDEE) patient, with anti-C alone, should receive blood of what Rh phenotype?

9) Appendix 5 gives a table listing additional techniques that can be useful in antibody identification.

Would you consider using any of these techniques as part of your investigation?

10) Appendix 7 discusses the requirement for two samples for ABO/D grouping prior to issue of red cells.

If your establishment has not already implemented this practice, reflect on how it would.

T H R E E

Continuing Professional Developmentwww.bbts.org.uk

Patient A and Patient B Answers

Answers (CPD issue 41)

SHOT or not? AnswerA man who was group B RhD positive required a top-up transfusionpost chemotherapy. An HCA who had been trained and competency-assessed collected the red cell unit from the locked issue fridge afterhours without the formal checking of documentation. The patient wasalert and conscious but was not involved in the checking procedurewhich was carried out at the nurses’ station by 2 registered nursesagainst a compatibility form, not the patient’s wristband. The patient

received nearly 100ml of ABO-incompatible red cells and developedpyrexia and rigors. He was transferred to HDU as a precautionarymeasure.

Who is this reportable to – SHOT, MHRA or both?

What should it be reported as?

This is reportable to both SHOT and MHRA (as a Serious Adverse Reaction)The SHOT category is IBCT – ABO Incompatibility

SHOT or not?A porter collected a unit of blood for a patient, but did not completethe necessary paperwork at the transfusion laboratory issue fridge. The blood was taken to the ward and administered to the correctpatient following independent bedside checking by two nurses.

Who is this reportable to – SHOT, MHRA or both?

If so, what as?

Patient A was referred for FMH estimation by flow cytometry, which gave an estimated (large) bleed of around 130mL.The ‘dual populations’ resulted from a group AB ccee mother and group A ccDEe baby.

Patient B gave serologic reactions consistent with ABO sub-group A3.

A reminder of patient A A reminder of patient B

F I F T E E N

Components Special Interest Group

The theme of this year’s Components SIG session was“Components far and wide – manufacture regulation andusage”. Once again we were able to attract threeinternationally known speakers, and were delighted tosee an audience of nearly 100 delegates.

The first talk was from Dr Peter van der Meer of the SanquinBlood Supply Foundation who presented a talk entitled “GoingDutch – the European Approach to Conventional Components”in which he made comparisons between the UK and Dutch bloodservices. Sanquin use cooling plates to control and standardise therate at which whole blood donations cool to 20oC. This has beenshown to retain higher levels of 2,3 DPG and ATP in the resultingred cell units, although in the UK the decision was taken that thelevels remained at an acceptable level without active cooling. In theNetherlands the risk of vCJD transmission via the blood supply isconsidered to be less of an issue than in the UK. Sanquin aretherefore able to collect 95% of their platelets using the buffy coatmethod, compared to <20% in the UK. Sanquin would considerimplementation of platelet pathogen inactivation if clinical trial datashowed efficacy and safety, which was not currently convincingalthough the Pathogen Reduction Evaluation and Predictive AnalyticRating Score (PREPAReS) study is due to complete in Dec 2013.Finally, the effect of storage or transport temperature on the qualityof components was discussed. There is little difference in the qualityof components made from whole blood that had been held ateither 18 or 24oC, and short term deviations during storage do notaffect the quality of red cells and plasma. However, plateletsexposed to cold temperatures do show signs of damage, whereasthose that are warmed beyond the normal limit of 24oC possiblyshow improved quality.

Our second speaker was the society’s 2012 James Blundell Awardwinner Dr Jim AuBuchon, CEO of the Puget Sound Blood Centrein Seattle. His talk gave an insight into challenges that US bloodservices face with their regulator, the Food and DrugAdministration. The FDA can be slow to embrace new processes formanufacturing or testing blood components, one example beingthe five year period between the introduction of HIV testing andthe appearance of regulations to govern it. The reason for theirextremely cautious approach is primarily the fear of making amistake (for example the thalidomide problem of the 1960s), andthe FDA prefers to continue to gather information rather than take

an action that could have unforeseen consequences. The result ofthis is that the USA does not hold whole blood overnight or makebuffy coat derived platelets, and does not have guidance onbacterial contamination in platelets despite this first being raisedin 2002. It does, however, issue guidance documents and drafts forconsultation, which have the effect of communicating the FDA’sstance, but fall short of being regulatory documents.Most hospitals therefore operate on a best practice systemcommunicated amongst themselves.

