Featured Recipients

Congratulations to Alana Delaforce, Blood Management and Apheresis RN, Mater Health, Queensland, on being awarded the 2019 Young Investigator Award for Best Abstract.

What was the aim of your work?
Compliance with Patient Blood Management (PBM) guidelines has become an increasing priority for health services. Our benchmarking data indicated that there was room to improve the rate of transfusion in elective surgical patients. We decided to undertake an audit to assess transfusion practice and gain a deeper understanding of what drives clinical decision making in our setting. A robust audit tool was then developed in consultation with the multidisciplinary team. We also wanted to enhance the delivery of the resultant feedback to help show opportunities of where prescribers could improve practice.

Why is this an issue for the transfusion medicine community?
Patient blood management is an important issue for all members of the transfusion medicine community, as we know that blood transfusions are associated with adverse patient outcomes. It has been widely published that facilities have had difficulties changing the practice of physicians, particularly when it comes to PBM, and we hoped to advance the existing knowledge base to provide a new method of feedback delivery. We hope that our transfusion episode flowchart will help other health services to deliver feedback and drive a targeted practice change.

How will it improve patient outcomes?
By developing more engaging methods of delivering audit and feedback results, we hope to encourage prescribers to reflect on their practice, and prescribe blood only to patients who absolutely need it. Since the inception of the feedback tool, our rate of transfusion in the original target population has decreased significantly, and we hope for this trend to continue. By avoiding transfusion, we are avoiding exposing an otherwise healthy population to unnecessary risk of harm.

Congratulations to Debbie Pinchon, Clinical Nurse Consultant, King Edward Memorial Hospital, WA on being awarded the 2019 Haemovigilance Award.

What was the aim of your work?
The multidisciplinary WA Haemovigilance Committee was formed several years ago and with over three years of high quality data, it was time to share our haemovigilance trends. I joined the committee in April when I took up a new post with the Department of Health. As the theme for Blood 2019 was a celebration of teamwork and collaboration, presenting our data was a great opportunity to demonstrate true teamwork in action across all our WA public and private hospitals. Showcasing how we work collectively to improve the safety of transfusion practice throughout the state.

Why is this an issue for the transfusion medicine community?
It is essential that we have robust haemovigilance program which collects high quality and consistent data. This allows us to quickly recognize and respond to trends in adverse reactions. It forms the basis of recommendations to mitigate any new or emerging risks and importantly allows us to assess changes in transfusion practice over time. Our data also contributes to the national and worldwide picture of haemovigilance.

How will it improve patient outcomes?
In previous years we have responded to emerging trends of TACO. A targeted education program was developed and reported incidents of TACO are on the decline. We have seen an increase in trends of DSTR following awareness campaigns by our amazing Transfusion Scientists in Charge. This year’s report showcases a wonderful example in a patient who receives emergency un-cross matched blood, so our message is that the use of Group O Rh D negative blood is not without risk.

We are also focusing on ensuring our colleagues in rural WA have access to high quality haemovigilance support available to staff working within metropolitan hospitals and have updated our web-based support and are providing education directly in the rural areas.

Just the start of a long but important haemovigilance journey for WA.

The stars of the award are my WA colleagues, peers and teams who continue to commit to reporting, investigating and submitting transfusion related adverse events over the years. It is their names that should be on the poster, they are fundamental to our success and progress in haemovigilance in WA.

Congratulations to Soyoung Choi-Maxwell, Transfusion Nurse Specialist at NZBlood Service, on being awarded the 2019 Transfusion Professionals Award on Clinical Transfusion Practice.

What was the aim of your work?
It aimed to improve transfusion practice particularly in haemovigilance; reduction in labelling errors (sample rejects and WBIT) and increase in acute transfusion reaction reporting.

Why is this an issue for the transfusion medicine community?
Labelling errors particularly WBIT is a big issue as its consequence could be fatal. The current system of manual labelling leads professionals involved in blood transfusion to failure. A system that can stop human errors or prevent those errors from harming patients must be developed. Meanwhile, health care professionals involved in blood transfusion should be reminded regularly of safe transfusion practice.

How will it improve patient outcomes?
This is an ongoing sustainable teaching system. By raising awareness in safe transfusion practice potential harm can be reduced.

Congratulations to Joanne Tan, Research Fellow, Australian Red Cross Lifeblood, on being awarded the 2019 ANZSBT Best Poster Prize.

