The Antibody Club is now live

You can now work through the first case study to identify which antibodies are present in MJ’s plasma, and then select appropriate tests to find compatible red cells for him.

Complete the eLearning, then join us at the Transfusion Science Symposium at the Adelaide Convention Centre on Saturday 17 October.

You can find the eLearning in Transfusion Online Learning.

The case will be presented and discussed by Chris Hogan, Medical Director, Pathology Services, Australian Red Cross Blood Service. He will also be monitoring our supporting discussion here on during the month of October, supported by other experts from the Blood Service.

If you can’t join us live in Adelaide, the session will be recorded and made available in Transfusion Online Learning.

Remember our blog will be open from Tuesday October 6 through to Sunday 1 November, so feel free to jump on, ask questions, and participate in the discussions.

Log on to Transfusion Online Learning to enrol in the eLearning and get started.

Join the Antibody Club!

Identifying antibodies can be a challenge at times. Performing exclusions, testing various panels, using different techniques and finally crossmatching, may all be required to provide compatible red cells that will be safe for transfusion to our patients.

Whether you are a scientist or technician, working in a multidisciplinary laboratory or a specialised transfusion lab, you have likely been exposed to antibody investigations in some form.

To assist with these challenges, we’re launching a new eLearning – the Antibody Club – on Tuesday 6 October.

Participants in the Antibody Club will learn how to perform antibody exclusions, select appropriate tests and provide compatible red cells for transfusion, all in the safety of the virtual world.

This package is primarily aimed at scientists and technicians, but is suitable for anyone who is interested in antibody investigations.

Whether you are a novice, or a scientist with many years of immunohaematology experience, the Antibody Club caters for you. You can choose to work through the case scenario on your own (unassisted mode), be provided with direction (assisted mode), or select the tutorial mode which will guide you step-by-step through the antibody identification process.

You will be able to gain one APACE point and download a certificate for each module completed.

Additional Antibody Club modules will be released each year ranging from basic, to intermediate, through to advanced.  You can start with case scenarios depicting simple antibody investigations and progress through to the more complex and challenging

Our transfusionblog will be open for a four week period from the launch date (6 October)to enable discussion around the case itself, transfusion laboratory practices, or anything ‘transfusion’ for that matter!

Complete the eLearning and come along for the presentation and discussion live at the Blood Service Transfusion Science Symposium, to be held in Adelaide on Saturday October 17 2015, ahead of HAA. This session will be recorded and made available on the blog and Transfusion Online Learning in case you can’t make it.

In the meantime, feel free to log on to Transfuse Online Learning (register if you are new to the site) and have a look at the other education we have to offer while you wait for the Antibody Club to be released.

Helen Stathopoulos

Helen is a Senior Transfusion Scientist with the Australian Red Cross Blood Service and SA Pathology.

Obstetrics and Maternity Patient Blood Management

How do you manage your obstetric and maternity patients with anaemia? Here are some scenarios to consider.

Nancy Chan, age 32 is 4 months pregnant. She had a history of iron deficiency anaemia in her last pregnancy. Her Hb is 123 g/L and her ferritin is <5 µg/L.

What treatment, if any would you recommend?

Sally Johnson, age 29, is in her third trimester of pregnancy. She has iron deficiency anaemia. She was not able to tolerate the oral iron you prescribed, despite decreasing the dose and frequency, so stopped taking it. Her Hb has dropped further and she is scheduled for a LUSC in two weeks due to placenta praevia.

Do you prescribe more steak dinners?

Tell her to persist with oral iron?

Give her a shot of intramuscular iron?

Or schedule some intravenous iron ASAP?

Kaylee Jones, age 31, is 7 months pregnant with her third child. She is feeling short of breath walking down the street. Her haemoglobin is 61 g/L. She is pale and tachycardic.

Do you transfuse her? How many units?

Find out the answers and learn more in our latest Transfusion Q&A topic Obstetrics and Maternity Patient Blood Management Guidelines part 1: Anaemia

All cases are based on the National Blood Authority Patient Blood Management Guidelines and the explanations provide links to the guidelines and other resources.

Dr Sandy Minck, the author of this post, is a Medical Officer at the Australian Red Cross Blood Service and a member of the Transfusion Practice and Education team.

Obstetrics and Maternity Patient Blood Management Guidelines released

The fifth in a series of six evidence-based patient blood management (PBM) guidelines, the Obstetrics and Maternity module was approved by the National Health and Medical Research Council (NHMRC) in December 2014, and released on 23 March 2015.

