NHS blood shortage: nurses encouraged to donate

An ‘amber alert’ has been issued by NHS Blood and Transplant (NHSBT) urging healthcare providers to implement emergency measures to minimise the use of blood, particularly O negative blood – the universal type which makes up around 16% of hospital orders.

“If you’ve ever given blood, thank you. If you haven’t, please think about doing so”

Dee Thiruchelvam

The recent cyber attack on several London hospitals in which Synnovis, a pathology testing system, was hacked, severely hampered their ability to check patients’ blood type.

As a result, hospitals have had to rely more on O negative blood as no such tests are required before giving a patient the universal blood type.

The issues with Synnovis, an overall dwindling of donors, a regular seasonal dip, and high demand has left blood stocks at “unprecedentedly low levels”, according to NHSBT.

The amber alert asks hospitals to only use O type blood for “essential cases” and to use substitutions when it is clinically safe.

NHSBT estimated that national stocks are at 1.6 days for O negative and 4.3 days for overall stocks.

Professor Dee Thiruchelvam, chief nursing officer for NHSBT, explained how the shortage came about.

She told Nursing Times: “When the cyber attack happened, it was clear it was going to be a challenge for that group of hospitals to match blood, and frankly they could not – it was being done manually.

“So the safest thing for the hospital to do was order more O negative blood, meaning they were ordering around 200% more than normal from [NHSBT].

“We knew that would probably create pressure across the entire system.”

Existing pressures to blood supplies, due to lower summertime donations on account of holidays, sporting events and other seasonal changes, made things worse.

Dee Thiruchelvam

For nurses, the amber alert will mean some changes for nursing practice for at least a few weeks, up to a few months, depending on how long the shortage takes to resolve, Professor Thiruchelvam said.

It will not impact the use of the blood for cancer surgery, transplants, transfusions for people with chronic conditions and emergency or trauma surgery – but it may mean that in less crucial cases, alternatives are used instead.

Professor Thiruchelvan said: “We must make sure we’re using blood in the most appropriate place, and nurses are generally the people putting that blood bag up.

“It’s important for us, as professionals, to ensure we are supporting our medical colleagues, and ensuring we’re doing the right clinical procedure for that patient.

“There are alternatives, one can use tranexamic acid in certain clinical environments.”

She continued that advanced nurse practitioners, and other nurses with independent prescriber qualifications, had a further responsibility during the amber alert to make sure the most urgent cases were prioritised for blood, particularly when O negative would be used.

“Life saving and certain surgical procedures are a priority,” she said. “It’s about going back to first principles of what is the primary cause of that anaemia, or that haemorrhaging?

“Is there any alternative that we can do to giving blood, and when we’re giving blood – what blood are we giving?

“Nurses are in a fantastic place to be able to use that critical risk assessment and support that multidisciplinary decision making because we are generally the person hanging up their blood… I think nurses can support that prioritisation.”

In response to the shortage, NHSBT has issued an urgent plea to the public to give blood, particularly O group donors, with additional capacity allocated to donation centres.

Professor Thiruchelvam echoed this plea, and encouraged nurses to lead by example: “Nursing is one of the biggest professions across the country and we are a donor base ourselves.

“So, a call out to my peers: if you’ve ever given blood, thank you. If you haven’t, please think about doing so. We do have appointments available if you use our website, blood.co.uk.

“But particularly what we want is if you know you are O negative, come forward because we know the cyber attack issue is going to carry on for a number of weeks or months.”

In particular, she said donors of Black heritage were needed to help replenish stores of blood to use for conditions like sickle cell disease and thalassaemia.

NHSBT estimated that it needed around 12,000 extra donors of Black heritage alone, in addition to the overall shortage.

“Because of the cyberattack, we’re using more O negative than normal, so there is a knock-on effect when you get a shortage of certain types of blood, which is a real challenge,” she added.

NHSBT chief executive Dr Jo Farrar said: “Last month we saw an incredible response from donors who answered our call and filled up our centres, helping us meet the increased demands for blood throughout June.

“However, seven weeks on, the need for O negative blood in particular remains critical.”

Professor Stephen Powis, national medical director at NHS England, added: “We’re seeing an increased demand for blood and shortages of stock so it’s important that donors come forward for appointments.

“With thanks to regular blood donors across the country, hospitals will continue to access stock when necessary and prioritise it for those who need it most.”