Transfusion Medicine

Traceability

There is a legal obligation on all hospital blood banks to be able to trace all units of blood and blood products from receipt to final fate. To comply with this St James’s Hospital introduced a tagging system of labelling blood packs. The pink peel off section must be placed in the patient's chart and tear-off section must be completed and returned to blood transfusion.

This legal obligation extends to reporting all Serious Adverse Reactions (SARs) and Serious Adverse Events (SAEs) to the National Haemovigilance Office.

Serious Adverse Reaction:
An unintended response in the patient associated with the collection or transfusion of blood and blood component that might:

• Lead to death.
• Be life-threatening
• Cause disabling or incapacitating conditions for the patient.
• Result in, or prolong, hospitalisation or morbidity.

Serious Adverse Event:
Any untoward occurrence associated with the collecting, testing, processing, storage and distribution of blood and blood components that might:

• Lead to death.
• Be life-threatening
• Cause disabling or incapacitating conditions for the patient.
• Result in, or prolong, hospitalisation or morbidity.

Any such reaction or event should be reported to the Blood Transfusion Department.

Routine Requests e.g Group & Hold or Crossmatch

Samples stored at 18-25oC for up to 48 hours are suitable for processing

A completed request form and sample must be forwarded to Blood Transfusion.

If the laboratory has a valid sample a phoned request and EPR is acceptable.

Blood Transfusion sample labelling requirements are very strict. See Section below - Acceptance/Rejection Criteria for Sample and Request Card

Please identify biohazard samples by placing a red sticker on the request form. The introduction of a policy of Universal Precautions is currently under consideration.

Telephone requests

• A crossmatch may be requested by phone and EPR if a valid sample is still held in the laboratory.   
• A sample is suitable for one month if the patient has not been transfused in the previous 3 months and for 72hrs if the patient has been transfused within 3 months.
• The following details must be given when phoning requests:
  Patient’s name 
  Hospital number
  Ward
  Product
  Number of units required
  Date and time required
  Reason for transfusion
  Name of requesting medical doctor. 

Urgent Requests

• The Medical Doctor must phone the Laboratory (2989, 2958 or 2945) explaining the urgency.
• Group and Hold (urgent) can take 30 – 40 mins.
• Group & Crossmatch can take 45 – 60 mins
• Crossmatch on a sample that is already on Group & Hold (Antibody Screen Negative) can take 10 mins.
• If the antibody screen is positive there is increased delay in providing blood.

Life-Threatening Emergencies / Code Red situations

'Code Red’ is the alert used in St James’s Hospital to advise the Blood Transfusion Laboratory of life threatening bleeds.

Emergency O Rh(D) Negative units are held in the Burns Unit fridge, Theatre fridge and ICU fridge for use in life threatening emergencies.

Target Turnaround Times in Blood Transfusion

Return of unused blood /blood product to laboratory

It is important for accurate record keeping and reduction of wastage that all unused blood or blood products are returned to the laboratory. When returning Blood / blood products for any reason to the blood transfusion laboratory, please inform a member of the blood transfusion staff.

Times of Opening

• 8am-8pm, Monday – Friday – Routine testing 
• 9.00am-1.00pm, Saturday – Routine testing

Cut-off time –3.00pm

• This is the latest time for receipt of routine samples.
• Specimens from patients for elective surgery should be received in the Blood Transfusion laboratory not later than 3.00pm on the last normal working day prior to the scheduled operation. If a definite date for operation is not known, the specimen should be sent to the laboratory for a ‘Group + Hold’.  An antibody screen will then be performed and plasma retained for one month.   Subsequently, when the operation date is known, blood may be ordered by phone up to 3.00pm on the last normal working day prior to operation. A new sample is required if the patient was transfused more than 72hrs before the surgery date. 
• Repeat samples every 72 hours on patients who received blood in the previous 3 months.

Out of Hours Service

Outside routine hours (see above) an emergency service is available for all urgent requests. Internal hospital bleep 671 should be used to contact on-call staff.

Acceptance/Rejection Criteria for Sample and Request Form

Mandatory and Desirable Labelling Criteria for Sample and Request Card

Note: *If not on request card this information can be found on PAS/EPR

          ** Provision of clinical details may be helpful for laboratory staff if the patient has any serological problems

          *** As a minimum a 'Group and Hold' test is carried out if the test required is not specified.

1. Action to be taken when mandatory criteria are not met:

Sample:

1. If the date/time is missing from the sample this must be completed by the sample taker. In addition a single amandment of the following core identifiers can be made - Surname/First name/DOB/MRN/Signature of sample taker.
2. If unable to contact the person who took the sample, the sample will be rejected.

