NHS Blood and Transplant is an executive non-departmental public body of the United Kingdom's Department of Health and Social Care.It was established on 1 October 2005 to take over the responsibilities of two separate NHS agencies: UK Transplant (now renamed Organ Donation and Transplantation), founded by Dr. Geoffrey Tovey in 1972, and the National Blood Service (now renamed Blood Donation). Its remit is to provide a reliable, efficient supply of blood, organs and associated services to the NHS. Since NHSBT was established, the organisation has maintained or improved the quality of the services delivered to patients, stabilised the rising cost of blood, and centralised a number of corporate services.
BACKGROUND:Acute upper gastrointestinal bleeding (AUGIB) is a common medical emergency with evolving demographics and management strategies, particularly in medical/endoscopic therapy and transfusion strategies. OBJECTIVE:To provide key data of the most recent 2022 UK audit and compare it with the preceding audit in 2007. DESIGN:Prospective multicentre audit conducted from 3 May to 2 July 2022, including adults (≥16 years) with AUGIB across 147 UK hospitals (response rate 86% vs 84% in 2007). AUGIB was defined by clinical symptoms (haematemesis, haematochezia, coffee ground vomiting or melaena confirmed by medical personnel). Patients were followed until discharge, death or 28 days, with re-admissions during the study period counted as new episodes. RESULTS:Among 5141 patients (59% male; median age 69), 15% had cirrhosis, 19% reported excess alcohol use, 7% used non-steroidal anti-inflammatory drugs (NSAIDs) and 46% were on antithrombotics. Most (77%) were new admissions, who were younger with fewer comorbidities, while the remainder bled during hospitalisation. Peptic ulcer disease accounted for 32% of cases, varices for 10% and no abnormality was found in 33%. Pre-endoscopic risk stratification was not performed in 42%.Compared with 2007, patients in 2022 had higher comorbidity (67% vs 50%), more cirrhosis (15% vs 9%), greater anticoagulant use (31% vs 13%) and higher transfusion rates (50% vs 43%). In 2022, among early transfusions (pre-endoscopy or within first 24 hrs; 38%), 43% were given at haemoglobin (Hb)>70 g/L, with 24% classified as inappropriate due to haemodynamic stability. A signal of harm was observed: while inappropriate transfusion was not associated with rebleeding at either 70 or 80 g/L, at 80 g/L it was linked to higher adjusted mortality (adjusted OR (aOR) 1.60, 95% CI 1.00 to 2.56).Inpatient endoscopy was more common (83% vs 74%), though endotherapy use remained modest (27% vs 23%). Salvage therapy rates were unchanged (3.3% vs 3.1%) but shifted from surgery to interventional radiology. Outcomes improved, with lower rebleeding (9.7% vs 13.3%), reduced in-hospital mortality (8.8% vs 10.0%) and shorter median stay (5 vs 6 days). In multivariate analysis, mortality was independently predicted by older age (≥80 years: aOR 2.32, 95% CI 1.64 to 3.30), shock (aOR 2.22, 95% CI 1.53 to 3.17) and comorbidity, while lower Hb at presentation increased risk (≤70 g/L: aOR 1.56, 95% CI 1.15 to 2.11). Anticoagulant use was associated with increased mortality (aOR 1.43, 95% CI 1.11 to 1.85), whereas NSAID use (aOR 0.49, 95% CI 0.25 to 0.96) and antiplatelet use (aOR 0.68, 95% CI 0.54 to 0.87) were associated with lower mortality. CONCLUSIONS:Despite a higher-risk case mix and incomplete adherence to guidelines (notably in transfusion thresholds and risk stratification), outcomes in AUGIB have improved. The observation of increased mortality with liberal transfusion above 80 g/L in stable patients reinforces the importance of restrictive transfusion practice. Quality improvement initiatives focused on risk stratification, endoscopic training and multidisciplinary care could further enhance outcomes in the UK and internationally.
BACKGROUND:Whole-blood transfusion has recently gained favor in the management of severe hemorrhage; however, data from large clinical trials evaluating its clinical effectiveness and safety are lacking. METHODS:We conducted a pragmatic, phase 3, multicenter, unblinded, randomized, superiority trial across 10 air ambulance services in England. Patients with major traumatic hemorrhage who were attended by a participating air ambulance service were randomly assigned to receive either whole-blood transfusion (up to 2 units) or standard care with blood components (up to 2 units each of red cells and plasma) before arrival at the hospital. The primary outcome was a composite of death from any cause or massive transfusion (≥10 units of blood components or products) within 24 hours after randomization. RESULTS:A total of 942 patients underwent randomization. After the exclusion of participants with nontraumatic hemorrhage or traumatic cardiac arrest, 616 were included in the analysis (314 in the whole-blood group and 302 in the standard-care group). A primary-outcome event occurred in 48.7% of the participants in the whole-blood group and in 47.7% of those in the standard-care group (relative risk, 1.02; 95% confidence interval, 0.80 to 1.31; P = 0.84). The incidence of death from any cause at all time points, massive transfusion, and other secondary outcomes appeared to be similar in the two groups. Prothrombin times were above the normal range in 40.7% of the participants in the whole-blood group and in 30.5% of those in the standard-care group. More serious adverse events occurred in the standard-care group than in the whole-blood group (37 and 31, respectively). The incidence of thrombotic events appeared to be similar in the two groups. CONCLUSIONS:Among participants with life-threatening hemorrhage, prehospital transfusion of 2 units of whole blood was not superior to standard care in reducing the risk of death or massive transfusion within 24 hours. (Funded by NHS Blood and Transplant and others; ISRCTN Registry number, ISRCTN23657907.).
