For Information

NICE quality standards issued for blood transfusion December 2016

The standards cover the principles of blood transfusion in adults, young people and children over 1 year old.

The quality statements are:

Statement 1

People with iron-deficiency anaemia who are having surgery are offered iron supplementation before and after surgery

Statement 2

Adults who are having surgery and expected to have moderate blood loss are offered tranexamic acid

Statement 3

People are clinically reassessed and have their haemoglobin levels checked after each unit of red blood cells they receive, unless they are bleeding or are on a chronic transfusion programme

Statement 4

People who may need or who have had a transfusion are given verbal and written information about blood transfusion

Aman Dhesi, Development Manager - Patient Blood Management Team

SHOT newsletter

The Winter 2016 issue is now available on the SHOT website.

Lisa Parker, SHOT Administration Office Manager

RCI reporting of obstetric cases: Antenatal reporting in line with BSH guideline

From 1 February 2017 RCI will be making changes to the antenatal reporting comments in line with the 2016 BSH guideline for blood grouping and red cell antibody testing in pregnancy.

The change is associated with the management of women with anti-D detected in their plasma and the guideline recommends that even if anti-D immunoglobulin has been given prior to 28 weeks gestation, monitoring by quantification must be undertaken as the antibody may be immune (until the anti-D is no longer detectable) whilst continuing to administer anti-D Ig as indicated.

There is also a recommendation that quantification is performed on samples in which anti-D detected in pregnancy with the exception of that detected immediately prior to delivery.

We will also be reflecting the guidance that titres of anti-K >32 are indicative of increased risk of HDFN. Previously we had referred to a lack of correlation between titre and severity of HDFN.

There will be a change to sample requests on some reports to consider referral for fetal genotyping when the partner phenotype is unknown or he expresses the corresponding antigen.

Change in RCI reporting of obstetric cases that have been investigated for Fetomaternal Haemorrhage

As part of the continuous improvement programme RCI have reviewed the application of Uncertainty of Measurement (ISO15189, 5.5.1.4) in Fetomaternal Haemorrhage estimation by Flow Cytometry and reporting results.

RCI will change practice in cases where the measured FMH is lower than a trigger point for additional anti-D (e.g. 4mL), but the result is close enough to the trigger to be within the limits of uncertainty for the test.

From 1 February 2017 RCI will take account of Uncertainty of Measurement, by recommending a higher minimum dose of anti-D and requesting follow-up samples on these cases.

For example in a case with a measured FMH of 3.9mL and an uncertainty of measurement of +/- 10% (the result possibly lies in the range 3.5 to 4.3), RCI will in future recommend a minimum dose of at least 1,000IU of prophylactic anti-D, and request follow-up samples.

Dr Mark Williams, National Head of RCI NHSBT