Our final speaker was Dr Jonathan Wallis, a consultanthaematologist in Newcastle. He focused on the clinical use of bloodcomponents, beginning with the 23% increase in platelet usageseen over the last 10 years with most of that increase coming in thelast 4 years. Prophylactic use accounted for 68% with haematologyand surgery being the biggest users (particularly in cardiac surgeryand GI bleeds). However, clinical studies have not shown benefitsthat would justify the increase in use. The Prophylactic Platelet Dose(PLADO) study showed that the risk of bleeding was virtuallyconstant from anything above 10 x 109/L and the dose of plateletsgiven only makes a difference to the frequency of with whichtransfusion is needed. The Trial of Prophylactic Platelets (TOPPs) iscurrently assessing the use of therapeutic versus prophylacticplatelets. He then highlighted that his preference for an idealcomponent would be universal platelets in either AB plasma oradditive solution, leucodepleted and pathogen inactivated as wellas being less than <48 hours old. Looking at FFP, there is a widedifference in use across Europe, with some countries using twice asmuch as others. Most of the UK plasma use is in treatment of orprophylaxis to prevent bleeding, but again there is little evidence tosupport this use. His ideal component would be pre-thawed plasmawith a shelf life of 3-5 days, or freeze dried plasma, made from amale donor or HLA tested, of group AB, and pathogen inactivated.Interestingly, he noted that a concentrated plasma would be of use,as many recipients will have received a lot of fluids by the timethere are transfused with plasma.

We would like to thank the speakers and the attendees fora very interesting and successful session. We would welcome suggestions for a theme for next year, or volunteers or nominationsfor speakers. Please feel free to contact any of our committeemembers via the BBTS website.

Alex Morrison, Secretary, Components SIG



S I X T E E N

Red Cell Special Interest Group

The Red Cell SIG meeting provides an annual forum forpresentation of UK based red cell research. This year, ninespeakers provided an exciting and varied programme.

The first session of the morning began with Professor StephenHenry, from AUT University and KODE Biotech Limited(www.kodebiotech.com), who spoke about the use of KODEFunction-Spacer-Lipid (FSL) technology in transfusion medicine. The F, S, and L components of these constructs can be selected toproduce hybrid molecules with defined properties in terms of theirmode of presentation and their function. In the field of bloodtransfusion, red blood cells can be modified with FSL constructsbearing synthetic blood group antigens (for example A, B andvariant MNS antigens). The resulting ‘kodecytes’ can be used asdiagnostic reagents in place of rare phenotype red cells, and asquality control reagents for monitoring reagent antibody qualityand for teaching purposes. In animal models, FSL constructshave also been used in vivo to remove antibodies prior toincompatible transfusion.

Dr David Rees, from Kings College Hospital London, then gavean overview of the pathophysiology of sickle cell disease (SCD). He outlined the many different clinical manifestations of SCD, fromsevere cases involving homozygous expression of haemoglobin(HbS) to moderate and mild cases involving HbS in conjunctionwith other haemoglobinopathies such as - thalassaemia. All pathophysiologies involve polymerisation of HbS leading to acascade of other events including endothelial cell adhesion, vaso-occlusion, red cell dehydration, inflammation, involvement ofwhite cells and platelets, intravascular haemolysis and hypertension,

but the relationship between these events, and the mode of actionof potential treatments for SCD, is not well understood.

Professor John Porter, from University College Londondepartment of Haematology, spoke about the effects of ironoverload and the use of iron chelation therapy for its prevention inhaemoglobinopathies and other inherited and acquired anaemiasrequiring transfusion support. He showed the dosing of chelationtherapy can be adjusted to the rate of iron loading from bloodtransfusion. In sickle cell disease, better management of the ironloading rate can be obtained by using automated exchangetransfusion which also allows improved control of iron overloadand more rapid response to chelation therapy.

The first of the afternoon sessions began with Dr Mike Blackmanfrom the Division of Parasitology at the MRC National Institute forMedical Research. He described his work on the identification andmode of action of malarial parasite proteases in the release ofparasites from infected red blood cells. The Plasmodium falciparumsubtilisin-like protease PfSUB1 is a potential target for directinhibition, but other enzymes indirectly involved in parasite egressmay also be useful anti-malarial drug targets to prevent release ofinfective parasites from red cells.

Dr Alister Craig (Liverpool School of Tropical Medicine) thenpresented work on the mechanism of malaria-infected red bloodcell adhesion to endothelial cells. Plasmodium falciparum infectedred cells have altered surface protein expression, includingexpression of the highly variant parasite-encoded protein PfEMP-1.Different PfEMP-1 variants target different tissues and adhesionreceptors, which has a direct impact on disease severity andpathophysiology. Understanding these interactions will inform thedevelopment of new anti-malarial therapeutics.

