Scotblood 2015 by Gareth Neil Design

SCOTBLOOD 2015 ANNUAL CONFERENCE Stirling University • June 04 & 05

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SCOTBLOOD 2015 ANNUAL CONFERENCE

CHAIRMANâ&#x20AC;&#x2122;S INTRODUCTION David Colligan Chairman, Scotblood 2015 Organising Committee Dear Delegate, Welcome to the University of Stirling and Scotblood 2015. With the many positive emails and comments that we received following Scotblood 2014, it can be safely said that last year could be regarded as a very successful Conference. Obviously this is what we all hoped for but in truth this only increases the pressure on the Organising Committee and how we can improve in 2015! The challenges for the Organising Committee are always the same, we must try to maintain the impetus the Conference has developed, innovate where appropriate and yet be mindful to retain that traditional Scotblood atmosphere. I hope that you will agree that this year we have attracted internationally renowned speakers to discuss the current and future developments and the challenges faced in delivering our core products. This marries well with our People Centred session in Plenary II. This session, which was introduced in 2014, is focussed on the outcomes and challenges for patients receiving SNBTS products and services. I would like to take this opportunity to thank the patients who have generously agreed to participate in this session. Additionally we also have a number of notable speakers discussing the exciting fields of new and emerging cell therapies and the critical areas of donor recruitment and management. Iâ&#x20AC;&#x2122;m sure you will agree that they will all deliver interesting and informative talks. We are grateful for the support from all senior managers which have made it possible to continue the opportunity to offer a free

day of attendance for all SNBTS/NSS staff. The theme for the Thursday evening social event has a Mexican 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 Commercial Exhibition, the conference booklet and the operation of the Conference requires dedication and hard work 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. I would like to stress that without these companies and their financial support this Conference would not be possible on this scale. Can I urge all of the delegates to make a concerted effort to meet and speak with the exhibitors, whether they be a regular or one of our new exhibitors. Finally we would like to thank you, the delegates, for your support of Scotblood. This is a unique conference in that it is 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 2015.

SCOTBLOOD 2015 ANNUAL CONFERENCE

Programme Thursday 4th 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 S Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Mr Ian Crichton NSS Chief Executive 10.00 – 12.00 Plenary Session I – Red Cells Chair: Mr Ian Crichton, NSS Chief Executive S New Processing & RBC Technologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dr Stephen Thomas NHSBT S Logistics of RBC Provision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mr Paul Milne SNBTS S Developing the Next Generation of Blood Substitutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Professor Chris Cooper, University of Essex

12.00 – 14.00

Opening of commercial exhibition, lunch & poster viewing

14.00 – 15.30

Plenary Session II – Patient Centred Chair: Mrs Mary Morgan

S Rachel Bouncing Back . . . . . . . . . . . . . . . . . . . . . . . Miss Rachel Laird & Dr Peter Johnson, Western General Hospital S Supporting Management of Major Haemorrhage in Scotland . . . . . . . . . Mr Douglas Watson & Mrs Tina Watson, GGC

S Maximising Use of the Donor’s Gift

SCOTBLOOD 2015 ANNUAL CONFERENCE

Programme 15.30 – 16.00

Coffee/tea, poster viewing & prize and commercial exhibition

16.00 – 17.30

Plenary Session III – Emerging Cell Therapies Chair: Professor Marc Turner

S From Research to the Clinic: The Mesenchymal Stromal Cell Experience at the FRCBS . . . . . . . . Dr Johanna Nystedt Finnish Red Cross Blood Service S Cell Therapy for Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Professor Kevin Docherty University of Aberdeen

S Autologous Monocyte Derived Macrophage Therapy for Liver Cirrhosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Professor Stuart Forbes University of Edinburgh 18.30 – Midnight

Reception, buffet dinner and disco

SCOTBLOOD 2015 ANNUAL CONFERENCE

Programme

Friday 5th June

All sessions in Logie Lecture Theatre unless otherwise indicated

09.30 – 11.00 Plenary Session IV – Donor Services Chair: Dr Moira Carter S Right Sizing Collections - A Paradigm Shift in Donor Recruitment . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dr Moira Carter SNBTS S A Year in Social Media – Why the Digital Landscape Impacts Upon the Blood Supply . . . . . . . . . . . . Miss Jennifer Wilson SNBTS S Tracking Transfusion in Scotland Where Does Blood Go? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dr Katherine Forrester SNBTS

11.00 – 11.30

Coffee/tea, poster viewing and commercial exhibition

11.30 – 12.30 Iain Cook Memorial Lecture S Blood Bank Technology Current & Future Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Professor Marion Scott NHSBT

12.30 – 14.30

Lunch, poster viewing and commercial exhibition

14.30 – 17.00

Concurrent Sessions

S Immunohaematology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Lecture Theatre W1

S Donor Services Chair: Dr Moira Carter

Logie Lecture Theatre

• Taking the Guesswork Out of Venue Layouts . . . . . . . . . . . . . . . . . . . . . . Victoria Shirran, SNBTS • Donor Clinical Support Team . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dr Angus Wells, SNBTS

SCOTBLOOD 2015 ANNUAL CONFERENCE

Programme

• Donor Services Engagement Day Updates . . . . . . . . . . . . . . . . . . . . . . . . . . Victoria Shirran/Mairi Gaffney Sandra McLachlan/Jacqueline Millar

S Research, Development & Innovation Tissues & Cells Chair: Professor John Campbell . . . . . . . . . . . . . . . . . Lecture Theatre B4

• The Isolation & Characterization of Extracellular Vesicles from Blood Components . . . . . . . . . . . . . . . . . . Dr Jill Stephens SNBTS • Ovarian Tissue Cryopreservation and Transplant – The Edinburgh Project . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Professor Evelyn Telfer & Miss Louise Adam, University of Edinburgh/SNBTS • Studying Vascular Injury in the Radial Artery Using Radio-Labelled Endothelial Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dr Andrew Mitchell University of Edinburgh • Launching of Lyophilized Platelets into Clinical Trials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Arthur P. Bode, PhD & Glen Michael Fitzpatrick, PhD Cellphire Inc; Rockville, MD, USA • Osteochondral Tissue Banking . . . . . . . . . . . . . . . . . . . . . . Miss Aleksandra Mozdzynska SNBTS

SCOTBLOOD 2015 ANNUAL CONFERENCE

General Conference Information Accommodation

A disco in the MacRobert Bar will start at 2030 until Midnight.

Accommodation for Scotblood delegates will be in Willow Court or Stirling Court Hotel. Key cards will be issued for Willow Court from the Reception Desk at Willow Court. Rooms will be available from 1200 on the day of arrival and must be vacated and keys returned to the Reception Desk by 1000 on the day of departure. Delegates with accommodation at Stirling Court Hotel can check-in after 1400 and should check out by 1000 on day of departure.

Meals Please note that delegates MUST wear their conference badges at all times to receive conference meals, including breakfast at Haldane’s. Thursday 4th June Breakfast . . . . . . . . . . . . 0730 to 0845 Haldane’s, Andrew Miller Building Lunch (Bento) . . . . . . . . 1200 to 1400 Andrew Miller Atrium Buffet/Drinks . . . . . . . . 1830 to 1945 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 5th June Breakfast . . . . . . . . . . . . Lunch (Bento) . . . . . . . .

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 this building, with cash machines available here.

0730 to 0845 Haldane’s, Andrew Miller Building 1230 to 1430 Andrew Miller Atrium

Message Board A Conference Message Board is located beside the Registration Desk.

Commercial Exhibition Parking The Commercial Exhibition will be in the Andrew Miller Atrium from 1000 on Thursday 4th June and will be open until 1600 on Friday 5th June.

Parking is available at Willow Court for residential delegates. Day delegates can park in Cottrell Car Parks. Delegates are requested not to park in Queen’s Court.

Social Event Poster Session The social evening for Thursday 4th June will have a “Mexican” theme with a buffet style menu. A cash bar will be open from 1830 onwards with food and complimentary drink being served from 1900 onwards.

Posters should be displayed in the Andrew Miller/Cottrell link bridge by 1000 on Thursday 4th June and should be removed by 1700 on Friday 5th June.

SCOTBLOOD 2015 ANNUAL CONFERENCE

Telephone

CPD

Telephone facilities are available throughout the University Campus. Urgent telephone messages on Thursday/Friday 0900 to 1700 should be made to Commercial Services at the University on 01786 466000. Outwith these hours, contact the main University switchboard at 01786 473171.

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.

Willow Court – 01786 466952 Stirling Court Hotel – 01786 451666

Please note that CPD schemes have changed 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.

Registration

Tea & Coffee

Registration will be open at the following times:-

Tea and coffee will be available as follows:-

Contact telephone numbers for the residences are:-

Thursday 4th June 0830 to 0930 & 1530 to 1600 beside the Commercial Exhibition in Andrew Miller Atrium.

Thursday 4th June – 0830 to 1700 Friday 5th June – 0830 to 1600 The Registration Desk will be manned throughout the Conference to provide further information as required.

Friday 5th June 0830 to 0930 & 1100 to 1130 beside the Commercial Exhibition in Andrew Miller Atrium.

SCOTBLOOD 2015 ANNUAL CONFERENCE

PLENARY SESSION I New Processing and RBC Technologies Dr Stephen Thomas NHSBT Red cell concentrates are the most commonly transfused blood component (around two million units per year in the United Kingdom and Ireland) yet it would appear that little has changed in the last twenty years. Changes in blood component manufacture can be driven by safety, efficiency or efficacy. The biggest change in recent years was driven by safety concerns: universal leucodepletion was introduced in 1999 to reduce the risk of transmission of vCJD. It appears to have been effective in this regard with the three recorded transmissions being from red cells prior to this date. The drive for increased efficiency, and to make the most of every donation led NHSBT to introduce ambient hold of whole blood prior to its separation into components. Whilst this enables the manufacture of red cell, platelet and plasma components from each bag of whole blood on the day after donation, some compromises are required in terms of the quality of the components, notably the red cells, which are best preserved at low temperatures as their metabolism is slowed. It is also important to ensure that the whole blood is kept within the required temperature range after collection to avoid deleterious effects on the platelets and plasma.

centres than we are used to in the UK and Ireland, and the latter was previously considered as another vCJD risk reduction measure (collection of two red cell units simultaneously, potentially reducing donor exposure). These ‘double red cell’ collections were not considered cost effective for vCJD, but they may be beneficial for reasons of sufficiency in collecting from donors with rare blood groups and low donation frequency. The drive for increased efficacy of the red cells has been weaker. The additive solution used for the storage of the majority of red cell components (SAGM) has been in use for over twenty years, and some of the alternatives that are now available may improve the quality of stored red cells or maintain their quality for longer. However, with current concerns regarding the ‘age of blood’ (founded or not) it is unlikely that longer shelf life will be welcomed by hospital customers. The cost of clinical trials and the regulatory approvals necessary may also deter manufacturers from pursuing what is a low-cost and low-return product. Ironically, a safety concern over the plasticiser used in some blood bags, which leaches into the red cell membranes and keeps them flexible, may drive the need for better storage solutions to counterbalance a change to the plastic.

