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LABORATORY MANUAL
FOR
BLOOD TRANSFUSION
2014)
Unit Tabung DarahJabatan Patologi
Hospital Sultanah Nora IsmailEXT : 4327
2
3
INTRODUCTION
The purpose of having a laboratory manual for transfusion service is to improve
the overall quality of the blood transfusion service in this hospital.
In this laboratory manual, topics such as consent for transfusion, procedures for re-
questing blood transfusion, sample taking and labeling, proper storage and transportation
of blood products, Clinical guidelines in blood transfusion and blood transfusion reaction
will be discussed.
This laboratory manual is for use within Hospital Batu Pahat only. This manual is
mainly based on guidelines from National Blood Center (PDN) and The Clinical Use of
Blood Products by WHO. It is intended to promote better and safer transfusion practice in
this hospital.
4
TABLE OF CONTENTS
CONTENTS PAGE NO
INTRODUCTION 3
TABLE OF CONTENTS 4 – 5
CONSENT FOR TRANSFUSION 6
MSBOS 6
GSH 6
BLOOD TAKING AND LABELING 6
FILLING REQUEST FORM 7
BLOOD REQUEST IN NEWBORN / CHILDREN 7
COLLECTING BLOOD / BLOOD COMPONENTS 7
ADMINISTRATION OF BLOOD / BLOOD COMPONENTS 8
PRETRANSFUSION MEDICATION 8
PATIENT MONITORING DURING TRANSFUSION 8
NIGHT TIME TRANSFUSION 8
USAGE OF BLOOD WARMER 9
DRUGS / FLUID ADMINISTRATION DURING TRANSFUSION 9
BLOOD TRANSFUSION REACTION 9 – 10
TRANSFUISON OF BLOOD PRODUCTS FROM CLOSED FAMILY MEMBERS / RELATIVE 11
5
GUIDELINES IN CLINICAL USE OF BLOOD / BLOOD PRODUCTS
RED BLOOD CELL TRANSFUSION ----------------------------------------------------------------------------
TRANSFUSION IN ANEMIA ----------------------------------------------------------------------------------------
TRANSFUSION TRIGGERS ------------------------------------------------------------------------------------------
GUIDELINES IN NEONATAL EXCHANGE TRANSFUSION -----------------------------------------------
SELECTION OF NON RED CELL PRODUCTS ---------------------------------------------------------------
GUIDELINE IN PLATELETS TRANSFUSION -----------------------------------------------------------------
GUIDELINE IN FFP TRANSFUSION --------------------------------------------------------------------------
GUIDELINES IN CRYOPRECIPITATE TRANSFUSION ------------------------------------------------------
GUIDELINE IN MANAGEMENT OF DISSEMINATED INTRAVASCULAR COAGULATION ----------
12 – 13
14
14
15 - 16
16
17 - 18
19
20
21
CT RATIO
WHAT IS CT RATIO ? --------------------------------------------------------------------------------------------------
CT RATIO OF HOSPITAL BATU PAHAT -----------------------------------------------------------------------
22 - 23
24
APPENDIX
1. TRANSFUSION OF RH D NEGATIVE PATIENT IN LIFE THREATENING SITUATION ----------------
2. MSBOS OF HOSPITAL BATU PAHAT ----------------------------------------------------------------------------
3. CONSENT FORM -------------------------------------------------------------------------------------------------------
4. CHECK LIST FOR TAKING BLOOD FOR GXM ---------------------------------------------------------------
5. BLOOD REQUEST FORM ---------------------------------------------------------------------------------------------
6. CHECK LIST FOR GIVING BLOOD OR BLOOD COMPONENT TO A PATIENT ------------------------
7. SUMMARY OF BLOOD REQUEST TILL BLOOD ISSUING ---------------------------------------------------
8. COLLECTION OF BLOOD / BLOOD PRODUCTS ---------------------------------------------------------------
9. STORAGE OF BLOOD PRODUCT PRIOR TO TRANSFUSION -----------------------------------------------
10. TIME LIMITS FOR TRANSFUSION ----------------------------------------------------------------------------------
11. HOW TO USE BLOOD STICKER -------------------------------------------------------------------------------------
12. BLOOD TRANSFUSION REACTION REPORT FORM ----------------------------------------------------------
13. S L I P P E N G A M B I L A N D A R A H -----------------------------------------------------------------------------
14. BORANG PEMULANGAN DARAH / KOMPONEN DARAH ----------------------------------------------------
26
27
28
29
30
31
32 - 34
35
36
37
38
39 – 40
41
42
REFERENCES 43
6
CONSENT FOR TRANSFUSION—Refer to APPENDIX 3 (Page 28)
The patient must give informed consent for transfusion. The clinician in charge of the patient has a responsi-bility to explain the benefits, risk and alternative to transfusion therapy and ensure that the patient comprehends theissues discussed. Other than in emergency, the patient should be given opportunity to ask questions, and his/herinformed decision be documented. If the patient is unable to give consent, a responsible family member mustbe asked to do so. If no family member is available or in emergency when the need for transfusion leaves no timefor consent, it is prudent to note this in the patient’s medical note.
The informed consent for blood transfusion is valid from the time the patient is admission till the time of dis-charge. If the patient requires multiple transfusions during the same admission, no additions inform consent isrequired.
MSBOS(Maximum Surgical Blood Order Schedule)—Refer to APPENDIX 2 (Page 27)
MSBOS is a table of elective surgical procedures which list the number of units of blood routinely requestedand cross matched for them preoperatively.
The schedule is base on retrospective analysis of actual blood usage associated with the individual surgi-cal procedure.
Please see attachment of MSBOS of Hospital Batu Pahat.
GSH (Group, Screen & Hold) GSH is for cases that are unlikely to be transfused during surgery, however when antibody screen is positive,
compatible blood must be made available. After GSH the sample will keep for 72hours, if blood is requires within 72hours, will proceed for further
cross matching. A GSH should be used in conjunction with a Maximum Surgical Blood Order Schedule (MSBOS).