What was the aim of your work?
We aimed to assess the compatibility of a novel red blood cell (RBC) storage system with our current Australian blood manufacturing process, to assess the in vitro quality of RBCs in this storage system for up to 42 days, and to evaluate which of several additive solutions was optimal under these conditions. We processed 48 RBC units and tested them weekly in our laboratory for a range of biochemical and functional characteristics. We found that anaerobically stored RBCs in three additive solutions maintained significantly higher 2,3- diphosphoglyceric acid concentrations than RBCs in the same additive solution stored conventionally. Haemolysis was slightly higher in RBCs stored anaerobically in three additive solutions, but was still well below the Council of Europe guidelines for haemolysis.

Why is this an issue for the transfusion medicine community?
RBCs undergo changes during storage (known as the storage lesion) that impair their function and reduce their survival after they are transfused. We may be able to limit the storage lesion and make our products safer to transfuse by using novel storage systems and/or changing additive solutions. We tested a storage system that could minimise oxidative damage to RBCs during storage by keeping them in an environment depleted of O2 and CO2.

How will it improve patient outcomes?
Following this study, we will make recommendations on the suitability of this particular storage system for our Australian blood products, and whether it will continue to uphold our high standards of blood product safety and quality. This novel storage system has been shown overseas to store RBCs for up to 9 weeks, which could mean more RBCs in our inventory and for a longer shelf life.

Congratulations to Vickie McDougall, A/Transfusion Coordinator, Perth Children’s Hospital , on being awarded the 2019 Transfusion Professionals Award on Patient Blood Management.

What was the aim of your work?
To improve the quality of care provided to neonatal and paediatric patients (≤ 17 years of age) by ensuring the appropriate use of red cell transfusion and patient blood management practices.

Why is this an issue for the transfusion medicine community?
To ensure that current patient blood management and red cell transfusion practice at Perth Children’s Hospital reflects the best available evidence as detailed in the National Blood Authority Patient Blood Management Guidelines: Module 6 Neonatal and Paediatrics.

How will it improve patient outcomes?
Reduce unnecessary allogeneic blood transfusions and reduce avoidable harm in neonatal and paediatric patients.

Congratulations to Candice Thomson, Flinders Medical Centre, Bedford Park, SA on being awarded the 2018 ANZSBT Presidential Award.

What was the aim of your work?
The aim of our research was to show that we could better use one of our currently available blood products. Cryoprecipitate is a blood product commonly used in trauma, massive haemorrhage, obstetric haemorrhage and DIC – primarily for its fibrinogen content. Currently it can be a relatively difficult product to use because of a short-expiry time of 6 hours post-thawing.

Our study aimed to show that we could extend the post-thaw expiry time to 120 hours (5 days) post-thawing whilst still obtaining adequate fibrinogen and FVIII levels. Because of the risk of bacterial contamination with prolonged storage of blood products post-thawing we assessed units of cryoprecipitate stored at both room temperature and 1-4C. We wanted to make this study a true assessment of the function of cryoprecipitate, so as well as standard FVIII and Fibrinogen assays measured every 24hours post-thawing, we also used ROTEM to assess functional clot formation at set time points.

Furthermore, we also wanted to make an assessment of bacterial contamination by assessing bacterial contamination rates in cryoprecipitate at 120 hours.

Why is this an issue for the transfusion medicine community?
There is currently an increasing need for cryoprecipitate throughout blood banks in Australia. This is despite some institutions using fibrinogen concentrates. Fibrinogen replacement is now readily used early in massive haemorrhage and trauma, and in obstetric haemorrhage. As a transfusion medicine community we should always be looking to optimise access to products. The short expiry time of post-thaw cryoprecipiate means that it is kept frozen and thawed on demand which leads to delays in administration. It also leads to wasted product if a requested is product is not used.

How will it improve patient outcomes?
Our study was able to demonstrate that cryoprecipitate stored for 120 hours post-thawing at both RT and 1-4 C had levels of fibrinogen and FVIII that met Australian and international standards for cryoprecipitate content. The functional adequacy of cryoprecipitate was confirmed with FibTem showing adequate Maximum Clot Firmness (MCF) out to 120 hours. On a limited number of units tested (n:20), no bacterial contamination was found at 120 hours.

These results suggest that we could extend the expiry of thawed cryoprecipitate out to 120 hours (in keeping with that of extended life FFP). This potentially means the ability to keep pre-thawed product ready to be provided for urgent situations. With increasing knowledge of the importance of fibrinogen replacement early in trauma and haemorrhage this quick access to cryoprecipitate is essential for best outcomes in these patients.