The vast majority of red cells are derived from whole blood donations, processed by centrifugation and semi-automated presses. However, there are new devices available that can automate the separation of a donated whole blood unit into components, and also devices that can collect red cells by apheresis. The former may be of use to increase efficiency in smaller blood

The threat of emerging pathogens and the expectation of a completely safe blood supply have driven the development of pathogen inactivation systems for red cells or whole blood. This has been more challenging than for plasma and platelet components – the UV light approach is less successful

SCOTBLOOD 2015 ANNUAL CONFERENCE

with the optically-dense red cell suspension. However, progress is being made with clinical trials of the Intercept system for red cells, and with the pre-clinical development of the Mirasol whole blood system. Licensing of such a system for routine use would present an opportunity for blood services

to realise all of the potential benefits of pathogen inactivation, such as the removal of irradiators, relaxation of some travel deferrals and some discretionary testing. This may be the next major change in the provision of not only red cells but all blood components.

SCOTBLOOD 2015 ANNUAL CONFERENCE

PLENARY SESSION I Logistics of RBC Provision Mr Paul Milne SNBTS The term Logistics is one which can have a range of definitions, there are three in the Oxford English dictionary;

first place in the right quantities takes a lot of planning and activity and this talk will hopefully give insight to what SNBTS has been developing to ensure that we have the right components in the right quantity.

1. The activity of organizing the movement, equipment, and accommodation of troops 2. The detailed organization and implementation of a complex operation 3. The commercial activity of transporting goods to customers

At the right time; this requires that RBC components are delivered to hospitals when they are required, this can be by a scheduled (preferred), ad hoc or emergency delivery. This can be achieved by a dedicated SNBTS vehicle (preferred), taxi or courier, or by a health board vehicle. This talk will try to give a picture of how this is currently achieved, the challenges we encounter and how we are planning to improve the service going forward.

None of these really fit well with the reality of the SNBTS Logistics function; that definition is better articulated as; the provision of the right components in the right quantity, at the right time, to the right place This talk will hopefully take these three elements, one at a time and explain a bit more about how the SNBTS Logistics function is delivered.

At the right place; this may seem the most obvious of the three, but with a finite stock and the drive to minimise non transfused RBC components, the right place is actually where the patient demand is, both geographically and location within a facility. Finally, this talk will attempt to demonstrate how SNBTS utilises the significant internal and external data to describe where this RBC components are required.

The right components, in the right quantity; this requires that a wide range of RBC components are available within the supply chain across: the Blood Groups and Rhesus systems, the main antigens and any modifiers such as irradiation. To be available in the

SCOTBLOOD 2015 ANNUAL CONFERENCE

PLENARY SESSION I Developing the Next Generation of Blood Substitutes Professor Chris Cooper University of Essex Heme-induced tissue damage is a major complication limiting the development of hemoglobin based oxygen carriers (HBOC) as blood substitutes [1]. Much of this damage manifests itself as oxidative stress. A key to developing the next generation of HBOC is therefore to limit this reactivity. We recently showed that the binding of the plasma acute phase protein haptoglobin to hemoglobin decreases the ability of the heme to induce free radical damage by stabilizing an otherwise reactive free radical on the amino acid tyrosine beta145. This stable radical can then be safely removed by plasma antioxidants such as ascorbate [2].

system. Studies using the model organism Aplysia fasciata have demonstrated even more significant changes. Introducing tyrosine mutants in Aplysia myoglobin (V63H/F42Y and V63H/F98Y) enhances ferryl reduction by three orders of magnitude; significant decreases in lipid peroxidation are also seen. The ongoing challenge remains to incorporate these desirable properties in a functional HBOC that can be produced cost effectively by recombinant protein technology.

We have adopted a similar approach to the design of a novel HBOC. We have created new tyrosine electron transfer pathways designed to make hemoglobin oxidative species (e.g. ferryl heme, protein free radicals) accessible to safe reduction by endogenous and exogenous antioxidants [3].

[2] Cooper, C. E., D. J. Schaer, P. W. Buehler, M. T. Wilson, B. J. Reeder, G. Silkstone, D. A. Svistunenko, L. Bulow and A. I. Alayash (2013). “Haptoglobin binding stabilizes hemoglobin ferryl iron and the globin radical on tyrosine beta145.” Antioxid Redox Signal 18: 2264-2273.

[1] Alayash, A. I. (2014). “Blood substitutes: why haven’t we been more successful?” Trends Biotechnol. 32: 177-185.

[3] Reeder, B. J., M. Grey, R. L. SilaghiDumitrescu, D. A. Svistunenko, L. Bulow, C. E. Cooper and M. T. Wilson (2008). “Tyrosine residues as redox cofactors in human hemoglobin: Implications for engineering non toxic blood substitutes.” J. Biol. Chem. 283: 30780-30787.

In this talk I will report the activity of exemplar hemoglobin mutants that illustrate this approach. They include betaPhe41Tyr (hemoglobin Mequon). This has a 200% enhanced ferryl reduction by ascorbate and a consequent 50% reduction of heme-induced lipid peroxidation in a cell free liposome assay

SCOTBLOOD 2015 ANNUAL CONFERENCE

PLENARY SESSION II Rachel Bouncing Back Miss Rachel Robyns Laird & Dr Peter Johnson National Services Scotland & Western General Hospital her experiences by writing a blog (‘Rachel Bouncing Back’ http://rachelbouncingback. blogspot.co.uk/) and a series of ‘Vlogs’ (Video blogs) with a view to express her experiences with a positive outlook and in turn providing information and advice to anyone else going through the same experience.

Rachel was diagnosed with a condition called Acute Myeloid Leukaemia (AML) in October 2012 when she was 17 years old. She subsequently spent five months in an isolation unit receiving treatment in the form of three cycles of a trial chemotherapy called AML 17. Once diagnosed Rachel was offered her treatment straight away and by November 2012 she was in remission!

Rachel has now been in remission for almost two years. Her blog has managed to reach over 45,000 hits and she has had the opportunity to talk about her experience as a teenager with cancer on several episodes of the ‘Surgery Show’ on BBC Radio 1. Alongside this she has had some brilliant support from SNBTS throughout her various ‘vlog’ adventures!

Whilst being in hospital as a immunocompromised patient, Rachel required and relied heavily on a significant amount of red cell and platelet blood transfusions. Rachel decided that whilst she was receiving treatment she would document

SCOTBLOOD 2015 ANNUAL CONFERENCE

PLENARY SESSION II Supporting Management of Major Haemorrhage in Scotland Mr Douglas Watson & Mrs Tina Watson SNBTS & GGC improve how major haemorrhage is managed. In Scotland four major trauma centres are being established and the transfusion service is supporting this. More patients are able to commence transfusion support earlier, with blood being made available to the emergency retrieval services. The introduction of technology to improve the timely availability of blood results, with the use of near patient testing to guide coagulation management will also contribute to overall improvements.

A substantial amount of blood and blood components are used each year to support patients with massive blood loss/ major haemorrhage. Major haemorrhage can happen in many different situations. Popular perception is around sudden catastrophic bleeding e.g in major trauma. However, major haemorrhage can occur in a controlled fashion e.g. in major vascular surgery, while some controlled haemorrhage may escalate out of control over varying lengths of time.

The management of major haemorrhage in â&#x20AC;&#x201C; hospital through the use of Major Haemorrhage Protocols has helped to improve transfusion support. All Boards in Scotland now have uniform protocols. Results of a recent Scottish audit of major haemorrhage will be presented.

The key to supporting patients and clinicians is having transfusion support available and effective lines of communication. Changes in clinical practice, service provision and laboratory support have helped to

SCOTBLOOD 2015 ANNUAL CONFERENCE

PLENARY SESSION II Maximising Use of the Donors’ Gift The mission statement of SNBTS is “Meeting the Transfusion Need of Patients in Scotland.” This patient focused session will highlight how SNBTS delivers this requirement, and the difference SNBTS makes to patients in Scotland and the wider NHS.

haemorrhage may escalate out of control over varying lengths of time. The key to supporting patients and clinicians is having transfusion support available and effective lines of communication. Changes in clinical practice, service provision and laboratory support have helped to improve how major haemorrhage is managed. In Scotland four major trauma centres are being established and the transfusion service is supporting this. More patients are able to commence transfusion support earlier, with blood being made available to the emergency retrieval services. The introduction of technology to improve the timely availability of blood results, with the use of near patient testing to guide coagulation management will also contribute to overall improvements.

Patients may have received blood for many reasons: after childbirth, as a result of trauma, or as part of a treatment plan. Rachel Robyns Laird, 19, had completed school and just started university at age 17 when she diagnosed with leukaemia. Rachel was in hospital for 15 months (Western General Hospital, Edinburgh) while being treated. During this time, Rachel realised how important blood transfusions were to her life. She estimates she received approximately 20 transfusions and will share her story.

The management of major haemorrhage in hospital through the use of Major Haemorrhage Protocols has helped to improve transfusion support. All Boards in Scotland now have uniform protocols. Results of a recent Scottish audit of major haemorrhage will be presented.

A substantial amount of blood and blood components are used each year to support patients with massive blood loss/ major haemorrhage. Douglas Watson is a Senior Nurse with Better Blood Transfusion and Tina Watson (no relation) is the Transfusion Practitioner for Greater Glasgow and Clyde, covering Royal Alexandra Hospital, Inverclyde and the Vale of Leven.

Significant advances continue to be made in the treatment of both neonates and aplastic anaemia in Scotland, and patient stories will be shared to demonstrate the dramatic impact this has on the lives of families.

Douglas and Tina will explain that major haemorrhage can happen in many different situations. Popular perception is around sudden catastrophic bleeding e.g in major trauma. However, major haemorrhage can occur in a controlled fashion e.g. in major vascular surgery, while some controlled

The clinical practice updates and personal stories will demonstrate how SNBTS continues to meet the Transfusion needs of Patients in Scotland.

SCOTBLOOD 2015 ANNUAL CONFERENCE

PLENARY SESSION III From Research To The Clinic: The Mesenchymal Stromal Cell Experience at the FRCBS Dr Johanna Nystedt Development Director, Cell Therapy Services Finnish Red Cross Blood Service The Finnish Red Cross Blood Service (FRCBS) is an independent, non-profit section of the Finnish Red Cross. The FRCBS is responsible for the blood supply in Finland and provides the Finnish healthcare sector also other services such as laboratory testing for organ, tissue and stem cell transplantations. The FRCBS also hosts the Finnish Stem Cell Registry and is the leading national center in the development and clinical manufacturing of novel cell-based therapies, currently with specific focus on mesenchymal stromal/stem cells (MSCs).

manufacturing method for allogeneic bone marrow-derived MSCs was also developed inhouse and the MSC product was authorized for the treatment of individual steroidresistant GvHD patients in 2012. Since then, 15 batches of platelet lysate-expanded MSCs have been released for clinical use. More details of the manufacturing process, quality control platform and characterization studies will be presented in the presentation. Additionally, preliminary data of the safety and efficacy of our platelet lysate-expanded and cryopreserved MSC product for the treatment of steroid-resistant GvHD in adult and pediatric patients will be presented.

