Blood Stocks Management Scheme
How much is O Neg blood really used by Trauma?
By Megan Lawn1, Aman Dhesi2, Elaine MacRate3 and Liz Foster4.
Kings College Hospital NHS Foundation Trust, 2NHS Blood and Transplant, 3NHS Blood Stocks Management Scheme, 4RGN/RN[C], MSC.Bart’s Health NHS Trust.
1
Background
O RhD Negative (‘O Neg’) blood is often referred to as “the Universal Donor” because
it is the safest blood group to transfuse until the patients own blood group is known.
Although the use of emergency O Neg red blood cells avoids major ABO mismatch,
there is still a risk of a transfusion reaction if the patient has atypical red cell antibodies
(from pregnancy or previous transfusion) and careful monitoring of the patient for
reactions is still required.
7% of UK population
are O Neg
Changes in Demand
Although the demand for red cells of all blood groups has fallen during the last three
years, demand for group O Neg red cells has remained constant. From 2009 to 2014,
Blood Stocks Management Scheme (BSMS) data shows an increase in the number of
O Neg red cells issued. Major trauma centre O Neg issues are higher than non-trauma
hospitals, now averaging 12.2% of all blood issued in England and North Wales
compared to 11.1% for other hospitals.
Red Cells (RBC) Units vs Trauma centre O Neg issues
3.100
96,000
12.5%
11% of England and North Wales
blood donors are O Neg
Only 7% of the UK population are blood
group O Neg, though intensive marketing
and recruitment means that 11% of England
and North Wales’s donors are O Neg.
3.000
90,000
88,000
2.900
86,000
84,000
2.800
82,000
80,000
2.700
78,000
76,000
On average each O RhD Negative
blood donor donates 20% more blood
than other donor groups.
In 2014, NHS Blood and Transplant (NHSBT, the blood service for England and North
Wales) issued three ‘cautionary alerts’ as blood stocks of O Neg fell to 3.5 days stock.
Hospitals are asked to support these stock levels by careful monitoring of appropriate
use of O Neg and NHSBT actively increases stocks through extra marketing campaigns,
avoiding the implementation of Amber Alerts which would require more direct action,
such as cancellation of cold surgery, to reduce usage.
Blood services face increasing challenges to collect and supply enough O Neg to meet
all hospital requests. There are patients who are only compatible with this blood group,
so it is essential that we manage this resource carefully, whilst providing sufficient,
appropriate and timely red cells for trauma patients.
2013
Aim
12.0%
92,000
Trauma O Neg issues
O RhD Neg
Donors
Total RBC issues (million)
94,000
Other
Donors
We analysed the demand for O Neg red cells and show248one hospital that has
successfully minimised the impact on O Neg blood demand.
7%
Trauma O Neg use
Hospital O Neg issued
2.600
Percentage2013
of O Neg issues – Trauma hospitals vs non-trauma
74,000
2009
2010
2011
Trauma Centre O Neg issues
2012
2013
2014
Total RBC issues
248
11.5%
11.0%
10.5%
10.0%
9.5%
9.0%
7%
Trauma O Neg use
Hospital O Neg issued
8.5%
8.0%
2009
2010
3,396
Trauma Centres
2011
2012
2013
2014
Non-trauma hospitals
2014
Why? 2013
Some of the recent changes which have changed 234
blood transfusion practices:
248
• Introduction of Trauma and Massive haemorrhage protocols
These have undergone dramatic changes in the past five years owing
to use
lessons
Trauma O Neg
Trauma O Neg use
shared by the UK military
and international initiatives. Emergency
blood
Hospital
O Neg(usually
issued
Hospital O Neg issued
O Neg) is used earlier and in larger quantities
6%
7%
• ‘On-demand’ and ‘Remote Issue’ fridges in Emergency Departments/theatres
3,842
3,396
This means clinicians are no longer dependant on red cells being delivered from
the laboratory, which introduces time delays
2013
• Blood2014
on board helicopters
An234
increasing number of air ambulances are carrying
blood on board. Emergency
104
transfusions are now given at the scene of incident outside of hospitals.
6%
Trauma O Neg use
Hospital O Neg issued
3%
HEMS O Neg use
Hospital O Neg issued
O Neg issues to trauma centres has increased. At Kings College Hospital although the number of trauma cases increased by 6% (1030 cases) between 2013 to 2014, by carefully
3,842
managing the provision of red cells, demand for O Neg red
cells was reduced during this period. The Royal
London Hospital who provide red cells for 3,491
the HEMS air ambulance have
3,396
also been able to manage O Neg resources successfully.
2013
2014
234
248
7%
Trauma O Neg use
Hospital O Neg issued
3,396
2014
In 2013, 3396 O Neg units were issued to Kings College Hospital.
7% (237) of these were used in trauma.
234
6%
Trauma O Neg use
Hospital O Neg issued
3,842
3,842
In 2014, 3842 O2013
Neg units were issued to Kings College Hospital.
6% (208) of these were used in trauma.
3%
3.1%
114
3%
HEMS O Neg use
Hospital O Neg issued
2014
In 2013, 3491
O Neg units were issued to Royal London Hospital.
3% (104) of these were used by the London Air Ambulance.
3.1%
HEMS O Neg use
Hospital O Neg issued
3,200
In 2014, 3200 O Neg units were issued to Royal London Hospital.
3.1% (99) of these were used by the London Air Ambulance.
Despite concerns about the increased risk of wastage when supplying red cells to
air ambulance services, wastage
of O Neg from the London Air Ambulance (HEMS)
HEMS O Neg use
is extremely low. To dateHospital
onlyO one
unit of O Neg has been wasted.
Neg issued
3.1%
Working together to conserve O Neg
Clinical Area
2013
2014
• Communication: give details (sex and age) about the trauma patient. This will
104
allow correct
group to be provided in ‘trauma pack’
114
• Rapid blood group sampling: provide a blood sample for patient immediately
so that group specific blood
can be provided for patient
HEMS O Neg use
HEMS O Neg use
Hospital
Neg issuedcomponents are no longer required to
• ‘Stand down’ inform the
labOwhen
Hospital O Neg issued
reduce wastage and enable recycling where possible.
3%
104
114
104
3,491
2014
3,491
At Kings College hospital larger proportions of O Neg were used in haemoglobinopathy
Traumadisease.
O Neg use Wastage of O Neg red cells in trauma is low;
patients and patients with liver
HEMS O Neg use
Hospital
O
Neg
issued
0% in the audit period of 2013 and 2% (5 units – one trauma pack) in 2014
Hospital O Neg issued
6%
2013
3,200
Lab Area
• Managing any emergency stock to prevent wastage (temperature or
time‑expiry)
• Rapid grouping: new “stat spin” centrifuges can reduce centrifugation time
to two minutes
• A modified direct automated group can be performed within five minutes,
depending on local equipment and protocols.
3,491
• Transport arrangements
3,200– have a system of efficient delivery of samples and collection of blood components
• Early availability and use of Fresh Frozen Plasma – not only is this beneficial to patients but allows the lab to prepare group specific blood
• Use of O Pos red cells as emergency blood for adult males – in Kings College Hospital 75% of the trauma patients audited were male
2014
• Process map the stages of massive haemorrhage protocol to see where improvements can be made.
114
As the burden of trauma is set to increase in the next 20 years, it is imperative that all hospitals audit O Neg use in trauma
HEMS O Neg use
and implement strategies to conserve this precious resource.
Hospital O Neg issued
3.1%