Congratulations to Dr Allison Mo on receiving one of the three 2018 Research Fund Grants – the ANZSBT annual grants to contribute to the advancement of research in transfusion medicine and science in Australasia and to promote and develop research in related medical knowledge and science.

A feasibility randomised pilot trial of weekly-interval red cell transfusion schedule in myelodysplastic syndromes: REDDS-2 pilot study

Investigators and research staff: Dr Allison Mo¹, A/Prof Zoe McQuilten¹, Prof Erica Wood¹, A/Prof Jake Shortt¹, Dr Elizabeth Pritchard¹, A/Prof John Reynolds¹, Ms Naomi Aoki¹, Prof Simon Stanworth², Prof David Bowen², Dr Jonathan Wallis².
¹ Monash University, ² UK NHSBT

What was the aim of your work?

The aim of this project is to improve transfusion practices in patients with myelodysplastic syndrome (MDS). MDS are a group of haematological cancers, more commonly affecting the elderly, resulting in bone marrow failure and cytopenias. Transfusions are frequently required however, current transfusion practices are not evidence based and vary between institutions and clinicians. The conventional practice is to transfuse patients several units of red blood cells (RBC) every 3-4 weeks, aiming for a ‘restrictive’ haemoglobin (Hb) target of 80-100g/L, however this approach is largely based upon trials in acute surgical or trauma settings, and the benefit is unclear in elderly MDS patients. Mathematical modelling suggests that maintaining a more stable Hb between transfusion episodes may improve patient outcomes but this has not be studied in a trial. Current transfusion schedules are also characterised by multiple delays in the intended sequence (e.g. requirements of comprehensive pre-transfusion testing). It is plausible that weekly transfusions with phenotype or genotype-matched RBCs, without the need to await prospective crossmatching, could be more effective and acceptable to patients and staff.

Building on the success of the REDDS-1 trial of Hb thresholds in MDS, we are conducting a randomised pilot clinical trial of weekly RBC transfusion using matched RBCs versus current practice, in transfusion-dependent MDS patients. This feasibility study conducted in collaboration with the UK NHSBT will assess i) delivery of a weekly RBC transfusion schedule and ii) QoL and physical function outcomes, which are of vital importance to elderly outpatients. Two transfusion treatments (usual transfusion schedule vs weekly matched RBCs) are being studied, with each patient receiving both arms in a randomly allocated sequence. To enable weekly transfusion in a timely manner, extended-matched RBCs will be used in the weekly arm, without the need to await results of prospective cross-matching.
A second part of the study will involve interviews of patients and staff focus groups to explore their experiences of the new weekly transfusion schedule.

Why is this an issue for the transfusion medicine community?
Anaemia and haematological malignancy such as MDS are the commonest indications for transfusion in medical patients. The transfusion needs of patients with MDS, and the subsequent demands on our national blood supply, are also likely to continue to increase as the population continues to age. Despite this, there is limited evidence to guide optimal transfusion strategy in MDS. This is highlighted in national and international guidelines. Further, the goal of transfusion support in MDS is to improve and maintain quality of life (QoL) and physical function, which are of vital importance to elderly outpatients. However, there are a lack of validated tools to measure and physical functional outcomes in this elderly patient population and these have not been investigated in relation to transfusion therapy. No clinical trials have investigated whether maintaining a more stable Hb by transfusing fewer units more frequently (eg.weekly) can improve outcomes. The use of extended matched RBCs may also improve workflow efficiencies and reduce delays for patients and staff. As chronic transfusion therapy can be burdensome (physically, psychosocially and financially) on patients, and also utilises significant financial and staffing resources within the healthcare system, it is imperative that we investigate the optimal transfusion strategy for these patients.

How will it improve patient outcomes?
This pilot study will provide important information on the feasibility of weekly matched RBC transfusion in patients with MDS, and explore novel QoL and physical functional outcomes relevant to this patient population. The overarching objective of this pilot is to inform the design and conduct of a definitive international randomised trial to compare different strategies for RBC transfusion in outpatients with MDS. We hope to improve patient outcomes by:

• Investigating whether weekly RBC transfusion can improve patient QoL and physical functional outcomes by maintaining a more stable Hb. The n-of-1 nature of the study design allows each patient to experience and compare their current transfusion schedule versus an individualised weekly transfusion schedule.
• Investigating the deliverability of weekly matched RBC transfusion at hospital sites, including whether this can improve patient and staff experiences (for example, effects staff efficiencies and workflow; impact on patient’s daily life). We will gain in-depth understanding of these issues via the qualitative substudy.
• Identifying the optimal QoL and physical functional tools relevant to this patient population, which can be used as outcome measurements in future clinical transfusion trials.