The FRCBS has been active in stem cell research and cell therapy development during the last 10 years with over 60 peerreviewed publications, of which 30 concerns MSC research. Active MSC research topics have involved e.g. MSC markers, optimization of culture conditions, characterization and functionality studies, preclinical disease models and innovations for improved cell targeting (e.g. Nystedt et al. 2010; Nystedt et al. 2013; Kerkelä et al. 2013; Mitkari et al. 2015). Results from some of these studies will be presented in more detail in the presentation.

References: Eichler H, Schrezenmeier H., Schmallmoser K., Strunk D., Nystedt J., Kaartinen T., Korhonen M., Fleury-Cappellesso S., Sensebé L., Bönig H., Rebulla P., Giordano R., Lecchi L., Takanashi M., Watt S. M., Austin E. B., Guttridge M., McLaughlin L. S., Panzer S. & Reesink H. W.. Donor selection and release criteria of cellular therapy products. Vox Sanguinis 2013 Jan;104(1):67-91. (IF 2.856)

An important step was undertaken in 2009 when a project aiming for a new cell therapy unit, especially intended for novel advanced therapy medicinal product (ATMP) manufacturing, was initiated. The cleanroom facility, based on an isolator solution, was GMP inspected and authorized by the competent authorities in Finland in 2012. A GMP- and clinically-compliant

Kerkelä E, Hakkarainen T, Mäkelä T, Raki M, Kampur O, Kilpinen L, Nikkilä J, Lehtonen S, Ritamo I, Pernu R, Pietilä M, Takalo R, Juvonen T, Bergström K, Kalso E, Valmu L, Laitinen S, Lehenkari P, Nystedt J. Transient Proteolytic Modification of Mesenchymal Stromal Cells Increases Lung Clearance Rate and Targeting to Injured Tissue. Stem Cells Transl Med. 2013 Jul;2(7):510-20. (inaugural IF 3.596)

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Laitinen A, Oja S, Kilpinen L, Kaartinen T, Möller J, Laitinen S, Korhonen M, Nystedt J. A Robust and Reproducible Animal Serumfree Culture Method for Clinical-grade Bone Marrow-derived Mesenchymal Stromal Cells. Cytotechnology 2015 in press (IF 1.449)

M, Satomaa T, Natunen J, Saarinen J, Lehenkari P, Valmu L, Laine J. Human CMPN-acetylneuraminic acid hydroxylase is a novel stem cell marker linked to stem cell-specific mechanisms. Stem Cells. 2010 Feb;28(2):258-67. (IF 7.781)

Mitkari B, Kerkelä, E, Nystedt J, Korhonen M, Jolkkonen J. Unexpected complication in a rat stroke model - Exacerbation of secondary pathology in the thalamus by subacute intra-arterial administration of human bone marrow derived mesenchymal stem cells. Journal of Cerebral Blood Flow & Metabolism 2015 in press (IF 5.339)

Nystedt J, Anderson H, Tikkanen J, Pietilä M, Hirvonen T, Takalo R, Heiskanen A, Satomaa T, Natunen S, Lehtonen S, Hakkarainen T, Korhonen M, Laitinen S, Valmu L, Lehenkari P. Cell surface structures influence lung clearance rate of systemically infused mesenchymal stromal cells. Stem Cells 2013 Feb;31(2):317-26. (IF 7.781)

Nystedt J, Anderson H, Hirvonen T, Impola U, Jaatinen T, Heiskanen A, Blomqvist

SCOTBLOOD 2015 ANNUAL CONFERENCE

PLENARY SESSION III Cell Therapy for Diabetes Professor Kevin Docherty University of Aberdeen Cell therapy in the form of human islet transplantation has been a successful form of treatment for patients with type 1 diabetes for over 10 years, but is significantly limited by lack of suitable donor material. A replenishable supply of insulin-producing cells has the potential to address this problem; however to date success has been limited to a few preclinical studies.

Two of the most promising strategies include differentiation of embryonic stem cells and induced pluripotent stem cells towards insulin producing cells and transdifferentiation of acinar or other closely related cell types towards Î˛Beta-cells. In this talk I will discuss recent progress and challenges that need to be overcome in taking cell therapy to the clinic.

SCOTBLOOD 2015 ANNUAL CONFERENCE

PLENARY SESSION III Autologous Monocyte Derived Macrophage Therapy For Liver Cirrhosis Professor Stuart J Forbes MRC Centre For Regenerative Medicine University Of Edinburgh / Scottish Liver Transplant Unit Mortality from cirrhosis in the UK has tripled over the last three decades and deaths from chronic liver disease account for 1 in 50 of all Scottish deaths. The only curative option for end-stage cirrhosis is liver transplantation but donor organ availability cannot meet demand and many patients die waiting for a suitable organ. We have therefore studies regenerative strategies to liver cirrhosis.

an autologous cell therapy approach. In collaboration with the SNBTS team we are therefore developing autologous CD14+ monocyte derived macrophage therapy for liver cirrhosis in man and are moving towards a â&#x20AC;&#x153;first in humanâ&#x20AC;? study funded by the MRC. This will consist of a phase 1 first in human dose escalation study followed by a phase 2 randomized study in patients with liver cirrhosis. This macrophage study follows on from the REALISTIC study of CD133+ autologous cell therapy for liver cirrhosis.

During chronic liver injury there is deposition of excess collagen scar, and impaired liver regeneration from hepatic progenitor cells (HPCs) which regenerate both cholangiocytes and hepatocytes. We have found that endogenous hepatic macrophages are important for the reversal of liver fibrosis (1,2). Furthermore during hepatocyte regeneration from HPCs, macrophages control the differentiation of HPCs to hepatocytes (3).

Regeneration and cancer are related and tumor associated macrophages stimulate liver cancer (5,6) and so careful patient screening and monitoring is required. References: (1) Duffield JS, et al. J Clin Invest. 2005 Jan;115(1):56-65 (2) Ramachandran P, et al. Proc Natl Acad Sci USA. 2012 Nov 13;109(46):E3186-95 (3) Boulter L, et al. Nature Medicine 2012;18(4):572-9 (4) Thomas JA, et al. Hepatology. 2011;53(6):2003-15 (5) TG Bird et al. Proc Natl Acad Sci USA. 2013 Apr 16;110(16):6542-7. (5) Wnt signalling promotes Cholangiocarcinoma growth and can be therapeutically targeted. L Boulter, Et Al. Journal of Clinical Investigation. 2015 Feb 17. (6) Alternatively activated (M2) macrophages promote tumour growth and invasiveness in hepatocellular carcinoma. Yeung OW, et al. J Hepatol. 2014 Oct 30.

We have tested macrophage cell therapy in models of chronic liver injury. Macrophage injection results in hepatic chemokine up-regulation and hepatic recruitment of endogenous macrophages and neutrophils to hepatic scars delivering the scar resolving enzymes MMP-13 and MMP-9 into the hepatic scar causing a significant reduction in hepatic fibrosis, increased the numbers of HPCs and increases serum albumin (4, 5). The anti-fibrotic and pro-regenerative features of macrophages make them attractive for

SCOTBLOOD 2015 ANNUAL CONFERENCE

PLENARY SESSION IV Right Sizing Collections A Paradigm Shift in Donor Recruitment Moira Carter & Jennifer Wilson SNBTS Donor Services In Scotland, the demand for Red Cells has declined by 22% since 2006/07. This reduction has arisen as a result of changes in clinical practice due from programmes of work designed to make the most effective use of blood such as the Better Blood Transfusion Programme. In addition, we now have a better understanding of demand and are able to more accurately forecast requirements. The current financial environment and the need for increased efficiency and productivity has driven the need for more effective management of the supply chain and to maintain a balanced and sufficient inventory. This has significant implications for the services and how we operate.

recruitment message to blood donors was about the constant urgent need to give blood that could be encapsulated in the message “Any Donor, Any Time, All the Time”. With the need to more closely match supply to demand this message has had to fundamental change to “Right Donor, Right Time”. In addition, the reduction in red cell collection creates pressure on manufacturing activities to maintain adequate supplies of recovered platelets and fresh frozen components from the reduced collection footprint. Therefore in the future this may evolve into “Right Donor, Right Time, Right Component”. The presentation will:

The reduction in red cell demand is not linear across the blood groups with the demand for O Pos declining by 25% while O Neg reduction is 14% and AB Neg. 6%. In contrast, the demand for platelets and fresh frozen components has remained relatively static during this period.

1. summarise the results of qualitative research undertaken to inform the donor recruitment strategy to manage this shift in communications to blood donors and the wider public 2. update on progress in the delivery of the revised messages and methods used to support delivery.

In the past the concept of having too much blood seemed inconceivable and the

SCOTBLOOD 2015 ANNUAL CONFERENCE

PLENARY SESSION IV A Year in Social Media – Why the Digital Landscape Impacts Upon the Blood Supply Jennifer Wilson SNBTS Donor Services In recent years, extensive fragmentation and an explosion in social media means significant changes have occurred in the media landscape. These changes mean the way SNBTS communicate with blood donors, and the way blood donors communicate with SNBTS, is dramatically changing.

• How social media supports intelligent inventory control • Managing messaging in a crisis – Glasgow December 2014 • Social media to support social inclusion • The Day the World looked at Scotland’s blood stocks.

This lecture will summarise these changes to the media landscape and review the impact it has had on donor behaviours.

Each example will be discussed. Conclusions will be drawn highlighting the increased importance of digital communications as a tool to communicate in an effectively and timely way with blood donors.

Salient examples will be given from SNBTS digital activity within the past 12 month period including:

SCOTBLOOD 2015 ANNUAL CONFERENCE

PLENARY SESSION IV Tracking Transfusion in Scotland - Where Does Blood Go? Dr Katherine J Forrester SNBTS Background Information on the clinical use of blood components at a population level is crucial to blood services in their ability to plan for and meet the transfusion needs of patients. To date, information has been limited to ‘snapshots in time’ using cross-sectional studies and audit. In Scotland, the Account for Blood (AfB) data mart provides routine, up-to-date national information on the supply and use of blood components and, when linked to NHSScotland (NHSS) hospital episode data, provides information on the clinical context in which blood components are used. Surgical populations are readily defined but non-surgical transfusions is harder to characterise due to the complexity of medical patients, their care pathways and the interventions that they receive.

