Falling donor numbers and the threat of transfusion-transmitted variant Creutzfeldt-Jakob disease may lead to shortages in the national blood supply. Knowledge of current patterns of transfusion and trends in usage will help predict future change in blood use. Our previous survey identified medical indications as the major reason for transfusion, but detailed information within this category was limited. We performed prospective surveys of indications for red cell transfusion for two 14-day periods in 2004 in the North of England, concentrating on medical reasons for transfusion. Data were obtained for transfusion indications of 9003 units, which accounted for over 99% of red cell issues from the regional blood centre during the study. In 2004, medical patients received 62% (5558 units) of all transfused units, surgical patients 33% (3001 units) and Obstetric & Gynaecology patients 5% (444 units). These figures compare with 52, 41 and 6% for Medicine, Surgery, and Obstetrics & Gynaecology in 1999/2000. The three largest uses of blood within the medical category were for patients with primary haematological disorders (18.2% of all transfused blood), for management of gastrointestinal haemorrhage (13.8%) and for patients with nonhaematological malignancies (8.8%). There has been a significant reduction in use of blood for surgical indications over the last 5 years, but an absolute increase in use of blood for medical indications. Lower transfusion triggers, education, use of cell salvage, the increasing price of a unit of red cells and changing population demographics may all have contributed to the reduction in surgical blood use. Promotion of good transfusion practice and alternatives to allogeneic transfusion should now focus on medical and surgical use of blood transfusion.

The epidemiology of hepatitis C virus (HCV) infection was studied in an English teaching hospital over an 18 month period. A total of 104 HCV antibody positive patients were referred for further investigation. They were divided into those diagnosed through screening (blood donors and intravenous drug abusers) and those diagnosed for other reasons, and their mean ages, known risk factors for HCV transmission, genotypes, and liver biopsy histology were analysed. Screened patients were significantly younger than the others. No significant difference in age was found between genotypes. Most patients genotyped (69%) were genotype 1. Intravenous drug abusers had a higher proportion of subtype la, and patients who acquired

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There is an interest and willingness to donate blood through the Blood Service amongst uncomplicated haemochromatosis patients undergoing therapeutic phlebotomy. Since the introduction of this facilitation process, we have significantly increased the number of regular donors amongst this cohort. If this process was to be replicated more widely across the UK, this could have a significant impact on the blood donor pool.

For intrauterine transfusion (IUT) specific red cells are provided by UK Blood Services, irradiated to prevent TA-GvHD. A fetus (21/40) was referred to a fetal medicine centre (FMC), severely anaemic (parvovirus) requiring urgent IUT. Maternal blood was transfused to fetus. Following poor cardiac output, further emergency intracardiac transfusion gave improvement. At 32/40 baby was delivered, severely hydropic and pancytopenic (aplasia later confirmed by marrow aspirate). Hyperbilirubinaemia and fungal chest infection followed. Mother was HLA homozygous. Chimerism studies confirmed maternal engraftment and TA-GvHD. Baby underwent stem cell transplantation, but died of pneumonitis. The case was reported to the Serious Hazards of Transfusion (SHOT) national haemovigilance scheme. A questionnaire was sent to the other 15 FMCs in England and Scotland to establish wider practice. 15/15 centres replied. 1/15 had used maternal blood (non-irradiated), once in 5 years, for bleeding during platelet IUT. 2/15 had used non-IUT blood (leucodepleted), for 8 IUTs: 1 irradiated neonatal exchange blood, rest non-irradiated neonatal ‘paedipacks’. 10/15 would transfuse alternative red cells if IUT units unavailable in emergency, 5/15 would not/had not. Preferred alternative varied, 3/11 would consider maternal blood. This rare case of TA-GvHD occurred following high-risk transfusion: to a fetus, with fresh, HLA homozygous, maternal blood, neither irradiated or leucodepleted. Use of maternal blood for IUTs is unusual in UK centres. Maternal blood for IUT is not recommended in the UK. FMCs should develop transfusion protocols for emergency red cell provision for IUT. Alternatives include neonatal paedipacks or exchange transfusion units, irradiated whenever possible.