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PO77 The role of patient blood management in promoting safe, effective blood transfusion in Scotla... Mr John Faulds 1, Dr Katherine Forrester, Helen Adams 1 NSS/Scottish national blood transfusion service, Edinburgh, United Kingdom B Introduction: b Patient Blood Management (PBM) is an umbrella statement for best transfusion practice while employing a range of PBM modalities such as anaemia management Intra Operative Cell Salvage Restrictive transfusion It can be further defined as a "multidisciplinary, evidence-based approach to optimising the care of patients who might need a transfusion" putting the patient at the centre of decisions made. PO87 Delayed transfusions contribute to death (SHOT data 2014-2021) Mr Simon Paul Carter-Graham 1, Dr Paula Bolton-Maggs 1, Ms Debbi Poles 1 1 Serious Hazards of Transfusion (SHOT), Manchester, United Kingdom B Introduction: b Transfusion of blood components in the UK is generally safe but delayed transfusion can have severe consequences for the patient. Key changes in the revised AWTR were: Inclusion of a field for patient weight, Expanded section on consent, to accommodate the SaBTO 2020 recommendations SP 1 sp , Expanded section on transfusion associated circulatory overload (TACO) risk assessment, Inclusion of a field for reason for transfusion/ National Blood Transfusion Committee of England (NBTC) indication code for each unit authorised, Inclusion of a QR code links to: "Receiving a blood transfusion" patient information leaflet, SHOT (Serious Hazards of Transfusion) TACO checklist, and NBTC indication codes. B Methods: b We retrospectively audited all patients receiving a blood transfusion consecutively across a four-month period in a general surgery department at a district general hospital The medical notes for each patient were assessed for their pre-transfusion haemoglobin, indication for transfusion, and whether transfusion was prescribed according to NICE guidelines. [Extracted from the article]

Background and Objectives: The extremely rare Rhnull phenotype is characterized by the absence of all Rh antigens on erythrocytes. It is divided into the regulator and amorph types based on the underlying genetic background. The more common regulator type depends on critical variants silencing RHAG, which encodes RhAG glycoprotein, necessary for RhD/RhCE expression. Rhnull cells have altered expression of glycophorin B and LW glycoprotein. Materials and Methods: Four unrelated Rhnull individuals were investigated. Serological testing was performed according to standard blood bank practice. RHD/RHCE and S/s allele‐specific Polymerase chain reaction (PCR) genotyping was done on genomic DNA using in‐house PCR assays. RHAG, and in some cases also RHD/RHCE, were sequenced. Initial s phenotyping results triggered additional serological investigation. Results: Anti‐Rh29 was identified in all four individuals. Extended typing with anti‐S and anti‐s showed that the three samples predicted to type as s+ failed to react with 2 of 5 anti‐s. Sequence analysis of all 10 RHAG exons and the immediate intron/exon boundaries revealed a single nucleotide variant in the 3′‐end of intron 6, c.946 −2a>g in all samples. RHD/RHCE showed no alterations. Conclusion: A novel Nordic Rhnull allele was identified. In addition, it was shown that s+ Rhnull red blood cells are not only U− but also have qualitative changes in their s antigen expression. [ABSTRACT FROM AUTHOR]

Interestingly, in DRB1*03:01 group all HLA-B*08 positive donors showed DRB3*01:01:02 allele, while all HLA-B*08 negative donors and 77.3% of HLA-B*18 positive donors carried DRB3*02:02:01 allele. Our results showed that three HLA alleles were associated with AIN only for patients with anti-HNA-1a specific antibodies; DRB1*01 (OR = 2.63 (1.65-4.21), DRB1*04 (OR = 0.29 (0.15-0.57)) and DQB1*03 (OR = 0.37 (0.23-0.59)), while DRB1*10 (OR = 8.74 (3.29-23.23)) was specific for the remaining group of anti-Fc IIIb antibody positive patients. The minor alleles were significantly over-represented in the subgroup of patients with EIM: 31.2% versus 7.5% in patients without EIM, I p i = 0.001, OR 5.54 for 308*A and 9.3% versus 0.7% in patients without EIM, I p i = 0.04, OR 13.55 for 238*A. No other associations were found in the studied group. A couple of HLA-B alleles showed significant differences when compared between the patient and control groups: HLA-B*15 was increased in patients, while surprisingly, HLA-B*35 showed a significant decrease in people suffering from migraines. The rare HLA-B*39:06:02:01 association with both HLA-C alleles and subsequent haplotype comparison between patient and mother, led to suspicions of possible HLA-C allele dropout in both samples. [Extracted from the article]

PO69 Blood transfusion laboratory staffing audit Dr Tracy Hui 1,2, Dr Fatts Chowdhury 1,2, Mr David Johnson 1, Ms Linda Chapple 1, Mr Athi... 1 Imperial College Healthcare NHS Trust, 2 NHS Blood and Transplant BLOOD TRANSFUSION LABORATORY STAFFING AUDIT BACKGROUND Concerns had been raised by staff in all 3 ICHNT blood transfusion laboratories (BT) over staffing shortages and resultant pressures on workload and adequate service provision. Therefore, for minor-incompatible transfusions, 8% of platelet transfusions were group A donor to non-A patients and 2% were group O donor to non-O patients. PO55 Patient identification errors resulting in a wrong component transfusion Mr Simon Carter-Graham 1, Dr Shruthi Narayan 1, Ms Debbi Poles 1 1 Serious Hazards of Transfusion (SHOT) Accurate patient identification (ID) is vital to patient safety; it ensures that the correct blood component is given to the correct patient. Knowledge was tested in different domains - blood components (A), pre-transfusion checks (B), transfusion process (C), post-transfusion process (D) and blood administration practice (E). Transfusion of ABO major incompatible platelets can lead to lower platelet count increments following transfusion whereas transfusion of ABO minor incompatible platelets has been associated with increased risk of haemolytic transfusion reactions SP 1,2 sp . [Extracted from the article]

Background: All SCD patients need extended RBC antigen typing (by serology or genotyping) for provision of extended RH, K matched blood and to guide RBC selection in those with complex transfusion requirements. Genotyping can also identify RH variants which can cause sensitisation even when extended RH phenotypically matched blood is provided and alloantibodies associated with RH variants can cause HTRs. Objectives: To review the use of RBC genotyping in SCD patients at two London trusts (ICHNT, LNWH) with a focus on RH variants. Methods: Retrospective review with data collected from clinical notes, local and national pathology reporting systems. Results: A 311/482 (64%) ICHNT patients and 181/346 (52%) LNWH patients had extended genotyping. Of genotyped patients, 68 (22%) ICHNT and 31 (17%) LNWH patients had RH variants. Eight ICHNT patients had RH variants and corresponding antibodies associated with RH variants; 4/8 received multiple transfusions with antigen positive RBCs but had no evidence of haemolysis. One LNWH patient had a RH variant with corresponding alloantibody but could not be investigated further for possible HTR. Conclusions: Most patients (59%) had genotyping and a significant number had RH variants (99, 20%). A small proportion (9, 9%) had antibodies associated with RH variants, but with no evidence of clinically significant HTRs despite transfusions in four of them with antigen positive RBCs. All SCD patients should have RBC genotyping including RH variants (preferentially over extended phenotyping) to guide better selection of RBC units. However, where antigen negative blood cannot be provided, the risk of alloimmunisation is not inevitable and subsequent HTRs from antibodies associated with RH variants might not always occur. [ABSTRACT FROM AUTHOR]