Blood Transfusion carries risk and good clinical practice requires that blood components should be prescribed only when the benefit to the patient is likely to outweigh the risks. Prescription of these components shall be in conjunction with the Maximum Surgical Blood Ordering Schedule (MSBOS) and Trust Transfusion Policy all of which can be found on the Trust Intranet.

The requirement for transfusion of blood or blood components shall be recorded in the notes prior to completing a request form. The patient should be informed that they require a transfusion and given the appropriate information leaflets if circumstances allow. These should available in all clinical areas. The component type and quantity required should be requested in conjunction with the above guidance, to request further information leaflets contact the Hospital Transfusion Practitioner on ext. 15966.

A comprehensive guide to UHB Transfusion Services, Guidelines, Sample Requirements and Indications for Blood Use can be found in the Blood Transfusion Policy and its linked Procedures 1-8 available on the Trust Intranet

The guidelines have been drawn up in line with nationally agreed indication codes and recommendations

Laboratory hours and telephone numbers are as listed under Laboratory Haematology Contact QEHB Blood Bank on ext. 13297/8 or bleep 1376, there is a member of staff on duty 24/7.

Samples for complex red cell, platelet and granulocyte antibody tests, will be referred to the NHSBT. It is recommended that if patients require these investigations it should be discussed with a Clinical H

All requests for blood or blood components (red cells, plasma, platelets and cryoprecipitate) should be made on the request form or by telephoning blood bank, if there is already a valid group and save available. Please note blood bank have a two sample rule, which requires all patients to have a historical blood group on file along with a current valid group and save prior to any crossmatched blood being issued. All urgent requests should be discussed with blood bank so they can process the samples as a priority.

All patients requiring a blood transfusion are required to have a historic blood group on file and a current valid group and save prior to receiving any crossmatched blood.

There is zero tolerance regarding sample labelling and requesting in blood bank. Only samples that meet the following criteria will be accepted:

• All samples must be hand written onto the bottle label, sticky labels of any kind are not acceptable.
• The details on the sample and request card must match.
• Pre-printed addressographs are acceptable on the request form but should be initialled.
• On the sample and the form there must be;
  • Registration number.
  • Surname.
  • Forename.
  • Date of Birth.
  • Gender.

In addition to this the form must also have:-

• Consultant details.
• A contact number.
• Reason for the request.
• Location of patient.
• Phlebotomist’s name.
• Signature of the requestor.
• Date and time when sample drawn.
• Type of Request i.e. G&S, Crossmatch and number of units if required.
• Special Instructions - The laboratory must be informed if these are required
  • e.g. Irradiated, CMV negative, HLA selected, sickle negative etc.

Information on the request form and the blood tube should be double-checked to ensure that it is both complete and correct. Patient information on the blood tube must be taken from the patient not the form.

In an emergency, the registration number, gender and phonetic trauma name will be acceptable.

Blood transfusion errors are most often those of patient identification. Full details on patient identification can be found on the Blood Transfusion Policy Procedure 2. Patients identity much be confirmed by asking the patient to state their

• First and Surname
• Date of Birth
• Check this information and the hospital registration number against the wrist band and request form.

Prothrombin complex concentrate (Beriplex)

Available from the emergency pharmacy fridges at QEH. Guidelines for use are on the hospital intranet under P (Prothrombin complex concentrate)

See Guidelines on trust intranet for the use of Prothrombin Complex Concentrate (Beriplex) in life-threatening haemorrhage in patients on warfarin or acquired deficiency of vitamin K dependant clotting factors.

Albumin

Obtained from Pharmacy

Activated factor VII - rFVIIa (Novoseven)

Available from emergency pharmacy fridges at QEH.

Guidelines for use are on the hospital intranet for the use of recombinant activated factor VII (NOVOSEVEN) in life-threatening uncontrolled haemorrhage.

Anti D

Obtained from the Women’s Unit after consultation with Haematology Medical staff

If unsure discuss the use of these products with Blood Bank or Haematology medical staff.

During massive transfusion, i.e. a patient receiving 10 or more red cell bags within 24 hours, the patient’s total circulation is replaced with donor blood. Note that subsequent serum samples will contain very little of the patient’s original blood serological profile. Stored blood contains minimal plasma/ platelets, shock also disturbs blood coagulation. (note: all patients born after 1 January 1996 must be identified as they must be issued with non UK sourced plasma. This is a DOH directive.)

Components do not require a cross-match but the blood group of the patient must be known before compatible components can be issued. These always require a fresh blood administration set. If a blood group has not been performed then a transfusion sample must be sent. A request form is required. In emergency situations a telephone order can be made giving all the details required and a request form must be sent as soon as possible. Specific details of each blood components can be found in the Trust Blood Transfusion Policy. Blood Bank provides red cells, platelets, fresh frozen plasma (including virucidally inactivated) and cryoprecipitate.

NB – Octaplas is obtained from blood from Blood Bank at QEHB after consultation with Haematology consultants.