The last talk in this session, entitled ‘Some observations onhaemoglobin A2’ was from Barbara Bain, Professor in DiagnosticHaematology at St Mary’s Hospital (Imperial College London).The measurement of HbA2 levels is used in the diagnosis of -thalassaemia and genetic counselling, but there are several assaysavailable with varying levels of accuracy and precision. Professor Bain discussed features of some of the assays, the needfor calibration standards, and how the assays are affected bythe presence of other Hb variants such as HbS, HbA2’, and by HIV infection.

The first speaker in the final session was Dr Lionel Arnaud whodescribed his work on the identification of the red cell membraneproteins carrying the Lan and Jra high incidence blood groupantigens. Monoclonal antibodies were used to immunoprecipitatethe relevant proteins from human (or cat!) erythrocytes, and the



Mosquito - carrier of Malaria

S E V E N T E E N

proteins were identified by mass spectrometry analysis of trypticpeptides.Both blood group antigens were found to be carried bymembers of the ATP-Binding Casette (ABC) transporter family, andconfirmed to be absent from antigen negative red cells.

The second speaker, Dr Stephen Richards from St James’s University Hospital, Leeds, described the use of flow cytometry inthe diagnosis and monitoring of paroxysmal nocturnalhaemoglobinuria (PNH). PNH is caused by somatic haematopoieticcell mutations in the PIG-A gene leading to lack of GPI-linkedproteins including CD55 and CD59 on the red cell surface, andis characterised by bone marrow failure, thrombosis, andcomplement-mediated intravascular haemolysis. PNH clone sizediffers between individuals and can vary over time. PNH can betreated by complement blockade with drugs such as Eculizumab,which can remove transfusion dependency. Clone characteristics,disease remission, and response to therapy can be monitored byflow cytometry.



The final talk of the day was given by Dr Tim Satchwell fromthe University of Bristol. Dr Satchwell described the red cellabnormalities seen in congenital dyserythropoietic anaemia type II(CDAII), caused by mutations in the gene encoding the secretoryCOPII component SEC23B. He is studying expression of SEC23protein isoforms during erythropoiesis using culturedhaematopoietic stem cells, looking at SEC23 protein levels atdifferent stages of erythropoiesis, and how they relate tohypoglycosylation of red cell membrane proteins, the presence ofmultinuclear erythroblasts and remodelling of the membraneduring the later stages of erythropoiesis in healthy donors andpatients with CDAII.

The 2012 Red Cell SIG meeting provided a very interesting andeducational day which was well attended and generated manyquestions and interesting discussions.

Kay Ridgwell and Lesley Bruce,Joint Chairs, Red Cell Special Interest Group

HIV Virus infection

N I N E T E E N



Congratulations to our winners!

Miscellaneous category

Quality Of Prion Reduced And ConventionalRed Cells After Treatment With The S-303 SystemFor Pathogen Inactivation

M.Wiltshire1, M. Ann Schott2, N. Mufti2,A.Erickson2, R. Cardigan3

1NHSBT Brentwood, 2Cerus, 3NHSBT, UK

IntroductionThe Intercept (S-303) treatment system has been developed toinactivate a broad range of pathogens, as well as leucocytes, in redcell concentrates (RCC). The system uses a frangible anchor linkereffector, compound S-303, to crosslink nucleic acids haltingpathogen replication, and glutathione (GSH) to quench unreactedS-303. The aim of the study was to investigate the effect of the

S-303 treatment system with and without prion reduction(P-Capt, Macopharma) on red cell quality.

MethodFive ABO and RhD matched RCC, manufactured following overnightambient hold of whole blood, were pooled and split on Day 1.These units were treated as follows: 1) stored at 2-6°C for 18 hours(Control 1), 2) stored at 20-24°C for 18 hours (Control 2), 3) S-303treatment, 4) S-303 treatment followed by prion reduction, 5) Prionreduction followed by S-303 treatment. S-303 treatment wasinitiated on Day 1 and included an 18 hour hold time at 20-24°C,after which RCC underwent an exchange step to remove S-303 andbreakdown products prior to re-suspension in SAGM. Componentswere stored at 2-6°C and tested throughout storage for parametersof red cell quality.

