Module 2: Request for blood and blood components

Transfusion Training WorkshopKKM 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:

ABO, Rh grouping

Screen:

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

Form: Complete Information 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: ABO, Rh grouping

Screen: 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+++ PR: 120 BP: 106/60

Packed cells are requested

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

Form: Complete Information 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

Form: Complete Information 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

Form: Complete Information 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 of Used blood BagProper return of 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