27 February 2023

NHS Blood and Transplant (NHSBT) expects to remain in Pre-Amber phase due to the on-going challenges of industrial action. 

Please note this update applies to England only and not Scotland, Wales and Northern Ireland as situations differ - please refer to specific national communications in each country. 

NHSBT has sent a notice to all hospitals and blood transfusion laboratories today.

Platelets and red cells are particularly vulnerable and your support to conserve stock from 6 to 20 March, is needed to help avoid going into an amber or red alert: 


  1. Ensure your lab has implemented the contingency platelet product barcodes, including the new reduced dose apheresis, neonatal and adult 5-day platelets. 
  2. Only request platelets for a specific identified requirement.  
  3. Extend time interval between prophylactic doses of platelets if the patient is clinically stable  
  4. Make sure the request for platelets and in particular HLA matched platelets, is cancelled if they are no longer needed 
  5. Ensure platelet transfusions are given in accordance with good clinical practice and national guidelines for adults (https://b-s-h.org.uk/guidelines/guidelines/use-of-platelet-transfusions) and children (https://b-s-h.org.uk/guidelines/guidelines/transfusion-for-fetuses-neonates-and-older-children), including:  
  • Optimise pre-operative preparation of patients e.g., stop anti-platelet agents 7 days prior to surgery whenever possible.  
  • Do not give prophylactic platelet transfusions to well patients with no evidence of bleeding who have had an autologous stem cell transplant.  
  • Use alternatives or additions to platelet transfusion e.g.  

1.Tranexamic acid - trauma, surgical bleeding and short-term for patients with chronic thrombocytopenia and bleeding  

2.Desmopressin for patients with uraemia or inherited platelet disorders at risk of bleeding or bleeding  

3. Fibrinogen or cryoprecipitate to maintain fibrinogen concentration at 1.5-2g/l if trauma or surgical bleeding

Also please promote platelet donation within your healthcare and home communities, particularly from blood donors who are group A or AB.

Red cells  

  1. Stockholding of O D negative red cells, including satellite laboratories, remote fridges, and irradiated stock, should be reduced.  
  2. Requests for “fresh red cells” and K neg units will be limited. 
  3. Use O D positive red cells for O D negative males, and females over 50, for single transfusion episodes, and in emergencies where their blood group is unknown.  
  4. O D negative red cells should be reserved for patients who are O D negative and have anti-D antibodies or are female with child-bearing potential or require regular or repeated transfusions.   
  5. Minimise iatrogenic anaemia; take samples from patients only if this will change clinical management.  
  6. Do not proceed with major, deferrable surgery in patients with severe anaemia until it has been properly diagnosed and treated.  
  7. Refer to NHSBT Pre-Amber guidance and continue to implement Patient Blood Management recommendations including:  
  • Use of tranexamic acid prior to major surgery  
  • Appropriate treatment of iron deficiency anaemia with oral or intravenous iron  
  • Appropriate treatment of vitamin B12/folate deficiencies   
  • Single unit red cell transfusions if not actively bleeding or on a transfusion programme  
  • Use a restrictive red cell transfusion threshold, haemoglobin of 70 g/L unless patient is bleeding, has acute coronary syndrome, or is on a chronic transfusion programme.

Links to previous pertinent BSH communications:  

Link to previous information on a reduced dose platelet component 


Link to previous red cell conservation measures. 


Dr Sue Pavord, BSH Vice President,
Dr Edwin Massey (Chair, BSH Transfusion Task Force)
Professor Lise Estcourt, Associate Medical Director NHSBT