ResultsRed cell concentrates in all study arms met specification for volume(220-340 ml) and haemoglobin content (>40 g/Unit

Poster Prize Winners

n=5 4 °C (Control 1) 22 °C (Control 2) S-303 (3) S-303 + Prion (4) Prion + S-303 (5)

% Lysis10.27 0.24 0.17 0.47# 0.18

(0.16-0.39) (0.19-0.39) (0.17-0.24) (0.43-0.54) (0.18-0.25)

pH1 6.42 6.41 6.32* 6.32* 6.31*(6.41-6.44) (6.40-6.44) (6.31-6.34) (6.31-6.35) (6.33-6.34)

ATP _g/gHb1 3.43 3.09 4.48# 4.00† 4.18#(3.08-3.98) (2.91-3.77) (3.77-5.15) (3.67-4.52) (3.73-4.35)

2,3-DPG2 1.57<1.25 <1.25 <1.25 <1.25(1.32-2.12)

Potassium mmol/U1 4.26 4.51 4.06 4.04 3.83(3.86-4.41) (4.45-4.81) 3.95-4.20) (3.80-4.40) (3.44-4.03)

Deformability at 3 Pa1 0.39 0.39 0.35* 0.33* 0.34*(0.37-0.41) (0.37-0.40) (0.33-0.36) (0.32-0.35) (0.32-0.37)

Deformability at 30 Pa1 0.62 0.62 0.60* 0.60* 0.60*(0.62-0.63) (0.62-0.62) (0.60-0.60) (0.60-0.60) (0.59-0.60)

Microvesicles1 2318 1813 410* 687* 486*(1190-2549) (285-3082) (211-458) (344-889) (233-690)

1 Data at day 35 (end of shelf-life)2 Data at day 7* Values are significantly lower than Control data 1 and 2, # Valuesare significantly higher than Control data 1 and 2, † Values aresignificantly higher than Control data 2

DiscussionRCC pathogen inactivated with the S-303 treatment system metspecification for volume, haemoglobin content and had lower levelsof haemolysis, supernatant potassium and red cell microvesiclescompared to control units. Red cells treated with the S-303 systemhad higher ATP levels but slightly lower deformability than controlunits. The effects of combining S-303 treatment and prionreduction were not more than additive.

T W E N T Y

Clinical audit category

Emergency O Negative blood usage in a districtgeneral hospital

J. Keidan1, D. Knight2, J. Keidan2

Queen Elizabeth Hospital, Kings Lynn NHS Foundation Trust

IntroductionTwo units of O RhD Negative red cells are available in the issue bank

at all times for use in life threatening circumstances when group- orfully-compatible blood is not immediately available. We have beenauditing emergency O negative transfusions since 2008 in order toensure appropriate use of this precious commodity.

MethodThe laboratory practitioner undertakes retrospective analysis of allemergency units collected from the issue bank, using paper andcomputer laboratory records, and patient notes. Demand for emergency blood has varied over the four years.



Results 2008 2009 2010 2011

No. of patients 12 21 14 25

No. of units 29 67 25 55

Age range 3 - 89 23 - 87 27 - 86 25 – 90

Male / Female 3 / 9 12 / 9 8 / 6 17 / 8

Discharged 9 11 5 9

Died 2 10 8 12

Transferred 1 0 1 4

Trauma 2 (17%) 2 (10%) 0 4 (16%)

Gastrointestinal 2 (17%) 5 (24%) 9 (64%) 9 (36%)

Obstetric 5 (42%) 5 (24%) 1 (7%) 2 (8%)

Aortic Aneurysm 2 (17%) 7 (33%) 1 (7%) 3 (12%)

Surgical 1 (8%) 1 (5%) 1 (7%) 3 (12%)

Cardiac 0 1 (5%) 1 (7%) 0

Unknown 0 0 1 (7%) 0

No. of pts massively 3 10 10 11

transfused 25% 48% 71% 44%

T W E N T Y O N E



The age range is wide but the majority of patients are elderly(in 2008 & 2009 50% of patients were over 60 years, increasingto 80% in 2010 & 2011.)

The percentage emergency blood used for obstetric cases has fallenwhereas use in gastrointestinal bleeding has increased.

Survival of patients receiving O negative emergency units was 75%in 2008, 55% in 2009 decreasing to 36% in both 2010 and 2011.

Provision of a sample for compatibility testing before collection ofemergency blood has improved from 17% in 2008 to 52% in 2011.

We have also seen a continuous reduction in administration delaysfollowing the collection of emergency blood units- 35% were given> 20 minutes after collection in 2008 falling to 4% in 2011.59% were transfused within 10 minutes in 2008, increasing to79% in 2011.

ConclusionDemand for emergency blood cannot be predicted. However, by continuously monitoring its use and reporting results we have improved staff knowledge both within the laboratory andclinical areas. As a result, controllable aspects of this process have been improved, leading to reduced patient risk andcomponent wastage.

