Scotblood 2014 Conference Programme by Gareth Neil Design

SCOTBLOOD 2014 ANNUAL CONFERENCE Stirling University • June 12 & 13

BOOKLET SPONSOR

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CHAIRMAN’S INTRODUCTION David Colligan Chairman, Scotblood 2014 Organising Committee Dear Delegate, The year 2014 was always going to be a busy one in Scotland, The Commonwealth Games in Glasgow , the Ryder Cup at Gleneagles, a National Independence Vote and of course Scotblood 2014 in Stirling. Following on from a successful conference last year the challenges for the Organising Committee are always the same, we must try to maintain the impetus the Conference has developed, innovate where appropriate whilst being mindful to retain that friendly Scotblood feel. I hope that you will agree that the various Organising Committees have risen to these challenges and delivered another exciting and informative scientific programme. We are lucky to have attracted speakers of national and international renown, and I would also like to thank the patients who have generously agreed to participate in this year’s conference. We have also introduced a number of changes for Scotblood 2014. Firstly the introduction of free delegate spaces for SNBTS delegates. Recognising the importance of Scotblood as a unique training event and the value it offers, we have received additional assistance from the organisation. We are grateful that with the support from all senior managers it was possible to allocate a free day registration for any NSS/SNBTS staff members wishing to attend. Secondly, we have introduced new delegate accommodation. Delegates will now have access to brand new rooms at Willow Court. These rooms have the advantages of additional amenities including a bar/café - handy for those early morning wake up espressos or for those who prefer their coffee a little more in the Irish style! Third and finally we have also moved the formal Conference Dinner to a

biennial event, so despite its absence from this years programme it will return in 2015. The theme for the Thursday evening social event has a “Best Of Scottish Food” theme. I am sure that this will live up to the high standard of food, hospitality and entertainment that Scotblood is rightfully well known for. On a personal note, I would like to thank all the members of the Scotblood Organising Committee for their tireless effort in supporting and organising this event. I have seen at first hand the considerable effort that goes on behind the scenes to make this meeting run smoothly and I am very grateful. The organisation of the scientific programme, the social evening, the commercial exhibition, the conference booklet and the setting up of the conference requires dedication and tireless effort which is all given voluntarily by SNBTS staff. Our thanks must also go to the staff at the University of Stirling and the SNBTS and NSS Boards for their support of the Conference. We would also like to thank the Companies whose patronage allows us to deliver this event. The long lasting relationships between ourselves and the Commercial Exhibitors are such that they continue to return and enjoy their attendance. Without these companies and their financial support this Conference would never be possible. Can I urge all of the delegates to take this opportunity to meet and speak with the exhibitors. Finally we would like to thank you, the delegates, for your support of Scotblood. This is a unique conference in that it organised by the staff for the staff, and it is your participation that makes it such a great event. I hope you all enjoy Scotblood 2014.

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Thursday 12th June

All sessions in Logie Lecture Theatre unless otherwise indicated

08.30 – 09.30

Coffee, registration and setting up of posters . . . . . . . . . . . . . . . . Andrew Miller Atrium

09.30 – 10.00 Opening Session: Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mrs Mary Morgan SNBTS Director

10.00 – 12.00

Plenary Session I – Embracing Quality & Safety

Blood Good Practice, an MHRA inspector’s perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mr Andrew Hopkins MHRA Your Quality Management System: What an Opportunity! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mr David Selby David Begg Associates Building in Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mr Tony Docherty SNBTS

12.00 – 14.00

Opening of commercial exhibition, lunch & poster viewing . . . . Andrew Miller Atrium

14.00 – 15.30 Plenary Session II – People Centred Islet Transplantation - Cell Therapy for Type 1 Diabetes . . . . . . . . . . . . . . . . . . . . . . Prof. John Casey, University of Edinburgh & Mr Keith Bailey Limbal stem cell transplantation for the treatment of corneal blindness: perspectives from the lab and the patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dr Sajjad Ahmad University of Liverpool & Mrs Sylvia Paton Phineas’ Friends – Challenging Popular Perceptions of Hospital-based Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mr Michael Cockerham Giving the Gift of Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mr Orin Lewis OBE & Mrs Beverley De-Gale OBE, ACLT

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15.30 – 16.00

Coffee/tea, poster viewing & commercial exhibition . . . . . . . . . . Andrew Miller Atrium

16.00 – 17.30

Plenary Session III – SNBTS Into the Future

Research, Development & Innovation – New Blood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dr John Campbell SNBTS The SNBTS National Centre – The Dream Becomes Reality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dr Safia Qureshi SNBTS The Redesign of Patient Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mrs Susan Buchanan SNBTS

18.30 – Midnight

Reception, buffet dinner and disco

Friday 13th June

All sessions in Logie Lecture Theatre unless otherwise indicated

08.30 – 09.30

Coffee, Registration and setting up of posters

09.30 – 11.00 Plenary Session IV – Donor Services Efficiencies of Collection and Donor Experience . . . . . . . . . . . . . . . . . Mr Matthew Jones NHSBT On the effectiveness of pre-session and on-session deferrals in preventing transfusion transmitted infections . . . . . . . . . . Dr Wim de Kort Sanquin Can we have a crystal ball please? Balancing Supply and Demand . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dr Moira Carter SNBTS 11.00 – 11.30

Coffee/tea, poster viewing and commercial exhibition

11.30 – 12.15 Iain Cook Memorial Lecture On The Shoulders of Giants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dr George Galea, SNBTS

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12.15 – 12.30 Copland Lifetime Achievement Award . . . . . . . . . . . . . . . . . . . . . . . Mr Tom McQuillan, SNBTS

12.30 – 14.30

Lunch, poster viewing and commercial exhibition

14.30 – 17.00

Concurrent Sessions (Incorporating presentations from abstracts & MSc Students)

• Research, Development & Innovation / Tissues & Cells

• Immunohaematology / Clinical • Donor Services

Research, Development & Innovation / Tissue and Cells Concurrent Session Session Chair: Mr Tom McQuillan Location: Lecture Theatre B4  14.30 – 15.30 A Macrophage Cell Therapy for Liver Cirrhosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dr Chloe Pass & Dr Laura Bailey, RDI, SNBTS  All You Can Eat Buffet : Functional Phenotyping of Macrophages for Cell Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dr Alasdair Fraser, RDI, SNBTS  Blood Sweat and Ears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dr Chris West, University of Edinburgh

16.00 – 17.00 Derivation of Vascular Endothelium from hESC . . . . . . . . . . . . . . . . . Ms. Elizabeth Scott, University of Glasgow  Bloodpharma Social Impact . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dr Emma King, University of Edinburgh 

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Clinical Services Concurrent Session Session Chair: Karen Baillie & Sylvia Armstrong-Fisher Location: Lecture Theatre W1

Genotype and Phenotype: A Diagnostic Partnership

14.30 – 15.00 Blood Group Genotyping: QA & EQA . . . . . . . . . . . . . . . . . . . Dr Sylvia Armstrong-Fisher SNBTS 15.00 – 15.30 The IBGRL Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dr Shane Grimsley NHSBT 15.30 – 16.00

Coffee/tea break

16.00 – 16.45     

Case Presentations

16.45 – 17.00

Open discussion

Donor Services Concurrent Session Location: Logie Lecture Theatre

• New RhD Variant – prophylaxis or not? • Twin pregnancy with immune anti-D • Pseudo – what? • AB /A group discrepancy – how? • NAIT with anti-HPA15

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Conference & Accommodation Accommodation

Meals

Accommodation for Scotblood delegates will be in Willow Court or Stirling Management Centre. Keys will be issued for Willow Court from the Reception Desk at Willow Court. Rooms will be available from 12.00 on the day of arrival and must be vacated and keys returned to the Reception Desk by 10.00 on the day of departure. Delegates with accommodation at Stirling Management Centre can check-in after 14.00 and should check out by 10.00 on day of departure.

Please note that delegates MUST wear their conference badges at all times to receive conference meals, including breakfast at Haldane’s. Thursday 12th June Breakfast . . . . . . . . . . . . 07.30 to 08.45 Haldane’s, Andrew Miller Building Lunch (Bento) . . . . . . . . 12.00 to 14.00 Andrew Miller Atrium Buffet/Drinks . . . . . . . . 18.30 to 19.45 Andrew Miller Atrium

To comply with the Smoking, Health and Social Care (Scotland) Act 2005, which came into force on 26th March 2006, SMOKING IS PROHIBITED THROUGHOUT ALL UNIVERSITY BUILDINGS, AROUND ENTRANCES TO BUILDINGS AND WITHIN INTERNAL COURTYARDS.

Friday 13th June Breakfast . . . . . . . . . . . . 07.30 to 08.45 Haldane’s, Andrew Miller Building Lunch (Bento) . . . . . . . . 12.30 to 14.30 Andrew Miller Atrium

Shops

Shops are available for a variety of goods within the Andrew Miller Building, adjacent to the Atrium. In addition, there is a Bank located within Message Board this building, with cash machines available here. A Conference Message Board is located beside the Registration Desk. Commercial Exhibition Parking The Commercial Exhibition will be in the Andrew Miller Atrium from 10.00 on Thursday 12th June Parking is available at Willow Court for and will be open until 16.00 on Friday 13th June. residential delegates. Day delegates can park in Cottrell Car Parks. Delegates are Social Event requested not to park in Queen’s Court. Poster Session

The social evening for Thursday 12th June will have a “Scottish” Theme with a buffet style menu. A cash bar will be open from 1830 onwards with food and complimentary drink being served from 19.00 onwards. A disco in the Studio Bar will start at 20.30 until Midnight.

Posters should be displayed in the Andrew Miller/Cottrell link bridge by 10.00 on Thursday 12th June and should be removed by 17.00 on Friday 13th June.

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Telephone

Tea & Coffee

Telephone facilities are available throughout the University Campus. Urgent telephone messages on Thursday/Friday 09.00 to 17.00 should be made to Commercial Operations at the University of 01786 467140. Outwith these hours, contact the main University switchboard at 01786 473171.

Tea and coffee will be available as follows:Thursday 12th June 08.30 to 09.30 & 15.30 to 16.00 beside the Commercial Exhibition in Andrew Miller Atrium. Friday 13th June 08.30 to 09.30 & 11.00 to 11.30 & 15.30 to 16.00 beside the Commercial Exhibition in Andrew Miller Atrium.

Contact telephone numbers for the residencies are:Willow Court – 01786 466952 Stirling Management Centre – 01786 451666 Registration Registration will be open at the following times:Thursday 12th June – 08.30 to 17.00 Friday 13th June – 08.30 to 16.00 The Registration Desk will be manned throughout the Conference to provide further information as required. CPD Plenary and Concurrent Sessions have all been accredited for the Continuing Professional Development Schemes of RCPath, IBMS and BBTS. A tear-off CPD Attendance Certificate is included at the rear of this Conference Booklet. Please note that CPD schemes are now gradually changing to a system that is not simply based on the number of “points” achieved. The emphasis is on the individual member to self assess the learning event and record the value of the learning activity via reflective notes.

