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Unconfirmed minutes of meeting of the National UK Blood


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									    Unconfirmed minutes of a meeting of the National Blood Transfusion Committee
        held on 3 October 2011 at the Royal College of Pathologists, London.

Present:   Prof A Newland                 Chairman
           Prof M Murphy          MM      Secretary
           Dr S Allard            SA      Royal College of Pathologists
           Mrs T Allen            TA      NHSBT Assistant Director Customer
           Dr M Allison           MA      Royal College of Physicians
           Dr J Bamber            JB      East of England RTC
           Dr P Bolton-Maggs      PBM     Serious Hazards of Transfusion
           Dr M Desmond           MD      North West RTC
           Mr G Donald            GD      Patient Representative
           Ms K Ellis             KE      Department of Health
           Mr R Elshaw            RE      Yorkshire & Humber RTC
           Ms R Gallagher         RG      Royal College of Nursing
           Ms S Harle-Stephens    SHS     British Blood Transfusion Society
           Dr C Harrison          CHa     London RTC
           Mrs C Howell           CH      NHSBT Chief Nurse Patient Services
           Mr J Hyare             JH      Transfusion Laboratory Managers Working
           Dr A Iqbal             AI      North East RTC
           Ms M Jokinen           MJ      Royal College of Midwives
           Dr A McKernan          AM      East Midlands RTC
           Dr S Morley            SM      Royal College of Paediatrics and Child
           Dr T Latham            TLa     South West RTC
           Dr D Norfolk           DN      Blood Components Working Group
           Mr C Robbie            CR      Medicines and Healthcare products
                                          Regulatory Agency
           Mr A Stock             AS      South Central RTC
           Dr C J Taylor          CJT     West Midlands RTC
           Dr D Thomas            DT      Blood Implementation Group, Wales
           Miss S Tuck            ST      Royal College of Obstetricians and
           Dr J Wallis            JW      British Society for Haematology
           Dr L Williamson        LW      NHSBT Medical Director
           Mrs T Little           TL      NBTC Administrator

In attendance:
           Ms A Harris            AH      NHSBT Better Blood Transfusion Lead for
                                          the Midlands and South West
           Mr G Gogarty           GG      NHSBT Assistant Director - Business
                                          Development and Strategy
26/11   Welcome and Introductions

        The Chairman welcomed everyone to the meeting and introduced new
        members Miles Allison, Royal College of Physicians; Paula Bolton-
        Maggs, Serious Hazards of Transfusion; Mike Desmond, North West
        RTC; Rose Gallagher, Royal College of Nursing; Angela McKernan, East
        Midlands RTC; and Jonathan Wallis, British Society for Haematology.

27/11   Apologies for Absence

        Apologies for absence were received from Mark Bellamy, Intensive Care
        Society; Andrew Cope, Royal College of Emergency Medicine; Rebecca
        Gerrard, NHSBT Head of Better Blood Transfusion; John Getty, Royal
        College of Surgeons; Judy Langham, MHRA; Peter Larcombe, South
        East Coast RTC; Allan Morrison, Institute of Biomedical Science; Patrick
        Roberts, South West RTC; Clive Ronaldson, NHSBT Director of Patient
        Services; Kieran Morris, NI Blood Transfusion Service; Henry Watson,
        Scottish Clinical Transfusion Service; Tanya Hawkins, British Blood
        Transfusion Society; David Whitaker, Royal College of Anaesthetists;
        and Sheila Wright-Hogeland, Patient Representative.

28/11   Minutes of the Last Meeting

        The minutes of the meeting held on 28 March 2011 were agreed as a
        correct record.

29/11   Minutes of the Executive Working Group

        The minutes of the meeting held on 6 June 2011 were noted.

        GD asked for an update on the recommendation made two years ago by
        the Advisory Committee on the Safety of Blood, Tissues and Organs
        (SaBTO) that use of non-UK sourced Fresh Frozen Plasma (FFP) is
        extended to all age groups and specifically what further data was
        awaited. LW stated that the number of reported cases of variant
        Creutzfeldt-Jakob (vCJD) is lower than anticipated and the Department of
        Health (DH) is re-evaluating the original risk assessments. The item
        would be further considered by the SaBTO in January 2012.