Clinical Transfusion category

What was the hold up? Reported delays in availabilityof blood in a large teaching hospital

G. Durgam1, G. Durgam2, K. Pendry2, M. Marsden2,C. Parker2, L. Polyzois2, J. Uttley2, R. Kettle2, A. Thomasson2

1Central Manchester University Hospitals NHS FoundationTrust, 2Central Manchester University Hospitals, UK

IntroductionThe National Patient Safety Agency issued guidance aimed atreducing delays in the availability of blood in emergencies in 2010.A delay in the provision of blood in less urgent situations also hasan impact on patient safety. We used our local haemovigilancesystem to investigate the causes and extent of perceived delays inorder to improve practice and reduce risks.

MethodAll transfusion delays reported through the incident reportingsystem over a 12 month period (2011) were graded according toseverity and evaluated to determine the cause of delay. Incidentswere investigated by the transfusion team with input from theclinical areas. Corrective and preventive actions were developed and implemented to reduce risk.

ResultsDuring the study period, 49 incidents were reported: 1 graded atlevel 4 near miss (major), 20 at level 3 (moderate), 19 at level 2(minor) and 9 at level 1 (minimal). There were no level 5(catastrophic) events. The most serious incidents were associatedwith delays in provision of blood during surgery. Median delay tostart of transfusion was 2.5 hours (range 0.15 to 24 hours). Clinicalerrors were identified in 25 cases, laboratory errors in 7 cases, and acombined laboratory / clinical error in 1 case. There were 10 delaysin delivery (4 of the samples to the laboratory by ‘pod’ and 6 of theblood to the clinical area), organisational factors in 3, patientfactors in 2 and an NHSBT recall in 1. Five main contributory factorswere identified during root cause analysis: communication (22),

wrong patient identification (5), equipment failure (6), deliverydelays (6) and organisational factors (3).

ConclusionsIt has been identified nationally that delays in provision of bloodcan have a significant impact on patient care. The analysis of theunderlying causes has enabled the transfusion team to implementtargeted improvements such as: introduction of the majorhaemorrhage pathway, a pocket sized aide memoire for correct useof the transfusion laboratory, more stringent performance targetsfor collection and delivery and more effective prioritisation ofurgent cases in the laboratory. The programme of improvement isunderpinned by enhanced education and training for all staffgroups involved in transfusion.

Immunoheamatology category

Laboratory Differentiation of Immune anti-D fromPassive anti-D; Mission Impossible?

D. Bruce1, L.Rounding2, H. Tinegate3

1NHSBT, Red Cell Immunohaematology, Newcastle UponTyne, 2OWD, NHSBT, Newcastle Upon Tyne, UK, 3NHSBT,Newcastle Upon Tyne, UK

IntroductionProphylactic Anti-D immunoglobulin (Anti-D Ig) is given tounimmunised RhD neg women following sensitising events and asroutine antenatal prophylaxis. Whilst the incidence of immuneanti-D has declined the number of positive antibody screens dueto anti-D Ig has increased. The clinical consequences ofmisinterpreting the origin of anti-D are serious; with the risk of haemolytic disease of the fetus and neonate.

Decision making is guided by the level of anti D, currently measuredusing Continuous Flow Analyser (CFA) quantification. Appropriateclinical information about the timing and dose of anti D is also vital.

T W E N T Y T W O

Current UK protocol states:

1. A CFA anti-D result of ≥ 1 IU/mL is likely to be due toimmune anti-D.

2. A CFA level of <1 IU/mL within 8 weeks of giving anti-D Ig,is likely to be passive.

Our recent work with titration and titre scores by the columnagglutination method has shown the method to be simple andreproducible, and sensitive to a wide range of antibody levels asdetermined by CFA quantification, including levels of alloanti-D andanti-c. We report a study assessing the suitability of titres / titrescores in determining the origin of anti-D.

MethodThe results of 42 samples containing passive anti-D were compared with 24 samples with known low levels of immune anti-D (<4 IU/mL). The antibody screen grade of reaction, the CFAquantification value (IU/mL) and titre end point / titre score wereassessed. To perform a titre score the observed strength ofagglutination is assigned a number. The score represents the sumof these numbers, for all serial dilutions.