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PLENARY SESSION I Blood Good Practice, an MHRA Inspector’s Perspective Andrew Hopkins MHRA The intent of the presentation is to lift the veil of “nervousness” surrounding the Agency and its activities and hopefully help with the realisation that Good Practice is not just a requirement but, when implemented properly, will help save lives and even save money.

This presentation will focus on the MHRA with a general view of the Agency’s structure and activities and then give more specific detail regarding the Agency’s role in implementing the blood directives and Blood Safety and Quality regulations and include an introduction to the assessment and inspection process. Specific areas covered will include: • • • •

MHRA structure and activities The implementation of the blood directives Inspectors and the inspection process The output from inspections (The good, the bad and the ugly)

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PLENARY SESSION I Your Quality Management System: What an Opportunity! David Selby David Begg Associates “Quality is never an accident. It is always the result of intelligent effort”. John Ruskin

It will identify the challenges and emphasise that this work will only be successful if everyone embraces change and a willingness to compromise and collaborate.

This presentation will focus on the opportunities a modern Quality Management System (QMS) presents to SNBTS and show how, if they are embraced, the GxP-regulated part of the organisation can operate in a different way with a lighter touch and make a very positive contribution to the business in future.

The force is with you (SNBTS)!!. The elements are in place. There is every reason to expect success if the new approach is adopted.

This presentation will focus on the opportunities provided by: • The projected move to the new facility • The new organisation with the senior management team embracing responsibility for quality and the QMS • The changing regulations, especially the introduction of risk management which opens up many avenues for change • The requirement for structured continuous improvement • Tools to help the donor teams operate more effectively out in the community.

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PLENARY SESSION I Building In Quality Mr Tony Docherty SNBTS This presentation will highlight those Quality Management System elements that SNBTS are in the process of improving along the principles of Quality by design and continuous improvement.

The ever quickening pace of regulatory change and guidance over the past few years has focused on process robustness and product quality. SNBTS as part of the Pharmaceutical environment have had to adapt to these changes.

We will discuss the approach we are taking to these initiatives and the planned outcomes to ensure we own a modern fit for purpose Quality Management System

The concept of Building Quality into our systems is not new. However, within the context of the significant change Agenda SNBTS is embarking on over the next few years, the development of new cellular therapy products at the Scottish Centre for Regenerative Medicine and the New National Centre project then a clear understanding and effective execution of this systematic approach to our systems and procedures are critical for our future success.

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PLENARY SESSION II Islet Transplantation â&#x20AC;&#x201C; Cell Therapy for Type I Diabetes Professor John Casey, University of Edinburgh & Mr Keith Bailey In Scotland, the service is a collaboration between SNBTS and the Transplant Unit at the Royal Infirmary of Edinburgh and since the first islet transplant in 2011 has performed over 30% of all the islet transplants in the UK.

Transplantation of human islets of Langerhans is now a nationally funded treatment for some patients with type I diabetes. The majority of patients suffer from a complication called hypoglycaemic unawareness and are unable to predict when their blood sugars are becoming dangerously low and are therefore at risk of accidents, coma and death. Islet transplantation reverses this complication in almost 100% of treated patients and is life changing for these patients.

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PLENARY SESSION II Limbal Stem Cell Transplantation for the Treatment of Corneal Blindness: Perspectives From the Lab and the Patient Dr Sajjad Ahmad and Mrs Sylvia Paton University of Liverpool

The cornea is the clear front of the eye and its surface is composed of an epithelium that is renewed by stem cells located at the edge of the cornea, in a region known as the limbus. These stem cells are therefore more commonly known as limbal stem cells. A deficiency or dysfunction of these stem cells results in the painful and blinding disease of limbal stem cell deficiency. There are many causes of limbal stem cell deficiency, including chemical and thermal burns to the eye, hereditary causes such as Aniridia and Ectodermal Dysplasia, inflammatory causes such as mucous membrane pemphigoid and iatrogenic causes.

Dr Ahmad developed a culture method for human limbal stem cells as part of his PhD (2003-2007) that is animal cell and product free. This method has been used in an autologous trial and is currently being used as part of a multi-centre allogeneic trial with SNBTS/Edinburgh/ Glasgow and Liverpool. He will describe these trials during the presentation. Mrs Paton suffers from Aniridia and has received such a limbal stem cell transplant and will describe her eye condition and her experiences of the transplant. We will also highlight the issues that remain in developing this therapy for more widespread use.

Limbal stem cell deficiency is difficult to manage and many of the conventional methods of treatment are not curative. The laboratory culture of human limbal stem cells was first proposed as a successful therapy for limbal stem cell deficiency in 1997. Since then, the culture method has developed and there are many different methods for culturing limbal stem cells. These will be outlined in this presentation. Regulation has also caught up with such new developing stem cell therapies and our experience with this will be highlighted.

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PLENARY SESSION II Phineas’ Friends – Challenging Popular Perceptions of Hospital-based Healthcare Mr Michael Cockerham Medical science specifically, and hospitalbased healthcare in general have advanced hugely over the past half century – indeed, in some respects they have advanced almost beyond recognition. But popular perceptions of the patient’s experience are still mired in a 1950s narrative: you get sick, you go to hospital a doctor and a couple of nurses will make you better. It is a narrative that is perpetuated by film and television dramas, and even by well-meaning documentaries that concentrate on just a few key characters for fear of losing the audience.

Both aims have been hugely successful, with the profile of the Evelina brought very much to the fore, resulting in a branding and PR campaign kicked off on the back of the publication, and an increase in charitable funding. Equally the story gained significant media attention with Michael (and Phineas) doing a tour of TV and radio studios following a spectacular spread in the Daily Mail under the headline “63 Heroes Who Saved Our Son”. Following this Michael has given many keynote speeches to bodies in the health sector and academia, encouraging them to reassess how their particular specialisations fit in to the broader picture.

Michael Cockerham published Phineas’ Friends in 2011 following his experience of his youngest son being retrieved into paediatric intensive care at London’s Evelina Children’s Hospital at the age of just three weeks. What started as an effort to raise the profile of a then little known children’s hospital, had a second mission: to change the general public’s perception of what hospital-based care actually means in the 21stCentury. It was the response of a surgeon in Cardiff to the publication that even he, with 16 years’ experience in the NHS had no idea how many people were involved in treating a single patient that made Michael realise just how much people’s misunderstanding needed to be addressed. After all, how can we guide our politicians if neither they nor we have an accurate understanding of what is actually going on?

Michael’s speech to Scotblood will focus on the particular role of blood in patient healthcare, and how clinicians working with this specialisation are much closer to the patient than they might always think, and what that means for them and the patient.

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PLENARY SESSION II Giving the Gift of Life Mr Orin Lewis OBE & Mrs Beverley De-Gale OBE ACLT The purpose of this talk is to highlight, debate and challenge the reasons behind the lack of ethnic minorities registering and donating bone marrow, blood or organs. The UK Stem Cell Strategic Forum Report in Dec 2010 estimated that if you’re white, you have as high as a 90% chance of finding a bone marrow match but if you are from an ethnic minority it is 40%, despite 23 million bone marrow donors worldwide. However, less than 3 percent of potential bone marrow donors are from the ethnic minorities. Less than 2.5 percent of blood donors are ethnic minorities, despite Sickle Cell Anaemia being common within Black communities. Black and South Asian people are three times more likely to need an organ transplant BUT less than 2% of minorities are on the NHS organ donor register. WHAT’S STOPPING US?

bone marrow transplant. However the best bone marrow matches are when patient and donor are from the same ethnicity. Following an extensive media campaign instigated by Daniel’s parents to find Daniel a matching bone marrow donor, Daniel beat his fight against leukaemia and lived a happy life alongside his family and friends for several years; however on 8th October 2008, Daniel aged 21 sadly passed away due to a health complication. Despite their sad and painful loss Orin and Beverley continue the 18 plus years’ aims and objectives of the ACLT (with their small but committed team of staff and volunteers) and host hundreds of Registration drives in predominately larger cities with high ethnic numbers. In turn the ACLT has increased the number of UK bone marrow donors from approx. 583 to approx. 54,000 and found 60 matching donors, and recruited thousands onto the National Blood Service and Organ Donor Registry. This is achieved by highlighting time is running out for many patients, and help is needed from HEROES within all communities, as registering is easy, and there are choices of a simple and painless donating procedure that could save a life. The aim is to have 100,000 BAME bone marrow donors registered by installing transparency, trust, integrity, ethics, dignity and respect; which in turn will foster greater trust between ethnic minority communities and the medical establishment, therefore putting the patient first and enabling another individual a chance to do something amazing and give the gift of life..

* “Bone Marrow is bits of bone or gristle”, “Drill into my spine with a huge needle” * ”Sickle Cell Trait, so can’t register”, “NBS don’t want our blood, you throw it away” * ”Cloning & experimentation”, “What are they going to do with my DNA?” The ACLT targets ethnic minorities and raises awareness (via education, cultural identity and trust, etc.) against cultural/ religious myths, fears & taboos about donating and registers blood, bone marrow and organ donors onto the UK donor registries. Established in 1996 by Beverley De-Gale OBE and Orin Lewis OBE, after their 6 year old son Daniel De-Gale had been diagnosed with acute leukaemia. Daniel’s only hope of survival was to receive a

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PLENARY SESSION III Research, Development and Innovation â&#x20AC;&#x201C; New Blood Dr John Campbell Associate Director RDI, SNBTS Research carried out by SNBTS has varied in focus in the past years, but can always be categorized as concentrating on three key areas:

stored RBC concentrates age and what effect this has on transfusion to different patient groups. Both of these issues could ultimately be addressed by using stem cells to generate red blood cells free of known infection and of uniform age.

1. Advancing knowledge in the field 2. Providing evidence for better use of blood and tissue products 3. Doing what we do, better

The better use of blood and tissues includes the improvement of islet transplantation, using banked donated eyes to treat limbal stem cell insufficiency or transforming blood monocytes into macrophages that can potentially repair damaged tissues.

These headings cover the wide variety of research topics carried out by RDI today, and I will focus in this presentation on how the different strands are complimentary, and how we concentrate on research that can be rapidly translated into tangible health benefits.

We are also actively researching who receives blood, for example immune compromised patients, and how this should shape how blood should be treated in the future.

Advancing Knowledge can be basic infection biology looking for emerging pathogens which could be an issue in blood supply; equally it could be understanding how

In the presentation I will highlight the recent advances from RDI, and look to future developments.