Results Linked data for 2011-2013 included 480,197 RC units transfused to 88,640 patients (average age 66 years; 43% male). 99% of RC units were linked to an episode of care. The majority (90%) were linked to an Inpatient episode where the transfusion date fell between the admission and discharge dates. 63% of RC units transfused were linked to medical specialties, the top three accounting for 75%: Haematology (35%), General Medicine (29%) and Oncology (9%). The top ten red cell-using Haematology diagnoses accounted for 80% of units transfused in that specialty and included malignant and non-malignant haematological conditions notably Myelodysplastic syndromes (19%) and Myeloid and Lymphoid leukaemia (25%). General Medicine included a variety of respiratory, renal and gastrointestinal diagnoses, and notably Iron deficiency (8%) and other anaemia (10%).

Methods In a pilot study to identify efficient and accurate ways to classify medical patients and the clinical reasons for non-surgical transfusion, red cell (RC) transfusion events from AfB have been linked by patient identifier and date rules to Inpatient, Outpatient, Neonatal, Maternity and A&E episodes of care at NHSS hospitals. Rules have been defined to prioritise the allocation of the most clinically relevant episode of care, and thus the clinical context, consultant specialty and diagnostic data to describe the reason for transfusion.

Conclusion As surgical blood use has reduced (now <20% RC units transfused), the future demand for blood will be driven by the needs of ‘medical’ patients. Routine linkage of transfusion data with hospital episode data provides a systematic, automated and temporal system for tracking trends in blood use at a population level and can facilitate appropriate blood use, a key objective for the Better Blood Transfusion programme (SNBTS).

SCOTBLOOD 2015 ANNUAL CONFERENCE

IAIN COOK MEMORIAL LECTURE Blood Bank Technology - Current and Future Trends Professor Marion Scott NHS Blood and Transplant The aim of pre-transfusion laboratory testing is to provide compatible donor red cells that will have maximum survival following their transfusion into a recipient. The current serological testing involves typing donor and recipient for blood group antigens, and screening recipients for antibodies to blood group antigens.

serology testing. These include microarray serology, the use of recombinant blood group antigens and genotyping. At present genotyping is generally restricted to patients with positive antibody screens and those likely to require multiple transfusions. Many countries are carrying out genotyping on a percentage of their donor to provide pools of donors who can be electronically better matched for these patients. The aim is to provide antigen negative blood for those patients who have already made antibodies, and to prevent further allo-immunisation in these patients, or those requiring multiple transfusions. If the costs of genotyping fall a lot further, it may be possible to consider full electronic cross-matching for all transfusions.

Traditional haemagglutination techniques meet the requirements for sensitivity and specificity, but have now been replaced in most hospital laboratories by column agglutination or solid-phase techniques, as these are more robust, can be automated, and have reduced costs. Only tertiary referral centres generally now use haemagglutination techniques for specialist investigations. Laboratories are increasingly using â&#x20AC;&#x153;electronic cross-matchingâ&#x20AC;? for patients who have a negative antibody screen. If ABO and RhD compatibility of donor and recipient can be reliably confirmed using electronic records, many labs now issue blood without performing a serological cross-match.

Advances in micro-array technology, recombinant antigens and genotyping may significantly reduce the requirement for pre-transfusion serological testing in the future, and provide better matched blood. We may need fewer regional testing labs and less staff. This is important to address for the training needs of the future workforce. We will still need some expert serologists, but these are likely to be based in central reference laboratories.

Various different approaches are currently being developed that may further change the type and amount of pre-transfusion

SCOTBLOOD 2015 ANNUAL CONFERENCE

Concurrent Session - Research, Development and Innovation/Tissues & Cells Launching of Lyophilized Platelets into Clinical Trials Arthur P. Bode, PhD, and Glen Michael Fitzpatrick, PhD. Cellphire Inc; Rockville, MD, USA Stabilization of cells with trehalose to withstand the rigors of desiccation and rehydration has been eminently welldemonstrated by anhydrobiosis in Nature. In a somewhat shorter timeline, Cellphire has developed processing technology to load blood platelets with trehalose and produced a lyophilized product, Thrombosomes®, which can be stored at ambient temperature for over a year with stable hemostatic properties. Upon rehydration with sterile Water for Injection (WFI), Thrombosomes® show preservation of the main integrins on the platelet surface and display the capability to aggregate with thrombin or other agonists, as well as accelerate thrombin generation and in vitro clot formation. Infusion of Thrombosomes® in animal models of efficacy have demonstrated correction of abnormal bleeding times in thrombocytopenic rabbits, and reduction of blood loss in a closedabdomen liver injury model in non-human primates. Multiple doses and exposures of human and species-specific lyophilized product in canines and rabbits has resulted in a safety profile bounded only by a no adverse event level since a limit of maximum tolerated dose was not reached. Quite remarkably, an immunologic challenge of (human) Thrombosomes® in rabbits with repeated exposure did not reveal any evidence of antibody formation or Arthus reaction. In 2014, Thrombosomes® were cleared by the US FDA for an exploratory IND in healthy human volunteers with escalating doses of autologous product manufactured at Cellphire under cGMP conditions. The clinical trial is underway with the Bloodworks Northwest facility (formerly Puget Sound Blood Center)

in Seattle, WA, USA, with multiple medical safety assessments including special attention to immunological response in the subject. At screening, eligible candidates are tested for pre-existing antibodies to allotypic stored platelets or Thrombosomes® from a set of pooled donors, as well as for HLA or auto-platelet antibodies; only subjects with completely negative profiles are entered into the clinical trial. Enrolled subjects donate apheresis platelets that are processed into Thrombosomes®. The subjects are then infused with Thrombosomes produced from their own platelets followed by a 42 day monitoring period (first three cohorts), or 60 day period for the two highest dose cohorts. During the monitoring period the subject is checked for changes in immunologic status, including testing for antibodies to the autologous Thrombosomes®. This testing is conducted by flow cytometry after incubation of the subject’s plasma with samples of his own Thrombosomes® or the pooled product to quantify bound immunoglobulin, with comparison to parallel incubation of a negative control plasma to provide background subtraction. In each cohort there are two subjects receiving their autologous Thrombosomes®, and one that receives only the processing loading buffer without particles as a vehicle control at the same volume. Thrombosomes antibody results from the first two cohorts will be presented without unblinding of the subject identities or the randomization of treatments. Since the trial is still underway, other clinical data will not be presented or summarized until sometime in the future when it has been fully reviewed by the Data Monitoring

SCOTBLOOD 2015 ANNUAL CONFERENCE

Committee and reported to the FDA. A brief discussion of future clinical trial designs will be mentioned with the obvious limitation of further IND approval. In summary, this will be the first public presentation of a focused set of details of the first human trial exposures to Cellphireâ&#x20AC;&#x2122;s first-in-class lyophilized plateletderived hemostatic agent.

This project has been funded in whole or in part with Federal funds from the Biomedical Advanced Research and Development Authority, Office of the Assistant Secretary for Preparedness and Response, Office of the Secretary, Department of Health and Human Services, under Contract No. HHSO100201300021C.

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research, audit and quality improvement. Sometimes patients require a large amount of donated blood components during life threatening bleeding. The existence of a protocol for the rapid provision of blood components is a key element in managing a major haemorrhage situation. A recent Scottish wide major haemorrhage audit was carried out and on the stand we will illustrate the results and other national ongoing work around this topic.

Having blood available at all times is essential and the Scottish National Blood Transfusion Service (SNBTS) works to ensure that patients in Scotland, wherever they are treated, have the very best of transfusion care. The Better Blood Transfusion Team (BBT) plays an integral role within SNBTS and is, committed to the guiding principles of appropriate use of the donorâ&#x20AC;&#x2122;s gift and safety of transfusion for the patient in the clinical setting. The team also supports

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SCOTBLOOD 2015 ANNUAL CONFERENCE

Poster Index

Poster No 1st Author 1 Stout, L.

Title

Affiliation

Integrating Human Factors into Transfusion Incident Investigations

Better Blood Transfusion, SNBTS

2 Lockhart, S. Review of ID-PaGIA Heparin / PF4 Antibody Test

Edinburgh H&I Lab, SNBTS

3 Bowbeer, C. Audit of Out-of-Hours Blood Transfusions 4 Cao, H. How Do Immune Responses Differ Against Senescent and Damaged Erythrocytes: Profiling Sugar and Protein Changes on the Cell Surface

Western Infirmary, NHS Greater Glasgow & Clyde

5 Whitelaw, J.

SNBTS, Aberdeen

A Survey of Membrane-bound Metalloproteinases of Red Blood Cells

University of Aberdeen, SNBTS & University of Dundee

6 Harrison, E. A Fresh Approach to Neonatal Surgical Blood Ordering

Greater Glasgow & Clyde Health Board

7 Morrison, A.

In Vitro Evaluation of the Effects of Timing of Irradiation on Stored Red Cell Concentrates: SNBTS Results

SNBTS, Edinburgh

8 Kreslins, A.

Review of Current Blood Ordering Practice for Craniotomy Surgery at the Royal Hospital for Sick Children (Yorkhill)

University of Glasgow

9 Rodger, D. Paediatric Craniofacial Surgery – A Review of Cross Matching Practice 10 Thomson, A. An Innovative Approach to Re-evaluating Staff Training and Competency

University of Glasgow, Greater Glasgow & Clyde Health Board

EMRS/SNBTS

Hughes, N.

Blood on Board

SNBTS

12 Sellers, F.

Comparison of LIFECODES Pak LxTM Assay with “gold standard” SNBTS, Aberdeen Monoclonal Antibody Immobilisation of Platelet Antigens (MAIPA) Assay

13 Imlach, S.N.

Frequency of BK Virus Reactive T Cells Within the Scottish Donor Population

SNBTS RDI, Edinburgh

14 Hendry, C.

Stepping up to the Mark: Increasing Compliance in Staff Competency for Blood Component Collection

SNBTS

15 Harrison, E. Incident Management – A Team Approach

Golden Jubilee National Hospital, Glasgow

16 Cheal, K.

Evaluation of Foetal DNA Controls for Non-Invasive Prenatal Diagnosis Blood Group Genotyping Assays

Aberdeen & North East SNBTS

17 Law, V.

Quantification of RhD Positive Foetomaternal Haemorrhage by Flow Cytometry

SNBTS

A Patient in Need

Better Blood Transfusion

NHS Lanarkshire – A Study of the Role of Support Staff in Blood Transfusion

Better Blood Transfusion/ NHS Lanarkshire

Watson, T.

