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pdf Blood Transfusion Manual - Aberdeen

1. 2013 BTM 12th Edition BTM 12th Edition 2013 Blood Transfusion Manual Blood Transfusion Manual General Notes General Notes 2013 BTM 12th Edition BTM 12th Edition 2013
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3. Blood Transfusion Manual Blood Transfusion Manual 9 5 APPENDIX 3 continued APPENDIX 4 3 Classification of Clinical Indications for CMV Seronegative Cellular Blood z WwW Components Fatal Q Death due to haemorrhage Demonstrated at autopsy radiologically or clinically obvious 1 All neonatal transfusions including premature infants and infants up to m 4 N Major Intracranial CT or MRI documented 2 All intrauterine transfusions exchange transfusions Retroperitoneal CT or MRI documented Intra ocular excludes conjunctival g Known CMV seronegative pregnant women emergency only Spontaneous muscle haematoma associated with compartment syndrome Pericardial Note Non traumatic intra articular Any invasive procedure required to stop bleeding gt Seronegative components will only be issued if these above patients from any orifice plus BP lt 90mmHg systolic or oliguria 209 fall in are registered with the Blood Bank or a specific request is made on the request form Minor Any other bleeding that would not influence your decision to anticoagulate a patient Cautions Beriplex P N contains heparin and is contraindicated in patients with heparin induced thrombocytopenia present or previous Beriplex P N is also relatively contraindicated in patients with 1 An incre
4. o 2 a Consider reversal of any anti thrombotic therapy the patient has been APPENDIX 2 3 Paediatric Massive Bleeding Protocol Flow Chart Aberdeen MASSIVE TRANSFUSION OR UNCONTROLLABLE BLEEDING Send FBC PT APTT fibrinogen crossmatch Indications for activation of MBP Senior clinical opinion of significant blood loss ongoing bleeding Blood loss of gt 40ml Kg with ongoing bleeding Transfusion gt 40ml Kg of RCC in 4hrs with continued major bleeding Patients requiring gt 40ml Kg in the taking Immediate transfusion required 1st hr of resuscitation Blood Transfusion Manual APPENDIX 2 4 Paediatric Massive Bleeding Protocol Flow Chart Dr Gray s Elgin Consider Tranexamic acid in trauma patients 25mg Kg IV bolus followed by 25mg Kg IV infusion over 8 hrs Consider reversal of any anti thrombotic therapy the patient has been MASSIVE TRANSFUSION OR UNCONTROLLABLE BLEEDING blood loss ongoing bleeding Send FBC PT APTT fibrinogen crossmatch taking Immediate transfusion required Indications for activation of MBP Senior clinical opinion of significant Blood loss of gt 40ml Kg with ongoing bleeding Transfusion gt 40ml Kg of RCC in 4hrs with continued major bleeding Patients requiring gt 40ml Kg in the 1st hr of resuscitation Patients requiring transfusion of 80ml Kg RCC within 24 hrs Give Group O neg unmatched
5. Delivery by BTC driver in SNBTS supplied insulated box es These boxes are specially designed and can be used to store blood for up to 8 hours as detailed on Blood Fridge Register BFR Maximum 2 units per delivery Unit s must remain in box with special cool packs until removed for transfusion Anyunits that have not been removed from insulated box by time recorded on BFR must not be transfused Unwanted units must not be returned to BTC and are to be disposed of via NHSG waste disposal routes 32 2013 BTM 12th Edition Blood Transfusion Manual Inform BTC of any unused units that have been discarded If units are discarded ensure the compatibility labels state that the unit was not transfused and return the compatibility labels to BTC Note Document on the blood fridge register when the units were removed from controlled storage Once the patient has received the transfusion the two practitioners who positively identified the patient sign the pink sticker and affix to the prescription and recording form The blood fridge register and the completed blue section of the compatibility label are returned to BTC in the transport box 6 BLOOD STORAGE AND LOCATIONS IN GRAMPIAN HOSPITALS Blood left for 24 hours only from the time date required Contact Blood Bank for advice Blood for transfusion within Aberdeen hospitals must always be stored in designated blood storage refrigerators and transported in insu
6. Group and Screen Graft vs host disease Gray Hepatitis A Virus Haemoglobin Hepatitis B core antigen Hepatitis B immunoglobulin Hepatitis B surface antigen Hepatitis B Virus Haematocrit Hepatitis C Virus Haemolytic disease of the fetus and newborn Mercury Histocompatibility and Immunogenetics Heparin induced thrombocytopenia Human Immunodeficiency Virus Human leucocyte antigen Human platelet antigen Haemopoietic Stem Cell Transplantation Haemolytic transfusion reaction Haemolytic uremic syndrome Indirect Antiglobulin Test Identification Immunoglobulin Immune Haemolytic Anaemia Intramuscular International normalised ratio International Society of Blood Transfusion Immune thrombocytopenia International unit Intrauterine Death 2013 91 Blood Transfusion Manual IUT IV IVigG IVT LISS LN2 MBP MBT MHC MI MO MRI MSBOS NAIT NAN NAT NATP NEBTC NEG NHL NHSG NIPD PAOP PBS PBSC PCC PCH PCR PCV PFR PNH PRP PRT 92 Intrauterine Transfusion Intravenous Intravenous Immunoglobulin Intravascular approach for IUT Low ionic strength saline Liquid nitrogen Massive Bleeding Protocol Methylene Blue Treatment Major histocompatibilty complex Molecular Immunohaematology Medical Officer Magnetic Resonance Imaging Maximum Surgical Blood Ordering Schedules Neonatal alloimmune thrombocytopenia Neonatal alloimmune neutropenia Nucleic acid testing Neonatal Alloimmune Thrombocytopenic Pur
7. 4 6 If a patient s plasma contains anti c or anti e the Emergency RhD negative blood which for transfusion purposes has phenotype C D E c e K SHOULD only be used after discussion with the BTC MO In all such cases contact Blood Bank for advice for Aberdeen Hospitals ext 52322 8 12474 and for DGH ext 67479 30 2013 BTM 12th Edition Blood Transfusion Manual 4 7 Before the emergency transfusion of unmatched blood is commenced a 7ml EDTA blood sample must be taken from the patient The full name first name surname DOB gender CHI number or A amp E TN number must be written on the sample tube the request form and also on the traceability label attached to the unit of blood The patient s sample must be sent to Blood Bank The completed blue section of the traceability label must be sent to the Blood Bank as it is a regulatory requirement THIS IS IMPORTANT otherwise the recipient of blood may be exposed to further unnecessary risks and the transfusion records will be incomplete see para 9 2 1 page 40 5 DELIVERY amp DISTRIBUTION OF MATCHED BLOOD TO GRAMPIAN HOSPITALS 5 1 Aberdeen Royal Infirmary ARI Deliveries by the BTC porter are made to ARI blood storage refrigerators twice a day Monday to Friday at 0730 and 1315hrs The Request Form for routine deliveries must be completed and be at the collection point by 0700hrs At all other times arrangements must be made for matched blood to be collected from
8. If you require any clinical advice contact the Duty Medical Officer via Aberdeen BTC on ext 52322 52512 during and out of core hours 2012 BTM 12th Edition Blood Transfusion Manual AIDE MEMOIR RE ACTIVATION OF MASSIVE BLEEDING PROTOCOL DR GRAY S ELGIN CLINICAL DECISION MADE TO ACTIVATE MASSIVE BLEEDING PROTOCOL y CALL BLOODBANK DR GRAY S DIRECT ON EXTENSION 67956 STATE MASSIVE BLEEDING PROTOCOL ACTIVATION and provide LOCATION OF PATIENT HOSPITAL AND WARD CALLER PROVIDES BLOOD BANK WITH PATIENT DETAILS FORENAME SURNAME DATE OF BIRTH GENDER AND CHI NUMBER For unidentified patients minimum data should include the unique A amp E patient identifier and gender CALLERS NAME AND CONTACT NUMBER It is important that the person calling has the ability to provide this information ALL SUBSEQUENT COMMUNICATIONS BETWEEN CLINICAL AREAS LABORATORY STAFF AND PORTERS SHOULD BE PRECEDED BY THIS CALL RELATES TO THE MASSIVE BLEEDING PROTOCOL AND STATE LOCATION AND NAME OF PATIENT Remember to advise Blood Bank porter and Haematology Lab when deactivation occurs This must be read in conjunction with NHS Grampian Massive Bleeding Protocol BTM 12th Edition 2012 77 gt 79 70 m O m o Blood Transfusion Manual Consider Tranexamic acid in trauma patients 25mg Kg IV bolus followed by 25mg Kg IV infusion over 8 hrs
9. Maternal Delivery Maternal Samples Mislabelled Molecular Immunohaematology 58 59 62 6 51 56 63 Cardio thoracic Surgery 26 General Surgery 2 265 Genitourinary 27 Neurosurgery 227 Obstetric amp Gynaecology 29 Orthopaedic Surgery 28 Otolaryngology ef Plastic Surgery Speciality Surgery 27 BTM 12th Edition Neonatal 6 15 23 Exchange 45 Group and DAT 6 23 53 Intrauterine NAIT NIPD Neutrophil Function Normal Immunoglobulin IM amp IV Obstetric Antenatal Service 6 51 64 21 43 46 Octoplas FFP RhD Negative Blood 18 30 34 35 P Paediatrics 21 78 79 Paternal Sample Patient Identification 9 10 14 40 71 Phlebotomists 18 Platelet Concentrates 41 44 45 Platelet Typing Auto Allo 7 66 Platelet Apheresis 69 Plasma Exchange 46 48 69 Plasma FFP 21 43 46 80 Plasma Protein Solution 2 48 PNE s diii essen 27 67 Pre Transfusion Tests 6 17 71 Private Requests Protocols see Guide Red Cell Auto Allo Antibody Red Cell Concentrate Red Cell Concentrate Supplemented 45 Red Gell Exchanga i tens 21 45 BTM 12th Edition 2013 Blood Transfusion Manual Refrigerator Storage 18 30 35 39 42 Reporting of Flesulls ios 56 Request Forms Blood Bank unies 10
10. Solution RCCS Red Cell Concentrate RCC packed cells Paedipack Washed Cellular Components red cells or platelets Platelet Apheresis Split donation Whole donation BTM 12th Edition To increase oxygen transport by increasing red cell mass To increase oxygen transport by increasing red cell mass For neonates amp infants In patients who develop antibodies and react to plasma constituents of transfused blood e g Anti IgA Bleeding due to thrombocytopenia or platelet function defect Red cells from which most of the plasma has been removed and the cells re suspended in 100 of an optimal additive solution containing Sodium Chloride adenine glucose and Mannitol PCV of 0 50 0 70 Shelf life 35 days at 4 Transfusion to be completed within 4 hours from the moment the bag is removed from cold storage facilities Whole blood less 200 ml 1096 plasma PCV Hct of 0 50 0 60 A component for exchange or large volume transfusion of neonates should be used within 5 days of issue and kept at 4 to 6 from preparation Multiple pack system to provide small volume red cell transfusions for top up only by apportioned leucocyte depleted RCC RCCS unit into 4 containers Paedipacks This system is used to avoid multiple donor exposure and decrease donor related risk A single unit of blood 4 paedipacks is assigned to a patient however if the clinical need exceeds the volume i
11. whether the expected benefits of continuing the transfusion outweigh the risks of a reaction becoming severe Specialist advice may be sought from the BTC Duty Medical Officer who may be contacted on NHS Grampian bleep 2346 during working hours or via the Blood Bank ext 52322 8 12474 outwith working hours 42 2013 BTM 12th Edition Blood Transfusion Manual When a transfusion has to be stopped because of a reaction the Blood Bank should be informed by telephoning 52322 8 12474 For Dr Gray s contact BMS ext 67479 The following should be sent IMMEDIATELY to the Blood Bank 1 The unit s of blood with its contents and the CL attached to it 2 The administration set still in place in the outlet port of the pack and the regulating clamp firmly closed 3 Any used and unused units of blood issued for the patient 4 Apost transfusion sample of blood 7ml EDTA together with a completed request form giving details of the reaction indicating the degree of urgency of further transfusion s If bacterial contamination of the blood component is suspected blood cultures from the patient together with the unit of blood should be sent directly to the hospital microbiology laboratory from the ward i e to avoid any potential further contamination 11 USE AND AVAILABILITY OF BLOOD AND BLOOD COMPONENTS PRODUCTS The following blood components are routinely available on request Components all blood components are
12. 1997 1996 1994 1993 1992 1991 1 2013 BTM 12th Edition Blood Transfusion Manual Emergency Request page 17 Specialist advice may be sought from the BTC Duty MO Blood Availability Please inform Blood Bank if blood is required urgently e g Massive Bleeding Protocol Appendix 2 1 page 73 A routine crossmatch takes approximately one hour from receipt of sample Group specific blood may be issued within approximately 20 minutes from time of receipt Alternatively Group O negative blood available from blood storage fridges in Accident amp Emergency ARI Labour Ward AMH Surgical Block BU Ward 14 ARI Room WE G Theatres ARI DrGray s Elgin DGH ECC ARI negative blood is required for RACH it is available from A amp E ARI Blood Components Products For provision of blood components Platelets Fresh Frozen Plasma Cryoprecipitate the Blood Bank must be contacted For provision of blood products see page 48 50 contact NHS Grampian Pharmacy at 5 53223 Mon to Fri 9am 5pm all other times contact on call pharmacist via ARI switchboard 0845 456 6000 Note Human prothrombin complex concentrate is available from the Blood Bank 5 52322 5 52512 or 01224 8 12474 Help and Advice For specialist advice see Staff Directory page 4 5 Duty Medical Officer contactable via the BLOOD BANK 24 hours on ext 5 52322 5 52512 or 01224 8 12474 BTM 12th Edition 2013 Blood Tra
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14. REMEMBER TO ADVISE BLOOD BANK PORTER AND HAEMATOLOGY LAB WHEN DEACTIVATION OCCURS 2012 BTM 12th Edition Patients requiring transfusion of 80ml Kg RCC within 24 hrs Give Group O neg unmatched in aliquots of 10ml Kg until group specific blood available ACTIVATE MASSIVE BLEEDING PROTOCOL Call Blood Bank Dr Grays direct on ext 67956 and state Massive Bleeding Protocol Activation and advise of patient location Further contact use the same ext 67956 Actual or predicted loss of 50 blood volume 40ml Kg or approaching transfusion of 40ml Kg in first hour with ongoing bleeding Give 20ml Kg of FFP 20ml Kg of platelets 10ml Kg cryoprecipitate if fibrinogen 1 0g after FFP Ongoing Massive Bleeding Give 20ml Kg FFP and 20mls Kg platelets per 40ml Kg of RCCs Monitor FBC PT APTT and fibrinogen If platelets 20 give 20ml Kg of platelets If fibrinogen 1 0g l give 10ml of cryoprecipitate No further FFP unl bleeding restarts When bleeding is coming under control Give 20ml Kg of FFP if PT or APTT prolonged gt 3s above upper limit of normal 20ml Kg of platelets if platelets lt 50 10ml Kg of cryoprecipitate if fibrinogen lt 1 09 A 1 unit of apheresis platelets is equivalent to 4 5 single donor units Any communication with Blood Bank after the initial activation call phone 67956 REMEMBER TO ADVISE BLOOD BANK AND HAEMATOLOGY LAB WHEN DEACTIVATION OCCURS BTM 12th E
