Blood Transfusion
Medical Staff
2011
Regulations
• Medicines and Healthcare
Products Regulatory Agency
(MHRA)
• EU Directive 2005/61/EC
(100% compliance)
• NHSLA
• Induction
• Annual Update
• NPSA competencies (3 yearly)
Where to find information
• Intranet
http://webapps/intranet/departments/blood_transfusion/default.asp
• Link person
• Bi monthly newsletter
• Blood Transfusion Manual
• www.transfusionguidelines.org.uk
• Remember if you are making a service change which involves blood
transfusion it may need to go through change control. (MHRA
requirement). Therefore inform us ASAP.
• Blood Warmers: Ward 34 and Theatres (UHCW/RSX)
Requesting Blood
• MSBOS – Maximum Surgical Blood Ordering Schedule
http://webapps/elibrary/index.aspx
• Pre optimise your patients
• Electronic issue
• Avoid wastage
Patient Identification
• Ensure the correct blood sample is taken from the correct patient by
identifying and completing patient’s full birth name, hospital/NHS
number, date of birth, gender
• Where appropriate ask the patient to state the above details and
check electronically issued armband
• If not appropriate check electronically issued armband and if
possible check ID with relative
• Do not multi task when obtaining blood samples
• There will be a procedure in every Trust for identifying unknown
male and females
Order of Draw and Inversions
• Every Trust has a collection system
• To ensure a quality sample the correct
order of draw must be observed
• All BD vacutainer tubes require
immediate mixing following collection
• Avoid the use of needle and syringe for
taking blood samples
• Hand label the blood samples clearly,
accurately, legibly at patient’s side
Cross Match Form
Prescribing blood and blood products
• Reason for transfusion
• Identity of prescriber GMC number or
name
• Ensure accurate documentation.
• Remember you may be called to recount
why you prescribed or administered blood
• Consent (Verbal)
• One unit versus two
• Maximum transfusion time 3 ½ hours
• Each unit volume differs
• Generally increases Hb by 0.8 g
Indications for RBC transfusion: Medicine
• Acute bleeding: urgent X-match
• Chronic anaemia, if no treatable cause AND
symptomatic AND Hb < 8g/dL (or 9g/dL, if age >75)
• Transfusion-dependant Pts, keep Hb >10
• Radiotherapy: keep Hb > 10
• Chemotherapy Pts; keep Hb > 9
Indications for RBC transfusion: Surgical
• Anaemia: if not easily
remediable in other ways
• Bleeding
• Pre-op ordering: Maximum
Surgical Blood Ordering
Schedule (MSBOS). Tariff.
Less can be ordered. More if
justified
• Intra-op and Post-Op: know
Hb before transfusing.
SPECIALITY: GENERAL SURGERY
Adrenalectomy
Appendicectomy
Breast biopsy
Cholecystecomy +/- explore CBD
Colectomy : Subtotal
Colectomy: Total or abdominal-perineal
(AP)
MAXIMUM BLOOD ORDER (units)
2
G&S
No specimen required
G&S
2
3
Indications for FFP transfusion
• Generalised coagulation factor deficiency (DIC, severe
liver disease)
• Trauma pt bleeding heavily: may use
and later RBC:FFP:Plt 1:1:1
RBC:FFP 1:1
• Warfarin OD: Vitamin K & ‘Prothrombinase complex’
Remember if defrosted can utilise up to 24 hours later if
returned to Blood Bank
Indications for platelet transfusion
• Not ‘Glue’
• Check FBC before giving
• Plt < 70 and bleeding / surgery
• Plt < 10 - maybe prophylaxis
• Assess function where possible (TEG, PFA)
Indications for cryoprecipitate
• Not ‘Glue’
• Factor VIII, von Willebrand Factor (but safer
concentrates available)
• Fibrinogen depletion (DIC, hyperfibrinolysis, liver
disease)
• Fibrinogen < 1g/L
Blood costs
Year
Red Cells
Platelets
FFP
1996/97
35.02
150.00
23.32
1999/2000
78.88
141.93
18.47
2000/01
82.50
151.27
19.47
2001/02
84.56
155.05
19.96
2002/03
99.77
165.22
20.72
2003/04
110.92
178.36
29.17
2004/05
120.22
198.76
30.89
2005/06
132.07
216.87
34.67
2006/07
130.52
213.79
31.64
2007/08
134.27
208.46
32.69
2008/09
139.72
232.29
36.33
2009/10
133.19
229.85
36.18
2010/11
124.21
230.39
28.42
Administration
• 2 trained staff must check patient against prescription and blood label
which is affixed to the bag of blood (luggage tag)
• Positively identify your patient. (Electronically issued wristband/verbal)
• Check vital signs before the transfusion is administered
• Identify adverse reactions. (Patients must be visible throughout the
transfusion).
