NHS Grampian Procedure for
Blood and Blood Component Transfusion
In Adults
Co-ordinator:
Approver:
Dr H Watson
Reviewer:
F Rentoul
L Stout
Signature:
Signature:
Signature:
Identifier:
NHSG/????/CTTE/0000
Review Date:
Date: issue date
Dr H Watson
UNCONTROLLED WHEN PRINTED
DRAFT
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Title:
Policy Ref.
Across NHS
Boards
Organisation
Wide
Directorate
Clinical Service
Sub Department
Area
This controlled document shall not be copied in part or whole without the express
permission of the author or the author’s representative.
Review date:
Author:
Policy application:
NHS Grampian
Purpose:
Responsibilities for implementation:
Organisational:
Clinical group:
Corporate:
Departmental:
Area:
-
Review:
Approved by:
Signature:
Designation:
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Date:
NHS GRAMPIAN BLOOD AND BLOOD COMPONENT TRANSFUSION IN ADULTS
Introduction
A blood transfusion is a relatively safe procedure. Like all medical treatments though, a blood
transfusion should only be given when absolutely necessary. The decision to give a blood
transfusion should only be made after careful consideration, balancing the risk of having a blood
transfusion against the risk of not having one.
The whole process of a blood transfusion involves a large number of people and organisations,
and mistakes can happen at any stage in the process.
Since 1996, there has been a national reporting system for adverse events associated with blood
transfusion in the UK known as the Serious Hazards of Transfusion (SHOT)1. SHOT has
demonstrated that the biggest risk to the patient is from receiving an incorrect blood component.
These wrong blood incidents are without exception avoidable errors.
The recommendations within this procedure are in keeping with the "Guidelines for the
Administration of Blood and Blood Components and the Management of the Transfused Patient"2,
drawn up by the United Kingdom Blood Transfusion Task Force.
Further Information and Advice:
For advice on all aspects of Transfusion, including adverse reactions to blood components contact:
Aberdeen Blood Bank:
Extension 52322 / 52512
Duty Medical Officer:
During normal working hours (Mon-Fri 9am - 5pm) Bleep 2346
Out of working hours contact the Blood Bank initially.
Dr Grays Blood Bank:
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Extension 67479
CONTENTS
1
Notes
2
Blood Sampling for Blood Component Transfusion
2.1
Blood Sample Identification
2.2
Taking the Blood Sample
3
Blood Collection
3.1
Collection of Blood From the Blood Transfusion Centre
3.2
Collection of Blood From the Blood Fridge
4
Blood Transfusion
4.1
Requirements for Setting up a Blood Transfusion
4.2
Procedure for a Blood Transfusion
4.3
Patient Identification Checks for a Blood Transfusion
4.4
Administration of Blood Transfusion
4.5
Observations During a Blood Transfusion
4.6
Post Blood Transfusion and Discard of Packs
5
Platelet Transfusion
6
Fresh Frozen Plasma and Cryoprecipitate Transfusion
7
Adverse Reactions
8
Emergency Blood
9
Blood Deliveries to Peripheral / Community Hospitals
10
Responsibility
11
Patient Counselling
12
Professional Accountability
13
References
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1
NOTES
1.1
Indications for a Blood Transfusion
1.2

To replace Blood Volume.

To replace a deficiency of specific blood components.

To increase the oxygen carrying capacity of the blood.

