How does tranexamic acid work to stop bleeding? 

Tranexamic acid is a fundamental component of patient blood management programs and prevents or decreases blood loss in a range of settings including trauma, postpartum haemorrhage, cardiac surgery and major orthopaedic surgery.

Thrombus must eventually be degraded by fibrinolysis where fibrin is dissolved, mediated by slow release of activators by the endothelium. Tissue plasminogen activator converts plasminogen to plasmin which cleaves fibrin in the thrombus leading to its degradation. 

Tranexamic acid is an anti-fibrinolytic medication used to prevent and reduce bleeding in a variety of settings. It decreases the conversion of plasminogen to plasmin. 

The London School of Hygiene and Tropical Medicine developed the below 3-minute animation to understand fibrinolysis and how tranexamic acid works to inhibit the enzymatic break down of blood clots. 

Where does all the blood go?

In 2022/23 Lifeblood collected over 1.6 million individual donations of whole blood, platelets, or plasma.

But have you ever wondered if we can follow the journey taken by each of these donations over their lifespan? What about 20 or 30 years after donation? Does it matter?  

Clearly, it does matter. Full and enduring traceability of blood and blood products is essential, for example, if we needed to identify donors or recipients if a historical transfusion or newly discovered pathogen prompted a retrospective investigation or lookback.  

What do we mean by ‘traceability’? Blood and blood products are medical products of human origin (MPHO) and recent International Society of Blood Transfusion (ISBT) Guidelines for traceability of medical products of human origin offers the following definition: “… the maintenance of a permanent continuous information trail beginning with the selection of donors of MPHO and continuing through procurement, processing, testing, distribution and recipient matching to the final disposition of all the sub-products, ensuring timely tracing from donor to recipient and vice versa is possible ...”.[1] 

Global horizon scanning for TFIDs

Lifeblood's fact sheets for transfusion-focused infectious diseases (TFIDs) provide an overview of a specific pathogen, including the associated disease, transmission modes, epidemiology and risk factors for infection, blood phase and potential transfusion-transmissibility. Latest ones available include:

• Human prion diseases (non-vCJD) 
• Non-prion proteins associated with neurodegenerative diseases
• Abnormal prion protein (variant Creutzfeldt-Jakob disease)
• Epstein Barr virus (EBV)
• Influenza A - virus subtype H1N1, A(H1N1)
• Lymphocytic choriomeningitis virus (LCMV) 
• St. Louis encephalitis virus (SLEV)
• Nematode species of the Wuchereria and Brugia genera                                  

New SHOT Report available  

SHOT (Serious Hazards of Transfusion) is the United Kingdom's independent, professionally led haemovigilance scheme. Since 1996 SHOT has been collecting and analysing anonymised information on adverse events and reactions in blood transfusion from all healthcare organisations that are involved in the transfusion of blood and blood components in the UK. Where risks and problems are identified, SHOT produces recommendations to improve patient safety. 

The 2023 SHOT Annual Report, Summary and Supplement, has now been published and is available.

Topics trending at Lifeblood

Every month one of our transfusion experts points us to the latest journal articles being discussed at Lifeblood.

Liberal or Restrictive Transfusion Strategy in Patients with Traumatic Brain Injury

In critically ill patients with traumatic brain injury, the impact of a liberal red blood cell (RBC) transfusion strategy as compared with a restrictive transfusion strategy on neurological functional outcomes is unclear.  

The HEMOglobin Transfusion Threshold in Traumatic Brain Injury OptimizatioN (HEMOTION) trial was an international, pragmatic, randomised, open label blinded-endpoint clinical trial where adults with moderate or severe traumatic brain injury and anaemia were randomised 1:1 to receive a liberal RBC transfusion (Hb threshold of ≤100 g/L) or a restrictive transfusion (Hb threshold of ≤70 g/L). 

Clinical transfusion program - Module 2: Transfusion in practice

Next month, our program for trainee registrars shifts focus from basic transfusion to transfusion in practice.

The first two sessions for this module will explore perioperative and intraoperative patient blood management. 

Release dates for August include:

7 August - Dr. Kathryn Robinson, Transfusion Medicine Specialist, Lifeblood, Haematologist, The Queen Elizabeth Hospital, Medical Advisor, SA BloodSafe Programs, discusses perioperative patient blood management. 

21 August - Dr Ben Slater, Anaesthetist, Deputy Director, Department of Anaesthesia and Acute Pain Medicine St Vincent’s Hospital, covers intraoperative patient blood management 

They'll be released at 12.00 pm AEST on the scheduled dates and will be available for 12 months on Transfusion Online Learning. 

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