BBTS Specialist Certificate

1. BBTS Specialist Certificate Jenni Jeffrey

2. The National Transfusion Laboratory Collaborative • Set up in August 2006. • Collaborators: • Institute Biomedical Science (IBMS) • Serious Hazards of Transfusion (SHOT) • Royal College of Pathologists (RCPath) • British Blood Transfusion Society (BBTS) • National Blood Transfusion Committee (NBTC) • The aims of the collaborative are to: • Obtain information on: • staffing in blood transfusion laboratories • the training undertaken in blood transfusion laboratories • the qualifications possessed by staff working in blood transfusion laboratories • workload in blood transfusion laboratories  • Make recommendations aimed at making the transfusion laboratory process safer

3. August 2009 - NTLC Recommended minimum standards for hospital transfusion laboratories • “The Serious Hazards of Transfusion (SHOT) Adverse Incident Reporting Scheme has consistently reported that 30 to 40% of ‘wrong blood’ event errors are due to errors originating in the hospital blood transfusion laboratory with a disproportionate number occurring outside ‘core hours’.” • The collaborative recommends that all unsupervised lone-working individuals • will be registered with the HPC, and all lone-working individuals whether working supervised or unsupervised will have attained one or more of the following as appropriate: • Registration via the Council for Professions Supplementary to Medicine (CPSM)/IBMS logbook in haematology and hospital based transfusion practice • Registration via the CPSM/IBMS logbook in blood transfusion • BBTS Specialist Certificate in Transfusion Science Practice • IBMS Specialist Diploma in Haematology with Hospital Transfusion Practice • IBMS Specialist Diploma in Transfusion Science

4. BBTS?

6. Why the BBTS Certificate? • Not for everyone! • Distance learning scheme • Open to all at anytime during career • Examination based, no course work or essay writing • Exam can be taken at any time after registration onto the scheme • Two years laboratory experience recommended • Recommend having completed approx. 400 hours of study (dependent on experience & background) • Evidence for moving from a qualified to specialist practitioner grade.

7. Training Package • Register on-line www.bbts.org.uk • £45 BBTS Members / £75 non-members • Study Guide = Information with regards to knowledge required • Book – ‘An Introduction to Blood Transfusion Science & Blood Bank Practice’ = Provides some factual information required to know along with self-assessment exercises. • Does not cover everything listed in study guide – book must be supplemented • Textbooks • BCSH Guidelines • Red Book Guidelines • MHRA Orange Book • SHOT reports • National Blood Transfusion Committee (NBTC) http://www.transfusionguidelines.org.uk/ • NHSBT Hospitals & Science Website http://hospital.blood.co.uk/

8. Examination • Twice a year – May & November • £100 BBTS Members / £130 non-members • Print exam registration form from website • NBS Centre • Colindale – London • Filton – Bristol • Plymouth Grove - Manchester • Three Papers all sat on one day

9. Paper 1. • One hour, multiple choice • 40 Questions each with 5 choices • More than one choice may be correct • Total marks for paper somewhere between 80 to 100 • Negative marking applies i.e. Mark all 5 choices, 3 correct, 2 incorrect = net mark of 1 • If correct choice not selected = lose a mark • If question left blank = zero marks • Must get 40% correct to pass • Therefore, need to circle at least somewhere in the region of 50 correct answers (before negative/missed answers removed) to pass.

10. Examples • Sent out approx. one month before exam • Some found in BBTS Bloodlines magazine • What is the approximate frequency in the UK population of group O RhD Negative? • 36,6% • 9.0% • 1.4% • 2.5% • 6.8% • A patient has been transfused within the previous 14 to 28 day period, the BCSH ‘Guidelines for compatibility procedures in blood transfusion laboratories’ (2004), recommends that a blood sample should be taken within what time period prior to the next transfusion? • 12 hours • 24 hours • 48 hours • 72 hours • 96 hours • Which of the following antibody specificities normally reacts by enzyme techniques at 37’C • Anti-K • Anti-c • Anti-k • Anti-Fyb • Anti-Jka

11. Paper 2 • One hour short answer questions • 15 Questions, 5 marks for each question • Can use notes, bullet points, tables etc. • 40% required to pass • Examples: • abbreviation interpretations • e.g.. SABRE, SHOT, TTI, TACO, GMP, vCJD

12. 1a. Give the genotypes of the following Rh shorthand terms (1pt): • R0r • R2r’’ • 1b. List the offspring from the mating R1r x R2r’ (4pts) • 2a. List the three phases of the complement pathway (1.5pts) • 2b. Explain how a blood sample collected into EDTA will affect the activity of complement (2pts) • 2c. What can activate the classic complement pathway? (1.5pts) • 3a. Some FFP is treated with methylene blue. What does this treatment do? (1pt) • 3b. How does it work? (3pts) • 3c. Why is it critical that leucodepletion is carried out prior to MB treatment? (1pt) • 4a. What does GMP stand for? (1pt) • 4b. What is the role of GMP? (4pts)

13. Paper 3 • 2 hour data interpretation & Case Scenarios • 40% Required to pass • Split into 2 sections: • Section A to be answered by ALL candidates • Choice of section B or C • B = Immunohaematology • C = Donation testing & component processing

14. Section A • 45 minutes • Given tables of serology results for 10 patients. • Patient age, gender & diagnosis • Table of ABO forward group, Rh Type, reverse group, antibody screen • Table of antigen profiles for screening cells • Antibody panel results • Examples of questions: • What is the patients group? • What antibodies are present? • What antibodies can not be excluded? • Is antigen negative blood required? • What blood would be provided?

15. Section B • Immunohaematology, 1hr 15 mins, 5 questions • More in depth questions on selected patients from section A • Example questions: • Patient 1: 26yr old female, 28 week pregnancy bloods. Identified anti-K present in Section A: • What further tests would you perform on this sample? • When would further testing be required? • What are the implications to the foetus? • How could the phenotype of the foetus be determined? Give one limitation to the method described. • How could the antibody have been stimulated?

16. 2 day old male, jaundice ( Maternal group O). Grouped as A Pos in Section A. • What could be the cause of the jaundice? • What further test would you perform? • If the baby was to require an exchange transfusion, what group red cells would you select and why? • List four requirements of red cells for exchange transfusion. • What are the minimum and maximum storage temperatures for red cells for exchange transfusion?

17. Job Done! • 60% overall mark required to pass • Approximate 6 week wait for return of results • Receive a certificate?? • Hints & Tips • Tables – handbook & guidelines • Data Interpretation exercises • Know and check your controls • know your polyclonal from your monoclonal / tube from microcolumn • Compatibility guidelines – 2 non-reactives, 2 positive reactives, 2 homozygous positive reactions for anti-S, -s, -Fya. –Fyb, -Jka, -Jkb • Section 13 – Blood Donation Testing – Don’t sweat it! • Most of it you already know and do everyday, just learn to answer the questions imagining yourself at work alone – what would you do? • Enjoy the quiz and gain confidence!