This update is as a result of ongoing audit by the Hospital Transfusion Team of significant events related to blood transfusion. We have identified a few areas for the consideration of GPs who prescribe blood in Community Hospitals.
1. Transfusion Associated Cardiac Overload (TACO)
This is now the leading cause of mortality associated with transfusion. It is defined as acute or worsening pulmonary oedema within 6 hours of blood transfusion. It is particularly likely to occur in small, frail, elderly patients (over 70 yrs) especially those with cardiac or renal co-morbidity or in those with a low albumin. In patients at risk of developing TACO it is important to consider:
If you suspect TACO, remember to involve the Consultant Haematologists, as patients may need CXR and blood gases and may be most appropriately managed at the RD& E.
2. Consider treating iron deficiency anaemia with oral or IV iron rather than transfusion
National BCSH guidelines for red cell transfusion state that patients with chronic iron deficiency should be treated with iron (oral or iv) rather than transfusion, unless the anaemia is considered to be life threatening and is causing end organ symptoms such as angina. Intravenous iron is now much safer to use and can be transfused over half an hour. There is still a very small risk of anaphylaxis but this is much lower than with the older preparations. Significant increases in haemoglobin levels occur after about 7 days.
3. Response to adverse events occurring during transfusion
There is a flow chart for actions to be taken should there be an adverse reaction related to transfusion. This can be found on the North Devon Healthcare intranet. Please note that advice from the Duty Haematologist is advised early in the algorithm. They can be contacted via switchboard by asking for the Consultant Haematologist on call.
If you would like to discuss any of these issues further, or would like a visit your surgery or community hospital for a brief talk about transfusion safety, please email Barrie Ferguson (Specialty Doctor in Blood Conservation) barrieferguson@nhs.net
