Transfusion Medicine

Test Repertoire in Blood Transfusion

Click here to see repertoire of Blood Transfusion Tests and Turnaround Times.

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 (PCO2) and correctly labelled sample must be forwarded to Blood Transfusion.

If the laboratory has a valid sample, an EPR request accompanied by a phoned confirmation is acceptable for blood and blood product requests. For internal users, a link to the instructions on using the EPR can be found in the Education and Resources section of the Blood Transfusion Departments webpage.

Blood Transfusion sample labelling requirements are very strict.

  • For internal SJH users, see acceptance/rejection Criteria for sample and request cards or refer to the clinical information section of the Blood Transfusion Department's webpage.
  • For information regarding the use and operation of the Blood Track PDA system please see the instructional videos below:

     

     

  • For external users, the minimum sample/request card labelling criteria are: Surname, Forename, DOB, Date and time of sampling and signature.

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 1 hour 15 mins.
  • Group & Crossmatch can take 1 hour 30 mins.
  • Crossmatch on a sample that is already on Group & Hold (Antibody Screen Negative) can take up to 30 mins.
  • If the antibody screen is positive there is increased delay in providing blood.
  • Any delays in the provision of Blood or Blood Components will result in the Clinical Team being notified.

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

SERVICE

Routine

Urgent

Code Red

Group +Hold

 

 

 24hrs

Patients with atypical antibodies may take longer depending on the complexity of the antibodies involved.

 

1 hr. 15min.

Patients with atypical antibodies may take longer depending on the complexity of the antibodies involved.

 

Crossmatch

 

24hrs.

See above for patients with atypical antibodies.

With valid sample (antibody screen negative): 30mins

From receipt of new sample: 1hr 30mins.

See above for patients with atypical antibodies

 

With valid sample: 15mins.

From receipt of new sample: 20 mins

Patients with atypical antibodies may take longer depending on the complexity of the antibodies involved.

Frozen Plasma

 

40 minutes

40 minutes

 

Platelets

 

6hrs.

15 minutes if stock available

1hr. if obtained from IBTS

 

Cryoprecipitate

 

40 minutes

40 minutes

On a 'Named Patient' basis only

DCT

Same day

1 hour

 

Requests for multiple products may result in a delay in turnaround times.

Please note that turnaround times do not include time required for delivery of products via portering services.

Blood and Blood Component / Product delivery

There are 5 routine deliveries of blood from the Blood Transfusion Laboratory to the satellite Blood Bank Fridges from Monday to Friday inclusive. These are at 08.00, 09.30, 11.30, 14.00 and 15.30.

For urgent deliveries of blood outside of these times, the blood transfusion laboratory staff will contact the porters from the Portering Service and they will collect the blood from the Blood Transfusion Laboratory and deliver it to the relevant satellite fridge.

For Blood Components / Products (eg platelets, plasma etc.) the blood transfusion laboratory staff will contact the porters from the Portering Service and they will collect the component / product from the Blood Transfusion Laboratory and deliver it directly to the relevant ward / clinical area.

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 and EPR 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 internal requests. Internal hospital bleep 671 should be used to contact on-call staff.

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.

Patient specimens are referred to the IBTS for a number of reasons. These include complex antibody combinations, patients with auto antibodies and people with weak blood groups which need to be comfirmed.

Time Limits for Requesting Additional Examinations

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

Reports

Two types of 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

For internal SJH users all reports are now reported on the EPR (Blood Transfusion section). This includes DCT reports previously reported on EPR(haematology section).

Printed reports are provided to external users and can be provided, on request, to internal users.

When required for clarification, descriptive comments are added to the report.

An amended report is a report that is changed in any way after the initial report has been authorised and issued. This is required following e.g. a change in patient demographics, post additional testing or if blood product details have to be amended. The amended report detailing the changes made (and original report) are available on the EPR.