Essential Transfusion. Medical Students

Transcription

1 Essential Transfusion Medical Students

2 Aim is to ensure that the student has knowledge of an acceptable and safe level for the authorisation of blood and blood components, and the management of a suspected transfusion reaction.

3 Objectives 1. Will be aware of the essential points concerning requests for blood/blood components to be transfused (indication codes, special requirements and patient ID) 2. Gain an understanding of the type and urgency of requests made prior to transfusion 3. Achieve an awareness of the need to ensure clear effective communication between clinical user and laboratory staff 4. Be able to list the benefit/risk of transfusion and the importance of documentation 5. nsure the safe authorisation of transfusion of blood/blood components to a patient 6. Be able to recognise and manage a suspected transfusion reaction/adverse event

4 Group & Save Determine the ABO Group & Rh(D) Type, and to detect red cell antibodies that could potentially haemolyse transfused red cells. Should be able to provide suitable units for transfusion within 35 minutes if necessary. Any antibodies may increase the time required to provide suitable units for transfusion. Specimen Blood Quantity7.5ml or 1.2ml Paediatric Specimens are stored at 4oC for 5 days - a crossmatch can be requested within this time, however this is dependant on the patients transfusion history Group & Save (Pregnant Patient)3 days

5 Cross- match A Group & Save request can be made into a crossmatch provided a current in date specimen is available. Specimen Blood Quantity7.5ml or 1.2ml Paediatric Viability of a specimen is dependant on the patients transfusion history. Patients with no previous transfusion history of blood products can be crossmatched for upto 5 days on a current specimen. If the patient has been transfused within the last 3-14 days, a current specimen is only valid for 24 hours, after which a fresh specimen request must be sent. If the patient has been transfused between days ago or the patient is pregnant, a current specimen is only valid for 72 hours, after which a fresh specimen request must be sent. Every effort will be made to provide blood at date and time requested.

6 1.The student will be aware of the essential points concerning requests for blood/blood components to be transfused (indication codes, special requirements and patient ID) SAMPLE - Acceptance criteria: It is mandatory that the sample contains the following patient identification - (Please ensure to check the sample tube expiry before taking any blood, expired sample tubes are not acceptable) Surname Forename DOB Hospital Number and NHS number (if known) Patient Location Practitioner responsible for taking the sample Date and time of sample collection

7 Indication Codes R codes listed on The front sheet of the request card Special requirements If products requested details of special requirements e.g. irradiated or CMV neg. Patient ID REQUEST FORM - Minimum patient detail acceptance criteria: It is mandatory that the request form contain the following minimum patient identification - Surname Forename DOB Hospital Number or NHS number Patient Location Requesting Practitioner Sex Date and time of sample collection Printed Name of person taking sample Signature of person taking sample (The name and signature should be completed in the box stating Patient ID checked and confirmed)

8 Local mode of requests to laboratory e.g. paper / verbal Tel ) Blood bank (General Enquiries) Tel Blood bank (Blood Product Requesting)

9 ASSESS URGENCY Choose the right products COMMUNICATE Allocate a lead to liaise with lab & porters AVOID ERRORS Careful bedside labeling G&S, FBC, DIC screen swiftly to lab Extreme emergency only Group O RhD Neg Important antibodies may cause reaction Valuable resource ~15mins from sample arriving Group specific ABO & RhD compatible Important antibodies may cause reaction Safest product if time allows Crossmatched Fully screened for antibodies ~30-60 mins from sample arriving Preempt need for FFP (30mins to thaw; 12-15mL/kg = 4 units for average adult) Preempt need for platelets (eg 1-2 adult therapeutic doses; d/w Haem Reg)

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15 Benefits Blood transfusions are a critical part of everyday medical procedures and save millions of lives each year Massive transfusion Surgery Correction of temporary anaemia Severe Burns Cancer Life-Sustaining Support with Bone Marrow Failure Risks Blood transfusions are not risk-free Potential infection risks from known and unknown infectious agents Immunosuppression -increased risk of post op infection Increased length of stay Inappropriate transfusion Transfusion of the wrong blood Anaphylactic reactions Alloimmunization and platelet refractoriness Febrile non-hemolytic transfusion reactions

16 Prescription The blood/blood product must be: Prescribed and signed by the Medical Officer. Written on prescription section of the Blood Transfusion Care Pathway. Must Specify: Surname First name Date of birth Gender Patient identification number These details must with the details on the patient s identification wristband correspond Blood/blood components/blood products to be administered e.g. blood platelets, fresh frozen plasma, Anti D immunoglobulin. Quantity to be given. Duration of infusion to be specified (usually 2-3 hours for red cell concentrates and 30 minutes for an adult therapeutic dose of platelets or a unit of fresh frozen plasma). Any special instructions e.g. use of a blood warmer, or reference to medication required before and during the transfusion. Medication required should be written on the drug prescription sheet.

17 Patient Identification Two. trained members of staff are Compatibility label on the blood responsible for following the patient product identification and checking procedure. The compatibility form The prescription sheet The patient must be positively identified Check that the ABO & Rh D group and unit number are identical on : by asking: NBS Label on the product The compatibility label attached in the Surname laboratory First name The compatibility form issued by the Date of birth laboratory Check the patients blood group and The procedure must be carried out Rhesus type matches that on the unit vigilantly at the side of the patient. The expiry date of the product has not passed Check the patients name D.O.B and 6 digit Check the unit for leakage, unusual colour, any clot formation hospital number are the same on After commencing member of staff Patient wristband taking responsibility for the transfusion must sign the compatibility form

18 TRANSFUSON REACTIONS Mild reaction Pyrexia < 1.5 C Urticaria Rash Pruritis Suspected severe reaction Pyrexia, rigors Hypotension Loin / back pain Increasing anxiety Pain at the infusion site Respiratory distress Dark urine Severe tachycardia Unexpected bleeding (DIC) STOP TRANSFUSION Review obs Paracetamol Chlorpheniramine? Restart cautiously STOP TRANSFUSION Right patient? Right blood product? Whole set to lab New set with saline Full bloods as policy Checklist (see policy) Incident form Refer to Trust Blood Transfusion Policy