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PLENARY SESSION III The SNBTS National Centre – The Dream Becomes Reality Dr Safia Qureshi SNBTS/Ellen’s Glen Road, Edinburgh/National Centre Project “A dream doesn’t become reality through magic; it takes sweat, determination and hard work” - Colin Powell

land at Heriot-Watt University Research Park was confirmed as the site for the National Centre. Heriot-Watt is one of the UK’s leading universities for business and industry and has a strong reputation for innovative education, enterprise and leading-edge research and the National Centre will fit well into this environment. In October 2012 the Outline Business Case was approved by the NSS board and subsequently by Scottish Government.

It might feel like there have been dreams of a new National Centre for SNBTS forever. Indeed, it was back in April 2008 that SNBTS held a public consultation about its possible strategies for “Meeting the transfusion needs of patients in Scotland”. This was the document that first sought feedback from stakeholders about how SNBTS could best modernise its blood and tissue processing and testing facilities to meet new regulatory requirements and accommodate future safety directives. Following the consultation and a series of associated stakeholder events, SNBTS made a commitment to develop a new, state-of-the-art single site facility that would be future proofed for all of Scotland’s blood, tissue and cell needs.

Scottish Government announced that the project would be procured through the Non-Profit Distributing revenue funded model. The associated process to procure a private sector partner to design, construct, finance and maintain the National Centre began in December 2012 and culminated in March 2013 with the appointment of the Interserve Kajima consortium as the Preferred Bidder for the National Centre.

And so the hard work began…

This session will showcase the chosen design for the National Centre – highlighting the facilities available for staff, how the design will deliver regulatory, safety and efficiency requirements and support the way we work and will show you how we are a huge step closer to achieving our dream of a facility that’s fit for the future.

In December 2009 the Scottish Government gave their support to the concept of a new National Centre through the endorsement of an “Initial Agreement” giving the go ahead for the development of an Outline Business Case. In November 2010 a plot of

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PLENARY SESSION III The Redesign of Patient Services Mrs Susan Buchanan SNBTS In November 2012, Clinical Services within SNBTS changed its name to Patient Services. This marked the start of a new management structure. Historically, Clinical Services had been managed regionally, however, this management structure was replaced with a functional management model managed by themes. The following Themed Groups were identified: Apheresis, Blood Banking, Better Blood Transfusion, Histocompatililty, Immunogenetics and Immunology, together with Cord Blood Banking. A lead was appointed to manage each of the Themes on a national basis and the Themed model was supported by Patient Services Operational Group. Membership of this group included the Associate Medical Director, the Operations Manger, Lead Finance Manager and Secretariat, a representative from both QA and Tissue Services, as well as the Lead Nurse for Patient services and the appointed Leads for each of the Themed groups. Each of the Themes have individual business plans with associated key performance indicators and risk management matrix which link to the organisational Local Delivery Plan agreed by Operational Management Group and the Senior Management Team. The key items on the business plans are supported and managed using project management support from the PGMS. During the first year many projects have been delivered, including: Process mapping all key services, with 36 processes mapped to date. The focus has been on Blood Bank redesign and a sub group of the Blood Bank Themed group has been working to redesign and lean processes to optimise efficiency and quality

improvement initiatives. Built into this process is the nationalisation of the key processes which have benefits for the whole of the organisation and will result in a substantial reduction in the number of SOPs, consistency in processes, training and validations, as well as facilitating organisational intelligence, capacity planning and agility of service. A Pan Scotland Apheresis Review is now nearing completion, the outcome of which will decide how, where and who will provide therapeutic and clinical apheresis within the 14 territorial Health Boards. Much work is going into a renewed workforce plan, which will renew and refresh the current workforce planning model across all staff groups. This work has been completed by the Better Blood Transfusion Team and they are now In the process of implementing their new plan. Conclusion Many additional projects have been delivered, whilst continuing business as usual to ensure that SNBTS continues to deliver a quality product that supports and sustains live for many patients throughout Scotland. The anticipated benefits are: • Improved customer satisfaction • Increased staff satisfaction • Reduction in wastage/non value add activity • Improved efficiency • Capacity to take on new projects/ initiatives – improving income revenue • Fit for the future organisation >>

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• •

Ultimately the impact of this redesign will be felt across the whole organisation resulting in SNBTS being more efficient, effective and agile – an organisation fit for the future which continues to meet the transfusion needs of patients in Scotland.

Improvement in regulatory compliance Reduction in work for other internal departments who support the clinical service i.e. Quality and procurement

The anticipated result is that by re-designing our existing service will ensure that SNBTS will: • Improved customer satisfaction • Increased staff satisfaction • Reduce wastage/non value add activity • Improved efficiency facilitating the capacity to take on new projects/ initiatives • Fit for the future organisation • Improve regulatory compliance • Reduce work for other internal departments who support the clinical service i.e. Quality and Procurement • Reduction in SOPs/paperwork • Lean manufacturing

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PLENARY SESSION IV Efficiencies of Collection and Donor Experience Matthew Jones NHSBT The balance between productivity and customer experience is a challenge in most sectors. When it comes to a publicly funded organisation with donors who are also stakeholders, any changes come with challenges.

Listening to colleagues at the coal face, and encapsulating their feedback into a structured, deliverable plan will not only provide an improved experience for those who walk through our doors, but will also improve staff engagement. A top down approach will never create a vibrant workforce. In order to succeed as an organisation NHSBT are proactively incorporating staff feedback into a deliverable donor improvement plan and in doing so insuring the donor is at the heart of its thinking.

This presentation aims to discuss the challenges of change and ways of overcoming them in order to improve efficiencies in the collection process but more importantly the experience received by those who decide to donate blood. We’ll discuss the ‘outsiders’ viewpoint and the differences with the private sector. Donor experience is a key driver to the future of blood collection. Expectations are constantly rising and these have to be met. In order to deliver this, an organisation has to listen to it’s donors but also be frank with them about the challenges faced through a balanced communication strategy. This strategy has to be embedded within the whole organisation for it to succeed.

SCOTBLOOD 2014 ANNUAL CONFERENCE

PLENARY SESSION IV On the effectiveness of pre-session and on-session deferrals in preventing transfusion transmitted infections. Dr Wim de Kort Sanquin Blood Supply, the Netherlands

The effectiveness of the donor health questionnaire (DHQ), a globally applied tool to measure donor eligibility both pre-session and on-session, is difficult to assess. In this presentation we will discuss some aspects of this important first step in the transfusion chain. To get a grip on what is happening, we have analysed data on whole blood donor eligibility assessments in the Netherlands. The procedure in the Netherlands, which includes a pre-qualification step –at the first visit only an eligibility assessment including laboratory screening takes place, while no blood donation is yet performed– allows for more detailed analyses. All donors are advised to use the online DHQ and to contact us in case of doubt on eligibility, as to prevent a disappointing visit to the collection site. Based on test results and epidemiological data on TTIs, the number of donor visits in their window phase could be calculated. To quantify the effectiveness, we also calculated the costs of using the DHQ in the on-session situation.

The annual costs for on-site TTI-risk related eligibility assessments, deferrals and substitutions were €84,807 for the Blood Establishment (BE) and €90,501 for deferred donors. Annual savings were €991, while annual Quality Adjusted Life Years, QALYs, gained were 0.120. Hence, the Incremental Cost Effectiveness Ratio, ICER, for the DHQ on preventing TTIs was €696,744 for BE costs only and €1,449,055 including costs for deferred donors themselves. Since the presession deferral costs were set to zero, this amount is likely to be an underestimation of the real costs. In contrast, the preventive effect of the self-deferral could not be assessed appropriately. Nevertheless, the DHQ enhances self-deferral and self-selection and should not be abandoned. However, the DHQ is not a cost-effective tool for further reducing TTIs. The high costs per case prevented and the small number of QALYs gained argue against maintaining deferral policy through the DHQ at the current level.

We found that the overall annual deferral rate in the study period was 9.6%. The annual on-site deferral rate for TTI risk was 0.86%, while the pre-session deferral rate was 1.05%. The total deferral rate for TTI risk in all donors was 1.90%. The calculated annual numbers of prevented cases of TTI on-session were: hepatitis B 0.142; hepatitis C 0.010; HIV 0.016; syphilis 0.135.

SCOTBLOOD 2014 ANNUAL CONFERENCE

PLENARY SESSION IV Can We Have a Crystal Ball Please? Balancing Supply and Demand Dr Moira Carter SNBTS

In Scotland demand for red cells has declined by 16% since 2007/08 but fall in demand is not linear across blood groups (O negative fall n3%). This has worsened the skew in demand for different blood groups with: -

Developments such as the Account for Blood data mart and the Better Blood Transfusion programme allow us to more fully understand blood usage and analyse trends. The ongoing development of Account for Donation offers SNBTS the unique opportunity to have an integrated view of blood usage from Donor recruitment to the bedside.

• increased dependence on the rarer Rhesus Negative blood groups. • surplus of under utilised groups such as A,B and AB positive • frequent pressure on over utilised groups • blood shortages in Rhesus Negative groups • additional donor recruitment activity at short notice • different messages for different donors at different times

During 2013/14, in the absence of a crystal ball, we constructed a forecasting tool using the Winters Additive Model that predicted monthly red cell demand. This was incorporated into our planning for 2013/14 and accuracy reviewed throughout the year. This presentation will • Assess the effectiveness and accuracy of the model • Review the lessons learned • Consider the benefits of forecasting • Discuss potential future developments

In the current financial climate it is increasingly important that we operate effectively and efficiently to ensure that we continue to meet the transfusion needs of patients in Scotland. This underlines need to redesign supply model to Right Donor, Right Group, Right Time to ensure that we match supply to demand more closely. Traditionally SNBTS have had limited ability to accurately forecast demand and limited market intelligence on factors influencing demand. This resulted in us planning on the basis of historical demand while ensuring we had sufficient resilience to cope with fluctuations in demand.

SCOTBLOOD 2014 ANNUAL CONFERENCE

IAIN COOK MEMORIAL LECTURE On the Shoulder of Giants Dr George Galea SNBTS It has been a privilege to work for SNBTS. It is a giant of an organisation that has offered me many opportunities to flourish professionally and to see well beyond what I could have possibly seen on my own.

Such services have developed in an increasingly tight regulatory environment and the impact of QA and QMS cannot be underestimated. Tissues and cells can transmit infections at least as efficiently as blood and safety of all tissues is a major concern. It is imperative that all infectious risks are minimised as far as is possible.

I have met a few key figures in my professional life that have profoundly affected what I did and how I thought and I will allude to some of them during my talk. They have taught me the values of innovation, clinical auditing and the importance of regulation and safety in the transfusion medicine environment.