To correct anaemia when methods other than transfusion are unlikely to be beneficial.
Relative Contra-Indications

1.3
Against the patients wishes e.g. religious beliefs.
Error Reporting

All errors and near misses must be reported using NHS Grampian's Occurrence
reporting system.
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2
BLOOD SAMPLING FOR BLOOD COMPONENT TRANSFUSION
2.1
Blood Sample Identification
Label the form with
Label the sample with:

Patient Surname

Patient Surname

Patients FULL forename

Patients FULL forename

Date of Birth as a unique identifier

Date of Birth as a unique identifier

Patient Unit Number / A&E number / CHI number

Patient Unit Number / A&E number / CHI number

Ward

Ward

Hospital

Hospital

Date and Time sample was taken

Date and Time sample was taken

Patients clinical condition

Signature of the person taking the blood sample

Whether the sample is for Group and Screen or Crossmatch

Number of units required

Reason for transfusion

Time and Date the blood is required

Any special requirements (CMV, irradiated)

Requesting Doctors bleep number and signature
Notes:
2
Please ensure details on request form and sample are accurate, complete, legible and identical. Otherwise unnecessary
delays will be incurred whilst details are verified or a fresh sample is requested.
3
UNLABELLED / MISLABELLED samples will NOT BE ACCEPTED by the Blood Bank. Addressograph labels, whilst
acceptable on request forms must not be used on sample tubes.
4
The CHI number is not acceptable as a date of birth. Where it appears on sample labels and no separate date of birth is
given, the date of birth must be added by hand.
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2.2
Taking the Blood Sample
This procedure must be carried out strictly in the following order.
2.1.
The request form for blood components is completed, all sections of which must be
accurate complete and legible.
2.1.
If conscious, and able to, the patient is verbally asked to give their forename, surname and
date of birth. These details are checked against the patient identification band.
2.1.
If the patient is unconscious or unable to state their name, the patient's identification band
must be checked against written documentation containing the patient's details (surname,
forename, date of birth and hospital unit number) e.g. patient's medical notes.
2.1.
Check these details match those on the request form. Any discrepancy must be resolved
before processing.
2.1.
Blood is taken from the patient and put into a purple-topped EDTA "vacutainer". In adults,
for a Group and Screen and/or Crossmatch, a 7ml EDTA sample is required.
2.1.
Label the blood tube at the bedside (by hand) with the patient's full name, date of birth,
hospital number, patient location , date and time the sample was taken and the signature of
the person taking the blood sample.
2.1.
Ensure the details on the blood tube and request form are identical.
2.1.
Write the time and date of taking the blood sample on the request form and finally sign the
request form. The signatures on the blood tube and the request form imply that you have
ensured that the sample is accurately identified and labelled for that specific patient.
2.1.
State the urgency of the request clearly on the request form. When an urgent sample is
sent, alert BTC by phone (ext 52322) and send the sample and request form in a transport
bag by the quickest method available.
Notes:
1
It is essential that any patient having a blood sample taken for blood transfusion purposes wears an identification band,
unless the patient is an out-patient, in which case, the patient must be asked to positively identify themselves by stating their
forename, surname and date of birth. This information must be checked against the medical notes and the transfusion request
form.
2
Taking blood samples for Group and Save and/or Crossmatching must only be performed on one patient at a time. Prelabelled tubes must never be used.
3
The person making the request is responsible for checking that the patient's details are correct. They are also responsible for
checking the patients notes to see whether there are any special transfusion requirements and to obtain a transfusion history.
4
The person obtaining the specimen is responsible for ensuring that the blood sample from the patient is placed in the correct
tube for that patient.
5
Do not take a blood sample from a drip arm. Small samples may be rejected by Blood Bank.
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3
BLOOD COLLECTION
3.1
Collection of Blood from the Aberdeen Blood Transfusion Centre.
3.1.1
Routine Deliveries by Designated BTC Porter.
The BTC has a designated BTC Porter attached to the department Monday to Friday 7am
until 3pm.
This porter collects the "Request for Routine Delivery of Matched Blood Form"(ZOE
555K/FT) routinely from the Aberdeen Royal Infirmary Clinical Areas each weekday
morning.
The ward staff complete these forms for routine blood deliveries. The form must contain:
the patient's details (surname, forename, date of birth and hospital unit number); the name
of the Doctor in charge of the patient; the blood component required, the time the blood is
required for and the destination of the components.
The form is retained in the Aberdeen Blood Bank until the blood is required.
On the date that the blood is needed, Blood Bank staff check the patients details on the
form against the compatibility label attached to the pack of blood that has been stored in
the BTC Blood Fridge.
The blood is then packed into the approved storage box and delivered by the BTC Porter to
the satellite blood fridge closest to the Clinical Area.
The "Request for Routine Delivery of Matched Blood Forms" are then destroyed by BTC.
3.1.2
Collection by Portering Staff.
In Aberdeen Royal Infirmary, Royal Aberdeen Sick Children's Hospital and Aberdeen
Maternity Hospital, a Collection Slip is used by Portering Staff only, to collect blood and
blood components from the Blood Bank.
When blood components are required by a Clinical Area, a phone call is made to the
Portering Services (ext 52218).
The Control Porter records:

