Transfusion organisations

These are just a quick reminder of what each organisation performs (mainly so you don't get confused with frowns in the viva!) All the buzzwords you need to know are highlighted in this colour.

Within your hospital:

Hospital transfusion team (HTT)

This is your day to day team which does the job of managing the blood bank, and will probably meet once a week to review the issues at hand (eg massive haemorrhages, unusual antibodies/cases, planned inspections, review of the SOP, maintenance of equipment, etc). The standard team might include the haematology consultant in charge of transfusion, transfusion practitioner, and the lead BMS in transfusion.

Hospital transfusion committee (HTC)

This group usually meets once every 2-4 months, typically chaired by a consultant who is not the transfusion consultant. This group sets the priorities and agenda which the HTT follow.

• promote best practice through local protocols based on national guidelines
• promote appropriate use of blood and blood components
• lead multi-professional audit of the use of blood components within the NHS Trust, focusing on specialities where demand is high, e.g. haemato-oncology and certain surgical specialities
• promote a Trust wide patient blood management programme and consider alternatives to blood transfusion
• promote the education and training of all clinical and support staff involved in blood transfusion
• have the authority to modify existing blood transfusion protocols and to introduce appropriate changes to practice
• report regularly to local, and through them to national, blood user groups
• consult with local patient representative groups where appropriate
• contribute to the development of clinical governance
• assist and endorse the HTT in appropriate rationing in the event of a shortfall in blood supply

Members might include: Chair – senior Consultant from any specialty, lead BMS in transfusion, transfusion consultant, transfusion practitioner, lay member, nurse manager, NHSBT representative, Emergency Department representative (and others as per local protocol)

Outside the hospital:

Safety of Blood, Tissues and Organs (SaBTO)

Advisory committee which produces recommendations on ensuring safety of cells/organs for transplantation, or cells/tissues for transfusion (and will thus include areas related to apheresis and bone marrow transplantation). The work they do is not solely related to haematology. Examples of haematology recommendations which have been issued are:

• The use of HEV screened blood components
• Blood donor selection from men who have sex with men (MSM) - and other donor selection criteria reviews
• Measures on the reduction of vCJD transmission in blood

You can review their recommendations on this website for updates

https://www.gov.uk/government/collections/sabto-reports-and-guidance-documents

Serious Hazards Of Transfusion (SHOT)

• voluntary organisation which is an advisory body in haemovigilance (ie monitoring of safety of blood transfusion) which does the following:
  • improves safety of the transfusion process
  • informing policy within the transfusion service
  • improving standards of hospital transfusion practice
  • aids production of clinical guidelines for the use of blood components

Participation in the scheme is voluntary, but is required for compliance with HSC/2002/009 'Better Blood Transfusion' and is a standard for the Clinical Negligence Scheme for Trusts in England. Active participation in SHOT by all hospitals was recommended by the CMO for England in his 2003 Annual report. The SHOT organisation is now intimately linked to the SABRE group, participation in which is mandatory. Unlike SABRE which only takes reports of adverse events, SHOT also takes reports of near-misses.

Medicines and Healthcare products Regulatory Agency (MHRA)

• government organisation that ensures the safety of medicines, medical devices and blood products (and the process) given to patients. This includes the entire chain from the collection of blood from the donors, processing at Blood Establishments (BE - ie NHSBT centres), administration at Hospital Blood Banks (HBB) and the safety of such reactions.
• they are responsible for ensuring that the Blood Safety and Quality Regulations of 2005 (BSQR) are kept.
• reporting to the MHRA if the organisation is a BE or HBB is mandatory (BEs are inspected every two years).
• in order to work as an HBB, MHRA mandates that the HBB participates in a haemovigilance scheme (ie SABRE).

For HBBs, MHRA monitors the following:

• If they collect autologous blood and blood components submit an application for a blood establishment authorisation
• If they perform secondary processing of blood component (for example, irradiation, washing, splitting etc.) submit an application for a blood establishment authorisation
• Maintain a quality system based on the requirements of Directive 2005/62/EC
• Notify the competent authority of any serious adverse events and serious adverse reactions (haemovigilance /SABRE)
• Confirm compliance with the requirements of the directives by submitting an annual compliance report to the competent authority
• Maintain records to ensure full traceability from donation to the point of delivery for not less than 30 years

Serious Adverse Blood Reactions and Events (SABRE)

This is a reporting process within the MHRA (rather than an organisation) in which serious adverse events (SAE) and serious adverse reactions (SAR) related to blood and blood components are notified to the MHRA. SABRE is an online system that allows BEs and HBBs to electronically submit reports, with integrated SHOT questionnaires in the system.

Generally speaking you would in most occasions report to SHOT and SABRE for transfusion related issues in the hospital, but in some situations you may only report to one and not the other, for example:

• report to SHOT and not to SABRE: Wrong Blood in Tube (WBIT) as a near miss, or lack of two checkers prior to blood transfusion as a violation of policy but correct blood was transfused (as another near miss)
• report to SABRE and not to SHOT: fluctuations in the temperature of a fridge holding red cells but none from this location were transfused.

A full guide to SABRE reporting is included below in the downloads section which you can skim read for relevant parts (can also be found on the SHOT website).

National Blood Transfusion Committee (NBTC)

The NBTC does the work of ensuring the safe effective use of blood components, blood products and alternatives, EXCEPT IN specialist areas such as haemophilia and immunodeficiency (naturally these requirements in these patients will generally apply, but additional guidance in these specialist areas is needed).

The overall objective is to promote good transfusion practice by providing a framework to:

1. Channel information and advice to hospitals and Blood Services (through 10 Regional Blood Transfusion Committees - RBTCs) on best practice and performance monitoring with the aims of:
   • improving the safety of blood transfusion practice
   • improving the appropriateness of clinical blood transfusion
   • exploring and facilitating the implementation of methods to reduce the need for allogeneic blood transfusion
   • listening to and informing patient concerns about blood transfusion
   • promoting the highest quality and consistency in transfusion practice
2. Consult with national groups developing guidelines in transfusion medicine in order to determine best practice.
3. Review the performance of the transfusion-related services provided by NHS Blood and Transplant.
4. Identify service development needs, and provide assistance, as required, with the work of the National Commissioning Group and the Blood Stocks Management Scheme.
5. Provide appropriate patient information and seek patients' opinion on these and other transfusion experiences.
6. Provide advice on all aspects of transfusion practice to the National Medical Director of NHS England, and also to the Chief Medical Officer or other Department of Health officials.
7. Provide information on appropriate education and training of blood transfusion.