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Life Blood
Issue 19
medical website
clinical guidelines
products & services
feedback
Dear Life Blood Reader
Welcome to this 19th edition where we request some feedback from you the reader, in order to continually improve our
services and keep you informed of interesting events. World Blood Donor Day on 14th June was especially meaningful this
year since we are proud to have expanded our facilities to include a new fixed site Donor Centre at the Blue Route Mall in
Tokai, thereby making it more convenient for our Southern Suburbs donors to donate. As we celebrate our 75th anniversary of
saving lives, we invite healthcare practitioners to join us at the 32nd SA National Blood Transfusion Congress which will be held
at the Lord Charles Hotel Conference Centre, Somerset West on 1st - 3rd October. Useful guidelines for the management of
patients who have haemochromatosis are included in this issue. We welcome the referral of such patients to our Therapeutic
Phlebotomy Programme where our highly specialised staff members liaise with their clinicians whilst we reduce their ferritin
levels through regular phlebotomy. Thanks for your co-operation in reporting all adverse events of blood transfusion to the
transfusion service. These statistics are forwarded to the International Haemovigilance Network. Well wishes for a wonderful
winter season until our next edition of Life Blood.
Regards
Dr J Makan
Medical Officer
Index
Blood User Survey Page 2
WPBTS CPD Programme Page 3
Blue Route Mall Blood Donor Centre Page 4
World Blood Donor Day Page 4
32nd SA National Blood Transfusion Congress Page 4
Single Donor Apheresis Mega Platelets Page 5
The Diagnosis and Management of FNHTR’s and Allergic Transfusion Reactions Page 6
Your Questions Answered Page 7
Therapeutic Phlebotomy – Part 2 Page 8
t: 021 507 6300 • www.wpblood.org.za
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Life Blood
Issue 19
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Blood User Survey
As part of our on-going process to improve the blood service, you are invited to participate in this blood user survey. Your feedback
is most important to us. Return the completed questionnaire to the marketing officer by e-mail/facsimile. Alternatively, complete it
on-line through the link situated at the bottom.
E-mail: [email protected] Facsimile: 086 756 7888
Name
Hospital E-mail 1.
Indicate through which media you would prefer to communicate with us.
E-mail
Magazine
SMS
Twitter
Facebook
2.
Do you have internet access?
Yes
No
3.
Indicate whether you receive the Life Blood e-zine to your inbox or junk e-mail folder.
Inbox
Junk E-mail
4.
Indicate your level of satisfaction with the communication channels.
Excellent Satisfactory
Poor
5.
Indicate how frequently you read the Life Blood e-zine.
AlwaysSometimes Rarely
6.
If rarely, indicate why.
Time constraints
E-zine too long
Irrelevant topics
PDF unsuitable
7.
Indicate your level of satisfaction with the quality of our blood components.
Excellent
SatisfactoryPoor
8.
Indicate your level of satisfaction with the medical/clinical support.
Excellent
SatisfactoryPoor
9.
Indicate your level of satisfaction with the timeous delivery of blood products.
Excellent
SatisfactoryPoor
10.
Indicate your level of satisfaction with the courtesy of blood bank staff.
Excellent
SatisfactoryPoor
11.
Indicate your level of satisfaction with the price of blood/blood products.
Excellent Satisfactory
Poor
12.
Have you attended a WPBTS educational talk at your hospital?
Yes
No 13.
Have you experienced problems with the availability of apheresis platelets?
Yes No 14.
Have you experienced problems with the delivery of apheresis platelets versus pooled random donor platelets?
Yes
No link to questionnaire
t: 021 507 6300 • www.wpblood.org.za
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WPBTS CPD Programme
Return the completed questionnaire to the marketing officer by e-mail/facsimile. Alternatively, complete it on-line through the link
situated at the bottom. E-mail: [email protected] Facsimile: 086 756 7888
For further reading refer to chapters 1 & 2 of the Clinical Guidelines for the Use of Blood Products in SA, 4th edition.
WPBTS CPD Activity No.1
3 CEU’s
Activity No. MTS 152/07/28
Level 2
Full Name & Surname
HPCSA Registration Number E-mail Please mark with an (X) Yes or No
1.
Informed consent is mandatory prior to the transfusion of all blood products, unless special
circumstances prohibit this.
2.
One qualified individual must correctly identify the patient and units to be transfused.
3.
Autologous and designated units may be transfused before or after allogeneic units.
4.
It is the responsibility of the requesting clinician to manage and report any untoward action directly
related to blood components transfused.
5.
Upon inspection, thawed fresh frozen plasma will be murky with the colour varying from dark brown to black.
6.
The donor’s ABO and Rh blood groups must be recorded on the blood unit and the transfusion requisition.
7.
If a unit has expired, it may still be transfused within 7 days after expiry if the unit has been adequately stored.
