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Transfusion Resource Handbook 2018

Contents

Transfusion Resource Handbook 2018 ................................................................................................................... 1

Abbreviations and acronyms .................................................................................................................................... 3
Introduction ................................................................................................................................................................ 5
The Australian context .............................................................................................................................................. 5
Transfusion Nurse/Trainer/Safety Officer ................................................................................................................ 5
Blood Matters program .............................................................................................................................................. 6
History ......................................................................................................................................................................... 6
Current ........................................................................................................................................................................ 6
What provides structure and informs your practice? ............................................................................................ 7
Australian Health Ministers’ Conference Statement on National Stewardship Expectations
for the Supply of Blood and Blood Products (Nov 2010) ....................................................................................... 7
National Blood Authority Patient Blood Management Guidelines ........................................................................ 7
National Safety and Quality Health Service Standards – second edition ............................................................ 8
ANZSBT guidelines .................................................................................................................................................... 8
Australian standard - AS 3864.2 - 2012 .................................................................................................................... 9
Medical refrigeration equipment - For the storage of blood and blood products ............................................... 9
Transfusion team ....................................................................................................................................................... 9
Blood Management Committee (BMC)/Transfusion Governance Group (TGG)/Hospital
Transfusion Committee (HTC) or Patient Blood Management Committee (PBMC) ........................................... 9
Resources ................................................................................................................................................................. 10
Guidelines and hospital circulars........................................................................................................................... 10
International sites..................................................................................................................................................... 11
Education events for TN/TT/TSOs .......................................................................................................................... 12
Graduate Certificate in Transfusion Practice ........................................................................................................ 12
Transfusion journals ................................................................................................................................................ 13
Educational materials .............................................................................................................................................. 14
Professional organisations: .................................................................................................................................... 15
ANZSBT and ANZTP ................................................................................................................................................ 15
Membership of ANZTP........................................................................................................................................ 16
ISBT and TP forum ................................................................................................................................................... 16
Transfusion Practitioner (TP) Forum* .................................................................................................................... 16
The Blood Service .................................................................................................................................................... 17
Blood donation ......................................................................................................................................................... 17
Donors and blood donation .................................................................................................................................... 17
Testing ....................................................................................................................................................................... 18
Test results ............................................................................................................................................................... 18
The decision to transfuse ........................................................................................................................................ 19
Patient blood management (PBM) guidelines ....................................................................................................... 19
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Pretransfusion testing ............................................................................................................................................. 19

Blood types ............................................................................................................................................................... 20
Are they compatible? ............................................................................................................................................... 20
Chart for red cell compatibility (http://www.donateblood.com.au/about-blood/types ) .............................. 20
ABO component compatibility table
(http://www.transfusion.com.au/blood_basics/compatibility ) ...................................................................... 21
Blood products ......................................................................................................................................................... 22
Fresh components ................................................................................................................................................... 22
Fractionated plasma products ................................................................................................................................ 22
CSL Behring products ............................................................................................................................................. 23
Synthetic blood clotting factors ............................................................................................................................. 24
Consent ..................................................................................................................................................................... 25
Introduction .............................................................................................................................................................. 25
Important points ....................................................................................................................................................... 25
Important points to cover when obtaining informed consent ............................................................................. 25
Explain: ................................................................................................................................................................ 25
Ask:....................................................................................................................................................................... 25
Provide: ................................................................................................................................................................ 26
Document: ........................................................................................................................................................... 26
Consumer information on consent for transfusion .............................................................................................. 26
Clinical audit ............................................................................................................................................................. 27
Tips for auditing ....................................................................................................................................................... 27
Haemovigilance ........................................................................................................................................................ 28
The Blood Matters’ Serious Transfusion Incidents Reporting (STIR) system ................................................... 28
National Haemovigilance ......................................................................................................................................... 29
Waste reduction ....................................................................................................................................................... 30
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Abbreviations and acronyms

This list is a starting point for the abbreviations and acronyms used in blood transfusion, laboratory
blood bank, the Blood Service and haematology, feel free to copy the list and add your own as you find
them and those that are particular to your health service.

the Blood Service Australian Red Cross Blood Service

AABB American Association of Blood Banks
ABO ABO blood group system
ABMDR Australian Bone Marrow Donor Registry
ACHS Australian Council Healthcare Standards
ACSQHC Australian Commission on Safety and Quality in Healthcare
AHMAC Australian Health Ministers Advisory Council
AHP Approved Health Provider
ANH Acute normolvolaemic haemodilution
Anti D Rh D Immunoglobulin
ANZSBT Australian and New Zealand Society of Blood Transfusion
ANZTP Australian and New Zealand Transfusion Professionals
ATR Acute Transfusion Reaction
BCI Blood Component Information
BCSH British Committee for Standards in Haematology
BloodNet Online blood ordering and inventory system
BloodStar Online blood system for tracking, authorisation and review of intravenous
immunoglobulin use
BMAC Blood Matters Advisory Committee
BMC Blood Management Committee
BUG Blood User Group
CMV Cytomegalovirus
CoE Council of Europe
DAT Direct Antiglobulin Test
DEPM Department of Epidemiology and Preventative Medicine (Monash University)
DTR Delayed Transfusion Reaction
EBMP Emergency Blood Management Plan
EBV Epstein-Barr Virus
EDTA Ethlenediaminotetraacetic acid
ELISA Enzyme-linked Immunosorbent Assay
EQuIP Evaluation and Quality Improvement program
FDA Food & Drug Administration (USA)
FFP Fresh Frozen Plasma
FNHTR Febrile Non-Haemolytic Transfusion Reaction
Hb Haemoglobin
HBV Hepatitis B virus
HBC Hepatitis C virus
HDN Haemolytic disease of the newborn
HIV Human Immunodeficiency virus
HLA Human Leucocyte Antigen
HPA Human Platelet Antigen
HSANZ Haematology Society of Australia and New Zealand
HTC Hospital Transfusion Committee
HTLV Human T-cell Lymphotropic Virus
HTR Haemolytic Transfusion Reaction
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IBCT Incorrect Blood Component Transfused

ISBT International Society of Blood Transfusion
IVIg Intravenous Immunoglobulin
JBC Jurisdictional Blood Committee
KPI Key Performance Indicator
MBOS Maximum Blood Ordering Schedule
MoU Memorandum of Understanding
NAIT Neonatal Alloimmune Thrombocytopenia
NATA National Association of Testing Authorities, Australia
NAT Nucleic Acid Testing
NBA National Blood Authority
NBMS National Blood Management System
NBS National Blood Service (UK)
NBSCP National Blood Supply Contingency Plan
NBTC National Blood Transfusion Committee
NHMRC National Health and Medical Research Council
NHS National Health Service (UK)
NIg Normal immunoglobulin
NSQHS National Safety, Quality Health Service Standards
PBM Patient Blood Management
PTP Post-Transfusion Purpura
RCPA Royal College of Pathologists of Australasia
Rh Rhesus blood group
SABM Society for the Advancement of Blood Management
SCIg Subcutaneous immunoglobulin
SHOT Serious Hazards of Transfusion (UK)
SOP Standard Operating Procedure
STIR Serious Transfusion Incident Report
TACO Transfusion-Associated Circulatory Overload
TA-GVHD Transfusion-Associated Graft Versus Host Disease
THANZ Thrombosis & Haemostasis Society of Australia and New Zealand
TGA Therapeutic Goods Administration
TGG Transfusion Governance Group
TMS Transfusion Medicine Service
TN/TP* Transfusion Nurse/Transfusion Professional
TORC Transfusion Outcomes Research Collaborative
TRALI Transfusion-Related Acute Lung Injury
TSO Transfusion Safety Officer
TT Transfusion Trainer
TTI Transfusion-Transmitted Infections
TTP Thrombotic Thrombocytopenic Purpura
VAED Victorian Admitted Episodes Dataset
vCJD variant Creutzfeldt-Jakob Disease
VHIMS Victorian Health Incident Management System
VIDG Victorian Immunohaematology Discussion Group
VTIS Victorian Transplantation and Immunogenetics Service
WBIT Wrong Blood in Tube
WHO World Health Organization