30/11   Regional Transfusion Committees (RTCs)

        Reports from the RTCs were presented to the morning meeting.          No
        report was received from the South East Coast RTC.

        CHa highlighted the main items of discussion:

               Three new RTC Chairs had taken up post and two were today
               attending their first meeting.
               The RTCs provide many education events attended by hospital
               staff involved in blood transfusion.
               There is continuing concern about the delivery of the NPSA Safer
               Practice Notice (SPN) 14 competencies.

                                                            NBTC 3rd October 2011
                                                                     Page 2 of 12
                 Concerns have been raised by the North East and Yorkshire &
                 Humber regions about the transfer of donation testing services
                 from Newcastle and Sheffield to Manchester and whether this
                 reorganisation is sufficiently resilient to adverse weather
                 conditions and pandemic flu.
                 Janet Birchall presented the findings of a national re-audit of the
                 use of platelets in haematology which found considerable
                 inappropriate use of platelet transfusions. The Blood Stocks
                 Management Scheme (BSMS) will provide the RTCs with data on
                 platelet usage in each hospital in their region to assist in efforts to
                 minimise inappropriate use.
                 In order to improve interaction between Hospital Transfusion
                 Committee (HTC) Chairs and RTCs it was agreed to survey HTC
                 Chairs to seek a better understanding of how the RTCs can
                 support them.
                 There is a need to improve training in transfusion for hospital staff
                 and the newly established NBTC Education Working Group will
                 work to achieve a consistent structured approach for transfusion

31/11     Blood Components Working Group

          DN presented his report highlighting:

31.1/11   Fresh Frozen Plasma

          At its July 2009 meeting, SaBTO recommended that the use of non-UK
          sourced FFP is extended to all age groups. This recommendation is still
          with DH who are in the process of re-evaluating the original risk
          assessments and as yet no guidance has been issued to NHSBT. NBTC
          Minute 06.1/11 of 28 March 2011 refers.

          ST raised the issue of the increasing scenarios of inter-hospital transfers
          of blood with patients. It was noted that a guidance document on the
          transfer of blood with patients between hospitals was discussed by the
          NBTC in September 2010.

31.2/11   Extended shelf-life for thawed Fresh Frozen Plasma

          At present, clinical FFP can be stored for 24 hours at 4oC after it is
          thawed. Studies to verify the safety and efficacy (in terms of changes in
          blood coagulation factors) of extending the shelf-life to 5 days have been
          completed by the NHSBT Components Development Laboratory and are
          being reviewed by the Standing Advisory Committee (SAC) on Blood
          Components of the UK Transfusion Services.

31.3/11   Bacterial screening of platelets

          Automated bacterial screening (BactAlert) of all platelet components
          across England and N Wales started in January and full implementation
          was completed in July 2011. There were initial problems with a higher
          than predicted Initial Reactive rate at some centres, almost all of which
          were false positives.

                                                                  NBTC 3rd October 2011
                                                                           Page 3 of 12
          The rate of Initial Reactives is falling (now around 60 per month 0.14%
          of units tested) and considerable efforts have been made to ensure
          effective communication with hospitals around the recall process and the
          clinical management, of patients who have already received one of these
          components. Of the 22 confirmed positive cultures by the end of
          August 2011, there were 4 organisms of high pathogenicity.

31.4/11   Pooled granulocytes in platelet additive solution

          This recently developed component successfully completed safety and in
          vitro quality studies and should become available for clinical use in early
          to mid-2012. It will replace conventional buffy coat transfusions as a
          purer source of granulocytes. Each adult dose is derived from 10 pooled
          buffy coat blood donations and contains approximately 1x1010

32/11     Education Working Group

          SA presented the scope and terms of reference for the new NBTC
          Education Working Group.

          Phase 1 of the work plan is to review the curriculum content of
          undergraduate and postgraduate training for Doctors and Nurses in
          England. For phase 2, representation would be sought from the Royal
          College of Physicians and a trainee doctor.

33/11     NPSA SPN 14 Review Working Group

          MM presented the terms of reference for the NPSA SPN 14 Review
          Group advising it would assess the implementation of the SPN focussing
          on the recommendation for training and competency assessment, its
          effectiveness in improving transfusion practice and the difficulties
          encountered by hospitals with its implementation. Additionally, the
          working group will review the recommendations of the NPSA Rapid
          Response Report (RRR 2010/017) on the transfusion of blood and blood
          components in an emergency.