8.
Platelets often contain large quantities of visible aggregates.
9.
Normal saline and 4 % albumin may be given through the same IV device as a red cell transfusion.
10.
The proposed venesection site should always be re-palpated after meticulous cleansing.
11.
Baseline observations of vital signs prior to the transfusion are mandatory.
12.
If a transfusion reaction is suspected, the transfusion rate should always be continued at a slower rate.
13.
In the event of a transfusion reaction, all empty blood units should immediately be discarded.
14.
Blood transfusions should be completed within 6 hours.
15.
Blood components no longer required for a specific patient, may be returned to the blood bank even if the
seals have been broken and the original container discarded.
16.
It is unnecessary to change the administration set between infusions of red cells of different ABO blood groups
or other blood components.
17.
Blood should be warmed in boiling water or in the microwave for 1 minute on high.
18.
Medication or other fluids should never be added to blood due to the high risk of bacterial contamination
when a unit is entered.
19.
Blood warming is not routinely indicated since refrigerated blood may be safely transfused over several hours.
20.
Red cells are routinely stored between 1 to 6 degrees Celsius for up to 60 days.
link to questionnaire
t: 021 507 6300 • www.wpblood.org.za
SMS ‘blood’ to 33507 and we’ll call back (R1.50 per SMS)
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Blue Route Mall Blood Donor Centre
Through our commitment to make blood donor centres more accessible for our remarkable
donors, the WPBTS is proud to have expanded its facilities with the recent addition of
the fixed site blood donor centre which is situated at the Blue Route Shopping Mall.
The contact particulars and hours are as follows.
Hours Mondays to Fridays: 10h00 until 17h45
Saturdays: 09h00 until 14h45
Sundays and public holidays: 09h00 until 11h45
Telephone
021 712 4521
Address Shop 56, Ground Floor (Opposite Spec Savers)
Blue Route Mall, 16 Tokai Road, Tokai
As part of the June blood donor month events which is highlighted by the 10th anniversary of World Blood Donor Day on the 14th of
June, the WPBTS warmed the Expresso set on eTV and informed fans across South Africa by emphasizing the theme for this year – Give
the gift of life: donate blood – through acknowledging and thanking its donors for their remarkable support.
Andrea du Plessis, who is the marketing manager for Vital Health Foods, bravely donated a unit of blood during the show to encourage
new donors to come forward – a single donation can save 3 lives.
For more information, SMS “Blood” to 33507 and we will contact you with information on where to donate. Donors can also call 021
5076364, e-mail [email protected] or visit http://www.wpblood.org.za/. Like us on Facebook (WP Blood) or follow us on Twitter (@
WPBlood) for interesting facts and blood stock updates.
32nd SA National Blood Transfusion Congress
Healthcare Professionals are invited to join us for the 32nd South African National Blood
Transfusion Congress to be held from the 1st until the 3rd of October 2013 at the NH Lord
Charles Hotel Conference Centre, Somerset West, Cape Town.
In recognition of the 75th existence of both blood transfusion services the theme for this year’s
congress is “Saving lives for 75 years”. The programme includes amongst others, transfusion
practices and clinical case studies, transfusion transmitted infections, haemovigilance and
adverse transfusion reactions.
Click here to view this mailer on your browser or visit www.sabloodcongress.org for more information.
t: 021 507 6300 • www.wpblood.org.za
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Single Donor Apheresis Mega Platelets
When a platelet transfusion is necessary the premium product
choice would be Single Donor Apheresis Mega-Platelets.
The Benefits of Single Donor Apheresis MegaPlatelets
•
•
•
•
•
The complete platelet dose is derived from a single donor.
Reduced donor exposure for the patient.
Reduced risk of alloimmunisation to HLA antigens.
Product undergoes an integral leucocyte depletion process.
Minimal product intervention.
HLA-Matched Single Donor Apheresis Mega-Platelets
Clinicians requiring HLA-Matched Single Donor Apheresis Mega-Platelets usually contact the SA Bone Marrow Registry to find a potential
donor(s) for the patient. As of the 11th of June 2013, the HLA-Match Fee was implemented by WPBTS to recover the cost of the blood
platelet search which is performed by the SA Bone Marrow Registry. This is a once-off fee that is billed per patient requiring HLAMatched Single Donor Apheresis Mega-Platelet(s), irrespective of the quantity units collected. The price for the HLA-Match Fee as at
June 2013 is R 1 100.00 excl. vat/ R 1 254.00 incl. vat.
HLA-matched platelets are prescribed for patients who have developed platelet refractoriness. An increment of less than 10x109 /l on
more than one occasion may be due to the development of antibodies to HLA and/or platelet antigens. Consult with the transfusion
service regarding provision of matched platelets. (Clinical Guidelines for the Use of Blood Products in SA, 4th Edition, page 22). We
also provide gamma-irradiated Single Donor Apheresis Mega-Platelets.