Tissue and cell activities could only take place with the constant support of SNBTS management and staff, transplant surgeons and co-ordinators, orthopoedic surgeons, pathologists and A& E nursing and medical staff who shared a common vision to develop all these new services for patients. They all deserve credit.

Following the outbreak of HIV and its key impact in transfusion medicine, it became clear that bone could not be handled in the way it had been historically by orthopaedic surgeons. DH working parties were set up to make recommendations and I saw this as a massive opportunity for SNBTS to get involved in bone and (later) tissue banking and to lead the way in this area. Bone and tissue banking are now established as core services provided by SNBTS and over the past 18 years has expanded significantly, meeting all Scottish tissue needs for patients and supporting other centres in the UK. Always at the forefront of developments, SNBTS has expanded into cellular therapy, initially by the processing and storing of autologous stem cells, later by establishing a very successful national islet transplant service and more recently by getting involved in clinical trials involving ATMPs.

SCOTBLOOD 2014 ANNUAL CONFERENCE

COPLAND LIFETIME ACHIEVEMENT AWARD Tom A McQuillan FIBMS, MSBiol, C Biol Tom was born in Edinburgh and, having always had an interest in science, started work as a junior technician at Edinburgh BTS in the old Royal Infirmary in 1962, having been introduced to blood transfusion work by Andrew Crosbie the senior chief technician there. He progressed through the training route, which at that time involved only night classes at Napier College, to qualify as a technician, passing the Institute of Medical Laboratory Sciences examination in Haematology and Transfusion Serology. On attaining this he was promoted to senior technician, the youngest ever within BTS at that time to achieve that position. The transfusion service was a very different place compared to now, with blood being collected in bottles, all donor and patient testing being performed manually with the interpretation of results based on the visual examination of red cell and serum interactions. It was an exciting time to be involved, with heart lung bypass operations becoming a routine, requiring fresh blood to be collected from ‘known’ donors on the morning of the operation for transfusion in theatre and the patient’s coagulation control being performed by the lab staff in the operating theatre. It was also the beginning of organ transplantation, with support provided by BTS for the tissue typing that was to become a key function of this branch of medicine. These were all areas that Tom was actively involved in delivering and developing, it was also at this time that he met a young registrar from the Department of Medicine and Therapeutics, John Cash, who was involved in coagulation research and was to develop further links with SNBTS over the years as he progressed to National Medical Director. Plasma fractionation was

established as a department in the centre at that time and in 1967 Tom moved to work with John Watt who had just started to develop the fractionation system that PFC would use in the future. He spent many a night in the department when the blood bank on call was quiet, experimenting and refining the continuous plasma fractionation process that would become key to the PFC process. In 1969 Tom moved to work with a pharmaceutical company, G D Searle, in High Wycombe. While there he was instrumental in developing their fractionation capability and became part of the team developing antilymphocyte globulin using lymphocytes from large scale cell culture. This in turn led to him leading the team responsible for developing their range of tissue typing antisera and reagents. While there Tom continued his studies and completed the Fellowship of the Institute of Medical Sciences. In 1972 the attraction of being involved in the development of the Protein Fractionation Centre drew Tom back to Edinburgh and working with John Watt, Peter Foster, Bill Grant and Alan Dickson the centre was opened in 1974 with Tom heading up the analytical and microbiological quality control department. Progress continued with him creating the quality control team and developing the analytical, chemical and biological assays and systems, a number of which were novel in their application to plasma products. Monitoring products for the detection of endotoxin was a key quality measure and with John Watt, Tom established a colony of limulus crabs at Edinburgh zoo, obtained from the east coast of the USA, as a source of lysate for the test. Interesting times but not very practical as a source of reagents, however they then proceeded >>

SCOTBLOOD 2014 ANNUAL CONFERENCE

with the purchase of lysate commercially and the current tests in use today are based on variations of this development. Coagulation factor concentrates were key products at PFC and Tom was instrumental in developing the clotting and chromogenic assay systems used to monitor the processes and products, and working with Chris Prowse and R&D colleagues in improving processes and yields from donor plasma. In 1979 the first inspection by the Medicines Inspectorate took place, this was something novel for all concerned including the Inspectorate and provided the platform for the quality structures that have been developed in SNBTS since then. Following this Tom developed the SOP structure and quality systems, the core elements of which remain throughout the organisation to-day. During this time he was actively involved in national and international collaborations on assay developments and quality systems and represented PFC on the Scotblood organising committee. In 1983, following Bob Perryâ&#x20AC;&#x2122;s appointment as PFC Director, Tom acted as Head of Quality for two years and moved on in 1987 to commercial plasma fractionation, also working as Director then Vice President, Quality for ABI Biotechnology in Canada. In 1991, Tom returned to Scotland and SNBTS, taking up the post of Clinical Laboratory Manager and then Operations Manager in the Aberdeen Centre, covering donor services and laboratory functions. This coincided with the decision to rebuild the centre there and Tom was instrumental in its planning, design and commissioning. By this time blood transfusion had changed significantly from his earlier days with a focus on automation for both serology and virology and the detection of Hepatitis and other viral markers key to the safety of the donations. SNBTS restructured in 1999 with processing and testing taking place in Edinburgh and Glasgow instead of all 5 SNBTS sites and this created the opportunity for Tom

to take up the new position of National Logistics Manager in Edinburgh and take on the responsibility for developing the logistics and transport functions. Key to this was establishing the supply and demand process for the timely provision of collected blood for processing and testing and the range of blood and products 24/7 to both SNBTS and other NHS Scotland customers. As part of the SNBTS restructuring the Tissue Services Directorate had been formed in 1999 and in 2002 Tom was seconded to Tissues, then took up a permanent post there as National Operations Manager working with George Galea and Nik Hunter. During this time Tom has been active in the British Association for Tissue Banking as an executive director and serves as Deputy Registrar for the Voluntary Registration Council. Tissues has also expanded significantly with the range of tissue products being supplemented by the addition of clinical stem cells for NHS Lothian, and the pancreatic islet cell programme that Tom was instrumental in establishing. The skills and expertise developed within Tissues and their exposure to regulatory inspections by the MHRA, HTA and HFEA meant that the group was the ideal base from which to develop cellular therapy products for potential clinical use. Tomâ&#x20AC;&#x2122;s management of these has helped to consolidate the SNBTS position as a major player in this field. His knowledge and expertise were put to good use in working with Roslin Cells in the planning, commissioning and subsequent licensing of the Scottish Centre for Regenerative Medicine and the SNBTS products being manufactured there. The organisation has changed significantly since Tom joined and is now set to go through further exciting developments with the building of the National Centre, his contributions to the planning for this are a fitting end to his 45 years working for the organisation.

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Better Blood Transfusion Team Scottish National Blood Transfusion Service 21 Ellenâ&#x20AC;&#x2122;s Glen Road Edinburgh EH17 7QT

The Better Blood Transfusion Team (BBT) has always identified the importance of haemovigilance in making blood transfusion safer more effective and efficient. BBT supports all Health Boards across Scotland to actively participate in the UK haemovigilance scheme

and investigate serious adverse events and reactions in the NHSS Boards, facilitating preventative action where necessary, and embedding the resultant SHOT recommendations and learning points back into local practice. On the stand we will illustrate some examples of the haemovigilance work being carried out.

- The Serious Hazards of Transfusion (SHOT). The BBT Transfusion Practitioners monitor

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Bio-Rad Immunohaematology Division DiaMed (GB) Limited Whitehall Business Centre Dalkeith, Midlothian EH22 2QB Telephone: 0131 654 0876 Fax: 0131 654 0717 Web: www.diamed.com Email: sales@diamed-gb.co.uk

As the UKâ&#x20AC;&#x2122;s leading supplier of instrumentation and consumables to blood transfusion laboratories, Bio-Rad is delighted to be able to support Scotblood 2014 and to contribute once more to this excellent event in the calendar of the Blood Transfusion community in Scotland. Our fully automated Blood Transfusion analyser the IH-1000 continues to go from strength to strength with almost 100 installations across the UK to date. We also have exciting news regarding our brand new analyser the IH-500, this

instrument represents a huge leap forward and together with the IH-1000 takes blood bank automation to the next level. Please visit us at stand number 20 for details of both systems and an update on our progress. The Scotblood 2014 Scientific Program is, as usual, of the highest quality and will provide valuable opportunities for colleagues to share their thoughts on current topics of concern to all who work within the transfusion environment. We look forward to seeing you.

IH1000 Analyser

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NSS National Services Scotland

Healthy Working Lives Team

NSS Healthy Working Lives National Services Scotland 1 South Gyle Crescent Edinburgh EH12 9EB Tel: 0131 275 7441 Fax: 0131 275 7607 To find out more about our team please visit our NSS Healthy Working Lives Exhibition Stand. Gaffney, who provide training, information and resources on Health & Safety, Fire Safety & Prevention,

The NSS Healthy Working Lives Team is delighted to be able to support Scotblood 2014 Our team consists of 9 members and our aim is to support staff by providing ways to help them maintain and improve their health and wellbeing, by providing a wide range of services that support a Healthy and Safe Working Culture and Environment. The services are Training, Information and resources on Occupational Health, Health and Safety, and Workplace Health Promotion.

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Octapharma Ltd The Zenith Building 26 Spring Gardens Manchester M2 1AB Tel: 0161 837 3770 Email: Octapharma@octapharma.co.uk Web: www.octapharma.co.uk Octapharma Ltd is based in Manchester and provides high quality human protein products for patients in the UK and Ireland. It is a subsidiary of Octapharma AG, a privatelyowned global human proteins manufacturer headquartered in Lachen, Switzerland.

Our critical care products are used by emergency medicine physicians, intensive therapy physicians and paramedics around the world. Every day they are helping to save lives and improve long-term patient outcome.

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Serious Hazards of Transfusion (SHOT) SHOT Office, Manchester Blood Centre, Plymouth Grove, Manchester, M13 9LL Tel: 0161 423 4208 Email: SHOT@nhsbt.nhs.uk The Annual SHOT Symposium in held in July each year to launch the newly published Annual SHOT Report. The 2014 symposium to launch the report of cases submitted in the calendar year 2013 will be held on Wednesday 9 July at The Lowry Theatre, Salford Quays, Manchester.

Serious Hazards of Transfusion (SHOT) is the UKâ&#x20AC;&#x2122;s independent, professionally-led haemovigilance scheme. It started in 1996 and was one of the first such schemes in the world. SHOT collects and analyses anonymised information on adverse events and reactions in blood transfusion from all healthcare organisations that are involved in the transfusion of blood and blood components in the UK. Where risks and problems are identified, SHOT produces recommendations in the Annual SHOT Report to improve patient safety. Haemovigilance is an ongoing exercise, so SHOT also monitors the effect of the implementation of its recommendations.

