Blood provision
- The Pretransfusion sample
- Pretransfusion testing
- 72 Hour Rule
- ASBT Protocol for Neonates
- Issue of blood products from the Blood Bank
- Emergency Blood Release
- Massive Transfusion Protocol (RCH) (pdf)
The Pretransfusion sample
| Correctly identifying the patient during collection of the pretransfusion sample is vital in avoiding 'wrong blood to wrong patient' episodes. |
Collector
Venepuncture will only be performed by an appropriately trained pathology collector, medical officer, registered nurse or anaesthetic or theatre technician, or a trainee in direct supervision of one of the above. The collector or trainee's supervisor is directly responsible for ensuring the accuracy of each specimen submitted for testing.
Patients must be identified before sample collection
- Ask the patient (or parent) to state their name, date of birth and address (outpatients)
- Inspect the patient ID bracelet (inpatients) and confirm that these details match those on the request form
Specimen labelling
The specimen must be labelled at the bedside before leaving the patient
Specimens must have the following identifiers
- Full Name (Surname and First name)
- Date of birth
- UR number (if known)
- Date and time of collection
- Date and time of collection and collectors signature or initial on the request form.
Labelling of tubes in advance of collection is not acceptable due to the risk of patient specimen mismatch.
Use of pre-printed bradma labels is permissible but only if they also bear the signature of the collector and date and time of collection. Care must be taken to ensure the correct bradma label is applied. Details on the bradma must be identical with those on the patient wristband.
All details must correspond completely and accurately between the sample and the request form. Where inconsistencies of spelling or numerical inaccuracy are present, the specimen will not be processed and the requesting medical officer will be notified to obtain a repeat sample.
Labelling of cord blood samples
RWH
Label the specimen/s immediately at the patient bedside with:
-
"Baby of" mother's full name (surname and first name), for multiple births add twin 1 of, triplet 2 of etc.
-
Date of birth
-
Gender
-
Date and time of collection
-
Collectors signature
-
Cord Blood
Note: A minimum of two patient identifiers are required (e.g. first identifier = full name, second identifier = date of birth / UR number
FPH
It is permissible to use a maternal bradma for cord blood samples provided the identity check is completed as above and the bradma has the following;
- Add baby of, twin 1 of, triplet 2 of etc.'
- Cord blood
- Delete maternal Date of Birth and add infant's Date of Birth
- Infant gender
- Signature of collector
- Date and time of collection
Where tests are required on both maternal and cord blood samples, a single request form is not permissible. Separate request forms must accompany maternal and cord samples.
Pretransfusion testing
Pretransfusion compatibility testing prior to transfusion is extremely important and involves the following;
Group and Screen (also called Group and Hold)
- Determines the ABO and Rh(D) group of the recipient
- Performs a red cell antibody screen to detect red cell antibodies
- For patients who have "no red cell antibodies detected", a crossmatch is performed to ensure compatibility of blood prior to issue of donor units
- For patients who have "red cell antibodies detected", further laboratory work is required to identify the specificity of the antibody, to type the patient and donor units in order to provide specific antigen negative blood and to perform a full serological crossmatch. For patients with multiple antibodies this work can take several hours to complete.
- Checking for previous transfusion and blood group records.
The patient's current blood group must agree with any previous record of the patients group. Patient's who have previously had clinically significant red cell antibodies detected require antigen negative blood and full serological crossmatching.
72 hour Rule
A crossmatch specimen expires 72 hours after collection. A fresh cross match specimen will be required for any units not commenced within the 72 hour period. The time and date of collection of the cross match specimen is indicated on Clara as well as the blood transfusion record issued with the first unit of blood.
The 72 hour rule also applies whenever a patient has been transfused or is/has been pregnant within the last 3 months. This internationally accepted safeguard is used to prevent a transfusion reaction in patients who form antibodies to foreign red cell antigens in response to pregnancy or transfusion. The only exception to this rule is some infants during the first four months of postnatal life (see ASBT Protocol).
ASBT Protocol for Neonates
The ASBT protocol enables us to omit repeated crossmatching for infants during the first 4 months of life, providing certain criteria are met. This protocol recognises that the development of antibodies to red cell antigens is very uncommon in the first 4 months of life, and attempts to limit the amount of blood required for crossmatching.
Requests: The clinician must request "ASBT Protocol" when the first sample is taken for crossmatch. The request must indicate any previous transfusion history, in particular intrauterine transfusion, or transfusion outside WCH (please indicate transferring hospital). Request ASBT protocol for any infant likely to have repeated transfusion.
Suitability: The laboratory will make an assessment according to established criteria (baby less than 4 months, pretransfusion ABO and Rh(D) group performed, DAT negative, no atypical red cell antibodies detected, one continuous admission). If accepted, the laboratory will issue a report indicating that a further sample will not be required for crossmatch until…date.
If an infant is discharged and readmitted, they must requalify for ASBT protocol.
Ordering Blood: Once an infant is accepted on the ASBT Protocol, further samples are not required for pretransfusion testing. Blood can be ordered by telephoning the blood bank.
Issue of blood products from the blood bank
Blood products should only be picked up when the transfusion is ready to commence in order to ensure appropriate storage of blood products.
Blood products must not be stored in ward areas or domestic fridges.
If the transfusion cannot commence within 30 minutes, the product must be returned to blood bank for storage.
- Blood Bank Release Order
A Blood Bank Release Order is required for all products to be picked up from the blood bank. Blood Bank Release order (PDF)
The release order can be completed by all clinical staff (nursing/medical).
Attach patient bradma label, sign and date form and indicate which product is to be collected.
If the product required is not listed, please hand write on the card.
For general wards, release will be limited to the following quantities at a time:
- one (1) unit of red blood cells
- four (4) units of platelets (or one pooled or apheresis bag)
- two (2) units of FFP
- five (5) units of cryoprecipitate
Special arrangements are available to the Emergency Department, ICU and Operating Suites for release of greater quantities.