BLOOD TAKING AND LABELING—Refer to APPENDIX 4 (Page29)
The process of taking and labeling blood samples must be done in one process at the bedside, one patientonly at any time. The doctor performing this must ensure:
1. The patient is correctly identified. The doctor taking the blood sample must read the wristband, if available,and whenever possible, ask the patient to state his/her full name. This information must be checked against thecase notes.
2. Unconscious patient MUST be identified by the information given on the identity band, such as thewristband.
3. An emergency casualty who cannot be reliable identified must be given and identity band with a unique num-ber. This number must be used to identify this patient until full and correct personal details are available
4. The person who takes the blood and the person who labeled the blood sample must be same person.5. The sample must be labeled clearly and accurately at patient’s bedside immediately after blood taking. Use
only hand written label and never use preprinted label for labeling sample. The label should include thepatient’s full name, hospital registration number or Identity card number.
6. Never label samples from 2 or more patients at the same time.
7
FILLING BLOOD REQUST FORM—Refer to APPENDIX (Page 30)
Prescribing blood and blood products is the responsibility of the doctor managing the patient. However, thedoctor is encouraged to consult the doctor in-charge of the Blood Bank on the products to be given, the quantity,the duration of infusion, the precautions to be taken and any other related matters
1. The request form should be completely filled and contain relevant patient information(Full name, IC,Sex, Reason for transfusion, blood group if known, previous transfusion reaction and etc). No preprintedlabel is allowed. Please make sure your hand writing is clearly written and not confusing.
2. The hospital registration number (R/N) should be used on the request form for patients who, at the timeof admission, cannot be reliably identified. This R/N must be ‘unique’ and any investigations for thispatient must be identified using this number. When the patient’s full and correct details are available theward personnel should accurately communicate this information to the Blood Bank.
3. The quantity and the approximate time when the blood and blood component would be required must bestated. Requests for blood to be made available “as soon as possible / STAT” should be avoided as thiswould not assist the blood bank personnel in determining priorities.
4. he request form should be signed by the requesting doctor and his/her name should be stamped or writtenclearly in block letters.
BLOOD REQUEST IN NEWBORN / CHILDREN
1. For infant less than 4 month of age, blood sample must be accompanied by mother’s blood sample.2. For baby /child using parent’s IC, please filled up the detail of the infant as shown below:
• Nama : B/O Kamariah Bt Othman / Name of the child(Father/Mother’s name)
• Kad Pengenalan : 840223-01-5029M2
COLLECTING BLOOD / BLOOD COMPONENTS—Refer to APPENDIX 7, 8 & 9 (Page 32 – 36)
The person collecting the blood must bring documentary proof of the patient’s identity. At the time ofcollection, both blood bank personnel and the person collecting the blood must check that these details matchthose of the blood unit to be collected. Date and time of issues & collection, name of blood bank personnel & per-son collecting must be recorded.
STORAGE AND TRANSPORT OF BLOOD / BLOOD COMPONENTS—Refer to APPENDIX 8 & 9 (Page 35-37)
M1 — 1st childM2 — 2nd childM3 — 3rd child Note:
Please write down thechild’ date of birth /
8
Notes:First 50ml of each unit should be transfused slowly as itserves as an in vivo compatibility testing.Major blood transfusion reaction will develop within secondsafter the transfusion started.
ADMINISTRATION OF BLOOD / BLOOD COMPONENTS
—Refer to APPENDIX 6, 7, 10 (Page 32 – 37)
Each unit of blood component supplied from the Blood Bank should be accompanied by a compatibilitylabel. This should carry the following information.
1. At the time of transfusion the information on the compatibility label accompanying the blood componentmust be checked carefully against the patient’s identification details on the blood request from and patient’scase notes, including the patient’s wristband.
2. Blood should not be transfused if any of the details; especially the name and identification card number ofthe patient does not match exactly with that given on the accompanying compatibility label or the bloodrequest form.
3. Blood should not be transfused if there is deviation from the usual condition. Blood should be checkedmacroscopically for any alteration in color of the blood, presence of clot, leakage, etc. The blood bankshould be informed immediately for appropriate measures to be taken and the blood must be returned to theblood bank.
PRETRANSFUSION MEDICATIONS Prophylactic medication to prevent transfusion reaction is still controversial. Premedication such as antipyretic, antihistamine or corticosteroid can be administer (oral/IV route) 30-
60minutes before transfusion for individual with history allergic or urticarial reactions to transfu-sions in the past.
PATIENT MONITORING DURING TRANSFUSION
The patient’s vital signs, including temperature, pulse rate and blood pressure should be recorded during: Before starting the transfusion (As a baseline) As soon as the transfusion is started 15 minutes after starting transfusion At least every hour of transfusion On completion of transfusion
4 hour after completion of transfusion
TIME LIMITS FOR INFUSION OF BLOOD COMPONENTS—Refer to APPENDIX 10 (Page 37)
NIGHT TIME TRANSFUSION
Where the clinical condition permits, then transfusion at night must be avoided whenever possible, except foremergency cases as:
There is difficulty in visually detecting reactions. Lower staffing levels make it difficult to carry out the observations in a timely fashion. Risk of Blood Transfusion Reaction might be happen unnoticed
If Transfusion must occur at night, The light above the patient must remain on while the patient is being transfused. It should be ensured that sufficient number of staff is available to monitor the patient. Major Transfusion Reaction is life threatening, qualified Medical personal must be available imme-
diately in this situation.
9
USAGE OF BLOOD WARMER
There is no evidence that warming blood is beneficial to patient when infusion is slow (1unit over 2hour). Blood warmers are used to minimize the incidence of cardiac arrest and arrhythmias associated with mas-sive transfusion of cold blood components. Use of blood warmers should be limited to patients receiving multiple,rapid transfusion at rates of >50ml/kg/hr in adults and 15ml/kg/hr in children, and infants undergoing ex-change transfusion. Blood warmer to be used must have a visible thermometer and audible warning service. How-ever keeping the patient warm is probably more important than warming the infused blood.