15. Test 4 5ml EDTA by 5 Laboratory At delivery Maternal 2x4 5ml EDTA At delivery Cord 4 5ml EDTA e Sample required page 52 para 3 Sample required when the antibody ies other than D is are associated with 3 BLOOD SAMPLES REQUIRED AND FREQUENCY OF TESTS 8 For ABO RhD group red cell antibody screen 88 Confirmation of blood group antibody screen estimation of FMH in RhD neg mothers see page 60 3 1 Antenatal Blood Samples 888 For ABO RhD group and DAT All patients except those with anti D anti c or Kell related antibodies Booking Sample ck Antibody associated with severe HDFN e g D c and Kell related antibodies 7ml EDTA blood sample Delivery in Specialised Hospital is advised when there is a possibility risk of a i transfusion problem and or HDFN Subsequent Sampling excluding delivery Delivery samples should consist of a maternal b cord blood and labelled baby 7ml EDTA unless specified otherwise of maternal surname gender baby s DOB and CHI see page 63 3 2 Frequency of Tests Suggested Frequency of Antenatal Testing see Table page 53 and Flow Chart page 54 Protocol for the management of alloantibodies in pregnancy e g anti Kell see page 55 52 2013 BTM 12th Edition BTM 12th Edition 2013 53 Blood Transfusion Manual SAMPLES AND TESTING REQUIRED IN A VIABLE PREGNANCY ABO and D type Antibody screen D positive Screen positive T Iden
16. Transfusion Manual 6 7 Kleihauer Test This test estimates the size of the feto maternal haemorrhage FMH necessitating additional anti D Ig by detecting fetal cells in the maternal circulation This test may also be requested for clinical management of specific situations as indicated in Table 3 below Up to 50 of large FMH s occur after normal deliveries However the clinical circumstances described in Table 3 are more likely to be associated with a large FMH and a Kleihauer test should be undertaken as soon as possible after the diagnosis has been made In the case of an FMH greater than 2ml of RhD positive fetal cells an additional screening test is recommended to accurately quantify the FMH volume and assess the need for additional doses of anti D Ig Flow cytometry FC assays have been shown to be sensitive rapid reliable and accurate in detection and quantification Table 3 Indications for Kleihauer or alternative tests e delivery of an RhD positive infant e bleeding after 20 weeks gestation traumatic deliveries including e 3 caesarean section e twin pregnancies at delivery abdominal trauma during the third trimester e manual removal of the placenta e e g RTA sinusoidal fetal heart rate tracing associated e unexplained hydrops fetalis e with e intrauterine deaths IUD e stillbirths The Kleihauer test is not used for FMH diagnosis but solely to determine if an extra anti D Ig dose is
17. a short period of exposure may increase the risk of bacterial proliferation A further important concern is the effect of temperature on the quality of red cell units What is the maximum time that a unit of red blood cells can be safely left out of controlled temperature storage Ref Trans med rev 2012 26 209 223 NOTE It is important that any bag of blood which is removed from cold storage for more than 30 minutes should be transfused within the 4 hours otherwise it must be discarded i e if the bag is unopened return to Blood Bank however if the bag was opened discard it according to the NHSG policy and ensure return of blue tag to Blood Bank for traceability BTM 12th Edition 2013 39 Blood Transfusion Manual 9 1 Before a Transfusion Check the compatibility label and the blood bag s carefully against patient s details on address label patient s notes when a unit of blood is removed from a blood storage facility You should also check this again at the bedside against the patient s ID band Check particularly that 9 1 1 The surname first name date of birth gender and CHI TN on the patient s identification ID band and the traceability tag correspond exactly to those of the patient to whom the blood is to be given The patient if conscious should be asked What is your name and date of birth not are you Mr Mrs Smith 9 1 2 The donation number and blood group on the compatibility label is the s
18. advised required 64 2013 BTM 12th Edition Blood Transfusion Manual SECTION III IMMUNOHAEMATOLOGY INVESTIGATIONS LABORATORY HOURS Working Hours Aberdeen BTC 0900 1700 Monday to Friday Ext 8 12477 INTRODUCTION The main role of the service is to provide the clinicians with the laboratory tests for cold warm Autoimmune Haemolytic Anaemia AIHA and other immunohaematological conditions Special samples may be required see pages 6 7 therefore it is necessary to contact the BTC or in certain situations the BTC Duty MO may contact the GP clinician to arrange a mutually convenient time for the collection or despatch of the appropriate blood samples The following tests are available Cold haemagglutinin screen by special arrangement DAT Direct Antiglobulin Coombs Test for complement and IgG 7ml EDTA sample Donath Landsteiner antibody test by special arrangement Extended Blood Group Phenotyping 7ml EDTA Redcell auto and alloantibody screen 7ml EDTA BTM 12th Edition 2013 65 Blood Transfusion Manual Blood Transfusion Manual SECTION IV Other Investigations Neutrophil function testing by quantitative DHR MOLECULAR IMMUNOHAEMATOLOCY MI dihydrorhodamine 123 test Special samples and laboratory investigations are required page 7 and clinical assessment is LABORATORY HOURS necessary For advice on clinical indications contact Professor Working Hours Aberdeen BTC M Vickers on 8 12
19. blood components containing viable immunocompetent donor lymphocytes Both immunocompromised and immunocompetent i e high risk recipients can be affected The use of X irradiation or Gamma irradiation at a minimum dose of 25Gy with no part receiving more than 50Gy inactivates any viable T lymphocytes and thus avoids TA GvHD It is not necessary to irradiate non cellular blood components i e FFP amp cryoprecipitate These Guidelines outline the procedure for handling notification and registration of requests for irradiated blood components All cases of TA GvHD should be reported to the national haemovigilance System Serious Hazards of Transfusion SHOT initiative as should all near misses where non irradiated components are transfused to high risk patients without incident For all patients at risk of TA GvHD irradiated blood is recommended provided this does not unduly delay transfusion e g Massive Bleeding Patients at risk of TA GvHD should be made aware of their need for irradiated blood components and be provided with clear written information Any problems with the operation of those procedures should be brought to the attention of the Medical Consultant in charge of the Blood Bank or the Blood Bank Head Deputy 2012 BTM 12th Edition Blood Transfusion Manual APPENDIX 5 continued For at risk patients all red cell platelet and granulocyte concentrates should be irradiated except cryopreserved r
20. hospital may be trusted with the collection of blood sample s for transfusion provided they follow the practices detailed in para 1 4 The requesting Medical Officer must sign the request form the person taking the blood who may be the Medical Officer or a phlebotomist must initial the sample container and write his her full name on the request form nthe event of unconscious patients the request form must be signed and the sample taken by the same Medical Officer see 1 5 BTM 12th Edition 2013 15 Blood Transfusion Manual 1 5 Accident amp Emergency A amp E Patients If the patient s name and or date of birth are not known e g patient is unconscious the request form and sample MUST carry the A amp E number a unique hospital number gender F M and the location of the patient This is also applicable in the event of a Major Accident At hospital admission all patients will be identified by a unique Major Accident number provided by A amp E Department i e TN number Advise Blood Bank that sample is on its way 1 6 Transport of Samples Samples and requests should be sent in a double compartment Polygrip sample bag Only one patient s sample s and request form must be enclosed in each bag 1 6 1 Samples will be collected by the portering service or BTS driver from the pick up points at the specified times Woodend Hospital WE and Aberdeen Maternity Hospital AMH from the refrigerator s twi
21. in aliquots of 10ml Kg until group specific blood available ACTIVATE MASSIVE BLEEDING PROTOCOL Call 2222 and state Massive Bleeding Protocol Activation and advise of patient location hospital and ward 20 min group specific unmatched 30 min emergency crossmatched Actual or predicted loss of 50 blood volume 40ml Kg or approaching transfusion of 40ml Kg in first hour with ongoing bleeding Switchboard will pass caller onto Blood Bank to provide patient information and then switchboard will contact Porter and Haematology Lab Standard management of clinical condition Give consider Initial Give 20ml Kg of FFP laboratory 10 ipitate if fibri 9 of cryoprecipitate if fibrinogen 20ml Kg of platelets results lt 1 09 after FFP Bleeding Stops Ongoing Massive Bleeding Give 20ml Kg FFP and 20ml Kg platelets per 40ml Kg of RCCs Monitor FBC PT APTT and fibrinogen If platelets 20 give 20ml Kg of platelets If fibrinogen 1 0g l give 10ml of Give cryoprecipitate 20ml Kg FFP if PT or APTT prolonged No further FFP unless bleeding restarts 535 above upper limit of normal 20ml Kg platelets if platelets lt 50 10 cryoprecipitate if fibrinogen lt 1 09 When bleeding coming under control A 1 unit of apheresis platelets is equivalent to 4 5 single donor units Any communication with Blood Bank after the initial activation call phone 50522
22. of Pregnancy Therapeutic plasma exchange Transplacental Haemorrhage Transfusion Related Acute Lung Injury Thrombotic Thrombocytopaenia Purpura Transurethral resection of the prostate 2013 93 Blood Transfusion Manual Tx UCB UP vCJD WAIHA WB WBC WE 94 Transfusion Umbilical cord blood Unknown Patient Variant Creutzfeldt Jakob Disease Warm Auto Immune Haemolytic Anaemia Whole blood or western blot White blood cell Woodend Hospital 2013 BTM 12th Edition Blood Transfusion Manual INDEX A A amp E Patients 10 72 Abbreviations Glossary 89 93 Abortion 56 60 Albumin 41 44 48 Alloantibody 7 65 Antenatal Service 51 Antenatal Obstetric Service 51 64 Antibodies 6 7 15 17 21 30 52 60 63 Granulocyte 7 85 7 67 68 88 Red Cell Auto Allo 6 66 Antibody Cards 30 57 Anti D 44 49 57 64 Administration Advice 57 60 Issue Collection 61 Location 61 NIPD 57 RhD Programme 57 64 Quantification 57 Anti HBs lg Anti Tetanus lg Anti Rabies 19 Anti Varicella Zoster lg Apheresis Services Autoantibodies Autoimmune Baby 6 15 21 53 57 62 63 CMV neg Blood 20 21 23 43 83 Cord Blood 6 53 54 63 IDNA 57 66 Exchange 21 23 45 63 66 70 Group and DAT 6 51 53 55 Intrauterine 23 55 60 83 85 Sample 6 13 15 52 Transfusion 21 22
23. or the patient s notes or patient s addressograph label In the interest of conservation of valuable blood stocks the BTC always proposes that not more than 1 unit of blood should be removed from the storage refrigerator at anyone time 8 COMPATIBILITY LABEL CL The compatibility label CL is attached to blood components issued by the BTC in order to meet the legal requirements outlined in the UK Blood Safety and Quality Regulations 2005 The following 6 step guide to transfusion will assist you in using the system If you require further assistance or information please contact Aberdeen Blood Bank ext 52322 52512 8 12474 and or Dr Gray s Blood Bank ext 67479 BTM 12th Edition 2013 35 Blood Transfusion Manual Blood Transfusion Manual IX STEP GUIDE TO TRANSFUSION 25 W Check that the correct label is attached to the blood bag If there is ANY discrepancy DO NOT transfuse Compatibility label Leaks 1 Discolouration Clumping Donation ETSI aie Raga Number Patient deny No Patient Blood Group Donation Number TIT Dg Donation Number 2 Expiry date Lab ample or II ba Gv ime Given If the checks are satisfactory complete the pink portion of the If there is ANY discrepancy DO NOT transfuse label IMMEDIATELY BEFOR
24. patients of childbearing potential until group specific is available or for anyone whose plasma is known to contain anti D O RhD positive blood may be given in an emergency to male patients and women of post childbearing age or known to be RhD positive Inform Blood Bank immediately emergency blood is used so that it can be replaced Uncontrollable Bleeding Activation of Massive Bleeding Protocol MBP ARI ext 2222 DGH 67320 For continued bleeding ext 50522 See flowchart pages 73 amp 75 Appendix 2 Is patient on Warfarin Massive life limb sight threatening bleed due to warfarin should be treated with PCC Page 81 Appendix 3 Contact On Call BTC Duty MO via Blood Bank ext 5 52322 5 52512 SAMPLE LABELLING CRITERIA Label the form and sample with Patient s first name surname Date of Birth Gender CHI Ward Hospital Date amp Time sample was taken Signature of person taking sample on sample tube and form See 6 steps for Positive Patient Identification pages 9 12 See Important Information Page I IV UNLABELLED MISLABELLED samples will NOT BE ACCEPTED If the patient s name and or Date of Birth are not known e g unconscious the request form and sample MUST carry the A amp E Number a unique hospital number i e TN no Gender and the location of the patient This is also applicable in the event of a Major Accident At hospital admission all patients
