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McCullagh J, Basham P, Davies J, Hicks V, Hunter A, Lancut J, Green L. The feasibility of introducing a whole blood component for traumatic haemorrhage in the UK. Transfus Med 2024. [PMID: 38576265 DOI: 10.1111/tme.13039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/24/2024] [Accepted: 03/19/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND The interest in re-introducing whole blood (WB) transfusion for the management of traumatic major haemorrhage is increasing. However, due to the current leucodepletion filters used in the UK a WB component was not readily available. Instead, an alternative but similar component, leucocyte depleted red cell and plasma (LD-RCP), which provided a unique experience in assessing the feasibility of a WB component was used whilst a WB component was being manufactured. STUDY DESIGN AND METHODS Between November 2018 and October 2020, LD-RCP replaced RBC as standard of care for all trauma patients with major haemorrhage in London. The aims of the study were to assess (a) deliverability, (b) component wastage and (c) safety. RESULTS Over the study period a total of 1208 LD-RCP units were delivered, of which 96.5% were delivered 'On Time In Full' (OTIF). Of the 1208 units, 733 (60.68%) were transfused and 475 (39.3%) units were wasted. Component wastage reduced significantly throughout the study (p = 0.001). A total of 177 patients had a blood group recorded, 86 were group O and 91 were non-group O. There was no statistically significantly difference between haemoglobin (p = 0.422), or bilirubin levels (p = 0.084) between group O and non-group O patients. DISCUSSION It was feasible for NHS Blood and Transplant to deliver LD-RCP on time in full, however component wastage was high due to short shelf life and limited use of the component. Low titre group O LD-RCP units were not associated with clinical evidence of haemolysis.
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Affiliation(s)
- Josephine McCullagh
- Clinical Haematology, Barts Health NHS Trust, London, UK
- Red Cell Immunoheamatology, NHS Blood and Transplant (NHSBT), London, UK
| | - Peter Basham
- Manufacturing, NHS Blood and Transplant, London, UK
| | - Jane Davies
- Manufacturing, NHS Blood and Transplant, London, UK
| | - Vicky Hicks
- Manufacturing, NHS Blood and Transplant, London, UK
| | | | - Julia Lancut
- Blood Transfusion, East and Southeast London Pathology Partnership, London, UK
| | - Laura Green
- Clinical Haematology, Barts Health NHS Trust, London, UK
- Blizard Institute, Queen Mary University of London, London, UK
- Blood Transfusion and Components, NHS Blood and Transplant, London, UK
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McCullagh J, Proudlove N, Tucker H, Davies J, Edmondson D, Lancut J, Maddison A, Weaver A, Davenport R, Green L. Making every drop count: reducing wastage of a novel blood component for transfusion of trauma patients. BMJ Open Qual 2021; 10:bmjoq-2021-001396. [PMID: 34244177 PMCID: PMC8268902 DOI: 10.1136/bmjoq-2021-001396] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/19/2021] [Indexed: 01/03/2023] Open
Abstract
Recent research demonstrates that transfusing whole blood (WB=red blood cells (RBC)+plasma+platelets) rather than just RBC (which is current National Health Service (NHS) practice) may improve outcomes for major trauma patients. As part of a programme to investigate provision of WB, NHS Blood and Transplant undertook a 2-year feasibility study to supply the Royal London Hospital (RLH) with (group O negative, 'O neg') leucodepleted red cell and plasma (LD-RCP) for transfusion of trauma patients with major haemorrhage in prehospital settings.Incidents requiring such prehospital transfusion occur randomly, with very high variation. Availability is critical, but O neg LD-RCP is a scarce resource and has a limited shelf life (14 days) after which it must be disposed of. The consequences of wastage are the opportunity cost of loss of overall treatment capacity across the NHS and reputational damage.The context was this feasibility study, set up to assess deliverability to RLH and subsequent wastage levels. Within this, we conducted a quality improvement project, which aimed to reduce the wastage of LD-RCP to no more than 8% (ie, 1 of the 12 units delivered per week).Over this 2-year period, we reduced wastage from a weekly average of 70%-27%. This was achieved over four improvement cycles. The largest improvement came from moving near-expiry LD-RCP to the emergency department (ED) for use with their trauma patients, with subsequent improvements from embedding use in ED as routine practice, introducing a dedicated LD-RCP delivery schedule (which increased the units ≤2 days old at delivery from 42% to 83%) and aligning this delivery schedule to cover two cycles of peak demand (Fridays and Saturdays).