DRUGS / FLUIDS ADMINSTRATION DURING TRANSFUSION
Red cell concentrates may be diluted with sodium chloride 0.9% to improve the flow rate. This is mostsimply achieved by using a Y pattern blood administration set. No solutions should be added to any blood compo-nent. This may contain additives such as calcium which can cause citrated blood to clot. Dextrose solution can ly-ses red cells.
Medicines should never be added directly to any blood components, if there is an adverse reaction duringtransfusion, it may be impossible to determine whether this is due to the blood, to the added drug or to aninteraction of the two.
If an intravenous fluid other than normal saline, or a colloid, has to be given at the same time as blood com-ponents, it should preferably be given through a separate IV line to avoid any risk of these problems. In asituation when the transfusion line is the only venous access available and a medication has to be given, the trans-fusion must be stopped and the tubing should be flush with 0.9% normal saline before and after injecting the medi-cation to prevent direct mixing of the blood and medication. The transfusion can then be resumed.
BLOOD TRANSFUSION REACTION—Refer to APPENDIX 12 (Page 40 – 41)Classification Acute Complication (Mild, Moderate Severe, Life Threatening)
Delayed Complication
Sign &Symptoms (Acute Complication)
Mild Moderate Life Threatening
Symptom
s
Pruritus• Anxiety,• SOB,• Palpitation,• Headache,
• Chest pain,• Pain at infusion site,• Respiratory distress ,• Loin/back pain
Signs
Rashes, Urticaria• Flushing,• Rigor, Fever,• Tachycardia,• Restlessness
• Hypotension,• Hematuria,• Unexplained Bleeding (DIC)
Possible C
auses
Hypersensitivity• Hypersensitivity ,• Non hemolytic Transfusion Reaction,• Contamination
• Acute Intravascular haemolysis*Major ABO incompatible
• Septic Shock,• Fluid overload,• T RALI
10
FLOWCHART IN MANGEMENT OF TRANSFUSION REACTION
A ) Mild Reaction
B) Moderate Reaction
C) Severe Life Threatening Reaction
b) Moderate Severe
Stop Transfusion
AdministerAntihistamine / Corticosteroid
No Improvement Symptoms Improve(30mins) (30mins)
Continue Transfusion(At Slower rate)
Stop Transfusion
Maintain ABC
Inform respective MO immediateltyMay required ICU Backup
AdministerAdrenaline / Frusemide
Corticosteroid / BronchodilatorInotrope / Antibiotic
According to Typeof reaction
Mild Transfusion reaction must be reported
Collection of sample for further Investigation isnot required
Please call MO blood bank for further clarifica-tion.
Moderate Severe Transfusion Reaction must bereported
Samples for investigation*EDTA Tube, Plain Tube & Urine*Other blood sample (if indicated)*Resent same sample 24hour later
All the blood products must be sent togetherwith the IV drip set to the blood bank for in-vestigation.
Please call MO blood bank for further clarifica-tion.
All Life Threatening Transfusion Reaction must bereported
*Samples for investigation*EDTA Tube, Plain Tube & Urine*Other blood sample (if indicated)
Resent same sample 24hour later
All the blood products must be sent together withthe IV drip set to the blood bank for investigation.
Please call MO blood bank for further clarifica-tion.
Stop Transfusion
AdministerAntihistamine / Antipyretic
Corticosteroid / Bronchodilator
No Improvement Symptoms Improve(15mins)
Withhold any transfusion for 24 hour
Restart transfusion with new blood products
According to Typeof reaction
11
TRANSFUSION OF BLOOD PRODUCT FROM CLOSED FAMILY MEMBERS / RELATIVE Blood transfusion within closed family / relative is not advisable. There is risk of develop of delayed type of blood transfusion complication(Graft versus host disease) Graft versus host disease occurs in situations.
Blood donor is homozygous and the recipient is heterozygous for an HLAhalotype (usually relativeblood)
Immunodeficient patients This type of delayed type of transfusion complication is cause by donor T Lymphocytes prolifera-
tion and attacking recipient’s tissues. Prevention of Graft versus host disease in blood transfusion :
Avoid Transfusion of blood products from closed family members / relatives. Gamma irradiation of blood products before transfusion (Facility not available in Hospital Batu
12
GUIDELINES IN CLINICAL USE OF BLOOD / BLOOD COMPONENTS
RED BLOOD CELL TRANSFUSION In deciding whether to transfuse red blood cells, the patient’s hemoglobin level, although important, should
not be the sole deciding factor. Patient signs and symptoms of hypoxia, ongoing blood loss, the risk to the pa-
tient of anemia and the risk or transfusion should be considered. Please refer to the following checklist be-
fore making any decision for blood transfusion:
Tak-enfrom:“The
Clinical Use of Blood by World Health Organization, Blood Transfusion Safety”
13
Taken from: “The Clinical Use of Blood by World Health Organization, Blood Transfusion Safety”
14
TRANSFUSION IN ANEMIA Blood transfusion should only be considered when the anemia is likely to cause or has already reduced the
oxygen supply to a level that is inadequate for the patient’s needs. Transfusion is rarely needed for patients with chronic anemia. Many transfusion are given that: Do not give the patient any benefit and may do harm. Could have been avoided by rapid and effective treatment not involving transfusion.
DO NOT TRANSFUSE MORE THAN NECESSARY. IF ONE UNIT OF RED CELLS IS ENOUGHTO CORRECT SYMPTOMS, DO NOT GIVE TWO UNITS.
Patient with severe anemia may be precipitate into cardiac failure by infusion of blood. If transfusion isnecessary, give one unit, preferable of red cell concentrate, over 2 to 4 hours and give rapid acting diuretic.
TRANSFUSION TRIGGERS
Taken From: “Guidelines For Rational Use of Blood and Blood Products by National BloodBank, Minister of Health, Malaysia”
Hb Consideration
< 70g/L Lower thresholds may be acceptable in patients without symptoms.