19 Stewart, P.

SCOTBLOOD 2015 ANNUAL CONFERENCE

Poster No 1 Integrating Human Factors into Transfusion Incident Investigations Stout L & Lussier J Better Blood Transfusion, SNBTS Background Within the UK blood transfusion is very safe (SHOT 2012), however if patient misidentification occurs, transfusion incidents can have potentially serious consequences (McClelland et al. 1994). Within transfusion, ‘Wrong Blood in Tube’ errors are concerning. Dzik et al. (2008) define such errors occurring when the blood in the tube belongs to an individual other than the individual whose details are on the label.

no member of staff repeatedly making an error, however indicated that individuals were making errors in similar circumstances and with comparable contributory factors. Reason (2004) draws comparisons between, error prone individuals and error prone situations. On analysis of the preventative actions of each individual incident, the focus for improvements concentrated mainly on training the individual involved and reiterating the correct procedure. There is now the recognition that a more human factors approach is required to explore why workarounds appear to occur, resulting in non-compliance with procedure.

Method Locally, whenever a ‘Wrong Blood in Tube ‘event occurs, the individual who took the sample is invited to explore the circumstances surrounding the incident to learn lessons from the error. The tool used is the NHS Grampian’s fishbone root cause analysis tool. A retrospective audit of such incidents between March 2011 and February 2014 was completed (n=20). The qualitative data of contributory factors for the defined period was thematically collated and analysed.

Recommendations • Revisit the root cause analysis findings with an enhanced human factors approach • Complete a failure mode analysis of the sampling process • Gather ‘soft intelligence’ by observation of the sampling process and by focus group interviews to compare what actually occurs in clinical areas to the process outlined by procedure • Review the dissemination process of lessons learned. The repeated occurrence of similar incidents indicates a sustained resolution has not occurred • Explore the incorporation of an ‘after action team review’. Involving collectively focussed reflective opportunities may provide enhanced insight into the actually incident occurrence and more importantly resolutions (Clinical Human Factors Group 2013).

Results The data highlighted that failure to complete correct positive patient identification was a major factor in incident occurrence. The results of this audit, indicated a system problem were predominant. Conclusion Fortuitously the barriers in place within the process of pre-transfusion sampling prevented any serious consequences for any patient. The incidents analysed involved

SCOTBLOOD 2015 ANNUAL CONFERENCE

Poster No 2 Review of ID-PaGIA Heparin / PF4 Antibody Test Symon Lockhart Edinburgh H&I Lab, SBU-SNBTS Introduction Heparin-Induced Thrombocytopenia (HIT) is a relatively common adverse drug reaction that is caused by platelet-activating IgG antibodies recognising multimolecular complexes of platelet factor 4 (PF4) bound to heparin. The presence of heparin in these patients causes thrombocytopenia and increases the risk for arterial and venous thrombosis. Within SNBTS, the detection of Heparin/ PF4 antibodies is carried out utilising either an initial polyclonal Particle Gel immunoassay (DiaMed ID-PaGIA Heparin/PF4 antibody test) that uses PF4/heparin complexes bound to red, high-density polystyrene beads or an IgG-specific ELISA-based PF4-dependent antigen assay from (GTI;Waukesha, Wis) where PF4/polyvinyl sulfonate is bound to a solid-phase. The advantage of the ID-PaGIA Heparin/PF4 antibody assay is that it takes less than 20 minutes to obtain a result, compared to 150 minutes for the IgG-specific ELISA.

with negative reactions, a homogeneous pale pink background throughout the gel may be seen which does not alter the interpretation of a negative result, but may be misinterpreted as a weak positive result. Patient 5 had tested strongly positive (4+) by ID-PaGIA Heparin/PF4 antibody test and was tested negative by subsequent IgG-specific ELISA. However, this patient tested positive by IgG-specific ELISA when tested 4 weeks later. This may reflect the use of an anti-human immunoglobulin antibody in the sephacryl gel of the ID-PaGIA Heparin/PF4 antibody assay to promote the agglutination of bound IgG (Heparin/PF4) antibody or agglutination of the polystyrene beads caused by binding of IgM Heparin/PF4 antibodies, which subsequently underwent class switching to IgG4. It would be of interest to repeat the IgG-specific ELISA on fresh samples from patients 6 and 8 who also had positive ID-PaGIA Heparin/PF4 antibody test to determine whether they reacted in a similar fashion to patient 5 and subsequently developed IgG-specific ELISA detectable Heparin/PF4 antibodies.

Results In March 2014, the Edinburgh H&I lab introduced the ID-PaGIA Heparin/PF4 antibody test to supplement the use of the IgG-specific ELISA. The lab has performed 64 ID-PaGIA Heparin/PF4 antibody tests with 27 positive results. Of these positive results 18 (66%) were confirmed by GTI ELISA, the remaining 9 are detailed below:

Conclusion The ID-PaGIA Heparin/PF4 antibody test has been used successfully to exclude the presence of Heparin/PF4 antibodies and speed up the detection of negative results. The interpretation of the IDPaGIA Heparin/PF4 antibody assay result is subjective and on occasion negative reactions may be misinterpreted as weak positive due to the deposition of red colouring as the red polystyrene beads migrate through the sephacryl gel.

Discussion The subjective nature of the PaGIA interpretation may have lead to â&#x20AC;&#x2DC;over-scoringâ&#x20AC;&#x2122; of weak positive results; 6/9 cases with weak positive results (1+) were negative by subsequent GTI ELISA. In some cases

SCOTBLOOD 2015 ANNUAL CONFERENCE

Poster No 3 Audit of Out-of-Hours Blood Transfusions Connor Bowbeer (FY1) & Cathy Collins (Transfusion Practitioner) Western Infirmary, NHS Greater Glasgow & Clyde Introduction The SHOT 2005 report recommends wards avoid out-of-hours (OOH) blood transfusions (BTs) to IMPROVE patient safety, unless clinically indicated. Following an OOH BT significant event on the Vascular Ward at the Western Infirmary of Glasgow, it was concluded that there may be inappropriate OOH BTs. This is an audit of vascular ward BTs. METHOD: Blood Crossmatch (X-match) request forms for Vascular patients were reviewed from 1/8/14-30/11/14 and the following data collected: Date/Time of request, No. of Units requested, Working Diagnosis/Reason for Transfusion, and Date/Time of transfusion. The haemoglobin (Hb) measurement taken prior to the X-match request was noted.

other information. 28 requests highlighted Hb <80g/L, 23 requests mentioned an operation, 3 patients had GI bleeding, and 3 requests had no information supplied. Discussion This audit revealed 41.9% of vascular ward BTs are OOH despite patient safety risk. Many patients had Hb <80g/L at the time of BT, but few requests justified an OOH transfusion (symptoms or comorbidities). There also appeared to be significant delay between X-match and BT. Recommendations to reduce OOH BTs: 1. Identify low HB levels early by chasing blood results earlier. 2. Make decision to transfuse at the time of Hb result, and not wait until ward rounds. 3. Postpone BTs until daytime if patient is asymptomatic, not due an imminent operation, and have no relevant co-morbidities. 4. Send X-match requests, prescribe BTs, and inform nurses promptly following low Hb result. 5. Implement notification system so that nurses know when blood products are available. 6. Nurses administer BT as soon as products become available. Implementing these recommendations may reduce the proportion of OOH BTs. A follow-up audit needs to be completed to determine whether changes made to ward practice reduces the proportion of OOH BTs. In order to improve audit data collection it would be useful for staff to provide more details and justification on X-match requests. Additionally inpatient notes are now available on Clinical Portal and would therefore provide further information surrounding decisions to transfuse OOH.

Results 44 X-match requests resulted in at least one BT on the Vascular ward, with 108 units X-matched leading to 84 individual BTs and 74 were on the Vascular ward. 31 BTs were OOH, and an additional 17 BTs were commenced after 17:00 where there was potential for the BT to continue OOH. 40 patients had a Hb level available prior to BT. The mean Hb was 76.3g/L, max 125g/L, and min 47.2g/L. 43 X-match requests had a recorded request date and time, and therefore the delay between X-match and BT could be calculated. The mean delay was 558 minutes, max 2914 minutes, and min 8 minutes. The Working Diagnosis/Reason for Transfusion freetext input were grouped into categories based on Hb level, operative status, and any

SCOTBLOOD 2015 ANNUAL CONFERENCE

Poster No 4 How Do Immune Responses Differ Against Senescent and Damaged Erythrocytes: Profiling Sugar and Protein Changes on the Cell Surface Huan Cao, Dimitrios Tampakis, Mike Moss, Sadie Henderson, Wendy J. Pickford, Lindsay S. Hall, Paul R. Crocker, Lars P. Erwig, Mark A. Vickers and Robert N. Barker Institute of Medical Research, University of Aberdeen; RD&I, SNBTS; College of Life Sciences, University of Dundee. Human erythrocytes typically live for 120 days and senescent cells are efficiently removed by macrophages in an immunologically silent process. Damaged red cells, however, stimulate immune responses as they are phagocytosed. We aim to identify the surface marker changes that differ between senescent cells and damaged cells.

observe major cleavage events on surface Glycophorins. We find that when erythrocytes are cultured in high glucose environment (25mM), proteolysis of both Glycophorin A and Glycophorin C take place. Cleavage of Glycophorins results in loss of lectin binding to the erythrocytes. Sialic acids, expressed at the terminus of most mammalian surface glycans, act as important negative regulatory signals to the immune system by binding to regulatory receptors such as the siglecs. We also show that phosphatidyl serine is exposed on glucose deprived erythrocytes, which is a sign of eryptosis (apoptosis of erythrocytes).

We have previously shown that aged red cells selectively shed α-2,6 linked sialic acids while preserving most of α-2,3 linked sialic acids by lectin based flow cytometry. A discontinuous Percoll fractionation technique was adapted to separate senescent erythrocytes by density while minimising centrifugation stress on erythrocytes.

These results show differences in surface marker expression on damaged and senescent red cells which may explain differences in host immune responses. We propose a model where α-2,3 linked sialic acids are key sugars in determining immunogenic host responses.

In contrast, we show significant loss of α-2,3 linked sialic acids on damaged red cells (heat shock, calcium ionophore, CuSO4, glucose deprivation). Furthermore, we

SCOTBLOOD 2015 ANNUAL CONFERENCE

Poster No 5 A Survey of Membrane-bound Metalloproteinases of Red Blood Cells Whitelaw, J., Henderson, S., Vickers, M.A. & Moss, M.T. SNBTS Aberdeen red cell membranes. It was hypothesised that membrane-type metalloproteinases (MT-MMPs) present on the red cell surface could be responsible for the digestion of GYPA observed. We undertook a survey to confirm the presence of MT-MMPs on red cell membranes using antibodies to the 6 membrane-type metalloproteinases (MT-MMPs 14, -15, -16, -17, -24 and -25). Using Western Blotting we demonstrated the presence of MMP 14, MMP 16 and MMP 25 on the membrane of human red blood cells. Results for MMP 15 and -24 did not indicate the presence of these enzymes on the red cell membrane whilst results for MMP 17 were inconclusive. Further investigations are required to determine if MT-MMPs are responsible for the proteolysis of GYPA observed and more importantly, whether this cleavage acts as a red cell senescence marker.

