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

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

3. What would you request?

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

5. 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

6. Form: Complete Information

7. 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

8. What would you request?

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

10. How to make a request for GXM

11. 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

12. Blood collection slip

13. 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

14. Case 3
En SY, 56 year-old man
Presented to A&E with torrential per-rectal bleeding
O/E: Pale PR: BP: 106/60
Packed cells are requested

15. What would you request?

16. 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

17. Form: Complete Information

18. 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

19. 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

20. Form: Complete Information

21. 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

22. 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

23. Form: Complete Information

24. 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

25. 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

26. Case 6 – cont’d LSCS uneventful PRBC returned Was GXM necessary?
Why bring PRBCs to OT when it takes only minutes to convert GSH to GXM?

27. 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

28. 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

29. 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

30. 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’

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

33. Proper return of blood components
Return of Used blood Bag 33

34. Improper return of used blood34

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

36. 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)

37. The end