Classification: Official
Publication reference: PRN01465
To:
- NHS trusts:
- chief executive
- medical director
- integrated care board chief executive
- transfusion laboratory manager
- transfusion practitioner
- chair of regional transfusion committee (RTC)
- chair of hospital transfusion committee (HTC)
- England emergency preparedness, resilience and response (EPRR)
- EPRR lead
- consultant haematologist with responsibility for blood transfusion
Dear colleagues,
NHS Blood and Transplant amber alert for O type blood
You will have received the amber alert on blood group O issued by NHS Blood and Transplant (NHSBT) to implement measures to conserve blood stocks this morning.
This letter provides additional background information and offers links to guidance on best clinical practice.
Firstly, we want to thank you for your efforts to preserve O type stocks. Unfortunately, stock levels are now at a point where they are below the 2-day threshold, and this means a shift to an amber alert.
This is NHSBT’s second-ever amber alert to conserve blood stocks and asks hospitals to deploy their emergency blood management arrangements for (blood group O) red cells. This requires hospitals to optimise the use of O type blood and use substitutions where clinically safe to do so.
Amber guidance previously restricted the use of blood in planned surgery – this is now not the case following revised blood management guidance implemented after the amber blood alert in 2022. However, all steps should be taken to minimising the need for transfusion of donor blood, including:
- in accordance with existing NHS England guidance, early screening of patients on waiting lists for inpatient surgery to identify anaemia and use of oral or IV iron, B12 and folate for optimisation – NHS England » Earlier screening, risk assessment and health optimisation in perioperative pathways: guide for providers and integrated care boards
- if necessary, deferring lower priority elective surgery to treat anaemia in the pre- operative pathway
- tranexamic acid at induction of anaesthesia for surgery and
- use of cell salvage where appropriate during surgery
Overall blood usage has been declining in recent years. However, the use of O type has been increasing – the profile of donor blood groups no longer reflects usage, despite campaigns by NHSBT to ‘know your type’.
Additionally, there has been significant increased use of O negative blood in South East London to mitigate the difficulties with cross-matching, due to the cyber incident affecting multiple trusts.
The amber alert and associated actions are intended to ensure stocks can recover to sustainable levels. Its impact on blood stocks will be reviewed in 4 weeks and NHSBT is urging donors to come forward.
Senior clinical oversight of all blood usage in individual patients and across hospitals is recommended and further guidance is provided below:
- NHSBT ‘Plan for NHS Blood and Transplant and hospitals to address red cell shortages: Microsoft Word – NBTC Red cell shortage plan April 2023.docx (nationalbloodtransfusion.co.uk)
- BMJ ‘Wider use of tranexamic acid to reduce surgical bleeding could benefit patients and health systems’ Wider use of tranexamic acid to reduce surgical bleeding could benefit patients and health systems | The BMJ
- Royal College of Surgeons of England ‘Tranexamic acid to reduce surgical bleeding’ Tranexamic acid to reduce surgical bleeding’ Tranexamic acid to reduce surgical bleeding — Royal College of Surgeons (rcseng.ac.uk)
- Centre for Perioperative Care ‘Anaemia in the perioperative pathway’ Anaemia in the Perioperative Pathway | Centre for Perioperative Care (cpoc.org.uk)
Please cascade to laboratory and clinical staff as appropriate. Yours sincerely,
Professor Sir Stephen Powis, National Medical Director NHS England
Dr Emily Lawson DBE, Chief Operating Officer NHS England