25. will be identified by a unique Major Accident number provided by A amp E Department NOTE Clinicians need to allow the time it takes for blood components to be collected from hospital Blood Bank to reach clinical area Inform Blood Bank immediately if anticipating uncontrollable bleeding to activate NHS Grampian Protocol for Massive Bleeding http intranet grampian scot nhs uk foi files NHS_Grampian_Massive_Bleeding_ Protocol for Adults v2 Oct12 2 1 1 pdf BTM 12th Edition 2013 Blood Transfusion Manual Blood Transfusion Manual CONTENTS 4 EMERGENCY TRANSFUSION OF UNMATCHED BLOOD 30 PAGE 5 DELIVERY amp DISTRIBUTION OF MATCHED BLOOD GENERAL INTRODUCTION 1 TO GRAMPIAN HOSPITALS 31 STAFF DIRECTORY 4 6 BLOOD STORAGE AND LOCATIONS IN GRAMPIAN HOSPITALS 33 SAMPLE REQUIREMENTS FOR BLOOD TRANSFUSION AND SEROLOGICAL INVESTIGATIONS 6 7 COLLECTION OF MATCHED BLOOD 35 SECTION I 8 COMPATIBILITY LABEL CL 35 SIX STEP GUIDE TO TRANSFUSION 36 BLOOD BANK SERVICES 9 LABORATORY HOURS 9 9 TRANSFUSION PROCEDURES 39 1 GENERAL INFORMATION 9 10 TRANSFUSION REACTIONS 42 1 1 The Role of the Duty Medical Officer MO 9 Ws 2 2 ANDBLOOD 43 1 2 Patient Identification Guide 9 Six steps for positive Patient Identification 9 SECTION II 1 3 Biohazard Danger of Infection 13 Postage Transport of High Infectious Risk Samples 13 ANTENATAL OBSTETRIC SERVICE 51 1 4 Request Form and Blood Samples for Crossmatch 13 LABORATORY HOURS 51 1 5 Ac
26. 12 13 16 71 Blood Group Serology 51 71 FAD Prograf sis 57 64 S Samples Frequency antenatal 52 53 62 Identification 9 10 14 40 71 15 52 54 62 64 Mislabellgd iioi coa bene io ctt 14 71 Neonatal Phlebotomists Requirements Transport Unlabelled Serology Investigations Six Step Guide to Transfusion Specific Immunoglobulin Storage of Blood see Refrigerator storage 15 21 66 T Therapeutic Venesection Tissue Services Tissue Typing Transplantation ien Transfusion Procedures After Before Cancellation Emergency Use Exchange Intrauterine Neonatal Paediatric 5 Postponement Cancellation of Tx Reactions Subsequent Administration Set 7 67 68 67 68 60 Blood Transfusion Manual U Unconscious Patients 15 16 72 Unlabelled 9 14 Unmatched Blood 18 30 31 Urgent Blood Requests sen 18 18 V Venesection 69 Warfarin 81 Washed Platelets Washed Red Cells 44 45 2013 BTM 12th Edition General Notes Blood Transfusion Manual BTM 12th Edition 2013 Blood Transfusion Manual Blood Transfusion Manual General Notes General Notes
27. 30 39 Bioliazeald ni coin nit n inten 13 Blood ABO Group 6 19 15 18 Administration set 99 41 43 46 Availability 14 17 43 45 Blood Bank 9 CMV Seronegative 21 29 88 BTM 12th Edition Delivery and Distribution Duty MO Emergency Flying Squad Frozen Fresh Plasma FFP FFP MBT Investigatio Irradiated Cellular Components Leucocyte Depleted Location RhD Neg Ordering Platelets Products Red Cell C Samples Storage Unmatched Urgent Requests Washed Red Cells Bone Bank C1 Esterase Inhibitor Cancellation Postponement of Tx CD 14 16 34 etc Cell Separator Unit 69 CMV Seronegative Blood 21 23 83 Cold Agglutinin Screen 2216365 Collection of Matched Blood 32 35 Coombs Test See DAT inv 865 Cord Blood 6 52 54 63 Crossmatch 6 17 18 24 Cryoprecipitate DAT see Coombs Test Delivery amp Distribution Delivery Maternal Directory Staff DNA D K typing Donath Landsteiner 2013 95 Blood Transfusion Manual E Elective 1 18 24 Emergency Blood Use 30 31 35 40 41 Emergency Blood Request ae 74 Emergency HLA Typing e NOT Exchange Transfusions 21 23 Extended Blood Group gt 6 65 F Factor PCC Beriplex 44 47 Fibrinogen Filtered Red C
28. 401 12402 0900 1700 Monday to Friday Ext 8 12461 Lymphocyte subsets for monitoring of HIV positive patients CD3 CD4 CD8 CD19 CD56 Samples require testing within INTRODUCTION 24hrs of withdrawal Services provided to clinicians by this laboratory include PNH investigation by flowcytometry CD14 CD16 CD55 and s Molecular Immunohaematology FLAER CD59 Samples require testing within 24hrs of withdrawal Platelet Granulocyte Immunohaematology 5 Other investigations Support of Solid Organ Transplantation All non urgent samples should be sent to the Aberdeen BTC for Molecular Immunohaematology forwarding to the Edinburgh BTC which provides the laboratory Molecular blood group genotyping for management of pregnancies at testing service Edinburgh BTC can be contacted on tel 0131 242 risk of HDFN and investigation of blood group anomalies 7528 Please refer to SNBTS Histocompatibility amp Immunogenetics Tests are available for RHD RHCE Laboratory User Manual for sample requirements SFY e KIDD MNS www scotblood co uk about us publications aspx For advice on clinical indications and authorisation contact ipea Dr M Greiss 8 12420 Note Emergency HLA typing compatibility testing This service is restricted to solid organ transplantation and is available only to organ donor transplant coordinators This laboratory offers diagnostic services including the investigation of nhs
29. AILABLE AT BLOOD TRANSFUSION CENTRE continued Beriplex BTM 12th Edition Haemophilia B Christmas Disease Rapid reversal of oral Beriplex PCC Contents after reconstitution IU ml Factor 20 48 FVII 10 25 FIX 20 31 anticoagulant overdose 22 60 IU ml Warfarin Factor and X deficiency Further active ingredients IU ml Protein C 15 45 Protein S 12 38 Store Do not store above 25 2013 47 Blood Transfusion Manual SUMMARY OF PLASMA PRODUCTS AVAILABLE FROM NHS GRAMPIAN PHARMACY at 5 53223 Mon to Fri 5 all other times contact on call pharmacist via ARI switchboard 0845 456 6000 All plasma products have been prepared from pooled units of human plasma collected from non UK voluntary non remunerated donors resident in the EU or USA Blood Product Human Albumin Solution 4 5 Human Albumin Solution 20 Normal Human Immunoglobulin Intramuscular IM Human immunoglobulin IgG for intravenous or subcutaneous use IVIg SClg 48 Main Indi Blood volume expansion Plasma exchange Severe hypoalbuminaemia i e Serum albumin 20 g L Ascites for drainage Hepatorenal Syndrome Or Spontaneous Bacterial Peritonitis Passive immunisation viral infections Hypogamma globulinaemia Hepatitis A passive immunisation Measles prophylaxis See National Guideline primary or secondary immunodeficiency immu
30. Aberdeen BTC there is a fully equipped cell separator unit including resuscitation facilities staffed with trained personnel where therapeutic haemapheresis may be carried out Procedures that can be performed include Erythrocytapheresis red cell exchange Leucopheresis Peripheral Blood Stem Cell PBSC harvests Therapeutic Plasma Exchange TPE Plateletpheresis Therapeutic venesection o o o o Although procedures are usually carried out in the cell separator unit if the patient s condition precludes this the procedure may be carried out in the Intensive Care Unit Before apheresis is carried out clinical assessment of the patient will be made to ensure that there are no medical contraindications to the procedure For advice on clinical indications and which investigations are required contact the On Call MO for BTC via the Blood Bank ext 52322 52512 8 12474 Cytotoxic T cell Lymphocytes CTL Anti Epstein Barr virus cytotoxic lymphocytes EBV CTLs Aberdeen BTC provides blood donor derived anti EBV CTLs for the treatment of EBV associated lymphomas mainly in the post transplant setting Any potential patient should be discussed with Professor M Vickers on 8 12401 12402 BTM 12th Edition 2013 69 Blood Transfusion Manual SECTION VI BONE BANK SERVICE HOURS Working Hours Aberdeen BTC 0900 1700 Monday to Friday To contact the Bone Bank Co ordinator page 07699 736763 Requests for surgical
31. DAT D amp C DDAVP DGH DHR DHTR DIC DNA DSTR ECC ECMO EDTA ERCP ERPOC FBC FBS FcR FFP FLAER FMH FNAIT FNHTR G CSF GI GI 90 Citrate phosphate dextrose Citrate phosphate dextrose adenine 1 Citrate phosphate double dextrose Caesarean Section Computed Tomography Cytotoxic T cell lymphocytes Cerebrovascular Accident Central Venous Pressure Chorionic villus sampling Direct Antiglobulin Test Dilation and curettage Deamino D arginine vasopressin Doctor Gray s Hospital Dihydrorhodamine 123 Delayed haemolytic transfusion reaction Disseminated intravascular coagulation Deoxyribonucleic Acid Delayed serological transfusion reaction Emergency Care Centre Extracorporeal membrane oxygenation Ethylenediamine Tetraacetic Acid Endoscopic Retrograde Cholangiopancreatography Evacuation Retained Products of Conception Full Blood Count Fetal Blood Sample Fc gamma receptor Fresh frozen plasma Fluorescein labelled proaerolysin Fetomaternal Haemorrhage Fetal neonatal alloimmune thrombocytopenia Febrile nonhaemolytic transfusion reaction Granulocyte colony stimulating factor Gastrointestinal Unit 2013 BTM 12th Edition GM CSF GMP G amp S GVHD Gy HAV Hb HBc HBlg HBsAg HBV Het HCV HDFN Hg HIT HIV HLA HPA HSCT HTR HUS IAT ID IgG INR ISBT ITP IU IUD BTM 12th Edition Blood Transfusion Manual Granulocyte macrophage colony stimulating factor Good manufacturing practice
32. E commencing transfusion Ask the patient to tell you their full name and Date of Birth Check Dagainst the ID band verbally Check 2 ID band against compatibility label on the component If there is ANY discrepancy DO NOT transfuse if you are interrupted STOP and start the checking procedure again Do not leave the patient until the transfusion has commenced 277 nevent of unconscious patient check unique Major Accident Number mamme Admission Number e g UP no COMMENCE THE TRANSFUSION 36 2013 BTM 12th Edition BTM 12th Edition 2013 37 Blood Transfusion Manual Once the patient has been exposed to the transfusion STOP SEE BACK OF THIS TAG BEFORE TRANSFUSION ps Prescription i i E Recording Form Peel off label above and place in patient s Surname Forename Peel off the completed pink portion and attach it to the Prescription and Recording Form remember to sign to say you have undertaken the patient ID checks Once the patient has been exposed to the transfusion Special Requirements SEND TO LAB Once transfusion has been started you must send the completed section below back to the Hospital Transfusion Laboratory as per local policy This is a legal requirement Time Given confirm that the above patient received this blood component Sign and Print Name i Sign a
33. EMOIR RE ACTIVATION OF MASSIVE BLEEDING PROTOCOL ABERDEEN APPENDIX 2 2 Adult Massive Bleeding Protocol Flow Chart Dr Gray s Elgin Consider Tranexamic acid MASSIVE TRANSTUSIONOR UNCONTROLLABLE BLEEDING in trauma patients CALL 2222 1g IV bolus followed by 1g IV infusion over 8 hrs Send FBC PT APTT fibrinogen crossmatch Consider reversal of any CLINICAL DECISION MADE TO ACTIVATE MASSIVE BLEEDING PROTOCOL ACTIVATE MASSIVE BLEEDING PROTOCOL GE 9 a Call bloodbank Dr Gray s direct on ext 67956 and STATE MASSIVE BLEEDING PROTOCOL ACTIVATION and provide anti thrombotic therapy the Sas as 4 t n LOCATION OF PATIENT HOSPITAL AND WARD patient has been taking Immediate transfusion required 5 q us Mowe ve Bleeding Y M advise of patient location Further contact use same ext 67956 SWITCHBOARD SHALL REPEAT INFORMATION BACK TO CALLER AND PASS CALLER ONTO BLOOD BANK CALLER HOLDS THE LINE AND IS PASSED ONTO BLOOD BANK Y ON BLOOD BANK ANSWERING CALLER REPEATS TO BLOOD BANK MASSIVE BLEEDING PROTOCOL ACTIVATION AND PROVIDES LOCATION OF PATIENT HOSPITAL AND WARD Y y and Give Group neg unmatched units until group specific blood available 20 min group specific unmatched 30 min emergency crossmatched More than 4 units of packed red cells in the first hour of blood loss 1500m
34. Lymphoma All Hodgkin s Disease at all stages o Duration for irradiated blood components indefinitely for life All Non Hodgkin s Lymphoma NHL at all stages o Duration for irradiated blood components indefinitely for life 2012 BTM 12th Edition Blood Transfusion Man ual 7 Patients receiving the following chemotherapy or monoclonal antibodies Purine analogues fludarabine cladribine clofarabine deoxycoformycin and anti lymphocyte globulin ALG o Duration for irradiated blood components indefinitely for life T cell depleted agents such as alemtuzumab CAMPATH or anti CD52 antibody for haematological and non haematological indications including solid organ transplantation multiple sclerosis and vasculitis o Duration for irradiated blood components indefinitely for life 8 Aplastic anaemia only if patients are receiving anti thymocyte globulin ATG treatment o Duration for irradiated blood components there is no firm recommendation as to how long Irradiated blood components NOT clinically indicated 1 Acute leukaemia only irradiate blood components if patients have a Clinical indication listed above e g purine analogue therapy HLA matched platelets 2 Itis not necessary to irradiate components for patients with solid tumours organ transplants or HIV including infants and children 3 It is not necessary to irradiate components for infants or children undergoing card
35. URE PATIENT DETAILS ON BLOOD TUBE AND REQUEST FORM ARE IDENTICAL WRITE THE TIME AND DATE OF DRAWING SAMPLE ON THE REQUEST FORM SIGN THE REQUEST FORM TO INDICATE WHO DREW SAMPLE 12 2013 BTM 12th Edition 1 3 Blood Transfusion Manual Biohazard Danger Of Infection All blood samples are potentially infectious however some are more hazardous than others The sample and request form MUST be clearly marked with a Danger of Infection label black letters on yellow background The request form and sample MUST be in separate compartments of a polygrip bag Postage Transport of High Infectious Risk Samples 1 4 Ensure caps are tightly fastened Secure cap with tape Wrap sample in absorbent tissues Seal in plastic bag or enclose within plastic mailing container Affix yellow Danger of Infection label to outside of package Place within second plastic bag e g polygrip keeping the paperwork separate from the sample Telephone the appropriate laboratory to inform them that a high infectious risk sample is on its way Send via routine delivery see also para 1 6 Request Form and Blood Samples for Crossmatch Six step procedure for positive patient identification for blood transfusion sampling pages 10 12 1 4 4 Complete a REQUEST FOR BLOOD BLOOD COMPONENTS BLOOD GROUP amp SCREEN form either electronically or hard copy stating clearly the clinical condition the time and
36. able 56 2013 BTM 12th Edition Blood Transfusion Manual 5 2 Anti D or Anti c Titre Quantification Where alloimmune anti D c has been identified in a patient this will be reported initially as an antibody titre but will then be quantified in International Units IU ml for pregnancies where it is suspected HDFN may result Quantification testing is carried out in the SNBTS Gartnavel Glasgow laboratories 5 3 Antibody Cards In the event of a patient developing antibodies during pregnancy an antibody card which they are advised to carry at all times will be issued directly to the patient s home address The GP will already have been updated with any serological changes 5 4 Paternal Samples Antenatal patients who have been shown to have clinically significant atypical antibodies require determination of the partner s red cell phenotype see para 2 4 page 51 unless already known This investigation may indicate whether or not the fetus is likely to be at risk from HDFN 5 5 DNA Genotyping of Fetus NIPD Where a woman has an antibody e g anti D c or K which may cause serious HDFN representing a risk of IUD and the father is predicted to be heterozygous for the relevant antigen by phenotyping routine blood grouping or is unknown the genotype of the baby may be determined by DNA typing of the fetus using the maternal plasma This will identify whether or not the baby is at risk of HDFN by determining the corre
