2014 Audit of Transfusion in Children and Adults with Sickle Cell Disease

Aims

  • To determine the organisational resources in place for transfusion for people with sickle cell disease
  • To find out what blood is being transfused, why, how, where, when and by whom
  • To examine whether laboratory support and policies meet nationally agreed standards 
  • To examine detailed transfusion timelines for five clinical scenarios

Who did we audit?

  • Children and adults with sickle cell disease who received a red cell transfusion between January 2014 & June 2014

Who took part?

  • Organisational audit: 80 hospitals

  • Clinical audit:
    • 98 hospitals (14 hospitals no transfusions occurred in the 6 month period)
    • 1290 patients
    • 4528 transfusion episodes

What did we find?

Recommendations

Organisational Resources and Network Arrangements

  • Commissioners should work with NHS Trusts and Health Boards to ensure the delivery of clinical networks of care for children and adults with sickle cell disease (SCD). There should be clear pathways and management protocols for emergency and elective blood transfusion for all patients in the geographical area including access to automated red cell exchange (RCE), where indicated.
  •  All hospitals that admit SCD patients should have protocols, training and documentation for staff in transfusion including manual RCE for children and adults.
  •  NHS Trusts and Health Boards should undertake regular service planning and capacity arrangements to meet the growing requirements for blood transfusion in SCD. This includes the provision of out of hours transfusions for patients on long term transfusion programmes.

Blood supply

  • Blood services need to ensure availability of Ro blood.

For improving laboratory practice

  • Rh and Kell blood groups should be known prior to transfusion. Red cell geno/phenotypes should be sent to the National Blood Service so that the results will be available throughout the patients’ lives wherever they choose to attend for their care.
  • Hospitals should ensure that there is clear guidance on how staff inform the transfusion laboratory about patients who have sickle cell disease. This may be through electronic requesting.
  • Transfusion laboratories should have a specific SOP on SCD which includes:
    • Identification of a patient who has SCD including in an urgent situation
    • Patient who may have been transfused elsewhere
    • Use of electronic dispatch note (EDN) where available
    • Contacting National Blood Service for any additional support in finding appropriate units for transfusion and using SpiCE or equivalent where available
    • When consideration can be made to override age requirements of donor units
    • When to escalate to the senior medical haematology team for support in such decisions
  • Hospitals should allow transfusion information sent to their National Blood Service to be shared with other hospital laboratories
  • Electronic issue (EI) can be considered where there is no history of alloimmunisation.

To help improve clinical practice

  1. Automated red cell exchange should be more widely available to all those on long term transfusion programmes.
  2. Transfusion decisions regarding acutely unwell patients should be discussed with the senior haematology or paediatric team.
  3. There is no evidence that an HDU/ITU bed is needed specifically to perform a RCE procedure. Waiting for a bed to become available is likely to delay the procedure. Patients should be admitted to these areas if clinical needs dictate but not solely for the purpose of the RCE procedure.

Resources

British Society of Haematology Guidelines on red cell transfusion in sickle cell disease. Part I: principles and laboratory aspects

British Society of Haematology Guidelines on red cell transfusion in sickle cell disease Part II: indications for transfusion

Report

Please cite the report as:

The Sickle Cell Audit Working Group, on behalf of the National Comparative Audit in Blood Transfusion (NCABT) Steering Group. The 2014 Audit of Transfusion in Children and Adults with Sickle Cell Disease (2017)