Metalloproteinases (MMP) are a subfamily of Metzincins, a family of universally expressed zinc2+ dependent endopeptidases. The MMP family contains twenty five related yet distinct secreted and membrane bound enzymes. MMPs can be divided into six subgroups based on their evolutionary relationships and substrate specificity: collagenases, gelatinases, stromelysins, matrilysins, membrane-type MMPs (MTMMPs) and other MMPs. Membrane-type metalloproteinases (MT-MMPs) are bound to the membrane of the cell, this compares to all other MMPs which are secreted into the extracellular matrix. Combined, MMPs have the ability to degrade all components of the extracellular membrane. We have previously demonstrated that incubation of red cells at 37째C for four days results in proteolysis of GYPA on the

SCOTBLOOD 2015 ANNUAL CONFERENCE

Poster No 6 A Fresh Approach to Neonatal Surgical Blood Ordering Elaine Harrison Transfusion Practitioner, Dr Phil Bolton Consultant Anaesthetist Greater Glasgow & Clyde Health Board Introduction 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.

Results Of the 14 patients, all had a minimum of one adult sized unit ordered for theatre cover. During surgery, seven patients received transfusion with the remaining patients requiring top-up transfusion post-operatively, the majority being within first four days. The ordering of red cells for theatre cover appeared haphazard, of the 32 units ordered only 11 were administered. There was little continuity in ordering and the average blood volume administered was 35mls.

With neonatal transfusions, reducing the donor exposure is of paramount importance for this heavily transfused group. Additionally the red cells must be fresh when covering any potential large volume transfusion which includes theatre cover.

Conclusion The use of fresh paedipacks will allow for the appropriate component to be used as theatre cover and the remaining paedipacks will stay with the child available for top-up transfusion. This will have a significant impact on reducing donor exposure, therefore reducing risk for our most vulnerable infants.

Current practice requires surgical neonates to have a fresh adult sized unit of red cells for theatre cover and then paedipacks are allocated to allow for any top-up transfusions post-operatively. Method All patients under the age of four months who received surgery for tracheo oesophageal fistula, diaphragmatic hernia and necrotising enterocolitis at RHSC between May and October 2012 were included in the audit.

SCOTBLOOD 2015 ANNUAL CONFERENCE

Poster No 7 In vitro Evaluation of the Effects of Timing of Irradiation on Stored Red Cell Concentrates: SNBTS results Alex Morrison, Loraine McMillan, Juraj Petrik Microbiology & Components RD&I Group, SNBTS Edinburgh, UK Background There are very few comprehensive studies investigating the effect of irradiation on red cell concentrates (RCC) at varying points during their storage. Presented here are SNBTS results from the Biomedical Excellence for Safer Transfusion (BEST) collaboration study.

Results During storage an increase of Annexin V, haemolysis and K+ concentration was found, with K+ increasing significantly (p<0.01) during the week immediately after irradiation. In general the earlier during storage that the units were irradiated, the higher the haemolysis and K+ concentration found at end of storage. No specific effects of irradiation on glucose consumption/ lactate production were observed.

Methods A pool-and-split design was used to investigate the effect of irradiation on erythrocyte in vitro quality after irradiation at several time points during storage. At SNBTS we used standard RCC stored in SAGM. We processed 4 pools of 7 RCC, which were each split back into 7 RCC. Over the 6 weeks of storage, one pool was irradiated each week. Units were sampled at various time points for in vitro quality parameters including Annexin V, haemolysis, Potassium (K+), glucose and lactate.

Conclusions Irrespective of the timing of irradiation during storage of RCC, irradiation caused a rapid increase in extracellular K+, followed by a more gradual increase in haemolysis. Results of this study combined with other BEST collaborators will be used to formulate guidance on the maximal pre- and postirradiation storage time for RCC.

SCOTBLOOD 2015 ANNUAL CONFERENCE

Poster No 8 Review of Current Blood Ordering Practice For Craniotomy Surgery at The Royal Hospital For Sick Children (Yorkhill) Kreslins A, Bolton P, Harrison E University of Glasgow Background Craniotomies are associated with a risk of significant blood loss and packed red blood cell (RBC) transfusions may be vital to maintain blood volume and tissue perfusion. Correct estimation of blood transfusion requirements for craniotomies are particularly important in the paediatric population to ensure patient safety and maximise use of the fresh blood available to this population. The current blood ordering guidelines (The Neurosurgical Maximum Surgical Blood Ordering Schedule (MSBOS)) states that two units of packed RBCs should be cross-matched for craniotomies (including trauma), unless there is a large or vascular tumour in which case four units of blood should be cross-matched. [1]

Haematoma (HA), 4) Cyst (CY), and 5) Other diagnosis/diagnosis not specified. The blood bank telepath system was used to quantify the number of units of packed RBCs requested prior to surgery and subsequently transfused during surgery. Recommendations for other diagnoses/ diagnosis not specified could not be generated due to insufficient number of cases in each diagnosis category. Subgroup 5 was therefore excluded from the analysis. Results 74 craniotomies were included in the audit (21 PF, 24 ST, 14 HA, 15 CY) and 21 were excluded. The mean (min-max) number of units of packed RBC cross-matched were 2.29 (0-7). The subgroup means were 2.71 for PF, 2.96 for ST, 2.50 for HA, and 1.00 for CY. In contrast, the mean (min-max) number of units transfused were 0.67 (0-4). The subgroup means were 0.95 for PF, 0.74 for ST, 0.71 for HA, and 0.27 for CY. No [proportion] of patients requiring >1 units transfused were 11 [11%] (3 [14%] for PF, 4 [17%] for ST, 3 [21%] for HA, and 0 for CY) and no [proportion] of patients requiring >2 units transfused were 6 [7%] (2 [10%] for PF, 2 [9%] for ST, and 2 [14%] for HA).

Aim The aim of this audit was firstly to review current blood ordering practice for elective and emergency craniotomies at the Royal Hospital for Sick Children (RHSC) Yorkhill and secondly to categorise craniotomies in order to simplify and improve the current blood ordering guidelines. Method All craniotomy patients at RHSC Yorkhill between March 2012 and November 2014 were identified from logbook records in the neurosurgery and emergency theatres. Craniotomies were categorised into five subgroups: 1) Posterior fossa tumour (PF), 2) Supratentorial tumour (ST), 3)

Conclusion There was a considerable inconsistency in blood ordering practice for emergency and elective craniotomy surgery at RHSC Yorkhill. Overall, blood transfusion requirements tended to be overestimated.

SCOTBLOOD 2015 ANNUAL CONFERENCE

Recommendations 2 units of packed RBCs should be requested prior to craniotomies for tumour debulking/ resection and haematoma evacuation. One unit of packed RBCs should be ordered for fenestration of cysts. Additional units can be requested after discussion with the consultant surgeon or, if necessary, obtained during the surgery. If the proposed recommendations would have been followed over the set period of the study, around 44 units less packed RBCs would have been requested.

References 1. Goutcher C, Hivey S, Brown J. Neurosurgical Maximum Surgical Blood Ordering Schedule (MSBOS). RHSC Yorkhill; 2012.

SCOTBLOOD 2015 ANNUAL CONFERENCE

Poster No 9 Paediatric Craniofacial Surgery - A Review of Cross Matching Practice Rodger D, Bolton P, Harrison E. University of Glasgow, Greater Glasgow & Clyde Health Board Background Blood transfusion in Scotland is a demand driven service coordinated by the Scottish National Blood Transfusion Service (SNBTS). This service operates based on the perceived requirements of each individual hospital and attempts to establish an appropriate supply from itâ&#x20AC;&#x2122;s donors. Paediatric transfusions add an extra level of complexity in that the blood must be no more than 10 days from donation due to the build up of potassium. Currently paediatric craniofacial operations carried out in the Royal Hospital for Sick Children (RHSC) have red cells ordered according to the neurosurgical Maximum Surgical Blood Ordering Schedule (MSBOS) guideline issued in 2012. This document specifies that 2 units of red cells should be crossmatched for correction of all craniosynostoses and cranial vault expansions, but does not give guidance for any other craniofacial procedures aside from recommending discussion with senior medical staff.

theatres and was subsequently applied to the Blood Bank Telepath system to ascertain the numbers of units used, ordered, and returned. Results In total for the 70 procedures carried out in the 30 month period analysed, 37% of the blood ordered was used and the remaining 63% returned to the Blood Bank. A total of 107 units were ordered and subsequently returned to the lab unused. The biggest discrepancies were in dermoid cysts where only 19% of units were used and vault expansions where 30% were used. Conclusion The results showed that for many of the procedures being carried out, more blood is being ordered than is ultimately required. In certain procedures the amount returned is significant enough that a guideline is warranted to minimise the numbers in the future. A MSBOS document was produced and circulated to theatre staff with subsequent review due in March 2017. This should reduce unnecessary blood ordering and the associated handling costs and resource usage.

Method The sample for this analysis consisted of all craniofacial surgeries carried out in RHSC from June 2012 to December 2014. This list was collated from the surgical logbooks in

SCOTBLOOD 2015 ANNUAL CONFERENCE

Poster No 10 An Innovative Approach to Re-evaluating Staff Training and Competency Anne Thomson, Lisa Bell, Johan Fleming, Chloe Pass, Diane Sydney, Moira Anderson, Gillian Clark, Joanne Thomson, Kathryn Dick, Helen Munro, Arlene David Aim Within National Services Scotland (NSS) and in particular the Scottish National Blood Transfusion Service (SNBTS), there is currently a cross section of NHS staff groups including medical, nursing and scientific staff. All of these groups must meet regulatory requirements and have their technical competency levels re-evaluated on a frequent basis. Local arrangements have been in place but this has lead to inefficiency. The aim of this project was to introduce a planned programme for the re-evaluation of staff based on risk. This innovative project (lead by a multidisciplinary team), has paved the way for sharing best practice, leaning processes and bringing several groups of staff under one framework. By re-evaluating competency based on risk, training and more importantly resources can be targeted to where it is needed.

and processes undertaken by each staff group. The prioritisation of staff reevaluation was based on several factors that increased the risk of the individual not being fully competent over time and what impact that would have on the patient/donor and their care. Results All tasks and processes were categorised into three distinct groups based on their level of risk, and classified as red, amber or green. The frequency of reevaluation was then determined. A new national programme across all staff groups undertaking technical tasks within SNBTS will now be introduced. Systems and evaluation tools have been put in place to manage this programme. Conclusion This innovative risk based approach will ensure resources are applied where needed by identifying staff re training needs based on their measured competency.