37. ame as the number and blood group printed on the blood pack label on some occasions a different compatible blood group may be issued to the patient 9 1 8 The blood is within the expiry date printed on the blood pack label 9 1 4 blood bag has no damage leaks or any abnormalities 9 1 5 If patient has special transfusion requirements e g irradiated components Only by careful attention to all these details will it be ensured that the patient receives the correct blood Do NOT add drugs or calcium containing solutions e g Ringer s Lactate Hartmann s to bags of blood However this should not preclude the clinician from giving any essential medicine by another route 9 2 After a Transfusion 9 2 1 In the case of any bag of blood transfused which is labelled EMERGENCY USE ONLY and which is transfused the full details of the patient to whom it has been administered Surname First Name Date of Birth Gender CHI No Ward 40 2013 BTM 12th Edition Blood Transfusion Manual and Hospital must be entered on the label attached to the bag and the label s returned to the Blood Bank When the emergency blood is used please inform the Blood Bank immediately on ext 52322 52512 8 12474 9 2 2 Compatibility Label CL It is a legal requirement that an accurate record of the transfusion process is kept as follows 1 A record is made in the notes of the decision to transfuse and the indication This
38. anual 2 3 3 Compatibility Label CL The compatibility label is generated in the Blood Bank It is attached to the blood bag and contains the following patient information Surname Forename Date of Birth Gender Number Patient Identification Number Ward and Hospital The patient s blood STOP SEE BACK OF THIS TAG BEFORE TRANSFUSION E group component NHS type and date required rdg EE LLL LL sd are also included on 124 the label The unique p do nati on num be r Peel off label above and place in patient s Medical Records is printed on the Surname Forename compatibility label DOB Gender this number must match exactly with the number on the blood or Patient Identity No Date Time Required bag label Patient Blood Group Component Donation Number Special Requirements Once transfusion has been started you must send the completed section below back to the Hospital Transfusion Laboratory as per local policy This is a legal requirement sumam Forename Ss Patient Identity No Lab Sample No Donation Number Component Date Given Time Given 1 confirm that the above patient received this blood component Sign and Print Name BTM 12th Edition 2013 19 Blood Transfusion Manual 2 3 4 Unique Donation Number This is the unique number assigned to each blood donation by the transfusion service and allows traceability from donor to patient All d
39. ased risk of thrombosis 2 Angina pectoris and after recent myocardial infarction In all clinical situations an assessment of the likely risks and benefits of administration needs to be made In disseminated intravascular coagulation prothrombin complex preparations e g Beriplex may only be administered after termination of the consumptive state T Intravenous Vitamin K may rarely cause anaphylaxis Administration should be By slow IV bolus Withheld in patients with a history of previous severe allergic reaction to Vitamin K Oral Vitamin K preparation used is the preparation for injection 10mg ml Konakion Roche Dilute dose in small amount of juice water after drawing up in an oral syringe Standard risk patients do not require INR reversal at INR 4 5 6 9 but correction should be considered in high risk patients whose risk of bleeding is approximately 15 fold higher Patients at high risk of warfarin associated bleeding Elderly Previous bleed Previous CVA haemorrhagic or ischaemic Anaemia Renal failure Diabetes mellitus 2012 BTM 12th Edition BTM 12th Edition 2012 83 APPENDICES Blood Transfusion Manual APPENDIX 5 Guideline on the use of irradiated blood components Clinical Indications for Irradiation of Cellular Blood Components Transfusion Associated Graft versus Host Disease TA GvHD is an often fatal complication of blood transfusion Itis caused by transfusion of
40. ature of person taking sample on sample tube and form 2 2 Report destination and requesting doctor s name rubber stamp or block capitals 2 3 If patientis PRIVATE indicate this in the appropriate section This form can be used for requesting Category 2 non clinical blood groups BTM 12th Edition 2013 51 Blood Transfusion Manual Blood Transfusion Manual 2 4 State clearly if itis an antenatal booking sample request indicating SUGGESTED FREQUENCY OF ANTENATAL TESTING whether the patient is prim multigravidae history of transfusion s 5 and if her plasma contains any clinically significant antibody ies Gesunde do WEEMS which are associated with HDFN Give as many clinical details Booking as available which could help in processing the request e g 8 a indicate if patient has been administered prophylactic any anti D Ig and if so when further b if submitting a partner s father sample for phenotype i please give details of the pregnant partner This form may by also be used for investigations related to Laboratory immunohaematological disease 2 5 Fora patient with or suspected of having a high risk infection Booking Monthly Fortnightly Weekly e g Hepatitis B C or HIV until 30 from 30 36 from 36 k k k Antenatal request 7ml EDTA see below 3 1 e e BEFORE Anti D prophylaxis further Blood Group amp Antibody Screen 7ml EDTA festos requested Kleihauer
41. ble individuals exposed to chicken pox Passive immunisation in susceptible individuals exposed to rabies infection 2013 Blood Transfusion Manual 250 IU 5000 500 IU 1000 and 1500 IU 300g IgG anti D per vial in aqueous solution Expiry date on label 3 year shelf life Store at 2 C to 8 C 250 IU of IgG anti tetanus per vial The measured potency of the product is stated on the vial label in IU ml Expiry date on label Store at 2 C to 8 C 500 IU of IgG anti HBs per vial Expiry date on label Store at 2 C to 8 C Dose Age 0 4 yrs 200 IU Age 5 9 yrs 300 IU Adults and children aged 10 yrs or more 500 IU 250 mg of IgG anti Varicella Zoster per vial Expiry date on label Store at 2 C to 8 C Dose Age 0 5 yrs 1 vial 250mg Age 6 10 yrs 2 vials 5000 Age 11 14 yrs 3 vials 750mg Age 15 yrs or more 4 vials 1000mg 500 IU of IgG anti Rabies per vial Expiry date on label Store at 2 C to 8 Dose 20 10 Kg body weight for both adults and children 49 Blood Transfusion Manual PHARMACY continued The following products are available on a named patient basis only They require specific administration and release procedures and supplier s instructions must be followed NAMED PATIENT Plasma Indication Description Product for Use C1 Inhibitor Treatment of acute C1 Inhibitor a purified concentrated 500 units attacks and short and stab
42. bone can be made by completing a Request for Bone Products Form obtainable from the Orthopaedic Ward or by telephoning Ext 52322 52512 Minimum details required will be the patient s full name date of birth CHI gender and RhD group the quantity of bone required small or large and the type of operation The hospital ward theatre of destination date and time of the planned procedure should also be provided All requests must be directed to Bone Bank Blood Transfusion Centre Foresterhill Road Aberdeen 2013 BTM 12th Edition Blood Transfusion Manual APPENDIX 1 The Scottish National Blood Transfusion Service SNBTS Zero Tolerance Policy Following the publication of the NHS Quality Improvement Scotland QIS Clinical Standards for Blood Transfusion in 2006 QIS recommended that every NHSS Board should introduce a zero tolerance policy for pre transfusion samples The British Committee for Standards in Haematology BCSH also strongly recommended zero tolerance in their updated Guidelines on the administration of blood components in 2009 The Scottish National Blood Transfusion Service SNBTS has implemented a zero tolerance policy for labelling of blood samples from patients potentially requiring blood transfusion e g Blood Bank and antenatal samples Zero tolerance in terms of sample labelling request form completion requires the following mandatory points of patient identification Last name Firs
43. ce daily at 0700 and 1300 hrs Monday Friday and at 0700 hrs on Saturdays Outwith these times arrangements for collection and delivery must be made by the ward staff pages 31 33 1 6 2 Community Hospitals the ward clinic staff must make arrangements for the collection and delivery of the blood samples 1 7 Urgent Requests Telephone the Blood Bank ARI ext 52322 52512 8 12474 DGH ext 67320 67479 before despatching the samples This will help to speed up the response For further details on obtaining urgent supplies of blood see pages 33 35 2 LABORATORY PROCEDURE FOR PROVIDING BLOOD 2 4 Group and Screen G amp S This test is to determine the patient s ABO and RhD groups and to Screen for the presence of atypical red cell antibodies in the plasma 16 2013 BTM 12th Edition Blood Transfusion Manual The G amp S samples are stored at 4 for 7 days from the date of withdrawal in case a subsequent request for conversion to a compatibility test crossmatch is received A fresh blood sample will not be required unless the patient has been transfused and more than 48 hrs has elapsed since the transfusion In the interest of conservation of valuable blood stocks the BTC always encourages the G amp S procedure whenever appropriate MSBOS pages 25 29 If atypical red cell antibodies are identified 2 units of crossmatched blood may be made available dependant on the clinical need The sample should be provide
44. cident amp Emergency A amp E Patients 16 1 6 Transport of Samples 16 1 ORDERING OF REQUEST FORMS 51 1 7 tR t 16 2 COMPLETION OF REQUEST FORMS 51 2 LABORATORY PROCEDURE FOR PROVIDING BLOOD 16 3 BLOOD SAMPLES REQUIRED AND FREQUENCY OF TESTS 52 2 1 Group and Screen G amp S 16 2 2 Crossmatch Compatibility Test 17 4 REPORTING OF RESULTS 56 2 3 Blood Ordering and Availability 7 5 ANTIBODY CASES 56 3 BLOOD ORDERING SCHEDULES 21 6 RhD PROGRAMME 57 3 1 Paediatric Transfusion 21 SECTION III 3 2 Maximum Surgical Blood Ordering Schedules MSBOS 24 1 GENERAL SURGERY MSBOS 25 IMMUNOHAEMATOLOGY INVESTIGATIONS 65 2 CARDIOTHORACIC SURGERY MSBOS 26 3 SPECIALITY SURGERY MSBOS 27 SECTION IV 4 ORTHOPAEDIC SURGERY MSBOS 28 MOLECULAR IMMUNOHAEMATOLOCY MI 66 5 OBSTETRICS AND GYNAECOLOGY MSBOS 29 V 2013 BTM 12th Edition BTM 12th Edition 2013 VI Blood Transfusion Manual SECTION V CLINICAL CELL SEPARATOR SERVICE Cytotoxic T cell Lymphocytes CTL SECTION VI BONE BANK APPENDICES Appendix 1 SNBTS Zero Tolerance Policy Appendix 2 Appendix 3 Appendix 4 Appendix 5 Appendix 6 Adult Massive Bleeding Protocol 2 1 Flow Chart Aberdeen 2 2 Flow Chart Dr Gray s Elgin Paediatric Massive Bleeding Protocol 2 3 Flow Chart Aberdeen 2 4 Flow Chart Dr Gray s Elgin 2 5 Leaking Ruptured Abdominal Aortic Aneurysm AAA Guide to Reversal of Oral Anticoagulation on Warfarin Classification of Bleeding Complications C
45. d will be sent to the patient with instructions to carry it at all times and to show it at any hospital admission She will be advised to read the card and to report to her GP hospital in the event of bleeding at any time during pregnancy If patient details change inform BTC to issue an updated card 6 4 Issue and Collection of Anti D Ig Anti D Ig stocks Held in AMH Labour Ward ARI Wards 42 amp 43 Dr Gray s Hospital Wards 1 3 amp 5 Most GPs and Community Hospitals also hold anti D Ig stock GP s and Maternity Units Note Stocks of anti D Ig are available from NHS Grampian Pharmacy at 5 53223 Mon to Fri 9am 5pm all other times contact on call pharmacist via ARI switchboard 0845 456 6000 It is important that Pharmacy is informed whenever anti D is required to replace your stock 6 5 Advice on Anti D Ig Administration In accordance with the criteria in Tables 1 amp 2 page 60 anti D 10 will be advised for patients by a member of BTC staff as follows Anti D will be advised by a member of the BTC staff by a telephone call to the GP or midwife in charge of the patient AMH a During pregnancies at weekends and public holidays the BTC BMS will advise anti D Ig to the ward staff in the form of a telephone message which contains the patient details and whether she does or does not require anti D Ig BTC will maintain a record of date time and the name of the ward staff i e clinical members of staff receivi
46. d with plenty advance notice of clinical procedure The BTC will automatically issue an antibody card to the patient via the consultant GP in charge of the case 2 2 Crossmatch Compatibility Test This is the selection of suitable units of red cells for compatibility test If red cell antibodies have been identified a more lengthy procedure is performed and finding compatible blood may be difficult and time consuming Whenever patient s plasma is known to contain atypical antibody ies advance warning must be given to the blood bank whenever possible 2 3 Blood Ordering and Availability Red Cell Concentrate Supplemented RCCS or Red Cell Concentrate RCC is routine issue Special requirements e g platelets by prior discussion request via BTC Duty MO To ensure that the specimen used for compatibility testing is representative of a patient s current immune status serological studies should be performed using blood collected no more than 3 days in advance of the actual transfusion when the patient has been transfused or pregnant within the preceding 3 months or when such information is uncertain or unavailable The 3 days includes the de reservation period e g if the sample was 1 day old the blood would have to be transfused within 2 days BTM 12th Edition 2013 17 Blood Transfusion Manual Whole Blood is not available 18 2 3 1 Emergency Request Note a pre transfusion blood sample from the patient is requir