The module contains a series of recommendations based on evidence from the systematic review; practice points developed through consensus decision making by the Clinical/Consumer Reference Group (CRG) where there was insufficient high quality data; and thirdly, unique so far to the fifth module, expert opinion points to guide practice in areas outside the scope of the systematic review.

Evidence from the systematic review led to four recommendations. Firstly, routine administration of iron supplementation to all pregnant women is not recommended. The administration of iron to pregnant women with iron deficiency is recommended, but not the routine addition of folic acid. Finally, ESAs should not be routinely used in maternity patients. Further guidance regarding anaemia and iron therapy is provided in the form of practice points.

The module also covers blood group and screen during pregnancy; planning for when transfusion is not an option; transfusion in women who are not actively bleeding, and when there is critical bleeding including the use of massive transfusion protocol. The use of modified blood components (CMV negative and phenotyped); transfusion support for maternity care/services; guidance for coagulopathic patients at risk of bleeding; and the use of recombinant activated factor VIIa, cell salvage, interventional radiology also feature.

To learn more about obstetric and maternal patient blood management and the PBM guidelines, why not register to attend Transfusion Update: Obstetric and Maternal Patient Blood Management either in person or by webinar. This session will cover PBM in maternity care including iron deficiency anaemia, indications for blood product support during pregnancy, the needs of the growing fetus and critical bleeding.

Wednesday 13 May, 1.30pm – 3.00pm (Sydney time), at The Royal Women’s Hospital, 20 Flemington Rd, Parkville, or by webinar.
Presented by Dr Helen Savoia, Head of Haematology, The Royal Children’s Hospital, Dr Wendy Pollock, Critical Care Nurse and Midwife, Mercy Hospital for Women, and Dr Shelley Rowlands, Obstetrician and Fetal Maternal Specialist, Royal Women’s Hospital. The session is Chaired by Mr Leigh McJames, General Manager, National Blood Authority.

Dr Sandy Minck, the author of this post, is a Medical Officer at the Australian Red Cross Blood Service and a member of the Transfusion Practice and Education team.

Demand for red cells is falling. What’s going on?

Demand for red cells is declining in Australia and internationally. In Australia, demand for red cell units dropped by 4.8 percent from 2011/12 to 2012/13, 7.9% in 2013/14, and is expected to decline by a further 3% in 2014/15. In the UK demand started to decline sharply in October 2012, with a reduction of 2.7% in 2012/13, a further 4.8% in 2013/14, and the trend forecast to continue over the medium term. Sanquin Blood Services in the Netherlands saw a greater than 20% reduction in demand from 2009 to 2013. In New Zealand the clinical use of red cell components has reduced significantly over the last decade with transfusion rates falling by almost 25% from 29.6 red cells per 1000 population in 2006 to a projected 22.3 per 1000 by the end of 2014. The US estimates 8.2% fewer transfusions in 2011 compared to 2008, with transfusion rates falling from 48.4 units per 1000 to 44.0/1000.

All organisations report that the decline in red cell demand is likely due to the growing adoption of programs to reduce wastage and improve appropriate use. In Australia, the National Blood Authority (NBA) has implemented the National Blood and Blood Product Wastage Reduction Strategy 2013-17 to facilitate improved inventory management and logistics. The NBA and other blood sector stakeholders have also been focussed on practice improvement, including improving appropriate use through the publication and implementation of Patient Blood Management Guidelines. The Australian Red Cross Blood Service has developed a transfusion education curriculum and numerous resources to promote patient blood management principles including appropriate and safe transfusion practices.

New Zealand specifically attribute the initial decrease in demand as being driven by blood conservation programs such as “Why use two when one will do?” emanating from Canterbury District Health Board and increasingly rolled out across the country. Australia is encouraging a similar theme with the single unit transfusion guide. Increasing awareness of the importance of maximising patient’s haemoglobins prior to surgery has also contributed to the fall in clinical use. Pre-operative assessment identifies many patients who are iron deficient, treatment of which improves haemoglobin levels prior to surgery with a consequent reduction in the need for transfusion. Additionally, improved surgical techniques and other patient blood management (PBM) strategies – such as cell salvage – have contributed.

What does the decline in red cell demand mean? The upside is the benefit to patients and healthcare facilities – reduced transfusion rates results in decreased adverse outcomes, such as decreased morbidity, mortality and length of stay; and decreased cost.