Further information on the forthcoming symposium is available on the SHOT website www.shotuk.org along with many educational resources produced by SHOT.

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TERUMO BCT EUROPE NV/SA IKAROSLAAN 41 1930 â&#x20AC;&#x201C; ZAVENTEM, BELGIUM Telephone: 01452 729292 Fax: 01452 729293 www.terumobct.com Email: CSUK@terumobct.com

Terumo BCT, a global leader in blood component, therapeutic apheresis and cellular technologies, is the only company with the unique combination of apheresis collections, manual and automated whole blood processing, and pathogen reduction.

We believe in the potential of blood to do even more for patients than it does today. This belief inspires our innovation and strengthens our collaboration with customers.

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SCOTBLOOD 2014 ANNUAL CONFERENCE

Poster No 1 Recorded Telephone Consent of Living Bone Donors Agnes Barr, Elizabeth Taylor SNBTS/Tissues and Cells/Glasgow and West Nursing Team Aim

Patients are called and recorded informed consent is obtained. The consent form is placed into the case record and theatre staff alerted via the normal processes, that a patient had consented to the donation of bone while undergoing hip replacement surgery.

Traditionally the Tissue Nurses of SNBTS consent for Bone Donation through face to face interview with patients that are to undergo Primary Hip Replacement, after a preliminary review of the case record to identify such medically suitable potential donors. Access to such patients can be problematic as the ability to interview and obtain consent at some Pre-admission clinics is not an option. Patients are admitted on the day prior to or the day of surgery (often late evening or before 8am) access/timing to obtain informed consent is not conducive as they are being prepared to go to theatre or there is no Tissue Nurse available to interview them. Consequently a pilot programme to remotely consent by recorded conversation has been instigated.

Results An audit of the number of potential donors, the number medically suitable, the number giving their permission for a phone call and the number that consented against the total possible is being undertaken. Conclusion This patient centred approach means that potential donors are consented in their own home, in a controlled environment at a time suitable to them. Hence, a more efficient, cost effective process allows SNBTS Tissue Nurses to be more resourceful in their time management.

Methodology Hospital staff disseminate a Pre Exclusion Questionnaire to primarily suitable patients. Such patients complete the questionnaire at the pre assessment clinic, to give permission for the Tissue Nurse to call and carry out the interview at a time suitable to them. To confirm medical suitability, the Tissue Nurse also undertakes a visual review of the case record.

SCOTBLOOD 2014 ANNUAL CONFERENCE

Poster No 2 Audit of Transfusion Requests for Six or More Units of Packed Red Blood cells Fairhurst P, Collins C Greater Glasgow & Clyde Health Board – Western Infirmary

Introduction The Scottish Major Haemorrhage Template suggest that when more than 4 units of packed red cells (PRC) are requested, aside from elective procedures, it is best practice to activate the major haemorrhage protocol (MHP) where a dedicated team including a biomedical scientist, porter, and anaesthetist are involved providing peri-transfusion care. It is also advisable to request fresh frozen plasma when larger requests are made. An audit was undertaken in January and February 2014 to quantitatively measure compliance.

reasons given for these were ‘haematemesis’ and ‘major haemorrhage’. In order of decreasing frequency of requests, the areas of need included Accident and Emergency/ Resuscitation Area (55.6%), Theatres (18.5%), General Surgery (11.1%), Vascular Surgery (7.4%). The reasons for these requests were primarily made up of the following: Abdominal aortic aneurysm (29.6%), Gastrointestinal bleeding (25.9%), Trauma or planned procedures. Unfortunately, further details of the reason for request were not provided, ostensibly because of time constraints in an emergency. Of note, 85.2% of these requests were made outside normal working hours (8am-5pm). The largest request during this time was for 14 units of PRC. The reason given for this was ‘Abdominal Aortic Aneurysm’. 8 units FFP were requested. The MHP was not activated for this request. Generally, FFP was requested whenever eight or more units were requested, which made up 22.2% of requests.

Aim The aim of this audit was to analyse, in requests where 6 or more units of PRC were made, whether the MHP was activated, which were the clinical areas of need, whether supplementary products were requested, and what the reasons for these would be. Method The Blood Bank staff recorded details of these requests onto a spreadsheet. Weekly monitoring took place to ensure this was correctly recorded. Data recorded included: location of request, how many units PRC were requested, what supplementary products were requested, the reasons for these requests, and what time and date they were requested.

Conclusion The findings suggest that the MHP is generally underused as a resource. There were only 4 areas of need. Large requests were largely made between 5pm and 8am, which may have implications for future staffing levels. In general, it is suggested that there should be greater awareness of the MHP and more detailed documentation specifying the reasons for these requests. If the MHP was activated more appropriately, this would arguably optimise patient outcomes in a clinical situation with high levels of mortality and morbidity.

Results In total, 27 Requests fulfilling the criteria were made over the course of two months. Of these, only two requests activated the MHP. The

SCOTBLOOD 2014 ANNUAL CONFERENCE

Poster No 3 Transport of Donor Red Cell Concentrates: The Effects of Exposure to 15oC or up to Twelve Hours on Component Quality Emma McGowan1, Loraine MacMillan2, Alex Morrison2 Clinical Laboratory, Scottish National Blood Transfusion Service, Inverness, IV2 3UJ, Scotland; Microbiology & Components RD&I group, National Science Laboratory, Scottish National Blood Transfusion Service, Edinburgh, EH17 7QT, Scotland; 1

Background

Results

UK guidelines specify that for maintenance of red cell quality and safety, transport temperature must be maintained between 2-10oC for a maximum of twelve hours. However, temperature excursions above the specified limit are occasionally encountered, often resulting in precautionary discard of donor red cell concentrates.

No statistically significant changes were observed for any of the parameters when compared to the control group. Conclusion

This preliminary study aimed to investigate the effects on red cell quality when red cell concentrates were exposed to 15oC for up to twelve hours.

The results suggest that exposure of donor red cells to 15oC for up to 12 hours does not cause significant deterioration in red cell concentrate quality. This preliminary study may be used as a foundation for a larger investigation, including bacterial and in vivo studies to provide the key evidence in order to facilitate a relaxation in current transfusion guidelines.

Methods

Running Title

Twenty-four leucodepleted, CPD-SAGM red cell concentrates were collected and equally divided into 4 groups. Three test groups were exposed to 15oC for either 1 hour, 6 hours or 12 hours on day 6 post collection and a control group stored strictly at 4Âą2oC. The red cell quality markers ATP, haemolysis, potassium and pH were measured on days 5, 6, 14, 21 and 35 and the results compared to the control group.

Donor red cell concentrate quality

Aims

SCOTBLOOD 2014 ANNUAL CONFERENCE

Poster No 4 Audit of Transfusion Requests for Six or More Units of Packed Red Blood cells Hema Mistry1, Hedley Glencross2, Bill Chaffe3, and Paula HB Bolton-Maggs1, 4 Serious Hazards of Transfusion Office, Manchester, UK, on behalf of the UK Transfusion Laboratory Collaborative and the SHOT Steering Group, 2Queen Alexandra Hospital, Portsmouth, 3 UK National External Quality Assessment Scheme, 4University of Manchester, UK,

Background

Results

Laboratory errors in transfusion practice continue to put patients at risk. The United Kingdom Transfusion Laboratory Collaborative (UKTLC) was formed in 2006. Following national surveys it published recommended minimum standards for hospital transfusion laboratories in 2009. These recommendations encouraged appropriate staffing, their training, knowledge and skills, and the use of computer information systems. The intention was to reduce laboratory errors reported to the national haemovigilance scheme, Serious Hazards of Transfusion (SHOT) by 50% by 2012.

SHOT data showed that although % errors had reduced (200/1040, 19% of reports in 2008 to 247/1516, 16% in 2012) this was not by 50% and the absolute number had increased. The number of responding laboratories in both surveys (162/322 responding, 50% in 2011 and 188/304, 62% in 2013) revealed a low level of senior staff with appropriate qualifications (44% in 2011, 47% in 2013). Between 2011 and 2013 there was a significant drop in numbers of staff spending >75% time in transfusion. Lack of funding adversely affected full implementation of automation. Funding for education and training was also reduced resulting in fewer staff with current competency assessments.

Aim Conclusions

Repeat the laboratory surveys to examine current practice and review SHOT reports to see whether the target error reduction had been met.

The 50% target for reduction in laboratory errors was not achieved. The 2013 survey showed implementation of the UKTLC recommendations was incomplete. The UKTLC has revised its recommendations into standards. All laboratories are encouraged to comply with these standards for the safety and security of provision of transfusion services.

Method

New surveys were sent to all transfusion laboratories registered with the national external quality assessment scheme (NEQAS) in 2011 and 2013, to be completed by the lead scientist on two specified working days. Annual SHOT data were reviewed to see if the error rate had reduced.

SCOTBLOOD 2014 ANNUAL CONFERENCE

Poster No 5 Injecting Better Practice Around Anti-D Alison Hanlon, Anne Morrison, Fiona MacKenzie, Julie Gillies Elaine Harrison, Margaret McGarvey NHS Greater Glasgow and Clyde (GG&C) Health Board Background / Introduction

Results

GG&C has three large maternity hospitals, including community services across the Board. An increase was noted in anti-D incidents reported to SHOT and this was escalated to the GG&C Overarching Transfusion Committee (OTC) and clinical risk management. Following investigation, it was identified that all 3 laboratories and maternity hospitals were working on slightly differing guidelines/SOPs. As these required updating, it was proposed that a new guideline/SOP, accompanied by a single flowchart outlining the appropriate use of anti-D, would be developed. Importantly, this would have to fulfil the requirements of both clinical and laboratory staff and comply with the most recently published national guidelines. Methods or Study Design

Following education of clinical and laboratory staff, the guideline, SOP and flowchart are due to be launched in May 2014. Information will be provided on the local Staffnet to alert staff to the changes and the aim is to get all staff to follow the guidance on the flowchart, leading to anti-D being administered more effectively. Conclusions

This extremely worthwhile exercise generated much debate around transfusion issues and anti-D in particular. Consistency of practice in a health board with 3 large maternity hospitals will contribute to the ongoing safety of patients. Although the development of these unified documents has been demanding, we are now confident that GG&C will comply with guidelines and patient safety will be improved.

A multi-disciplinary working group was appointed to develop an anti-D obstetric guideline, a laboratory SOP and a flowchart, for display across all clinical and laboratory areas within GG&C. The group reviewed the most recent guidelines and existing local policies to identify the key points and best practice. Agreement was reached with clinical and laboratory staff, all documents were ratified by the OTC and the Gynaecology, Obstetrics and Neonatology Effectiveness Committee (GONEC), and an action plan was developed in preparation for the launch.

