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 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.

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 transfusion.com.au, 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

Quick transfusion quiz for busy health professionals

Transfusion Q&A is a database of questions, grouped by topic, designed to test your knowledge of safe transfusion practices and patient blood management. We made it specifically for the time poor (that would be all of us, then).

You can access Transfusion Q&A at qanda.transfusion.com.au. Alternatively you can access individual topics on Transfusion Online Learning on transfusion.com.au.

You choose how you complete a topic: all in one hit as a “quick quiz”; or enrol to get sent questions over time. You choose the device on which you access the education – PC, laptop, mobile phone, or tablet.

If you enrol, the system sends notifications when questions are due to be answered. During enrolment you choose to receive these via email or SMS. You can also choose to customise delivery notifications, indicating how many questions you want to receive with each notification and how often you get the notifications.

But don’t worry if you can’t be bothered with the customisation – we have pre-set a delivery schedule for you.

Every time you answer a question you get feedback on your response and an explanation with links to the relevant information about the topic.

If you want to receive a certificate for CPD purposes, enrol in a topic. You’ll need to get each question correct twice to be awarded a certificate – there are no rewards for random guessing in this game.

If you think you already know your stuff, but just want to confirm this, do a quick quiz. You’ll still get instant feedback on the answers to your questions and a score at the end, but no certificate.

Once you log into Transfusion Q&A, your dashboard will list the topics you are currently enrolled in and those you have completed, with links to your certificate.

 

– Dr Sandy Minck

Intraoperative cell salvage and the ROTEM system – what’s the benefit?

A recent webinar on cell salvage and the ROTEM system hosted by the TPE team at the Blood Service was a great opportunity to come up to speed on new patient blood management techniques.

This joint presentation was given by Peter Frantzis, Head Perfusionist at the Royal Adelaide Hospital and Associate Professor David Roxby, Head of SA Pathology Transfusion Services at Flinders Medical Centre.

Here’s some of the key information from the session:

What is cell salvage?
Intraoperative cell salvage (ICS) is performed as a blood conservation technique and is frequently used in cardiothoracic and vascular surgery as these areas traditionally have high levels of blood usage. It has been gaining more attention lately as transfusion risks have become more fully appreciated, patient blood management (PBM) guidelines have been released and the National Blood Authority of Australia has recently implemented guidelines for intraoperative cell salvage (March 2014).

What happens during the cell salvage process?
During the process, the surgeon aspirates any bleeding into a collection reservoir, the blood is filtered and anticoagulant is added in order to remove debris and prevent clotting. The blood is then centrifuged and washed to produce separated red blood cells (RBC) with a high Hct, suspended in 0.9% normal saline for re-infusion to the patient (autotransfusion).

What are the benefits of cell salvage?
Cell salvage helps to reduce the requirement for allogenic blood transfusion during cardiothoracic and vascular surgery and when combined with improved bypass circuitry/techniques and haemofiltration, patients can even have elevated Hb levels post-surgery. ICS is also very useful for Jehovah witness patients who refuse blood transfusions as a circuit is set up between the patient, heart lung machine and the autotransfusion device providing continuity and ensuring all their red blood cells are returned.

What is the ROTEM system?
The ROTEM (rotational thromboelastometry) system is actually a modified version of thromboelastography [TEG], probably a more familiar term to many of us. The ROTEM system provides real-time measurement of the interactions of coagulation factors, inhibitors and cellular components during the phases of clotting and subsequent lysis over time. The aim of this method is to mimic the sluggish flow of blood in veins.

What are the benefits of ROTEM?
The ROTEM system provides a point of care (POC) test and is proving to be an extremely useful source of information. Clinicians are able to assess their patients before surgery (to determine if coagulopathies are present), during surgery (to determine if coagulopathies are developing) and after surgery (when trying to establish the cause of bleeding). It can also be located in either the operating theatre, transfusion laboratory or networked between these areas. ROTEM results are also available much quicker than traditional coagulation tests like INR, APTT, Fibrinogen and platelet count and enable the treating clinician to discriminate between coagulation related conditions in a more efficient manner.

The benefits of coagulation POC testing have also been highlighted in an article in Anesthesiology, where the randomised clinical trial was terminated 6 months early as initial results demonstrated that haemostatic therapy based on POC testing significantly reduced patient exposure to allogenic blood products and provided significant benefits with respect to clinical outcomes.

Additional information and extra reading
The Blood Service clinical website transfusion.com.au contains excellent information about PBM, blood conservation and the PBM guidelines. In fact, the PBM guidelines: Module 2 Perioperative actually state that ICS is recommended for adult patients undergoing surgery in which substantial blood loss is anticipated and also mentions that TEG and TEG-based POC tests should be considered in adult patients undergoing cardiac surgery.

If you would like more information on these topics, this joint webinar was recorded for educational purposes and can be accessed in Transfusion online learning.

– Tanya Raison, Project Officer, TPE