Murphy, Roberts and Stanworth Group: Oxford Clinical Research in Transfusion Medicine
Increasing and disseminating the evidence-base to improve practice in Transfusion Medicine.
We have established three groups to achieve our aim.
The SRI’s remit is to develop the evidence base for the practice of transfusion medicine. We do this by: producing systematic reviews; and creating a comprehensive online library of systematic reviews and randomised controlled trials (the Transfusion Evidence Library).
Our systematic reviews are produced according to strict methodological criteria. Approximately a third are undertaken with Cochrane whilst the remainder are published in appropriate peer reviewed journals. Our reviews provide evidence for national and international clinical guidelines (including NICE, ICTMG, BSH) and inform clinical practice and research agendas.
We hold an NIHR Cochrane Programme grant for the completion of a set of reviews on the safe and appropriate use of blood components.
The Transfusion Evidence Library is fully searchable and updated monthly. The library produces a free monthly email alert, the Transfusion Evidence Alert, which is received by over 14,000 subscribers.
A number of our clinical trials have originated from the output of our systematic reviews: tranexamic acid to prevent bleeding in haematology patients (TREATT); red cell transfusion thresholds in gastrointestinal bleeding (TRIGGER); prophylactic platelet transfusions in haematology patients (TOPPS); granulocyte transfusions in neutropenic sepsis (GIN-1) and plasma use in critical care (ISOC).
Our trials have been published in the NEJM and Lancet (use of prophylactic platelet transfusions in patients with haematological malignancies, red cells in gastrointestinal bleeding and Age of Blood in critical care). Other notable examples of research include the completion of a 50,000 participant INTERVAL trial (donation intervals); publication of a GWAS study of blood traits in 180,000 subjects; a £2million NIHR award on the development and evaluation of enhanced audit and feedback interventions to increase the uptake of evidence-based transfusion practice (AFFINITIE); and a trial evaluating the effects of early high-dose cryoprecipitate in adults with major trauma haemorrhage (CRYOSTAT-2).
Use of IT for safe and effective transfusion practice
Our group has developed and implemented a unique ‘end-to-end’ electronic (paperless) transfusion process. This process utilises barcoded patient wristbands, bedside handhelds, electronically controlled blood fridges and integration with the electronic patient record and laboratory IT. It has improved the safety and efficiency of transfusion, and delivered cost savings in reduced blood usage for Oxford University Hospitals NHS Foundation Trust (OUH) of £870k in the last three years. This contributed to OUH being recognised as Digital Hospital of the Year 2015. The process is used in all acute hospitals in Oxfordshire, and is being implemented in other countries including the USA and Australia.
Our group produced a national specification for the use of IT for transfusion, and has won several national awards, including the 2013 Health Service Journal Awards for Improving Care in Technology and Efficiency in Pathology. It was endorsed as a NICE 'Quality and Productivity’ Case Study in 2016, and highlighted by the Chief Medical Officer in her 2015 NIHR Annual Report as a ‘foolproof way of ensuring transfusion safety with potential savings of more than £50 million/year if implemented across the NHS’.
Clinical studies and trials
- Intracranial haemorrhage in thrombocytopenic haematology patients (INCITE) ISRCTN05026912
- HLA Epitope Trial ISCTRN2399653
- PlaNet-2 ISRCTN87736839
- The Intensive Care Study of Coagulopathy part 2 (ISOC 2) ISRCTN50516147
- The development and evaluation of enhanced audit and feedback interventions to increase the uptake of evidence-based transfusion practice (AFFINITIE Programme) ISRCTN15490813
- Trial to evaluate tranexamic acid therapy in thrombocytopenia (TREATT) ISRCTN73545489
- Red blood cell transfusion thresholds and QoL in myelodysplastic syndromes: a pilot, feasibility study (REDDS) ISRCTN26088319
- E-Fit 1 Study (Early Fibrinogen in Trauma) EudraCT no:2015-000875-
- Red cell transfusion in acute myeloid leukaemia (REAL) ISRCTN96390716
- Desmopressin for procedures or radiological interventions (DRIVE) ISRCTN12845429
- INTERVAL study: To determine whether the interval between blood donations in England can be safely and acceptably decreased ISRCTN24760606
Consultant Gastroenterologist, Department of Gastroenterology
The Newcastle Upon Tyne Hospitals, NHS Foundation Trust.
PI for upcoming study of tranexamic acid in GI bleeding.
Consultant Haematologist, Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals, NHS Foundation Trust.
Dr Vip Jairath
Clinical Lecturer, University of Oxford. And from 2016: Associate Professor of Medicine, University of Western Ontario in Canada [recipient of the John and Susan Macdonald Endowed Chair in Inflammatory Bowel Disease Clinical Research].
The SRI are supporting a James Lind Alliance Priority Setting Partnership (JLA PSP) on Blood transfusion and Blood Donation. This work started in October 2015 and the end result – priorities for future research in blood transfusion and blood donation – should be known by the end of 2017. This project sees an equal number of clinical staff and patient representatives working together to survey and thereafter generate a list of priorities for research.
The SRI has recently engaged with two members of the public with an interest in transfusion medicine to act as advisors (alongside our clinical and methodology collaborators) on our work – our strategy, our priorities and our output.