• If there is an anomaly, correct if possible before blood transfusion
commences. i.e. Pyrexia
• Complete the blood transfusion administration record. Start and stop
times must be recorded
• If patients are being transferred between departments and blood is in
progress, they must be accompanied by a qualified nurse/Doctor if
appropriate.
• Dispose empty blood bags into the clinical waste stream once the
blood has been AutoFated. (Partially full or full must be disposed of
into a rigid container)
Transfusion Reactions: Acute Haemolytic
Reaction
• ABO incompatible red cells, e.g. Group A into Group O patient
(anti-A, anti-B)
• Errors: 65% ward, 35% Lab
• Patient & Sample ID
• Pain (infusion site, back, chest), ‘sense of impending doom’, red
urine
• Shock, DIC, Renal failure
• Death (10%)
Long term side effects
• Red cell antibodies:
e.g. anti-c, Anti-Kell
• HLA-sensitization (now rare)
• Infection: Hepatitis B, C. CMV,
HIV, Parvo, HTLV-1/2, malaria, syphilis, vCJD …...
• Iron overload
• Cant donate blood! Recent audit indicates only 19% of
unconscious patients at UHCW were notified they had
received blood during their hospitalisation
Emergency Blood
•
•
•
•
OWhite form
Cool box
Retain skins and fate blood after the
event
• Record donation numbers in medical
notes
• Red Label
• Fridges (O-)
• Pathology Dept, (Main Fridge Blood
Bank), 4th Floor, west Wing
• Emergency Department
• Main Theatres (Central)
• Labour Ward Theatres (West Wing)
• St. Cross (Rugby) Opposite Cedar ward
Patients who refuse blood
•Increasing
•Policy: Really important however
minor the procedure!
•Intranet: Resources
•All patients who refuse blood
must complete paperwork
•Jehovah Witness Liaison
Wastage
• If you don’t follow process i.e. utilise blood track blood will be wasted
• Must be avoided
• Can lead to limited UHCW blood stocks especially
• O – ve, B –ve and platelets
• Blood / products are expensive and a limited resource
• Complete a blood wastage form (Found on the e-library or blood
Transfusion Intranet site)
• Fate must be recorded as wasted
Contacts:
• Janine Beddow: Modern Matron (Transfusion) X25470 Bleep 1287
• Janine.Beddow@uhcw.nhs.uk
• Angela Sherwood: Transfusion Liaison Nurse X25469 Bleep 2280
• Angela.Sherwood@uhcw.nhs.uk
• John Hyslop: Blood Bank Manager (Network) X25322
• John.Hyslop@uhcw.nhs.uk
• Dr Nick Jackson: Consultant Haematologist (Network), Bleep 1750.
Nicholas.Jackson@uhcw.nhs.uk
• Dr Keith Clayton : Consultant Anaesthetist (HTC Chair). Bleep 1488
• Keith.clayton@uhcw.nhs.uk
• Hayley Brace: Administration X25436
• Hayley.Brace@uhcw.nhs.uk
Questions?