Life Blood – Issue 34, April 2020 - Western Cape Blood Service

Dear Life Blood Reader,

Welcome to Life Blood 34.

Despite the initial setback at the onset of the COVID-19 crisis in South Africa, the WCBS has successfully been able to stabilise the blood supply and is lifting the blood usage restrictions effective immediately. Clinicians should please feel free to request blood and blood products from their designated Blood Bank as the supply is currently adequate.

This edition includes information about the relocation of the Paarl Blood Bank, impact of COVID-19 on WCBS blood product safety, upcoming collection of convalescent plasma from recovered COVID-19 patients at WCBS, introduction of platelet additive solution for WCBS single donor platelet products, useful blood safety material for clinicians, the 2018 South African Haemovigilance Report, and feedback from the 2019 customer satisfaction survey.

Please feel free to reach out to us if you have any queries, comments or suggestions.

Regards,

Hayley Alie, WCBS Marketing Officer (Editor)
Phone 021 507 6326 | Fax 086 756 7888 | Cell 083 454 3455 | Email marketing@wcbs.org.za

Dr Caroline Hilton, WCBS Head – Medical Division (Associate Editor)
Phone 021 507 6329 | Fax 021 531 3335 | Cell 083 282 1612 | Email caroline@wcbs.org.za

Paarl Blood Bank is Relocating

After operating from the Paarl Branch premises for the past 28 years, we have outgrown the space and are relocating to larger premises across the road from the Paarl Provincial Hospital, effective Wednesday 8 April 2020 at 08h00.

The new Blood Bank is a state-of-the-art facility, equipped with the latest technologies for cross-match testing and issuing safe blood products for patients as efficiently as possible. It processes about 320 patient samples and issues about 500 red cell products and 80 plasma products monthly for the approximate total of 9 hospitals and healthcare facilities in the region. Secure private parking is available at the Blood Bank.

The contact particulars for the new Paarl Blood Bank are as follows:

Telephone                                           : 021 871 1030
Callout cellphone                                 : 083 303 8658
Duane Jacobs, Manager – Blood Bank   : Cellphone 083 796 0463
email duane@wcbs.org.za
Physical location                                  : 53 Hospital Street, Lemoenkloof, Paarl, 7646

The operating hours for the new Paarl Blood Bank are as follows:

Mondays to Fridays
Normal business hours : 08h00 to 22h00
Callout hours : Between 22h00 and 08h00

Weekends and public holidays
Normal business hours : 08h00 to 14h00
Callout hours : Between 14h00 and 08h00

The after-hours service fee is applicable for every requisition that the Blood Bank receives between 18h00 until 08h00 on normal weekdays, and 24 hours on Saturdays, Sundays and public holidays.

We hope that the move to the new Paarl Blood Bank will improve our overall service delivery for patients in the region.

For Paarl Blood Bank-related queries, please contact Duane Jacobs, Manager – Paarl Blood Bank.

Impact of COVID-19 on WCBS Blood Safety

At the time of writing this article, there were no globally reported cases of transmission of COVID-19 infection via a blood transfusion. We were, however, faced with the challenge of preventing potential disease transmission to donors and staff who were gathered together at donation clinics.

As of February 2020, the WCBS implemented a self-deferral policy for blood donors that stipulated that they must not donate blood for 28 days after:

their return to South Africa from international travel
their last close contact with a person diagnosed or suspected of having COVID-19
full recovery from COVID-19 infection

Donors were asked to complete a check-list set of questions to identify any risk factors for having COVID-19 prior to entering the clinic. If they had any of these risk factors, they were asked to defer their donation to a later date. Our standard donor questionnaire was an additional tool to identifying donors who may be infectious. Numerous other measures such as distancing of donor beds, separation of donors while waiting in queues, hand disinfection stations at regular intervals and the use of personal protective equipment by staff were implemented.

Despite the limitation of public movement and closure of businesses and educational facilities that housed our regular donation clinics, we have seen a huge number of people coming out to donate blood since the onset of the lock-down period in South Africa. The donor response has been amazing in this time of uncertainty and fear.

For donor blood safety-related queries please contact Sr Kim Strutt – Clinic Coordinator. T 021 507 6355 | E Kims@wcbs.org.za

WCBS to Implement Convalescent Plasma Collection for COVID-19 Patients

There is research to suggest that the use of convalescent plasma from recovered COVID-19 patients may be a beneficial treatment for patients through the passive transfer of immunoglobulins. To this end, the WCBS and the South African National Blood Service (SANBS) are engaging in a research study to collect recovered plasma for use in clinical trials in South African hospitals. We are currently awaiting delivery of appropriate plasma apheresis machines and study protocol approval. Recovered COVID-19 donors will be recruited via the National Institute for Communicable Disease (NICD) through specific selection criteria.

