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.)

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

Planned Transfusion

At least 24 hours notice of blood requirement must be given before the blood is required. Blood will be issued after the ABO and Rhesus (D) groups have been checked and the blood has been screened for atypical antibodies. If there are atypical antibodies, suitable blood may then have to be obtained from the NHSBT. This may take up to 48 hours. Please note all patients are required to have their blood groups performed on two separate samples prior to the issue to crossmatched units, one of these may be an historical group. 

Urgent Transfusion

When a transfusion is urgently required It is very important that Blood Bank are informed  that an emergency specimen is on the way and how soon blood is required as the choice of emergency procedure depends on this information. The ward or operating theatre will be telephoned when blood is ready. Please allow for the time taken for the specimen to arrive in the laboratory. Please note the two sample rule applies to all crossmatch requests.

Immediate Transfusion
(For massive and rapid blood loss – please refer to: Blood Transfusion: Massive haemorrhage protocol.

Loss & Urgent Transfusion available on the Trust Intranet)

Immediate transfusion may be required for massive and rapid blood loss. Please send a EDTA sample to the Blood Bank as soon as possible. If blood is required urgently, group specific blood will be issued in the absence of a completed antibody screen. The decision to transfuse uncross matched blood is a medical decision, please see procedure 5. Please note the two sample rule applies to all crossmatch requests.

If the need for transfusion is so great that there is no time to wait for ABO grouped blood, then emergency O RhD negative blood can be found in the following locations