Request Card:

1. If mandatory requirements on request card are not completed the requestor and/or the person who took the sample may amend.
2. If unable to contact these staff the sample will be rejected unless the request card accompanying a correctly labelled sample is from a patient where the clinical situation (poor veins, urgent sample) leads to delay or discomfort to patient. In these circumstances the sample may be processed at the discretion of a senior medical scientist (or medical scientist out of hours) following discussion with clinical area.

Safetrack Labels:

Blood Track Tx (Safe Track) is a module of the Blood Track System. It is loaded on a handheld Personal Digital Assistant (PDA) and can be used for phlebotomy. The phlebotomist scans their own ID badge and the patient's identity band and a label is printed. This is signed by the phlebotomist and is acceptable for pre transfusion samples as it contains the core patient identifiers.

2. Incomplete Request Form:

 Where sample is correctly labelled and the request form is not completed and the sample is processed  the report should show a disclaimer as follows: ‘Request card not fully compliant with the accreditation standard ISO 15189’

3. Unlabelled samples:

Unlabelled samples will not be tested under any circumstance and will be discarded.

4. Unconscious Patients

Where a patient is unconscious the pre-transfusion sample must be labelled with the following:

• Name either John/Jane Doe
• MRN
• DOB -either 01-01-41 or NK should be used
• Gender of patient
• If female give < or > 60 years of age
• Date/Time of sampling
• Location
• Signature of person who took sample

5. Major Incident Plan

In the event of the MIP being activated samples must be labelled with :

• MIP MRN
• Surname & Forename will be MDP (Major Disaster Plan) unless name is known
• Gender
• < / > 60 years if DOB is known
• Date/Time Sample taken
• Signature of Sample taker
• Location

According to ED policy all samples will also have a red MIP sticker attaced with MRN, SEX and DOB. This does not replace the requirement for handwritten details.

 6.  Life threatening situations:

If one or more patient identifiers are not provided on the sample in a life threatening situation: - Group O blood should be issued until a correctly labelled sample is provided

If the patient is female of child bearing age Group O Rh Negative blood  should be issued.

7. External Samples:

External samples must have the following minimum sample/request card labelling criteria:

• Surname
• Forename
• DOB
• Date of sampling
• Signature of person who took the sample

8.  Other tests e.g. DCT

In-patient samples for other tests e.g. DCT, cold agglutinins, are accepted with First name, Surname, MRN and date sample taken. FBC (EDTA) samples with OCM labels are therefore suitable for DCT.

As investigation of a suspected transfusion reaction may lead to further transfusion the EDTA and Clotted sample should meet pre transfusion testing requirements. 

Sending the sample to Laboratory

Place sample in an appropriate biohazard plastic bag with the request form in a separate plastic bag.

Clinical Advice and Interpretation

Scientific advice and interpretation is available from blood transfusion scientific staff. Clinical advice is available from the Consultant in charge of blood transfusion including haemovigilance or out of hours from the consultant haematologist on-call.

Referral Laboratory Details

A Service Level Agreement exists between the Irish Blood Transfusion Service (IBTS), National Blood Centre, James’s St., Dublin 8. and St James’s Hospital.
The blood transfusion dept. has access to the External Quality Control results of the IBTS.

Time Limits for Requesting Additional Examinations

Samples are retained for one month. Additional products can be requested by telephone. A new sample may be required if the patient has been transfused in the previous three months.

Reports

Two types of printed reports are issued by Blood Transfusion.  All blood components and blood products issued are labelled with a 'Compatibilty Tag'. The tag has a peel off portion which is attached to the patient's medical chart if product is transfused.

The tag contains the following information

• Correct patient identification ie Name/MRN/DOB/Gender
• Location
• Patient blood group
• Unit no.
• Product
• Product blood group
• Expiry date of product
• Space for Date/time transfused

All other reports for requests eg group and antibody screen, DCT, antibody titres, transfusion reactions etc are printed as hard copies and sent to the patient's location. Reports will be delivered on a daily basis.