Blood transfusion risks must be reduced

In February this year, the first case of variant Creutzfeldt-Jakob disease (vCJD) was confirmed in a patient with haemophilia. The announcement stated that a positive result for the prion protein associated with vCJD had been found in the spleen on autopsy of a patient previously treated with Factor VIII for haemophilia. The patient, a male, had received the contaminated plasma products before new safety regulations were introduced to limit transmission of the disease. Following this news, up to 4,000 haemophilia sufferers have been warned they could also be at risk of contracting vCJD. Although the route of the transmission is still unclear, it is known that the patient was treated with several batches of UK blood plasma products before 1999, when the risk of transmission was not known. A review of his medical history revealed that he was, in fact, treated with a batch of Factor VIII concentrate that was manufactured from the plasma of a donor who went on to develop symptoms of vCJD. It was with this unfortunate news still fresh in mind that an audience of over 270 delegates recently gathered at the headquarters of the Royal College of Physicians, London, to attend a one day national education meeting, co-hosted by NHS Blood and Transplant (NHSBT) and the Department of Health (DH). The event, “Strictly Blood Transfusion”, provided the opportunity for representatives of hospital transfusion teams from across the UK to enjoy a multitude of engaging lectures from specialist guest speakers and transfusion experts.

High activity, high cost, high risk

Opening the meeting, morning chair Dr Bill Kirkup (CBE), associate NHS medical director at the DH, was under no illusion that, due to recent events, better blood transfusion should be placed high on the agenda of hospital Trusts everywhere. Dr Kirkup believed it was vital that the profession should share best practice in all aspects of blood transfusion – thereby ensuring patient safety is not compromised. According to first speaker, Steve Morgan, head of International Services NHSBT, the UK can learn some valuable lessons in this area from its European counterparts. Presenting benchmarking data on international blood component and clinical usage rates, Steve Morgan considered that the strong network that now existed between NHSBT and similar overseas organisations was proving a valuable tool in reducing wastage and increasing efficiency. His data revealed that clinical issue rates of red cells, platelets and fresh frozen plasma (FFP) continue to vary widely from country to country, but more research is required to understand the key drivers of optimal practice. The “French model”, in particular, was leading the way in this area and, although the UK (in the shape of NHSBT) was performing well in comparison, Steve Morgan’s final verdict was that there was still scope for improvement. Professor Mike Murphy, consultant haematologist, Oxford Radcliffe Hospitals and clinical director for Patient Services, NHSBT, has long advocated the importance of implementing “Better Blood Transfusion” (BBT) initiatives within hospitals. Presenting the results of the recent BBT 2008 “Survey of Compliance”, Prof. Murphy began by outlining the on-going challenges for blood services and hospitals. Improving patient safety through the use of technology, incorporating wristband identification systems, along with the promotion of more effective blood use, were highlighted as the key areas of focus. “Transfusion is a high activity, high risk, high cost area,” he commented, stating that 2.25 million units of red cells are transfused each year, in England alone, costing over £300 million to process. In the process, this was responsible for 115 transfusion-related patient deaths in the last 11 years. The 2008 BBT survey, which covered England, attracted an impressive 92% hospital participation rate but revealed some worrying transfusion trends. While 97% of Trusts had a hospital transfusion committee (HTC) meeting at least three times per year, only 56% of these had lead consultant haematologists with dedicated transfusion sessions, which Prof. Murphy said was “clearly not good enough”. Other disappointing revelations in the survey were that use of IT in patient identification and bedside checking to improve patient transfusion safety was only being adopted by 59% of Trusts. This highlighted the fact that there was still no evidence of the long awaited national strategy for the implementation of these systems. Additionally, areas encompassing the appropriate use of blood and conservation strategies, which in previous surveys had showed promising results, now appeared to be “slipping away” slightly, which Prof. Murphy considered a cause for concern. He commented that, although great progress has been made with BBT in recent years, the profession is still not yet where it should be if transfusion is to be made safer for patients. This prompts the question: What factors are now preventing the implementation of BBT in hospitals? The increasing regulatory requirements and compliances within all areas of transfusion, which are now competing for more and more time, was one distinct possibility – as was inadequate staffing for the hospital transfusion team (HTT). Prof. Murphy concluded, however, that transfusion is still not seen as a high priority within senior hospital management and that the profession therefore urgently needed to raise its profile in this area.