Conference report: International Haemovigilance Seminar and the SHOT Annual Symposium, 10–12 July 2018

Abstract

The Annual SHOT Report was published on July 12 at the Annual Symposium. This was preceded by a 2-day meeting of the International Haemovigilance Network (IHN). The IHN meeting provides an opportunity for haemovigilance experts to network with one another and share presentations, which this year included those from China and Taiwan. Reviews of pulmonary complications were highlighted since the definitions of both transfusion-related acute lung injury and transfusion-associated circulatory overload are undergoing revision. The seminar provided an opportunity to present some UK data to an international group (the INTERVAL donor study, the value of big data and work on genomics and human factors). SHOT reports for incidents reported in 2017 demonstrate that, overall, 85·5% are caused by errors. Key recommendations from SHOT are: (i) All staff involved in transfusion must be trained in and know ABO group compatibility. Clinical staff must not just rely on the laboratory staff to get this right. (ii) IT systems have the potential to increase transfusion safety by minimising human factors and should be considered for all transfusion steps. (iii) A formal risk assessment for transfusion-associated circulatory overload should be undertaken wherever possible.