Module 2: Request for blood and
blood components
Transfusion Training Workshop
KKM 2012
Case 1

24 year-old lady

Problem: underbite

Scheduled for orthognathic surgery

Hb is 11.7 g/dL

Packed red cells are requested
What would you request?
Group, Screen and Hold (GSH)

Group:


Screen:


ABO, Rh grouping
antibody screen and identification
Hold:

hold the sample for 48h
How to make a request for GSH

Inform patient the possibility of a transfusion

Fill in request form

Confirm patient’s identity

Take blood sample

Label sample at bedside



NEVER use pre-printed labels
NEVER pre-label tubes
Send sample and request form to BB
COMPLETE INFORMATION
Form: Complete Information
Case 2

55 year-old man, chronic smoker

c/o swelling R buccal mucosa & R neck x 2 months

HPE: squamous cell carcinoma

Planned for surgery

Hb is 12.5 g/dL

Packed cells are requested
What would you request?
Group cross-match (GXM)

Group:


Screen:


ABO, Rh grouping
antibody screen and identification
Cross-match:



Immediate spin/ RT
LISS 370C
AHG
How to make a request for
GXM
Making a request for GXM

Inform patient the likelihood of a transfusion

Fill in request form

Confirm patient’s identity

Take blood sample

Label sample at bedside


NEVER use pre-printed labels
NEVER pre-label tubes

Send sample and request form to BB

Collect blood with blood collection slip and blood box
Blood collection slip
GXM vs. GSH

GSH

Blood is not prepared
for patient

ONLY the sample is
processed

BUT can easily convert
to GXM if required

GXM

Blood is prepared for
patient

Sample is cross-matched
with donor red cells

BUT this increases workload
Case 3

En SY, 56 year-old man

Presented to A&E with torrential per-rectal
bleeding

O/E: Pale+++

Packed cells are requested
PR: 120
BP: 106/60
What would you request?
Emergency Cross-match

Send sample + request
form a.s.a.p

Discuss with blood bank
MO on call

Doctor or staff to standby
at BB with an ice box

Verify blood upon release
COMPLETE INFORMATION
Form: Complete Information
Case 4

21 year-old lady

Post-stem cell transplant for acute myeloid
leukaemia

Platelet count is 10 x 109/L

Platelet concentrates are requested
Request for platelets

Discuss the case with the blood bank MO on call

Once approved, send request form

NO BLOOD SAMPLE required if blood group is
known and in BB records

Collection slip will be issued once platelets are
ready
COMPLETE INFORMATION
Form: Complete Information
Case 5

56 year-old lady

Admitted to ICU for necrotising fascitis of
left leg

Prepared for amputation of left leg

Coagulation profile was deranged

Fresh frozen plasma was requested
Request for fresh frozen plasma

Discuss with Blood Bank MO on call

Once approved, send request form

NO BLOOD SAMPLE required if blood group is
known and in BB records

Thawing of plasma takes 30 minutes

Collection slip issued once plasma is ready
COMPLETE INFORMATION
Form: Complete Information
Case 6

26 year-old lady

Elective LSCS for transverse lie

Group B, D negative

GXM 2 units PRBC

Requested for PRBC to be in OT
Case 7

45 year-old lady

Long-term anticoagulation for recurrent DVT

Admitted for elective knee arthroscopy

Warfarin stopped 5 days

INR 1.6 on day before surgery

2 units FFP requested
Case 6 – cont’d

LSCS uneventful

PRBC returned

Was GXM necessary?

Why bring PRBCs to OT when it takes only
20 minutes to convert GSH to GXM?
Case 7 – cont’d

FFP brought to OT

INR 1.3 on day of surgery

Arthroscopy went well

FFP transfused anyway after procedure

Reason: need to write explanation letter to BB
Returning unused blood

Best practice is NOT to remove blood/
components from BB until needed

Packed red cells, whole blood are stored in
blood refrigerators at 4±2°C

Domestic refrigerators are not meant for blood

Plasma products (FFP, CryoP) are kept frozen
and thawed ONLY upon request

Once thawed, they cannot be frozen again
Returning unused blood

However, DO NOT TRANSFUSE if deemed
UNNECESSARY

Best to return than to transfuse inappropriately

If returned:




Place PRBC, WB and FFP in blood box with ice
Return platelets in blood box without ice
Fill in ‘borang pemulangan darah’ or brief
explanation letter (memo)
Blood bank WILL NOT reprimand you
Returning unused blood/ blood
components

Call & inform BB

Complete ‘ borang pemulangan darah’ or
write a memo

Return blood/ components in separate plastic
bags with ‘borang pemulangan darah/ memo’
Memo

Name of patient and AM no.

Type of blood/ component

Blood bag no.

Reason/s for returning the blood/ component
Return ofof
Used
blood Bag
Proper return
blood
components
Improper return of used blood
The next time you decide
to transfuse
Stop, think and ask yourself …
Is it really necessary?
Be aware of the risks of transfusion and the
morbidity/ mortality associated with it!

Febrile/ non-febrile transfusion reactions

Wrong blood

Bacteremia

Transfusion-related acute lung injury (TRALI)

Transfusion-transmitted infections (TTI)
The end