Methodology A risk model was developed to assist in categorising all the technical tasks

SCOTBLOOD 2015 ANNUAL CONFERENCE

Poster No 11 Blood on Board Dr Neil Hughes, Dr Karen Bailie EMRS/SNBTS Background The Emergency Medicine Retrieval Service (EMRS) consists of a specialist team of medics who are able to deliver critical care skills in a pre-hospital setting. Based at the Clyde Heliport in Glasgow, the service attends sick and injured patients by helicopter and trauma response car. In 2014 EMRS attended over 500 primary missions, managing a variety of traumatic injuries. Prior to this project, seriously injured patients only had access to blood transfusion when they arrived at the hospital.

taken on even the longest of missions. A box rotation and daily delivery system from SNBTS Gartnavel was set up, and governance systems put in place to ensure robust checks and safe administration of the blood. All staff were current on LearnPro training. Teething problems with the system were recorded and responded to, and reporting systems put in place for any ongoing issues. Results In the first 10 months of the project (June 2014-April 2015) blood was taken on 251 missions. CRCs were given to 21 individual patients, with a total of 47 units delivered. 18 patients survived to the Emergency Department and 9 survived to hospital discharge. Hospital transfusion data available via AfB for 13 patients shows 121 further blood products given after arrival. 15 of the 19 trauma patients were injured in a road traffic accident with other mechanisms including high fall, stabbings and hit by a subway train. Blood was delivered IV in 18 cases, and by the interosseous route in 3.

Aim To implement a system which would allow Concentrated Red Cells (CRCs) to be stored at the heliport base and be immediately available for deployment with EMRS teams to perform pre-hospital blood transfusion in critically ill and injured patients. Methods The project was co-ordinated in close collaboration between SNBTS at Gartnavel and EMRS from October 2014. We undertook a review of available blood storage and transport systems, deciding on the Credo EMT box, or â&#x20AC;&#x153;Golden Hourâ&#x20AC;? box. When properly conditioned and sealed, this small box holds the CRCs at a temperature of 2-6C for upwards of 36 hours with no power source, and allows the blood to be

Conclusion: Delivery of pre-hospital blood transfusion by EMRS has been shown to be feasible and safe and the treated patients are severely injured with high healthcare needs and further transfusion requirements.

SCOTBLOOD 2015 ANNUAL CONFERENCE

Poster No 12 Comparison of LIFECODES Pak LxTM Assay with ‘gold standard’ Monoclonal Antibody Immobilisation of Platelet Antigens (MAIPA) Assay Fiona Sellers, Jacqui Blackburn, Radhika Bhandari,Joanna Coull, Natalia Wlizlo SNBTS - Molecular Immunohaematology Aberdeen Background Pregnancy or transfusion can result in the development of alloantibodies against platelet antigens which can be associated with severe bleeding disorders such as fetal and neonatal allo-immune thrombocytopenia (FNAIT), refractoriness to platelet transfusions or post-transfusion purpura (PTP).Platelets express glycoproteins, such as GPIIb/IIIa, GPIb/IX and GPIa/IIa to which the antibodies bind. Polymorphic epitopes on these glycoproteins give rise to two alleles “a” and “b” for each platelet antigen. Human Platelet Antigens (HPA)-1, HPA-3, and HPA-4 are located on GPIIb/IIIa; HPA-2 on GPIb/IX ,HPA-5 on GPIa/IIa and HPA-15 on CD109. Currently in SNBTS all potential disorders are screened for platelet antibodies by Lifecodes GTIPAK 12 ELISA and confirmed at the Aberdeen Platelet and Granulocyte Reference Laboratory by Monoclonal Antibody Immobilisation of Platelet Antigens (MAIPA) assay which is considered the ‘gold standard’ for platelet antibody detection. The new Lifecodes PAKLX assay gives greater specificity than GTIPAK 12 for all alloantibodies in particular HPA-2 and HPA-4. The PAKLX does not detect anti-HPA-15.

be tested in batches of 8 but it is very labour intensive and takes approximately 7 hours to complete each assay ,for each glycoprotein. The new Lifecodes PAKLX assay is a qualitative bead assay measuring fluorescent intensity on the Luminex instrument with PAKLX Match IT software for result interpretation. It can detect specific antibodies to HPA-1, HPA-2, HPA-3, HPA4, HPA-5, GPIV and Class I HLA in human serum. Samples can be tested in batches of 14 and can be performed within 2 hours with minimal manual intervention. To establish comparisons of sensitivity and specificity the reference laboratory have tested the PAKLX assay in parallel with all samples requiring a MAIPA assay for the last12 months . Results 83 patient samples and 26 workshop samples were tested by MAIPA and PAKLX. There were 7 discordant results within the patient group and none for the workshop samples. Conclusion The majority of HPA antibodies tested at the Aberdeen Reference laboratory were detected by PAKLX and MAIPA . These results will be shared with NHSBT Platelet and Granulocyte Reference laboratory and PAKLX incorporated into the HPA antibody testing algorithm.

Methods MAIPA is a highly sensitive technique used for the detection of platelet alloantibodies to HPA-1, HPA-3, HPA-5 and HPA-15. Samples can

SCOTBLOOD 2015 ANNUAL CONFERENCE

Poster No 13 Frequency of BK Virus Reactive T Cells Within the Scottish Donor Population S.N. Imlach1, A.R. Fraser2, J Petrik1 & J.D.M. Campbell2 1 Microbiology and Components Group, SNBTS Research, Development and Innovation 2 Tissue and Cell Therapy Group, SNBTS Research, Development and Innovation Ellenâ&#x20AC;&#x2122;s Glen Road, Edinburgh, EH17 7QT contribute to the elimination of acute viral infections, restrict the reactivation of latent viral infections and control viral loads at steady state levels during chronic infections. T cell based therapies have been shown to be successful in the treatment of post transplantation viral reactivation as used in the case of Epstein-Barr virus mediated post-transplantation lymphoproliferative disorder. Here we describe a pilot project to determine whether it is possible to detect antigen-specific BKV T cells from peripheral blood mononuclear cells (PBMC) samples obtained from normal donors, as a precursor to isolation for therapy. PBMC samples were obtained from the SNBTS donor anonymous archive, stimulated with BKV peptides for 6 hours then assessed for T cell phenotype and IFN-g production by flow cytometry (FC) as a measure of reactivity to BKV. Preliminary results indicate that FC is able to detect BKVspecific IFN-g positive T cells in 47.9% (n=48) of normal donors. Further investigation will indicate the potential to develop T cell based therapies for BKV reactivation post transplantation.

BK virus (BKV) is a polyomavirus where initial infection normally occurs in early childhood which results in mild disease in immunocompetent individuals. The virus then disseminates to the kidneys and urinary tract where it persists in a latent form for the life of the individual. Established seroprevalence rates of between 65% and 82% within the general population are reported. In renal transplant recipients, due to the immunosuppressive drugs given to allow graft survival, BKV reactivation occurs in 80% of patients. This can result in loss of the transplanted kidney through BKV associated nephropathy in up to 10% of cases. At present there is no specific pharmacological treatment available for BKV reactivation other than reduction of immunosuppression to allow the immune system to deal with the BKV infection but this can lead to loss of the transplanted organ via graft verse host disease. As an emerging infection, BKV reactivation is also a complication of stem cell transplantation. Anti-viral T cells are a key component of the adaptive immune response and

SCOTBLOOD 2015 ANNUAL CONFERENCE

Poster No 14 Stepping Up To The Mark: Increasing Compliance In Staff Competency For Blood Component Collection Catrina Hendry SNBTS Background The EU Blood Directive 2002/98/EC came into UK Law as the Blood Safety and Quality Regulations (BSQR) (2005) and were enforceable from November 2005. The regulations state that only staff who have evidence of being competency assessed in the collection of blood components should participate in this task (BSQR 2005). The Medicines and Healthcare products Regulatory Agency (MHRA) oversees compliance of the BSQR within the NHS Boards. It is a requirement that 100% of all NHSS staff involved in collecting blood from the Hospital Transfusion Lab (HTL) / satellite fridge, demonstrate competency using the Training Assessment and Accreditation Programme (TAAP) Blood Collection competency tools.

• Targets were set for all divisions. • TAAP training days set up, to increase number of trainers able to assess staff. • Restriction of staff collecting blood components, appropriate to the clinical area. • Regular updates on staff trained figures sent to TAAP trainers and charge nurses. Results There was a steady upward climb of staff, with valid competency assessment in blood component collection, from 27% in September 2014 reaching 70% in April 2015. Conclusion The multi faceted approach to improving staff trained figures, was embraced by the TAAP trainers and wholly supported by Nurse Management in Dr Gray’s and NHS Grampian. By giving the TAAP trainers administration rights to the Learn Blood Transfusion web site, this gave them more visibility and control over the staff training figures in their area. Setting targets gave clear and achievable goals to be reached

Method In September 2014, the percentage of staff with valid competency assessment in collecting blood in Dr Gray’s hospital was 27% (Overall NHS Grampian figure 37%). In order to increase these figures as quickly as possible, a Situation, Background, Assessment Recommendation (SBAR) report was written, and following a meeting with the Associate Nurse Director,an improvement plan was drawn up with interventions outlined. These included: • Meetings and communication with the Associate Nurse Director, Charge Nurses in Dr Gray’s and the Professional Practice Development Unit (PPDU). • Correspondence, from the above to, divisional leads and Practice Education Facilitators.

Recommendations • Quarterly audits will be carried out to ascertain that only those staff with the appropriate training are collecting blood components and non compliant staff names will be sent to Senior Charge nurses. • Continued support will be given to the TAAP trainers in achieving the goal of 100% staff trained. • Quarterly update of staff trained figures to TAAP trainers and Charge nurses in Dr Gray’s hospital.

SCOTBLOOD 2015 ANNUAL CONFERENCE

Poster No 15 Incident Management – A Team Approach Elaine Harrison, Transfusion Practitioner; Elaine Laurie, Blood Bank Manager; Fiona Holland, Quality and Training Manager; Jackie Wales, Head of Laboratory Services. Golden Jubilee National Hospital, Glasgow. Introduction Reporting transfusion related incidents is mandatory for the Medicines & Healthcare products Regulatory Agency as the competent authority for the BSQR (2005). Reporting to The Serious Hazards of Transfusion is professionally mandated.

Method A monthly ‘Incident and Performance’ meeting was established. There was a review and update of the Incident Reporting Policy and SOP. Importantly there was engagement with key clinical staff to ensure continuity in the investigation and lessons learned from the investigations were shared appropriately.

Incident reporting within the Golden Jubilee National Hospital (GJNH) is documented on the Datix reporting system and was used by individual departments as a tool to report findings of incident investigations.

A system was developed on Q-pulse, which allowed certain incidents to be recorded and importantly, ‘real time’ feedback on the number and nature of incidents could be given to relevant staff, something that could not be achieved on Datix.

Historically, information on all incidents was gathered by Clinical Governance but not shared out with the individual department; subsequently there was little opportunity to report and comment on trends identified and give feedback especially to clinical staff.

Conclusions A structure now exists to give feedback to clinical staff and ‘close the loop’ on incident investigation. Ensuring all corrective actions and lessons learned are shared appropriately, reduces the risk of the incident re-occurring and enhances patient safety.