* The term transfusion practitioner (TP) is used internationally to describe roles/titles that are referred to
in Australia as transfusion nurse, transfusion trainer, transfusion safety officer, transfusion quality
officer, transfusion clinical nurse consultant, or PBM coordinator. This term is not used in Australia to
prevent any possible confusion with the authorised and licensed Nurse Practitioner roles.
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Introduction
The Australian context
Health funding is complex with a mix of Commonwealth and jurisdictional contributions including an
active private health system.
The National Blood Authority (NBA) is a statutory agency within the Commonwealth Government’s
health portfolio that manages and coordinates arrangements for the supply of blood and blood products
and services on behalf of the Commonwealth and jurisdictional (State and Territory) governments. The
NBA reports to the health minister and the Jurisdictional Blood Committee (JBC).
The JBC is the conduit between governments and the NBA. Representation from all jurisdictions
provides positions on:
• blood policy, demand, supply planning and product distribution
• funding and evidence-based approaches to emerging products
• services and technologies
It oversees the NBA’s role in blood supply contracting.
Australia has only one fresh product supplier, The Australian Red Cross Blood Service (the Blood
Service), whereas fractionated products are managed through contracts with the successful tenders and
include Australian and international suppliers e.g. intravenous immunoglobulin, haemophilia products.
The Blood Service then distributes these products to health services.
The budget for blood and blood products is cost shared between the Commonwealth government at 63
per cent and jurisdictional governments at 37 per cent collectively.
At a jurisdictional level, blood budgets are distributed in a variety of ways,
 centrally controlled by the local jurisdictional health department (central),
 devolved to health services/pathologies where the proportional dollar value is attributed
according to designed usage/population figure (devolved), or
 partially devolved which is a mix of central and devolved funding. Where funding is devolved, it
is to public health services, not private.
Regardless of the funding model applied at the jurisdictional level, blood product costs are not passed
onto the Australian health consumer.

Transfusion Nurse/Trainer/Safety Officer

Within each state and territory, there are a number of transfusion nurses/trainers/safety officers, often
supported by jurisdictional programs. In Victoria, the transfusion nurses/trainers/safety officers are
supported by the Blood Matters team, who also provide support to roles in Tasmania, Australian Capital
Territory (ACT) and Northern Territory (NT), through Memorandums of Understanding. In New South
Wales, it is Blood Watch and South Australia has BloodSafe. Western Australia and Queensland
programs are no longer centrally coordinated; however, there are many roles within each of these
states. These programs provide support for the role and help direct activities within each state
dependant on the specific structure of these programs. The Blood Service also has Transfusion Nurse
roles covering all states and territories, with their focus being on facilitating specialist blood product
support.
Reference: Bielby, L., Akers, C., Francis, S., Darby, S., Campbell, L., Hollis, L., Quested, B. and Hogan, C. (2016), The role of the
transfusion safety coordinator in Australia. VOXS, 11: 118–125. doi:10.1111/voxs.12201
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Blood Matters program

History
The Blood Matters project commenced in April 2002, with the formation of a consortium composed of
the then Victorian Department of Human Services, Peter MacCallum Cancer Institute, The Royal
Melbourne Hospital and the Blood Service. This consortium developed and tested tools and processes
to improve transfusion practice in hospitals.
The Blood Matters project was expanded in 2003 to include an additional 12 public hospitals in a Blood
Matters Breakthrough Collaborative project; a project methodology developed by the Institute for
Healthcare Improvement (IHI) in the United States. These hospitals further tested and developed
transfusion interventions over an 18-month period.
The interventions included:
• improving clinician and patient awareness and knowledge of blood product use
• improving clinical decision making
• enhancing the blood administration process by making all successful practical improvement
strategies available to other hospitals in Victoria and Tasmania
As part of the Blood Matters project, the transfusion nurse (TN) role was established in metropolitan and
major regional hospitals. To support those in the role, the Blood Matters Consortium project developed
a postgraduate Certificate in Transfusion Practice. The Better Safer Transfusion (BeST) program was
established in 2004 continuing the work of the Blood Matters project and in 2008 changed its name to
the Blood Matters Program. In 2009, further funding was sought to provide workforce in the area of
transfusion improvement to regional and rural health services, with a focus on cancer services. A
transfusion trainer (TT) role was established. Currently 43 health services in Victoria employ either a
TN/TT or Transfusion Safety Officer (TSO) to undertake blood management and transfusion
improvement.

Current
The Blood Matters program is a joint initiative of the Cancer, Specialty Programs, Medical Research,
and International Health Branch of the Department of Health and Human Services, Victoria, and the
Australian Red Cross Blood Service. The goal of the program is to support and enhance best practice in
patient blood management (PBM), and the stewardship of blood and blood products, for improved
patient outcomes in Victorian health services. Tasmania, the ACT, and the NT collaborate with Blood
Matters regularly through Memorandums of Understanding.
The Blood Matters program is supported by a secretariat including a program manager, data and
information managers, a transfusion nurse, a PBM education coordinator and two project roles. One
targeting red cell wastage reduction and the other assisting health services implement subcutaneous
immunoglobulin (SCIg) programs. Blood Matters is structured such that expert working parties focus on
specific target areas, to determine strategies for improving transfusion and PBM practices. Blood
Matters is supported by a multidisciplinary advisory committee.
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What provides structure and informs your practice?

The following statements, guidelines, and standards are pivotal to providing the structure and evidence
for practice.

Australian Health Ministers’ Conference Statement on National

Stewardship Expectations for the Supply of Blood and Blood
Products (Nov 2010)
The Australian Health Ministers’ Conference has determined that a clear statement is needed on
governments’ stewardship expectations for the providers of blood and blood products within the health
sector. Stewardship, in this context, means responsible, sustainable and appropriate use of blood and
blood products. http://www.blood.gov.au/system/files/documents/nba-stewardship-stewardship-
statement.pdf

National Blood Authority Patient Blood Management Guidelines

The National Blood Authority (NBA) has funded and managed the development of a series of evidence-
based Patient Blood Management (PBM) Guidelines, comprising six modules.