          Dr Diane Harvey, Consultant Haematologist at the Queen Elizabeth II
          hospital in Welwyn Garden City and formerly Chair of the East of England
          RTC, has agreed to chair this group.

          Action: The Working Group will provide a report to the NBTC in
          March 2012.

34/11     Pathology Modernisation and IT Working Group

34.1/11   Seminar on Pathology Modernisation and Blood Transfusion

          The NBTC hosted a seminar on Pathology Modernisation and Blood
          Transfusion in April with an expert from the USA and speakers from
          Oxford, Barts and The London and NHSBT presenting on the topic of
          Integrated Transfusion Services (ITS).

                                                                NBTC 3rd October 2011
                                                                         Page 4 of 12
          Further work is underway on the modernisation of hospital transfusion
          services with the support of NHSBT. Presentations from the meeting are
          available on

34.2/11   Survey of IT systems in Hospital Transfusion Laboratories

          MM presented the results of a survey of IT systems in hospital
          transfusion laboratories carried out during July and August 2011. This is
          a repeat of the survey carried out in 2007 to determine what
          improvements have taken place.

          The participation rate for NHS Trusts was 118/160 (74%) compared with
          38% in 2007 thereby providing a more complete snapshot of the current
          status of IT systems used in hospitals transfusion laboratories. Of the IT
          systems available, 70/118 (59%) were installed before 2000. Electronic
          requesting for transfusion is becoming more common but 25% of Trusts
          with electronic requesting do not insist that key information such as
          diagnosis and procedure are entered. Diagnosis is almost universally
          entered as free text losing an opportunity to encourage consistency in the
          provision of information about the indication for transfusion. There is
          limited ability of the IT systems to search patients transfusion records for
          information on diagnosis, procedure and adverse events.

          The percentage of Trusts who have implemented blood tracking has
          increased from 24% in 2007 (23/98) to 47% (55/116), and 54% (32/59) of
          those without blood tracking indicated they are planning to install a

          85/115 (74%) of Trusts are ordering blood from NHSBT using the Online
          Blood Ordering System (OBOS), and 27/30 (90%) of those not using it
          are planning to implement OBOS in 2011.

          The Chairman stated that although there have been improvements these
          are not dramatic and good IT systems are paramount to successful
          progress with pathology modernisation. It was noted that the British
          Committee for Standards in Haematology (BCSH) has produced
          guidelines for IT systems in hospital transfusion laboratories.

          The results for individual RTCs will be added to the report and circulated
          as soon as possible.

          Action: MM/TL

35/11     Patient Involvement Working Group

          SA gave an update on the key activities of the Patient Involvement
          Working Group:

                 There is an ongoing review of all NHSBT patient information
                 leaflets related to blood transfusion.      Three new versions of
                 patient leaflets are now available Will I need a blood transfusion ,

                                                                 NBTC 3rd October 2011
                                                                          Page 5 of 12
                Iron in your diet and Information for patients needing irradiated
               blood .
               Designated web space now agreed on www.blood.co.uk to
               develop information on blood transfusion for patients.
               Promotion of transfusion awareness in collaboration with
               specialist societies and groups including participation in trauma
               display Science of the Bleeding obvious at the Royal Society in
               July 2011. This event was attended by 13,500 people over the
               course of one week.
               There is a new initiative on promoting awareness of the
               importance of patient identification Do you know who I am
               following SHOT recommendations and inclusion of mis-
               identification by DH as a Never Event .

        The Chairman stated that patient awareness should be more strongly
        promoted within the transfusion community.

36/11   Transfusion Laboratory Managers Working Group

        JH reported on the work of the Group:

               The scope of the working group has been reviewed and the
               membership restructured on the basis of one representative per
               region each with a deputy.
               Action: Submit revised Terms of Reference to the NBTC
               Executive in January 2012
               The current work includes monitoring NHSBT performance
               through the agreed Key Performance Indicators.
               An impact assessment of pathology modernisation in each region
               has been initiated and a report will be finalised by December
               Action: Submit to the NBTC Executive in January 2012
               There are increasing concerns regarding the downgrading of
               biomedical scientist posts and the loss of transfusion expertise.
               The capture of regional data regarding the use of antibody cards
               has commenced in preparation for a national report by March

37/11   Royal College of Emergency Medicine

        The Chairman reported that AC had submitted apologies as he was
        about to be deployed. The main comment from the College relates to
        recent interest concerning thromboelastography which may become
        more common in the newly created Major Trauma Centres and may
        result in some increased blood usage at these locations.

