Welcome to March Med e-News

Transfusion Update 2010 is getting closer, and earlybird registrations have been extended. If you want to take advantage of the discounted rate, get your registration and payment in by the new date of Monday 29 March.

We will be updating the program details this week as more speakers and topics for the sessions are confirmed.

To find out about the conference and to register, go to www.transfusion.com.au

If you would like to add yourself or your colleagues to the Med e-News mail list, please send an email to lreid@arcbs.redcross.org.au

To ensure the availability of platelet stocks over the Easter holiday period, the Blood Service has planned to increase blood collection and will prepare additional pooled platelets. We will be monitoring the local and national stocks carefully and moving platelets between the Blood Service distribution centres as required.

The anticipated lowest point for the platelet inventory is likely to be Wednesday 7th April.

It is important for this information to be taken into consideration when scheduling platelet transfusions during and immediately after the holiday period. Where possible, the Blood Service encourages platelet transfusions over the period on days when the platelet inventory is stronger, where clinically appropriate. Similarly, advanced notification of any specific clinical requirements anticipated over this period would be greatly appreciated as this will aid our production and collection planning.

The Blood Service convenes an annual Strategic Blood Forum, providing clinical and government stakeholders an update on our activities, particularly those related to patient safety and service issues. The meeting is an opportunity to obtain feedback from our clinical colleagues and representatives from professional societies and the specialist colleges regarding areas of priority for them.

This year’s Forum was held in Sydney on Wednesday 10 February.

Presentations and discussions on the day covered clinical and operational issues relating to the current debate about the red cell storage lesion and the age of red cells at the time of transfusion, the rationale for and implications of the Blood Service’s implementation of fully automated nucleic acid testing (NAT) and NAT for hepatitis B, the Blood Service’s approach to TRALI risk reduction and an overview of clinical practice trends in the use of intravenous immunoglobulin.

Updates were also provided on the results to date and the operational and clinical impacts of platelet bacterial contamination screening, the aims and progress of the Blood Service Re-engineer our Supply and Service (RoSS) Program, and clinical and other research activities which the Blood Service is currently undertaking, including the evaluation of currently available pathogen inactivation technologies.

There was considerable discussion during the stakeholder feedback sessions, covering issues such as the possible utility and the logistics of provision of frozen blood, the availability of blood and blood products in rural and remote areas, massive transfusion protocols and the clinical desirability of having access to a fibrinogen concentrate and importance of establishing patient blood management programs.

Further details regarding specific issues discussed during the Forum will be published in our next MediLink newsletter.
 

On 9 February 2010, the National Blood Transfusion Committee (NBTC) held its annual face-to-face meeting in Sydney.

The Committee, membership of which includes a clinical representative from each state and territory, a representative from the Australian and New Zealand Society of Blood Transfusion (ANZSBT) and the Blood Service, was established in 2005 with the following objectives:
• To promote high-quality, safe and appropriate transfusion practices;
• To provide a forum whereby the clinical views on key transfusion issues can be voiced;
• To inform decision-making within the blood sector as required; and
• To provide feedback and recommendations in relation to our service delivery.

The Committee meets by teleconference on a bi-monthly basis and has an annual, one day, face-to-face meeting. Topics discussed at this year’s face-to-face meeting included:

• ANZSBT Requirements for the Preparation and Use of Thawed Plasma;
• Draft revision of the ANZSBT Guidelines for the Irradiation of Blood Components
• Review of the Criteria for the Clinical Use of IVIG in Australia
• Patient Blood Management Guidelines
• Draft National Safety and Quality Standards
• Department of Health and Ageing Review of Pathology Funding
• Age of blood at supply and transfusion
• Red cell phenotyping
• Apheresis cryoprecipitate
• Introduction of Flebogamma
• Post-implementation review of leucodepletion of 100% of red cells and platelets
• Implementation of fully automated nucleic acid testing (NAT) and NAT for hepatitis B
• Platelet bacterial contamination screening
• National Haemovigilance Program
• Blood Service Re-engineer our Supply and Service (RoSS) Program
• Format of the Blood Component Information Booklet

If you are interested in obtaining information regarding any of the issues discussed or wish to forward an issue to the Committee for consideration, please contact your local state or territory representative or a member of the Blood Service Transfusion Medicine Services team in your local jurisdiction.
 

The Blood Service has recently received a small number of reports of white stains or milkiness on one type of red cell bag (Fresenius T3922 blood bags).

The blood bag manufacturer, Fresenius Kabi, has advised that the milkiness or white stain observed on some of their bags is inherent to the sterilisation process and that this has no negative impact on the performance of the system or the quality and safety of the processed blood components. As such, the red cells are safe to transfuse.

Should you have any further queries, please contact your local TMS team.
 

Daniels G & Reid ME. Blood groups: the past 50 years. Transfusion 2010; 50(2): 281-289. http://www3.interscience.wiley.com/journal/122680320/abstract

Neuhaus SJ et al. Australian experience with frozen blood products on military operations. MJA 2010; 192: 203-205. http://www.mja.com.au/public/issues/192_04_150210/neu10649_fm.html

Basora M et al. Allogeneic blood transfusion does not increase the risk of wound infection in total knee arthroplasty. Vox Sanguinis 2010; 98(2):124 – 129. http://www3.interscience.wiley.com/journal/122596575/abstract

Slichter SJ et al. Dose of prophylactic platelet transfusions and prevention of hemorrhage. N Engl J Med 2010; 362: 600-13. http://content.nejm.org/cgi/content/short/362/7/600

Palo R et al. Platelet transfusions in adult patients with particular reference to patients undergoing surgery. Transfusion Medicine 2010; 20 (1): 30 – 37.
http://www3.interscience.wiley.com/journal/122607302/abstract

Fischer-Nielsen A et al. Pressure-aided transfusion of platelets: does it affect the platelets? Transfusion 2010; 50(2): 361-365. http://www3.interscience.wiley.com/journal/122608459/abstract

Skripchenko A et al. Periods without agitation diminish platelet mitochondrial function during storage. Transfusion 2010; 50(2): 390-399. http://www3.interscience.wiley.com/journal/122662044/abstract

Shaz BH et al. Increased number of coagulation products in relationship to red blood cell products transfused improves mortality in trauma patients. Transfusion 2010; 50(2): 493-500. http://www3.interscience.wiley.com/journal/122616471/abstract

Sarode R et al. Prospective monitoring of plasma and platelet transfusions in a large teaching hospital results in significant cost reduction. Transfusion 2010; 50(2): 487-492. http://www3.interscience.wiley.com/journal/122616470/abstract) 

Patient Blood Management Guidelines

Public consultation on the Critical Bleeding Guidelines, the first draft Patient Blood Management Guideline to be produced, is expected to commence in March 2010.

This consultation process is central to achieving the best possible outcome for these guidelines and your participation is very strongly encouraged.

If you would like to receive updates on the progress of the Guidelines, please register at www.nba.gov.au or contact guidelines@nba.gov.au.
 

Australian and New Zealand College of Anaesthetists Annual Scientific Meeting 2010
1 – 5 May, Christchurch, New Zealand

Royal Australian College of Surgeons Annual Scientific Congress
4 – 7 May, Perth, Western Australia

Transfusion Update 2010
19 – 21 May, Melbourne, Australia

31st International Congress of the International Society of Blood Transfusion
26 June – 1 July, Berlin, Germany