All the modules are intended to assist and guide health-care professionals in making clinical decisions
when managing patients in the following clinical situations:
 Module 1 Critical Bleeding/Massive Transfusion
 Module 2 Perioperative – including pre, intra and postoperative of patients undergoing surgery
or invasive procedures, particularly those in which blood loss is anticipated.
 Module 3 Medical – including patients with acute or chronic medical conditions requiring
haematological intervention.
 Module 4 Critical Care
 Module 5 Obstetrics and Maternity for managing pregnant and postpartum women.
 Module 6 Neonatal and Paediatrics for blood management in neonatal and paediatric patients.
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National Safety and Quality Health Service Standards – second

edition
In 2011, the first edition of the Australian Commission on Safety and Quality in Healthcare National
Safety and Quality Health Service (NSQHS) Standards were released to drive the implementation of
safety and quality systems and improve the quality of health care in Australia. The NSQHS Standards
provide a nationally consistent statement about the level of care consumers can expect from health
services. Health services have been assessed to these standards since January 2013.
The second edition was released November 2017 and health services will be assessed to these new
standards from January 2019. The second edition addresses gaps identified in the first edition and
actions have been consolidated and streamlined to make them clearer and easier to implement and
reduces duplication.
The Blood and Blood Product standard has been renamed to the Blood Management standard. The
revised standard has added important aspects of patient blood management, acknowledging patients’
blood is a valuable and unique resource that should be conserved and managed well. This standard
aims to ensure that safe, appropriate, effective, and efficient blood systems are in place to minimise risk
associated with the use of blood products.
The Transfusion Governance Group (TGG), often known as the Blood Management Committee (BMC),
Hospital Transfusion Committee (HTC) or Patient Blood Management Committee (PBMC) play a very
important role in the health service to ensure that all actions for the standards are addressed and met.
This group develops and oversees systems to identify and coordinate actions to improve the quality of
practice across the range of activities relating to blood and blood products.
Rural or small metropolitan health services may not have access to the expertise available in larger,
metropolitan sites; therefore, the model should be varied so that the outputs still occur. In lieu of a
specific committee or group, hospital transfusion governance oversight may occur by adding transfusion
as an agenda item on an existing clinical governance committee such as a clinical review, risk
management or infection control committee. A team should be formed, however it may only consist of
two people with regular contact that ensures the direction and objectives set by the transfusion
governance group or equivalent, are implemented. Important individuals may be educators and/or those
in quality/risk roles.
Information on the National Safety Quality Health Service Standards and the accreditation process is
available at: https://www.safetyandquality.gov.au/our-work/assessment-to-the-nsqhs-standards/nsqhs-
standards-second-edition/

ANZSBT guidelines
The Australian & New Zealand Society of Blood Transfusion (ANZSBT) have developed a suite of
guidelines, which can be access via the following link: https://www.anzsbt.org.au/pages/anzsbt-
guidelines.html
Guidelines that will be of particular benefit to you are:

nd rd
Administration of blood products, 2 edition, 2011 (currently working on 3 edition)

st
Transfusion and immunohematology laboratory practice, 1 edition 2016
 Prevention of transfusion-associated graft-versus-host disease (TAGVHD), January 2011
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Australian standard - AS 3864.2 - 2012 - Medical refrigeration

equipment - For the storage of blood and blood products
The objective of this Standard is to safeguard recipients of blood transfusions by ensuring that blood
and blood products are properly and safely stored at the required temperature in refrigeration equipment
or walk-in rooms specifically manufactured for the purpose.
The Standard consists of two parts:
 Part 1: Manufacturing requirements
 Part 2: User-related requirements for care, maintenance, performance verification and
calibration.

Transfusion team
The ‘team’ expedites work determined by the committee and responds to transfusion issues that arise
between committee meetings, and therefore needs to have membership with relevant expertise.
The team may include a TN/TT/TSO, transfusion scientist, transfusion registrar, medical champion and
quality/risk representative.
The medical champion may vary depending on the work areas of the transfusion team and committee,
for example: a cardiac anaesthetist for cardiac-related work, an intensivist or a haematologist. Ideally,
the medical champion has a full-time or permanent appointment in the organisation for continuity.
The quality/risk management representative may be the quality or risk management coordinator. They
are a valued member because they have an understanding of national standards, systems in their
organisation and how to achieve hospital-wide change in practice. This knowledge is important for
transfusion improvement activities and to ensure the BMC/TGG/HTC/PBMC is embedded and visible
within the quality systems of the organisation.
The team should meet at regular intervals, however work should proceed between meetings and this
may be more as a ‘virtual’ team; collaborating and communicating as a single entity on the directions set
by the transfusion committee, or on issues arising between committee meetings. The TN/TT/TSO may
have a major coordination role for this team, if it is not taken up by a senior manager in the organisation.

Blood Management Committee (BMC)/Transfusion Governance

Group (TGG)/Hospital Transfusion Committee (HTC) or Patient Blood
Management Committee (PBMC)
To promote best practice in PBM and the use of blood and blood products, health services need robust
PBM/transfusion quality improvement and risk management programs including BMC or equivalent.
This requires commitment of the health service management and clinical/laboratory staff to a PBM/
transfusion infrastructure including a BMC, blood issue and PBM/transfusion policies, a maximum
blood-ordering schedule, and monitoring processes.
Not all health services will need to have a stand alone BMC, however all health services should have
structures and processes in place that fulfil the role and function of a BMC. A key responsibility of BMC
is risk management. The primary role of an BMC is to provide an active forum for communication
between staff directly involved in clinical and laboratory-based PBM/blood transfusion activities, to
provide solutions, feedback and education in relation to identified problems, and to ensure that
transfusion practice accords with best practice.
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Resources
Guidelines and hospital circulars
The following list includes current Australian guidelines, standards and Victorian Department Health and
Human Services hospital circulars available to inform your practice. Full versions of the guidelines,
standards and circulars can be found at the website links.

Title Website Year of

publication
National Blood Authority—NHMRC endorsed https://www.blood.gov.au/pbm- 2011-2016
patient blood management guidelines (Modules 1- guidelines
6)
Australian and New Zealand Society of Blood 2011
transfusion (ANZSBT)/Royal College of Nursing https://www.anzsbt.org.au/pages/anzs
Australia (RCNA)—Administration of blood bt-guidelines.html
products version 2 (3)
ANZSBT— Guidelines for transfusion and https://www.anzsbt.org.au/pages/anzs 2016
st
immunohaematology laboratory practice, 1 edition bt-guidelines.html

ANZSBT—Prevention of Transfusion-Associated https://www.anzsbt.org.au/pages/anzs 2011

Graft-versus -host disease (TA-GVHD) bt-guidelines.html

Australian Health Ministers Advisory Council http://www.blood.gov.au/system/files/d 2006

(AHMAC)—Guidelines for the use of recombinant ocuments/fviii-fix-guidelines.pdf
and plasma derived FVIII & FIX products
Immunoglobulin Product Authorisation and http://www.blood.gov.au/Ig-governance 2012
Management
An update of consensus guidelines for Warfarin https://www.mja.com.au/journal/2013/1 2013
reversal, on behalf of the Australasian Society of 98/4/update-consensus-guidelines-
Thrombosis and Haemostasis. warfarin-reversal

Department of Health & Human Services — http://health.vic.gov.au/hospitalcircular 2008

Hospital circular on traceability of blood and blood s/circ08/circ3208.htm
products 32/2008
https://www.safetyandquality.gov.au/ou 2017
National Safety Quality Health Service Standards r-work/assessment-to-the-nsqhs-
Second edition – Blood Management standard standards/nsqhs-standards-second-
edition/
Australian Standard -AS 3864v2-2012 Medical 2012
refrigeration equipment – for the storage of blood https://infostore.saiglobal.com/en-
and blood products-user –related requirements for au/Standards/AS-3864-2-2012-
care, maintenance, performance verification and 1600491/
calibration
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International sites
The following sites may also provide useful information to inform your work.

