Blood Transfusion

1. Blood Transfusion Medical Staff 2011

2. Regulations • Medicines and Healthcare Products Regulatory Agency (MHRA) • EU Directive 2005/61/EC (100% compliance) • NHSLA • Induction • Annual Update • NPSA competencies (3 yearly)

3. 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) Where to find information

4. Requesting Blood • MSBOS – Maximum Surgical Blood Ordering Schedule http://webapps/elibrary/index.aspx • Pre optimise your patients • Electronic issue • Avoid wastage

5. 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

6. 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

7. Cross Match Form

8. 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

9. 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

10. 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.

11. 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

12. 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)

13. Indications for cryoprecipitate • Not ‘Glue’ • Factor VIII, von Willebrand Factor (but safer concentrates available) • Fibrinogen depletion (DIC, hyperfibrinolysis, liver disease) • Fibrinogen < 1g/L

14. Blood costs

15. 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)

16. 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%)

17. 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

18. 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

19. 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

20. 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

21. 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

22. Questions?