70 – 100g/LLikely to be appropriate during surgery associated with major blood loss or ifthere are signs or symptoms of impaired oxygen transport.
> 80g/LMay be appropriate to control anemia-related symptoms on a chronictransfusion regimen or during marrow suppressive therapy.
> 100 g/L Not likely to be appropriate unless there are specific indications.
15
GUIDELINES IN NEONATAL EXCHANGES TRANSFUSION
CALCULATIONS FOR NEONATAL EXCHANGE TRANSFUSION
SELECTION OF BLOOD GROUP FOR NEONATAL EXCHANGE TRANSFUSION
Taken From: “Transfusion Practice Guidelines for Clinical and Laboratory Personnel 3rd editionMarch 2008”
16
EXCHANGE TRANSFUSION PROCEDURE
Taken from “ The Clinical Use of Blood by World Health Oraganization, Blood Transfusion Safety"
17
NON RED CELL PRODUCTS
SELECTION OF NON RED CELL PRODUCTSRecommended ABO group for plasma products (FFP, Cryoprecipitate)
Platelet Concentrates in order preference should be: Patient’s own ABO group ABO antigen compatible (but plasma incompatible) ABO antigen incompatible
GUIDELINES IN PLATELETS TRANSFUSION 1 unit random platelet will increases platelet count up to 5-10 x 109 Cut off values of platelet count for platelet transfusion :
Taken From: “Guidelines For Rational Use of Blood and Blood Products by National Blood Bank, Minis-ter of Health, Malaysia”
Clinical Indication Cut off values of platelet countHematological Malignancies <20x109
PROCEDURE
Bone marrow Aspiration <20x109, providing adequate surface pressure is applied
Lumbar Puncture, Epidural,OGDS, Indwelling lines,Biopsy, Laparotomy
<50x109
Brain & Eye operation <100x109
MASSIVE TRANSFUSION
Acute Bleeding <50x109
Multiple Trauma / CNS Injury <100x109
DISSEMINATED INTRASCULAR COAGULATION
Acute DIVC <50x109
DIVC with absence of bleeding Platelet transfusion should not be given
IMMUNE THROMBOCYTOPENIA
AutoimmuneThrombocytopenia
Only for life – threatening bleeding form GIT/GUT/CNS and other con-ditions with severe thrombocytopenia (<10x109 )
Neonatal AutoimmuneThrombocytopenia (NAITP)
Transfuse compatible platelet ASAP, ideally HPA-1a neg, HPA-5b neg.Platelet prepared from mother should be irradiated and washed
Post Transfusion Purpura Platelet transfusion usually ineffective, maybe used in acute phase e.g opera-tion
PLATELET TRANSFUSION IN DENGUE FEVER – Please refer to latest CPG in Management of Dengue
PLATELET FUNCTION DISORDERS
Platelet only indicated if other measures fail to control bleeding
18
Decision for platelet Transfusion
Tak- en
from :New York State Council on Human Blood and Transfusion Services( http://www.gosh.nhs.uk/health-professionals/clinical-guidelines/platelet-ordering/?locale=en )
19
GUIDELINES IN FFP TRANSFUSION (10 - 15ml/kg)
Taken From: “Guidelines For Rational Use of Blood and Blood Products by National Blood Bank, Min-ister of Health, Malaysia”
NOTES FFP is not indicated in DIC without evidence of bleeding. There is no evidence that prophylactic replacement regimens prevent DIC or reduce transfusion
requirement When used for surgical or traumatic bleeding, FFP usage should be guided by coagulation profiles.
20
GUIDELINES OF CRYOPRECIPITATE TRANSFUSION (5-10ML/kg)
Indicated if the plasma fibrinogen is < 1g/L
Taken From: “Guidelines For Rational Use of Blood and Blood Products by National Blood Bank, Minister of Health,Malaysia”
21
GUIDELINES IN MANAGEMEN OF DISSEMINATED INTRAVASCULAR COAGUALATION
Taken from : “The Clinical Use of Blood by World Health Organisation, Blood Transfusion Safety”
22
WHAT IS CT RATIO ?
CT RATIO
23
Laboratory QA Programme - National Indicator Approach
PROGRAMME : Laboratory QA Programme (Transfusion)
AREA OF CONCERN : Transfusion for Group and Crossmatch blood .
INDICATOR : CROSSMATCH : TRANSFUSION (C:T) RATIO
Rationale : This indicator is to assess the app ropriateness of crossmatching of blood in comparison tothe unit s of blood transfused. A C/T ratioof more than 2.5:1 reflects inappropriateness ofcrossmatching and thus lead to the increase in workload, cost, wastage and compromises inthe quality of blood.
Definition of Terms :
Crossmatch Is a compatibility test carried out on patient’s serum with donor red blood cells beforeblood is transfused.
Transfusion Is the infusion of crossmatched whole blood or red cell concentrate to the pa-tient.
C:T Ratio C:T ratio is:Number of units of blood crossmatched
Number of units of blood transfused
Inclusion criteria : All crossmatches done in blood bank
Exclusion criteria : Safe Group O blood given without crossmatch in an emergency.
Type of Indicator : Efficiency.
