References

Hill B, Derbyshire J. Blood transfusions: ensuring patient safety. British Journal of Nursing.. 2021; 30:(9)520-524 https://doi.org/10.12968/bjon.2021.30.9.520

Letter to the Editor

08 July 2021
Comment
02 July 2021
Volume 30 · Issue 13

Blood transfusion safety

On behalf of NHS Blood and Transplant (NHSBT) Patient Blood Management Team, the Serious Hazards of Transfusion (SHOT) UK Haemovigilance Scheme and the National Blood Transfusion Committee, I have been asked to raise some concerns regarding the content of this recent article on blood transfusion safety. It is encouraging to see a transfusion-related article in the BJN, and much of the content is valuable; however, we are concerned that there is some misleading information, and out-of-date references and terminology used. Therefore, we have provided some details on some necessary clarifications and suggested improvements.

Safety

  • Compatibility: it is not made clear that Table 1 and the discussion is only applicable to red cells. Compatibility for plasma and platelet components differ and an understanding of this is crucial, particularly in emergency situations when the patient's blood group is unknown. Compatibility tables for all components can be found in the 2019 NHSBT document NHSBT Portfolio of Blood Components and Guidance for their Clinical Use (https://tinyurl.com/kr4cdrnr).
  • Although the importance of, and steps included in, checking the patient and component at the bedside are detailed, the use of a formal bedside checklist, as mandated in the 2017 Central Alerting System (CAS) alert (CEM/CMO/2017/005) is not mentioned (https://tinyurl.com/h244n864).
  • Transfusion associated (referred to incorrectly as ‘related’) circulatory overload (TACO) is mentioned briefly, but TACO is the leading cause of transfusion-related combined mortality and major morbidity. Reference to the recommended checklist from SHOT is not included (https://tinyurl.com/2hv8jjet).
  • Components vs products: the Blood Safety and Quality Regulations' (BSQR) (https://tinyurl.com/2zuu8h6u) legal definition of blood components in comparison to blood products is included; however, the terms are used interchangeably throughout the article. Legally, there is an important distinction between them, which is particularly relevant in nursing practice. Many nurses, and other health professionals, now authorise (legally only medicines can be prescribed) blood components and/or prescribe medicines including blood products. It is essential that they understand the difference so that they practise within the law. Further clarification can be found in The Human Medicines Regulations 2012 (https://tinyurl.com/mx9wybju).

    • Suggestions for improvement

  • The references to consent for transfusion refer to the Joint United Kingdom Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee (JPAC) from 2014. This guidance has been superseded by new guidelines from the expert advisory committee on the Safety of Blood, Tissues and Organs (SaBTO) (https://tinyurl.com/4e4zjfwy) published in December 2020, and the JPAC page has been updated accordingly. However, we do appreciate that this article may have been written several months before publication.
  • Sample collection procedures are a critical step in ensuring the safety of transfusion and the article would benefit from highlighting the risks of wrong blood in tube and the importance of positive patient identification and sample labelling at the bedside in this step.
  • The article correctly asserts that ‘Red blood cells are stored in a refrigerator’; however, we recommend clarification that ward and drug fridges are not suitable for this purpose.
  • The article does not indicate that the guidance is specific to adults, therefore we recommend that the importance of dosing in mL/kg in neonates and paediatrics is emphasised. Paediatric reports account for nearly 9% of reports submitted to SHOT.
  • The term ‘Rhesus’ is no longer used or considered appropriate in relation to transfusion, Rh is the appropriate nomenclature. Also, in reference to anti-D immunoglobulin, it would be helpful to highlight that administration when anti-D antibodies are present exposes the patient unnecessarily to a blood product.

    • NHSBT is always pleased to provide information and assistance regarding blood component transfusion.

    Response from Barry Hill and Julie Derbyshire

    Thank you for raising these key points. We appreciate your letter recommending a few clarifications and enhancements to our recent blood transfusion article. This article aimed to emphasise the importance of patient care in relation to blood transfusions using an at-a-glance series approach, thus addressing and focusing on key points. The article was delayed due to COVID-19, and consequently had an extended peer review process, and therefore the JPAC guidance from 2014 was noted but the 2020 SaBTO guidelines regarding consent were not as they had not been published. You have raised some valid points and we have made necessary updates using your feedback. Thank you for collectively offering your expertise, it is very much appreciated. We have updated the article accordingly so that our readership can access this, available at 10.12968/bjon.2021.30.9.520.