Patient's Surname

Patient's Forename

Date of Birth

Patient Unit Number/A&E number

Blood Component

Destination
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The Control Porter then bleeps a porter to collect the blood components from the Blood
Bank and they collect the Collection Slip en route.
At the BTC, the patient details on the collection slip are checked against the blood
component. Any inaccuracies should be brought to the attention of the Blood Bank staff.
The person collecting the blood component(s) will be asked to sign the Blood Prescription
Form to identify that they removed blood from the BTC.
The porter delivers blood to the satellite blood fridge nearest the Clinical Area and writes
the time and date of delivery on the Collection Slip. The Collection Slip is then signed and
placed in the locked box located at the Blood Fridge. These slips are collected, for audit
purposes, by BTC.
Red Cell Concentrates
Porters do not deliver blood directly to a ward unless it is an emergency, in which case a
Collection Slip may not have been used.
Other Blood Components (Platelet Concentrates, Fresh Frozen Plasma and Cryoprecipitate)
The porter delivers the blood component to the Clinical Area and a Registered
Nurse/Midwife or Doctor then writes the time and date of delivery and signs the Collection
Slip. The porter then returns the collection slip to the Portering Office.
3.1.3
Collection of Blood by Nursing or Medical Staff from BTC
Written documentation containing the patient's details, (surname, forename, date of birth
and hospital unit number) must be taken by the staff member collecting blood components
from BTC or Satellite Blood Fridge. This could be the patient's admission slip, prescription
sheet or medical notes.
Details on this documentation must be checked against the compatibility label attached to
the blood pack.
The person collecting the blood component(s) will be asked to sign the Blood Prescription
Form to identify that they removed blood from the BTC.
3.1.4
Delivery of Blood to Woodend Hospital
Routine deliveries are made to the Blood Fridge at the Portering Reception for Woodend
Hospital on weekday mornings.
At other times, when blood components are required by a Clinical Area, a phone call is
made to the Portering Services (ext 52218).
The Control Porter records:

Patient's Surname

Patient's Forename
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
Date of Birth

Patient Unit Number/A&E number

Blood Component

Destination
The Control Porter then bleeps the porter driver to collect the blood components from the
Blood Bank.
The person collecting the blood component(s) will be asked to sign the Blood Prescription
Form to identify that they removed blood from the BTC.
At the BTC, the patient details are checked against the blood component. Any inaccuracies
should be brought to the attention of the Blood Bank staff.
The porter delivers blood to the satellite blood fridge at Portering reception.
3.1.5
Collection of Blood from Satellite Blood Fridge
Written documentation containing the patient's details, (surname, forename, date of birth
and hospital unit number) must be taken by the staff member collecting blood components
from BTC or Satellite Blood Fridge. This could be the patient's admission slip, prescription
sheet or medical notes.
Details on this documentation must be checked against the compatibility label attached to
the blood pack.
If there are multiple packs for the same patient, ensure that the first unit selected is the one
that contains the Blood Component Transfusion Prescription Form.
3.1.6
Collection of Blood or Blood Components from Blood Bank in Dr Gray’s Elgin
To access the Blood Fridge within the Laboratory a code is required to enter the building,
this code is known to the ward staff who require access.
Written documentation containing the patient's details, (surname, forename, date of birth
and hospital unit number) must be taken by the staff member collecting blood components
from the Blood Fridge. This could be the patient's admission slip, prescription sheet or
medical notes.
Details on this documentation must be checked against the compatibility label attached to
the blood pack.
If there are multiple packs for the same patient, ensure that the first unit selected is the one
that contains the Blood Component Transfusion Prescription Form.
Removal of the unit is documented in the Fridge Register and signed by the person
removing the blood component.
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3.2
BLOOD TRANSFUSION
3.3
Requirements for setting up a Blood Transfusion