Numerator : Number of units of blood crossmatched
Denominator : Number of units blood transfused
Standard : No greater than 2.5 : 1
24
“CT RATIO”HOSPITAL BATU PAHAT STANDARD = < 2.5
1.24 1.25 1.19 1.21 1.22 1.20
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
2008 2009 2010 2011 2012 2013
CT Ratio (MEDICAL)
1.16 1.17 1.14 1.14 1.13 1.27
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
2008 2009 2010 2011 2012 2013
CT Ratio (PEADIATRIK)
2.20 2.10 2.23
2.97
2.54
2.13
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
2008 2009 2010 2011 2012 2013
CT Ratio (O & G)
1.891.66 1.67 1.59 1.59 1.44
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
2008 2009 2010 2011 2012 2013
CT Ratio (SURGICAL)
1.47 1.52 1.631.84
1.43 1.38
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
2008 2009 2010 2011 2012 2013
CT Ratio (ORTHO)
25
APPENDIX
26
APPENDIX 1
27
APPENDIX 2
GENENRAL SURGICALGSH GXM
CholecystectomyColectomyColostomy ClosureHemicolectomySmall Bowel ResectionHiatus Hernia RepairInguinal Hernia RepairThyroidectomy
ParathyroidectomyVagotomyVaricose VeinsMastectomyLaparotomy
4 PINTSAbdominal Perineal ResectionOesophagectomyPancreatectomyPortocaval ShuntWhipple’s ProcedureLaporatomy for intrabdominal haemorrhage / Perforated
Viscus
2 PINTSGastrectomyHiatus Hernia Repair - TransthoracicSplenectomy
OBSTECTRIC & GYNAECOLOGYGSH GXM
Induction of labourHigh risk pregnancy in labourDiagnostic Laparoscopy For Ectopic pregnancyAll LSCS except bleedingAll Other Gynaecological Operations
TerminationD&CVaginal RepairManual Removal Of PlacentaEvacuation Under AnesthesiaVaginal Hysterectomy
2 PINTSHysterectomy - WertheimBleeding Placenta PreviaAbruptio PlacentaMyomectomyVulvectomySevere Endometriosis For TAHMolar PregnancyEctopic Pregnancy For LaparotomyHigh risk LSCS
Anaemia cases Hb < 9g%Classical Caesarian SectionPlacenta Previa with Previous scar
ORTHOPAEDIC DEPARTMENTGSH GXM
Trauma - Upper LimbShoulder And Humerus Shaft
SurgeryTrauma - Lower Limb
Tibia shaft/Plateau (Plating/Interlocking)
Femur Interlocking /Plating/IMNTrauma - Hip
HemiarthroplastyDynamic Hip Screw Fixation
ArthroplastyTotal Knee Arthroplasty
Paediatric OrthopaedicAll surgeries with tourniquet
SpineLaminectomySpinal Fusion
MiscellaneousElective Below knee Amputation
(BKA)Elective Above knee Amputation
(AKA)Arthrodesis of major joints
1 PINTTrauma – Pelvic
Pelvic Surgery- Acetabulum
2PINTSTotal Knee Replacement
3 PINTSTotal Hip ReplacementTumor SurgeryEndosprosthesisTumor resection
EAR, NOSE & THROAT
GSHRhinoplastyParotidectomy
TonsilectomyAdenoidectom
AdenotonsilectomyDrainage of retropharyneal & Parapharyngeal abscess
MAXIMUM SURGICAL BLOOD ORDER SCHEDULE (MSBOS)UNIT TABUNG DARAH
HOSPITAL BATU PAHAT
28
APPENDIX 3
29
APPENDIX 4
CHECKLIST FOR TAKING BLOOD FOR GROUP AND CROSSMATCH
Taken From: Transfusion Practice Guidelines For Clinical and Laboratory Personnel, 3rd Edition 2008 by National
Blood Centre, Ministry Of Health Malaysia.
30
APPENDIX 5
31
APPENDIX 6
32
Gro
up,S
cree
n&
Hol
d(G
SH)
Pac
ked
Cel
lF
FP
/C
RY
OP
late
let
Con
cen-
trat
ion
Ord
erin
g(E
DT
A T
ube)
P
erm
issi
on f
rom
MO
blo
od b
ank
isno
t nec
essa
ry
Req
uest
acc
ordi
ng to
MSB
OS
Sa
mpl
e w
ill b
e ke
pt f
or 7
2hou
rs
Per
mis
sion
fro
m M
O b
lood
ban
k is
need
ed if
req
uire
con
vers
ion
form
GSH
to G
XM
O
nce
conv
erte
d is
con
side
r us
ed, n
ewre
ques
t is
need
ed a
fter
con
vers
ion
P
erm
issi
on f
rom
MO
blo
od b
ank
is n
eede
d
No
sam
ple
is r
equi
red
if p
atie
nt h
as r
ecor
ds o
fpr
evio
us tr
ansf
usio
n du
ring
cur
rent
adm
issi
on.
R
eque
st w
hen
need
ed
No
rese
rvat
ion
/sta
ndby
is a
llow
Tur
n A
roun
dP
roce
ssin
g(T
AT
)
Blo
od &
Rh
Gro
upin
g
Ant
ibod
y Sc
reen
ing
Blo
od &
Rh
Gro
upin
g
Salin
e C
ross
mat
chin
g
Doc
umen
tatio
n
Blo
od w
as s
uppl
ied
Pro
ceed
to F
ull C
ross
mat
chin
g
Blo
od &
Rh
Gro
upin
g
GX
M
Doc
umen
tatio
n
Blo
od is
rea
dy f
or c
olle
ctio
n
Blo
od &
Rh
Gro
upin
g
Doc
umen
tatio
n
Blo
od p
rodu
cts
is s
uppl
ied
Em
erge
ncy
G
et p
erm
issi
on f
rom
MO
blo
od b
ank
In
form
Blo
od B
ank
R
un f
or b
lood
Reg
ular
G
et p
erm
issi
on f
orm
MO
blo
od b
ank.
D
ispa
tch
requ
est f
orm
& b
lood
sam
ple
to b
lood
ban
k
Pos
itive
Pro
ceed
toG
XM
Dir
ectl
y
Neg
ativ
e
Sam
ple
will
be
kept
for
72h
rs
1.T
he d
urat
ion
of p
roce
ssin
g w
ill v
arie
s ac
cord
ing
to w
orkl
oads
& a
vaila
bilit
y of
com
patib
le b
lood
/ bl
ood
prod
ucts
2.T
he a
bove
est
imat
ed d
urat
ion
of p
roce
ssin
g on
ly v
alid
if n
o pr
oble
ms
foun
d du
ring
Ant
ibod
y Sc
reen
ing
/ Cro
ss m
atch
ing
& a
vaila
bili
ty o
f co
mpa
tible
bloo
d.3.