Title Website
British Committee for standards in http://www.b-s-h.org.uk/guidelines/
haematology
American Association of Blood Banks http://www.aabb.org/Pages/default.aspx

Better Blood Transfusion Programme – NHS http://www.betterblood.org.uk/

Scotland
British Society of Haematology http://www.b-s-h.org.uk/

Canadian Society for Transfusion Medicine http://www.transfusion.ca/Home

Serious Hazards of Transfusion (SHOT) http://www.shotuk.org/home/

National Health Service Blood and Transplant http://www.nhsbt.nhs.uk/

(UK)
International Society of Blood Transfusion http://www.isbtweb.org/

Ontario regional blood coordinating network http://transfusionontario.org/en/

(ORBCoN)
Ontario Nurse Transfusion Coordinators https://www.ontracprogram.com/Login.aspx?company=&R
(ONTraC) eturnUrl=%2fdefault.aspx

Network of Advancement of Patient Blood http://nataonline.com/

Management, Haemostasis and Thrombosis
(NATA)
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Education events for TN/TT/TSOs

Education is fundamental to ensure that staff working in the area of transfusion/PBM have the
knowledge and understanding to provide high quality, effective and safe patient care. It is an ongoing
process, requiring regular updates and reinforcement to keep pace with changes, to reduce errors and
risk, and improve patient outcomes. Providing education and acting as a resource is a significant part of
the TN/TT/TSOs role.
There are a range of education opportunities for TN/TT/TSOs to support their development and
enhance their knowledge and skills to undertake or enhance their roles as providers of education.
These include the acquisition of knowledge through:
 on the job training
 mentorship from a transfusion specialist, scientist or nurse
 support from members of the Blood Management Committee
 support from the Blood Matters team.
Blood Matters also holds two forums each year for TN/TT/TSOs affiliated with the Blood Matters
program. These forums are an opportunity to network with other transfusion nurses, trainers, and safety
officers, provide updates on current transfusion practice, and the activities of the Blood Matters
Program.
Please contact Blood Matters for further information bloodmatters@redcrossblood.org.au
The Blood Service provides educational opportunities to all clinicians which includes eLearning and
webinars. For further information on available education opportunities go to
https://learn.transfusion.com.au/

Graduate Certificate in Transfusion Practice

The Graduate Certificate in Transfusion Practice is highly recognised and valued in the blood sector.
The course incorporates transfusion practice and guidelines and patient blood management strategies
to achieve best practice in transfusion.
The course is recommended for all new TN/TT/TSOs.
In 2017, the course has been completely reviewed with the addition of the Specialist Certificate in Blood
Management Foundations for health care professionals with a responsibility for managing organisational
compliance with Standard 7 and associated activities.
Offered by the Melbourne School of Health Sciences at The University of Melbourne, in partnership with
the Blood Service through the Blood Matters program, the course is the only one of its kind in the
southern hemisphere and is endorsed by the International Society of Blood Transfusion (ISBT)
Academy. The online course is facilitated by an experienced Clinical Nurse Educator. The course is
open to anyone interested in working as a resource in the area of transfusion/PBM practice,
predominately from nursing, and laboratory specialties.
The course is delivered part time with Foundations in Blood Management in the first semester and
Advanced Concepts in Blood Management and a Quality Practice Portfolio in the second semester.
The Specialist Certificate in Blood Management is a foundation-training course for healthcare
professionals who work in areas where blood or blood products are transfused or for those staff
members responsible for managing organisational compliance with the National Standards and
associated activities. It introduces the concepts of PBM, safety and governance relating to blood. This
subject supports the development of specific skills, and provides information to assist health services to
meet these National Standards.
13

The Graduate Certificate in Transfusion Practice builds on the knowledge and expertise gained in the
Specialist Certificate in Blood Management and provides advanced knowledge of clinical practice
guidelines and PBM strategies. It focuses on the critical-thinking and leadership skills required to
implement transfusion and/or PBM practice improvement initiatives within a clinical department/health
service, with practical approaches to change management, audit and leadership.
Information is available at: https://www2.health.vic.gov.au/hospitals-and-health-services/patient-
care/speciality-diagnostics-therapeutics/blood-matters/graduate-certificate-transfusion and the direct link
to the University of Melbourne http://commercial.unimelb.edu.au/custom-
education/courses/transfusionpractice

Transfusion journals
This is not an exhaustive list of resources, but provides a starting point for those new to the role. As you
progress in the role, you will develop a suite of resources that are useful to your practice.
1. Transfusion
2. Vox Sanguinis
3. Transfusion and Apheresis Science
4. Transfusion Medicine
5. Transfusion Medicine Reviews
6. British Journal of Haematology
7. Haematological Journal of the European Haematology Association
8. Journal of Thrombosis and Haemostasis
9. Transfusion Alternatives in Transfusion Medicine
10. ISBT Science Series
11. Journal of Infusion Nursing
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Educational materials
The following websites provide education materials that may be used for both staff and patients.

Title Website Comments

Includes Blood
Management Standard
tools and resources, audit
Blood Matters www.health.vic.gov.au/bloodmatters templates and reports,
serious transfusion
incident (STIR) information
etc.
Includes information on
http://www.sahealth.sa.gov.au/wps/wcm/connect/pu blood administration and
BloodSafe blic+content/sa+health+internet/clinical+resources/cl anaemia management,
inical+programs/bloodsafe/bloodsafe including tools related to
iron supplementation.
Provides courses for all
staff on various aspects of
BloodSafe eLearning the transfusion process,
https://bloodsafelearning.org.au/
Australia administration, critical
bleeding, patient blood
management etc.
Provides patient
http://www.cec.health.nsw.gov.au/programs/blood-
Blood Watch watch
information brochures in
several languages.
Provides information on
products and reactions.
Australian Red Cross http://www.transfusion.com.au/ There are a number of
Blood Service
educational webinars etc.
that you can attend.
Australian Red Cross Website for patients and
Blood Service Patient http://mytransfusion.com.au/ carers with information on
Information the transfusion process.
Australian Red Cross Provides information on
Blood Service Donor http://www.donateblood.com.au/ the donation process,
information eligibility and bookings.
Provides information on
Western Australia
http://www.health.wa.gov.au/bloodmanagement/ho setting up PBM programs
Patient Blood me/ with tools and resources to
Management Program
support this.
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Professional organisations:

ANZSBT and ANZTP

ANZSBT is an internationally recognised professional society that comprises members from diverse
scientific, technical, and medical backgrounds working within the areas of blood transfusion and
transfusion medicine within Australia and New Zealand.
The broad aims of the ANZSBT are:
 The advancement of knowledge in blood transfusion and transfusion medicine
 The promotion of improved standards in the practice of blood transfusion
 The collaboration with international and other regional societies interested in blood
 The promotion of interest in research into blood transfusion and allied subjects
 The formulation of guidelines in key areas of transfusion practice

The ANZSBT is affiliated with the following societies:

 Australasian Society of Thrombosis and Haemostasis - www.asth.org.au
 Haematology Society of Australia and New Zealand (HSANZ) - www.hsanz.org.au
 British Blood Transfusion Society (BBTS) - www.bbts.org.uk
 International Society of Blood Transfusion (ISBT) - www.isbt-web.org
 Australian Society of Medical Research (ASMR) - www.asmr.org.au
ANZSBT membership offers benefits for members through networking, publications, eligibility to apply
for awards and grants, members only access to transfusion journals and a discount to attend the annual
scientific meeting (usually held in October).
Requirements to join the ANZSBT and affiliate with the ANZTP are available at
https://www.anzsbt.org.au/pages/how-to-join.html
There may be other organisations, specific to your occupation, such as the Royal College of Nursing,
Australia and the Australian Institute of Medical Scientists, which you may wish to consider.
In 2011, those working in the area of transfusion nursing formed the Transfusion Professionals Network
(TP Network) special interest group under the auspices of the ANZSBT.
The ANZTP Network aims to improve transfusion practice by:
 promoting consistency in transfusion practice
 contributing to patient blood management practices
 sharing knowledge and experience gained from local implementation of practice change,
particularly with reference to national transfusion guidelines and standards.
16

Membership of ANZTP
Members of ANZSBT who are nurses, midwives, scientists or other health professionals in advanced
roles, undertaking quality improvement and clinical practice in transfusion and patient blood
management.
Areas of interest/activities:
 Provide support, education, advice and exchange of information within the group for new and
existing transfusion professionals, and externally, as requested
 Identify areas for transfusion practice audit, other quality improvement activities and research
as well as facilitate participation, feedback of results, recommendations and interventions
 Work collaboratively with the ANZSBT Council and Standing Committees to identify issues and
areas of common interest for the attention by the Society
 Provide suggestions and support for formal (external) communications, educational and other
materials, for coordination and endorsement through Council and Standing Committee Chairs.

ISBT and TP forum

The International Society of Blood Transfusion (ISBT) is a scientific society that was founded in 1935.
Since that time, the ISBT has grown in to an international society where transfusion medicine
professionals from across the globe come together and do the one thing they do best: share knowledge
to improve the safety of blood transfusion worldwide.
The society’s most important activity is to promote science and education related to blood, cells and
transplantation. They have created an educational platform; the ISBT Academy ePortal. This eLearning
facility includes webcasts of ISBT congress presentations and a library of transfusion guidelines.
In addition the society:
 Encourages and supports the ISBT Working Parties that focus on the study of specific topics.
 Publish a scientific journal Vox Sanguinis and provide other high quality educational print and
electronic material.
 Organise International and Regional congresses.
 Support and participate in regional workshops, seminars, and congresses either financially or
by use of the ISBT logo.
 Support professionals from low and medium development index countries financially.
Membership information can be found at: http://www.isbtweb.org/my-isbt/isbt-membership/

Transfusion Practitioner (TP) Forum*

The Transfusion Practitioners (TP) forum has been established with the Clinical Transfusion Working
Party to promote the role and value of TPs within the international blood sector. The forum provides a
platform for international TP collaboration; where knowledge and experience can be shared to support
development of initiatives and practices of safe transfusion practice, implementation of patient blood
management and haemovigilance. The Transfusion Practitioners also have their own online discussion
forum on the ISBT Forum; you can join by contacting communication@isbtweb.org
17

The Blood Service

Blood donation
The Blood Service collected1.3 million individual donations in 2016-17 [Blood Service Annual report
2016-17] from 461,268 donors with 97,635 being new blood donors.
Each week 27,000 donations are required to meet demand. The Blood Service attracts and retains
donors through regular advertising and marketing campaigns. The Blood Service also provides advice,
information and education about blood products and practices to clinicians and health professionals,
through Medical Services. Further information is available at https://transfusion.com.au/
The Blood Service was established as a national organisation in 1996, but its history dates back to 1929
through various state and territory Red Cross transfusion services. Since 2005–06, The Blood Service
has been fully funded by the governments of Australia through an agreement with the NBA. Blood and
blood products utilised at health services are funded by Australian Federal Government contributing 63
per cent of funding and each of the eight state/territory governments contributing the remaining 37 per
cent proportion.
In Australia, blood and its components are collected at fixed and mobile collection centres in
accordance with recommendations from the World Health Organization (WHO), the International
Society of Blood Transfusion (ISBT) and the International Federation of Red Cross and Red Crescent
Societies. Blood donations are made voluntarily and are non-remunerated.
The Blood Service works alongside Australian regulators, government departments and commercial and
professional organisations, as well as international bodies, to constantly review and improve the safety
and provision of blood and blood components in Australia.

Donors and blood donation

Donors are required to be aged between 18 and 70 years, weigh more than 50 kg and be fit and
healthy, at the time of donation. Donors are asked to complete a donor questionnaire prior to donating.
This confidential and legally binding form asks about health and lifestyle and whether they are eligible to
donate blood on that day. Donors are interviewed by a trained member of staff, with the short interview
including a health check, a haemoglobin check and blood pressure. This discussion takes place each
time the donor donates, to assess recent health and determine that nothing has altered since the last
visit.
Approximately 470 mL whole blood is donated. For the majority this is around 10 per cent of their total
blood volume and can be donated safely every 12 weeks. Total time taken to give this amount in a
whole blood donation is around 10 minutes. A whole blood donation is separated into three critical
components: red cells, plasma, and platelets.
Donors can specifically donate plasma and/or platelets through apheresis donation and this can occur
every two to three weeks. Donating this way takes approximately an hour. Donor information is
available at http://www.donateblood.com.au/
Worldwide the demand for red cells is reducing and in Australia, demand for red cell units dropped by
almost 8 per cent in 2013/14, and expected to decline by a further 3 per cent in the 2014/15 financial
year. In contrast to declining demand for red cell units, Australia is seeing exponential growth in the use
of plasma. The number of plasma donations in Australia is growing by an average of 14 per cent per
year. In 2016-17, more than 500,000 plasma donations were required.
18

Testing
Each time blood is donated samples are taken for testing. The Blood Service tests the donation for ABO
group, Rh D group and other red cell antibodies. All donations for clinical use are also tested for five
transfusion-transmissible infections. These are:
• HIV
• hepatitis B
• hepatitis C
• human T-cell lymphotropic virus (HTLV)
• syphilis
Specifically, blood donations are tested for the hepatitis B surface antigen, antibody to hepatitis C,
antibody to both HIV-1 and HIV-2, antibody to HTLV types I and II and antibodies to syphilis. From
2016, apheresis plasma for fractionation donations are no longer tested for HTLV and syphilis.
All donations for clinical use are tested for HIV-1, hepatitis B (HBV) and hepatitis C (HCV) RNA using
Nucleic Acid Testing (NAT). This process is different from traditional testing because it looks for the
actual presence of viruses, in this case HIV, HBV and HCV. Most other tests detect the presence of
antibodies, which are the body’s response to an infection and which take time to develop. NAT provides
an opportunity to further improve the safety of the blood supply by reducing the ‘window period’, which
is the time between exposure to a virus to the time current tests are able to detect antibodies to the
virus.
The Blood Service also performs a test for malaria on donations from donors who have reported
residence in, or travel to, an area with malaria. Other tests such as CMV antibodies are performed on
some donations.
Each platelet component is tested 24 hours after collection for bacterial contamination; samples are
cultured in both aerobic and anaerobic culture bottles. Platelets are issued as ‘negative to date’, with
cultures continuing to incubate over the full shelf life of the components and 3 days beyond the expiry. If
a culture becomes positive, the screening equipment automatically flags this as ‘initial machine positive’
(IMP), if these have been issued to a health service they will be notified.