Congratulations to Merrole on her extraordinary career and contribution to transfusion science and medicine. Below is an excerpt from Merrole’s interview.

Dr Cole-Sinclair is an Australian trained clinical and laboratory haematologist, currently Head, Laboratory Haematology, and Chair of the Transfusion Committee at St Vincent’s Hospital Melbourne; with an honorary appointment in the Department of Pathology at the University of Melbourne.

Dr Cole-Sinclair majored in Immunology and Pathology and achieved RACP and RCPA Fellowships in Haematology. She has worked as a clinical research fellow and in clinical haematology and pathology hospital positions; and has held many memberships, positions, roles and responsibilities with the RCAP, RACP and various transfusion-related organisations.

Dr Cole-Sinclair’s initial exposure to transfusion was during her immunology studies where transfusion serology was used as a practical demonstration of antigen/antibody interaction and detection; her own specimen was deemed ‘interesting’ and taken away for further analysis! During her resident years she realised that transfusion, although considered by some to be a routine ancillary supportive therapy, was in fact a unique, important and widely used therapy not without major risk. Having to investigate and manage an ABO incompatible transfusion reaction as a laboratory registrar made a significant and lasting impression, as did the somewhat stressful overnight manual cross-matching that was the responsibility of haematology trainees in many hospitals in those years.

Highlights of Dr Cole-Sinclair’s career include the privilege and at times challenges of direct patient care; the opportunity to work with multidisciplinary teams to achieve improvements for patient care and safety; and education, training, curricula development and assessment of health professionals in Haematology and transfusion (both clinical and laboratory). Involvement in the TORC collaboration has been very gratifying due to the “expanding and high quality contributions to the evidence-base of transfusion practice.”

“All of us in the business of providing blood and transfusion advice should use every opportunity to educate staff, patients, carers etc about the importance of safe transfusion practice across the entire transfusion chain and the positive aspects of blood donation for the good of the whole community.”

Dr Cole-Sinclair highlights contributions to the improvements in transfusion medicine but states that “equity of access to safe transfusion on a global scale….. still requires a huge amount to be achieved.”

“While national guidelines for transfusion and patient blood management support the current quite appropriate paradigm of good practice and avoidance of transfusion wherever possible, we sometimes need to remind ourselves of the significant benefits of transfusion and ensure that patients who would benefit and should be transfused actually receive this therapy.”

The full interview is available here.

Congratulations to Alison Badger, Supervising Scientist, Reference Laboratory, New Zealand Blood Service. Alison reports on her attendance at the 5th Molecular Blood Group Forum, Frankfurt November 2018.

What was the purpose of your travel?
I attended the 5th Molecular Blood Group Forum presented by inno-train Diagnostik GMBH. This conference is offered every 2 years in the English language and addresses a number of topics with a variety of speakers who are leaders in their field of transfusion science.

Why is this an issue for the transfusion medicine community?
There are a number of challenges facing the world of transfusion science for example, serological limitations when rare antibodies are present, when a patient has been transfused, when new drug treatments become available and finding a blood supply for such patients can be difficult.

What did you learn?
During the conference we were giving a thorough background of the inno-train products and the throughput capabilities versus time and effort. We heard about the daily business of the ISBT Red Cell Immunogenetics and Blood Group Terminology Working Party and what is required when presenting a new blood group or blood group antigen.

There was an update on the UK NEAS BTLP Red Cell Genotyping EQA scheme and what novel results have been detected with the variety of different methods of genotyping being used worldwide.

New reagents in RBC antibody diagnostics; towards a more efficient blood supply for immunised patient introduced us to the use of recombinant blood group antigens in cases where there are limited red blood cells lacking the corresponding antigen. This allows for simple and fast detection and identification of alloantibodies to high-prevalence blood group antigens. DaraEx is also among these neutralising agents and is used to neutralise the effects of anti-CD38.

The Associate Professor of the International Blood Group Reference Laboratory at NHS Blood and Transplant discussed how they investigate complex immunohaematology problems including the use of molecular techniques. There were case studies discussed from laboratories in Sweden and Switzerland addressing maternal RHD genes and detecting fetal RHD during pregnancy.