Product safety is important to us
Donors are screened prior to donating by completing the medical and lifestyle questionnaire. Each donation is individually tested for
HIV1/2, Hepatitis B and C, Syphillis, ABO blood group and the Rh type - by serologic and/or nucleic acid technology.
To order is only a phonecall away
Placing your order with the Blood Bank or our Apheresis Donation Unit by 13h00 weekdays ensures the platelet is ready later the same
day. Clinicians in the George region should place the order as soon as possible to prevent a delay in transportation. Contact the apheresis
donation unit during normal working hours on telephone 021 507 6395/6 or fax 021 531 3335.
For after-hours orders between 15h00 and 07h00, contact the on call cellphone, number 083 265 3056.
t: 021 507 6300 • www.wpblood.org.za
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Adult Single Donor Apheresis
Mega-Platelet
Platelet Count: ≥ 2.4 x 1011
Volume: 200-300ml
Paediatric Single Donor Apheresis
Mega-Platelet
Platelet Count: ≥ 1.5 x 1011
Volume: 100-160ml
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Infant Single Donor Apheresis
Mega-Platelet
Platelet Count: ≥ 5.5 x 1010
Volume: 40-60ml
An emergency supply is kept for after hours usage weekdays, weekends and public holidays.
Prescribed for
•
•
•
Bleeding associated with thrombocytopenia and defective platelet function in conditions such as bone marrow failure eg. aplastic
anaemia, acute leukaemia, massive transfusion with dilutional thrombocytopenia, acute disseminated intravascular coagulation,
congenital disorders of platelet function.
Patients who develop platelet refractoriness.
Recommended for patients who experience febrile reactions as a result of sensitisation to leucocyte antigens.
Recommended for patients who are on long term therapy eg. leukaemia.
The Diagnosis and Management of Febrile Non Haemolytic Transfusion Reactions and Allergic
Transfusion Reactions
Febrile Non Haemolytic Transfusion Reactions
Cause: Signs/Symptoms: Management:
Further management: Usually recipient leucocyte or platelet antibodies to transfused donor cells.
Onset usually within 1 – 2 hours after start of transfusion. Headache, myalgia, malaise, fever, chills,
tachycardia and hypertension. Commonly found in multiparous or multi-transfused patients.
Stop the transfusion. Maintain venous access with crystalloid/colloid solution.
Notify blood bank and send post transfusion samples and pack to blood bank.
Must be differentiated from early acute haemolytic transfusion reaction. Administer antipyretics.
If it recurs on further transfusion, then transfuse with leucocyte depleted blood.
If latter not available, then give antipyretics and filter red cell products with a bedside leucocyte depletion filter.
Allergic Transfusion Reactions
Cause: Allergens to plasma proteins.
Signs/Symptoms: Usually mild. NO FEVER. Itching, hives, urticaria, erythema. Limited to skin only.
Management: Stop the transfusion. Keep IV open. Notify blood bank and send post transfusion samples, urine and packs.
Administer antihistamines.
Commence transfusion with a new unit once blood bank has ascertained that this is not a haemolytic transfusion reaction.
Reference: The Clinical Guidelines for the Use of Blood Products in South Africa, 4th Edition, Chapter 10.
Further reading: http://www.bcshguidelines.com/documents/ATR_final_version_to_pdf.pdf
t: 021 507 6300 • www.wpblood.org.za
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Your Questions Answered
1.
What are the contra-indications to platelet transfusions?
Platelet transfusions are generally contraindicated in patients with immune causes of thrombocytopenia unless there is severe life
threatening haemorrhage.
• Immune Thrombocytopenic Purpura (ITP): Transfused platelets will be destroyed by the autoantibodies.
• Thrombotic Thrombocytopenic Purpura (TTP): Platelet transfusion may potentiate thrombotic tendency.
• Heparin Induced Thrombocytopenia (HIT): May potentiate thrombosis.
Reference: The Clinical Guidelines for the use of Blood Products in SA, 4th Edition, page 21.
2.
What are the paediatric transfusion rates?
Administer red cells through a standard blood administration set within 5 hours, depending on patient tolerance. Do not exceed 5ml/
kg/h for top-up transfusion. Most neonatal transfusions are small volume (10-20 ml/kg). It should be noted that during the first 4
months of life, blood bank pre-transfusion testing differs from adults. If there are no clinically significant red cell antibodies in the
infant or maternal plasma, and the direct antiglobulin test is negative, a full crossmatch is not necessary, although the ABO and Rh-D
group should be re-confirmed prior to each transfusion.