Results

IU Given Quantification Antibody Titre Titrevalue IU/m screen grade End Score

reaction (1-4+) Point

2500.04 – 0.05 0 - 1 0 0

(n=4)

5000.03 – 0.1 WK - 1 0 - 2 0 - 13

(n=15)

12500.03 – 0.14 1 - 2 1 - 4 5 – 18

(n=5)

15000.04 – 0.26 WK - 2 0 – 8 0 – 24

(n=18)

Immune 0.3 - 1.0 1 - 3 2 - 16 5 – 44

anti-D1.0 – 4 .0 2 - 4 32 - 256 42 – 72

(n=24)

ConclusionsAll 42 patient samples with anti-D Ig were found to have a titre endpoint ≤ 8 and a titre score <26. Titre end points/scores in thisregion may help to distinguish passive from immune anti-D.

www.bbts.org.uk

The 31st Annual ConferenceThe ICC Birmingham16th - 18th October 2013

T W E N T Y F O U R

PAT I ENT B LOOD managemen t

The Future of Blood TransfusionThe Royal College of Pathologists, London, 18 June 2012

The meeting was a joint initiative between the Departmentof Health and the National Blood Transfusion Committee.Consultant haematologists, anaesthetists and key peoplefrom various societies and stakeholder organisations wereinvited to attend.

The first session covered a review of the previous Better BloodTransfusion (BBT) initiatives. Mike Murphy, Professor of BloodTransfusion Medicine from Oxford opened the session. He outlinedthe reasoning behind the three previous health service circulars of1998, 2002 and 2007, namely the concerns over the infectivity ofthe blood supply with vCJD, the continuing rise in reported errorsto SHOT, the increased demand for blood components andpotential shortages, and the evidence from audits of a variation inblood transfusion practice, both locally and nationally. Surveys haveshown that there is a poor uptake of blood conservationmethodologies, and that there is still a lack of basic knowledgeabout blood transfusion amongst clinicians. There is also an issuewith extracting clinical data for audit purposes from many ITsystems which hampers the assessment of poor practice. He concluded that although there have been numerous nationalinitiatives and audit programmes, there has been little progress.

Jonathan Wallis, Consultant Haematologist from Newcastle, wenton to look more closely at the age group of patients requiring ablood transfusion. Due to improvements in the medical and surgicalcare of patients it has become clear that patients over the age of 50are making the biggest demand on the donor blood supply. Withan ageing population this trend is set to continue. He presented a slide of red cell usage across Europe and USA/Canada. The UKappears to be one of the lower users of red cells, with manycountries using far more e.g. Germany, Greece and Denmark. He surmised that the decrease in red cell usage in the UK may have been influenced by the BBT initiatives, the introduction oftransfusion practitioners and perhaps the reduction in blood useduring cardiac surgery, with the switch to cell salvage devices.

The second session covered the existing use of data to assist PatientBlood Management (PBM). Janet Birchall, ConsultantHaematologist from Bristol, opened the session with a look at theNational Comparative Audit (NCA) use of Platelets in Haematology(2010). The audit showed that of the nearly 3,000 platelet packsaudited, over a third of them had been transfused inappropriately,with a large proportion being given despite the platelet countexceeding the allotted threshold.

T H I R T E E N

T W E N T Y F I V E

iron preparations. Blood transfusions in this patient group madethe patients more susceptible to alloimmunisation to HLAantibodies, which would decrease their chances of a successfulrenal transplant. Since introducing ESAs blood usage in thesepatients has decreased from 14% to 7% and patients havemanaged to maintain higher red cell haemoglobin levels. However,since the findings of the the Trial to Reduce Cardiovascular Eventswith Aranesp Therapy (TREAT) study (increased risk of stroke, VTEetc with the use of ESAs) many patients are experiencing falling redcell haemoglobin levels as clinicians are deciding to reduce the doseof ESAs. As a result, blood transfusions are on the rise.

Ian Roberts, Professor of Epidemiology from the London School ofHygiene and Tropical Medicine, discussed the use of tranexamicacid (TXA) to control surgical bleeding, a therapy that has beenused in the surgical setting for over 50 years. Despite thepublication of the the Clinical Randomisation of Antifibrinolytic inSignificant Haemorrhage (CRASH-2) trial in 2010, which showedthat the use of TXA reduced death due to trauma by 10%, only5% of trauma patients received TXA in 2011. Tranexamic acid hasalso been found to reduce the possibility of receiving a bloodtransfusion by about 40% in many complex surgical settings. There is a clinical trial about to be conducted that will involve theuse of TXA in elective surgery.

The final speaker, Kathryn Robinson, Consultant Haematologist,attached to the Red Cross Blood Service in Australia spoke of theimplementation of PBM in a regional setting. Armed with theperioperative PBM guideline and anaemia algorithms andmeasurable indicators of improvement (MCH/MCV/Hb) the hospitalsestablished a guidance team. The patient pathway was mapped,and all stakeholders were involved in the final protocol. A genericGP letter, a patient information leaflet, and access to oral/parenteraliron protocols were established as well as an elearning program/IDAapplication. Her advice was to start with a particular patient groupe.g. arthroplasty and work through the process. Once the protocolis working, extend to other specialities.