Finally we were informed about the creation of a red cell genotype database at the Blood Centre of Wisconsin, USA. This database has been instrumental in the management of patients with sickle cell disease and the genetic variants carried by the African American population.

How will this improve transfusion knowledge and/or patient outcomes?
The introduction and the developments in red cell genotyping have already proved to be paramount in the investigation of complex immunohaematology cases, solving problems where serology has failed or is not available. The introduction of neutralising agents will revolutionise investigations that cannot progress due to a lack of appropriate antigen negative red cells or available antisera. The use of anti-CD38 therapy is only bound to increase with the use of this treatment now continuing outside the setting of multiple myeloma. By having a neutralising agent for testing, it will remove the need for blood banks to send samples to a Reference Laboratory for specialised testing with dithiothreitol (DTT) and the delay in blood supply that causes.

Congratulations to Neil Waters, Transfusion Research Unit, Monash University, Melbourne VIC. Neil reports on his attendance at the 2019 AABB Annual Meeting (19 – 22 October) and the Biomedical Excellence for Safer Transfusion (BEST) Collaborative meeting (16 – 17 October).

What was the purpose of your travel?
I travelled to San Antonio USA to attend the 2019 AABB Annual Meeting (19 – 22 October) and the Biomedical Excellence for Safer Transfusion (BEST) Collaborative meeting (16 – 17 October) as a guest.
The BEST collaborative is an international research organization that conducts international studies addressing important questions regarding safe transfusion. Projects include pilot exploratory studies, definitive large­scale studies, randomised trials, surveys, laboratory-based investigation and qualitative research. BEST is a unique group of over 150 clinicians, scientists and blood services from 22 countries.

What was the aim of your work?
At AABB I presented, on behalf of the Transfusion Research Unit at Monash University, an analysis of the data in the Australian and New Zealand Massive Transfusion Registry which looked at Whole Blood Use and Patient Outcomes in Major Haemorrhage.

Why is this an issue for the transfusion medicine community?
The use of whole blood in critical bleeding is a hot topic at the moment. There were two editorials in Transfusion in 2019 focused on the use of whole blood in critical bleeding, and a number of articles looking at how whole blood compares with component therapy for safety and patient outcomes.
The New Zealand Blood Service produces a whole blood product for pre-hospital use by the Helicopter Emergency Medical Service and in cardiac surgery. This provides an interesting source of data for an analysis of patient outcomes in whole blood recipients Vs red cell only recipients.

What did you learn?
Attending the BEST meeting was an opportunity to hear what international research leaders consider are the important questions in transfusion medicine are at this moment and how these are being tackled. Updates on existing projects were given and new project proposals were discussed to receive feedback, support and to improve design. It was a great pleasure to attend such a collaborative and collegiate meeting.
AABB has a huge program and there were many decisions to make about which sessions to attend. A highlight was the session on blood use in trauma resuscitation. This involved presentations from opinion leaders in the area, Philip Spinella, Brian Eastridge and Richard Haspel and a debate moderated by Mark Yazer.
I also had the opportunity to meet with Haemanext who are developing technology to enable the storage of RBC under anaerobic conditions with a view to preventing oxidative damage and reducing the features associated with the storage lesion. There is still a lot of work to do on getting this product to commercialisation, and it was good to hear what they have planned.

How will this improve transfusion knowledge and/or patient outcomes?
Research in to transfusion is vital in order to improve patient outcomes. Discussing opportunities for collaboration with international researchers serves to strengthen the quality and breadth of transfusion research in Australia and globally; and discussions from this travel have already resulted in the development of ideas for future collaborative research projects.
I am very grateful to CSL and ANZSBT for the opportunity to attend these two important meetings and to present some of the Transfusion Research Unit’s work on the world stage.

Congratulations to Halimatun, Scientific Officer, Universiti Teknologi MARA Sungai Buloh Malaysia, on receiving the 2018 South East Asia/Pacific Islands Travel Award to attend Blood 2108. Below is an extract from Halimatun’s report.

A talk by Saskia Middledorp gave me a different insight on thrombophilia as often it is requested when there is no clinical indication or when sample is inappropriately taken. As a diagnostic laboratory it is crucial to perform correct test for a correct reason.

I am also impressed on talk about digital morphology by Craig Williams in this era as in the past it is impossible to store so much of digital images but now it is feasible and widely used. I now must get used to this technology as our EQA morphology by RCPAQAP has slowly changed to using digital images. Before this I am bit reluctant to accept (I prefer the conservative way, seeing physical slide using microscope), but I guess I have to move forward to current technology/trend.