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Affiliation(s)
- Josephine McCullagh
- NHS Higher Specialist Scientist Training (HSST), DClinSci Programme, The University of Manchester, Manchester, UK .,Pathology, Barts Health NHS Trust, London, UK
| | - Nathan Proudlove
- Alliance Manchester Business School, The University of Manchester, Manchester, UK
| | - Harriet Tucker
- Blizard Institute, Queen Mary, University of London, UK, London, UK
| | - Jane Davies
- Manufacturing and Development, NHS Blood and Transplant, Bristol, UK
| | - Dave Edmondson
- Manufacturing and Development, NHS Blood and Transplant, Bristol, UK
| | | | | | - Anne Weaver
- Major Trauma Centre, Barts Health NHS Trust, London, UK
| | - Ross Davenport
- Blizard Institute, Queen Mary, University of London, UK, London, UK.,Major Trauma Centre, Barts Health NHS Trust, London, UK
| | - Laura Green
- Pathology, Barts Health NHS Trust, London, UK.,Blizard Institute, Queen Mary, University of London, UK, London, UK.,Blood Component Department, NHS Blood and Transplant, London, UK
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Platton S, Mendes N, Booth C, Lancut J, Lee K, Regan F, Green L. Positive direct antiglobulin tests in patients with COVID-19. Transfusion 2020; 61:333-334. [PMID: 33043455 PMCID: PMC7675442 DOI: 10.1111/trf.16156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 01/11/2023]
Affiliation(s)
- Sean Platton
- Haematology and Blood Transfusion Laboratories, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Nicole Mendes
- Haematology and Blood Transfusion Laboratories, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Catherine Booth
- Haematology and Blood Transfusion Laboratories, Royal London Hospital, Barts Health NHS Trust, London, UK.,NHS Blood and Transplant, London, UK
| | - Julia Lancut
- Haematology and Blood Transfusion Laboratories, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Kurtis Lee
- Haematology and Blood Transfusion Laboratories, Royal London Hospital, Barts Health NHS Trust, London, UK
| | | | - Laura Green
- Haematology and Blood Transfusion Laboratories, Royal London Hospital, Barts Health NHS Trust, London, UK.,NHS Blood and Transplant, London, UK.,Blizard Institute, Queen Mary University of London, London, UK
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Platton S, Elegbe O, Bower L, Cardigan R, Lancut J, McCullagh J, Green L. Thawing times and hemostatic assessment of fresh frozen plasma thawed at 37°C and 45°C using water-bath methods. Transfusion 2019; 59:3478-3484. [PMID: 31618455 DOI: 10.1111/trf.15553] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/15/2019] [Accepted: 07/17/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The Barkey Plasmatherm (BP; Barkey GmbH & Co. KG) can thaw plasma at 37°C and 45°C. No studies have assessed thawing times or hemostatic qualities of plasma thawed at 45°C with BP. This study assessed fresh frozen plasma (FFP) thawing times with use of BP at 37°C and 45°C and Thermogenesis ThermoLine (TT; Helmer Scientific) at 37°C and compared the hemostatic quality of LG-Octaplas (Octapharma) with use of BP at 37°C and 45°C with TT at 37°C. STUDY DESIGN AND METHODS The thawing time of FFP (pairs or fours) was assessed using BP at 37°C and 45°C (not prewarmed and prewarmed) and TT at 37°C. Hemostasis was assessed in LG-Octaplas at 5 minutes, 24 hours, 48 hours, and 120 hours after thawing with use of the three methods. RESULTS Thawing time for two units was 13.44 minutes using TT, the same as using BP at 37°C (12.94 min not prewarmed; 12.20 min prewarmed) or 45°C (12.38 min not prewarmed), but longer than using BP prewarmed to 45°C (11.31 min, p < 0.001). Thawing time for four units was 13.41 minutes using TT, shorter than using BP at 37°C (17.19 min not prewarmed, 18.47 min prewarmed; both p < 0.001) or 45°C (15.03 min not prewarmed, p = 0.012; 15.22 min prewarmed, p = 0.004). There was no reduction in hemostatic markers in LG-Octaplas with use of BP at 37°C or 45°C compared to TT. CONCLUSION BP is quicker than TT by 2 minutes when thawing two units of FFP if it is prewarmed to 45°C. BP is slower than TT by at least 2 minutes when thawing four units of FFP at 37o C. There was no significant difference in the hemostatic qualities of plasma whether thawed at 37°C or 45°C.
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Affiliation(s)
| | | | | | - Rebecca Cardigan
- NHS Blood and Transplant, UK.,Department of Haematology, University of Cambridge, Cambridge, UK
| | | | | | - Laura Green
- Barts Health NHS Trust, London, UK.,NHS Blood and Transplant, UK.,Blizard Institute, Queen Mary University of London, London, UK
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