NHS Blood and Transplant, Imperial College Healthcare NHS Trust, London, University College Hospitals NHS Trust, London, Serious Hazards of Transfusion, NHS Blood and Transplant, Manchester, Royal Hospital for Sick Children, Glasgow, NHS Blood and Transplant, St. Mary’s Hospital, Manchester/University of Manchester, Manchester, Royal Brompton Hospital, London, UK, Mater Research Institute, University of Queensland, Brisbane, Australia, Addenbrookes Hospital/NHS Blood and Transplant, Cambridge, and Oxford University Hospitals NHS Trust/NHS Blood and Transplant, Oxford, UK

https://onlinelibrary.wiley.com/doi/pdf/10.1111/bjh.14233

Guidelines on transfusion for fetuses, neonates and older children

H. Qureshi,1 E. Massey,2 D. Kirwan,3 T. Davies,4 S. Robson,5 J. White,6 J. Jones7 & S. Allard8 1Department of Haematology, University Hospitals of Leicester, Leicester, UK, 2NHS Blood & Transplant, Bristol, UK, 3NHS Fetal Anomaly Screening Programme, UK National Screening Committee, University of Exeter, Exeter, UK, 4NHS Blood & Transplant, Manchester, UK, 5Department of Fetal Medicine, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK, 6UKNEQAS Blood Transfusion Laboratory Practice, West Hertfordshire Trust, Hertfordshire, UK, 7Welsh Blood Service, Pontyclun, UK, and 8NHS Blood and Transplant, London, UK

https://onlinelibrary.wiley.com/doi/pdf/10.1111/tme.12091

BCSH guideline for the use of anti‐D immunoglobulin for the prevention of haemolytic disease of the fetus and newborn

Patient blood management (PBM) is the timely application of evidence-informed medical and surgical concepts designed to maintain haemoglobin concentration, optimise haemostasis and minimise blood loss in an effort to improve patient outcomes. The aim of this consensus statement is to provide recommendations on the management of anaemia and haematinic deficiencies in pregnancy and in the post-partum period as part of PBM in obstetrics. A multidisciplinary panel of physicians with expertise in obstetrics, anaesthesia, haematology, policymaking and epidemiology was convened by the Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis (NATA) in collaboration with the International Federation of Gynaecology and Obstetrics (FIGO) and the European Board and College of Obstetrics and Gynaecology (EBCOG). Members of the task force assessed the quantity, quality and consistency of the published evidence and formulated recommendations using the system developed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group. The recommendations in this consensus statement are intended for use by clinical practitioners managing the perinatal care of women in all settings and by policymakers in charge of decision making for the update of clinical practice in health-care establishments. They need to be tailored for application in individual patients or any population after consideration of the values and preferences of both health-care providers and patients, as well as equity issues; explicit assessment of harms and benefits of each recommendation; feasibility including resources, capacity and equipment; and implementability.

https://www.zora.uzh.ch/id/eprint/144902/1/2017_32_Patient_blood_Transfusion_Medicine_Brreymann.pdf

Patient blood management in obstetrics: management of anaemia and haematinic deficiencies in pregnancy and in the post-partum period: NATA consensus statement.

Red Blood Cell Alloimmunization in the Pregnant Patient.

Background Caesarean section is associated with blood loss and maternal morbidity. Excessive blood loss requires transfusion of donor (allogeneic) blood, which is a finite resource. Cell salvage returns blood lost during surgery to the mother. It may avoid the need for donor blood transfusion, but reliable evidence of its effects is lacking. Objectives To determine if routine use of cell salvage during caesarean section in mothers at risk of haemorrhage reduces the rates of blood transfusion and postpartum maternal morbidity, and is cost-effective, in comparison with standard practice without routine salvage use. Design Individually randomised controlled, multicentre trial with cost-effectiveness analysis. Treatment was not blinded. Setting A total of 26 UK obstetric units. Participants Out of 3054 women recruited between June 2013 and April 2016, we randomly assigned 3028 women at risk of haemorrhage to cell salvage or routine care. Randomisation was stratified using random permuted blocks of variable sizes. Of these, 1672 had emergency and 1356 had elective caesareans. We excluded women for whom cell salvage or donor blood transfusion was contraindicated. Interventions Cell salvage (intervention) versus routine care without salvage (control). In the intervention group, salvage was set up in 95.6% of the women and, of these, 50.8% had salvaged blood returned. In the control group, 3.9% had salvage deployed. Main outcome measures Primary – donor blood transfusion. Secondary – units of donor blood transfused, time to mobilisation, length of hospitalisation, mean fall in haemoglobin, fetomaternal haemorrhage (FMH) measured by Kleihauer–Betke test, and maternal fatigue. Analyses were adjusted for stratification factors and other factors that were believed to be prognostic a priori. Cost-effectiveness outcomes – costs of resources and service provision taking the UK NHS perspective. Results We analysed 1498 and 1492 participants in the intervention and control groups, respectively. Overall, the transfusion rate was 2.5% in the intervention group and 3.5% in the control group [adjusted odds ratio (OR) 0.65, 95% confidence interval (CI) 0.42 to 1.01; p = 0.056]. In a planned subgroup analysis, the transfusion rate was 3.0% in the intervention group and 4.6% in the control group among emergency caesareans (adjusted OR 0.58, 95% CI 0.34 to 0.99), whereas it was 1.8% in the intervention group and 2.2% in the control group among elective caesareans (adjusted OR 0.83, 95% CI 0.38 to 1.83) (interaction p = 0.46, suggesting that the difference in effect between subgroups was not statistically significant). Secondary outcomes did not differ between groups, except for FMH, which was higher under salvage in rhesus D (RhD)-negative women with RhD-positive babies (25.6% vs. 10.5%, adjusted OR 5.63, 95% CI 1.43 to 22.14; p = 0.013). No case of amniotic fluid embolism was observed. The additional cost of routine cell salvage during caesarean was estimated, on average, at £8110 per donor blood transfusion avoided. Conclusions The modest evidence for an effect of routine use of cell salvage during caesarean section on rates of donor blood transfusion was associated with increased FMH, which emphasises the need for adherence to guidance on anti-D prophylaxis. We are unable to comment on long-term antibody sensitisation effects. Based on the findings of this trial, cell salvage is unlikely to be considered cost-effective. Future work Research into risk of alloimmunisation among women exposed to cell salvage is needed. Trial registration Current Controlled Trials ISRCTN66118656. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 2. See the NIHR Journals Library website for further project information.

/pdf/a-randomised-controlled-trial-and-economic-evaluation-of-yb0746cvxa.pdf

A randomised controlled trial and economic evaluation of intraoperative cell salvage during caesarean section in women at risk of haemorrhage: the SALVO (cell SALVage in Obstetrics) trial.

White, J1 Qureshi, H2 Massey, E3 Needs, M4 Byrne, G5 Daniels, G6 Allard S7 & British Committee for Standards in Haematology 1UK National External Quality Assessment Scheme for Blood Transfusion Laboratory Practice, Watford, 2Department of Haematology, University Hospitals of Leicester, 3NHS Blood and Transplant & University Hospitals Bristol NHS Foundation Trust, 4Institute of Biomedical Scientists and NHS Blood and Transplant, 5Department of Haematology, University Hospitals of Leicester, 6International Blood Group Reference Laboratory, NHS Blood and Transplant, and 7Barts Health NHS Trust and NHS Blood and Transplant

https://onlinelibrary.wiley.com/doi/pdf/10.1111/tme.12299

Guideline for blood grouping and red cell antibody testing in pregnancy

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Guideline for blood grouping and red cell antibody testing in pregnancy