Lynne Mannion, Transfusion Practitioner, East Lancashire Hospitals NHS Trust

Kate Pendry, Consultant Haematologist from Manchester, thenenlightened the audience on the difficulty many hospitals have inacquiring meaningful, prospective data. She spoke about a clinicaltrial that she is currently involved in that is looking into this issue(AIM II). It utilises a software package that extracts data fromhospital systems and, via a data warehouse, produces data andreports on a host of topics including the patients’ hospital stay, ageof the transfused component, requesting physician etc.

The third session covered the practical aspects of Patient BloodManagement (PBM). Gavin Murphy, Cardiac Surgeon from Bristol,discussed the effectiveness of near patient testing haemostasis. He suggested that the use of thromboelastography devices(TEG/ROTEM) were ideally suited to the cardiac setting as they wereable to give almost instant answers compared to the traditionallaboratory tests. However he thought that they were only of limiteduse in the treatment of massive haemorrhage. Plateletaggregometry devices (e.g. Multiplate) give an indication of thefunctional properties of the circulating platelets, particularly when patients are under antithrombotic therapies.

Toby Richards, Vascular Surgeon and Senior Lecturer fromUniversity College London Hospitals, covered the concept of patientoptimisation prior to surgery. He presented data that showed thatthe risk of mortality or morbidity of patients following surgery isassociated with lower preoperative haemoglobin levels. With theadvent of various enhanced recovery programmes (ERPs), aimed toincrease the turnover of patients for some operations, anaemiahas been associated with a longer hospital stay, hence negating the ERP ethos. Approximately 30% of patients attending for someprocedures have an absolute or functional iron deficiency. By treating these patients whilst on the waiting list leads toimproved productivity.

Iain Macdougall, Consultant Nephrologist from Kings CollegeHospital, discussed the management of anaemia in medicalpatients. Clinical evidence has shown that 30-40% of bloodtransfusions occur as top-up transfusions. As a renal physician hispatients used to have blood transfusions every 2-4 weeks until theadvent of erythropoietic stimulating agents (ESAs) and intravenous

PAT I ENT B LOOD managemen t

ISBT Congress, Cancun, Mexico - 7-12 July 2012

suggests that the S antigen causes significantly more immunisationthan K, leading the speaker from Uganda to recommend matchingfor C, E and S (rather than K) in African countries.

The next day started even earlier, at 8.15am, but was worth missingbreakfast for. Dr Horn from Germany talked about in vitrogeneration of patient specific blood components, e.g. HLA deficientplatelets, and Dr Lo from Hong Kong, discussed how digital PCRallows us to distinguish small differences in the level of anabnormal gene in fetal DNA obtained from maternal plasma,opening the way for the exciting, but ethically challenging prospectof fetal genomic screening.

Over the next two days, I attended a diverse range of lectureswhich informed me about lots of different things, from a novelmonoclonal anti-D which has shown in early trials that it may be suitable for use as prophylactic anti-D in pregnant women, tohow and why sickle cells are ‘sticky’, and how this knowledge maybe used to develop new treatments, to why we should considergiving our blood donors iron supplements, to a theory about whyvery fresh blood might be bad for you!

All in all, I really enjoyed the conference, and managed to fit ina couple of early morning swims, several margaritas, lots ofguacamole, plenty of socialising, and nearly 40 lectures! It wasamazing that the sessions were so well attended all day, even atthe weekend, despite the competition from the glorious sun, sea and sand.

We’ll be updating you on plans for ISBT London 2015 in futureeditions of Bloodlines, so watch this space. Clare Milkins, BBTS President

As BBTS President, I had the privilege of attending the ISBTCongress in Cancun in July to present our bid to host the2015 Regional Meeting of the ISBT.

My trip began well, with BA deciding to upgrade me to BusinessClass (a first for me!); however things rapidly took a turn for theworse in Miami, as Jonathan Wallis and I spent two hours gettingthrough immigration, consequently missing our connection toCancun. After 14 hours with no luggage and no US dollars, we setoff for Cancun hoping to arrive in time for our presentation.Thankfully we did, and the rest is history, as they say.