Ref
erra
l to
HS
AJB
/ P
usat
Dar
ah N
egar
a w
ill b
e re
quir
ed f
or a
ny d
iffi
cult
cros
s m
atch
ing.
In
this
sit
uatio
n, it
may
req
uire
2-3
or m
ore
wor
king
day
sfo
r th
e pr
oces
s.
< 3
0 m
in
1–
2 ho
urs
or m
ore,
dep
end
onav
aila
bilit
y of
com
pati
-bl
e bl
ood
< 3
0 m
in
If
pat
ient
hav
e hi
stor
y of
blo
od tr
ansf
usio
ndu
ring
cur
rent
adm
issi
on, n
o bl
ood
sam
ple
is r
equi
red.
P
late
le/F
FP/C
RY
O w
ill b
e su
pplie
d di
rect
-ly
acc
ordi
ng to
blo
od g
roup
ing
APPENDIX 7
33
Gro
up,S
cree
n&
Hol
d(G
SH)
Em
erge
ncy
Who
le B
lood
Pac
ked
Cel
l(C
ompl
eted
GX
M)
FF
P /
CR
YO
Pla
tele
t C
once
ntra
tion
Dur
atio
n of
res
er-
vati
on
24 h
ours
befo
re r
elea
se
No
rese
rvat
ion
is a
llow
R
eque
st w
hen
requ
ire
Supp
ly
Blo
odB
ox w
ith
Ice
A
fter
bloo
dgr
oupi
ngan
d sa
line
cros
s-m
atch
ing
D
octo
r/ s
taff
mus
t rus
hto
bloo
dba
nkw
ith ic
ebox
imm
edia
tely
Aft
ercr
oss-
mat
chin
g
Aft
er G
roup
ing
N
ocr
oss-
mat
chin
g re
quir
ed
Req
uest
onl
yw
hen
requ
ired
Col
lect
ion
Blo
odB
ox w
ith
Ice
Blo
odB
ox w
itho
utIc
e
Use
/ Tra
nsfu
sed
M
ust b
e tr
ansf
use
imm
edia
tely
wit
hin
30af
ter
colle
c-tio
n, p
leas
e re
turn
imm
edia
tely
to b
lood
ban
k if
not
tran
sfus
e
C
ompl
eted
Tra
nsfu
sion
wit
hin
4 ho
ur
FF
P/C
RY
O
Ple
ase
info
rm t
he b
lood
ban
k b
efor
e co
elle
ctio
n (t
haw
ing)
T
rans
fuse
imm
edia
tely
aft
er th
awin
g , t
o co
mpl
ete
tran
sfus
ion
wit
hin
4 h
ours
PL
AT
EL
ET
ST
rans
fuse
imm
edia
tely
, to
com
plet
e tr
ansf
usio
n as
soo
n as
pos
sibl
e
Stor
age
St
ore
atle
ss th
an-2
5°C
Sh
ould
not
best
ored
or
kept
inth
ew
ards
M
ustb
e tr
ansf
used
as s
oon
aspo
ssib
le a
fter
thaw
ing
C
oagu
latio
n fa
ctor
will
be
degr
aded
rapi
dly
afte
r th
aw-
ing
R
oom
Tem
pera
ture
+20
°C +
24°
Con
agita
tor
N
ever
sto
re in
ref
rige
rato
r
St
ore
atte
mpe
ratu
re+
2°C
to +
6°C
B
lood
sho
uld
notb
e st
ore
inw
ard
for
mor
eth
an 4
hour
.
St
andb
ybl
ood
for
surg
ery
inO
pera
tion
The
ater
mus
tbe
sto
rein
wel
lmon
itore
d te
mpe
ratu
rebl
ood
frid
ge.
34
Gro
up,S
cree
n&
Hol
d(G
SH)
FF
P /
CR
YO
Pla
tele
t C
once
ntra
tion
Ret
urn
Ret
urn
imm
edia
tely
ifno
t use
d
Aft
erus
eFi
llup
the
Blo
od T
agan
d re
turn
toge
ther
with
empt
y ba
gto
blo
odba
nkas
soo
n as
poss
ible
Pac
ked
Cel
l
Impo
rtan
ceno
tes:
C
heck
list
befo
rede
cide
dto
col
lect
bloo
dpr
oduc
tsfr
ombl
ood
bank
C
onse
ntfo
rtr
ansf
usio
n
P
rese
ntof
func
tioni
ngIV
acce
ss
V
itals
sign
of th
epa
tient
is s
tabl
e
Ple
ase
tran
sfus
ebl
ood
prod
ucts
imm
edia
tely
,blo
odm
ustN
EV
ER
best
ored
ina
war
dor
drug
sre
frig
erat
orun
der
any
circ
umst
ance
s.
Stan
dby
Blo
odfo
rpa
tient
sdu
ring
surg
ery
and
inth
eim
med
iate
post
-ope
rativ
epe
riod
mus
tbe
stor
edin
the
TH
EA
TR
Ebl
ood
frid
ge.
A
LL
BL
OO
DP
RO
DU
CT
SM
UST
BE
RE
TU
RN
IMM
ED
IAT
EL
YT
OB
LO
OD
BA
NK
IF N
OT
USE
.
35
APPENDIX 8
CO
LL
EC
TIO
N&
RE
TU
RN
ING
OF
BL
OO
DP
RO
DU
CT
S
Ple
ase
use
diff
eren
tblo
odbo
xfo
rco
llect
ion
ofbl
ood
prod
ucto
f di
ffer
ent
patie
ntA
bove
prac
tice
isto
prev
ents
witc
hing
of b
lood
prod
ucts
duri
ngtr
ansf
u-si
on,t
hus
prev
entm
ajor
tran
sfus
ion
com
plic
atio
n.