SCOTBLOOD 2014 ANNUAL CONFERENCE

Poster No 6 Audit of Management of Irradiated Blood Components in the Beatson West of Scotland Cancer Centre (BWOSCC) Sweeney, CP., Lua, J., Soutar, RL. SNBTS/ NHS Greater Glasgow and Clyde Transfusion-associated graft versus host disease (Ta-GvHD) is a rare but serious complication of blood transfusion which resulted in one UK death in 2012 (See SHOT report 2012). A recent change to the hospital irradiated blood components policy highlighted the need to re-audit local practice. A two-part retrospective audit was carried out covering the three month period from 4th December 2013 until 28th February 2014. Part one assessed whether there was adequate documentation available to assist clinicians and laboratory staff in deciding if irradiated products were indicated for specific patients. At risk patients included newly diagnosed Hodgkin’s lymphoma patients, those receiving an autograft or allograft, and those being treated with purine analogue or bendamustine chemotherapy during the 3 month audit period. Relevant documentation included alerts in Clinical Portal and TrakCare, ‘Irradiated Products Required’ stickers on the patients case notes, and alerts in local blood bank computer files (Traceline). Part two looked at all the patients who received irradiated products during the 3 month audit period and reviewed their clinical need for such products using letters and alerts available in Clinical Portal and TrakCare. Part 1 of the audit looked at 56 individual patients. Of these, 21 patients (38%) did not have adequate documentation on Clinical Portal, 15 patients (27%) did not have adequate documentation on TrakCare, 7 patients (13%) did not have stickers on their case notes, and, critically, 5 patients (9%) did not have appropriate alerts in Traceline.

All 5 of these patients were teenagers and young adults with Hodgkin’s lymphoma. Part 2 of the audit revealed 220 transfusion episodes (some patients were transfused more than once during the audit period) involving irradiated products occurred over the 3 month audit period. Of these, irradiated products were not indicated in 101 (45.9%) transfusion episodes. Six hundred and sixty four units of irradiated blood were transfused during the audit period. Of these, 199 (29.9%) were transfused to patients with no specific indication for irradiated products. This audit was useful as it revealed teenage and young adult patients with Hodgkin’s lymphoma had the most inconsistencies in documentation, and it highlighted a logistical problem with the way this cohort of patients are registered locally. This problem has now been addressed. Investigations revealed the majority of irradiated blood components issued to patients without an indication was for stock management reasons alone however unnecessary requests for irradiated products by clinical staff following the policy change also contributed. Acknowledgements: The authors would like to thank Alan Robertson, deputy lab manager at the Scottish National Blood Transfusion Service, Sinead Connelly, clinical pharmacist at BWOSCC, and Mary Wilson of the medical records office for their help in providing patient information and data collection. Thanks to Cathy Collins, transfusion practitioner, for her clinical advice.

SCOTBLOOD 2014 ANNUAL CONFERENCE

Poster No 7 Nurses’ Perceptions of Transfusion Training Lynn Stout SNBTS/BBT/NHS Grampian

Objectives

the transfusion education provided. Some barriers to staff undertaking the transfusion training were highlighted, IT skills (11%), computer access (24%), conflicting priorities on time (72%) and staff shortages (72%).

Within Scottish hospitals transfusion education is mandatory for those involved in the process of transfusion. Currently two modes of delivery exist, face-toface and e-learning. The researcher wished to evaluate the perceptions of registered nurses within a local hospital to the transfusion training available. The aims were to ascertain whether: • there were perceived benefits from undertaking transfusion training • transfusion training meets the expectations of registered nurses • nurses perceive that there are barriers to their undertaking transfusion training

Conclusions The study indicates a high level of compliance with mandatory transfusion training and suggests both satisfaction and perceived benefits with transfusion training amongst those who responded. Some barriers were highlighted, but it was noted that these were not exclusive to transfusion training and in the current climate of staff shortages and conflicting priorities on time, resolution may be complex.

Methods

Recommendations

A mixed methods approach was used; data were obtained by means of a piloted and validated questionnaire. All registered nurses in the hospital were invited to participate (n= 167).

• Improve access to computers at work to all staff • Explore the possibility of incorporating local issues into the e-learning module by means of a blog site • Compare strategies in place between other mandatory training across NHS Grampian • Repeat the study for other disciplines and other hospitals • Undertake a study to triangulate the findings; theoretical testing of knowledge and competency assessment of practical skills.

Results 98 completed questionnaires were returned (59% response rate). From the data received it could be concluded that staff did perceive there to be benefits to both their knowledge and practice from undertaking the theoretical transfusion training. It was also reassuring that there appears to be a high level of satisfaction with

SCOTBLOOD 2014 ANNUAL CONFERENCE

Poster No 8 Developing a Home Transfusion Service Daniels H, Stewart P, Paterson P, Clinton P, Paterson I & Rennie,T Better Blood Transfusion/NHS Lanarkshire

Aim

Results

Many patients with haematological disorders require long term blood transfusion support to maintain life and relieve symptoms. Transfusions are often performed in hospital day units, but these regular visits, which can last eight hours, can negatively impact the patient’s Quality of Life (QOL), particularly if transfusion is part of palliative care. We have developed a service to allow these transfusions to be safely administered in patient’s homes using the expertise of commercial partner, Healthcare at Home, who has proven experience in delivering healthcare in the community and at home. Patient choice and quality of care is our main driver in making this change.

A detailed policy has been written and it incorporates clear guidance on the decision to transfuse; patient referral; safe transportation and administration of blood components; management of adverse reactions; staff responsibilities and overall governance. Provision of this service does have cost implications and will be offered to those patients most in need. Conclusion This innovative new service will soon be available for those patients and most in need. It will be vital to record patient feedback to allow us to monitor for effectiveness. Our main objective is to demonstrate an improved Quality of Life for both patient and carer(s) and we are confident this new service can deliver on this.

Methodology A ‘Framework for the Development of an out of Acute Hospital Blood Transfusion Service’ was developed in 2012 by a joint venture between the Scottish National Blood Transfusion Service (SNBTS) and the UK equivalent, NHS Blood and Transplant (NHSBT). Better Blood Transfusion (BBT), saw an opportunity for this framework to be developed into a policy for haematology patients with terminal illnesses to be transfused at home in NHS Lanarkshire. A working group was established incorporating clinical and laboratory teams, Transfusion Practitioners and Healthcare at Home.

SCOTBLOOD 2014 ANNUAL CONFERENCE

Poster No 9 Activity Theory Used as a Theoretical Template to Develop a Staff Survey to Identify Workflow Constraints in SNBTS Christie E SNBTS/Faculty of Life Sciences, University of the West of England

Do You Know Who I Am?

NHS Grampian, one of several Scottish Health Boards to embrace this National campaign, ran a two week event within their hospitals; targeting both staff and patients.

The patient identification check continues to be a critical point in the transfusion process where errors could be made. Misidentification of patients and Transfusion of ABO-incompatible blood are listed in the Department of Health ‘ Never Events’ (2011).

The event was well attended by a variety of staff groups and by patients. Promotional materials, hospital radio, NHS Board social media websites; Facebook and Twitter, were all utilised to support and encourage patient empowerment and involvement in this vital aspect of patient safety. For staff sessions, incidents and root cause analysis including contributory factors were shared and the opportunity to express opinions on the campaign was requested via a graffiti wall.

Initiatives involving patient participation in minimising adverse events have been previously implemented in healthcare; the most high profile, being encouraging staff to wash their hands. Recently this concept has been adapted by the world of transfusion, titled ‘Who am I?’ The campaign was endorsed by the Royal College of Pathologists to raise awareness of ensuring that this critical aspect of correct patient identity is embraced and was a recommendation from the Serious Hazards of Transfusion (2009).

SCOTBLOOD 2014 ANNUAL CONFERENCE

Poster No 10 Improving Blood Transfusion Ordering in Obstetric Patients – Analysis of Current Guideline Use and Unused Units Grahyl Artis – University of Glasgow Medical Student Niaz McGuire – University of Glasgow Medical Student Dr Sarah Barr – Obstertrics and Gynocology ST Elaine Harrison – Transfusion Nurse Specialist Background

Conclusion

Blood transfusion in obstetrics is common, particularly following post-partum haemorrhage. There is a high level of return of blood products, which could be considered a waste of NHS resources. The use of a Maximum Blood Ordering Schedule (MSBOS) is employed to try to minimise this wastage by having standard indications for blood usage.

There have been a large number of returns to the blood bank at the Unit. This did not appear to be due to inappropriate ordering but rather an overestimation of blood requirements. The guideline has now been updated, to include converting many conditions previously requiring blood products to group and save and shortening reservation times after caesarean section. Re-audit next year is planned.

Methods Crossmatch requests in the Princess Royal Maternity unit were obtained between March-May 2012. Indications for crossmatch were recorded and compared to the MSBOS. Returned blood was also recorded. Findings There were 116 crossmatch requests. Of these, 77.6% were returned. The majority of requests were in the context of postpartum haemorrhage. 80% of requests were deemed appropriate to the MSBOS, 10% were inappropriate requests, 2% had no indication under the MSBOS and in 8% there was insufficient clinical information to justify crossmatch.

SCOTBLOOD 2014 ANNUAL CONFERENCE

Poster No 11 Blood Transfusion - Consent and Prescription - Are We Doing Enough? Williamson, Adam, McGarvey, Margaret Department of Haematology and Scottish National Blood Transfusion Service, Southern General Hospital (SGH), Glasgow, NHS Greater Glasgow and Clyde. Background

Results

Guidelines from the British Committee for Standards in Haematology exist regarding consent and documentation for patients receiving a blood transfusion and how blood products should be prescribed. Consent is easily facilitated via a national patient information leaflet and NHS Greater Glasgow and Clyde uses a transfusion record which prompts the prescriber to complete the blood prescription in full, improving patient safety and protecting patient autonomy.

There were 47 transfusion episodes reviewed; 28% (13) had consent for transfusion documented with eight using a patient information leaflet. The information leaflet was usually used by an FY 1 Doctor (88%). The prescription was completed in 54% of cases. Patients core identifiers, component(s) to be transfused, date, volume/number, and rate was complete in 100% of cases. The commonest missing data was Special Requirements section. Comparing to previous audits, consent documentation has fallen from 65% to 28% and completion of prescription from 75% to 54%.

Aim Re-examine the utilisation of patient information leaflets, or in their absence, documentation of consent elsewhere, and the completion of blood transfusion record. Compare results with two previous audits (February and October 2012).

Conclusions and Recommendations Utilisation of patient information leaflets, consent documentation and completion of prescription is poor. Whilst there have been areas identified that can improve this, comparison to previous audits highlights the need for continuous awareness and education amongst medical and nursing staff to maintain compliance. The audit cycle is ongoing, with current interventions including relocating patient information leaflets to be beside transfusion record documents. Education remains key and should be addressed at regular intervals throughout the year.

