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

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

What would you request?

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

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

Form: Complete Information

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

What would you request?

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

How to make a request for GXM

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

Blood collection slip

GXM vs. GSH GSH GXM 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

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

What would you request?

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 Group: Screen: Immediate spin: Release blood: Continue full cross-match

Form: Complete Information

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

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

Form: Complete Information

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

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

Form: Complete Information

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

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

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?

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

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

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

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’

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

Proper return of blood components Return of Used blood Bag 33

Improper return of used blood 34

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

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)

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