BL
OO
D P
RO
DU
CT
SP
LE
ASE
USE
SE
PA
RA
TO
RP
leas
e pr
epar
e a
sepa
rato
r be
twee
n th
e ic
e pa
ck a
nd th
e bl
ood
prod
ucts
Dir
ect c
onta
ct o
f bl
ood
wit
h th
e ic
e w
ill c
ause
red
blo
od c
ell t
o ly
ses.
PL
EA
SEU
SE F
RO
ZE
NIC
EP
AC
KP
leas
em
ake
sure
you
have
afr
ozen
ice
pack
bef
ore
you
com
eto
colle
ctbl
ood
prod
ucts
Par
tial
lyfr
ozen
orm
elt
ice
pack
isst
rict
lyno
tal
low
Thi
s is
toen
sure
the
cold
chan
ges
isw
ellm
aint
ain
duri
ngth
etr
ansp
orta
-tio
nof
the
bloo
dpr
oduc
ts.
FOR
ZE
N I
CE
PA
CK
PL
AT
EL
ET
CO
LL
EC
TIO
N!!
!N
oic
epa
cked
isne
eded
duri
ngpl
atel
etco
llect
ion
Ple
ase
mak
esu
reyo
uha
veat
leas
ttw
o/m
ore
bloo
dbo
x(1
with
ice
,an
ther
wit
hout
ice)
,in
situ
atio
nw
hen
you
requ
ire
toco
llect
othe
r bl
ood
prod
-uc
ts d
urin
gth
esa
me
tim
e.T
hepl
atel
etm
ustb
est
ore
atro
omte
mpe
ratu
re(2
0Cto
24C
)on
agi
tato
rto
prev
ent p
late
letc
lum
ping
and
mai
ntai
nits
func
tion
CO
LL
EC
TIO
NO
F B
LO
OD
/BL
OO
DP
RO
DU
CT
S
36
STO
RA
GE
OF
BL
OO
DP
RO
DU
CT
SP
RIO
RT
OT
RA
NSF
USI
ON
RE
D C
EL
LS
AN
DW
HO
LE
BL
OO
D
Red
cell
san
dw
hole
bloo
dm
usta
lway
sbe
sto
red
at a
tem
pera
ture
betw
een
+2°
Cto
+6°
C.T
hey
mus
tnev
erbe
allo
wed
tofr
eeze
.
The
uppe
rli
mit
of6°
Cus
esse
ntia
lto
min
imiz
eth
egr
owth
ofan
yba
cter
ial
cont
amin
atio
nin
the
unit
ofbl
ood.
The
low
erli
mit
of2
°Cus
esse
ntia
lbec
ause
red
cell
sth
atar
eal
low
edto
free
zebe
com
eha
emol
ysed
.If
they
are
tran
sfus
ed,
the
pres
ence
ofce
llfr
agm
ents
and
free
haem
oglo
bin
can
caus
efa
talb
leed
ing
prob
lem
sor
ren
alfa
ilur
e.
The
solu
tion
inth
ebl
ood
bag
cont
ains
both
anti
coag
ulan
t(s
odiu
mci
trat
e)to
stop
bloo
dfr
omcl
ottin
gan
dde
xtro
se(g
luco
se)
to‘fe
ed’
the
red
cell
sdu
ring
sto
rage
.Sto
rage
ata
tem
pera
ture
betw
een
2°C
to6°
Cis
esse
ntia
lto
mak
esu
reth
ede
xtro
seis
notu
sed
toqu
ickl
y.
Who
lebl
ood
and
red
cells
shou
ldbe
issu
edfr
omth
ebl
ood
bank
in a
bloo
dtr
ansp
ortb
ox o
rin
sula
ted
carr
ier
O
nce
the
Who
lebl
ood
and
Red
cell
sar
eco
llect
ed,i
t mus
tbe
infu
sed
wit
hin
30m
inut
es.
W
HO
LE
BL
OO
D/ P
AC
KE
DC
EL
Lar
eno
tallo
wed
toke
epin
war
d cl
inic
alre
frig
erat
orat
anyt
ime.
F
orop
erat
ive
case
s,un
less
requ
ired
for
imm
edia
tetr
ansf
usio
n,W
HO
LE
BL
OO
D/P
AC
KE
DC
EL
Lfo
rST
AN
DB
YP
UR
-P
OSE
shou
ldbe
stor
edop
erat
ing
thea
tre
bloo
dre
frig
erat
orat
ate
mpe
ratu
rebe
twee
n2°
Cto
6°C
W
HO
LE
BL
OO
D/ P
AC
KE
DC
EL
LM
UST
BE
RE
TU
RN
IMM
ED
IAT
EL
YT
OB
LO
OD
BA
NK
IFN
OT
USE
D
PL
AT
EL
ET
CO
NC
EN
TR
AT
ES
P
late
letc
once
ntra
tes
mus
tbe
kept
ata
tem
pera
ture
of 2
0°C
to24
°Con
apl
atel
etag
itat
orto
mai
ntai
npl
atel
etfu
ncti
on.S
ince
ther
eis
ari
skof
bact
eria
prol
ifer
atio
n,th
est
orag
elif
e is
rest
rict
edto
3to
5da
ys.P
late
lets
that
are
held
atl
ower
tem
pera
ture
lose
thei
rbl
ood
clot
ting
ca-
pabi
lity
.
Pla
tele
tcon
cent
rate
ssh
ould
beis
sued
from
the
bloo
dba
nkin
abl
ood
box
or in
sula
ted
carr
ier
that
wil
lkee
pth
ete
mpe
ratu
reat
abou
t20°
Cto
24°C
P
late
letc
once
ntra
tes
shou
ldbe
tran
sfus
edas
soon
aspo
ssib
le.T
hey
shou
ldne
ver
bepl
ace
in a
refr
iger
ator
.Tra
nsfu
sion
afte
r30
min
utes
isof
nous
efo
r tr
eatm
ent
sinc
eth
epl
atel
etlo
ses
thei
rfu
ncti
ons.
