SHOT: The Serious Hazards of Transfusion
Dr John Griffiths DICM MRCP FRCA MA
Focus on SHOT
A case of suspected TRALI should be reported to The Serious Hazards of Transfusion (SHOT) scheme. SHOT was established in 1996 to collect reports of major adverse events associated with the transfusion of blood components in the UK. SHOT receives about 15 reports each year of TRALI, for which red cells have been implicated as the causative unit in about one third, and FFP and platelets in just under half. In their 2000-2001 annual review, SHOT reported receiving 70 cases of TRALI resulting in 18 deaths over a 5-year period. This ranks TRALI as the second commonest cause of transfusion-related major morbidity and mortality after ABO incompatibility in the UK.
Focus on Better Blood Transfusion
Better blood transfusion is an initiative led by the Chief Medical Officers to improve the safety and effectiveness of transfusion practice. Its output has been two Health Service Circulars (HSC’s) setting out a number of recommended actions to hospital Chief Executives. An audit of the implementation of the HSC 1998/224 Better Blood Transfusion showed that most hospitals had established Hospital Transfusion Committees, were participating in the SHOT scheme, and had protocols for the administration of blood. The Chief Medical Officer’s National Blood Transfusion Committee (NBTC) was established in England in 2001. It oversees the national better blood transfusion initiative, and acts as the Steering group for an initiative for national comparative audit of clinical transfusion practice. The NTBC reviews the findings of the SHOT scheme, and supports its recommendations. Specific measures that could be considered in critical care practice include better compliance with evidence based triggers for transfusion, greater use of near patient testing to determine the need for transfusion, and minimising blood loss due to sampling. Recent evidence suggests that transfusion triggers in the critically ill may be safely lowered without increasing significant morbidity. The production of FFP from only male donors, and reducing the volume of plasma in platelet concentrates are under consideration as measures to reduce the risk of TRALI.
- It is important to report all suspected or confirmed transfusion related adverse events in line with the recommendations from the SHOT and Better Blood Transfusion initiatives
- TRALI is currently ranked as the second most common cause of transfusion-related death in the UK
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