Transfusion Training Checklist
for Haematology Specialist Trainees
Aims of the Transfusion Training Checklist
The Transfusion Training Checklist for Haematology Trainees is aimed at integrating
transfusion training provided by the UK Blood Services with clinical and laboratory
training within hospitals. In England, NHS Blood & Transplant (NHSBT) organises
Essential, Intermediate and Revision courses targeted towards different seniority of
trainees.
It is recognised that there is variability between services and expertise within hospitals
so the provision of hospital based training should be considered within rotations as a
whole. The relevant practical training covering key topics can be split between smaller
general hospitals and teaching hospitals within the rotation.
Some of this practical training can be undertaken within extended attachments to the
blood service where available.
The trainees in conjunction with the educational supervisor should agree time frames for
completion of the different topics in the checklist.
The topics are mapped to the Joint Royal Colleges of Physicians Training Board
(JRCPTB) Haematology Curriculum 2010 (amendment 2012) available on the JRCPTB
website www.jrcptb.org.uk.
Examples for evidence for training collected such as case based discussion should be
entered into the trainee’s Haematology ePortfolio.
The checklist also includes examples of training resources available including e-learning
modules
In addition to gaining clinical and laboratory knowledge in Transfusion Medicine the
topics in the checklist promote interaction with other disciplines within Haematology ie
haemato-oncology, haemostasis, haemoglobinopathy as well as with other acute clinical
disciplines eg surgery, obstetrics, anaesthesia, paediatrics etc. with the aim of
developing essential liaison and communications skills.
Some of the terminology in this checklist in particular in relation to blood services is
applicable to England but can be amended if needed for other countries in the UK*.
*UK Blood services
NHS Blood and Transplant (NHSBT)
Scottish National Blood Transfusion (SNBTS)
Welsh Blood Service (WBS)
Northern Ireland Blood Transfusion Service (NIBTS)
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1. Introduction to the hospital transfusion service
Topic Date
Induction session with Consultant lead for Transfusion overview of Hospital Transfusion
Service
Meet members of the Hospital Transfusion Team
Trust Protocols & Guidelines
Transfusion Policy
Massive haemorrhage – including Obstetrics, trauma, surgery, GI bleed, use rVIIa
including communication between lab and clinical teams
Warfarin reversal, Bleeding with Novel Oral Anticoagulants (NOACs) & antiplatelet
agents
Special requirements for haemato—oncology patients eg Irradiated components
Policy for use of CMV negative components
MSBOS
Patients refusing blood transfusion
Introduction to Patient Blood Management
2. Basic Transfusion Laboratory techniques
Topic Date
Routine ABO and RhD typing
Emergency ABO & RhD typing
Antibody screening & identification
Crossmatching
Electronic issue of blood components
Patient identification – correct labelling of samples
Reason for transfusion on requests
Communication between clinical teams and Transfusion laboratory
3. Use of blood and components
Topic Date
Storage, shelf-life, Indications/contra-indications and transfusion triggers for use of the
following
Red cells
Platelets
Fresh Frozen Plasma
Solvent detergent plasma
Methylene Blue Treated plasma
Cryoprecipitate
Fibrinogen concentrate
Specialist products, e.g. washed red cells, washed platelets, granulocytes
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4. Clinical Transfusion practice
Topic Date
Attend meetings of the Hospital Transfusion Team
Hospital Transfusion Committee/Regional Transfusion Committee
Contribution to audit of blood usage - (local or national)
Trust Guidelines on
Paediatric and Neonatal Transfusion
Anti D Prophylaxis
IVIG use
Plasma -exchange
Major incident plan
BCSH transfusion guidelines
Blood Conservation and transfusion alternatives
Use of Intra-operative cell salvage
Pre-op haemoglobin optimisation
Tranexamic acid
Patient information and consent for transfusion
(Learn Blood Transfusion e learning module)
Haemato-oncology patients
Selection of blood and components for ABO mismatched SCT
Stem cell harvest and principles
5. Transfusion Laboratory and immunohaematology problems
Topic Date
Attendance in transfusion laboratory to observe the following:
DAT testing
FMH Testing (Kleihauer)
Positive antibody screen with review of additional testing and if needed involvement
reference centre
Review knowledge of following blood systems
ABO – A, B (and H) Rh – C, c, D, E and e
Kell – K and k Duffy – Fya and Fyb
MNS – M, N, S, s, (U) Kidd – Jka and Jkb
Others – rare blood groups
Emergency provision of blood to patients with red cells antibodies
How to source ‘rare’ units where blood not readily available
Criteria for selection of red cells for transfusion in sickle and thalassaemia patients
Principles of manual and automated red cell exchange transfusion
Neonatal and Paediatric components available and indications for use
Local Anti D prophylaxis regimes and system for traceability
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6. Transfusion reaction and adverse events
Topic Date
Case-based discussion where there has been an adverse event
Review of recent cases reported to SHOT / SABRE from the hospital
Review main hazards involved in the transfusion of blood components- management and
avoidance
Incorrect Blood Component Transfused
Acute haemolytic transfusion reactions (ATR)
Haemolytic transfusion reactions (HTR)
Transfusion-related acute lung injury (TRALI)
Transfusion-associated circulatory overload (TACO)
Transfusion-associated graft versus host disease (TA-GvHD)
Transfusion-transmitted infections (TTI)
Others – PTP, other SHOT categories
Learn Blood Transfusion elearning module on ‘Transfusion Reactions’
7. Regulatory Aspects of Transfusion
Topic Date
Impact of BSQR on hospital transfusion practice
Quality management system – review validation of recently acquired equipment
Training
Traceability – review systems used at hospital
Haemovigilance overview (SHOT/SABRE)
BSQR compliance reports
Role of MHRA
External Quality Assurance
Review local Transfusion NEQAS reports
Discuss report with Consultant Lead for Transfusion where preventative and
corrective action required (actual or hypothetical)
CPA – Review standards for compliance
8. Case review
Date
Topic
Management of auto-immune haemolytic anaemia – investigation and provision of blood
A patient refractory to random platelet transfusions
Positive antenatal serology with risk of HDFN
Management of a case of intra-partum fetomaternal haemorrhage in a D negative mother
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Management of the fetus / neonate in a case of HDFN
Neonatal exchange transfusion or intauterine transfusion
Investigation and management of suspected Neonatal Alloimmune Thrombocytopenia
Transfusion in a patient with sickle cell disease
Provision of blood and blood products to a patient who has undergone a recent allogeneic
stem cell transplant
Management of a severe acute transfusion reaction (including ABO incompatibility,
anaphylaxis, infected unit, TRALI etc) – review cases published in SHOT report
Case of therapeutic plasma exchange
Management of chronic transfusion programme in patient with thalassaemia and/ or patient
with MDS
Massive transfusion in trauma, obstetrics or a GI bleed in a medical patient
Selection of blood and pre transfusion testing where there are multiple RBC antibodies
Management of patient refusing blood transfusion
Additional cases Date
Resources available:
1. Handbook Transfusion Medicine 5th edition 2014 www.transfusionguidelines.org
2. Practical Transfusion Medicine 4th edition 2013 Wiley-Blackwell
3. BCSH Guidelines – various at www.bcshguidelines.org ( inc Apps now available)
4. The UK Blood services ‘Red book’ www.transfusionguidelines.org
5. NHSBT website for hospitals www.hospital.blood.co.uk
6. Learn Blood Transfusion elearning modules – various,ask Hospital Transfusion Team for
access details
7. Patient information leaflets – various at http://hospital.blood.co.uk/
8. SHOT at http://www.shotuk.org/
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