For Action

Get your free lanyard checklist and support SHOT's key recommendation ‘bedside checklist must be used as a standard of care’
Following the release of the SHOT Annual Report 2016 and recommendation 1, a free checklist card is available from your local Patient Blood Management practitioner. Alternatively, you can download the checklist and insert in your lanyard.

August 2017 checklist for lanyard

Please use the checklist to prevent transfusion error and detect any errors made earlier.

Jayne Addison, PBM Practitioner

 

Supporting patients with sickle cell disease
Sickle cell disease (SCD) is a common inherited genetic disorder. There are an estimated 14,000 affected individuals living in the UK. Regular blood transfusion is one of the primary treatment regimes and is used in both emergency and elective situations. The requirement for blood for these patients is increasing. This pressure on blood supply is added to because:

  1. Blood for patients with SCD should be Rh and K compatible (BSH Guidelines, Red Cell Transfusion in Sickle Cell Disease Part l, 2016) (http://www.b-s-h.org.uk/guidelines/guidelines/red-cell-transfusion-in-sickle-cell-disease-part-l/). The 2014 National Comparative Audit (NCA) (http://hospital.blood.co.uk/audits/national-comparative-audit/) showed that 67% of patients receiving transfusion for SCD are Ro and only 1.2% of the largely Caucasian donor population have the Ro phenotype. There arealso increasing difficulties to match the antigen profile of the donor population to the needs of these patients.
  2. BSH guidance recommends using blood that is 7 days old or less for red cell exchange and 14 days old or less for top-up transfusions. For automated red cell exchanges, adults may need 8 to 12 units every 6 to 8 weeks.

In 2014, the NCA audit noted that 50% of Ro HbS negative requests received by NHSBT were being substituted for other phenotype compatible units e.g. O rr for O Ro.

In 2014, NHSBT began a Ro Improvement Project. Since that time, demand for Ro red cells has increased two-fold, to over 4,000 units per month. During the same period, NHSBT has improved availability from an average of 975 units to approximately 1970 units per month.

The main initiatives of the Ro improvement project are: 

  1. Increased marketing activity/publicity: To meet Ro demand NHSBT needs 40,000 new Black donors i.e. 9% of new donors attending for three years, representing 2.9% of the Black population actively donating.
  2. Ro donor Identification: Units from known Ro donors are labelled at donation and fast tracked through Manufacturing, ready for issue within 2 days of donation.
  3. Special Stock Location: NHSBT has developed a special stock location for Ro units which assists the monitoring, search and identification of these units and any subsequent distribution that is required.
  4. Restricted Stock-Holding: Ro units are only stocked at sites with the largest demand. Transport Systems have been established to distribute units from these Ro holding Centres, to those sites where the units are required, in time to meet the patient needs.
  5. Software Updates: NHSBT has recently developed software changes enabling the Hospital Services staff to view Ro orders before the issue date and procedures are being established to manage these orders in good time.
  6. Awareness: NHSBT has raised the profile of the needs of these patients to all staff involved in the supply chain encouraging them to understand their role in this.
  7. Substitution: NHSBT has developed a substitution matrix (DAT2948) to ensure Ro donations are used appropriately and to minimise the demand on O D negative red cells:

Substitution

O Ro (C-D+E-)

A Ro (C-D+E-)

B Ro (C-D+E-)

AB Ro (C-D+E-)

1st

O rr (C-D-E-)

O Ro (C-D+E-)

O Ro (C-D+E-)

A Ro (C-D+E-)

2nd

 

A rr (C-D-E-)

B rr (C-D-E-)

O Ro (C-D+E-)

3rd

 

O rr (C-D-E-)

O rr (C-D-E-)

B Ro (C-D+E-)

4th

 

 

 

A rr (C-D-E-)

5th

 

 

 

AB rr (C-D-E-)

6th

 

 

 

B rr (C-D-E-)

7th

 

 

 

O rr (C-D-E-)

With NHSBT and hospitals working in partnership, we can help ensure that Ro units are available for patients when and where they are needed.  We are setting up new processes to ensure we can view orders and source suitable units well in advance and request your assistance in the following areas:

  1. Where possible, please place orders for Ro units 5 days in advance.
  2. Please order Ro units for Ro patients so NHSBT has accurate demand data.
  3. If an order for Ro, HbS negative units is no longer required, please delete the outstanding request on OBOS.  NHSBT can return these units to stock and they will then be available for other SCD patients.
  4. Please accept the Ro substitutions that take place, these are in accordance with the Substitution Matrix that has been introduced.
  5. Please discuss any issues or suggestions regarding the Ro ordering process with your local Customer Services Manager.

Many thanks for your assistance in our work to improve the supply of Ro blood for patients with Sickle Cell Disease. We would also appreciate your help with recruitment of Black donors. It would be very helpful that if, where appropriate, hospitals could discuss the challenges faced with providing blood for this specific patient group and encourage relatives to become blood donors themselves.

Richard Whitmore- Customer Services Manager

Helen Mugridge- National Operations Modernisation Lead