As I come from a small hospital laboratory, I used to be left behind the technology. The exhibition has exposed me to a new technology on haematology and transfusion. As my colleague and I are moving to a new laboratory in one year time, it is timely for me to attend the conference. I did make a contact with few representatives to look for new instrument/system. I also managed to know which instrument is FDA-approved/CE-approved. This is one of the important criteria in selecting biomedical instrument.

I attended a morphology session and was quite surprised on how the session was held in a very vibrant environment. This has reminded me on why I love haematology. Audience and speaker were engaging very well. This does not happen at my workplace hence perhaps I shall make morphology session with my colleagues more interactive and lively.

As I am a travel grant awardee, I was given an opportunity to visit transfusion laboratory at Royal Brisbane Hospital. It is a very rare opportunity to visit a hospital abroad and get in touch with the laboratory staff. Here I was able to witness on how an electronic crossmatch (EC) was performed. The EC has been performed at the Royal Brisbane hospital for quite sometimes but here in my home country, there is hardly any EC being practised as there are few requirements to practise the EC. The lab staff were kind enough to show us around the laboratory and told us (me and other travel awardee) about the laboratory management and operation.

Congratulations to Dr Peter Flanagan on receiving the 2017 Ruth Sanger Award – the premier award of the ANZSBT given in recognition of a significant contribution to the field of transfusion medicine.

The Ruth Sanger oration is given at the Annual Scientific Meeting. Peter’s Ruth Sanger Oration can be viewed by members here…

What has been the highlight of your career in transfusion medicine to date?
I think that this has to be my election as President of ISBT back in 2010. It is particularly rewarding, and gratifying to be recognised by one’s peers.

What was the biggest challenge?
The biggest challenge probably arose in 1996 following the initial reports of variant CJD in the United Kingdom. This had, and indeed continues to have, a massive impact on the way that UK blood services work. I was fortunate to be closely involved in a range of initiatives linked to vCJD including the original Det Norske Veritas Risk assessment. This was an exciting and challenging professional period that has heavily influenced my overall approach to maintaining a safe blood supply.

What do you see as the key issue in transfusion medicine today?
The most important issue probably relates to the impact of the introduction of patient blood management and blood conservation strategies on overall demand for the products that we provide for patients. This has had a very significant impact on blood services across the world. In many ways it combines a real opportunity to improve the overall practice of transfusion medicine and science whilst, at the same time, resulting a severe economic challenge arising from the reduction in revenue associated with reduced use of products.

What do you think the future holds for transfusion medicine?
I believe that the future remains bright for transfusion medicine and science. Inevitably technology will continue to develop and we will see increasing automation and application of high throughput molecular testing over time. This will improve our understanding of variables that affect storage of donations and support better matching of components. There is also a real opportunity for blood services to establish themselves as a transitional provider of cell therapy services. I suspect that much of the scientific innovation and development will continue to take place in the universities and Research institutes. Blood Services are well positioned to take a leading role as the therapies move from the research environment into the clinical main stream. Arguably current involvement in areas such as serum eye drops and haemopoeitic progenitor cell collection and processing is early evidence of this occurring.

Congratulations to Clive, Senior Blood Safety Analyst with the Australian Red Cross Blood Service for his significant contributions to transfusion medicine. Clive describes some of the highlights of his work below.

What was the aim of your work?
My focus for almost 3 decades has been improving our knowledge regarding the risks to patients from both known and emerging infectious disease pathogens. Leveraging my laboratory medicine and research background I developed a number of mathematical models to estimate transmission risk for transfusion-relevant infectious disease pathogens.

Why is this an issue for the transfusion medicine community?
The emergence of HIV in the early 1980’s and the tragic realisation that many transfusion recipients had been infected, indelibly changed the practice of transfusion medicine and the public perception of transfusion risks. This demanded accurate and timely risk estimation for proven transfusion transmissible pathogens like HIV and hepatitis B and C, as well as emerging threats like dengue virus.

How will it improve patient outcomes?
The regular estimation and publication of risks for transfusion transmissible pathogens directly supports clinicians in providing optimal consent for transfusion. Additionally, these data underpin risk assessments for policy decision-making; including assessing novel threats (e.g. the recent emergence of Zika virus) and new technology (e.g. implementing nucleic acid testing for HIV, hepatitis C and hepatitis B). Together, these initiatives contribute to maintaining Australia’s excellent international standing in respect of transfusion safety.