FR
ESH
FR
OZ
EN
PL
ASM
A
Fres
hfr
ozen
plas
ma
mus
tbe
stor
edin
the
bloo
dba
nkat
ate
mpe
ratu
reof
-25°
Cor
cold
erun
tili
tis
thaw
edbe
fore
tran
sfus
ion.
M
ost
clot
ting
fact
ors
are
stab
leat
refr
iger
ator
tem
pera
ture
s,ex
cept
for
Fac
tor
Van
dFa
ctor
VII
I.If
plas
ma
isno
tst
ored
froz
enat
-25°
Cor
cold
er, F
acto
r V
III
and
Fac
tor
Vfa
lls
rapi
dly
over
24ho
urs.
Pla
sma
wit
h a
redu
ced
Fac
tor
VII
Ile
vel i
sof
nous
efo
rtr
eatm
ent.
Fr
esh
froz
enpl
asm
ash
ould
beth
awed
inbl
ood
bank
ina
wat
erba
thbe
twee
n+
30°C
to37
°Can
dis
sued
ina
bloo
dtr
ansp
ort
box
inw
hich
the
tem
pera
ture
ism
aint
aine
dbe
twee
n+2
°Cto
6°C
FF
Psh
ould
bein
fuse
dw
ithi
n30
min
utes
ofth
awin
g.T
rans
fusi
onaf
ter
30m
inut
esis
ofno
use
for
trea
tmen
tsi
nce
the
func
tion
ofcl
otti
ngfa
ctor
sde
grad
esra
pidl
yaf
ter
thaw
ing.
APPENDIX 9
37
TIM
EL
IMIT
SF
OR
INF
USI
ON
S
STA
RT
INF
USI
ON
CO
MP
LE
TE
INF
USI
ON
WH
OL
EB
LO
OD
(450
ml)
/RE
DC
EL
LS
(150
-200
ml)
Whi
tin30
min
utes
aft
er c
olle
ctio
n<
4ho
urs
PL
AT
EL
ET
CO
NC
EN
TR
AT
ES
(50-
60m
l)A
sso
onas
poss
ible
As
soon
aspo
ssib
le
FR
ESH
FR
OZ
EN
PL
ASM
A(2
00-3
00m
l)C
RY
OP
RE
CIP
ITA
TE
(10-
20m
l)Im
med
iate
ly (
afte
r th
awin
g)<
4ho
urs
APPENDIX 10
38
HO
WT
OU
SEB
LO
OD
STIC
KE
RAPPENDIX 11
UP
PE
R S
EC
TIO
N:
Fill
up
the
deta
ils o
f tr
ansf
usio
n co
mpl
etel
yR
etur
n th
e ca
rd t
oget
her
wit
h em
pty
bloo
d ba
gs t
oB
lood
Ban
k as
soo
n as
pos
sibl
e
LO
WE
R S
EC
TIO
N:
Fill
up
the
deta
ils o
f tr
ansf
usio
n co
mpl
etel
yPa
ste
on p
atie
nt’ f
ile fo
r fu
ture
ref
eren
ce
39
APPENDIX 12
40
APPENDIX 13
41
APPENDIX 14
42
UNIT TABUNG DARAHJABATAN PATOLOGI
HOSPITAL BATU PAHAT
BORANG PEMULANGAN DARAH / KOMPONEN DARAH
Nama Pesakit _____________________________________________ Wad : _________________
K/P : ______________________________________________ R/N : ________________________
Umur : _________________ tahun Bangsa : _____________ Jantina : Lelaki / Perempuan
Nama & Tandatangan Pegawai Yang Memulangkan:Tarikh :Masa
Nama & Tandatangan Pegawai Yang Menerima :Tarikh :Masa :
BIL TARIKH & MA-SA DIAMBIL
JENIS DARAH / KOPONEN(WB/PCPlatelet/FFP/Cryo/dll)
NO SIRI BEGDARAH
SEBAB –SEBABPEMULANGAN
BOR / HBP / PAT / 005 / Issue 1 /Rev.0 / 21.07.2008
APPENDIX 15
43
REFERENCES
TRANSFUSION PRACTICE GUILDLINES FOR CLINICAL AND LABORATORY PERSONNEL,3RD EDITION 2008 (By National Blood Centre, Ministry Of Health Malaysia)Website: http://www.pdn.gov.my
GUILDLINES FOR THE RATIONAL USE OF BLOOD AND BLOOD PRODUCTS, 2ND EDITION2007 (By National Blood Centre, Ministry Of Health Malaysia)Website: http://www.pdn.gov.my
LABORATORY MANUAL (By Unit Transfusion medicine, HSAJB)Website: http://hsajb.moh.gov.my/modules/xt_conteudo/index.php?&id=196
THE CLINICAL USE OF BLOOD(By World Health Organization, Blood Transfusion Safety)Website: http://www.who.int/bloodsafety/clinical_use/en/Manual_EN.pdf
TECHNICAL MANUAL(By American Association of Blood Bank)
A PHYSICIAN’S GUIDE TO TRANSFUSION OPTIONS (By New York State Council on HumanBlood and Transfusion Services, Second Edition 2008)
OTHER REFERENCE / WEBSITEMOH Dengue Management CPG( http://moh.gov.my/v/id )MOH Management of Thalassemia( http://moh.gov.my/v/ha )MOH Management of ITP (http://moh.gov.my/v/hae )http://www.transfusionguidelines.org.uk/docs/pdfs/htm_edition-4_all-pages.pdfhttp://www.gosh.nhs.uk/clinical_information/clinical_guidelines?category=Blood%20transfusionhttp://www.sld.cu/galerias/pdf/sitios/anestesiologia/practical_guidelines_blood_transfusion.pdfhttp://www.nhmrc.gov.au/publications/synopses/cp77syn.htm
44
45
Notes
46
Notes
47
Notes
48
TERIMA KASIH DARI UNIT TABUNG DARAH HBP