38/11   Royal College of Obstetricians and Gynaecologists

        ST tabled a report advising that the main topics for the College relate to
        massive obstetric haemorrhage and ongoing difficulties with optimal
        assessment and management of pre-operative and pre-delivery anaemia.

                                                              NBTC 3rd October 2011
                                                                       Page 6 of 12
          A continuing issue is the pressure on expectant parents from commercial
          organisations offering cord blood storage. There are concerns they are
          not providing balanced and realistic information on how useful the stored
          cord blood may be and can sometimes cause competing pressure to the
          patient care for clinical staff on labour wards. MJ advised that the Royal
          College of Midwives and the Royal College of Obstetricians and
          Gynaecologists have recently published a joint position statement on
          cord blood.

39/11     Royal College of Pathologists

          SA provided a report advising that the College is celebrating its 50th
          anniversary with contributions being invited to the 50 objects which will
          include key developments in transfusion medicine.

          A highly successful two-day Transfusion Tomorrow symposium was
          held in November 2010. This was oversubscribed with attendance from
          medical, nursing and scientific staff from many hospitals with overall
          excellent feedback.   The next two-day symposium is planned in
          November 2012.

40/11     British Society for Haematology

          JW advised that with regard to education on platelet usage the Society
          propose to develop some case scenarios and an up-to-date list of
          guidelines. There will be no new national guidelines on blood transfusion
          this year.

41/11     NBTC Work Plan 2011/12

          An updated work plan was provided to the meeting.

42/11     Royal Colleges and Specialist Societies

42.1/11   Minutes of the meeting held on 28 March 2011

          The minutes of the meeting held on 28 March 2011 were noted.

42.2/11   Update from the morning meeting of 3 October 2011

          ST reported on discussions from the morning meeting where the
          following topics were raised:

                 There is no further progress to report on the review of guidelines
                 concerning the management of patients with thrombocytopenia
                 and other coagulation disorders undergoing spinal anaesthesia.
                 On the issue of patient consent for blood transfusion, none of the
                 specialties support a specific consent form for blood transfusion.
                 However, there is agreement on the need to provide relevant
                 information about blood transfusion to different patient groups.
                 The group reviewed and supported their Terms of Reference.

                                                                NBTC 3rd October 2011
                                                                         Page 7 of 12
                 The Group welcomed representation from the Royal College of
                 Physicians and the Royal College of Nursing.
                 There is a lack of clarity about which professional bodies are
                 responsible for education and training in transfusion and it was
                 suggested that transfusion training could be provided at the same
                 time as training in resuscitation.
                 It is understood that the protocol for the national audit of pre-
                 operative anaemia has not yet been published.
                 The SHOT reports are a very useful tool for raising the profile of
                 transfusion and it would be helpful if SHOT would differentiate
                 events by specialty.
                 It is considered that more regular contact in-between NBTC
                 meetings by teleconference would be beneficial.
                 Action: TL

43/11     Better Blood Transfusion

43.1/11   Future of the Better Blood Transfusion Initiative

          The Chairman advised that the Chief Medical Officer is keen to continue
          support for the Better Blood Initiative and Professor Sir Bruce Keogh,
          NHS Medical Director, will take on the lead for promoting this work. A
          small group will be set up to discuss how to reinvigorate and take forward
          this initiative.

          Action: The Chair and Secretary to report to the Executive in
          January 2012.

43.2/11   NBTC Indication Codes for Transfusion      An audit tool

          JW presented an updated audit tool of indication codes for transfusion
          taken from UK national guidelines for the use of blood components.
          These were approved and will be distributed via the RTCs with the NBTC

          Action: MM/TL

43.3/11   Report from the National Comparative Audit Programme (NCA)

          MM presented a report providing information on current and completed
          audits. Most of the audits evidence areas of transfusion practice which
          do not comply with national guidelines. A weakness of the current audit
          programme is that it provides limited interventions to help improve
          practice and this will be addressed for future audits.