Suggested transfusion thresholds for infants < 4 months of age are listed below:
• Anaemia in the first 24 hours
Hb <12g/dl (Hct c 0.36 l/l)
• Neonate receiving mechanical ventilation
Hb < 12g/dl
• Acute blood loss
= 10% blood volume lost
• Oxygen dependent (not ventilated)
< 8-11g/dl
• Late anaemia, stable patient (off oxygen)
Hb < 7g/dl
The age of the unit does not matter for small volume top-up transfusions, but large volume transfusions (exchange transfusion or acute
blood loss) should be < 5 days old in order to avoid hyperkalaemia and reduced 2,3 DPG levels with poorer oxygen release. Leucocyte
depleted products are also recommended for infants < 1 year.
Neonatal units should arrange with their local blood banks that those neonates with extended transfusion needs are placed on a
“limited donor exposure” programme where the transfusion requirements of one infant are met by reserving units bled from one donor
for a specific infant. This ensures minimum infectious risk and red cell antigen exposure.
Reference: The Clinical Guidelines for the use of Blood Products in SA, 4th Edition, page 24.
3. How does one ensure that the full volume of a unit of cryoprecipitate which is only ± 7 ml reaches the patient during the
transfusion process?
The blood administration line may be primed and flushed with normal saline prior to and after transfusing the unit of
cryoprecipitate.
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Therapeutic Phlebotomy – Part 2
In part 2 of this series we focus on the guidelines for the management
and diagnosis of Hereditary Haemochromatosis (HH). HH is a genetic
disorder which results in iron overload, as a result of absorbing too
much dietary iron. As iron is not effectively excreted, iron stores
build up and this is toxic to cells.
Organs and tissues affected include:
Liver
Heart
Pancreas
Pituitary
Thyroid
Joints
Adrenal glands
Gonads
Clinical signs and symptoms include:
Hepatomegaly
Liver damage/cirrhosis
Congestive heart failure
Diabetes / insulin resistance
Fatigue / malaise
Arthralgia
Skin pigmentation
Adrenal insufficiency
Hypogonadism: loss of libido / impotence in men, amenorrhea
in women
Classification
Type I (Classic)
Autosomal recessive trait.
Mutation of HFE gene on short arm of chromosome 6.
Most commonly seen in Caucasians.
Most common mutations: C282Y and H63D. S65C also screened.
C282Y homozygote presents greatest risk.
Iron overload builds up over 25-30 years before symptoms
appear.
Type II (Juvenile/Neonatal)
Autosomal recessive trait.
Very rare.
Rapid build up of iron before 30 years of age.
Gonadal and cardiac pathology commonly seen.
Type III
Autosomal recessive trait.
Clinically similar to Type 1.
Result of mutations in transferrin receptor gene.
Type IV
Autosomal dominant.
Increased serum ferritin levels usually with normal transferrin
saturation.
Ferroportin gene mutation.
Genetic testing is essential to ensure early detection and appropriate management of patients and their families.
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Diagnostic Tests Required
Ferritin and Iron Profile
Serum Ferritin:
Women
> 200 µg/L
Men
> 300 µg/L
Serum iron: > 30 µmol/L
Transferrin saturation: Increased
Women > 50 %
Men
> 55 %
Genetic markers: C282Y, H63D, S65C
Liver functions
Liver biopsy:
If PCR negative
Hepatomegaly/suspected Cirrhosis
Ferritin > 1000 µg/L
An isolated finding of a raised Ferritin is not diagnostic of Haemochromatosis since Ferritin is an acute phase reactant and supporting
tests as above are essential to confirm the diagnosis.
Recommended Phlebotomy Intervals
1-2 Weekly
until Ferritin 500 μg/L
Monthly
until Ferritin 100 μg/L
1-2 Monthly
until Ferritin 50 μg/L
2 Monthly
maintain Ferritin at 50 μg/L
WPBTS Therapeutic Programme Requirements
WPBTS Doctor’s Request Form to be faxed to 021 531 3335.
Blood test results must include:
Ferritin
Iron Profile: serum iron + transferrin saturation
Genetic markers
Full Blood Count
Medical reports as requested by WPBTS Medical Officer.
Ferritin and Iron Profile to be repeated after the 6th donation and bleeding intervals adjusted accordingly.
Annual Ferritin and Iron Profile to be done once target Ferritin is achieved.
Bleeding intervals of < 56 days (regular blood donor) require monitoring and will be authorised by WPBTS Medical Officer.
WPBTS Therapeutic Phlebotomy Clinic Hours and Contact Details
Should you require more information about our therapeutic phlebotomy facility in Cape Town, Paarl, Worcester and George, please
contact us on telephone 021 507 6393/20 or e-mail [email protected]
t: 021 507 6300 • www.wpblood.org.za
SMS ‘blood’ to 33507 and we’ll call back (R1.50 per SMS)
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