SummaryAlthough acute non-haemolytic febrile or allergic reactions (ATRs) are a common complication of transfusion and often result in little or no morbidity, prompt recognition and management are essential. The serious hazards of transfusion haemovigilance organisation (SHOT) receives 30-40 reports of anaphylactic reactions each year. Other serious complications of transfusion, such as acute haemolysis, bacterial contamination, transfusion-related acute lung injury (TRALI) or transfusion-associated circulatory overload (TACO) may present with similar clinical features to ATR.This guideline describes the approach to a patient developing adverse symptoms and signs related to transfusion, including initial recognition, establishing a likely cause, treatment, investigations, planning future transfusion and reporting within the hospital and to haemovigilance organisations.Key recommendations are that adrenaline should be used as first line treatment of anaphylaxis, and that transfusions should only be carried out where patients can be directly observed and where staff are trained in manging complications of transfusion, particularly anaphylaxis. Management of ATRs is not dependent on classification but should be guided by symptoms and signs. Patients who have experienced an anaphylactic reaction should be discussed with an allergist or immunologist, in keeping with UK resuscitation council guidelines.
SUMMARY 19Outbreaks of cutaneous infectious disease in amphibians are increasingly being attributed to an 20 overlooked group of fungal-like pathogens, the Dermocystids. During the last 10 years on the Isle 21 of Rum, Scotland, palmate newts (Lissotriton helveticus) have been reportedly afflicted by unusual 22 skin lesions. Here we present pathological and molecular findings confirming that the pathogen 23 associated with these lesions is a novel organism of the order Dermocystida, and represents the first 24 formally reported, and potentially lethal, case of amphibian Dermocystid infection in the UK. 25Whilst the gross pathology and the parasite cyst morphology were synonymous to those described 26 in a study from infected L. helveticus in France, we observed a more extreme clinical outcome on 27
KEY FINDINGS 45 Here we characterise a novel amphibian pathogen infecting an isolated population of 46 palmate newts in Scotland. 47 Using gross examination, histopathology, and molecular phylogenetics, we conclude that the 48 pathogenic agent belongs to a group of fungal-like organisms within the Dermocystida, 49 Disease described on Rum represents a severe form of Dermocystid infection not previously 50 reported. 51 We conclude that this novel organism, synonymous to the parasite described in palmate 52 newts in France, is a new species of amphibian infecting Dermocystid, part of the genus 53Amphibiothecum.
Despite an array of initiatives designed to support the delivery of safe and appropriate transfusion practice, incidences of patients receiving the wrong blood continue to be reported. Nurses play a key role in delivering safe and appropriate transfusion care and have a responsibility to support national initiatives, such as the NHS Better Blood Transfusion programme of action and the National Patient Safety Agency Safer Practice Notice 14, Right Patient, Right Blood. This article examines factors, which impact on the successful implementation of a programme aimed at promoting best transfusion practice, such as organizational support, leadership, education and competency assessment, and the role of audit and feedback. By championing the systematic assessment of transfusion procedures, the implementation of education and guidelines and the use of innovative approaches, such as care bundles, we can ensure that nurses have the appropriate knowledge, skills and understanding to provide the highest standards of transfusion care to our patients.
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