          The re-audit of the use of platelets identified a considerable level of
          inappropriate use and the aim is to provide support to hospitals in the
          form of good platelet transfusion guidance and tools to educate those
          prescribing platelet transfusions. A further immediate action will be to
          provide regular platelet usage data to the RTCs and hospitals.

                                                                 NBTC 3rd October 2011
                                                                          Page 8 of 12
43.4/11   Learnbloodtransfusion

          AH provided a status report on the Learnbloodtransfusion e-learning
          project. Development of the Learn Cell Salvage course has been
          completed and it is expected to go live on all platforms in November.

44/11     NBTC Budget

          The committee noted a statement on the financial position of the three
          budgets supporting the work of the national and regional transfusion
          committees as at 1 September 2011.

45/11     NHSBT

45.1/11   Blood Demand Drivers

          TA presented an update report from the Demand Planning Group.
          Current demand projection for red cell issues is 1.838m for 2011/12
          which suggests that demand is stable. Demand for platelets continues to
          rise representing an 11.9% increase compared to the first half of
          2010/11. Issues of frozen components remain in line with projection.

          With regard to platelet usage, GD enquired whether there was a multi-
          factorial explanation for the steady rise over recent years followed by a
          steep rise over the past 2/3 years. The Chair stated that there has been
          a change of use of platelets in trauma packs, complex cardiac surgery
          and an increased usage in older cancer patients. However, the recent
          audit of platelet usage in haematology showed that a large proportion of
          prophylactic usage is inappropriate. The increase had enormous
          resource implications for NHSBT. The NBTC will work with NHSBT to
          gain a better understanding of how platelets are being used and to
          reduce inappropriate use.

          TA advised that NHSBT had linked closely with fifty of the largest
          hospitals at individual consultant level to asses the increased usage and
          the findings indicate of a combination of all the above reasons for
          increased platelet usage.

45.2/11   Key Performance Indicators (KPIs)

          TA presented a paper from the NBTC Laboratory Managers Working
          Group which provided an overview of performance against key indicators
          for the 1st quarter of 2011/12. The average percentage of issues of group
          O RhD negative red cells has slightly increased possibly as a direct
          consequence of stocking remote blood issue fridges.

45.3/11   Tracking of Clinical Use of Blood

          TA presented a paper prepared by Kate Pendry which provided an
          update on the clinical tracking of blood project. The work is being
          undertaken in collaboration with four hospitals in England.

                                                               NBTC 3rd October 2011
                                                                        Page 9 of 12
45.4/11   NHSBT Commercial Review

          The Department of Health s report into its review of arm s-length bodies
          (ALBs) in July 2010 concluded that there were strong arguments for
          retaining the majority of NHSBT functions within a single national system.
          However, it also concluded that there may be opportunities for more cost-
          effective operations. Any possible options that are identified will be
          considered very carefully with NHSBT before a final decision is made by
          Ministers. KE advised that that a Ministerial report is expected to be
          published shortly.

          LW referred to discussions at the last NBTC meeting concerning
          importation of red cells from a commercial organisation and advised that
          NHSBT had received an offer from a commercial company to supply red
          cells. The NHSBT Board have declined the offer due to the potential
          negative impact on volunteer donors as well as the logistical problems of
          dependence on blood supplies from another country. In response to a
          query on whether such alternate blood supplies could be seen as a
          contingency measure, LW stated that NHSBT is liaising with other not for
          profit blood services through the European Blood Alliance.

45.5/11   Expert Panel

          LW stated that the Expert Panel was established in 2007 and NHSBT
          has valued its advice and discussions on developing proposals.
          However, it is felt that it is now time to review its purpose and the
          members of the panel have been asked whether these meetings continue
          to be of value.

45.6/11   Clinical Research

          LW referred to last year s call by NHSBT for clinical studies in the specific
          area of coagulation support for massive haemorrhage. The research
          submissions are still being reviewed and scheduled for discussion by the
          Research and Development Committee in November. In addition,
          NHSBT is participating in the Age of Blood Evaluation (ABLE) trial with a
          Canadian group and three other NHSBT sponsored trials have recently
          been completed.

