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Last night I ran another introduction to transfusion session with the West Mids ST3s (we're still catching up from August 
), discussing complications of transfusion and consent.
Read on for highlights of what we discussed
#blooducation
), discussing complications of transfusion and consent.Read on for highlights of what we discussed
#blooducation
What is the most common cause of major morbidity or mortality from transfusion?
Febrile non haemolytic transfusion reactions (FNHTR
) are very common but v rarely result in significant harm, errors are implicated in >70% of incidents referred to @SHOTHV1 and thankfully ABO incompatible transfusion is rare (but a Never Event)
) are very common but v rarely result in significant harm, errors are implicated in >70% of incidents referred to @SHOTHV1 and thankfully ABO incompatible transfusion is rare (but a Never Event)
Most recent SHOT report is here https://www.shotuk.org/shot-reports/report-summary-and-supplement-2019/2019-annual-shot-report-individual-chapters/
Transfusion associated circulatory overload is the most common cause of major morbidity for patients undergoing transfusion. Identifying risk factors is key. I could talk about TACO all day 
(but I won't, or at least not today)...
(but I won't, or at least not today)...
We should definitely be consenting patients for TACO. But what are three other really important risks rarely mentioned (in my experience) to patients ahead of transfusion?
Firstly, error. As above, error is actually the most frequent thing to go wrong relating to transfusion. Thankfully resultant harm is less common. I always tell patients about this. Why?
So I can empower them to ensure bedside checks are performed, and so they understand that being asked their name and DOB repeatedly is a good!
Sadly, in my experience of serious errors, had the patient been empowered to challenge, they could potentially have stopped the error
Sadly, in my experience of serious errors, had the patient been empowered to challenge, they could potentially have stopped the error
Next up, alloimmunisation. How many people of child bearing potential are counselled about their risk of antibody formation and future risk of HDFN? 
Not many. Would this change a young woman's decision re desire to receive a transfusion for e.g. severe iron deficiency?
Not many. Would this change a young woman's decision re desire to receive a transfusion for e.g. severe iron deficiency?
I would think so. Where there is genuine medical equipoise as to whether transfusion is likely to be beneficial, these discussions are critical.
Last on my list of issues that are rarely discussed, patients who have received blood in the UK cannot donate blood in the UK. It is *really vital* this information is given.
Which of the following human derived products does this *not* apply to?
Which of the following human derived products does this *not* apply to?
This applies to everything other than Anti-D. The rationale is reduction of vCJD transmission (a very tiny risk we now know). All patients receiving blood components and products should be counselled about this.
There are many other risks of transfusion and the new SaBTO guidance from Dec 2020 about consent for transfusion is here https://www.gov.uk/government/publications/blood-transfusion-patient-consent/guidelines-from-the-expert-advisory-committee-on-the-safety-of-blood-tissues-and-organs-sabto-on-patient-consent-for-blood-transfusion#information-resources-for-patients-and-public
. @NHSBT also have some excellent resources from the @PBM_NHS team here https://hospital.blood.co.uk/patient-services/patient-blood-management/consent-for-transfusion/
And there are patient information leaflets here, which include retrospective info for patients who received blood as an emergency https://hospital.blood.co.uk/patient-services/patient-blood-management/patient-information-leaflets/
That was a quick run through our highlights from last night. Make sure you talk to your patients about blood, the indications, risks and alternatives! #blooducation