Secure venous access point e.g. Cannula

Drip stand and Infusion Device if required at bedside

Sphygmomanometer

Thermometer

Observation Recording Sheet (a separate sheet for using during blood component
transfusion)

Fluid Balance Chart

Patients Profile Sheet / Admission slip / Medical Notes

Blood Component Transfusion Prescription Form (PF)

Blood component pack

Disposable Apron

Disposable gloves - for attaching administration set to patient's venous access and for
handling blood component

Blood or platelet administration set

Clear polythene bag
3.4
Procedure for Blood Transfusion
4.2.1
Gather the equipment stated above
4.2.2
Check the blood component has been prescribed.
4.2.3
Record base line observations of temperature, pulse and blood pressure on Observation
Recording Sheet.
4.2.4
Check the blood component pack to ensure there are no leaks, no unusual discolouration,
cloudiness or clots.(if any of these signs are detected, seal in two polythene bags and
inform the Blood Bank returning the component to them).
4.2.5
Check that the component has not passed its expiry date and will not expire during the
transfusion episode. (Midnight of the expiry date as stated on the bag)
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4.3
Patient Identification Checks for Blood Transfusion
THE FOLLOWING CHECKS MUST BE CARRIED OUT AT THE PATIENT’S BEDSIDE
IMMEDIATELY PRIOR TO TRANSFUSING ANY COMPONENTS. If there are any
discrepancies DO NOT PROCEED. Inform BTC and the prescriber.
4.3.1
If conscious and able to, the patient is asked to verbally give their name and date of birth.
These details are checked against the patient's identification band.
4.3.2
If the patient is unconscious or unable to state their name, the patient's identification band
must be checked against written documentation containing the patient's details (surname,
forename, date of birth and hospital unit number) e.g. patient’s medical notes. (A second
person check is advisable in this situation.)
4.3.3
Check the information on the patient's identification band contains:

Surname

Forename

Date of Birth

Hospital identification number
And is identical to the information on the:
4.3.4

Blood Component Transfusion Prescription Form

Blood compatibility label attached to the blood pack
Check that the blood group and donation number on the blood component pack is identical
to that on the Blood Component Transfusion Prescription Form, and the compatibility label
attached to the blood component pack.
If the Blood Bank have provided a blood component and the blood group on the pack and
of the patient are not identical but are compatible (e.g. group O blood to a group A patient,
or RhD negative blood to an RhD positive patient) the BTC will make a comment on the
Blood Component Transfusion Prescription Form. If in any doubt contact the Blood Bank.
4.3.5
The blood component pack must be checked for compliance with any special requirement
on the Blood Component Transfusion Prescription Form.
4.3.6
If at any time you are interrupted or distracted, you must recommence the patient
identification checks from the beginning.
MOST FATAL TRANSFUSION ERRORS ARE MADE BY NOT CHECKING THE UNIT OF
BLOOD IS BEING ADMINISTERED TO THE CORRECT PATIENT.
Notes:
1
Red cell transfusion must commence within 30 minutes of being removed from the fridge. If this time is exceeded inform the
Blood Bank and return the blood component to the Blood Bank with a note stating "out of fridge for more than 30 minutes".
(This is to minimise the risk of bacterial growth).
2
Where possible, two people should carry out the necessary checks, this must be done independently of each other. One must
be a registered nurse/midwife or doctor. Where one person is carrying out the identity checks, they must be either a
registered nurse/midwife or doctor who has undertaken relevant transfusion education.
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4.4
Administration of a Blood Transfusion
4.4.1
Put on apron, wash hands and put on gloves.
4.4.2
Blood should be transfused through a sterile giving set designed for the procedure. The set
has a double chamber and must contain a 170 micron filter.
4.4.3
EITHER
Prime the blood administration set with prescribed 0.9% Sodium Chloride
OR
Flush the venous access with 5-10mls prescribed 0.9% Sodium Chloride
and invert the blood administration set whilst running blood, to avoid air
bubbles.
4.4.4
Attach the administration set to the venous access device,
OR
if using an electronic infusion pump, place the administration set in the
infusion pump following the manufacturer's guidelines.
4.4.5
Set the rate and volume to be infused as stated on the prescription form.
4.4.6
Sign, date and time the Blood Component Transfusion Prescription Form.
Notes:
1
0.9% Sodium Chloride is the only solution that should be infused through the administration set immediately before blood.
2
Electronic infusion pumps can be used to transfuse red cells, but they must have been verified as safe to use for this purpose
and used according to the manufacturer's instructions. Blood administration sets specific for these devices must be used.
3
There is no minimum or maximum size of cannula for transfusion, the size of cannula chosen should depend on the size of
the vein and the speed at which the blood is to be transfused.
4
Blood should only be warmed using a specifically designed commercial device and following the manufacturer's instructions.
5
Blood and blood components must not be warmed using improvisations such as putting the pack into hot water, in a
microwave or on a radiator.
6
Drugs must not be added to blood packs under ANY circumstance.
7
A new administration set should be used after the transfusion has run for more than 12 hours to prevent bacterial growth.
8
Red cells should be collected from the blood refrigerator immediately prior to transfusion. Commence the transfusion within 30
minutes of removal from the refrigerator and completed within 4 hours of spiking the pack. If the infusion is not commenced
within 30 minutes, the pack must be returned to the Blood Bank and labelled "out of the fridge for more than 30 minutes"
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4.5
Observations During a Blood Transfusion
4.5.1
For each unit transfused check the patients:
Temperature, Pulse and Blood Pressure

Every 15 minutes for the first hour and hourly thereafter

Record these on an observation chart specifically used for the transfusion episode

