What Has SHOT Told Us and What Are We Doing About It?

Abstract

The UK haemovigilance scheme Serious Hazards of Transfusion (SHOT) has just issued its 7th report. Particpiation remains high, and is now actively encouraged by the Dept of Health. The main areas of concern over this period have been hospital errors, bacterial contamination, and more recently transfusion-related acute lung injury (TRALI). Post-transfusion purpura and transfusion-associated graft-versus-host disease, which were already uncommon, have virtually disappeared since universal leucocyte depletion in 1999. To minimise hospital errors, new guidelines for blood administration have been issued, and hospitals are trialling bar code equipment from patient wrists bands and blood fridges, which presents implementation challenges. SHOT is working with the new National Patient Safety Agency on further measures to reduce errors. Bacterial reduction is being approached in a stepwise manner, with new 2-stage donor arm cleansing being rolled out, and blood bag divert pouches now universal. Bacterial screening and pathogen reduction remain under consideration. Review of donors and components associated with TRALI cases showed a strong association between HLA- or HNA- positive female donors and ‘high plasma’ components (FFP and platelets). Therefore we are moving towards ‘male only’ FFP, and approach which requires neither donor testing or deferral. We have achieved 90% success so far, and some centres also use male plasma for suspension of buffy coat pools. Additional options for platelets including additive solution are being considered. Future haemovigilance data will assess the impact of these initiatives.