1. + Dr. Megan Rowley Consultant in Transfusion Medicine Blood Transfusion

2. + What would you like to know? Is blood safe and what happens if it goes wrong? How do you decide when to transfuse? And how much? Where does my blood come from? What happens to blood once it has been collected? What is in a bag of blood? Who are all the people who make this work?

3. + There are lots of people who work hard to get blood to you Blood donor and the blood collection teams NHS Blood and Transplant Hospital Transfusion DepartmentDoctors and nurses who look after you EXPERTS PEOPLE WHO ADVISE ON BEST PRACTICE EXPERTS PEOPLE WHO ADVISE ON BEST PRACTICE REGULATORS PEOPLE WHO OVERSEE ADVERSE EVENTS REGULATORS PEOPLE WHO OVERSEE ADVERSE EVENTS

4. + Where does my blood come from? www.blood.co.uk Look on the website – lots of interesting facts, figures and video clips Healthy Blood donors aged 17-65 can donate every 4 months Fill out a donor health questionnaire and have a haemoglobin check Fixed and mobile donor sessions – a masterpiece of organisation!

5. + What happens to blood once it has been collected? Blood group ABO D positive or negative Other blood group antigens Viruses and other infections Hepatitis B and C HIV 1 and 2 and HTLV1 Syphilis (Malaria) (Cytomegalovirus) 1. Tested

6. + What happens to blood once it has been collected? No such thing as ‘whole blood’ What we need are ‘components’ RED CELLS PLATELETS PLASMA And the white cells have to be removed LEUCODEPLETION 2. Processed

7. + What is in a bag of blood? Red Cells in Optimal Additive Solution (SAG-M) Shelf-life 35 days at 4°C No white cells or platelets and very little plasma

8. UK Blood Donors Blood Group RhD Positive RhD Negative Total O37%7%44% A35%7%42% B8%2%10% AB3%1%4% Distribution of blood groups varies across the world

9. + DONOR BLOOD GROUP PATIENT BLOOD GROUP ANTIBODI ES IN THE PATIENT OABAB O Anti-A and Anti- B GOODBAD AAnti-BGOOD BAD BAnti-AGOODBADGOODBAD ABNoneGOOD How do we choose which blood group to give?

10. + Serological (XM) is where the patient’s plasma is mixed with the donor’s red cells Takes 40 minutes Electronic Issue (EI) is where the computer checks there are two patient blood groups that agree, there is a is valid (recent) G&S sample and a negative antibody screen Takes 10 minutes Serological (XM) is where the patient’s plasma is mixed with the donor’s red cells Takes 40 minutes Electronic Issue (EI) is where the computer checks there are two patient blood groups that agree, there is a is valid (recent) G&S sample and a negative antibody screen Takes 10 minutes Before transfusion of red cells the blood has to be appropriately matched to the patient The transfusion lab will select the correct ABO/D red cell group for the patient Some patients also have ‘special requirements’ e.g. IRRADIATED, KELL NEG Matching blood

11. A blood bag with a compatibility label attached All the information on the blood bag label is bar-coded as well as eye readable Labelling and Issue

12. + Is blood safe? Yes! Most of the time…. If blood transfusion is the only treatment for your condition and the consequences of not having a blood transfusion outweigh the the risks of having one then it is then having a blood transfusion is the right thing to do Patient blood management

13. + Patient Blood Management Minimise anaemia Patient information and valid consent Consider and discuss alternatives Give the right amount of blood Consider special requirements Review the outcome

14. + Patient Information and Consent ‘Valid’ consent is required for transfusion (verbal) Alternatives should be offered if appropriate If transfused in an emergency, patient must be informed afterwards Involve patients in the process to ensure they get the right blood and the right ‘special requirements’

15. + Why and when do we give blood? The decision to transfuse is based on the whole clinical picture Is the patient bleeding? What are the blood results? Is the patient symptomatic? Will a transfusion solve the problem? What are the risks of transfusion? Are there alternative treatments? ‘The decision to transfuse must be based on a thorough clinical assessment of the patient and their individual needs. The rationale for the decision to transfuse and the specific components to be transfused should be documented in the patients’ clinical records’ BCSH guidelines 2012 ‘The decision to transfuse must be based on a thorough clinical assessment of the patient and their individual needs. The rationale for the decision to transfuse and the specific components to be transfused should be documented in the patients’ clinical records’ BCSH guidelines 2012 4mL/kg will typically give a Hb increment of 10g/L = 1unit RBC gives a Hb increment of 10g/L in a 70-80 kg patient

16. + What happens if it goes wrong? Investigate incidents locally ROOT CAUSE ANALYSIS Report serious hazards via a national system SHOT Clinical audit PROCESS and APPROPRIATNESS of TRANSFUSION Learn and continuously improve DOCTORS and NURSES TRANSFUSION LABORATORIES BLOOD SERVICES EXPERTS and REGULATORS

17. + What reactions occur with red cells?

18. + Serious Hazards of Transfusion 1996-2012 (n=11570) Getting the wrong blood Getting an infection from blood Having a reaction to blood Getting too much blood too quickly

19. + Carson J L et al. Ann Intern Med doi:10.1059/0003-4819- 156-12-201206190-00429 ©2012 by American College of Physicians Fluid overload from blood transfusion and patients with a fever during transfusion is quite common Hepatitis and HIV transmitted by transfusion is very rare Adverse effects of RBC transfusion contrasted with other risks

20. + Conclusion Blood is a precious gift given by a blood donor Each bag costs £120 but all of that goes towards collecting blood making it safe and getting it to the hospital – no money goes to the donor There are many people working behind the scenes to get you the right blood at the right time, every time If it goes wrong we do our best to understand why and continually improve It is important that you understand the risks and benefits of transfusion and give your consent to receive this treatment The team caring for you need to tailor your blood support to you personally and to check it is having the desired effect