Transfusions

Our team is committed to evaluating the findings from research to identify ways to improve transfusion services. We also aim to make good use of new technology to improve services.

Informing health professionals

Some of our research involves reviewing all the research evidence available on a particular topic, and then producing a summary of the conclusions to inform practice (this is called a systematic review).

We have also developed an online database, the Transfusion Evidence Library, which includes information from all the systematic reviews and clinical trials relating to transfusion, that have been carried out all over the world. This resource provides up-to-date information for health professionals, so they can easily access the evidence that supports best practice.

Clinical Trials

The team has led several clinical trials which have been completed including:

The TOPPS trial which looked at when platelet transfusions should be used as a way of preventing bleeding in patients.

The ABLE trial which looked whether the age of stored red cells made a difference to the outcomes for patients receiving critical care.

The TRIGGER trial which looked at how much blood is needed by patients with a bleed in their gut.

Current trials include:

The TREATT trial (due to finish 2019), which is looking the safe and effective use of tranexamic acid to prevent bleeding in blood cancer patients.

The HALT-IT trial (due to finish 2018), which is looking at the use of tranexamic acid for treating bleeding in the gut.

The AFFINITIE trial (due to finish 2019), which is testing the use of audit and feedback procedures, designed to reduce the unnecessary use of blood products.

Electronic Blood Ordering

We have developed a new paperless system to support clinicians in deciding when to transfuse a patient, based on the patient’s health status and blood counts. It can also be used to order blood products. The system has been integrated with the electronic processes for blood sampling, blood collection, remote blood issue and blood administration, and has been introduced throughout Oxfordshire’s acute NHS hospitals.

These new processes have been endorsed by NHS QIPP (Quality, Innovation, Productivity and Prevention), and the team have won numerous national awards for this work. The electronic blood ordering system is already in use throughout the haematology service at Oxford University Hospitals NHS Foundation Trust reducing the number of unnecessary transfusions, improving patient safety and resulting in substantial cost savings. The system is now being rolled out across all clinical services in the trust and it is expected that it will be taken up by other trusts in due course.

Controlling blood loss and abnormal blood clotting

We are developing a research programme that includes studies of bleeding and clotting disorders, which are either inherited from birth or develop later in life. Current work includes research into:

• Haemophilia
• Improving outcomes for patients receiving drugs to prevent blood clots
• Uncontrolled bleeding in trauma patients

Haemophilia research

Some patients with haemophilia who are treated with Factor VIII, develop antibodies against the drug, which stops it working. It’s not clear why this happens. We are carrying out a study to investigate what kinds of molecular and genetic changes in Factor VIII cause this unwanted immune response.

Improving outcomes for patients receiving treatment to prevent blood clots

Many thousands of patients across Oxfordshire require treatment to prevent blood clots for a variety of conditions. This treatment carries risks of bleeding and of clotting, and caring for these patients is complex and requires ongoing clinical input. We are currently looking to use our specialist knowledge in this area to improve outcomes for patients who require this treatment. We plan to work with other expert groups across Oxford and the Clinical Commissioning Group to explore what innovative approaches we might introduce to improve outcomes for these patients.

Uncontrolled bleeding in trauma patients

Up to 40% of all trauma patients, people who have experienced an injury or accident, will die from uncontrolled bleeding following the trauma. Our team is evaluating which transfusion approaches might lead to better outcomes for these patients. One of the reasons that uncontrolled bleeding occurs is because the patient has low levels of a clotting factor called fibrinogen. We are developing clinical trials to test different ways of raising the levels of fibrinogen to see which is most effective.