Patients with Allo-antibodies

Blood for transfusion is routinely typed for ABO and Rhesus (D) groups only. If a patient has produced an allo-antibody stimulated either by a previous transfusion or by pregnancy, it will be necessary to search for blood negative for the antigen. Some patients carry an antibody identification card, or such information is displayed in their notes. This information MUST be written on all cross-match request forms. Please try to give at least 24 hours notice of transfusion or expect a delay otherwise. When a new antibody is identified in a patient, Blood Bank will request a further 4 x EDTA of blood for investigation by the National Blood Service who will confirm the antibody and issue an antibody identification card which the patient must carry at all times. 

One of the complications of blood transfusion is that the patient may develop a new red cell antibody. Red cell antibodies may cause a serious transfusion reaction if incompatible blood is given to the patient. If there is a gap between transfusions then a new sample is required to check whether a new antibody has developed.

For repeat transfusions the following applies:

Patients Transfused Within the Last 3 Months

Samples collected no more than 72 hours prior to the actual transfusion when the patient has been transfused or pregnant within the preceding 3 months.

ROH, QEHB and Pre Assessment Clinics

The samples from patients attending QEHB and ROH pre-op assessment clinic are stored for 4 weeks. It is important that pre-operative assessment clinic nursing staff inform patients that a condition of keeping the transfusion sample for 4 weeks is that patients must inform the ward upon admission that they have had a transfusion elsewhere or are or have been pregnant. In these cases, a new transfusion sample must be taken. Samples which contain antibodies require a FRESH sample for crossmatch.

Renal

If a patient attending the dialysis unit as an out-patient has a sample taken during the visit, providing no transfusion was given at the same visit, this sample can be used. If a transfusion was given then a fresh sample MUST be taken no more than 72 hours before the next transfusion episode.

Cardiac Clinic

The samples from patients attending cardiac pre-op assessment clinic are stored for 4 weeks during which time some patients may have received top up transfusions pre–op. As a precaution when the cardiac list arrives check each transfusion history.

Haematology Day Unit

The requests for cross-match from patients attending Haematology Clinics are for in-patient treatment during the next few days and providing the patient has not been transfused for 3 months prior the sample being taken then this sample is safe to use. If the patient has been transfused during the last 3 months then a fresh sample MUST be taken no more than 72 hours before the next transfusion episode unless the consultant concerned authorises the use of the sample.

Liver

Liver samples are kept for seven days in the specimen fridge. Treat as a routine group and save sample.

IF IN DOUBT IT IS SAFER TO REQUEST A FRESH SAMPLE

Blood for Surgery

Cross-matched blood for patients undergoing surgery will be automatically de-reserved between 08.00 and 09.00 two days following the stated date required and the blood returned to bank stock. If the operation is delayed, or if you wish to transfuse after this time, then you must telephone the Blood Bank so that the blood will continue to be reserved for your patient. Platelets, Fresh Frozen Plasma and Cryoprecipitate will be automatically de-reserved between 08.00 and 09.00 on the day following the date required.

Blood for Anaemia

Cross-matched blood will be held for a maximum of 48 hours after the stated time required or first unit transfused. The patient may have formed antibodies during this time and it is therefore unsafe to transfuse the remainder of the cross-matched blood. If further transfusion is required, please send a fresh blood sample and transfusion request.

All unused blood/components must be returned to Blood Bank with the form Authority For Return of Unused Blood/ Blood Components. Please complete all patient details on the form. Return Blood/FFP to drawer marked ‘returned blood’ in Issue Blood Bank fridge. If cryoprecipitate or platelets are to be returned, contact Blood Bank. If blood/FFP was not stored at 4o (+/- 2o) for longer than 30 minutes, the Blood Bank on 13297 or bleep 1376, must be contacted.

It is mandatory that serious transfusion hazards and incidents must be recognised, managed and reported to either SHOT (Serious Hazards of Transfusion); and/or SABRE (Serious Adverse Blood Reactions and Events). All blood transfusion related incidents, including serious transfusion reactions, must be reported using the Trust Clinical Incident process. In addition Blood Bank must be notified immediately by telephone so that appropriate investigation can be undertaken which may include the immediate withdrawal of issued components. The Hospital Transfusion Team will generate a report for SHOT and SABRE, and the matter will be reported to the Hospital Transfusion Committee. All transfusion reactions will be investigated by the laboratory.

By law blood bank is required to document evidence of the fate of every blood component received by the Trust. If blood or blood components are administered to a patient, it is the clinical areas responsibility to record this evidence in PICS or the area’s blood registers/transfusion record. All blood components that are not transfused must be returned to blood bank as soon as possible with appropriate documentation (form WNP 0606; authority to collect/return blood or blood components). The law requires 100% traceability and Blood Bank audits, reports and monitors compliance on a continuous basis. Issues of non-compliance are reported to the Trust’s Hospital Transfusion Committee on a quarterly basis and to the MHRA in an annual return.