Test results
The Blood Service notifies its donors of any abnormal results on infectious disease and red cell antibody
screening once testing is completed. The donor is advised about the health implications of the positive
tests. As with all information held by the Blood Service, the information is confidential and released only
to the donor and agencies, such as the Department of Health and Human Services, as required by law.
19

The decision to transfuse

The decision to transfuse a patient should be based on the clinical picture of the patient, not laboratory
results alone.
Guidelines from the NBA are available, as outlined below, covering different groups of patients and are
formed using the most current available evidence.

Patient blood management (PBM) guidelines

PBM encompasses a holistic approach to the use of blood products for each individual patient; using
the premise of ‘why transfuse’ rather than ‘why not’. It focuses on the need to carefully balance benefits
and potential harm. Transfusion avoidance or minimisation stems from the belief that blood and its
components are biological products, the effects of which are not fully understood, and have the potential
for unwanted consequences.
PBM has the patient at its centre, and aims to maximise haemoglobin (preoperatively, intraoperatively
and postoperatively); minimise blood loss (including sample collection) and use alternatives to blood
transfusion where these are available and feasible.
The National Blood Authority (NBA), on behalf of all governments, has produced six modules as part of
a comprehensive, evidence-based suite of PBM Guidelines.
The guidelines are:
• Module 1 Critical Bleeding/Massive Transfusion
• Module 2 Perioperative
• Module 3 Medical
• Module 4 Critical Care
• Module 5 Obstetrics
• Module 6 Paediatric/Neonates
The modules are developed by Clinical/Consumer Reference Groups (CRGs). Each CRG has active
representation from the clinical community, colleges, organisations and societies. You can view and
download the modules or order the modules and Quick reference guides free of charge by going to the
NBA website http://www.blood.gov.au/pbm-guidelines

Pretransfusion testing
Pretransfusion testing is undertaken to determine a patient’s blood group and antibody status to enable
a suitable donor product to be selected and transfused. The pretransfusion test is known as a ‘Group
and Hold’ or a ‘Group and Screen’ (G&H, G&S). This test must be performed at least once prior to
routine transfusion of any fresh blood product. Once the G&H is completed, red blood cells can be
issued on request for up to 72 hours following sample collection. For all red cell transfusions a
crossmatch is required, where donations are confirmed to match the patients’ blood type. This may be
done electronically (where available), if the patient has a negative antibody screen and no history of
antibodies. Alternatively, a full crossmatch is performed. This involves mixing donor red cells with the
patient’s plasma to check compatibility. If the antibody screen is positive, the antibody identification may
take a further 1-4 hours. Once the specificity of the antibody has been determined, donor units negative
for the cognate antigen must be sourced and crossmatched for the patient. If the antibodies are
complex or uncommon it may take time to source suitable donations.
20

Blood types
Blood type is jointly inherited from your parents. A combination of genes determines the presence or
absence of substances called antigens, on the surface of all your red blood cells. These antigens are
capable of stimulating an immune response.
In 1901, an Austrian scientist, Karl Landsteiner, found that reactions between these antigens and other
substances in plasma, called antibodies, sometimes caused the red blood cells to clump together
(agglutinate) resulting in adverse reactions in transfusion recipients. After further experiments, he
identified four blood groups based on the presence or absence of two specific antigens which we now
know as A and B.
This discovery paved the way for a system of blood grouping called the ABO system.
In 1939 and 1940, research involving rhesus monkeys identified another grouping factor called the
Rhesus factor: Rh factor or D antigen. People, regardless of their ABO blood group, who were found to
have a D antigen present were grouped as Rh positive and those without the D antigen were grouped
as Rh negative. The Rhesus group is indicated by a ‘+’ (Rh positive) or ‘-’ (Rh negative) after a person’s
ABO type; for example: A+ or O-. All these groups are genetically inherited. People who are Rh
negative may develop an antibody (called anti-D) if they are exposed to the D antigen during pregnancy
or a blood transfusion.
In addition to these two antigens there are many other red cell antigens that can cause reactions in
patients. Some examples are Kell, Duffy, MNS and Rhesus (c, C, e, E).
Further information on this topic can be found at the Blood Service website:
http://www.transfusion.com.au/ or any of the recommended texts.

Are they compatible?

The transfusion of compatible blood is fundamental to safe transfusion. When red cells are transfused, it
is preferable that patients receive blood of the same ABO and Rh (D) group, however in an emergency,
if the required red cell blood group is unavailable, the patient may be given another ‘compatible’ blood
group. Rh (D) positive patients may safely receive Rh (D) negative blood. In exceptional circumstances
Rh (D) negative patients may need to receive Rh (D) positive red cells. Further information on
compatibility for red cells, plasma and platelets is available through the Blood Service website
http://www.transfusion.com.au/blood_basics/compatibility , http://www.donateblood.com.au/about-
blood/types

Chart for red cell compatibility (http://www.donateblood.com.au/about-blood/types )

21

ABO component compatibility table

(http://www.transfusion.com.au/blood_basics/compatibility )
22

Blood products
Fresh components
These very useful resources are available providing information on all fresh blood products and any
modifications to these products:

1. The Blood Service-Blood Component Information – Circular of Information An extension of blood

component labels is updated regularly and can be downloaded from:
http://resources.transfusion.com.au/cdm/ref/collection/p16691coll1/id/18

2. The Blood Service and BloodSafe (South Australia) Flippin’ Blood – a flip chart to help make
transfusion practice straight forward and as a bedside resource to assist with correct transfusion
practice. Available at: http://resources.transfusion.com.au /
(http://resources.transfusion.com.au/cdm/search/searchterm/flippin%20blood/order/nosort)

3. Transfusion pack check – This is a learning resource for checking a blood component pack before
transfusion, complete with exercises for students, which is available at:
http://resources.transfusion.com.au
(http://resources.transfusion.com.au/cdm/search/searchterm/pack%20check/order/nosort)

4. Transfusion fact sheets –The Blood Service created fact sheets to provide basic information about
blood, blood components, transfusion and related concepts. These are available at:
http://resources.transfusion.com.au
(http://resources.transfusion.com.au/cdm/search/searchterm/Fact%20sheet!PDF/field/type!format/mode
/all!all/conn/and!and/order/nosort)

Fractionated plasma products

CSL Behring (formerly CSL Bioplasma) has been Australia’s national fractionator of plasma-derived
therapeutics since 1952 and is regulated by the Therapeutic Goods Administration (TGA). Plasma is
provided by the Blood Service from voluntary Australian donations to produce high-quality plasma-
derived therapeutics. This includes:
• Immunoglobulins: both intravenous immunoglobulin and other immunoglobulins
• Clotting factors
• Albumex
(see chart below for further information)
The growth in demand for intravenous immunoglobulin (IVIg) means it must be reserved for use in those
with the greatest need. Australia has not been able to fully supply all the IVIg it requires for a number of
years, so in 2008 criteria for access to IVIg funded under the National Blood Agreement was developed
and endorsed by the Australian Health Ministers Advisory Council for use by clinicians, these criteria
were updated in 2012 and 2017. Version 3 will be available in 2018.
Nationally there are three funded IVIg products available, CSL Behring – Intragam 10 and Privigen,
Grifols – Flebogamma. A presentation about the current products is available on the Blood Matters
website (https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/speciality-
diagnostics-therapeutics/blood-matters/ivig-changes-to-supply ) The Blood Service distributes IVIg to
health services for patients. Clinicians may stipulate which imported product they wish their patient to
receive, however Intragam 10 (domestically produced IVIg) cannot be requested as distribution is
23

allocated by the Blood Service. All products are approved by the TGA for therapeutic use. The following
table outlines both IVIg and subcutaneous immunoglobulin (SCIg) products currently available.

