Baby given wrong blood after blunder at transfusion centre

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A BABY was given the wrong blood because of a blunder at the transfusion centre in Edinburgh, it emerged today.

Safety guidelines demand that babies are not given blood containing the CMV virus, which is virtually harmless to adults but potentially life-threatening to babies.

The infant received CMV positive blood at the Kirkcaldy Victoria Hospital in Fife after a mistake was made by blood packers in Edinburgh.

The error was revealed after Scottish National Blood Transfusion Services (SNBTS) in Lauriston Place sent a memo to staff with guidelines to "prevent it happening again".

An investigation is now underway into the incident which happened in the past few weeks.

Today SNBTS said the risk to the baby was very low but that their computer system was being upgraded to ensure there was no chance of a similar mistake in the future.

CMV (cytomegalovirus) is a herpes-type virus which lives almost entirely in the white blood cells and occurs in 50 to 60 per cent of the population.

It can cause severe illness in some cases, but in most cases is akin to having the common cold.

A spokeswoman for SNBTS admitted that it could be "serious" if a baby contracted CMV. She said that since 1999, blood has been filtered to make it "leucocyte-depleted" by removing almost all white blood cells, a process that significantly reduced the risk of transmitting CMV with a blood transfusion.

She said: "In this case, the CMV positive blood which was transfused was leucocyte-depleted and was therefore considered to be safe."

The spokeswoman said that as a doubly cautious measure SNBTS provided blood components for babies or high-risk patients that had both tested negative for CMV and were leucocyte-depleted.

"This should have been the case in this instance."

She added: "Although we would not expect this transfusion to have transmitted CMV, SNBTS takes this issue very seriously and will amend its procedures so that the problem cannot recur.

"This will mean that in future, our computer will not permit the issue of [blood] for a baby unless tested CMV negative."

The Victoria Hospital is now believed to be preparing a report to send to Serious Hazards of Transfusion (Shot), the body that monitors such incidents.

Dr Dorothy Stainsby, of Shot, said although the mistake was "not ideal" they had never received a report of this type of incident causing harm.

She said CMV was a viral infection that could cause problems in small infants whose immune systems were not functioning fully.

However she added that the CMV virus was carried in white blood cells and as blood used in transfusions now had all white cells removed, continuing to ensure babies received CMV negative blood was just an extra cautionary measure. She said: "The recommendation that it is tested as well is very much a belt and braces approach.

"But it is important that failures should be openly investigated so patients get the right blood for them and I would congratulate the hospital on being open about it."

A spokeswoman for NHS Fife said: "We are aware of the incident and are investigating it with colleagues from the Scottish National Blood Transfusion Service.

"Due to patient confidentiality we are unable to expand further on the individual circumstances."

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