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Module 2: Request for blood and blood components

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Module 2: Request for blood and blood components

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  1. Module 2: Request for blood and blood components Transfusion Training Workshop KKM 2012

  2. Case 1 • 24 year-old lady • Problem: underbite • Scheduled for orthognathic surgery • Hb is 11.7 g/dL • Packed red cells are requested

  3. What would you request?

  4. Group, Screen and Hold (GSH) • Group: • ABO, Rh grouping • Screen: • antibody screen and identification • Hold: • hold the sample for 48h

  5. 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

  6. COMPLETE INFORMATION Form: Complete Information

  7. 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

  8. What would you request?

  9. Group cross-match (GXM) • Group: • ABO, Rh grouping • Screen: • antibody screen and identification • Cross-match: • Immediate spin/ RT • LISS 370C • AHG

  10. How to make a request for GXM

  11. 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

  12. Blood collection slip

  13. 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

  14. 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

  15. What would you request?

  16. 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

  17. COMPLETE INFORMATION Form: Complete Information

  18. 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

  19. 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

  20. COMPLETE INFORMATION Form: Complete Information

  21. 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

  22. 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

  23. COMPLETE INFORMATION Form: Complete Information

  24. 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

  25. 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

  26. 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?

  27. 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

  28. 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

  29. 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

  30. 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’

  31. Memo • Name of patient and AM no. • Type of blood/ component • Blood bag no. • Reason/s for returning the blood/ component

  32. Return of Used blood Bag Proper return of blood components

  33. Improper return of used blood

  34. The next time you decide to transfuse Stop, think and ask yourself … Is it really necessary?

  35. 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)

  36. The end