SUB-THEME: TRANSFUSION AND CONTROLLING BLOOD LOSS AND ABNORMAL CLOTTING
1. Tranfusions
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.
The HALT-IT trial looked at the use of tranexamic acid for treating bleeding in the gut.
The AFFINITIE trial tested the use of audit and feedback procedures, designed to reduce the unnecessary use of blood products.
Current trials include:
The TREATT trial considers whether tranexamic acid is safe and effective to prevent bleeding in blood cancer patients. The trial is currently open to new participants, for more information consult the patient website.
The CRYOSTAT-2 trial evaluating the effects of early high-dose cryoprecipitate in major haemorrhage.
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.
REFERENCES
Murphy, M.F., Jayne Addison, J., Poles, D., Dhiman, P. and Bolton-Maggs, P. (2019), Electronic identification systems reduce the number of wrong components transfused. Transfusion, 59: 3601-3607. https://doi.org/10.1111/trf.15537
Transfusion Research Team
2. 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
- Novel diagnostic tools for deep vein thrombosis
- Uncontrolled bleeding in trauma patients
HAEMOPHILIA RESEARCH
Haemophilia B is a blood clotting disorder caused by deficiency of blood coagulation Factor IX, resulting in bruising and bleeding. Haemophilia B affects 1:30,000 males in the UK and is treated by infusion of Factor IX concentrate to sustain normal function of the blood clotting process. There has been evidence pointing to Factor IX being stored out with the blood vessels which may result in less severe bleeding. We are investigating where Factor IX is stored in the body after infusion and how it alters the frequency and severity of bleeding episodes for patients.
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 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.
NOVEL DIAGNOSTIC TOOLS FOR DVT
Deep Vein Thrombosis (DVT) is a common condition affecting 1 in 1000 people annually. Diagnosis is confirmed by an ultrasound scan which is only performed by trained radiology specialists at present. We are running a clinical trial to explore the use of artificial intelligence (AI) for diagnosis of DVT, where an untrained healthcare professional is directed by the AI tool to correctly diagnose the presence (or absence) of a DVT.
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. One of the reasons that uncontrolled bleeding occurs is because the patient has low levels of a clotting factor called fibrinogen. We will complete a clinical trial in December 2021 which is evaluating whether early fibrinogen treatment improves death rates in trauma haemorrhage.
HAEmostasis Research Team
Publications
1. Curry N, Foley C, Wong H, Mora A, Curnow E, Zarankaite A, Hodge R, Hopkins V, Deary A, Ray J, Moss P, Reed MJ, Kellett S, Davenport R, Stanworth S. Early fibrinogen concentrate therapy for major haemorrhage in trauma (E-FIT 1): results from a UK multi-centre, randomised, double blind, placebo-controlled pilot trial. Crit Care. 2018 Jun 18;22(1):164.
2. Morrow GB, Carlier MSA, Dasgupta S, Craigen FB, Mutch NJ, Curry N. Fibrinogen Replacement Therapy for Traumatic Coagulopathy: Does the Fibrinogen Source Matter? Int J Mol Sci. 2021;22(4).
3. Morrow GB, Beavis J, Harper S, et al. Coagulation status of critically ill patients with and without liver disease assessed using a novel thrombin generation analyser. J Thromb Haemost. 2020.
4. Morrow GB, Beavis J, Harper S, Bignell P, Laffan MA, Curry N. Characterisation of a novel thrombomodulin c.1487delC,p.(Pro496Argfs*10) variant and evaluation of therapeutic strategies to manage the rare bleeding phenotype. Thromb Res. 2021;197:100-108.
5. Morrow GB, Whyte CS, Mutch NJ. Functional plasminogen activator inhibitor 1 is retained on the activated platelet membrane following platelet activation. Haematologica. 2019.
6. Whyte CS*, Morrow GB*, Mitchell JL*, Chowdary P, Mutch NJ. Fibrinolytic abnormalities in acute respiratory distress syndrome (ARDS) and versatility of thrombolytic drugs to treat COVID-19. J Thromb Haemost. 2020. *Authors contributed equally to this work.