47. date the blood is needed The requesting doctor s bleep number name and signature must be included to facilitate communication 1 4 2 The sample must be 7ml in EDTA 1 4 8 Whenever possible the patient should be asked to identify himself herself verbally and the information given checked against the information on their ID band BTM 12th Edition 2013 13 Blood Transfusion Manual 14 1 4 4 1 4 5 1 4 6 1 4 7 The collection of the blood dispersal into sample tubes and labelling of the sample tubes must be carried out as one continuous uninterrupted event involving one patient only Addressograph labels must not be used on blood sample tubes The minimum acceptable labelling on the form and sample is 1 Patient s full name first name and surname 2 Date of birth DoB 3 CHI number 4 Gender Ward Hospital DoB must be given separately not extrapolated from CHI number which must be given fully otherwise samples will not be processed See also para 1 5 In addition the date and time sample was taken are also required on the request form This facilitates delivery of the required blood component The request form must also be signed by the requester and the person taking the sample Unlabelled Mislabelled Unlabelled Mislabelled samples will NOT BE ACCEPTED Discrepancies between the information on the sample tube and the request form will result in unnecessary delays while a fresh sample and reques
48. dies other than anti D Please annotate in the Special Features column of the antenatal notes that the woman has been given prophylactic anti D 10 PLEASE INFORM THE BTC VIA REQUEST FORM IF WHEN ANTI D Ig WAS ADMINISTERED NOTE During other times of potentially sensitising episodes e g PV bleeding at any gestation anti D Ig is administered in the usual way as in Tables 1 amp 2 page 60 The Kleihauer test is only to be carried out on the blood sample taken prior to anti D administration when there is bleeding after 20 weeks gestation see page 64 para 6 7 and Table 3 BTM 12th Edition 2013 59 Blood Transfusion Manual GUIDELINES FOR THE USE OF ANTI D Ig FOR Rh PROPHYLAXIS Those eligible are RhD negative women with no antibodies or antibodies other than anti D Table 1 Recommendation All RhD negative women with no pre existing immune anti D are eligible for RAADP A single dose of 1500 IU is administered at 28 weeks gestation HOWEVER IN ADDITION Events following which anti D Ig must be given to all RhD negative women with no allo anti D and or with antibodies other than anti D delivery of an RhD positive infant abortion see Table 2 invasive prenatal diagnosis amniocentesis chorionic villus sampling CVS fetal blood sampling FBS other intrauterine procedures insertion of shunts embryo reduction antepartum haemorrhage APH external version of the fetus closed abdominal in
49. dition 2012 79 9 A z a Blood Transfusion Manual APPENDIX 2 5 Leal Ruptured Abdominal Aortic Aneurysm AAA Blood Components Pack Ten units of RCCS Four units of FFP and An adult dose of platelets 4 5 single donations This could be issued in the first instance and it is possible to be repeated without BTC MO intervention 2012 BTM 12th Edition Blood Transfusion Manual APPENDIX 3 GUIDE REVERSAL ORAL ANTICOAGULATION WARFARIN CLASSIFICATION OF BLEEDING COMPLICATIONS BLEEDING NO BLEEDING TVitamin K 5mg IV and P N IV amp High Risk Initial INR Beriplex Dose amp Vitamin K amp Vitamin K 2mg orally IV 2mg orally Withhold Withhold 1 4ml Kg approx 35 IU Kg warfarin warfarin 2 0 3 9 1ml Kg approx 25 IU Kg 2ml Kg approx 50 IU Kg Vitamin 1mg orally Withhold Check INR at 24 hours or warfarin earlier if deterioration in clinical condition Immediately check PT and APTT Reduce warfarin dose or withhold Adequate correction one dose Repeat PT and APTT in 4 6 hours Inadequate correction Consider other factors contributing to prolonged coagulation tests eg DIC Congenital coagulation factor deficiency Liver disease Lupus inhibitor Inadequate replacement SEEK HAEMATOLOGICAL ADVICE BTM 12th Edition 2012 81
50. e Erythema urticaria Fever not a manifestation Hypertension tachycardia Elevated Onset within hours of any type of blood component Fever hypotension vascular collapse are prominent symptoms Possible TRALI Presence of risk factor for ALI 2012 BTM 12th Edition Blood Transfusion Manual GLOSSARY OF ABBREVIATIONS AAA ACD A amp E AHG AHTR AIDS AIHA ALG ALI AMH APC APH APPT ARI AS ATG BFR BMT BTC BTS BU CABG CAD CAS CD cDNA CHD CHAD CHI CJD CMV BTM 12th Edition Abdominal aortic aneurysm Acid citrate dextrose Accident and Emergency Anti human globulin Acute haemolytic transfusion reaction Acquired Immune Deficiency Syndrome Auto Immune Haemolytic Anaemia Anti lymphocyte globulin Acute Lung Injury Aberdeen Maternity Hospital Antigen presenting cell Antepartum Haemorrhage Activated Partial Thromboplastin Time Aberdeen Royal Infirmary Additive solution Anti Thymocyte Globulin Blood Fridge Register Bone Marrow Transplant Blood Transfusion Centre Blood Transfusion Service Bleeding Unit Coronary Artery Bypass Graft Cold Antibody agglutinin Disease Cold agglutinin syndrome Corrected count increment Clusters of differentiation Complementary deoxyribonucleic acid Cold Haemagglutinin Disease Community Health Index Creutzfeldt Jakob Disease Cytomegalovirus 2013 89 Blood Transfusion Manual CPD CPDA 1 CP2D cs CT CTL CVA CVP Cvs
51. e an out of hours service for transfusion medicine advice The Aberdeen amp North East Scotland Blood Transfusion Centre provides both clinical and laboratory support for other hospital blood banks including Dr Gray s Elgin Gilbert Bain Lerwick Balfour Hospital Kirkwall and Albyn Hospital Aberdeen BTM 12th Edition 2013 1 Blood Transfusion Manual 1 2 Laboratory Mr Douglas Clark BMS 4 is the Clinical Laboratory Manager the laboratories are in three main sections Blood Banking Mrs Jane Burnett BMS 3 is the Laboratory Department Head This section provides the blood bank service antenatal serology and has a reference laboratory service for investigative red cell serology Molecular Immunohaematology MI Mrs Fiona Sellers BMS 3 is the Laboratory Department Head This section s main roles are platelet and granulocyte immunohaematology molecular blood grouping Cellular Therapies Mr Nicolas Robinson BMS 3 is the Laboratory Department Head This section provides stem cell processing support in addition to the development of new cellular therapy products 1 3 Cell Separator Unit Nursing Mrs Helen Clark Senior Nurse Manager Ms Lynn Fyfe is the Clinical Team Manager nursing in this section where the main function is clinical apheresis including haematopoietic stem cell collection venesection and therapeutic plasma exchanges OTHER DIRECTORATES 2 Quality Mr Neil Fraser BMS 3 is Quality Manager in this Dir
52. ectorate and is responsible for ensuring that all departments comply with necessary regulatory standards and legislation as well as overseeing all laboratory or donor related incidents 3 Research Development amp Innovation and National Reference Work Prof Mark Vickers is head of ATMU and is supported by two clinical Scientists Dr Sylvia Armstrong Fisher and Dr Michael Moss 4 Tissue Services Dr Philip Yates is Consultant This Directorate is responsible for the collection and processing of tissues for use therapeutically 2 2013 BTM 12th Edition Blood Transfusion Manual 5 Supply Chain Mrs Lynne Willdigg Donor Services Manager This Directorate is responsible for organising blood donor sessions throughout Grampian and ensuring that there are ample donors recruited to maintain continuing supply of blood This is supported by two Senior Nurse Managers Mrs Helen Clark and Mrs Deborah McNaughton Useful contacts Phone number BTM 12th Edition 2013 3 Blood Transfusion Manual STAFF DIRECTORY ABERDEEN BTC Laboratory Services Direct Dial Lines Blood Bank 24 hours NHS Grampian 24 hours Blood Transfusion Centre Fax Blood Bank Laboratory Reception Enquiries Requests Blood Bank 24 hours Duty Medical Officer Antenatal Obstetric Service Red Cell Special Investigation Molecular Immunohaematology Clinical Immunology Laboratory Bone Bank The
53. ed cells after deglycerolisation It is not necessary to irradiate Fresh Frozen Plasma cryoprecipitate or fractionated plasma products Bone marrow and haemopoietic stem cells for the purposes of transplantation must not be irradiated Clinical Indications for Irradiation of Cellular Blood Components 1 All donations from first or second degree relatives for any recipient even if the patient is immunocompetent 2 HLA selected platelets for any recipient even if the patient is immunocompetent 3 All granulocyte transfusions for any recipient which must then be transfused with minimum delay 4 Paediatric practice All intrauterine transfusions IUT All exchange transfusions or top up transfusions after IUT until 6 months after expected delivery date 40 week gestation Exchange transfusion with no previous IUT irradiated blood is recommended provided this does not unduly delay transfusion Top up transfusion with no previous IUT irradiated blood is not required Platelet transfusions irradiated components only if previous intrauterine red cell or platelet transfusion or if the donation comes from a first or second degree relative All granulocyte transfusions Congenital immunodeficiencies in infants and children all severe primary T lymphocyte immunodeficiencies SCID Di George s Wiskott Aldrich syndrome purine nucleoside phosphorylase deficient cell mediated immunodeficiency reticular dysgenesis ade
54. ed to confirm blood group Specialist advice may be sought from the BTC Duty MO Blood availability depends on the degree of clinical urgency e Aroutine crossmatch takes approximately one hour from receipt of sample e In an URGENT clinical situation ABO amp RhD group specific blood may be rapidly matched if the patient s blood group is known and no clinically significant antibody has been reported and will be available approximately 20 minutes from the time of request e EVENT OF MASSIVE BLEEDING Group RhD negative rr blood is available from specific blood storage refrigerators pages 33 35 Or alternatively Group O unmatched blood can be issued within 10 minutes of request from the Blood Bank MASSIVE BLEEDING PROTOCOL see page 73 Appendix 2 2 3 2 Elective Request e For G amp S refer to paragraph 3 2 provide sample AT LEAST 24 HOURS in advance of clinical procedure e Forelective transfusion procedures give AT LEAST 24 HOURS NOTICE and state the time the blood is required e Whenthis much notice is not possible blood is routinely processed in two batches to make it available as follows Samples received at BTC Blood matched by 0900hrs 1400hrs 1230hrs 1730hrs This timing depends on priority urgent clinical situations Please note Blood Bank enquiry numbers 52322 52512 8 12474 should be used mainly for clinical urgency For DGH ext 67479 67320 2013 BTM 12th Edition Blood Transfusion M
55. ells Flow Cytometry Forms Reports Antenatal Blood Bank T Blood Group Serology Investigation Immunohaematology 65 Fresh Frozen Plasma FFP G Glossary of 5 89 93 Guidelines Anti D Ig CMV Seronegative Indications Irradiation Indications Massive Bleeding Protocol Reversal of Warfarin TRALI Diagnosis Granulocyte Typing amp Auto Allo antibody Group and Screen Group Cards Antibody 90 57 RhD negativ 59 61 H Haemolytic Anaemia Screen 6 65 TIBI co on taco ter ees High Risk Infection HLA Typing Hours of Duty 9 30 42 51 65 66 69 70 Fl marnAIDUmib xis coder oce cent 41 44 48 96 Identification Patients 9 10 14 33 71 48 49 Immunoglobulins Immunohaematology Infectious Risk Intrauterine Transfusions Insulated Blood Boxes Irradiated Cellular Components K Kell antibodies 53 55 57 58 63 Kleihauer flow cytometry Roco dul dan 6 52 54 58 60 63 64 L Laboratory Antenatal Serology Antibody Screen Blood Bank Immunohaematology Immunology Investigative Serology Tissue Typing Leucocyte Depleted Blood LD Leucopheresis Location of Emergency Blood Lymphocyte Subsets CD4 CD8 Lymphocytotoxic
56. for the use of fresh frozen plasma cryoprecipitate and cryosupernatant BrJ Haemotol 2004 126 11 28 These and other guidelines available at www transfusionguidelines org uk and at http intranet grampian scot nhs uk click on the hospital portal link http nhsgintranet grampian scot nhs uk portal hospitalportal pages default aspx then click on the Blood Transfusion 22 2013 BTM 12th Edition Blood Transfusion Manual SUMMARY FOR NEONATES AND INFANT TRANSFUSIONS Reason means of Specificity of Comments and or Transfusion selected unit s additional requirements Post Intrauterine Paedipack RCC Must be compatible with Transfusion maternal plasma and blood must be irradiated prior to use Massive Transfusion Hct 0 50 0 60 Must be compatible 1 Exchange transfusion Prepared and issued with maternal plasma in case of HDFN within 5 days if it contains a clinically 2 Cardiac Bypass significant antibody 3 ECMO Transfusion of Paedipack or If no maternal newborn infants RCCS antibody and infant is 0 4 months DAT negative no crossmatch required Transfusion of RCCS Crossmatch against older infants infant s plasma 4 12 months Massive Transfusion as above NAIT HPA antigen negative Lack antigen against platelets which maternal antibody directed All blood for transfusion of infants less than one year is l seronegative from accredited donors i e from donors who have given blood at least tw
57. g predialysisandtransplantnurses nhs net and is provided by the Edinburgh BTC tel 0131 242 7528 Blood samples must be Platelet and Granulocyte Immunohaematology XR EE Sample Requirements sent directly to Edinburgh BTC Royal Infirmary of Edinburgh 51 Little France Crescent Edinburgh EH16 4SA after contacting Neonatal Alloimmune 2 pes g 2 x 4 5ml EDTA the Edinburgh Laboratory Thrombocytopenia Ero ese adi HLA and Disease Associations Platelet Refractoriness 2 x 7ml clotted 2 x 4 5ml EDTA Post transfusion Purpura PT ITP 2 x 7ml clotted 2 x 4 5ml EDTA All samples should be sent to Aberdeen for forwarding to TRALI Appendix 6 page 88 3 x 7ml clotted 2 x 4 5ml EDTA Dundee BTC which provides the laboratory testing service Dundee BTC can be contacted on tel 01382 645 166 The above tests MUST be authorised by the hospital Consultant in 2 consultation with the BTC Duty MO via Blood Bank 52322 52512 This service is restricted to HLA B 27 HLA B 5701 Abacavir 8 12474 sensitivity in HIV positive patients and HLA DR and DQ association in 66 2013 BTM 12th Edition BTM 12th Edition 2013 67 Blood Transfusion Manual Narcolepsy patients only No other investigations are available unless by special arrangement Sample requirements are HLA typing 1 x 4 5ml EDTA page 7 Support for Haematopoietic Stem Cell Transplantation All sample