If using infusion devices, perform visual and pump volume infusion checks as per the
organisation procedure ( Policies and Procedures Relating to Medicines in Grampian,
Incorporating the Prescribing and Administration of Medicines, Grampian Medicines
Committee April 2001-S100doc )
4.5.2
These observations must be repeated for each separate bag transfused.
Notes:
1
The first 15 minutes of each unit is the most critical for the patient.
2
Visual observation of the patient is often the best way of assessing the patient during the transfusion. Patients should be
transfused in an area where they can be readily observed and they should have a call button to obtain assistance.
3
Acute transfusion reactions can occur up to six hours post transfusion.
4
Unconscious patients are more difficult to monitor for signs of transfusion reactions.
5
Transfusion reactions should be considered when assessing a change or deterioration in a patient's condition, particularly
during the first 15 minutes following the start of a unit of blood. Hypotension, uncontrolled bleeding due to Disseminated
Intravascular Coagulation (DIC), haemoglobinuria or oliguria may be the first indications of an acute haemolytic transfusion
reaction in these patients.
6
A new administration set is only required every 12 hours or between different types of blood component.
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4.6
Post Blood Transfusion and Discard of Blood Packs
At the end of the transfusion, it is unnecessary to flush the giving set to extract the final
10mls of blood.
Once the transfusion is complete:
4.6.1
Record the time of completion on the Blood Component Transfusion Prescription Form.
This MUST be placed in the appropriate section of the patient's medical notes.
4.6.2
Observe and record the patient's temperature, pulse and blood pressure on the frequent
observations chart.
4.6.3
Put on an apron, wash your hands, put on gloves
4.6.4
Disconnect the administration set.
4.6.5
EITHER
Prime the blood administration set with prescribed 0.9% Sodium Chloride
OR
Flush the venous access with 5-10mls prescribed 0.9% Sodium Chloride
4.6.6
If the cannula is also removed, disconnect from the administration set and dispose of in
Sharps container.
4.6.7
Keep the administration set connected to the blood component pack (with roller clamp
closed). Place in two polythene bags and tie the bags.
4.6.8
Keep all packs until the transfusion episode is complete.
4.6.9
Once the transfusion episode is complete, dispose of the bags in the orange waste system.
4.6.10 For punctured packs, wrap the pack in a polythene bag and place in a rigid leak-proof
container (Sharps bin). Label "Blood for Disposal" clearly with the ward number and
hospital. Call the portering department to arrange pick up.
4.6.11 For other disposal situations, refer to Section 7 on adverse reactions and Section 8 for the
use of emergency blood.
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5
PLATELET TRANSFUSIONS
3.2 Collection from BTC
Refer to section 3 - Blood Collection.
3.3 Requirements for a Platelet Transfusion
Refer to section 4.1 Requirements for setting up a- Blood Transfusion, 4.2 Procedure for a
Blood Transfusion and 4.3 Patient Identification Checks for a Blood Transfusion
3.4 Administration of Platelet Concentrates
3.4.6
Put on an apron, wash hands and put on gloves.
3.4.7
If required, flush venous access with 5-10mls of 0.9% Sodium Chloride.
3.4.8
A platelet administration set with a 170 micron filter should be attached to the platelet pack.
3.4.9
Set the rate for infusion as stated on the prescription chart.
3.4.10 Sign, date and time the Blood Component Transfusion Prescription Form.
3.5 Observations During Transfusion
Refer to Section 4.5 - Observations During a Blood Transfusion.
3.6 Post Transfusion and Discard of Blood Packs
Refer to Section 4.6 - Post Blood Transfusion and Discard of Blood Packs.
Notes:
1
Platelets may be transfused over a period of 30-60 minutes but must be transfused within 4 hours of spiking the pack.
2
Should any packs collected/delivered to the clinical area be unused, the Blood Bank must be informed to ensure the accuracy
of the patients records.
3
Platelets are stored at 22oC and are continually agitated whilst in BTC. On arrival at the clinical area, they should be given as
soon as possible and must NEVER be placed in a fridge.
4
Platelets must be checked visually for leaks or discolouration of the pack that might suggest bacterial contamination.
5
Platelet blood groups may not necessarily be identical to the patient's own blood group, but if in doubt contact the BTC.
6
Platelet must be administered through a platelet giving set that has a 170 - 200 micron filter.
7
Platelet MUST NOT be given through a giving set that has been used for blood.
8
Platelet must only be given by gravity feed and not via a pump as this may damage the platelets.
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4
FRESH FROZEN PLASMA (FFP) AND CRYOPRECIPITATE
4.1 Collection from BTC
Refer to section 3 - Blood Collection.
4.2 Requirements for a Fresh Frozen Plasma or Cryoprecipitate Transfusion
Refer to section 4.1 Requirements for setting up a- Blood Transfusion, 4.2 Procedure for a
Blood Transfusion and 4.3 Patient Identification Checks for a Blood Transfusion.
4.3 Administration of Fresh Frozen Plasma or Cryoprecipitate Transfusion
4.3.6
Put on an apron, wash hands and put on gloves.
4.3.7
If required, flush venous access with 5-10mls of 0.9% Sodium Chloride.
4.3.8
Fresh Frozen Plasma can be given through a blood administration set with a 170 micron
filter or a platelet giving set with a 170 micron filter.
4.3.9
Cryoprecipitate can be given through a platelet giving set with a 170 micron filter.
4.3.10 Attach the giving set to the pack.
4.3.11 Set the rate for infusion as stated on the prescription chart.
4.3.12 Sign, date and time the Blood Component Transfusion Prescription Form.
4.4 Observations During Transfusion
Refer to Section 4.5 - Observations During a Blood Transfusion.
4.5 Post Transfusion and Discard of Blood Packs
Refer to Section 4.6 - Post Blood Transfusion and Discard of Blood Packs.
Notes:
1
Fresh Frozen Plasma and Cryoprecipitate may be transfused over a period of 30-60 minutes but must be transfused within 4
hours of thawing as stated on the pack.
2
Plasma blood groups may not necessarily be identical to the patients own blood group, but if in doubt contact the BTC
3
Fresh Frozen Plasma and Cryoprecipitate are stored in BTC below -40oC for up to two years.
4
At the request of the Medical Officer, Fresh Frozen Plasma and Cryoprecipitate are thawed on demand. Once thawed the
product cannot be re-frozen. If unused by the Clinical Area, BTC must be informed to ensure accuracy of patient records.
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5
ADVERSE REACTIONS
IF THE PATIENT EXPERIENCES ANY TRANSFUSION REACTION, STOP THE TRANSFUSION
AND SEEK MEDICAL ADVICE.
Type of Reaction
Signs and Symptoms
Management
Mild Reaction