Congratulations to Dr Dianne van der Wal on receiving one of the three 2017 Research Fund Grants – the ANZSBT annual grants to contribute to the advancement of research in transfusion medicine and science in Australasia and to promote and develop research in related medical knowledge and science.

Dianne describes her Research below.

Aim
Platelets are crucial for cessation of bleeding; therefore transfusion of platelet products is life-saving for haemato-oncology and surgical patients. Since platelets deteriorate rapidly during storage, their current shelf-life is only 5 days. Preliminary studies indicate that platelet activation is associated with neuraminidase activity, which varies between donors. Platelets contain many sugars on their surface, important for removal of dying/dysfunctional platelets from the body. The sugars can be removed by specific enzymes, called neuraminidases. While the role of glycans in platelet clearance and neuraminidases in influenza patients have been extensively studied previously, the role of neuraminidases in platelet function is not known.

Why is this an issue for the transfusion medicine community?
Studying the glycans and neuraminidases in platelets is important not only to characterise our platelet products further; it will lead to more insights into platelet function in general, and in future, diseases involving regulation of platelet function, such as cardiovascular disease. Results of this study are important to unravel the molecular mechanisms underlying the release of platelet-attached glycans. Identifying the role of neuraminidases is essential for unravelling platelet function in general and also for understanding why platelet quality and function deteriorates during storage.

How will it improve patient outcomes?
Studying glycans and neuraminidases in our apheresis platelets on collection day and following storage might lead to identification of ‘hyper-reactive’ donors or potential donors who may not be suited to platelet donations. A better understanding of platelet biology (haemostasis) and our clinical platelet products has the potential to reduce wastage and lead to improved transfusion practices.

The findings from this project will lead to better quality platelet products. Since the importance of neuraminidase activity in platelet clearance is well established, the findings of this project might lead to a potential quality marker that could facilitate assessment of the effectiveness of a platelet transfusion. For example, if high neuraminidase activity is found in platelets from one donor, their platelets might be deglycosylated more readily and hence cleared more rapidly from the patient’s circulation. Hence, providing the highest quality platelet products has the potential to improve transfusion outcomes.

Dianne’s abstract can be found here…

Congratulations to Helen, a Project Officer with the Transfusion Research Unit at Monash University. Helen describes her award winning work below.

The True Cost of Transfusion in Thalassaemia (TRUSTT) Study

What was the aim of your work?
The aim of the TRUSTT Study was to determine the true cost of transfusion in adult thalassaemia patients at the major thalassaemia treatment centre in Melbourne using a detailed time-driven, activity-based costing (TDABC) method. Through direct observation, process maps were developed that included every step in the transfusion process including phlebotomy, testing, transfusion, quality assurance, governance, haemovigilance and managing the long-term effects of transfusion. Direct and indirect costs for personnel, consumables equipment and infrastructure were included. The process maps were then translated into spreadsheets for economic analysis. We also conducted a sensitivity analysis, whereby the different processes and variables which may have a greater or lesser effect on the overall result were identified.

Why is this an issue for the transfusion medicine community?
The true cost of transfusion in Australia is largely unknown. Blood products have a manufacture price on the label, however this does not include all the costs that are actually involved in transfusion of blood products. Understanding the true cost of transfusion means that the cost of alternate therapies can be evaluated against the cost of current standard of care; and the incremental costs of system improvements can be measured.

The development of the process maps was instructional in both the laboratory and clinical setting, allowing comparison with documented procedures and a review and assessment of efficiency. Understanding where and what the costs in transfusion are is important in understanding resourcing requirements.

How will it improve patient outcomes?
The costing model is portable to other settings and is easily updatable where inputs such as staff costs change. It can also be used in other clinical settings and for other blood products (e.g. cryoprecipitate vs fibrinogen concentrate; immunoglobulins IV vs SC), for other laboratory processes (e.g. manual vs automated testing) and to guide design of simpler and safer transfusion systems.

I’d like to thank the ANZSBT very much for this award for members who engage with the society through the annual scientific conference. The award gives encouragement to members to perform research to help answer the myriad of unanswered questions still remaining in transfusion medicine—all of which is pleasing to those with curious minds!

Helen’s abstract can be found here.

Congratulations to Rebecca who is the Transfusion Medicine Safety Clinical Nurse at Fiona Stanley Hospital, and a member of the ANZSBT Education Standing Committee. Rebecca describes her award winning project below.

