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SUMMARY Objectives To estimate the current incidence of maternal sensitisation to Rhesus (Rh) D in Northern Ireland, examine adherence to recommendations for administration of anti-D immunoglobulin and identify potential causes for all cases of anti-D alloimmunisation sensitisation from January 2010 to September 2015. Background Post-partum anti-D immunoglobulin administered to Rh D-negative women and routine antenatal anti-D prophylaxis have greatly reduced the incidence of haemolytic disease of the fetus and newborn due to immune anti-D. Despite these measures, anti-D alloimmunisation sensitisation continues to occur, albeit much less frequently than in the past. Methods/Materials This was a retrospective review of new sensitisations to Rh D detected in antenatal records between January 2010 and September 2015 in Northern Ireland. A review of patient notes and laboratory data was carried out to examine adherence to standards and identify potential causes of sensitisation. Results A total of 67 new sensitisations to Rh D were identified over a 69-month period, and the sensitisation rate for the full calendar years 2010-2014 was 0·310%. Only 4% of cases appear to have been preventable, with two cases involving failure to adhere to guidelines. Conclusion A total 96% of sensitisations occurred despite full compliance with guidelines. In a large proportion, sensitisation occurred following delivery (51%). A change in practice in Northern Ireland is under consideration to increase the dose of anti-D immunoglobulin given following delivery from 500 to 1500 U in an attempt to reduce these sensitisations. [ABSTRACT FROM AUTHOR]

Background and Objectives To reduce the risk of transfusion-transmissible viruses entering the blood supply, the nucleic acid amplification testing (NAT) was implemented to screen Scottish and Northern Irish blood donations in minipools. After 5 years of NAT for hepatitis C virus (HCV) and 2 years for human immunodeficiency virus-1 (HIV-1), the yield of serologically negative, nucleic acid positive ‘window donations’ and cost-benefit of NAT is under review. Materials and Methods When the Scottish National Blood Transfusion Service (SNBTS) implemented NAT in 1999, a fully automated ‘black box’ system was not available. Therefore, an ‘in-house’ assimilated NAT assay was developed, validated and implemented. The system is flexible and allows testing for additional viral markers to be introduced with relative ease. Results The HCV and HIV NAT assays have 95% detection levels of 7·25 IU/ml and 39·8 IU/ml, respectively, as determined by probit analysis. One HCV (1 in 1·9 million) and one HIV (1 in 0·77 million) window donation have been detected in 5 and 2 years, respectively, of NAT. Conclusion The SNBTS NAT assays are robust and have performed consistently over the last 5 years. The design of the in-house system allowed HIV NAT to be added in 2003 at a relatively small additional cost per sample, although for both assays, the royalty fee far exceeds the cost of the test itself. Clearly NAT has a benefit in improving the safety of the blood supply although the risks of transfusion-transmitted viral infections, as reported in the Serious Hazards of Transfusion (SHOT) report, are extremely low. Also, in UK the yield of HCV antibody negative, NAT positive donations is far lower than predicted although the early detection of an HIV window period donation and the increase of HIV in the blood donor and general populations may provide a stronger case for HIV NAT. The yield of HCV and HIV NAT in UK is significantly less than that anticipated from statistical models. [ABSTRACT FROM AUTHOR]

Introduction: Mentorship/Preceptorship (M/P) has been utilised within the nursing profession since the early 1980's. Successful, structured M/P programmes can be hugely beneficial to Northern Ireland (NI) Trusts who recruit regularly and often rely on the fluidity of staff movement regionally. In the absence of standardised tools to accurately and universally measure the competency of newly qualified Radiographers (NQR) as they evolve, establishing the benchmark for effective practice within Radiology departments in NI is difficult and highly subjective at best. This study aimed to evaluate the current M/P strategies within NI as perceived by NQR and Radiology Managers (RM)., Methods: A mix of both qualitative and quantitative data was obtained using questionnaires through a scoping exercise. Opinions were sought from a target audience of NQR, who began full-time employment following graduation in 2018, and RM involved in the delivery of current M/P programmes within the NI Trusts., Results: Responses were gained from all five NI trusts to achieve a representative regional sample, with final opinions of RM (n = 8, 54%) and NQR (n = 30, 67%) received. With the exception of one response, all NQRs confirmed receiving some form of M/P support within their inaugural post., Conclusion: Significant variations were apparent in both the structure and delivery of Trust M/P induction programmes, calling into question the comparable competency of NQRs regionally., Implications for Practice: The disparity in approach towards M/P programmes across NI, and subsequent lack of comparability of NQR competence, endorses the development of a more robust and universal method for the regional assessment of NQRs, such as that of the 'Flying Start NHS®' programme utilised by National Health Service (NHS) Scotland, in combination with knowledge and skills framework (KSF) practices in supervision., Competing Interests: Conflict of interest statement None., (Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.)

We assessed the clinical outcome of pregnancies with non-Rh-D antibody in Northern Ireland using retrospective case note review. During the study period (April 1999- March 2000) 186 women with clinically significant antibodies were identified from the records of the antenatal laboratory of the Northern Ireland Blood Transfusion Service. Eighty-five women were included in the study using the criteria mentioned above. None of the fetuses required intrauterine transfusion during this period. One baby required exchange transfusion, three were given top-up transfusions and 17 had phototherapy. Nine babies with a positive direct antiglobulin test (DAT) received no treatment. The incidence of anti-Kell could be reduced by transfusing Kell negative red cells to premenopausal women. It is important that all pregnant women are tested at least twice in their pregnancy to detect the antibodies formed late in the pregnancy. It is useful to formulate a standard protocol for antenatal interventions. Non Rh-D antibodies can cause significant anaemia for up to six weeks in the neonatal period, hence early detection of maternal antibodies is important so that the neonates are followed up for an appropriate length of time.

It has been suggested that routine antenatal prophylactic anti-D should be introduced for prevention of Rhesus D (RhD) haemolytic disease. Before making changes to the current prevention program it is important, therefore, to have up-to-date data on affected infants. Pregnant women with anti-D antibodies between September 1994 and February 1997 were identified by the Northern Ireland Blood Transfusion Service. The records of 124 women and 130 babies were examined. 26% of planned deliveries occurred in hospitals without paediatric cover. Rhesus isoimmunisation affected 78 babies. Fifty-nine infants were admitted to one of seven neonatal units. There were 2 stillbirths and 1 neonatal death. Two infants have severe neurodevelopmental delay. There is still significant morbidity associated with RhD haemolytic disease. Care for RhD affected pregnancies should be centralised to guarantee training opportunities and maintenance of expertise. The current management of these pregnancies should be re-examined before changing the Rhesus prevention program.

Hepatitis C virus screening of blood donors was introduced in September 1991 using a second-generation enzyme-linked immunoassay (ELISA) and subsequent confirmatory testing with immunoblot (RIBA) and polymerase chain reaction (PCR). In April 1995 a lookback exercise was announced by the Department of Health, the purpose of which was to trace, counsel, investigate and, if necessary, treat individuals who may have been infected with HCV through blood and blood products prior to screening. A total of 231,321 donations have been screened, of which 553 were found to be reactive. Subsequent confirmatory tests identified 24 HCV-positive donors; 13 were repeat donors who had given a total of 164 units. Ninety-three units were traced and 117 components were identified as having been issued to hospitals. Twenty-five recipients requiring follow-up were identified, of which three were assessed by their GPs as not requiring counselling. Of 22 recipients of potentially infectious units 12 showed no evidence of exposure to HCV. We discuss these results in detail.