Current supply arrangement

®
Imported IVIg products Grifols Australia
Flebogamma 5%
®
Flebogamma 10% Grifols Australia
®
Privigen 10% CSL Behring

Domestic IVIg product Intragam 10 (10%) CSL Behring

®
Imported SCIg products CSL Behring
Hizentra 20%
Domestic SCIg product Evogam 16% CSL Behring
If a patient’s condition is outside the current criteria for IVIg use it may be possible to access an
imported IVIg product using the Direct Order process.
The governance of IVIg is strictly enforced and information on the process for authorisation and
management of IVIg products can be found at http://www.blood.gov.au/Ig-governance

CSL Behring products

Used when the blood volume is low, during heart-lung bypass
Albumex® 4%
surgery and in plasma exchange
Used when quantity of albumin in blood is low, for resuscitation in
Albumex ®20%- shock, in extensive burns, respiratory distress syndrome, blood
purification and plasma exchange
Used for patients with haemophilia A, in which there are reduced
Biostate®
levels of factor VIII and for von Willebrand disease
Used to replace antibodies to help prevent infections and to treat
Intragam 10 (10%)
some autoimmune disorders
Used for the prevention and treatment of bleeding in patients with
Prothrombinex®-VF
reduced levels of factor IX, II or X.
Domestic SCIg product - used to replace antibodies to help
Evogam 16%
prevent infections and to treat some autoimmune disorders
Imported SCIg product - used to replace antibodies to help
Hizentra® 20%
prevent infections and to treat some autoimmune disorders
Used in patients with haemophilia B, in which there are reduced
MonoFIX®-VF
levels of Factor IX
Rh(D)
Used to prevent haemolytic disease of the newborn
Immunoglobulin-VF
Hepatitis B Used to help prevent hepatitis B infection in a person who comes
Immunoglobulin-VF into contact with suspected infected material
CMV Immunoglobulin- Used to help prevent cytomegalovirus infection in specific
VF transplant patients
24

Normal
Used to replace antibodies to help prevent infections
Immunoglobulin-VF
Tetanus
Used to help prevent tetanus in a person who has not recently
Immunoglobulin-VF
been immunised against tetanus
IM
Tetanus
Used to treat tetanus infection
Immunoglobulin-VF IV
Zoster
Used to help prevent chickenpox and shingles
Immunoglobulin-VF
Used to treat patients with conditions relating to an inherited
Thrombotrol®-VF
deficiency of antithrombin III

Further information on these products, including prescribing information and consumer information is
available at: http://www.cslbehring.com.au/products/product-finder.htm

Synthetic blood clotting factors

Synthetic blood clotting factors are also manufactured by a number of companies and are used in the
treatment and prevention of bleeding in patients with Haemophilia.
Activated Factor VII (NovoSeven®RT) is also occasionally used off-licence to control bleeding in a
patient where all usual methods have been employed but failed.
http://www.novonordisk.com.au/healthcare-professionals.html
25

Consent
Introduction
Patients have a choice about whether or not to undergo a proposed procedure or treatment, including
transfusion of blood and blood products. The purpose of the informed consent process is to ensure
patients are provided with information about the transfusion care they may receive, and to enable them
to make informed decisions regarding this. Documentation of informed consent is required and this
should be supported by local policy.
Available on the Blood Matters website is a document outlining the elements of informed consent for
transfusion, developed in 2012 http://www.health.vic.gov.au/bloodmatters/tools/consent.htm.This
document is to be read in conjunction with the health service’s consent policy which should cover
general consent for medical treatments including processes for consent in competent, non-competent
patients, patients from non-English speaking backgrounds, children and the role of medical and nursing
staff and how this consent process will be documented. https://www2.health.vic.gov.au/hospitals-and-
health-services/patient-care/speciality-diagnostics-therapeutics/blood-matters/tools-nsqhs-standard-
7/communicating-with-patients

Important points
Prior to undertaking any non-emergency transfusion on any patient, a valid and informed consent
should be gained and documented according to the hospital policy. Emergency transfusions will be
undertaken in compliance with the Guardianship and Administration Act 1986.
Appropriate substitute consent will be taken when patients cannot consent for themselves. The
prescribing medical practitioner is responsible for obtaining consent.
Patients may, and are entitled to refuse transfusion, for example Jehovah’s Witness, who may refuse all
or some blood products on religious grounds. In either adults or children, refer to the health service’s
policy and procedures for guidance regarding these situations. Advice can be sought from the
Jehovah’s Witness liaison committee, the Australian Red Cross Blood Service or the Office of the Public
Advocate.

Important points to cover when obtaining informed consent

The following section ‘Important points to cover when obtaining informed consent’ has been extracted
from the Blood Service website http://www.transfusion.com.au/transfusion_practice/consent [accessed
22/12/17]

Explain:
• the cause/likelihood of bleeding or the low blood count (including any uncertainty)
• the nature of the proposed transfusion therapy - what is involved
• the benefits expected
• the risks - including both common and rare but serious
• the alternatives including the risk of doing nothing

Ask:
• is there anything else you would like to know?
• is there anything you do not understand?
26

Provide:
• an interpreter for non-English speaking patients
• written information.

Document:
• Documentation is an essential part of the informed consent process. Consent should be documented
either in the medical record (the amount of recording necessary depends on the circumstances of
consent and local policy) or on a generic or transfusion specific consent form (as specified in the
health service policy).

Consumer information on consent for transfusion

Consumer information brochures to support the consent process are available from a number of
sources including the Blood Matters website, the Blood Service (including the mytransfusion website
http://mytransfusion.com.au/), Blood Watch (NSW) and BloodSafe (SA). See Educational materials for
more information.
27

Clinical audit
The clinical audit process seeks to identify areas for practice improvement; develop and carry out action
plans to rectify or improve care; and then re-audit to ensure that these changes have achieved the
desired outcome.
Blood Matters conducts regular audits of practice to compare current transfusion/PBM practices with
clinical best practice guidelines. The aim is to identify areas for improvement and make
recommendations in line with clinical best practice guidelines.
Audit data provided by health services is collated by the Blood Matters secretariat and reviewed by
experts in the field. Reports are produced and made available on the Blood Matters website with
individual reports provided to participating health services. These reports contain the health service’s
own data benchmarked against the data from other participating health services. Individual reports can
be used to develop unique hospital improvement plans.
Past audits, including information sheets and audit tools, are available on the transfusion audit page on
Blood Matters website. These can be utilised by individual health services in quality improvement
activities. https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/speciality-
diagnostics-therapeutics/blood-matters/transfusion-audits
These audits are only one part of the clinical audits involving transfusion that are undertaken at a health
service. It is expected that there will be an ongoing audit program led by the blood management or
quality committee. For example: auditing nursing transfusion practice can assist in improving blood
administration practice, and can give focus to nurse education programs. Re–auditing will evaluate
whether the changes and education implemented have had an impact.
Audit tools have been produced to assist in the collection of data regarding transfusion documentation,
wastage and appropriateness of transfusion practice. These tools are available at
http://www2.health.vic.gov.au/bloodmatters/tools/data-collection.htm

