Ongoing projects

About the project

Most UK air ambulances that carry blood components only carry red cells for transfusion.

Evidence suggests that early resuscitation of bleeding trauma patients with red cells, plasma and platelets in 1:1:1 may improve patient outcome. But NHSBT currently does not supply whole blood as a product.

To facilitate better management of major haemorrhage, we are collaborating with Barts Health Trust and London Air Ambulance to evaluate and provide a whole blood component for use in the pre-hospital setting.

Using the data we prepared a provisional trial specification for ‘Whole blood, leucocyte depleted, for clinical studies’ that was agreed by SACBC and JPAC, with a 14 day shelf life.

In phase 1 of the study, we assessed the product which would be simplest to provide: leucocyte depleted whole blood that does not contain platelets (red cells and plasma).

In phase 2, we assessed platelet function in whole blood.

This was incorporated onto the ‘Guidelines for the Blood Transfusion Services’ website in October 2020 and was presented to the International Society of Blood Transfusion (ISBT) Annual conference in December 2020.

Next steps

We now plan to assess the benefits of this component in a randomised control trial to assess its benefits in the pre-hospital management of major haemorrhage in trauma.

Project update

As part of the NIHR BTRU in Red Cells, Rebecca Cardigan is co-investigator and chair of the Trial Management Group for the first in man clinical trial for in vitro grown red cells.

Following completion of all external approvals, the trial was due to start in spring/summer 2020, but had to be paused due to COVID-19.

We have risk assessed the impact of COVID-19 on the trial, and have made a number of changes to the study protocol to take account of this.

These amendments have been approved by our regulator (MHRA) and we now plan to start the trial in 2021/22.

About the project

The Universal Plasma Project is an NIHR funded project led by NHSBT in consortium with commercial (Macopharma/NIRI) and academic partners.

The project aims to develop a device to remove anti-A and anti-B antibodies from plasma to render it ABO blood group universal.

Next steps

Following a period of extensive R&D evaluating two different technologies, the project is now proceeding with an alternative solution to the original Proof of Concept.

Further work is required to evaluate this option fully, with the aim of reaching a design freeze at the end of the funding period in 2022.

Upon completion, the project hopes to have produced a working prototype that will remove blood group antibodies, and that would be suitable for future upscale and commercialisation.

About the project

Platelet concentrates (PCs) are currently tested and labelled with ABO and RhD blood groups.

Although platelets do not express RhD on their surface, platelets must be RhD compatible due to contaminating red cells.

The primary aims of this project are firstly to understand the risks to patients in issuing RhD mismatched PCs and thus whether clinical practice could be safely changed, and secondly to evaluate potential technologies to minimise and monitor the levels of rRBCs in PCs.

Project update

We have completed and published an international, multi-centre study looking at the establishment of a methodology using the Blood Bank mode software loaded onto the Sysmex XN-series of haematology analysers to enable the robust and sensitive enumeration of rRBCs in manufactured PCs from NHSBT, Sanquin and Ireland.

This work was paused due to COVID and will recommence in 2021/22, including additional considerations around ABO universality.

About the project

We have previously established that donors with the rare condition Familial Pseudohyperkalemia, present in around 1/500 of UK blood donors, leak potassium more readily than controls when their red cells are stored refrigerated.

This may be relevant to recipients at risk for negative clinical effects of hyperkalaemia following transfusion, such as large volume neonatal transfusion.

Project update

We undertook a clinical risk assessment to inform the decision that donors identified with a specific variant that causes familial pseudohyperkalemia, if known, should not be used to make red cells for neonates.

Based on the data, it appears safe to transfuse these red cells to adults. That piece of work has recently been accepted for publication in Transfusion (Meli A, et al. 2021).

A further study, in collaboration with the Australian Red Cross Lifeblood, showed that gamma irradiation of red cells from individuals with familial pseudohyperkalemia, does not produce any unexpected effect.

We are in the process of investigating other variants that cause this condition and the effect of other processes such as ‘washing’ on red cells with these variants.

About the project

The initial aim of our research was to develop an in vitro model of traumatic coagulopathy as a means of better assessing the role of transfusion in trauma treatment.

This was established and has been used to assess the efficacy of extending the shelf life of thawed cryoprecipitate up to 5 days.

Next steps

The next phase of this work is centred around the impact and feasibility of a component that is rich in fibrinogen and highly concentrated in platelets (platelet rich cryoprecipitate) specifically designed to treat major haemorrhage.

Lab studies assessing the feasibility of such a product will complete in 2021/22.

This work is in collaboration with internationally respected clinical researchers Prof. Simon Stanworth and Dr Nicola Curry (Oxford), and Prof. Mike Laffan (Imperial).

About the project

The overall effect of storage on red cell Oxygen release rates has not been measured.

However, this is important, particularly in critically ill patients receiving large volume transfusion.

Partly, this is because methods to do so are not well established other than measurement of p50.

We undertook a study in collaboration with Pawel Swietach’s group in Oxford University, who employ live imaging fluorescent microscopy combined with ultrarapid solution switching of oxygenated and deoxygenated buffers to measure in a novel way single red cell Oxygen saturation kinetics.

We showed that with standard red cell storage cellular Oxygen, unloading became slower and Oxygen binding capacity decreased.

Rejuvenation of stored cells restored depleted intracellular metabolites back to levels of fresh whole blood and fully restored the Oxygen release kinetics.

Next steps

This work has been submitted at the virtual ISBT conference 2021 and is being written for publication.

We are investigating what other geometric factors may affect red cell Oxygen release kinetics and the utility of this method for understanding red cell storage.