What was the aim of your project?
We were keen to remove the Theatre blood fridge at our site. We had issues with cold chain traceability due to poor documentation of blood movement in and out of the theatre blood fridge. The Scientist in charge in the Transfusion Medicine Unit identified alternatives to the theatre blood fridge in the form of “shippers”.

Why is this an issue for the transfusion medicine community?
Being unable to confirm that cold chain has been maintained can lead to Red Blood Cells being administered out of the appropriate temperature. Also, the documentation of the theatre blood fridges was done so poorly and infrequently that this change was necessary to prevent blood waste.

How will this project improve outcomes?
Through our audit, we were able to review the number of blood products that were returned out of the temperature range (0). There was zero blood waste as a result of this change. We also noted that of the 364 Red Blood Cells issued to theatre during our 8 week trial that only 36% (n=133) were actually transfused. This information has led to an introduction of a surgical blood ordering tool which aids the medical officers with determining if they need to order or request blood for a patient based on the procedure they are consented for.

Rebecca’s poster can be found here.

Congratulations to Christine, a Transfusion Nurse with Blood Matters and the Alfred Hospital. Christine describes her award winning project below.

What was the aim of your work?
Our aim was to improve the care of patients undergoing elective surgical procedures by reducing the need for transfusion in the postoperative phase. We did this by developing an algorithm for anaemia assessment and management, based on the PBM Guidelines: Module 2 algorithm. This is used by our Anaesthetic staff in pre-admission clinic.

We were lucky to be able to join the National Patient Blood Management Collaborative in 2015. This Collaborative aimed to test methods of introducing preoperative anaemia investigation and management within health services. As a result of this program ferritin testing increased from 16% to 96% of all patients. The Collaborative has released Resources for Improved Patient Blood Management to assist others.

Why is this an issue for the transfusion medicine community?
Literature suggests that transfusion post-surgery is a contributor to increased morbidity and length of stay. Both of which are generally undesirable for the patient and the health service. National Safety and Quality Health Service Standards have an increasing focus on patient blood management as part of the increased safety of transfusion.

How will it improve patient outcomes?
It is more common to use iron in patients with iron deficiency, something that wasn’t tested for previously. The use of tranexamic acid has also increased, and when a transfusion is required it it more commn to use a single unit approach.

As a consequence of implementing PBM we have seen a reduction in our transfusion rate, which continues to decrease. We hope that this will have a flow-on effect of reducing postoperative complications, such as infection and length of stay.

Christine’s poster can be found here.

Congratulations to Joanne, a Research Fellow with the Australian Red Cross Blood Service. Joanne describes her award wining work below.

What was the aim of your work?
The aim of our work was to look at the propensity of alloantibody formation in transfusion-dependent patients. Thalassaemia and sickle cell disease patients receive ongoing transfusion support over their lifetime and receive regular phenotype-matched red blood cell transfusion. Sometimes, these patients develop alloantibodies to antigens that were mis-matched. We have previously studied anti-D donors, who are RhD-negative blood donors who have been immunised with RhD-positive red blood cells to stimulate their immune system to develop anti-D alloantibodies. We devised a screening test that we believed could identify a ‘Responder’ individual, someone who was likely to develop an antibody if exposed to non-self antigens.

Why is this an issue for the transfusion medicine community?
Transfusion-dependent patients who develop alloantibodies are at risk of delayed haemolytic transfusion reactions if they receive a red blood cell unit of the same antigen specificity. This means blood banking staff and Blood Service staff need to work harder to find extended phenotype-matched red blood cells for these patients for future blood transfusions. One of the management strategies for these patients is to prevent the formation of alloantibodies in the first instance.

How will it improve patient outcomes?
In our study of 42 thalassaemia and 4 sickle cell patients, 15 patients had developed either alloantibodies or autoantibodies. After genotyping these patients for target single nucleotide polymorphisms (SNPs), we found that these ‘Responder’ patients were significantly associated with two SNPs. By applying our screening test to these patients, we identified 15 patients who were correctly predicted to have no antibodies and 9 patients who were predicted to have antibodies. Furthermore, one thalassaemia patients who at the time of the study was recorded as having no antibodies but was predicted to develop antibodies in the screening test, has since gone on to develop an anti-E alloantibody after receiving a mis-matched red blood cell transfusion. Additional follow up and testing in other patient groups would be useful for validation of this screening test.

Joanne’s abstract can be found here.