The hotel was lovely, with a view of the Atlantic from both sides(another first for me!). I relaxed by the pool for a couple of hourson Saturday afternoon, post presentation, meeting up withcolleagues and friends from around the world, followed by a Britsnight out at a local Mexican restaurant, complete with sombrerosand guitars. Sunday was the ISBT Academy Day, but I had time towatch Andy Murray lose in the Wimbledon final first (one benefit ofCancun being several hours behind the UK), in my room withseveral somewhat downcast British colleagues. There was a grandopening ceremony Sunday evening where the Mayan culture wasillustrated with music and dance by locals dressed in the mostamazing costumes.

Monday morning started with a 7am National Presidents’ meeting,which just gave me time to get to the first session at 8.30.The opening plenary called ‘Cells in the Making’ was fascinating.Dave Anstee talked about how reticulocytes extrude their nuclei tobecome erythrocytes and how cultured reticulocytes may ultimatelybe used as a source of red cells for transfusion. Dr Weyrich from theUniversity of Utah, talked about his recent work which shows thatmature human platelets, which cannot reproduce in vivo, canextend new cell bodies in culture in a similar way to the formationof proplatelets from megakaryocytes, so could be a possible sourceof platelets for transfusion in the future.

The four day programme featured six themed parallel sessionsinterspersed with plenaries, so there was plenty of variety to interesteveryone. In addition to listening to state-of-the art lectures givenby researchers and clinicians from around the world, the ISBTprovides the ideal opportunity to learn more about the challengesfaced by the developing world, putting our own problems intoperspective, and showing that one-size solutions do not necessarilyfit all. This was demonstrated by the first talk in an interestingsession on transfusion in sickle cell disease – many African countriesdo not have the resources to undertake antibody screening orcrossmatching by antiglobulin test, or full phenotyping to preventalloimmunisation; however, alloimmunisation rates in sickle cellpatients appears to be lower than in the West, and their data

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I S B T c ong r e s s @BritishBloodTS


T W E N T Y S E V E N

TRADE NEWS & e v en t s

Joint meeting of UK NEQAS (BTLP) & the BBTS BloodBank Technology SIG ‘Man vs Machine’

Wednesday,14th November 2012 Manchester Conference Centre, Sackville St, Manchester

BBTS Member £80 + vat, Non Member £100 + vatIf you registered to pre-pay through UK NEQAS in March, you will need the 4 digit codeprovided by UK NEQAS when you register on-linewww.eventsforce.net/neq12

09.00 Coffee, Registration & Commercial Exhibition09.55 Opening Remarks by Peter Baker (Chair UK NEQAS Steering Committee)Session 1 10.00 to 11.30

Chair: Clare MilkinsWhose blood is it anyway?

10.00 Background to and data from the National Audit of Sampling labelling Anne Varey, Transfusion Quality Coordinator, James Cook University Hospital

10.20 Two samples – what, when, why and howDr Jeannie Callum, Director of Transfusion Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada

11.05 Discussion11.30 Coffee & Commercial Exhibition11.50Session 2 11.50 to 12.50

Chair: Steve TuckerWho’s got the remote control?

11.50 Remote authorisation of results – fact or fiction?Stephan Bates, ex Laboratory Manager, Cheltenham & Gloucester

12.10 Tracking, trauma and traceabilityColin Barber, Transfusion Practitioner, The Royal London Hospital

12.30 UK NEQAS On-line Competency Assessment SchemeBill Chaffe, Senior EQA Scientist, UK NEQAS (BTLP)

12.50 Lunch & Commercial Exhibition14.0014.00 UK NEQAS update

Megan Rowley, Clare Milkins, Jenny WhiteSession 3 14.30 to 16.00

Chair: Mallika SekharYou are the weakest link!

14.30 The root cause of ‘human error’Judy Langham, Principal Haemovigilance Specialist, MHRA

14.50 The psychology of distractionSusy Churchill, Independent Psychological Consultant, Researcher and Trainer at Churchill Associates

15.30 The management of distraction in the laboratoryRichard Haggas, Quality Manager, Leeds Teaching Hospitals

15.45 Discussion16.00 Close

We are delighted to have received unconditional educational grants fromthe following commercial companies who will be exhibiting at the meeting:

Bio-Rad Laboratories Ltd, Brenmoor Ltd, CitySprint Healthcare, Deva Medical Electronics Ltd, Grifols UK Ltd, IBG Immucor, Labcold, MSoft eSolutions, Pharmacosmos UK

@BritishBloodTS


BBTS 30th Annual Conference,

Harrogate

26-28 September 2012

Documents

Bloodlines - BBTS | Home · The breaking news in my last column was that the BBTS has been successful in its bid to host the 2015 Regional Congress of the ISBT in London. Jonathan