58. iac surgery unless clinical or laboratory features suggest coexisting immunodeficiency References Guidelines on the use of irradiated blood components prepared by the British Committee for Standards in Haematology Blood Transfusion Task Force BUH 2010 152 35 51 Handbook of Transfusion Medicine Editor DBL McClelland 4th Edition www transfusionguidelines org uk BTM 12th Edition 2012 87 ul 9 2 a a Blood Transfusion Manual sis of TRALI CLINICAL DIAGNOSIS OF TRALI Acute lung injury within 6 hours of blood transfusion Independent of laboratory findings RISK FACTORS FOR ALI e Sepsis Burns injury e Inhalation injury e Aspiration Lung contusion Pneumonia Multiple trauma Drug overdose Cardiopulmonary Acute pancreatitis bypass DIFFERENTIAL DIAGNOSIS Anaphylactic Transfusion Reaction Circulatory Overload Bacterial Contamination Likely TRALI Absence of risk factor for ALI APPENDIX 6 ACUTE LUNG INJURY ALI Acute onset respiratory distress with dyspnoea 2 FiO2 300mm Hg 40 kPa ALI 2 FiO2 lt 200mm Hg 26 7 kPa ARDS New bilateral diffuse patchy or homogeneous pulmonary infiltrates on chest radiograph No clinical evidence of heart failure fluid overload or chronic lung disease PAOP 18mm Hg DISTINGUISHING FEATURES Bronchospasm and laryngeal oedema predominat
59. ice within the last 2 years Note Where neonate has received intrauterine transfusion s blood for exchange transfusions and top up transfusions must be irradiated For all other exchange transfusions the blood should be irradiated provided this does not lead to an unacceptable delay in the provision of blood BTM 12th Edition 2013 23 Blood Transfusion Manual 3 2 Maximum Surgical Blood Ordering Schedules MSBOS 3 2 1 3 2 2 3 2 3 3 2 4 24 Operational Details The guidelines represent the standard orders for the following list of elective operations pages 25 29 They have been prepared in order to allow the most efficient utilisation of blood stocks and laboratory facilities and are the result of a consensus between NHS Grampian surgeons anaesthetists and the BTC Clinical staff have the option of changing these orders when increased blood needs are likely e g anaemic patients or other complicating factors A telephone call to the Blood Bank or a clear indication of the reason s on the request form is all that is required Conversion of a Group and Screen request to a Crossmatch is effected by a telephone call to the Blood Bank giving the patient s full details and the number of units and when they are required The Blood Bank staff will record the details of the requester doctor s full name and bleep ext no All blood samples sent to the BTC will be held for seven days after which time they w
60. ilised form Each vial contains term prophylaxis of 500 units Store at 2 C to 8 C Expiry hereditary angio date on label doa ISSUED ON A NAMED PATIENT BASIS BASIS ONLY ONLY THESE PLASMA PRODUCTS MUST BE STORED PROTECTED FROM LIGHT AT TEMPERATURES AS STATED DO NOT FREEZE ALWAYS CONSULT THE DATA SHEET TO FOLLOW SUPPLIER S INSTRUCTIONS AND CHECK THE EXPIRY DATE BEFORE USE 50 2013 BTM 12th Edition Blood Transfusion Manual SECTION II ANTENATAL OBSTETRIC SERVICE LABORATORY HOURS Working hours Aberdeen BTC 0900 1700 Monday to Friday Ext 52322 INTRODUCTION The main role of this service is to provide the clinicians with the laboratory tests to aid prevention of Haemolytic Disease of the Fetus and Newborn HDFN This includes ABO and RhD grouping and antibody screening 1 ORDERING OF REQUEST FORMS REQUEST FOR BLOOD GROUP SEROLOGY INVESTIGATION forms are supplied as pads of 50 forms and a pad can be ordered by completing the tear off order slip found within the existing pad Send the order by Royal Mail post or by internal mail to BTC The order will normally be returned within 5 working days In the event of an urgent request telephone 5 52322 52512 8 12474 stating your request for a pad of forms and the address to which it is to be sent 2 COMPLETION OF REQUEST FORMS 2 1 Patient s details surname first name DoB gender CHI and address see page 71 and also sign
61. ill be discarded 2013 BTM 12th Edition BLOOD ORDERING SCHEDULES 1 GENERAL SURGERY MSBOS OPERATION GROUP AND SCREEN Cholecystectomy Lap Chole v Anterior Resection Colonic Resection Hemicolectomy ERCP v Gastrectomy Hiatus Hernia Repair v Laparotomy v Liver Biopsy v simple NIL Mastectomy se radical Oesophagectomy Rectal Polypectomy NIL Splenectomy Thyroidectomy v Vagotomy v BTM 12th Edition 2013 Blood Transfusion Manual UNITS MATCHED 25 Blood Transfusion Manual 2 CARDIOTHORACIC SURGERY MSBOS OPERATION GROUP AND SCREEN Angioplasty v Aortic Aneurysm elective resection Aortobifemoral Graft CABG Cardiac Valve Replacement Lobectomy Pneumonectomy Oesophagectomy Pericardectomy Pleurectomy v Thoracotomy Hiatus Hernia v Tracheostomy NIL 26 2013 UNITS MATCHED A oO Oc A NIL BTM 12th Edition 3 SPECIALITY SURGERY MSBOS OPERATION GROUP AND SCREEN 3 1 GENITO URINARY SURGERY Cystectomy radical Nephrectomy Pyelolithotomy v TURP v 3 2 NEUROSURGERY Craniotomy v Craniotomy Meningioma Laminectomy v Spinal Decompression v Spinal Decompression for Tumour 3 3 OTOLARYNGOLOGY Laryngectomy Mandibular Resection Neck Dissection Parotidectomy v 3 4 PLASTIC SURGERY Breast Reduction v Face Lift v BTM 12th Edition 2013 Blood Tran
62. jury transplacental haemorrhage TPH ectopic pregnancy intrauterine death IUD stillbirth f the RhD type of the infant has not been determined or is in doubt and or the mother is to be discharged Dose before 20 weeks gestation 250 IU 50 after 20 weeks gestation 500 IU 100 0 m Or a single dose of 1500 IU at any time during the pregnancy conjunction with Kleihauer test to assess the size of any TPH see Table 3 page 64 Table 2 Prophylactic anti D following abortions to all RhD negative women with no RhD antibody and or with antibodies other than anti D therapeutic termination of pregnancy spontaneous abortion followed by instrumentation spontaneous complete or incomplete abortion after 12 weeks gestation threatened abortion before 12 weeks when bleeding is heavy or repeated or is associated with abdominal pain in particular if these events occur as gestation approaches 12 weeks threatened abortion after 12 weeks all women are eligible in addition when bleeding continues intermittently after 12 weeks gestation anti D Ig should be given at approx 6 weekly intervals and after 20 weeks gestation assess the size of TPH see Table 3 page 64 60 2013 BTM 12th Edition Blood Transfusion Manual 6 3 Issue of RhD Negative Card to RhD Negative women This card is issued only to RhD negative women capable of childbearing who have no immune anti D in their blood This car
63. l be sent to individual GP s with a copy to the appropriate Consultant Ward and any further reports as requested 4 1 Immunohaematology Report The upper form contains a computer generated report of the patient s results This part of the form is affixed to the patient s notes Do not detach the lower form until the repeat sample is sent to BTC 4 2 Repeat Request for Serological Investigation in Pregnancy The lower form contains a computer generated request form containing patient details for repeat samples within the same pregnancy Complete additional amended details as required detach from upper form and send to BTC with a fresh patient sample 4 3 Telephone Reporting On receipt of a blood sample in the case of threatened abortions miscarriages etc a telephone report will advise the RhD group and whether prophylactic anti D is necessary To avoid the danger of transcription errors the ABO status will NOT be given The time date and name of the person to whom the advice is given will be recorded in the patient notes at BTC 5 ANTIBODY CASES 5 1 Antibody Update Antenatal patients previously shown to have clinically significant red cell antibodies require regular monitoring of antibody titre pages 52 55 Recommendations for follow up will be included on the report form It is advisable that all such cases are referred for delivery at AMH or Dr Gray s Hospital where the full transfusion support of the BTC will be avail
64. lated boxes prior to use Blood must not be kept more than 30 minutes in these boxes Blood Fridge Register BFR Blood must be booked into and out of the blood storage refrigerators as per local procedures If the blood has been removed from the blood storage refrigerator for more than 30 minutes and NOT transfused it may NO LONGER BE SAFE Such blood MUST NOT be returned to the blood storage refrigerator but must be clearly labelled as having been OUTWITH STORAGE CONDITIONS and returned to the Blood Bank laboratory as soon as possible In AMH insulated boxes will be found adjacent to the blood storage refrigerator for use by the Obstetric Staff and for transport of blood to the Labour Ward Theatre The overwrap bag of the units must not be opened until immediately prior to transfusion as this may result in the unit s having to be discarded BTM 12th Edition 2013 33 Blood Transfusion Manual 6 1 Blood For Emergency Use Units of O RhD NEGATIVE for EMERGENCY USE will be found in the BLOOD STORAGE REFRIGERATORS as indicated Refrigerator Location Emergency Blood Units O RhD Neg ABERDEEN ROYAL INFIRMARY ARI Emergency Care Centre ECC 4th Floor Phase II Accident and Emergency Phase II G Theatres Lower Ground Floor Special Block Ward 14 BU ABERDEEN MATERNITY HOSPITAL AMH Labour Ward Corridor 6 includes Neonatal Blood for top up only 1 WOODEND HOSPITAL WE Mail Room in Communications Ce
65. leeding cases when there is no time for an emergency compatibility test Although the transfusion of unmatched blood carries a risk this must be weighed against the danger of not giving the patient a transfusion at all The risks of unmatched blood are increased when the patient has had a previous blood transfusion or pregnancy or is known to have a red cell antibody 4 2 Amale who has not been transfused may be given group RhD positive blood whatever his ABO RhD group 4 3 Afemale lt 60 yrs old capable of having children should be given group O RhD negative Kell negative blood 4 4 For locations of units of group O Rh D negative Kell negative blood for emergency use see pages 33 35 NOTE When this blood is removed from the blood storage refrigerator the Blood Bank 52322 52512 8 12474 Dr Gray s Hospital ext 67479 outwith normal working hours contact duty BMS via switchboard MUST be notified immediately The purpose of this call is to enable us to replace the blood as soon as possible for the next emergency use 4 5 The Blood Transfusion Centre issues antibody cards to all patients for whom an atypical red cell antibody of clinical importance has been detected This card indicates the patient s blood group ABO amp RhD and that his her plasma contains alloantibodies When possible the patient should be asked whether he or she possesses such a card and the advice on the card conveyed to the Blood Bank
66. leucodepleted CMV seronegative cellular components for indications see Appendix 4 page 83 Irradiated cellular components for indications see Appendix 5 page 84 e Cryoprecipitate page 46 Cryoprecipitate MBT Fresh Frozen Plasma FFP page 46 FFP SD for the treatment of TTP e g Octaplas FFP BTM 12th Edition 2013 43 Blood Transfusion Manual Platelet Apheresis single donation adult dose or paediatric split Platelet Pooled multiple donations platelet units are supplied irradiated Washed cellular components this component is prepared on demand only Specialist advice is required PCC Prothrombin Complex Concentrate Beriplex Available from the Blood Bank Ext 52322 52512 8 12474 Products page 47 50 Human Albumin 2096 Human Albumin 4 596 Normal immunoglobulins IM amp IV Specific immunoglobulins e g anti D anti Zoster C1 Inhibitor Non licensed product for routine use These products are obtained from NHS Grampian Pharmacy at 5 53223 Mon to Fri 9am 5pm all other times contact on call pharmacist via ARI switchboard 0845 456 6000 In addition see www transfusionguidelines org uk For details of the blood blood components and products see pages 45 50 44 2013 BTM 12th Edition Blood Transfusion Manual SUMMARY OF BLOOD COMPONENTS AVAILABLE AT BLOOD TRANSFUSION CENTRE Blood Main Indication Red Cells in Additive
67. linical Indications for CMV Seronegative Cellular Blood Components Clinical Indications for Irradiation of Cellular Blood Components Clinical Diagnosis of TRALI GLOSSARY OF ABBREVIATIONS INDEX Vil 69 69 70 431 73 75 78 79 80 81 83 84 88 89 94 2013 BTM 12th Edition Blood Transfusion Manual GENERAL INTRODUCTION The Aberdeen amp North East Scotland Blood Transfusion Centre BTC is part of the Scottish National Blood Transfusion Service SNBTS SNBTS is a division of NHS National Services Scotland NSS SNBTS is organised into functional directorates The Directorates represented in Aberdeen include CLINICAL DIRECTORATES 1 1 Medical e Dr Greiss Consultant in Transfusion Medicine is in charge of Therapeutic Plasma Exchange and clinical immunohaematology which includes the blood bank service antenatal serology reference red cell serology and molecular clinical diagnostics e Dr J Associate Specialist whose main role is in clinical apheresis including haematopoietic stem cell collection and therapeutic venesection He is also the TRALI co ordinator for SNBTS e Prof MA Vickers Consultant Haematologist a Lead Clinician and in charge of the Academic Transfusion Medicine Unit ATMU haematopoietic stem cell collection cellular therapies and molecular immunohaematology Research Development amp Innovation RD amp I The three medical staff also provid
68. ls with ongoing bleeding Standard management of clinical condition Give consider Initial Give CALLER PROVIDES BLOOD BANK WITH PATIENT DETAILS FORENAME SURNAME 4 units of FFP 4 gt laboratory 2 units of cryoprecipitate if DATE OF BIRTH GENDER AND CHI NUMBER For unidentified patients minimum 1 unit adult dose of platelets results fibrinogen 1 0g after FFP data should include the unique A amp E patient identifier and gender CALLERS AND CONTACT NUMBER It is important that the person calling has the ability to provide this information Ongoing Massive Bleeding Y Give 4 units of FFP plus 1 adult dose of SWITCHBOARD CONTACT A PORTER AND HAEMATOLOGY LAB Y Monitor FBC PT APTT ALL SUBSEQUENT COMMUNICATIONS BETWEEN CLINICAL AREAS LABORATORY WWhsniblesding le eoming undercontrol STAFF AND PORTERS SHOULD BE PRECEDED BY THIS CALL RELATES TO THE Give MASSIVE BLEEDING PROTOCOL AND STATE LOCATION AND NAME OF PATIENT No further FFP unless bleeding restarts 4 units of FFP if PT or APTT prolonged For Blood Bank the dedicated massive bleeding protocol phone should be used for gt 3s above upper limit of normal values subsequent calls Extension 50522 1 bag adult dose of platelets if platelets 50 Y 2 units of cryoprecipitate if fibrinogen lt 1 0g Remember to advise Blood Bank porter and Haematology Lab A 1 u
