Tonyd

Yes, and that is the recommended method for quantitation of FMH in the UK.

Lol ! :haha:

Tell me about it !

Very true Malcolm, but that is because the particular FFP of which you speak is not classed as a blood component, and so does not fall under the requirements of the BSQR. It is a pharmaceutical blood product, ie a medicine, and comes under the provisions of the Medicines Act in the UK, which does not mandate blood group labelling requirements - again it is why it appears in the British National Formulary, whereas blood components do not. Best wishes Tony

Actually, SHOT have been collecting this very information - we now include a review of cases where transfusion is inappropriate and unnecessary as well as those where there is significant harm to the patient resulting from a failure to transfuse, or a delay in transfusion for whatever cause. I completely agree that we have to balance the clinical need for transfusion with trying to demonstrate 100% compatibility, and that comes down to an informed clinical decision based on consideration of the relative risks involved.

I would agree with keeping strictly to an Rh D match for Rh D neg babies, for all the reasons stated above. Ref the point about platelets not containing any red cells - yes it is true that component donation platelets (ie apheresis) have extremely low levels of red cell contamination, but remember that QA standards are that only a percentage of components are tested to confirm this, and only 75% of those tested are required to conform to specification - I certainly wouldn't take the risk of transfusing RhD pos platelets to a RhD neg baby unless I really had no other option. It's a shame that the Regulations don't allow us to remove the RhD type completely from labels of FFP packs, as that is one case where it really doesn't matter.

Thanks for this info Deny - unfortunately the site won't let me log in as I don't have a Hospital Red Cross number (or something like that), being in the UK. Does anyone have the pdf on file, that they wouldn't mind sharing ? Best wishes Tony

Hi Rashmi As per my previous reply, I don't think that many of these cases at all would be reportable to the MHRA, as they fall under the purview of 'the clinical area', so no pressure to get them on to SABRE. The SABRE help desk may have a view on this Tony

Hello Rashmi This is an interesting one, as the NPSA originally based their recent Rapid Response Alert on the provision of blood in an emergency (and recommendation to report) on unsubstantiated/uninvestigated rants from frustrated clinicians. You have to tease out at a local debrief/investigation whether the reported delay (for whatever reason) was an inconvenience or whether it significantly affected the patient. In cases where it is found that there has been mortaliy/morbidity related to a delay in transfusion, then these should be reported to SHOT in the 'catch-all' category of "I&U" - Inappropriate/Unnecessary/Delayed/Undertransfused. Not sure they are always reportable to the MHRA, unless you decide it is a failure of your QMS that has led to the delay Hope that helps Best wishes Tony

Perhaps not as 'asap' as Malcolm implied :-) ... but Haemovigilance is defined as "The systematic surveillance of the whole of the transfusion process in order to highlight adverse events and reactions, with the aim of improving safety of donors and patients" So, it covers everything from taking the blood in the first place, through processing, storage, transport, testing, issue, administration, and months or years post-transfusion too in the cases of viral transmission. You can imagine that the diversity of people involved in the process is immense, not just lab staff and clinical staff administering the components. We have traditionally looked at process errors of testing and administration, physiological reactions and infections in the SHOT scheme, but are now expanding our remit to include cases of over/under/inappropriate/delayed transfusions and are also hoping to include donor adverse events in our annual report, where people have fainted (or worse), have had allergic reactions to adhesive tape etc Hope that helps give a flavour of what it is about Best wishes Tony

It is good practice to commence the transfusion as soon as possible following removal from 'safe storage', but current guidelines in the UK do not mandate a specific time limit within which to start a transfusion, just that it needs to be completed within 4 hours of removal from safe storage From a pragmatic point of view, it seems absolutely stupid to waste units that may be started 40 minutes-1 hr after collection, but then completed within the 4-hour window. The key thing is that the ward should be ready to commence the transfusion before sending for the unit !!

Hi It is good practice to commence the transfusion as soon as possible following removal from 'safe storage', but current guidelines in the UK do not mandate a specific time limit within which to start a transfusion, just that it needs to be completed within 4 hours of removal from safe storage From a pragmatic point of view, it seems absolutely stupid to waste units that may be started 40 minutes-1 hr after collection, but then completed within the 4-hour window. The key thing is that the ward should be ready to commence the transfusion before sending for the unit !! With best wishes Tony

Hi Rashmi Many of the SAEs reported to the MHRA would fall into the SHOT 'Near Miss' category - at the moment the reporting of SAEs and SARs remains a legal requirement of compliance with the BSQR / EU Directive, rather than an exercise designed to produce feedback and learning, though the MHRA are analysing how errors in the widest sense seem to be made and how they can be avoided, and the MHRA are now putting together an 'expert panel' to review some incidents, so things may develop along that front. We have an annual 'data reconciliation' meeting between SHOT and MHRA, to ensure that we are picking up the same serious reactions, and so far we have been pretty close - MHRA will always look as though they have more SAR reports than SHOT, because they include events where the reaction was 'possibly' caused by the blood component (imputability score 1 ), rather than 'likely' or 'certain' as we use in SHOT (imputability score 2 or 3 ) Hope that helps a bit.. Tony

If it helps, we have a similar situation in the UK, where anti-D is defined as a medicine and should technically be under Pharmacy control. Because the transfusion laboratories have the expertise in dealing with the testing around anti-D issue (and more importantly are open 24/7, unlike most Pharmacy depts in the UK), we have found that Pharmacy are more than happy for the 'status quo' to continue, and in many hospitals have formally devolved responsibility to the transfusion laboratory via the medicines management committee of the Trust. The MHRA police both the Blood Safety & Quality Regulations and also the Medicines Act in the UK, and seem at the moment quite happy to let the current arrangements continue, as laboratories are not "supplying" the medicine direct to a patient, but are "issuing" it on the order of a suitable person who will then supply or administer it to the patient (ie a medical officer or registered midwife). Best wishes Tony

Sounds pretty theoretical. I'd rather make sure they got into theatre with a good haemoglobin, then perform Acute Normovolaemic Haemodilution coupled with a cell-saver. Our experience with pre-deposit autologous donation in these patients is that they get to theatre fairly anaemic and feeling pretty ropey - nobody does it any more in the UK unless it's an exceptional case with mulitple antibodies, when the Blood Service will perform it rather than the hospital.