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 – 6oC. 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.

Platelets Usage & Storage

• 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.

Fresh Frozen Plasma Usage & Storage

• Shelf life of 36 months when frozen

at -40oC.

• Shelf life of 24hrs when thawed and stored at 2 – 6oC.

• 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 -40oC.

• 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

For the prescribing of: Blood Platelets FFP Cryoprecipitate

Adult & Paediatric Blood / Blood Components Prescription Chart

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.

Transfusion Reactions Observations associated with

transfusion reaction include:

• Shivering • Rashes • Flushes • Shortage of breath • Pains • Rigors • Agitation • Tachycardia • Hypotension • Nausea • Fever • Clammy

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?