Interesting Articles:

Convalescent Plasma to Treat COVID-19
John D. Roback, Jeanette Guarner JAMA March 27, 2020. Doi:10.1001/jama.2020.4940

Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma
Chenguang Shen, Zhaoquin Wang, Fang Zhao et al JAMA March 27, 2020.doi:10.1001/jama.2020.4783

The convalescent sera option for containing COVID-19
Arturo Casadevall and Liise-anne Pirofski The Jounal of Clinical Investigation March 13, 2020.10.1172/JCI138003

The feasibility of convalescent plasma therapy in severe COVID-19 patients: a pilot study
Kai Duan et al MedRxiv, March 23 2020 https://doi.org/10.1101/2020.03.16.20036145

Coronavirus Disease 2019 (COVID-19) outbreak in China
Zunyou Wu, Jennifer M. McGoogan JAMA. February 24, 2020. Doi:10.1001/jama.2020.2648

Inactivation of Middle East respiratory syndrome-coronavirus in human plasma using amotosalen and ultraviolet A light
Salwa I. Hindawi et al Transfusion.2018 Jan;58(1):52-59 doi: 10.1111/trf.14422

For convalescent plasma collection queries please contact Dr Caroline Hilton, Head – Medical Division (caroline@wcbs.org.za)

WCBS Introduces Platelet Additive Solution for Single Donor Platelet Products

The WCBS will become the first blood service in Africa to introduce platelet additive solution (PAS) for all single donor platelet (SDP) products. PAS replaces a portion of the donor plasma volume in the final SDP product in a ratio of about 70:30. The reduction in the donor plasma volume decreases the risk of adverse transfusion reactions associated with plasma proteins and antibodies, such as allergic reactions and Transfusion Related Acute Lung Injury (TRALI).

PAS is a sterile, buffered salt solution that contains acetate to replace glucose as fuel for the platelets, which effectively prevents acidification of the storage environment. Other additives, including potassium and magnesium, are responsible for improvement in platelet recovery and survival. PAS does not affect the platelet count in the final platelet product (> 2.4 x 10¹¹) nor the expected platelet increment or clinical outcome in the patient. The introduction of PAS in SDP products allows availability of more plasma for the production of plasma-derived medicinal products by the fractionator.

WCBS Blood Safety Information for Clinicians

Comprehensive blood safety information for clinicians has been made available on our blood safety information page. The information includes aspects about informed consent, risks of blood product transfusions, management of patients who refuse transfusions, haemovigilance information, investigation of adverse transfusion reactions and look-back investigations.

Our core blood safety concepts include recruitment of voluntary and non-remunerated blood donors, the self-exclusion questionnaire to identify risk behavior, meticulous blood donation testing, promotion of rational and restrictive clinical usage, look-back investigations and haemovigilance reporting.

Click here for information about informed consent

Click here for information about risks of blood product transfusions

Click here for information about the management of patients who refuse transfusions

Click here for information about haemovigilance

Click here for information about the investigation of adverse transfusion reactions

Click here for information about look-back investigations

For blood safety queries, please contact Dr Caroline Hilton, Head – Medical Division (caroline@wcbs.org.za)

South African Haemovigilance Report 2018

The 2018 South African Haemovigilance Report recently released by the WCBS and South African National Blood Service (SANBS) delivers a concise national overview of the surveillance of adverse transfusion and donation events. The information should guide the blood services and hospitals toward pre-emptive strategies to avoid risk and a tool to implement patient blood management strategies.

The Report focusses on red cell concentrate usage across provinces, adverse transfusion events, transfusion-transmitted infections, bacterial surveillance of platelet products (SANBS), and donor adverse events.

A brief synopsis of the findings follows:

Red cell concentrates were the most transfused blood product (78.41%).
Allergic transfusion reactions were the most common type of transfusion reaction (33.7%).
Incorrect blood or component transfused (IBCT) events accounted for 3.8% of all transfusion reactions. Of these, 2.6% were misdirected transfusions with or without ABO blood group incompatibility, and 0.2% were Rh incompatible transfusions.
There were no reported transfusion-transmitted infection events.
There were 864 donor-triggered look-back investigations.
The rate of bacterial contamination in platelets continued to decline due to further improvements in infection control practices (SANBS).
Vasovagal reactions were the most common type of donation adverse event (59.03%).

IBCT events occur as the result of preventable human error where a patient receives a transfusion with a blood component that did not meet specific requirements or was for another patient. We encourage medical staff to regularly revise the educational material about the ordering and administration of blood products. These can be found in the Clinical Guidelines for the use of Blood Products in South Africa, 5th Edition, Chapter 2, Ordering and Administration of Blood (download the PDF version) and the educational video titled “Ordering and administration of blood products” (view the video). Alternatively, please feel free to request a talk or workshop from Dr Caroline Hilton.