It was recognised that a review of the way incidents are evaluated, trended and shared could improve transparency with incident investigation with the aim of improving the culture of reporting incidents, with a focus on learning.

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Poster No 16 Evaluation of Foetal DNA Controls for Non-Invasive Prenatal Diagnosis Blood Group Genotyping Assays K Cheal & S Armstrong-Fisher Aberdeen and NE Scotland Blood Transfusion Background Non-invasive prenatal diagnosis (NIPD) has been utilised for the diagnosis of genetic diseases including haemolytic disease of the foetus and newborn (HDFN). NIPD diagnosis currently uses genetic differences between maternal and foetal DNA to ensure presence of foetal DNA in samples. Most assays include detection of SRY and DYS14 (sex genes located on the Y chromosome) which can act as a control for foetal DNA. However, this is only informative where male DNA is present. It has been reported (1) that maternal and foetal DNA have different methylation properties and this has been utilised by several groups as a specificity control for NIPD testing. Restriction enzyme digestion (BstUI) of the cell free DNA (cfDNA) isolated from maternal plasma will digest the maternal hypomethylated RASSF1A gene leaving methylation-resistant foetal RASSF1A sequences intact. This provides confidence from NIPD testing with digested cfDNA as positive RASSF1A amplification post-digestion confirms the presence of foetal DNA, even in the absence of Y chromosome i.e. female foetus.

intact. RASSF1A and Beta-actin (housekeeping gene) RT-PCR assays were developed to confirm successful digestion and presence of foetal DNA. Confirmation that digested cffDNA (cell free foetal DNA) could be used with â&#x20AC;&#x153;in-houseâ&#x20AC;? validated RT-PCR protocols to perform foetal blood group genotyping was required. Results and Conclusion: Successful digestion of maternal RASSF1A sequences was achieved using BstUI enzyme. Foetal sequences were intact post-digestion and positive amplification of RASSF1A confirmed presence of foetal DNA. The majority of samples showed concordance with previous RHD types and gender. Introduction of restriction enzyme digestion of maternal RASSF1A could be implemented in routine service and would most likely be utilised where RhD negative mothers are suspected of carrying an RhD negative female foetus. This will provide confidence that sufficient foetal DNA is present to validate a negative PCR result in this situation. The Beta-actin PCR assay requires further work for confirmation of hypomethylated (maternal) DNA digestion. However, adult donor controls satisfactorily confirmed this digestion.

Aims Using maternal and control samples, to determine if BstUI digestion cuts maternal hypomethylated cell free DNA thus leaving hypermethylated RASSF1A foetal sequences

(1) Chan KC, et al. Clin Chem 2006;52:22112218

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Poster No 17 Quantification of RhD Positive Foetomaternal Haemorrhage by Flow Cytometry Vicky Law, Roger McGilvray, Sylvia Armstrong-Fisher Scottish National Blood Transfusion Service Haemolytic disease of the foetus and newborn (HDFN) can be a serious condition that affects the foetus and / or neonate, with severe cases most commonly caused by anti-D. In order to prevent severe HDFN, anti-D prophylaxis (RAADP) is in use in the UK and it is vitally important that the correct dose of anti-D immunoglobulin (Ig) is given to the patient when necessary.

Initial testing showed that white blood cells were removed from analysis during the preparation of the working cell suspensions. Further investigation into the preparation of cell suspensions using two different techniques (protocol A and protocol B) were carried out in order to determine their respective effect on FMH quantification. Protocol A used washed, packed red cells whereas protocol B used a sample of whole blood to prepare the working cell suspensions.

The Kleihauer-Betke Test (KBT) is a useful screening test for estimation of foetomaternal haemorrhage (FMH) volume; however, it can be inaccurate at times. More accurate FMH quantification can be achieved by performing flow cytometric (FC) analysis. It has been reported by some laboratories that an excess of white blood cells in maternal samples can cause high background readings in FC analysis. The International Blood Group Reference Laboratory (IBGRL) has produced an R-phycoerythrin (PE) conjugated anti-CD66b reagent for use in FC quantification of FMH, proposing that by using anti-CD66b to label granulocytes within a sample, alongside the fluorescein isothiocyanate (FITC) conjugated anti-D, a more accurate count can be achieved for the number of foetal cells present as the granulocytes will be identified and eliminated from analysis. This study aims to investigate whether an additional anti-CD66b reagent is necessary in FMH quantification to eliminate white blood cells from the FC analysis.

Results indicate that using whole blood cell suspensions could give a high FMH quantification; however, the protocol in use within the North East Scotland SNBTS Immunohaematology Laboratory removes white blood cells and as such, does not require additional procedures for their exclusion. Laboratories should perform their own investigations and analysis in order to determine if there is a need for additional reagents or for a change of their standard operating procedures and monitoring against NEQAS performance.

SCOTBLOOD 2015 ANNUAL CONFERENCE

Poster No 18 A Patient in Need Tina Watson Transfusion Practitioner Better Blood Transfusion Programme Acknowledgments: Andy Jones, Lab Manager, Dr P Clarke, Consultant Haematologist, Dr C Oâ&#x20AC;&#x2122;Neill, GP, Julia Lussier, Transfusion Practitioner. Background A patient who lived on a small island, had been ill for a number of years and now required palliative care, this included the regular transfusion of red cells and platelets. To receive these, the patient was attending hospital for the treatment, however this involved a boat journey which was 2.5 hrs each way. It was indicated by the Consultant Haematologist and General Practitioner (GP) that if the products could be given to the patient at home this would be of great benefit. Home transfusion had not been carried out within this area previously.

Results The patient received the platelets and latterly red cells in his own home, these were transported safely within MHRA guidelines. The GP and district nurse felt fully supported and confident to give the products. The patient did not have to travel the long journey to receive the care he required. Conclusion The scoping exercise undertaken for this patient to receive their care at home was quite lengthy, however very worthwhile. Having had to travel to the hospital for six years, latterly twice per week, for three weeks they were at home where they died peacefully. If this kind of care was required in the future the team felt that it can be carried out safely however, an individual package of care would be required for each case tailored to the individual patients needs.

Methods The practicalities were scoped by the Transfusion Practitioner, local GP, lab manager and Consultant Haematologist. The local airport was contacted and an action plan was formed. To ensure that the storage of the products complied with MHRA regulations, data loggers were sent via the route to ensure the products would be safe when transported. The GP and district nurse were requested to complete the blood transfusion training required, the local paperwork and polices were sent and the haematologist spoke with the patient to inform them of the risks. A platelet agitator was sent to the island in case storage was required.

SCOTBLOOD 2015 ANNUAL CONFERENCE

Poster No 19 NHS Lanarkshire - A Study of the Role of Support Staff in Blood Transfusion P Stewart, H Daniels, P Paterson, I Paterson, K Dow Better Blood Transfusion/NHS Lanarkshire Introduction In Scotland, â&#x20AC;&#x153;no staff member should participate in blood transfusion unless they have evidence that they have been trained to Module 1 Safe Transfusion Practice level or equivalentâ&#x20AC;? [1]. Previous audits have shown that if a patient has a transfusion reaction this usually occurs within the first 15 minutes [2]. This would be detected as part of routine observations which can be undertaken by Healthcare Care Support Workers (HCSW). In NHS Lanarkshire (NHSL), a recent BBT training report indicated that 80% of staff have valid training appropriate to their role. However, as we looked closer HCSWs are only 38%. As the Lanarkshire Transfusion Governance committee (LanTaG) recognise the importance that HCSWs are adequately trained a study was commissioned . This study attempted to establish HCSW participation in blood transfusion and provide an appropriate pathway to support their training.

between hospitals and between clinical areas. Indeed even clinical areas within the same speciality e.g. surgical wards within the same hospital could have different roles for HCSW staff . This variation translates to some HCSWs taking patient observations during transfusion; taking pre-transfusion samples; completing blood collection slips and signing for delivery of blood components. Involvement ranges from all to none of these key tasks and it is unclear how this is decided Conclusions and Implications This presents a challenge for us in NHSL. We had hoped that with this study , the development of the mandatory induction standards and code of conduct for HCSWs [3] we would see a consistency but this is not the case. In the meantime, the LanTag committee have agreed that all HCSWs will complete assessment 1, 2, 5 and 7 of the Module 1 Safe Transfusion Practice[4] which meets national requirements. Without a doubt , further research is required and discussion with professional and regulatory bodies should be promoted to standardise transfusion practise for HCSWs not just in NHSL but hopefully throughout NHSScotland.

Methodology A questionnaire was sent to all clinical managers in NHSL; this included simple questions to determine numbers of HCSWs and their role in the transfusion process in their area. The returned data was then analysed.

References 1. NHSQIS, Clinical Standards for Blood Transfusion. 2006, NHS Quality Improvement Scotland: Edinburgh. 2. National Comparative Audit of Blood Transfusion Project Group. National Comparative Audit of Blood Transfusion - 2011 Re-audit of

Results We received responses from 85% of clinical areas with 100% of the responders reporting that HCSWs were part of their clinical team. However, results showed that the role of the HCSW varies greatly

SCOTBLOOD 2015 ANNUAL CONFERENCE

Bedside Transfusion Practice,. 2011 3. Health Workforce Directorate and Chief Nursing Officer Directorate. CEL 23 (2010) 2010; Healthcare Support Workers â&#x20AC;&#x201C; Mandatory induction standards and

code of conduct for Healthcare Support Workers and mandatory code of practice for employers of Healthcare Support Workers]. 4. Better Blood Transfusion. Module 1 Safe Transfusion Practice. 2011.

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Organisers

Core Group

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

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

SCOTBLOOD 2015 ANNUAL CONFERENCE

Acknowledgements

The contribution of Sandie Young & Isabel Ward in the compilation of the Abstracts and Kirstin Thomson 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.

Abbott Diagnostics Delegate Badges and Lanyards

Commercial Operations University of Stirling Notepads and Pens

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David David Colligan Colligan NeilNeil McGowan McGowan Colligan Neil McGowan David Colligan DavidDavid Colligan Neil McGowan Neil McGowan On On behalf behalf of the of the Scotblood Scotblood 2015 2015 Organising Organising Committee Committee On the Scotblood Organising Committee On behalf On of behalf thebehalf Scotblood of theofScotblood 2015 Organising 20152015 Organising Committee Committee IBMS IBMS have have awarded awarded 15 15 credits credits for for thefor the whole whole meeting meeting IBMS have awarded 15 credits the whole meeting IBMS RCPath have IBMS awarded have awarded 15 credits 15 credits for the for whole the meeting whole meeting RCPath have have awarded awarded 8 credits 8 credits for for the the whole whole meeting meeting awarded credits formeeting the whole meeting RCPathRCPath haveRCPath awarded have have awarded 8 credits 8 credits for8the for whole the whole meeting

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