Patient Experience
The Transfusion Medicine Department is part of the St James’s Hospital Centre for Laboratory Medicine and Molecular Pathology and provides blood and blood products for the hospital’s inpatients.
We also perform blood tests including ABO/Rh typing, antibody screening, antibody investigation, cross matching and direct Coombe tests.
Traceability of all blood products is essential and our Haemovigilance department ensures this is carried out.
General Enquiries: Main Laboratory
(01) 416 2989 / (01) 416 2958
Consultant in Transfusion Medicine
Dr Diarmaid O Donghaile
(01) 416 2945
dodonghaile@stjames.ie
Chief Medical Scientist
Ms Siobhan Killeen
(01) 410 3571
skilleen@stjames.ie
Haemovigilance Officer
Ms Julie Mc Cabe
(01) 416 2974
jumccabe@stjames.ie
24hr Clinical Advice
Consultant in Transfusion Medicine/Consultant Haematologist
Routine Hours: (01) 416 2989 / 2958
Out of Hours: Switchboard (01) 410 3000
On-call Laboratory (Out of hours)
Bleep 671
The Department of Transfusion Medicine including Haemovigilance provides support to all the clinical specialities in the hospital. We provide a 24 hour service 7 days a week.
This service includes blood grouping, antibody screening, antibody investigation, direct coombs test, cross matching and issuing of blood, blood products and blood components including frozen plasma, platelets, fibrinogen, Anti-D, coagulation factor concentrates and albumin. Please refer to the lab med user guide for a complete test repertoire.
Haemovigilance, in collaboration with the Transfusion Medicine Department and other blood users through the Transfusion Committee contribute to the delivery of best practice transfusion service including monitoring and traceability of blood/blood component use. The Haemovigilance department has an important role in many transfusion practices including investigation and reporting of adverse events and reactions.
There is a consultative service, for both laboratory and Haemovigilance issues, available to users 24 hours a day. This is led by the Consultant in Transfusion Medicine.
The Health Professionals involved in Transfusion Medicine include:
Consultant in Transfusion Medicine
Medical scientists
Haemovigilance officers (CNM III/Medical Scientists)
Administration officer
The Department of Transfusion Medicine including Haemovigilance of St James’s Hospital was initially awarded accreditation by the Irish National Accreditation Board (INAB) on 28th October 2008 as being in compliance with ISO/IEC/15189. The scope of the accreditation is detailed under Registration Number 327MT.
It is also competent to comply with articles 14 and 15 of the EU Directive 2002/98/EC (S.I. No. 360 of 2005 and S.I. No. 547 of 2006).
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:
Serious Adverse Event:
Any untoward occurrence associated with the collecting, testing, processing, storage and distribution of blood and blood components that might:
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) or a Group & Hold/Crossmatch request on EPR and a 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, instructions on how using the EPR can be found on the intranet under EPR & PAS support in the IMS Departmental section.
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. Users should also refer to the Pre-Transfusion Compatibility Testing: Blood Sampling Protocol/SOP located under PPG’s in the Department’s webpage.
For external users, the minimum sample/request card labelling criteria are: Surname, Forename, DOB, Date and time of sampling and signature
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/received a bone marrow transplant (BMT) in the previous 3 months and for 72hrs if the patient has been transfused/received a BMT within 3 months, or is currently pregnant.
• Samples for cardiothoracic patients may be suitable for up to 2 months provided they have not been transfused/received a BMT in the last 3 months or are currently pregnant.
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 2 hours.
Crossmatch on a sample that is already on Group & Hold (Antibody Screen Negative) can take up to 1 hour.
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.
Emergency Plasma and Emergency PCC are held in the Burns Unit fridge for use in life threatening emergencies.
Sending the sample to Laboratory
Place sample in an appropriate biohazard plastic bag and send via the Pneumatic Tube System (PTS) or via portering services for urgent samples.
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
Patient specimens may be referred to external laboratories for a number of reasons. These include complex antibody combinations, patients with auto antibodies, and people with weak blood groups which need to be confirmed.
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 (cardiothoracic patient samples for up to two months). Additional products can be requested by telephone and EPR. A new sample may be required if the patient has been transfused/received a BMT in the previous three months or is currently pregnant
Reports
Two types of reports are issued by Blood Transfusion. All blood components and blood products issued are labelled with a 'Compatibility 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
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.
Telephoned Reports may be issued under the following circumstances:
• Where a patient has a clinically significant antibody which may result in a delay in providing compatible blood.
• Any delay in the provision of blood and blood component(s) is relayed to the patient’s medical team.
• To notify the requesting ward/theatre when urgent crossmatched blood is ready.
• All cases of unsuitable samples including those which are clotted, insufficient, haemolysed, aged or taken into an incorrect container for the test(s) requested.
• Cases of incorrect sample identification or unlabelled sample, as defined in SOP BT 1.0008 ‘Acceptance / Rejection criteria for sample and request card’.
• When testing indicates that there is a discrepancy between historical results (e.g. WBIT) which may result in a delay in the provision of blood components.
• When short dated red cells have been crossmatched for a patient.
• Suspected delayed haemolytic transfusion reaction.
• When requests are received from GPs for blood group analysis, to inform GPs that the laboratory no longer provides a blood grouping service for GP samples.
• When the requesting clinician has requested that the results are telephoned.
• Transfusion / pregnancy history required.
Where critical/alert results are received from the IBTS it may be necessary to inform the medical team by telephone if there is going to be a significant delay in providing blood for a patient.
Service: Group + Hold
Routine: 24 hours, patients with atypical antibodies may take longer depending on the complexity of the antibodies involved
Urgent: 1 hour 15 minutes, patients with atypical antibodies may take longer depending on the complexity of the antibodies involved
Service: Crossmatch
Routine: 24 hours, See above for patients with atypical antibodies
Urgent: With valid sample (antibody screen negative): 1 hour, From receipt of new sample: 2 hours. See above for patients with atypical antibodies
Code Red: With valid sample: 20 minutes. From receipt of new sample: 20 minutes. Patients with atypical antibodies may take longer depending on the complexity of the antibodies involved
Service: Frozen Plasma
Routine: 1 hour
Urgent: 40 minutes
Service: Platelets
Routine: 6 hours
Urgent: 20 minutes if stock is available, 1 hour if obtained from IBTS
Code Red: 15 mins if stock available, 30 mins if obtained from IBTS
Service: Cryoprecipitate
Routine: Not a stock item, available on a named patient basis only
Urgent: N/A
Code Red: N/A
Service: DCT
Routine: Same Day
Urgent: 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
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.
• 8am - 8pm, Monday – Friday – Routine testing
• 9am - 1pm, Saturday – Routine testing
Cut-off time –3pm
• 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 3pm 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 (two months for cardiothoracic patient samples). Subsequently, when the operation date is known, blood may be ordered by phone and EPR up to 3pm 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/a bone marrow transplant 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.