Final FRCA Study Day
Blood Transfusion Issues
Mary P. Mc Nicholl
Haemovigilance Practitioner
25th October 2013
Overview
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How to respond in a timely & appropriate
manner when a patient has a massive
haemorrhage.
ABO incompatible transfusions.
Transfusion Reactions.
Background - MHP
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Oct 2006 to Sep 2010 - 11 deaths & 83
incidents - patient harm relating to delays in
provision of blood in acute situation (NPSA).
RRR issued by NPSA 21.10.10.
Approved by DHSSPS 18.11.10 - Circular
Reference: HSC (SQSD) 16/10.
WHSCT Major Haemorrhage Protocol
(MHP) active since May 2011.
Key Points
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Local protocols with a trigger phrase.
Dedicated communicator with Blood Bank &
Support Services (ie Porters).
Early / easy release of blood components
from Blood Bank.
All cases reviewed by Hospital Transfusion
Committee & delays/problems investigated
locally / reported externally as required.
DEFINITION OF
MAJOR BLOOD LOSS
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Loss of one blood volume within a 24hr period
– Normal adult blood volume approx 70ml/kg
ideal body weight; 80-90ml/kg in children.
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Loss of 50% blood volume within 3 hours.
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Loss of blood at rate in excess of 150mls/minute.
Correction of low haemoglobin
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Immediately – uncrossmatched group O negative
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Group Specific – 15 minutes after accurately
labelled sample delivered to Blood Bank
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Crossmatched – 45 minutes after accurately
labelled sample delivered to Blood Bank
Uncrossmatched Group O Negative blood available in
Altnagelvin – Satellite Blood Fridge, Recovery Area, Theatres
Communication of Emergency
 Clinical area must ensure Blood Bank aware of patient with
haemorrhage ASAP.
 Locally agreed & well understood trigger term:‘I want to activate the Major Haemorrhage Protocol’
 Provide the following information:
1. Patient details.
2. Clinical situation.
3. Clinical area.
4. Urgency of Blood Components.
5. What Blood Components to be sent to Clinical Area.
6. Contact details (Name & Contact Number) of person nominated
to be responsible for liaising with Blood Bank.
Use term ‘In relation to Activation of Major
Haemorrhage Protocol in A&E …’ for all subsequent
calls to Blood Bank.
2nd Phone Call when activating MHP
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Contact Porters.
State ‘I have activated the Major Haemorrhage
Protocol.’
Inform Porter:
Clinical Area
Where to go (eg to Satellite Blood Fridge for
uncrossmatched O negative blood; to clinical
area to collect sample; to Blood Bank to collect
units).
Porter will remain between Clinical Area & Blood
Bank until the MHP is deactivated.
Blood Bank Protocol on Activation
 BMS will prepare:– 6 units red cells (45 minutes from receipt of sample)
– 4 units Fresh Frozen Plasma (takes 30 minutes to thaw)
– Order 2 units Platelets from NIBTS, Belfast
 Group specific blood (available 15 minutes after accurately
labelled sample sent to Blood Bank) – safer than
emergency O negative.
213830
213830
Stand Down
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At the point where emergency is perceived
to be ended contact Blood Bank.
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State ‘I want to deactivate the Major
Haemorrhage Protocol.’
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Blood Bank will then make contact with
Porters.
Key Learning Points
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Need for positive patient identification.
Need for accurately labelled samples.
Excellent communication required between
Clinical Area/Blood Bank/Porters.
Know the WHSCT Major Haemorrhage
Protocol…
Emergency Transfusions
BBT3 states:
Every effort must be made to monitor vital
signs during emergency transfusions.
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A list of all blood components / blood
products transfused during the emergency
should be recorded.
Uncrossmatched O negative units
have no patient details. Prior to
administering units: - Confirm units are O Rh D negative.
- Check expiry date and pack for
leaks/ clumping.
If uncrossmatched O negative unit used,
remove this label & stick in the patient
casenotes under current admission notes.
Please ensure that accurate patient identification details are completed on the
Blood Traceability Record as well as details, time & date that staff members
remove, receive & administer the unit & then return to Blood Bank.
ABO incompatible
transfusions
SHOT 2012
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Transfusions in UK remains very safe (2.9
million components issued in 2012, very few
deaths*).
However, errors continue to put patients’ lives
at risk, particularly from ABO incompatible
transfusions.
13 ABO incompatible transfusions.
4 transfusions resulted in major morbidity
(“Never Event”).
*Risk of death: 1 in 322, 580 components issued;
Risk of major morbidity 1 in 21,413 components issued.
Risk of transfusion-transmitted infection much lower.
DoH ‘Never Events’ list 2011/12
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New addition –
Death or serious harm as a result of the
inadvertent transfusion of
ABO-incompatible blood components
Transfusion Reactions
Transfusion Reactions
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Most common is an Acute Transfusion
Reaction (allergic, severe febrile or
anaphylactic).
Acute Transfusion Reactions & TransfusionAssociated Circulatory Overload (TACO)
carries highest risk for morbidity & death.
SHOT 2012 – 43% of reported cases of
TACO resulted in death or major morbidity.
TACO
Transfusion Associated Circulatory Overload
 Any 4 of the following that occur within 6
hours of a transfusion:- Acute respiratory distress
- Tachycardia
- Increased blood pressure
- Acute or worsening pulmonary oedema
- Evidence of positive fluid balance
(BCSH, 2012)
Remember
Importance of correct completion of all steps
in the transfusion process, particularly the final
check at the bedside, & not making
assumptions about the safety of the steps
prior to this (SHOT, 2012).
Advice & Enquiries
Haemovigilance Practitioners,
Altnagelvin Hospital
02871345171 Ext 213794 / 213793
Or Bleep 8434
Or Contact Blood Bank EXT 213830