Download the complete South African Haemovigilance Report 2018

We wish to thank medical staff for their support of the national haemovigilance programme and reporting suspected adverse transfusion events to the Blood Bank.

For haemovigilance-related queries, please contact Dr Caroline Hilton, Head – Medical Division (caroline@wcbs.org.za)

Customer Satisfaction Survey 2019 Feedback

The WCBS 2019 customer satisfaction survey was conducted at 38 hospitals and healthcare facilities in the Western Cape. It encouragingly indicates that customers overall remain satisfied with the quality of our products and services. Our feedback to the areas of concern and general comments from survey respondents are as follows:

Medical support and advice

Clinical/medical support and advice is available from our medical staff, namely, Dr Caroline Hilton, Head – Medical Division (T 021 507 6329, C 083 282 1612, E caroline@wcbs.org.za) and Dr Greg Bellairs, CEO and Medical Director (T 021 507 6319, C 083 259 2119, E greg@wcbs.org.za)

Blood products and services information

For information about our blood products and services, please feel free to visit our blood products and services page.

Designated time-frame for blood requests

It takes the Blood Bank approximately 20 minutes to issue a STAT request, and two hours to complete a full cross-match from the time of receipt of the patient sample in the Blood Bank. Problem cross-matches (eg. when the patient has a complex antibody profile) will take longer and may require additional blood samples for testing.

Availability of blood products

We aim to keep sufficient stocks to meet the needs of patients in the Western Cape for a five day period. Exceptions are Group O Positive red cell concentrates set at 7.5 days, and Group O Negative and B Negative red cell concentrates set at a stock of 10 days. In the event of a blood shortage, we will implement restrictive ordering policies where urgent cases are prioritised.

Single donor platelet (SDP) products are available on request. Clinicians should place their order with the Blood Bank by 10h00 on normal weekdays for same day delivery. We aim to keep an emergency supply of SDPs for use on a first come first serve basis. We also stock blood group specific random donor platelet (RDP) products for patients who are on long-term platelet therapy, to use when SDPs are not available. Filtering of group specific RDP products is advised to reduce the risk of alloimmunisation.

Finding out if the blood request is ready

The Blood Bank staff do not have the capacity to telephonically inform ward staff when the blood is ready. Ward staff should please contact the Blood Bank to track the status of the order. The Blood Bank will contact the requesting clinician in the event of a problem cross-match, and ward staff to request a new patient sample and form.

Product labelling

The WCBS product labels indicate the specified minimum and maximum product volume for the various blood products. The labelling complies with the criteria in the Standards of Practice for Blood Transfusion in South Africa wherein it is compulsory to indicate the minimum product volume.

Blood donation serial numbers

The blood donation serial number stickers on blood products, blood donation samples and documentation are designed for the sole use of WCBS, not hospitals or health facilities.

Onsite Blood Banks

While we understand more hospitals may wish to have an onsite Blood Bank, we only have capacity to operate eight Blood Banks in the province. These are strategically located to maximise our service delivery in the Western Cape.

Finally and importantly, if you have any Blood Bank-related queries, comments, suggestions or complaints, please feel free to contact your nearest Blood Bank for assistance.

We wish to thank everybody who participated in the survey for their invaluable feedback.

For survey-related queries, please contact Hayley Alie, Marketing Officer (marketing@wcbs.org.za)

Your Questions Answered

Question: I would like to enquire about the options for autologous blood transfusion intra-operatively, specifically the supply of blood collection bags.

Answer: Both acute normovolaemic haemdilution (ANH) and blood salvage techniques (eg. use of cell saver machines) are options for intra-operative autologous blood transfusion.

ANH entails the removal of blood from a patient before or shortly after induction of anaesthesia and simultaneous replacement with appropriate volumes of an acellular fluid (crystalloid/colloid) followed by the return of the blood as dictated by the intra-operative blood loss.

The standard single blood collection bag with anticoagulant is available from Carol Collett, SSEM Mthembu Key Account Consultant – Blood Division (T 021 712 0653 | C 072 807 2166 | E carolc@ssemmthembu.co.za)

The particulars for the blood bag are as follows.
Catalogue code: 811 4072
Product description: JMS BLOOD BAG Single 450 ml, anticoagulant CPDA1 with 16 G needle
2020 Price: @ R48.20 excluding VAT each (minimum ordering quantity 10)

For more information about intra-operative blood recovery and other alternatives to allogeneic blood transfusion, see the Clinical Guidelines for the use of Blood Products in South Africa, 5th Edition, Chapter 10.