Method Collection of data using a standardised audit tool for transfusion of any blood product between 17th February 2014 to 16th March 2014 within seven medical wards in SGH. Comparison of results with previous audits.

SCOTBLOOD 2014 ANNUAL CONFERENCE

Poster No 12 An Exploratory Research Study into the Effects of Staff Feelings and Perceptions Following a Transfusion Incident Investigation Creighton Diane., Wright Marty. NSS, SNBTS Better Blood Transfusion Glasgow Caledonian University Aim

confidence was impacted by the event and most were worried about confidentiality and other staff knowing that they had made an error. Support was in the main positive although two participants experienced negative reactions from colleagues. All had learned lessons which they would carry forward into the future work life and share with colleagues. The participant’s reactions directly correlated to the severity of the adverse event and potential outcome for the patient.

The aim was to identify the emotional impact that the error and the subsequent investigation has on the member of staff involved and review contributing factors to the errors. Method An exploratory qualitative method was utilised using a critical incident technique approach to semi-structured interviews. A non-random purposive method was used by Transfusion Practitioners to recruit participants where a transfusion error had happened. Ethics approval was obtained. Following recruitment the participants were interviewed using the Luu et al (2012) template. All Interviews were recorded and transcribed and thematic analysis was undertaken using the Braun and Clarke (2006) approach.

Conclusion The awareness of human factors requires to be incorporated into training packages to ensure that staff are aware of the risks that these bring into procedures in busy ward environments. The reactions and feelings of staff involved in an adverse event can be overwhelming; support provided to the staff is a crucial aspect of the lessons learned in the wake of an error.

Findings and Discussion References Twelve Staff were invited to take part at the recruitment phase, of which five agreed, representing a 42% response rate. Following analysis and coding (Saldana, 2009) nine emergent themes were identified. The main human factors acknowledged from four participants were distraction and a busy work environment at the time of the event. All five expressed feeling of disbelief that they had been involved, which impacted on four of the participants emotionally, experiencing physiological symptoms like insomnia. Their

Braun, V. and Clarke, V. (2006) Using thematic analysis in psychology. Qualitative Research in Psychology, 3 (2). pp. 77-101. Luu, S., Patel, P., St-Martin, L., Leung, A., Regehr, G., Murnaghan, M, L., Gallinger, S., Moulton, C. 2012, “Waking up the next morning: surgeons’ emotional reactions to adverse events”. Medical Education, vol. 46, no. 12, pp. 1179 – 1188. Saldana, J. 2009, The coding manual for qualitative researchers. Sage, Los Angeles.

SCOTBLOOD 2014 ANNUAL CONFERENCE

Poster No 13 “Can I Give Blood” : Piloting Practice-Based Questions for the Blood Donor Health Check Mike Kesby, Matt Southern and Fionagh Thomson Department of Geography and Sustainable Development University of St Andrews

With reference to risk presented by ‘sexually relationships’, the question ‘can I give blood?’ is predominately answered, ‘not if you have had a ‘high-risk’ partner in the last 12 months?’ Existing deferral policy excludes sub-populations (e.g. active MSM, user of commercial sex) that epidemiological studies associate with elevated per capita levels of Blood Borne Viral Infections. This population level risk-assessment fails to prevent a larger absolute number of infected donations from ‘low risk’ categories because the Donor

Health Check does not specifically examine actual sexual practices clinically associated with infection (Kesby & Sothern 2014). NHS Blood and Transplant (2011) insist that practice-based questions would be intrusive and lead to donor loss but the evidence base for this policy is sparse. Our small-sample, qualitative pilot study will, for the first time, begin to answer the question: are potential donors willing to answer questions about clinically relevant practices or would such questions deter them from donating?

SCOTBLOOD 2014 ANNUAL CONFERENCE

Poster No 14 Is the GG&C Guideline for Nurse Authorisers being Adhered to In B7 Haemato-Oncology Ward - Beatson West of Scotland Cancer Centre Dowdle C, Collins C Greater Glasgow & Clyde Health Board Beatson West of Scotland Cancer Centre Introduction The concept of nurse authorisation of blood products arose from a collaborative project which was undertaken between the NHS Blood and Transplant and the Scottish National Blood Transfusion Service (SNBTS) to examine the possibility of “prescribing or more fittingly authorising” of blood and blood components by nurses and midwives. Section 130 of the 1968 Medicines Act has been amended by Section 25 of the Blood Safety and Quality Regulation 2005 (SI 2005 no 50) signifying that blood and blood components are excluded from a legal definition of medicinal products and so the term “prescription” does not apply. Therefore there is no legal barrier to nurses and midwives authorising a blood or blood component for transfusion. This role development is supported by a Governance Framework Document developed by SNBTS and NHS Blood and Transplant. In response to the changing needs of patients and clinical practice this role was embraced within Greater Glasgow & Clyde. A GG&C guideline was developed in accordance with the Governance Framework Document to support this role and establishes the criteria and assessment framework required for the authorisation of blood and blood components by nurse authorisers. Approval for nurse authorisation would be verified by supervised practice of ten transfusion episodes by a Consultant Haematologist. The nurse practitioner within B7 wished to implement this role development, audited transfusion practice which identified a gap in service. A decision was made by the Lead Nurse and Consultant Haematologist to take this role development forward for the nurse practitioner working in the Haemato-Oncology ward where patients receive chemotherapy and undergo stem cell transplants; this would potentially reduce the delay in authorising the transfusion.

Aim The aim of this audit was to establish if the nurse authoriser within ward B7 was adhering to the GG&C Guideline when authorising blood or blood components. Method A retrospective audit of ten Blood Component Prescription & Record of Transfusion Document were examined by the practitioner between August and October 2013. These were obtained from the patient’s case notes. The information gathered included: number of case notes audited, reason for transfusion, consent, special requirements and evidence of discussion between nurse authoriser and senior medical staff when required to determine the requirement for the transfusion. Results A total of ten Blood Component Prescription and Record of Transfusion Documents were reviewed. Of the ten documents reviewed, the decision to transfuse was made by the Nurse Authoriser and evidence showed that eight out of the ten was in compliance with the GG&C guideline. Evidence included: suitability of patient group ( i.e. not first transfusion), patients diagnosis, patients transfusion history, special requirements and reason for transfusion. Conclusion The Haemato-Oncology unit is as high user of blood and blood components. This audit has identified that the majority of patients do receive transfusions in accordance with the GG&C Nurse Authoriser Guideline, as well as in a timely and safe manner. On reflection it has been recognised that it is not always feasible for the supervising mentor to be a Consultant Haematologist. It has been agreed that changes will be made to the GG&C guideline to permit Haematology Specialist Registrars to also undertake the supervisory role.

SCOTBLOOD 2014 ANNUAL CONFERENCE

Poster No 15 Guiding Light or Straightjacket?: The Role of EC Blood Directives in Improving Donor Adherence to the Self-Deferral Criteria. Thomson, Fionagh School of Geography & Geosciences University of St Andrews NBTS/Location/Dept./NSS/Hospital Improving donor adherence to all selection criteria during the blood donation process is considered key to improving the safety, and self-sufficiency, of the supply of blood products within Europe. The main tool cited is the predonation healthcheck questionnaire (HCQ) with the final responsibility to defer resting with each donor (hence the term to self-defer). To support donors in making an informed decision, the current donation process is designed around the mutual exchange of information between potential donor (my lifestyle & medical history) and the National Blood Service (why we need your blood, what we do with it and some potential risks to you). Lack of adherence to the self-deferral criteria, however, is of major concern for implementing and regulatory bodies in the European Commission (EC) and Member States. In March 2013, the findings of an EC working group, set up to review ‘Risk Behaviours having an impact on Blood Donor Management and Transfusion Safety, “re-emphasis(ed) that adherence to donor deferral rules is crucial for blood safety.” The overriding solution is to provide more public information and increase donor education about blood donation, as emphasised in recent EC Directives, World Health Organisation (WHO) guidelines and updates to the ‘red book’ (UK blood guidelines.) Currently detailed discussions revolve around i) how best to present the information (e.g. visually or computer assisted technologies), ii) when this information is presented (e.g. HCQ or medical interview) and more recently iii) where to complete questionnaires (e.g. piloting home-completed questionnaires in Dumfrieshire). Notably, the choice of information appears unproblematic and, instead, the focus is on increasing donor understanding of the ‘right information’. A recent example is the National Compliance survey, set up by Public Health England in 2013, designed around checking accuracy of donor understanding of the questions in the current HCQ that they

‘need to know’ in order to self-defer. As such, the problem is framed as technical, where potential (in particular new) donors have a deficit in knowledge that needs to be enhanced/’topped up’, although why donors do not self-defer when they should remains poorly understood. This ‘deficit model’ of education has been critiqued for over a decade in other areas of medical research, in particular in patient decisionmaking and compliance to treatment regimes, but such debates are notably absent from the field of blood donation. One potential reason may be that making an informed decision to self-defer from donating blood differs ethically and legally from a patient making an individual treatment choice; the former is a public health decision that could affect the safety and self-sufficiency of the European/ national blood supply, and the blood products market. As a result, while the donor has the right to self-defer and not be discriminated against, no donor has the right to give blood (WHO, 2013). However, the rationale for including donor voice(s) in discussions on improving adherence to selfdeferral criteria is pragmatic rather ethical; based on the view that the Donor-Blood Service relationship is a partnership that relies upon exchange of mutually beneficial information and trust. To add to the complexity, while WHO promotes the view that healthcare information differs across borders and cultures and national interpretations should reflect this diversity, in March 2013, the EC working group also concluded that “Standardised donor questionnaires and donor education are needed to increase adherence to deferral rules”. In addition, EC Blood Directives are unusual as the EC can directly intervene in national interpretations and Member States face penalties if they do not conform. The poster, building on Farrell (2010) and Dixon-Woods et al (2007), expands the above outline and offers a discussion question: are EC Blood Directives a guiding light or a straightjacket in improving adherence by donors to the self-deferral criteria?

SCOTBLOOD 2014 ANNUAL CONFERENCE

Poster No 16 General Surgical Maximum Blood Ordering Schedule (MSBOS) for South of Glasgow. Gillespie, Laura & Harrison, Elaine NHS Greater Glasgow and Clyde, Southern General Hospital Introduction

Results

The use of Maximum Surgical Blood Ordering Schedules (MSBOS) are widely acknowledged to assist staff with the complexities of when to order blood components and allow Blood Bank staff a benchmark for optimal requesting for surgical interventions. This project aimed to audit current blood ordering against the existing MSBOS, updating it where required.

