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We were excited to run our second @BritSocHaem Transfusion in Practice course today with @BuntyStowe @shshsid @h4yder ! #BSHTIP
@BritSocHaem @BuntyStowe @shshsid @h4yder First we talked about blood donation in the UK. All our blood is donated by altruistic donors, most commonly through whole blood donation but 30-40% platelets are donated by apheresis
@BritSocHaem @BuntyStowe @shshsid @h4yder Donors are assessed prior to donation with the Donor Health Questionnaire and a hb check to ensure the donor is safe to donate and the blood is safe to give to patients.
Almost forgot to mention our consent session! #BSHTIP
Patient information leaflets available here
hospital.blood.co.uk/patient-servic…
Patient information leaflets available here
hospital.blood.co.uk/patient-servic…
We talked about special requirements today as well. Irradiated components required for T cell immunodeficiency or when donor/recip HLA types are similar. Full guideline is here
b-s-h.org.uk/guidelines/gui…
#BSHTIP
b-s-h.org.uk/guidelines/gui…
#BSHTIP
Important examples are
Chemotherapy with purine analogues (eg fludarabine) BUT NOT most chemotx
Hodgkin lymphoma
Post allo or auto BMT
HLA selected platelets
Donation from 1st degree relative
but NOT HIV
If in doubt, check before prescribing! #BSHTIP
Chemotherapy with purine analogues (eg fludarabine) BUT NOT most chemotx
Hodgkin lymphoma
Post allo or auto BMT
HLA selected platelets
Donation from 1st degree relative
but NOT HIV
If in doubt, check before prescribing! #BSHTIP
CMV negative components rarely required. SaBTO guidelines here gov.uk/government/new…
Essentially only for
Elective transfusion in pregnancy
IUT
Neonates
#BSHTIP
Essentially only for
Elective transfusion in pregnancy
IUT
Neonates
#BSHTIP
Our second #BSHTIP session of the day was more on transfusion indications. Cannot tweet this enough times...
hospital.blood.co.uk/media/28629/16…
hospital.blood.co.uk/media/28629/16…
In thrombocytopenia, ask WHY is the platelet count low? HOW can I correct it?
Is the patient at higher risk of harm from possibility of bleeding than risk of platelet transfusion? Usually the answer is 'no'.... #blooducation #BSHTIP
Is the patient at higher risk of harm from possibility of bleeding than risk of platelet transfusion? Usually the answer is 'no'.... #blooducation #BSHTIP
In ITP, platelets only indicated if the patient has severe haemorrhage. Correct treatment is steroids, or if plt >20-30, leave well alone! #blooducation #BSHTIP
Busy day with the #BSHTIP delegates today. Lots of small group sessions and interactive Kahoot! voting on more transfusion topics! kahoot.com #blooducation
Anaemia of chronic disease signified by low serum fe, low transferrin saturation and normal or low TIBC. Functional iron deficiency is an important cause of ACD.
Thorough guideline here on FID for the #haemSpRs
b-s-h.org.uk/guidelines/gui…
#blooducation
Thorough guideline here on FID for the #haemSpRs
b-s-h.org.uk/guidelines/gui…
#blooducation
B12 levels can be affected by many things including drugs. With borderline levels think metformin, OCP, pregnancy and repeat level. Intrinsic factor antibodies can help decide on further management #BSHTIP
More info here b-s-h.org.uk/guidelines/gui…
More info here b-s-h.org.uk/guidelines/gui…
Had our third Whatsapp tutorial with the #BSHTIP delegates last week. Focus was on DIC. Causes are loosely sepsis/inflammation, obstetric and malignancy #blooducation
Transfusion not indicated in DIC in the absence of bleeding (or pre procedure). NBTC indication codes for transfusion are here hospital.blood.co.uk/media/28629/16…
If DIC suspected, measure PT, APTT, fibrinogen, platelets and d-dimers. D-dimers will be raised (but not because of a PE!!!) #blooducation
Just about to start our third and final online tutorial for #BSHTIP delegates... last week they learned about DHTR. Can any of them remember what that stands for...? #blooducation
DHTR presents 5-10 days post transfusion and may be confused with other causes of anaemia/raised bilirubin/fever #BSHTIP
DAT positive (usually) in DHTR. What DAT? Who DAT? Great podcast here (not just for the puns) bbguy.org/2017/02/27/028/ @bloodbankguy
Transfusion alternatives:
WHY is the patient anaemic?
WHAT can you do to rectify that?
HOW LONG will your definitive treatment take?
Transfusion only indicated if the pt can't wait while other treatments to work or if there is no other treatment #BSHTIP
WHY is the patient anaemic?
WHAT can you do to rectify that?
HOW LONG will your definitive treatment take?
Transfusion only indicated if the pt can't wait while other treatments to work or if there is no other treatment #BSHTIP
Iron deficiency is not a diagnosis. What caused it? 15% will have GI malignancy #BSHTIP
Oral iron should only be given once a day; side effects usually due to inadequate absoprtion
IV iron is widely available and safer than blood transfusion
#BSHTIP
IV iron is widely available and safer than blood transfusion
#BSHTIP
@BuntyStowe next up talking about major haemorrhage- blood and guts before lunch! #BSHTIP
Mechanism of injury in trauma often causes coagulopathy in itself, even before haemodilution, acidosis, hypocalcaemia and hypothermia - important to 'get ahead' with the clotting factors in trauma haemorrhage by giving up front FFP #BSHTIP
CRASH2 showed safety and efficacy of tranexamic acid in trauma patients #BSHTIP
Now @h4yder talking on transfusion reactions. @BritSocHaem guidelines here b-s-h.org.uk/guidelines/gui… #BSHTIP
Hydrocortisone grossly overused. Glad to see our delegates are not routinely giving "H&P" for transfusion reactions or as a premed... #BSHTIP
Patient becoming unwell during the transfusion - it may be completely unrelated to the transfusion- never assume! #BSHTIP
My session on transfusion science before coffee - ABO is the most important blood group because 1/ antibodies are preformed 2/ abs are IgM and can activate complement #BSHTIP
Group and antibody SCREEN is the fundamental test done in the lab. If ABO group clear and no antibodies, can issue blood without a physical cross match i.e. "electronic issue" #BSHTIP
O D neg blood is "universal" but does not account for abs to non ABO blood group antibodies. Should be used with care! #BSHTIP
First up @shshsid on the journey of blood. Did you know the National Blood Service was established before the NHS? #BSHTIP
<3% people aged 17-70 donate blood and 96% of them are Caucasian. Thankfully more than 3% of our delegates are donors!
Double red cells can be donated for rarer blood groups by apheresis- but donors must be >70kg, have hb >140g/L and only donate 2x/year (vs 50kg, 125g/L (women)/135g/L (men) and every 16/12 weeks) #BSHTIP
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