UK experience from recent conflicts in Iraq and Afghanistan has resulted in improvements in clinical care of injured patients. Resuscitation and blood transfusion is an area that has seen some of the greatest changes. The ongoing war in Ukraine has highlighted the challenges of medical support to Large-Scale Combat Operations (LSCO), one of which is the ability to deliver blood-based resuscitation near to the point of wounding. Plasma is a key aspect of damage control resuscitation and balanced blood transfusion strategies. It is supported by a strong evidence base, which also demonstrates that early administration improves patient outcomes. Conventional plasma transfusion using thawed fresh frozen plasma (FFP) has logistical constraints that preclude its expedient use in the prehospital environment. Temperature-controlled storage, and transport, of sufficient FFP to support LSCO is unrealistic, and temporary campaigns to increase civilian plasma donations signal a combat intent and could compromise Operational Security. Dried plasma components are stable in storage at ambient temperature. They are easily and quickly reconstituted to produce a plasma component with clinically acceptable clotting and coagulation profiles. The UK has access to dried plasma from two European allies, but availability is very limited and use is off-licence. The ongoing UK dried plasma project will provide clinical, tactical and strategic benefits to UK and allied armed forces in future conflicts.
BACKGROUND AND OBJECTIVES:Bacterial contamination of blood components is an ongoing problem in transfusion medicine. We analysed the bacterial screening data of platelets from England, 2014-2023, and compared this with data on reported near-misses and transfusion-transmitted infections (TTIs). MATERIALS AND METHODS:Anonymized data on bacterial screening of pooled and apheresis platelet donations were reviewed, including the number of donations collected yearly, results from bacterial screening and time from sampling to detection. The findings were compared with data on near-misses and TTIs reported during the same period. RESULTS:Screening of 1249,513 apheresis and 1,495,707 pooled platelet donations identified bacterial contamination in 2949 donations, including 78 bacterial species. Over four-fold higher frequency of confirmed bacterial contamination was observed in pooled platelets compared to apheresis donations (0.09% [1096/1,249,513] vs. 0.02% [362/1,495,707], p < 0.0001). Rates of bacterial contamination of pooled platelet doubled during the study period. Staphylococcus aureus was the most commonly detected highly pathogenic bacterial contaminant (29/147, 19.7%; 15/29, 52% in apheresis platelets). It was also implicated in 1 confirmed case of bacterial TTI and in 8 of 10 reported bacterial near-miss cases. CONCLUSION:Increasing frequencies of bacterial contamination, mostly related to skin flora, were noted in pooled platelets. Furthermore, S. aureus was notably associated with near-miss events. Our findings demonstrate a limitation of bacterial screening, with evidence of bacterial growth after platelets were likely supplied for clinical use.
INTRODUCTION:Delivering balanced blood resuscitation at the point of injury remains a significant logistical challenge in prehospital trauma care. To inform optimal transfusion strategies in austere environments, we conducted a simulation-based study comparing the operational demands of three prehospital transfusion approaches. METHODS:Three doctor-paramedic teams (six clinicians) undertook a crossover simulation of traumatic haemorrhage, completing all three arms in random order: two units red-cells-in-plasma (RCP), two units red blood cells plus two units thawed fresh frozen plasma (RBC+FFP), and two units red cells plus two units lyophilised plasma (RBC+LyoP). Outcomes were flow time (defined as time from decision-to-transfuse to completion of transfusion of all units), touch time (hands-on time) and process burden (steps, equipment, checks, personnel), timed in real-time and verified on video. A postscenario questionnaire captured user perceptions. RESULTS:All scenarios were completed without missing data. RCP consistently required the least time and operational effort. Median flow times (min:s) were 06:31 (RCP), 12:20 (RBC+FFP) and 16:29 (RBC+LyoP) (p=0.019). Median touch times (min:s) were 02:31 (RCP), 05:21 (RBC+FFP) and 13:03 (RBC+LyoP) (p=0.017). Touch/flow ratios were lowest for RCP (0.39), indicating reduced cognitive and physical load. Standardised process mapping identified 26 steps for RCP versus 46 for RBC+FFP and 52 for RBC+LyoP, reflecting a single set-up and one repetition for RCP compared with multiple repetitions and added reconstitution steps for LyoP. Equipment (4, 10, 12), checks (8, 16, 16) and personnel required (2, 2, 3) followed the same efficiency gradient. Five of six participants rated RCP as optimal for the patient, and all six for the crew; LyoP was unanimously judged as the most demanding. CONCLUSIONS:In a simulated trauma scenario, a combined RCP component was delivered more quickly and with substantially less process burden than separate components. These operational gains support combined-component strategies for prehospital haemorrhage resuscitation in both military and civilian settings.
