Transfusion tomorrow: advancing safety

Blood transfusion is an essential component of modern health services and its safety is still high on the political agenda. A twoday symposium, “Transfusion Tomorrow”, aimed to address many of the current issues affecting blood services – both here in the UK and throughout the transfusion world – as well as looking at the shape of things to come in the context of advancing technology in a rapidly evolving regulatory environment. Setting the scene for the meeting, Steve Morgan, head of international services, NHS Blood and Transplant (NHSBT) and co-chair, European Blood Alliance Benchmarking Group, examined the latest international trends in blood component usage. Blood banking is now a global process, with huge variations in the rates of red cell utilisation rates per population, and the UK sits at the “mid-range” of this. However, with sufficiency issues in many developing countries a serious concern, Steve Morgan outlined how NHSBT supports these areas as part of its social responsibility in its role as a member of the Alliance of Blood Operators. Overall worldwide trends in component usage are currently on the rise due to an ageing population, but significant falls in stocks are predicted due to a dramatic decrease in the availability of potential young donors, which Steve Morgan described as “a ticking time-bomb for blood operators”. Consequently, the challenge ahead for blood services is to introduce new blood management systems incorporating the increased usage of schemes such as autologous transfusions, bloodless surgery and transfusion alternatives (such as cell salvage), to alleviate the predicted future demands on the global blood supply.

How safe is blood?

“How safe is blood in 2010?” was the question posed by Dr Clare Taylor, medical director of the Serious Hazards of Transfusion or “SHOT” scheme. The UK’s only independent, professionally-led haemovigilance scheme, SHOT is essentially an anonymous and voluntary system that invites reports of major adverse events surrounding the transfusion of blood components from UK hospitals. Using various blood safety data, taken from SHOT’s 13 years of findings to date, Dr Taylor first examined the donor related microbiological risks posed by transfusion transmitted infections (TTIs) as well as viral risks such as HBV, HCV and HIV. Describing the risks as “residual”, Dr Taylor outlined how these and other risks posed by conditions, such as TRALI, post-transfusion purpura and haemolytic transfusion reactions, have all been reducing over recent years, as a result of safety precautions such as leucodepletion and better donor arm cleaning procedures. Other hospital-based clinical risks – such as blood administration errors, laboratory errors, identification errors, as well as the specific problems posed in paediatric transfusions – were highlighted and recurrent themes outlined. These included mistakes occurring in emergency situations and errors at the bedside. In comparison with medicines, however, Dr Taylor commented that blood is, in fact, a very safe product indeed. In the US, for example, as many as 7,000 patients die each year as a result of medication errors in comparison to the relatively low rates posed by transfusion. Dr Taylor concluded by praising the work of haemovigilance schemes throughout the world, such as SHOT, for helping to achieve a safer transfusion experience for patients. A cardiac surgeon’s perspective on blood transfusion was delivered by Gavin Murphy, University Hospitals Bristol NHS Foundation Trust, who examined the paradox between the need to give blood during major surgery and its potential harmful effects.