69. n current assigned unit additional units are assigned as needed to meet each patient s transfusion requirement see page 21 Red cells platelet apheresis from a single donation centrifuged free of plasma and resuspended in saline PCV of 0 65 0 75 Residual protein 0 5g per unit To be used within 14 days from the time of preparation Special notice and discussion required with BTC Platelet content 240 x 10 Shelf life 5 days at 22 with continual agitation Give via platelet giving set or fresh blood administration set DO NOT REFRIGERATE Use immediately on receipt 2013 45 Blood Transfusion Manual SUMMARY OF BLOOD COMPONENTS AVAILABLE AT BLOOD TRANSFUSION CENTRE continued Blood Main Indication Platelet Pooled Fresh Frozen Plasma FFP Octaplas Human Plasma in solvent detergent SD FFP Methylene Blue Treated MBT virus inactivated Octaplas Cryoprecipitate Cryoprecipitate MBT virus inactivated 46 As for platelet apheresis Replacement of coagulation factors not available as specific concentrates Plasma exchange for TTP HUS Used as normal FFP It is mainly for patients with TTP as FFP Fibrinogen deficiency Fibrinogen deficiency A pool derived from 4 or 5 buffy coats contained in a volume of up to 300ml of plasma Platelet content of each pool gt 240 x 10 Shelf life 5 days at 22 with continual agitation Give via platelet giving set
70. nd complete the blue return to laboratory portion of the label Tear off and place in the container provided for return to Blood Bank 38 2013 BTM 12th Edition Blood Transfusion Manual 9 TRANSFUSION PROCEDURES The prescription of blood and blood components is the responsibility of the Medical Officer in charge of the patient Any individual undertaking any of the tasks within the transfusion process must ensure that they are aware of these procedures and act in accordance with them They must have valid transfusion training and competency assessment appropriate to their role To minimise the risk of bacterial proliferation blood must not be removed from the blood storage refrigerator until transfusion is ready to commence From the moment of removing the bag of blood from the cold storage facility and puncturing it with the administration set the maximum time taken for transfusing a bag of blood should not exceed 4 hours This will also depend on clinical decision If the unit has been out of the blood fridge for more than 30 minutes it is still suitable to transfuse to the intended patient as long as the transfusion will be completed within the recommended 4 hours of removal from the blood fridge The rational is that once the bag of the blood is out of controlled temperature storage the component warms up and the risk of bacterial proliferation increases with time There is a greater risk in a warm ambient atmosphere even
71. ng the advice Note Rubislaw Ward will receive clinical reports delivered by BTC driver Monday Friday to AMH receptionist BTM 12th Edition 2013 61 Blood Transfusion Manual b At delivery a BTC driver delivers clinical reports with anti D advice daily Monday Friday to the AMH receptionist who distributes them to the appropriate ward These reports contain details of patients for whom anti D Ig prophylaxis is advised or not advised ARI Clinical reports for anti D advice are delivered daily Monday Friday to Wards 42 43 Reception by a member of the BTC staff The reports contain details of patients who are advised not advised anti D 10 prophylaxis However at the weekend or on public holidays the BTC BMS will advise anti D Ig to the ward staff in the form of a telephone message which contains the patient details and whether she does or does not require anti D Ig BTC will maintain a record of date time and the name of the ward staff i e clinical members of staff receiving the advice Dr Gray s Hospital Advice on anti D Ig prophylaxis will be given by phone by a BMS member of the Aberdeen BTC staff to the ward staff in charge of the patient BTC will maintain a record of date time and name of the ward staff i e clinical members of staff receiving the advice 6 6 Maternal Deliveries Hospitals Home Suggested Frequency of Antenatal Testing see Table page 53 Despatch of delivery samples At deli
72. nit of adult dose of platelets is equivalent to 4 5 single donations Any communication with blood bank after the initial activation call phone 67956 when deactivation occurs REMEMBER TO ADVISE BLOOD BANK AND HAEMATOLOGY LAB WHEN This must be read in conjunction with NHS Grampian Massive Bleeding Protocol DEACTIVATION OCCURS 74 2012 BTM 12th Edition BTM 12th Edition 2012 75 e 2 Blood Transfusion Manual APPENDIX 2 2 continued Adult Massive Bleeding Protocol Flow Chart Dr Gray s Elgin NOTES 1 Once the BMS has obtained the patient s blood group RhD status they will contact the clinician dealing with the patient and inform them of available on site blood stock until re supply from SNBTS 2 Re supply of blood FFP will take 1 5 2 hours 3 Platelet supply will take 1 5 2 hours No platelet stock is held by the Blood Bank Dr Gray s Hospital 4 Outside core hours during the protocol the BMS will only answer the emergency telephone ext 67956 no other Laboratory telephone will be answered 5 During core hours of 8 30am to 5pm Monday to Friday the Site Manager for Dr Gray s Hospital can be contacted via Outpatient Reception Dr Gray s Hospital on extension 67385 in the first instance or via Outpatient Clinical Co ordinator on ext 67264 67987 Outside core hours Senior Manager on call via Aberdeen Royal Infirmary switchboard extension O 6
73. nomodulatory therapy of a range of autoimmune and inflammatory disorders 2013 ion for 3 Supplied in bottles of 100ml and 400ml isotonic solution containing 42 5 47 5 g L plasma protein of which 95 is albumin Formulated to contain 8mmol L Sodium Octanoate and 130 150mmol L Sodium Chloride and lt 2mmol L Potassium Citrate Expiry date on label 3 year shelf life Store at temperature not exceeding 25 C 100 ml bottle of concentrated serum 190 210 g L containing 200 g L plasma protein of which not less that 9596 is albumin Expiry date on label 3 year shelf life This solution is HYPERONCOTIC and equivalent to 400 ml of plasma and should be given SLOWLY Store at temperature not exceeding 25 250mg IgG per 1 5 ml in aqueous solution Expiry date on label 3 year shelf life Store at 2 C to 8 C Bottles or vials containing liquid phase IgG of variable concentration for IV SC use BTM 12th Edition PHARMACY continued Human Anti D Immunoglobulin IM Human Tetanus Immunoglobulin IM Human Hepatitis B Immunoglobulin IM Human Varicella Zoster Immunoglobulin IM Human Rabies Immunoglobulin IM BTM 12th Edition Prevention of sensitisation to RhD antigen in susceptible individuals Special memorandum applies Passive immunisation in susceptible individuals Passive immunisation in susceptible individuals exposed to Hepatitis B Passive immunisation in suscepti
74. nosine deaminase deficiency MHC Class and II deficiency leucocyte adhesion deficiency immunodeficiency with eosinophilia ataxia telangiectasia chronic mucocutaneous candidiasis BTM 12th Edition 2012 85 APPENDICES Blood Transfusion Manual donors or recipients Bone marrow and haemopoietic stem cell transplantation HSCT Allogeneic bone marrow or peripheral blood stem cell DONORS o Duration for irradiated blood components 7 days before harvesting and at all times during the procedure until the harvest is completed Allogeneic bone marrow or peripheral blood stem cell RECIPIENTS o Duration for irradiated blood components from the start of conditioning chemo or radiotherapy and while the patient remains on GvHD prophylaxis i e usually 6 months or until the lymphocytes are 1 x 10 L It may be extended for a longer duration at the discretion of the haematologist e g chronic GVHD Autologous bone marrow or peripheral blood stem cell DONORS o Duration for irradiated blood components 7 days before harvesting and at all times during the procedure until the harvest is completed Autologous bone marrow or peripheral blood stem cell RECIPIENTS o Duration for irradiated blood components from the start of conditioning chemotherapy or radiotherapy until 3 months post transplant or 6 months post transplant if conditioning total body irradiation TBI was given
75. nsfusion Manual PROCEDURE FOR OBTAINING BLOOD To Activate the NHS Grampian Protocol for Massive Bleeding Appendix 2 p73 80 ARI Blood Bank 5 52322 5 52512 Dr Gray s Elgin DGH All emergency calls must be via Blood Bank BMS ext 67479 67320 On Call BTC Duty MO is available for advice via the Hospital Blood Bank Send a patient crossmatch sample before Transfusion Advise Blood Bank dns ae ae Use emergency O RhD negative red y cells from designated fridge pages 34 35 Send a patient crossmatch sample gt Advise Blood Bank Red cells needed in ABO and RhD group specific red cells 20 minutes available for collection from Blood Bank within 20 minutes of receipt of sample Send a patient crossmatch sample Advise Blood Bank Red cells needed in ABO and RhD group antibody screen 60 minutes and crossmatch will be carried out Red cells available for collection within 60 minutes of receipt of sample Can be ordered via Blood Bank as per protocol Normally available 25 30 minutes after request to allow time for thawing Can be ordered via Blood Bank as per Platelets protocol Normally available in 10 minutes Can be ordered via Blood Bank if fibrinogen is less than 1 0 g l via the BTC Duty MO Normally available in 25 30 minutes tl 2013 BTM 12th Edition Blood Transfusion Manual COMPONENTS IN AN EMERGENCY NOTE RhD negative K negative blood should be used for all female
76. ntre 4 emergency blood is RhD negative Kell negative phenotype C D E K see also para 4 6 page 30 When the Emergency Blood is taken the Blood Bank must be notified immediately on ext 52322 8 12474 Asingle unit of blood 4 paedipacks is available as emergency for a neonate If a paedipack is used for an infant the rest i e 3 paedipacks are to be returned to the Blood Bank as soon as possible where they will be reserved for that infant pages 21 amp 45 34 2013 BTM 12th Edition Blood Transfusion Manual 6 2 Blood Storage and Locations in Dr Gray s Hospital Elgin For advice contact the duty BMS Blood Bank ext 67479 67320 Blood For Emergency Use Units of O RhD NEGATIVE for EMERGENCY USE will be found in the BLOOD STORAGE REFRIGERATORS as indicated Refrigerator Location Emergency Blood Units DGH S LABORATORIES O RhD Neg Top Drawer Emergency use only and also 4 suitable for obstetric patients All emergency blood is RhD negative Kell negative phenotype C D E c e K see also para 4 6 page 30 When the Emergency Blood is taken the Blood Bank at Dr Gray s must be notified immediately on ext 67479 67320 7 COLLECTION OF MATCHED BLOOD The staff member removing blood from the hospital s blood storage refrigerator must have documentation containing the patient s details surname forename date of birth and CHI number This is by means of a collection slip
77. onations bear the 14 digit ISBT128 donation number The unique donation number on the blood bag must match exactly the number on the compatibility label Cautionary Note This section of the label gives instructions on storage conditions and the checking procedure you are required to undertake when administering a blood component It also includes information on the component type and volume Blood Group Shows the blood group of the component This does not have to be identical with the patient s blood group but must be Ano ae compatible Group O patients wil must only receive group O red cells Expiry Date The expiry date time must be checked do not use any component that is beyond the expiry date Special Requirements This shows the special features of the donation e g CMV negative 20 2013 BTM 12th Edition Blood Transfusion Manual 3 BLOOD ORDERING SCHEDULES 3 1 Paediatric Transfusion Exchange Transfusion Special arrangements apply Please contact the Blood Bank in advance to make arrangements For exchange transfusions maternal and baby samples are required see page 23 for details Only semi packed red cells are suitable for exchange transfusions Top ups for Neonates and Infants CMV seronegative cellular components will be provided for all infants up to one year old Paedipacks will be provided for all infants who require top up transfusions Blood Req
78. or a fresh blood administration set DO NOT REFRIGERATE Use immediately on receipt Each bag contains approx 220ml plasma from whole blood separated and frozen within 8 hours of collection Shelf life 24 months at 30 C FVIIIc gt 0 7 IU ml USE IMMEDIATELY after thawing Transfusion must be complete within 4 hrs of thawing Each bag contains 200 ml plasma from non UK donors This component could also be used for children born after 1st January 1996 Neonates and children born after 1st January 1996 should be treated with Fresh Frozen Plasma that has been virally inactivated with Methylene Blue Treatment and imported from US Use IMMEDIATELY after thawing Transfusion must be complete within 4 hrs of thawing FVIlIc gt 0 5 IU ml pages 21 43 Each bag contains gt 70 IU Factor VIII and gt 140 mg Fibrinogen Shelf life 24 months at 30 C Use Factor VIII concentrate whenever possible USE IMMEDIATELY after thawing Infusion must be complete within 4 hrs of thawing Neonates and children born after 1st January 1996 should be treated with cryoprecipitate that has been virally inactivated with and imported from US Each bag contains gt 70 IU Factor VIII and 2140 mg Fibrinogen Shelf life 24 months at 30 C Use Factor VIII concentrate whenever possible USE IMMEDIATELY after thawing Infusion must be complete within 4 hrs of thawing 2013 BTM 12th Edition Blood Transfusion Manual SUMMARY OF BLOOD PRODUCTS AV
