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PAPERS: L M Williamson, S Lowe, E M Love, H Cohen, K Soldan, D B L McClelland, P Skacel, and J A J Barbara Serious hazards of transfusion (SHOT) initiative: analysis of the first two annual reports BMJ 1999; 319: 16-19 [Abstract] [Full text]

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Conclusion not supported by data presented?

Paul Nederlof   (8 July 1999)

Untitled

Michael JG Thomas   (2 August 1999)

Conclusion not supported by data presented? 8 July 1999
Paul Nederlof Send response to journal: Re: Conclusion not supported by data presented?	Editor Williamson et. al. are reporting on safety of transfusions (1). Despite of 366 cases of serious complications after transfusion, the conclusion is drawn that transfusions are extremely save. This conclusion is not supported by the data presented in this article, because there is no mention about the total number of transfusions. For junior doctors, who are usually those consenting patients before transfusion, it would be very useful to be able to quote a rate of complications. Does any such data exist? Dr Paul Nederlof SHO Obstetrics & Gynaecology Gloucestershire Royal Hospital, Gloucester Reference 1 Williamson LM, Lowe S, Love EM, Cohen H, Soldan K, McClelland DBL, Skacel P, Barbara JAJ. Serious hazards of transfusion (SHOT) initiative: analysis of the first two annual reports. BMJ 1999;319:16-9.
Untitled 2 August 1999
Michael JG Thomas Send response to journal: Re: this article	Sir, Two recent articles1,2 have highlighted important issues in blood transfusion, namely safety and autologous transfusion. They also emphasise the need for education and the standardisation of procedures. Additionally Provan1 raises the issues of availability and cost. The requirement for red cells is increasing annually by 2-3% against a static,or even falling, number of donations. One solution suggested by both Provan1 and the NHS Executive3 is to increase the use of autologous transfusion (AT). The safest and most ecologically friendly method of AT is perioperative cell salvage (PCS), but, until the introduction of universal leucodepletion of allogeneic blood, the cost of this procedure was seen as a major hurdle. Now the salvage of as little as 1.5 units of red cells can be cost effective4. Williamson et al2 report that over half the cases reported involved the administration of the wrong unit of blood. This problem is avoided by the use of PCS. However, in only a small percentage of the total number of cases requiring blood transfusion is it possible to use any form of AT. There will, therefore need to be a major increase in the use of AT in suitable cases to make any noticeable impact on the overall usage of blood in the UK. Recently the Autologous Transfusion Special Interest Group (ATSIG) of the British Blood Transfusion Society (BBTS) has conducted a confidential survey of the provision of autologous transfusion in England and Wales. This survey revealed that, contrary to the suggestions of best practice by Provan1 and Williamson2, the level of training is patchy and that there is little standardisation of techniques. As a consequence, and in an effort to overcome this problem, the Council of the BBTS has invited ATSIG to set up a series of Regional Autologous Transfusion Training Sessions. A pilot session has been successfully completed and details of future sessions can be obtained from either the Mrs Alison Wilkins administrator, BBTS,Plymouth Grove, MANCHESTER M13 9LL, or from the author. Michael JG Thomas Colonel (Retd) MA, MB, BChir, FRCP Edin, LMSSA, DTM&H References: 1. Provan D. Better Blood Transfusion. BMJ. 1999;318:1435-6. 2. Williamson LM, Lowe S, Love EM, et al. Serious hazards of transfusion (SHOT) initiative: analysis of the first two annual reports. BMJ. 1999;319:16-9. 3. NHS Executive. Better Blood Transfusion. Leeds: NHS Executive, 1998 (HSC 1998/224). 4. Desmond M, Gillon J, Thomas MJG. Perioperative Red Cell Salvage. Transfusion Medicine. In Press.