Tips for auditing

Auditing takes time
1. Have clear objectives and aims
2. Identify stakeholders that may be affected by your audit and involve them in discussion
3. If required engage a team of people
4. Collect only the essential data
5. Maintain and ensure patient confidentiality
6. Analyse and compare your audit against standards or guidelines
7. Make recommendations and develop a plan to implement those recommendations
8. Re-audit, once recommendations are in place, to assess improvements
9. Talk to your quality/clinical governance manager/department, as they may have an audit
schedule or already conducted audits similar to those you are considering or may be able to
help with development of an audit tool.
28

Haemovigilance
Haemovigilance is a ‘set of surveillance procedures covering the whole transfusion chain (from the
collection of blood and its components to the follow-up of recipients), intended to collect and assess
information on unexpected or undesirable effects resulting from the therapeutic use of labile blood
products, and to prevent their occurrence or recurrence.
International Haemovigilance Network http://www.ihn-org.com/ accessed 9/9/2015.
Within the health service environment this may include the use of incident reporting systems such as
Victorian Health Incident Management System (VHIMS) and/or transfusion reaction reports.
Investigation of incidents and reactions is important to ensure risks to patients are identified and where
possible actions are taken to reduce these risks.
Participation in case reviews of sentinel events may be required, including root cause analysis. These
reviews should be undertaken with quality staff trained in incident management.
Further information on VHIMS and the sentinel event program can be found at the Clinical Risk
Management page of the Victorian department of Health and Human Services website.
http://www2.health.vic.gov.au/clinrisk/

The Blood Matters’ Serious Transfusion Incidents Reporting (STIR)

system
The Blood Matters’ STIR program is a central voluntary reporting system for serious adverse events in
hospitals or laboratories involving the transfusion of fresh blood or blood products including near-miss
incidents. STIR currently collects data on the following serious incidents: (see STIR guide at
https://www2.health.vic.gov.au/about/publications/researchandreports/blood-matters-stir-guide-2017 for
complete definitions)
The system captures two main categories of serious transfusion incidents: clinical and procedural which
are reported via data collection forms:
• Clinical reporting forms –
 acute transfusion reactions – this includes febrile non-haemolytic reactions, allergic or
anaphylactic reactions and acute haemolytic reactions
 transfusion-related acute lung injury (TRALI)
 transfusion-associated circulatory overload (TACO)
 transfusion-associated dyspnoea (TAD)
 delayed haemolytic transfusion reactions (DHTR)
 delayed serologic transfusion reactions (DSTR)
 transfusion-associated graft-versus-host disease (TA-GVHD)
 post-transfusion purpura (PTP)
 bacterial/other infection
 post-transfusion viral infection

• Procedural reporting forms –

 incorrect blood component transfused (IBCT)
 wrong blood in tube (near-miss incident)
 cell salvage incidents
 Rh D immunoglobulin (anti-D)
 Near miss events
29

The STIR program commenced in 2007 and receives reports from public and private hospitals from
Victoria, Tasmania, ACT, and NT. The program involves the capture and de-identification of data
regarding serious hospital transfusion incidents, including near misses, which is then collated and
analysed. Recommendations can then be made with the aim of improving transfusion safety. The latest
serious transfusion incident report is available at
http://www2.health.vic.gov.au/bloodmatters/tools/stir.htm
Confidentiality of data is fundamental to the success of this system. Each hospital is uniquely coded and
no patient identifiers are requested, other than age and gender.
Your hospital may already be reporting to STIR. A haematologist or quality manager may have further
information regarding this. If not, a STIR guide is available through the Blood Matters website. Please
contact the Blood Matters secretariat for further information about joining.
Victoria has developed a statewide clinical incident dataset, under the VHIMS which was rolled out in
Victoria in 2010. Definitions for STIR events have been included in this dataset. Contact your risk
manager or quality manager for your responsibilities in relation to blood and blood product incident
reporting.

National Haemovigilance
The NBA has developed the reporting and governance frameworks for a voluntary haemovigilance
program for Australia. It reports on serious transfusion-related adverse events relating to fresh
components occurring in public and private hospitals. The Australian Haemovigilance Minimum Data
Set (AHMDS) has been developed to ensure consistent data collection and analysis of transfusion
related adverse events to improve the quality of national haemovigilance reporting. STIR provides de-
identified data to this dataset annually.
The primary aim of an Australian haemovigilance program is to improve transfusion safety and quality
by collecting, analysing, and disseminating information on a common set of adverse events surrounding
the transfusion of blood products. Trends will be identified over time and recommendations to improve
transfusion outcomes, based on the data, will be developed.
The initial Australian haemovigilance report was released in February 2008, with continuing regular
reports made available on the NBA website (http://www.blood.gov.au/haemovigilance-reporting).
Information about the Strategic Framework for the National Haemovigilance Program can be found at:
http://www.blood.gov.au/system/files/documents/Strategic%20Framework%20for%20National%20Hae
movigilance%20Program%20.pdf
30

Waste reduction
As part of the NBA Wastage Reduction Strategy, from May 2013 blood components supplied by the
Australian Red Cross Blood Service included a cost indicator printed on the blood bag label.
The aim of this NBA initiative is to increase health provider awareness and appreciation of the costs
associated with the provision of blood and blood products within Australia. It also supports awareness
that blood is a precious resource given generously by donors, which should be used and managed with
care.
Although blood is collected from non-remunerated donors, the collection, processing, testing and
distribution of blood and blood products incur significant costs. The cost printed on each blood
component label is indicative of the manufacturing costs for that component type.
Blood Matters coordinates the Victorian red blood cell (RBC) wastage reduction project, which aims to
reduce wastage, and assist health services to reach national targets set by governments.
All entities who participate in the supply chain for blood and blood products have a responsibility to
ensure that all aspects of the supply chain including transport, storage, and inventory management are
optimised to minimise unnecessary wastage.
A certain level of discard of blood and blood products, particularly fresh products with short expiry dates,
is both inevitable and appropriate to ensure that products are available where and when they are
clinically required. However, there is a proportion of discards of blood and blood products that is neither
inevitable nor appropriate.
In Victoria, all RBC waste is recorded via an online platform called BloodNet. BloodNet is a web-based
system that allows staff in health services and laboratories across Australia to order blood and blood
products in a standardised way, quickly, easily and securely from the Blood Service.
BloodNet requires health services to record a reason for discard when a RBC is discarded. The health
service is able to allocate the location where the discard occurred, which gives them the ability to
attribute waste appropriately, and share this data, enabling an accurate record of RBC waste at each
individual site/area/ward. This information can be used to alert staff of RBC waste issues.
The Blood Matters wastage reduction project has been in place since August 2014 and RBC waste has
reduced from 6.1 per cent to 1.7 per cent in October 2017 through the efforts of the laboratories and
health services. The following points have been identified as crucial to the continued success of the
project:
• Effective inventory management is paramount in the reduction of expiry related waste
• Sharing blood fridge compliance data between health services and pathology providers is essential
• Utilising the BloodNet fridges module for blood fridge data recording
• Movement of red cells between health services in a timely manner to ensure units have adequate
time to be utilised at the accepting organisation
• Reducing that period of time blood maybe kept following a crossmatch
• Compliance with correct transportation methods RBC
• Increasing the use of visual prompts in blood fridges e.g. short expiry units
• State-wide implementation of electronic crossmatching methods
• Simplifying procedures, production of and compliance with a maximum blood ordering schedule
(MBOS)
• Ongoing collaboration between health/pathology services
More information is available at http://www2.health.vic.gov.au/bloodmatters/wastage-project.htm