164 red cell units were requested for patients going to theatre. Only 19 of 164 requested units were administered (12%). From this, recommendations to update the MSBOS were made. Many of these changes reflect updates in clinical practice. 3 procedures were noted as having the greatest number of returned red cells, with 6 procedures needing no alteration to current MSBOS. Conclusion: The South Glasgow hospitals General Surgical Maximum Blood Ordering Schedule is out of date. Current practices are resulting in waste of: blood product; staff time; and resources. If the new recommended MSBOS was followed then 93 units would be saved in 6 months.

Method Red cell requests for general surgical inpatients were reviewed retrospectively, between February-July 2012 in 2 South Glasgow hospital sites. Electronic records were accessed to establish undertaken procedure. The number of requested and administered red cell units were compared accordingly.

SCOTBLOOD 2014 ANNUAL CONFERENCE

Poster No 17 Operation of a GMP-Compliant Allogeneic EBV-Specific Cytotoxic Cell Bank for the Treatment of Lymphoproliferative Disease M Vickers, G Wilkie, N Robinson, N Rivera, N Fraser, D Turner, V Robertson, J Campbell, M Turner SNBTS into ten patients with lymphoproliferative disease, eight of whom achieved complete remission. Neither of the two patients with refractory disease were matched at an HLA class II locus. Two cases of EBV-associated sarcoma received cells, but neither achieved complete remission. There were no serious adverse reactions. A further thirteen patients died before any cells could be issued. Eleven infusions were not pursued in patients, six did not have PTLD and six improved on conventional therapy. A third party donorderived EBV-specific CTL cell bank can be operated under current legislation and is a valuable addition to existing therapies for selected patients, but there is potential for better utilization of the resource.

Epstein-Barr virus (EBV) is associated with several malignancies, including posttransplant lymphoproliferative disorder (PTLD). Conventional treatments for PTLD are often successful, but risk organ rejection and cause significant side effects. EBV specific cytotoxic lymphocytes (CTLs) generated in vitro from peripheral blood lymphocytes provide an alternative treatment modality with few side effects, but autologous CTLs are difficult to use in clinical practice. Here we report the establishment and operation of a bank of EBV-specific CTLs derived from 25 blood donors with HLA types found at high frequency in Caucasian populations. Since licensure, there have been enquiries about 37 patients. Cell lines have been infused

SCOTBLOOD 2014 ANNUAL CONFERENCE

Poster No 18 Blood Bank Redesign Alison Badger SNBTS Aim Within Blood Banking, 80% of activity is providing blood and blood products for transfusion to patients requiring it as part of their management of care. These products may be elective or urgent, but usually life enhancing or life saving. It was, therefore, a priority for Patient Services to review the blood bank process within the 5 regional centres and ensuring consistency in Standard operating procedures (SOP) Training, validations batch acceptance and all parts of the process including methods of communication, forms etc. To carry out this review, the Blood Bank Redesign (BBLR) group was formed in January 2013 including members of staff with knowledge of the process from the five regional service to take this forward as a project:

Act) cycle of improvement. A national Change Control was submitted and the process was piloted for a month. At the end of the month there was a lessons learned and a process review, at which point any alterations to SOPs, forms, etc were carried out and a National training programme organised by the national training officer. The project went Live in January 2014 The success of the first phase of the project can be measured by its achievements: • A National Process has been agreed • The number of SOPs for phase one has reduced from 25 to 3 • Nationalisation of Forms/letters and all documentation • Training and competency have been nationalised • Equipment has been reviewed to allow forward planning and future Managed Service contracts to be delivered • The process map will inform the Patient Services workforce plan for Blood Banking

Methodology The blood banking process for each of the five regional blood banks was mapped and process maps produced. The project team then evaluated the five separate maps and developed one national map based on best practice from all sites, leaning processes wherever possible and removing historical non value added tasks and paperwork. At the same time, the project team reviewed National Guidelines (BSCH, Red book, European Directives, etc) to ensure that any recommendations were incorporated into the new process The national process map took three months to develop and included the nationalisation of forms and SOPs. The process itself is complex, so the project team decided, therefore, to adopt a systematic and phased approach to deliver changes in a timely manner.

Conclusion The anticipated benefits for BTC in using this approach are: • Improved customer satisfaction • Increased staff satisfaction • Reduction in wastage/Non Value Add Activity • Improved efficiency • Capacity to take on new projects/ initiatives – improving income revenue • Fit for the future organisation • Improvement in regulatory compliance • Reduction in work for other internal Department who support Clinical service i.e. Quality and procurement

Results The first phase of the project was delivered on 9 December 2013 using a PDSA (Plan, Do, Study,

The result of this process re-design is that Patient Services is helping to ensure that BTC is an organisation fit for the future.

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Poster No 19 Development of IgA / Anti-IgA Testing Protocols within the SNBTS Margaret Forsyth1, Dr Ulrike Paulus1, Marie McQuade1, Dr David Colligan2 1

SNBTS, Clinical Services Glasgow, 2 SNBTS Research, Development and Innovation.

Introduction IgA deficient patients can be at risk of allergic/ anaphylactic reactions during transfusion of blood products or components containing IgA. These transfusion reactions are rare but can be severe, and occasionally fatal. Such patients are a particular challenge to the Scottish National Blood Transfusion Service (SNBTS) as IgA deficient blood components are required for transfusion support. In these circumstances SNBTS can supply plasma reduced red blood and platelets for IgA deficient patients. Transfusion of these components may be considered for IgA deficient patients who have not experienced a transfusion reaction but are likely to require frequent transfusions in an attempt to avoid sensitisation. The provision of IgA deficient components versus standard components often requires a timely clinical decision. The consequences of a delay of transfusion must be balanced against the risk of a potential reaction.

assay. All results were compared with the existing indirect ELISA anti-IgA antibody technique, novel IgA quantification ELISA methodology and commercial Bio-Rad kits: “ID-PaGIA IgA Deficiency Test” and “ID-PaGIA Anti-IgA Antibody Test”. Patient samples tested had been referred for previous antiIgA testing within the SNBTS historically and subsequently stored at -40°C. Historical results for anti-IgA and Clinical Portal data for IgA levels were used for comparison. Results ELISA anti-IgA antibody assay was more sensitive than Bio-Rad anti-IgA antibody test. However this may result in too many false positive results. Whereas the Bio-Rad anti-IgA antibody assay appeared to be more specific. Bio-Rad IgA deficiency testing identified 25% of patients in this cohort as having IgA levels >0.0005g/L therefore not requiring special components. 75% of patients in this cohort with IgA levels <0.0005g/L would still require special components.

Objective This project aimed to compare and assess the sensitivity and specificity of different IgA and anti-IgA antibody investigation methodologies.

Conclusion For IgA deficiency screening the author would recommend the use of Bio-Rad IgA deficiency assay as it provides a rapid, sensitive test for IgA levels greater or less than 0.0005g/L within 20 minutes of sample arrival into the laboratory for referrals for urgent transfusion. In this author’s opinion, the ELISA anti-IgA antibody assay appears to be more sensitive than the anti-IgA gel card assay, and SNBTS should continue using the current ELISA until a flow cytometry assay can be developed to perform further comparative analysis.

Material and methods This project included development of a Flow cytometer based immunoassay and evaluation of a commercial available BioRad anti-IgA assay, compared against the standard, existing inhouse anti-IgA ELISA. Additionally this project investigated methods for quantification of IgA levels, including Flow cytometry and an ELISA

SCOTBLOOD 2014 ANNUAL CONFERENCE

Poster No 20 Mesenchymal Stromal Cells and their Chemokine Receptor Expression Kayleigh Thirlwell 1, Michelle Le Broq 1, Gerard Graham 1 and John Campbell 2 Institute of Infection, Immunity and Inflammation, University of Glasgow. 2 Scottish National Blood Transfusion Service, Edinburgh

effects on islet function and longevity. Chemokines and chemokine receptors are tissue specific “address codes”, which are responsible for migration and persistence of cells at a specific site. Unsurprisingly, BM-MSCs have been shown to express CXCR4, however this varies between single passages of the same cell line. Therefore there is a need to fully phenotype the chemokine receptor expression of MSCs isolated from various locations within the body in order to determine the appropriate optimal candidate for co-infusion with islet transplants. Additionally, I aim to assay chemokine receptor expression under different conditions such as hypoxia and inflammation to deter if pre-treating these cells before infusion could increase their homing capacity to target tissues.

Diabetes type 1 mellitus (DT1M) is a chronic autoimmune disease resulting from destruction of the insulin producing pancreatic β-islet cell. In 2011 DT1M cost the UK £1.9 billion, with this figure expected to rise to £4.2 billion by 2035 if treatment remains unchanged. Islet transplantation can lead to insulin independence and reduced hypoglycaemia. However, there is long term deterioration in islet function and the formation of autoantibodies in patients receiving more than one graft. Mesenchymal stromal cells are under intense investigation as cellular therapeutics due to their tissue regenerative capacity, suppression of allo-immune responses and graft rejection. Therefore, it may be possible to co-transplant MSCs with pancreatic islets with potential beneficial

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Organisers

Core Group

David Colligan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Chairman Sheila Ross . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Registration Lisa Bell & Isabel Ward . . . . . . . . . . . . . . . . . . . . . . . . . Commercial Exhibition Neil McGowan . . . . . . . . . . . . . . . . . . . . . . . . . Scientific Programme & Posters Dick Drake . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Social Programme Anne Howieson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Conference Booklet Steve Pennington . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Treasurer

Local Co-Ordinators

Lesley MacDonald . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SNBTS East Suzanne Milliken . . . . . . . . . . . . . . . . . . . . . . . . . . . SNBTS West (Athenaeum) Anne Thomson & Anne Howieson . . . . . . . . . . . . . . . . . . . . . . . . SNBTS West Sheila Ross . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SNBTS North Colin Robertson . . . . . . . . . . . . . . . . . . . . . . . . . . . SNBTS South East, New RIE Jason Whitelaw . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SNBTS North East Shirley Gibson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SNBTS South East

Programme Committee Neil McGowan (Chairman) Moira Carter Marc Turner David Colligan Rachel Green Anne Thomson Juraj Petrik

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Acknowledgements

The contribution of Sandie Young & Isabel Ward in the compilation of the Abstracts and Mags Dunleavy in the maintenance of the Scotblood Conference website is gratefully acknowledged. Additionally, the Organising Committee is grateful for the continuing support of the SNBTS & NSS Boards and the Commercial Contributors, without whose sponsorship this Conference would not be possible. The Scotblood Organising Committee and delegates are grateful to all the Commercial Companies who have financially supported this yearâ&#x20AC;&#x2122;s Conference by their attendance at the Commercial Exhibition. In addition, we would also like to acknowledge the number of Companies/Organisations who have supported the event by additional sponsorship.

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