Blood / Blood Products Transfusion A Liquid Transplant Caroline Holt Specialist Practitioner of Transfusion caroline.holt@tgh.nhs.uk Tel : 922 5484 Mob: 07759260044
The Transfusion Team Gillian Lewis Blood Bank Manager Caroline Holt Transfusion Practitioner Andrew Blackburn Advanced Biomedical Scientist for Transfusion Transfusion Laboratory Tel: 922 6391
Transfusion Lab
Role of the Specialist Practitioner of Transfusion (SPoT) Ensure Legislation / Guidelines and Policy are followed Participate in clinical audit Offer transfusion support/advice Education Incident investigation Facilitate the Hospital Transfusion Committee Overall aim is to enhance best practice
Legislation/Guidance Blood Safety & Quality Regulations 2005 MHRA / SABRE / SHOT Better Blood Transfusion 2007/001 (Health Service Circular) NPSA Right Patient, Right Blood RCN Right Blood, Right Patient, Right Time Trust Blood Transfusion Policy
European Regulations Traceability Member States shall take all necessary measures in order to ensure that blood and blood components collected, tested, processed, stored, released and/or distributed on their territory can be traced from donor to recipient and vice versa. Data needed for full traceability in accordance with this Article shall be kept for at least 30 years.
Blood Products (Issued by the Transfusion Laboratory) Red Cells Platelets Fresh Frozen Plasma Cryoprecipitate
Red Cells Usage & Storage Available in 2 sizes. Adult units (approx 300mls) and paedi packs (approx 50mls.) Shelf life of 35 days. Cross matched against patient s plasma. Stored in monitored blood fridge at 2 6 o C. Should not be used if it has been out of temperature control for longer than 30 minutes. Administered over 2 4 hours via a blood giving administration set. Maximum time 4 hours. Used to replace overt blood loss, treat anaemia and provide support during cytotoxic therapy.
Available in 1 adult therapeutic dose or paedi packs. Has a shelf life of 7 days. Not stored in the Transfusion lab. Stored on an agitator at room temp and must never be placed in a blood fridge. Group specific. Administered via a blood administration giving set which has not been used for blood. Typically given over 30 minutes Adheres to damaged blood vessels to prevent blood loss and promote coagulation. Used in patients with low platelets, control of bleeding or marrow support when on Cytotoxic Drugs. Platelets Usage & Storage
Fresh Frozen Plasma Usage & Storage Shelf life of 36 months when frozen at -40 o C. Shelf life of 24hrs when thawed and stored at 2 6 o C. Given over 30 minutes Used for clotting abnormalities where no recombinant factor is available. Administered via a blood administration giving set. Should not be used as a volume expander.
Cryoprecipitate Usage & Storage Frozen Product stored at -40 o C. Shelf life of 4 hrs when thawed and stored at room temperature. Small volume of 20 30mls. Pooled Cryo now available. Given over 30 60 minutes Administer via a blood administration giving set. Used when fibrinogen is low. Usually in disseminated intravascular coagulation (DIC.)
Specimen Acceptance Policy
Sample Collecting Ensure you only deal with one patient at a time. Check the expiry date of the tube Do not label bottles before you take the sample. Bottles MUST be labelled at the bedside. Ask patient to confirm their name where possible. Take patient details from the wrist band. Sample MUST contain 3 positive patient identifiers. Always sign the sample bottle. DO NOT use Lorenzo labels. Tubes must be hand written. All details on the sample and the request form must match.
Transfusion Tubes Transfusion tubes contain an anticoagulant and each tube has an expiry date. Staff are reminded to check each tube before collection as samples will be rejected by the labs if the tubes are out of date.
Sample Requirements In order to issue blood the laboratories will require a historic blood group for the patient plus a current group and save sample. A current group & save is a sample less than 72 hours old. This is used to confirm the patient s blood group and detect the presence of any irregular antibodies. If the laboratories do not have a historic blood group, they will require a second sample taken at a different time to ensure absolute patient safety / identification. They will NOT accept 2 samples for the same patient at the same time.
Urgent samples for Transfusion MUST always be accompanied by a telephone call to the Transfusion Laboratory Ext 6391
Adult & Paediatric Blood / Blood Components Prescription Chart For the prescribing of: Blood Platelets FFP Cryoprecipitate Please document: Consent Patient information Reason for transfusion
Blood Tags
Consent & Patient Information for Transfusion The Advisory Committee on the Safety of Blood, Tissues, and Organs, (SaBTO) recommend that patients receiving a blood transfusion should give their consent. All patients receiving a blood transfusion have the right to access written information. Patients who have received a blood transfusion and who were not able to give valid consent prior to the transfusion should be provided with information retrospectively.
Who Can Perform the Bedside Check? First Checker A Registered Nurse or Registered Midwife or Registered Sick Children s Nurse or Qualified Doctor or a Qualified, Registered Agency Nurse who holds a Trust Contract. Second Checker Any of the above staff listed as first checkers or a Registered Operating Theatre Practitioner or a Qualified Agency Nurse. Accountability for the checking procedure rests with both people carrying out the checks. The following staff must not be involved in the checking procedures. Student Nurses, Student Midwives, Trainee Operating Department Practitioners, Medical Students, Assistant Practitioners, Clinical Support Workers, Nursery Nurses and Health Care Support Workers
Observations The minimum observations must be recorded for all blood / blood components being transfused: Pre transfusion observations. TPR & BP Observations at 10-20 minutes following the start of the transfusion. TPR & BP End of the transfusion of each unit. TPR & BP These observations must be clearly identifiable on the Blood Prescription Chart Transfusions should only be administered where and when the patient can be clinically observed by clinical staff and transfusing when transferring a patient should be avoided if at all possible.
Observations associated with transfusion reaction include: Shivering Rashes Flushes Shortage of breath Pains Rigors Agitation Tachycardia Hypotension Nausea Fever Clammy Transfusion Reactions
What to do in the Event of an Adverse Reaction (1) STOP the transfusion. Inform the doctor. Inform Transfusion Dept. Inform the Haematologist. Record the patients observations. Change the giving set and commence 0.9% sodium chloride to keep the vein open. Re check the patients details with the compatibility form and the blood product. Arrange for the return of the blood product bag and giving set to the laboratories. (This should include all previous bags)
What to do in the Event of an Adverse Reaction (2) Patient blood samples must be sent for further investigations: Fresh samples for a Direct Antiglobulin test (DAT also known as Coombs test) and an antibody screen. EDTA sample for FBC and blood film. Blood cultures from the patient. Biochemistry routine & LFT (urea, electrolytes, bilirubin). Clotting profile (PT, APTT & fibrinogen.) Urinalysis DONOT USE THE SAME ARM AS THE TRANSFUSION
Incident Reporting In the event of an adverse reaction: A Trust incident form must be completed and sent to the Quality & Governance Department. A copy of the form must be sent to the Transfusion Practitioner. A ward transfusion reaction form must be completed. It is the responsibility of the Blood Bank Manager to determine which incidents are reported to SABRE/SHOT
Finally...Remember to check the IV site regularly. Any questions?