45.7/11   Integrated Transfusion Service (ITS) Programme

          GG gave a presentation on the ITS programme. Discussions have been
          held with several Trusts regarding their plans for modernisation and the
          scope for hospitals to improve patient safety whilst reducing wastage and
          inappropriate use. Active planning and consultations are underway in
          many Trusts on the reconfiguration of hospital transfusion laboratories.
          NHSBT could play a key role in developing ITS and is carrying out a
          detailed analysis with the aim of developing pilot operating models.

                                                                  NBTC 3rd October 2011
                                                                          Page 10 of 12
          The three pilots being considered are:

             1. NHSBT management of stock in hospitals.
             2. Use of remote issue fridges in hospitals with small and non-acute
                blood requirements.
             3. Centralisation of hospital transfusion laboratory services.

          NHSBT will hold two or three workshops over an eight week period to
          test the emerging outcomes and solutions and RTC Chairs were invited
          to attend or identify representatives from their regions to assist with the

          Concerns were raised about the loss of local laboratories and staff
          expertise. The Chairman stated that his Trust supports cardio-thoracic
          work using remote blood issue with fridges replenished each day. It is
          difficult to support a 24-hour laboratory service in each hospital. MM
          advised that a remote transfusion service operates in one of the acute
          hospitals in Oxford with many complex procedures being carried out
          including cancer treatment and organ transplants.

          Action: ITS to be an agenda item for the NBTC meeting in March.

46/11     Advisory Committee on the Safety of Blood, Tissues and Organs

46.1/11   Review of blood donor selection

          LW reported on the announced changes to the blood donor selection
          criteria for men who have sex with men (MSM). The changes mean that
          the deferral policy will change from a permanent exclusion to a fixed
          period deferral of 12 months from the latest relevant sexual contact for
          men who have sex with men.

46.2/11   Consent for Blood Transfusion

          CH gave a presentation on patient consent to blood transfusion which is
          the subject of the SaBTO public meeting to be held on 11 October 2011.

          The meeting to be chaired by Professor Sir Bruce Keogh will recommend
          a series of strategies for improving patient information including
          publication of standardised information resources, setting out good
          practice guidance for clinicians and retrospective information for patients.
          The Better Blood Transfusion Toolkit will contain a number of tools to
          assist organisations improve consent for transfusion practice.

47/11     Serious Hazards of Transfusion (SHOT)

          PBM reported that participation in SHOT continues to increase, with
          94.7% of NHS organisations submitting reports in 2010. Other issues

                 Octapharma have agreed to supply data about issues to hospitals
                 of solvent detergent plasma for anonymous inclusion within the
                 denominator data.
                                                                 NBTC 3rd October 2011
                                                                         Page 11 of 12
               Discussions have been initiated between SHOT, MHRA and DH
               with the aim of streamlining haemovigilance reporting in the UK.
               SHOT will now receive reports on delayed and under transfusion
               which may have a significant impact on patient outcome.

48/11   Medicines and Healthcare products Regulatory Agency (MHRA)

        The Committee received an MHRA article due for publication in the
        November edition of Bloodlines which summarises the 2010
        haemovigilance data submitted to Serious Adverse Blood Reactions &
        Events (SABRE) and forwarded to the EU Commission as per regulatory

49/11   Chairman s Items

        The Chairman reported receipt of a letter from the Chief Medical Officer
        thanking the Committee, its working groups and the regional and hospital
        transfusion committees for their hard work to improve practice in all
        aspects of transfusion. The Committee will continue its work and
        discussions will shortly take place on how to pursue the BBT agenda for
        the future.

50/11   Derek Norfolk

        The Chairman advised that Derek Norfolk is stepping down from the
        Committee.   DN was a founding member of the NBTC and its
        predecessor committee the National Blood Users Group, a member of
        the NBTC Executive, chair of the Blood Components Working Group and
        the Website Steering Group and previously chair of the Yorkshire &
        Humber RTC.

        On behalf of the Committee the Chairman thanked him for his significant
        contribution to the NBTC over many years and wished him a long and
        happy retirement.

51/11   Dates of Meetings for 2012

        The meetings for 2012 will take place Monday, 26 March and Monday, 24
        September at the Royal College of Pathologists in London commencing.
        The meetings will commence at 1.00pm.

52/11   For Information

        QIPP example: Publication of 11/0033 Electronic blood transfusion: to
        improve safety and efficiency of transfusion systems.

                                                            NBTC 3rd October 2011
                                                                    Page 12 of 12

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