The downside is the impact on the blood services – the costs of the blood supply chain are relatively fixed in nature and it is challenging to reduce costs at the same rate as volume reduction. As capacity is reduced in line with longer term trends in demand, blood services remain dependent on their donors to be able to respond to short term demand pressures. In addition, there is the need to increase the proportion of rare blood group donors, especially of O negative. In managing this environment we can sometimes be seen as presenting conflicting messages to our donors.

If you would like to find out more about how the Blood Service aligns supply and demand, You can head along to the Melbourne Processing Centre, 100 – 154 Batman Street, West Melbourne on Wednesday 8 April at 1.30pm. You can also join this session by webinar, or catch up with a recorded version after the event. Register at Transfusion Online Learning on

Some other useful resources:

Understanding red cell decline: a global challenge for blood services.
National Blood Authority Australia Annual report 2013-14.
The 2011 National Blood Collection and Utilization Survey Report. Department of Health and Human Services, USA.
NHS Blood and Transplant Annual Report and Accounts 2013/14.
New Zealand Blood Service Annual Report 2013/2014.
Sanquin Blood Supply Annual Report 2013.

Dr Sandy Minck is a Medical Officer at the Australian Red Cross Blood Service and a member of the Transfusion Practice and Education team.

Latest study debunks age of red cell advantage

Results from the ABLE (Age of Transfuse Blood in Critically Ill Adults) study have just been published in the New England Journal of Medicine.

This study is an important milestone in the debate around the value of “fresh blood”. For several years now there has been increasing evidence of differences in stored blood with time: the longer red cells are stored, the more measurable changes occur. It has been assumed that this red cell storage lesion has negative clinical consequences. Indeed, several observational studies strongly suggested that older blood had deleterious effects.

The ABLE study compared key outcomes –  in particular 90-day mortality –  for critically ill patients in 64 hospitals across Canada and Europe. Patients were randomised to receive <7 day old blood or standard transfusion. The patient groups were very closely matched and the groups received either 6.1 day old or 22 day old red cells for transfusion. The primary outcome found no difference in the 90-day mortality between the groups. Secondary outcomes such as major illness, length of stay, transfusion reactions etc also found no difference between the study groups.

The ABLE study now sits beside the other large randomised trials in this area: the ARIPI study (Fergusson et al), which found no advantage of fresh blood in sick premature babies and the RECESS study (Steiner et al), which found no difference in cardiac surgical patients.

Together these studies are building evidence that the red cell storage lesion is not very important in some clinical situations. We should note that only very sick patients have been studied in these large trials and the results may not be generalisable.

There are other high quality studies still ongoing in this field, in particular the Australian TRANSFUSE study and the Canadian-Australian INFORM study.

For my clinical practice, I am becoming progressively reassured that I don’t need to ask for young blood compared to standard, especially in the setting of ICU.

Dr Ben Saxon is the National Transfusion Specialist at the Australian Red Cross Blood Service and haematologist at the Women’s and Children’s Hospital, Adelaide.

Adverse events; help is at hand

Our blood supply today is the safest it has ever been, but the latest UK Serious Hazards of Transfusion (SHOT) data shows the greatest risk to the patient is non-infectious complications of blood transfusions such as transfusion related acute lung injury (TRALI), haemolytic transfusion reactions (HTR) and incorrect blood component transfused (IBCT).

It is important for clinicians to be aware of these risks when prescribing transfusions for patients, and equally important for nurses who administer the components to be familiar with signs and symptoms of possible transfusion reactions, and what steps need to be taken if a patient is having a reaction.

We have designed an eLearning module on transfusion adverse events and the first in the series of four has already been released. It’s a quick, simple package primarily aimed at scientists, technicians, registrars, interns and nurses, but suitable for anyone who wants to learn more about transfusion-associated adverse events.

You can find it in Transfusion Online Learning on, the Blood Service website for health professionals.

The eLearning is presented as a clinical scenario and allows you to work through the case interpreting results, learning information and answering a variety of questions to help you identify which transfusion adverse event the patient is experiencing.

On completion you will be able to download a certificate and gain one APACE point for each module you work through.

Log on to Transfusion Online Learning (register if you are new to our site) and enrol in one of the modules.

While you’re there, have a look around as you might find other educational material which may be of interest to you. We have a great bedside reference tool; the Adverse events app as well as Adverse events cards suitable for lanyards. Both of these can provide you with information at your fingertips.

– Helen Stathopoulos, Senior Transfusion Scientist, Transfusion Practice and Education