Blood TransfusionMedical 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 MAXIMUM BLOOD ORDER (units)Adrenalectomy 2Appendicectomy G&SBreast biopsy No specimen requiredCholecystecomy +/- explore CBD G&SColectomy : Subtotal 2Colectomy: Total or abdominal-perineal(AP)

3

Indications for FFP transfusion

• Generalised coagulation factor deficiency (DIC, severe liver disease)

• Trauma pt bleeding heavily: may use RBC:FFP 1:1 and later RBC:FFP:Plt 1:1:1

• 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 costsYear 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• O-• White 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?