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Featured Recipients

Merrole Cole-Sinclair
Helen Haysom
Clive Seed
Joanne Tan
Christine Akers
Rebecca McLean

 

A/Prof. Merrole Cole-Sinclair
2017 ANZSBT Life Membership Award

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

Merrole

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...

 

Helen Haysom
ANZSBT Presidential Award

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

Helen Haysom

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...

 

Clive Seed
Peter Schiff Award (sponsored by CSL Behring)

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 higlights of his work below.

Clive Seed

 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. 

 

Joanne Tan
Young Investigator Award for Best Abstract (sponsored by the NBA)

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

Joanne Tan

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...

 

Christine Akers
Transfusion Professionals Award in Patient Blood Mangement (sponsored by Vifor Pharma)

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

Christine Akers

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...

 

Rebecca McLean
Transfusion Professionals Award in Clinical Transfusion Practice (sponsored by CSL Behring)

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.

Rebecca McLean

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...