Transfusion – Antenatal Serology —
Training activity: 8

Details

Develop a management plan including selection of appropriate blood components for:

• Mother
  • Pre-delivery
  • Post-delivery
• Fetus
• Neonate

Type

Entrustable training activity (ETA)

Evidence requirements

Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion. ​

Reflection at multiple timepoints on the trainee learning journey for this activity.

Considerations

• Requirements for blood component selection
• RBC
• Plasma
• Platelets
• Including special requirements
• IUT requirements
• Exchange and top up transfusions
• Alternative interventions for patients who refuse blood components

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

What does success look like?

• Identify what is expected of you in relation to developing a management plan and selecting appropriate blood components for these patient groups.
• Review the related learning outcomes which relate to standards/guidelines, component selection, and patient blood management principles.
• What criteria define a successful management plan and the selection of appropriate blood components for pregnant patients, fetuses, or neonates?
• What are the expected outcomes of providing appropriate transfusion support based on a well-developed plan?
• Discuss with your training officer to understand the different clinical scenarios you should cover and the expected detail in the management plans and component selection criteria.

What is your prior experience of this activity?

• Think about what you already know about the requirements for blood component selection for maternal/foetal/neonatal transfusion. What are the special blood requirements for pregnancies?
• What factors influence component selection for Intrauterine Transfusions (IUTs), exchange transfusions, or neonatal top-up transfusions?
• Consider possible challenges you might face in developing plans or selecting components, such as:
  • Complex antibody profiles
  • Urgent requests
  • Specific neonatal requirements
  • And think about how you might handle these
• Recognise the scope of your own practice for this activity, meaning knowing when you would need to seek advice regarding challenging antibody combinations, rare component requirements, or difficult clinical scenarios.
• Acknowledge how you feel about the responsibility of selecting blood components for these patient groups, recognising the potential risks and benefits.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop in applying transfusion guidelines to complex antenatal and neonatal cases and formulating rational transfusion plans.
• Identify the specific insights you hope to gain into the practical application of patient blood management principles in pregnancy and neonatal care, and the unique considerations for these patients.

What additional considerations do you need to make?

• Consult actions identified following previous experience with blood component selection or managing patients with antibodies.
• Identify important information you need to consider before embarking on the activity, such as relevant guidelines for maternal/foetal/neonatal transfusion, the patient’s antibody status, clinical condition, gestational age, and local availability of specialised components e.g., irradiated, CMV-seronegative, HbS-negative.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst developing the management plan and selecting blood components?
• Are you encountering situations such as:
  • A case requiring blood components with multiple special requirements e.g., irradiated, CMV-negative, antigen-negative that present logistical challenges or require careful sequencing
  • A complex antibody profile or specific patient history e.g., rare maternal antibody making standard component selection inadequate or necessitating urgent consultation
  • An urgent need for components for Intrauterine Transfusion (IUT) or neonatal exchange transfusion, requiring immediate decision-making under pressure

How are you reacting to the unexpected development?

• How is this impacting your actions? Did you adapt or change your selection process or management plan in the moment?
• Consider the steps you are taking in the moment, such as:
  • Immediately reviewing guidelines for special blood requirements in pregnancy and neonatal care
  • Making a real-time decision on the justification for using specialised components (e.g., irradiated blood for IUT) based on the specific patient group
  • Seeking immediate guidance from a clinical scientist or consultant regarding the optimal management plan or component selection for complex scenarios
• How are you feeling in that moment? For instance, are you finding it difficult to apply patient blood management principles while dealing with complex component specifications? Is it affecting your confidence in advising on appropriate blood components?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully applying transfusion guidelines to develop a management plan, or needing support because the component requirements are rare and complex?
• What are you learning as a result of the unexpected development? For example, are you gaining critical insight into the unique considerations for blood component selection for foetuses and neonates, or mastering the application of patient blood management principles in transfusion support?

On action

What happened?

• Begin by summarising the key points of the experience of developing a management plan and selecting blood components for a mother, foetus, or neonate in an antenatal-related scenario. What specific clinical details and laboratory results did you consider when making decisions about component selection e.g., for IUTs or neonatal exchange transfusion?
• Consider specific events, actions, or interactions which felt important, such as moments where selecting the most appropriate components felt complex. Acknowledge how you felt when making these critical decisions.
• Include any ‘reflect-in-action’ moments where you adapted to the situation as it unfolded. For instance, describe when a change in patient status or new test result immediately led you to adjust the proposed management plan or component selection.

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding the specific requirements and considerations for blood component selection for pregnant patients, foetuses, and neonates.
• What skills in integrating clinical and laboratory information to develop transfusion plans did you develop? Were there knowledge gaps about specific product modifications e.g., irradiated, CMV negative, patient blood management principles, or transfusion criteria for these patient groups?
• Compare this experience against previous component selection tasks. Has your understanding of the complexities of transfusion support in antenatal/perinatal care improved?
• Identify any challenges you experienced e.g., urgency of the situation, complex antibody profiles and how you reacted to these. Were you able to overcome the challenges?
• Did you need to seek advice or clarify the requirements for specific components or procedures (e.g., IUTs)? Did you ensure your management plan and component recommendations were within your scope of practice and reflected current guidelines?
• Acknowledge any changes in your own feelings now you are looking back on the experience regarding your confidence in developing transfusion management plans and selecting blood components in these scenarios.

What will you take from the experience moving forward?

• Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt. For example, determining specific areas related to blood component selection for antenatal/perinatal care that you need to study further e.g., indications for exchange transfusion, management of rare antibodies.
• How will this experience change your approach to reviewing patient cases and recommending transfusion support?
• Do you need to practise any aspect of the activity further, such as applying specific guidelines or integrating complex patient data for component selection?

Beyond action

Have you revisited the experiences?

• Reviewing your past experiences developing management plans and selecting blood components for mothers, foetuses, and neonates, have you reflected on your previous learning points?
• What specific aspects did you aim to improve, such as understanding the unique transfusion requirements at different stages (IUTs/neonates) or selecting appropriate components based on clinical scenarios? Have you successfully applied these improvements in subsequent cases? Are you now more proficient in this area?
• Have you engaged in professional storytelling or discussed cases requiring blood component selection for pregnant patients, fetuses, or neonates with peers or supervisors? Did these discussions provide new insights into the complexities of these transfusions or the available blood products?

How have these experiences impacted upon current practice?

• How does the cumulative learning from developing management plans and selecting blood components, and your reflections, contribute to your overall preparation for observed ‘in-person’ assessments such as a DOPS on selecting blood components for an IUT or for transfusion during pregnancy, or a Case-Based Discussion involving complex transfusion management?
• How has your ability to develop appropriate management plans and select blood components for pregnancy-related transfusions evolved over time? Are you more skilled at applying patient blood management principles and considering the specific needs of the mother, foetus, or neonate?
• How confident are you now in recognising when a case involves rare requirements or significant risk factors that necessitate senior input?

Relevant learning outcomes

#	Outcome
# 1	Outcome Practice in accordance with antenatal serology standards and guidelines.
# 5	Outcome Predict current and future pregnancies at highest risk of HDFN.
# 6	Outcome Identify and advise healthcare professionals on appropriate actions to manage HDFN.
# 7	Outcome Develop management plans including selection of blood components for mother, fetus and neonates during pregnancy.
# 8	Outcome Identify actions required in cases of potentially sensitising events during pregnancy.
# 9	Outcome Apply patient blood management principles during pregnancy.