Temperature rise
Rash
Pruritis
DO NOT IGNORE.
A mild reaction
may be the initial
signs of a severe
reaction.
Severe Reaction
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Signs and symptoms
 Rigors
 Restlessness
 Tachycardia
 Anxiety
 Pruritis
 Palpitations
 Dyspnoea
 Headache
 Pyrexia > 1oC from
baseline
 Hypotension
 Haemoglobinuria
 Unexplained bleeding
(Disseminated
Intravascular Coagulation)
 Chest pain
 Loin/back pain
 Pain at infusion site
 Respiratory distress
Stop the transfusion
Inform the medical staff
Recheck the patient and component
compatibility
 Assess the patient
 Commence appropriate treatment
 Document the adverse event in the
patient's notes.
If there is no improvement within 15
minutes, or if any deterioration occurs,
treat as a severe reaction.







Stop Transfusion
Inform medical staff an commence
appropriate resuscitation procedures
Disconnect blood administration set and
replace with an administration set which
is run through and attached to 500 mls
of 0.9% sodium chloride
Recheck patient and component
compatibility
Inform Blood Bank and return pack to
them still attached to the administration
set (with roller clamp closed) and sealed
in two polythene bags. Return all used
packs along with this.
Take blood samples as requested by
the Blood Bank, including Blood
Cultures
Document the adverse event in the
patient's notes.
6
EMERGENCY BLOOD
Emergency Blood is group O RhD Negative and has not been cross-matched against the patient
for transfusion.
Location
No of units
Aberdeen Royal Infirmary
Special Block - ward 14 (Bleeding Unit)
4
Phase II - Accident and Emergency
4
Phase II - Main Theatres (Lower Ground Floor)
4
Aberdeen Maternity Hospital
Labour Ward Corridor
6
Blood for Neonates only (for top-up)
1
Royal Aberdeen Children's Hospital
Theatre Suite
2
Woodend Hospital
Mail Room in Communications Centre
6
Dr Gray's Hospital Elgin
Department of Medical Laboratory Science Crossmatch fridge
Top Drawer
Right Hand Side (obstetric use only)
2
Top Drawer
Left Hand Side (other emergency situations)
4
6.1 Prior to a transfusion, a pre-transfusion sample must be taken from the patient and sent to
Blood Bank for testing.
6.2 Complete the accompanying blood pack label with the details of the recipient of the blood and
return to BTC in order that the patient records may be updated and replacement units sent.
6.3 Each unit has a prescription form which must be completed with the patient's details and then
used as for a normal transfusion.
6.4 On completion, the pack itself must be double bagged and discarded in the orange waste
system.
Notes:
1
When the Emergency Blood is used, the BTC Blood Bank must be notified immediately on extension 52322/52512
(Aberdeen). For Dr Gray’s in Elgin extension 67479 (Outside normal working hours contact the duty MLSO via the Dr Gray's
switchboard).
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7
BLOOD DELIVERIES TO PERIPHERAL /COMMUNITY HOSPITALS
Delivery of blood components will be pre-arranged with the Nurse in Charge of the Peripheral /
Community Hospital.
9.1
If a dedicated, temperature monitored blood fridge is available:

