Curriculum standards

• ABO discrepancies and RhD variants
• Blood group systems
• Clinically significant red cell, neutrophil, and platelet antibodies and disease
• Pathophysiology of adverse transfusion reactions
• Patterns of inheritance of blood group systems
• Principles of pretransfusion testing

• Adverse transfusion reactions
• Critical bleeding
• Informed consent for transfusion
• Major haemorrhage protocols
• Mandatory specimen labelling and request form requirements for pretransfusion testing
• Principles of patient blood management, including evidence-based transfusion thresholds

• Obstetric transfusion, including:
  • fetal / neonatal alloimmune thrombocytopenia
  • fetal / neonatal transfusion, including:
    • exchange transfusion
    • intrauterine transfusion
    • top-up transfusions
  • haemolytic disease of the fetus and newborn
  • patients who refuse to consent to blood components and products
  • patients with critical bleeding requiring large volume transfusion resuscitation
  • patients with rare red cell antibodies requiring transfusion
  • platelet transfusion refractoriness
  • recommended monitoring of alloimmunised women during pregnancy
  • routine management of RhD negative women during pregnancy
• Unique considerations for different patient cohorts undergoing transfusion:
  • patients receiving recurrent or frequent transfusions, including haemoglobinopathies
  • patients undergoing bone marrow transplantation
  • patients with autoimmune haemolytic anaemia or receiving monoclonal antibodies that interfere with pretransfusion testing, such as:
    • anti-CD38
    • anti-CD47

Blood components

• Administration and monitoring requirements for patients undergoing transfusion
• Fresh component modifications, including:
  • apheresis versus whole blood donations and low anti-A / B titre fresh components
  • cytomegalovirus (CMV) seronegative donors
  • human leukocyte antigens (HLA)-compatible platelet
  • hyperconcentrated red cell requirements
  • immunoglobin A (IgA) deficient components
  • irradiation requirements
  • phenotype red cells
  • washed fresh components
• Manufacture of blood components and products
• Storage and transport requirements for:
  • fractionated products
  • fresh and frozen blood components

Blood transfusion

• Comply with national guidelines and standards to ensure safe and appropriate transfusion practice
• Decision to transfuse should be informed by evidence-based patient blood management principles
• Liaison with national transfusion services for patients with complex transfusion requirements:
  • platelet refractoriness
  • rare red cell antibodies
  • severe adverse transfusion reactions reporting, such as:
    • transfusion-related acute lung injury (TRALI)
    • transfusion-transmitted bacterial infection (TTBI)
• Patient blood management, including evidence-based transfusion thresholds
• Recognise and manage adverse transfusion reactions
• Recognise and report to local and/or national haemovigilance systems
• Transfusion documentation, including:
  • assessment of response to transfusion
  • informed consent

Fractionated blood components

• Indication and administration requirements of fractionated products, including:
  • hyperimmune immunoglobulin:
    • hepatitis B immunoglobulin
    • intravenous or subcutaneous immunoglobulin
    • plasma-derived clotting factors and albumin
• RhD immunoglobulin

• Assessment and documentation of outcomes of transfusion
• Follow-up of adverse transfusion reactions and events
• Haemovigilance reporting

• Function of the hospital transfusion committee
• Governance of the national blood supply
• Role of audit and quality improvement science in transfusion