Blood is delivered by BTC driver in a specially designed insulated box(ex).

There is a maximum of 4 units per transfusion therapy.

These units must be stored in a dedicated, temperature monitored blood fridge.

Discard unused units within 48 hours of delivery from BTC.

Inform BTC of any unused units that have been discarded, otherwise they will be
regarded as having been transfused to the patient.
9.2
If no dedicated, temperature monitored blood fridge is available

Blood is delivered by BTC driver in a specially designed insulated box(es).

There is a maximum of 2 units per transfusion therapy.

These units must be stored in the closed designated delivery blood box for a maximum
period of 8 hours.

Discard any units that have not been used within the recommended storage time for the
designated delivery box.

Inform BTC of any unused units that have been discarded, otherwise they will be
regarded as having been transfused to the patient.

Specially designated boxes will be supplied as required by BTC and will contain special
cool-packs.
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10
RESPONSIBILITY
The Hospital Consultant (Head of Service / Clinical Lead - Medical Staff) and the appropriate
Clinical Nurse Manager of each and every clinical department is responsible for ensuring that this
procedure is made known to all relevant staff undertaking any role in the transfusion process.
Any individual undertaking any of the tasks within the Transfusion Process must ensure that they
are aware of these procedures and are acting in accordance with them.
11
PATIENT COUNSELLING
Although gaining consent for a blood transfusion is currently not a legal requirement within the UK,
there is a responsibility to ensure that the patient receives adequate information regarding their
transfusion. This should include information pertaining to the benefits and risks of transfusion as
well as information relating to available alternatives. Therefore all practitioners have a professional
duty to ensure they have adequate knowledge of transfusion related issues or can access the
information and support required by patients undergoing transfusion therapy.
Current legislation, requires that a permanent record of the administration of each blood
component is stored, this must include the reason for transfusion, the number of units prescribed
and the outcome of the transfusion episode.
12
PROFESSIONAL ACCOUNTABILITY
Every practitioner is subject to the law. As well as adhering to professional standards, drawn up by
the Nursing and Midwifery Council and the General Medical Council, all practitioners are
accountable to patients for the provision of safe and appropriate care during the transfusion
process. They are also accountable to their employer for the provision of care appropriate to their
level of knowledge, skills and competence.
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13
References
1
Serious Hazards of Transfusion Annual Report, www.shot-uk.org
2
British Committee of Standards in Haematology Blood Transfusion Task Force. The
administration of blood and blood components and the management of the transfused
patient. Transfusion Medicine, 1999,9,227-238.
2
British Committee of Standards in Haematology Blood Transfusion Task Force. Guidelines
for pre-transfusion compatibility procedures in blood transfusion laboratories. Transfusion
Medicine, 1996,6,273-283.
4
Aberdeen and North East Scotland Blood Transfusion Manual, 10th edition, 2005.
5
Grampian University Hospital Trust - Policies and Procedures Relating to Medicines in
Grampian, Incorporating the Prescribing and Administration of Medicines, Grampian
Medicines Committee April 2001-S100doc.
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