79. pura North East of Scotland Blood Transfusion Centre Negative Non Hodgkin s Lymphoma NHS Grampian Non Invasive Prenatal Diagnosis Pulmonary Artery Occlusion Pressure Phosphate buffered saline Peripheral Blood Stem Cells Prothrombin Complex Concentrate Paroxysmal cold haemoglobinuria Polymerase chain reaction Packed Cell Volume Pelvic Floor Repair Paroxysmal Nocturnal Haemoglobinuria Platelet rich plasma Pathogen reduction technology 2013 BTM 12th Edition PT PTP REL PV PVC QA QC RAADP RACH RBCs RCC RCCS rFVila Rh RTA SCID SD SHOT SNBTS SOP STOP TACO TAGVHD TBI TCR TN TOP TRALI TURP BTM 12th Edition Blood Transfusion Manual Prothrombin time Post transfusion Purpura Partial thromboplastin time Per vagina Polyvinyl chloride Quality assessment or quality assurance Quality control Routine Antenatal Anti D Prophylaxis Royal Aberdeen Children s Hospital Red Blood Cells Red Cell Concentrate Red Cell Concentrate Supplemented Recombinant Factor Vila Rhesus Group Rh immune globulin Road Traffic Accident Severe Combined Immunodeficiency Solvent Detergent Serious Hazards of Transfusion Scottish National Blood Transfusion Service Standard operating procedure Surgical Termination of Pregnancy Transfusion associated circulatory overload Transfusion associated Graft versus Host Disease Total Body Irradiation T cell receptor Temporary Number Termination
80. qum Eo iM mi L Rh D POSITIVE Transfusion Manual Department of Transfusion Medicine Aberdeen 12th Edition 2013 NHS M Scotland Blood Transfusion Manual Department of Transfusion Medicine Aberdeen 12th Edition 2013 7 5 ET g 2 gt Services 9 Blood Transfusion Manual IMPORTANT INFORMATION Blood Bank ext 5 52322 5 52512 Blood Sample Identification UNLABELLED MISLABELLED samples will NOT BE ACCEPTED The SNBTS Zero Tolerance Policy is in place Appendix 1 Addressograph labels must not be used on sample tubes Label the form and sample with Patient s full name first name and surname Date of Birth Community Hospital Index CHI or A amp E Number TN Gender Ward Hospital Date amp Time sample was taken and signature of person taking sample on sample and form On the Request form include Clinical Condition Time and Date the blood is needed The requesting doctor s name bleep number signature name Please ensure details on request form and sample are correct and identical otherwise unnecessary delays will be incurred whilst a repeat sample is provided para 1 4 5 Blood Samples required pages 6 7 Group amp Screen and or Crossmatch 7ml EDTA Children Paediatric 4 5ml EDTA Baby Neonatal Blood Group and DAT 1 1 5ml EDTA Edition 12th 2013 2008 2005 2002 2001 2000
81. rapeutic Apheresis Telephone Bleep 01224 552322 01224 552512 8 12474 0845 456 6000 01224 685685 01224 662200 01224 695351 5 52322 5 52512 812474 5 52322 8 12474 via blood bank 5 52322 8 12474 8 12477 5 52058 5 52058 8 12448 5 52322 8 12474 8 12436 5 51370 ONLY FOR MASSIVE BLEEDING PROTOCOL MBP Ext 2222 AND POST ACTIVATION PROTOCOL 50522 2013 BTM 12th Edition Medical Staff Dr Michel A Greiss Consultant Prof Mark A Vickers Consultant Dr Joe Associate Specialist Dr Philip Yates Consultant Nursing Staff Mrs Helen Clark Senior Nurse Manager Clinical Apheresis Nurses Transfusion Practitioner TP Nurse Dr Gray s TP Laboratory Staff Blood Transfusion Manual Telephone Bleep 12420 2871 12401 8 12402 3349 12409 2872 8 12444 8 12436 5 51370 8 12427 5 67940 Mr Douglas Clark Clinical Laboratory Manager 8 12404 Mrs Jane Burnett Lab Head Blood Bank Mrs Fiona Sellers Lab Head MI Mr Nicolas Robinson Lab Head CTL Mr Neil Fraser Quality Manager Supply Chain 8 12476 8 12472 8 12465 8 12485 Mrs Lynne Willdigg Donor Services Manager 8 12454 Dr Gray s Hospital Elgin Laboratory Blood Bank 24 hours BTM 12th Edition 2013 0845 456 6000 5 67479 5 67320 Blood Transfusion Manual Blood Transfusion Manual pesnun pue pasn sxoed je
82. s should be sent to Aberdeen BTC but only after special arrangement due to the complexity and length of time needed to undertake the tests Aberdeen BTC will forward the samples to Edinburgh BTC which provides the laboratory testing service Edinburgh BTC can be contacted on tel 0131 242 7528 The following tests are available for potential haematopoietic stem cell recipients and donors and MUST be authorised by the Haematology Consultant typing HLA antibody screening and identification For sample requirements see page 7 Peripheral Blood Stem Cells and Donor Lymphocytes Aberdeen BTC in conjunction with the staff on the Haematology Ward ARI RACH undertakes peripheral blood stem cell and donor lymphocyte collection processing storage and infusion It is strictly by prior arrangement Any requests are placed through the Haematology BMT coordinator Haematology Consultants or through the Stem Cell Consultant in the BTC All patients or donors require a clinical assessment and mandatory virology testing and patient donor consent prior to the stem cell collection When testing mobilised patients for CD34 level the samples are sent to the Cellular Therapies laboratory 8 12462 8 12465 as early as possible on the day 68 2013 BTM 12th Edition Blood Transfusion Manual SECTION V CLINICAL CELL SEPARATOR SERVICE SERVICE HOURS Working Hours Aberdeen BTC 0900 1700 Monday to Friday Ext 51370 Within the
83. sfusion If a transfusion has been completed and a further transfusion is to be given after 48 hours has elapsed a fresh blood sample from the patient must be sent to the Blood Bank together with a completed request form 9 5 Postponement or Cancellation of a Transfusion If a transfusion is postponed the Blood Bank ext 52322 8 12474 Dr Gray s ext 67479 must be informed as soon as possible as matched blood will only be held for up to 24 hours unless special arrangements have been made for an extension with Blood Bank staff Unused bags of blood must be left at all times in the blood storage refrigerator even when no longer required for a patient and NEVER discarded 10 TRANSFUSION REACTIONS Should an unfavourable reaction occur during a transfusion the transfusion should be stopped clerical check undertaken and the patient s blood pressure pulse rate and temperature recorded In the event of any transfusion reaction the patient s doctor should weigh the transfusion reaction against the patient s need for the transfusion Allergic reactions are not uncommon Minor urticarial skin reactions in the absence of other symptoms or signs need not prevent continuation of the transfusion More serious reactions are associated with rigor lumbar pain faintness headache and a rise in temperature above 38 In these cases the transfusion must be STOPPED The clinician must exercise his her clinical judgement to determine
84. sfusion Manual UNITS MATCHED 27 Blood Transfusion Manual 4 ORTHOPAEDIC SURGERY MSBOS OPERATION GROUP AND SCREEN Amputation v Bone Biopsy v Decompression including Laminectomy wv Fracture Neck of Femur intertrochanteric Fracture Neck of Femur subcaptial Hasting s Arthroplasty Tibial v eee Pelvic Spinal fusion v Total hip replacement v Total knee replacement v 28 2013 UNITS MATCHED BTM 12th Edition Blood Transfusion Manual 5 OBSTETRICS AND GYNAECOLOGY MSBOS OPERATION GROUP UNITS AND SCREEN MATCHED 5 1 OBSTETRICS low risk v Caesarean Section 2 high risk 2 e g placenta praevia severe pre eclampsia maternal anaemia previous CS Manual removal of placenta v 5 2 GYNAECOLOGY Cone Biopsy v low risk v Ectopic 2 0 high risk 2 D amp C NIL NIL abdominal v Hysterectomy vaginal v radical 4 Laparoscopy NIL NIL Lymphadenectomy NIL NIL Myomectomy 2 cystectomy v Oyanan eer ec Carcinoma 2 v Radical Vulvectomy 4 STOP TOP ERPOC v Tubal Surgery v Specify type of operation on Request Form BTM 12th Edition 2013 29 Blood Transfusion Manual 4 EMERGENCY TRANSFUSION OF UNMATCHED BLOOD 4 1 Group O RhD negative blood is available for emergency use but it should only be transfused in massive b
85. should be approved by MO s signature 2 A record is kept of who prescribes the blood 3 Arecord is kept of who checks patient ID and cross checks with details on blood bag and the CL 4 Arecord is kept of the donation number by affixing the pink section of CL in the patient s notes 5 Time and date of transfusion of each unit start and finish 6 Blue section of CL returned to the Blood Bank as soon as possible after completion of transfusion 9 3 The Blood Administration Set Specific blood administration set with integral filters 1704m can be used for up to 12 hours The number of units that can be transfused with a single administration set will depend on the speed of transfusion At the end of the transfusion it is unnecessary to flush the administration set to extract the final 10mls of blood If the transfusion is to be interrupted e g 2 units of red cells to be transfused followed by albumin and then a further 2 units of red cells a new administration set is required after each block of red cells even though the total transfusion period is less than 12 hours In this example an administration set would be required for the first two units of red cells and another for the second two units of red cells NOTE There are different administration giving sets for RCCS and another giving set for Platelets Fresh Frozen Plasma and Cryoprecipitate BTM 12th Edition 2013 41 Blood Transfusion Manual 9 4 Subsequent Tran
86. sponding antigen This procedure is known as NIPD non invasive prenatal diagnosis For advice on clinical indication contact Dr M A Greiss 8 12420 6 RhD PROGRAMME The objective of the RhD programme is to prevent HDFN due to anti D It is therefore essential to determine the RhD group and to screen for immune anti D in all women who are capable of having BTM 12th Edition 2013 57 Blood Transfusion Manual children This will decide the eligibility for anti D prophylaxis For indications see Tables 1 amp 2 page 60 6 1 Dosage and Administration 100 125 IU 20 250 of intramuscular anti D Ig preferably into the deltoid muscle is capable of suppressing immunisation by 1 1 25ml of RhD positive red cells For successful immunoprophylaxis anti D Ig should be given as soon as possible after the sensitising event but always within 72 hours If for some reason it is not given within 72 hours every effort should still be made to administer the anti D Ig since a dose given within 9 10 days may provide some protection Prophylaxis for Sensitising Events before Delivery A dose of 250 IU 50 of anti D Ig is recommended for prophylaxis following sensitising events up to 20 weeks gestation When bleeding continues intermittently after 12 weeks gestation anti D Ig should be given at approximately 6 weekly intervals For all events after 20 weeks 500 IU 100 0 anti D Ig should be given followed by Kleihauer test to iden
87. t form are obtained The sample tube must not carry the details of another patient even if these have been scored out obliterated and the sample relabelled The BTC adheres to mandatory regulations four points of identification for the exacting Good Manufacturing Practice Standards GMP of labelling samples and request forms Appendix 1 2013 BTM 12th Edition 1 4 8 1 4 9 Blood Transfusion Manual Neonatal Samples At the time of the first request for blood for a baby less than 4 months old a maternal sample 7ml EDTA is required in addition to the baby s blood sample 1 1 5 ml EDTA Neonates rarely make antibodies in response to blood transfusion however the maternal sample will be screened for antibodies which are likely to be in the baby s plasma passively acquired The infant s sample is used to determine the ABO and RhD groups and for the Direct Antiglobulin Test DAT This is to make sure that there is no clinically significant antibody coating the baby s red cells In subsequent requests for blood components a repeat of the baby s blood sample is not required Phlebotomists Attention is drawn to the guidelines for phlebotomists drawn up by the Royal College of Pathologists 1989 A properly constituted team of phlebotomists who have been properly trained who have signed an undertaking which makes their responsibilities absolutely clear and who are responsible to a member of the consultant staff of the
88. t name Date of Birth must be given separately from CHI number CHI number Gender Signature or initials of person taking the sample Samples request forms which do not comply WILL NOT BE ACCEPTED Amendments to mislabelled samples forms WILL NOT BE ACCEPTED Rejection of such requests may cause delay in provision of blood components for transfusion BTM 12th Edition 2012 71 2 Blood Transfusion Manual Blood Transfusion Manual gt 70 5 APPENDIX 1 continued APPENDIX 2 Massive Bleeding Protocol 9 APPENDIX 2 1 z Accident amp Emergency A amp E patients Adult Massive Bleeding Protocol Flow Chart Aberdeen the patient s name and or date of birth are not known e g patient a RETNATEMASENIE m is unconscious the sample and request form MUST carry the A amp E in trauma patients UNCONTROLLABLE BLEEDING BLEEDING PROTOCOL number a unique hospital number gender F M and location of the Ries S SU aces patient Consider reversal of any fibrinogen crossmatch Mese asiste eig anti thrombotic therapy the it 5 8 hospital and ward This is also applicable in the event of a Major Accident At hospital admission all patients will be identified by a unique Major Accident warfarin reversal number provided by the A amp E department i e UP TN number Saitchboard wil pass caller onto Blood Bank to provide patient s informa
89. t safety and to comply with guidelines on the Administration of Blood and Blood Components and the Management of Transfused Patients which were prepared by the British Committee for Standards in Haematology 1999 unlabelled wrongly labelled samples WILL NOT BE ACCEPTED in accordance with the SNBTS ZERO TOLERANCE POLICY Appendix 1 BTM 12th Edition 2013 9 Blood Transfusion Manual SIX STEPS FOR POSITIVE PATIENT IDENTIFICATION POSITIVE PATIENT ID FOR BLOOD TRANSFUSION SAMPLING NHS Grampian procedure for blood and blood component transfusion MUST be followed For further information contact the Transfusion Practitioner on ext 8 12427 USE AN OPEN QUESTION TO POSITIVELY IDENTIFY PATIENT WHAT IS YOUR NAME WHAT IS YOUR DATE OF BIRTH CHECK THESE DETAILS AGAINST PATIENT S ID BAND CHECK THAT THE DETAILS ON ID BAND MATCH REQUEST FORM CHECK FIRST NAME SURNAME DATE OF BIRTH CHI GENDER 10 2013 BTM 12th Edition Blood Transfusion Manual DRAW BLOOD INTO PURPLE TOPPED EDTA VACUTAINER DO NOT USE PRE LABELLED TUBES LABEL BLOOD SAMPLE BY HAND AT THE BEDSIDE WITH PATIENT S FULL NAME First Name and Surname DATE OF BIRTH CHI COMMUNITY HOSPITAL INDEX or TN A amp E NUMBER GENDER WARD HOSPITAL DATE amp TIME SAMPLE WAS TAKEN SIGNATURE OF PERSON TAKING SAMPLE ON SAMPLE TUBE AND FORM BTM 12th Edition 2013 11 Blood Transfusion Manual ENS
90. the BLOOD BANK by portering services The person collecting the blood must bring a completed Blood Porter Collection Slip or the patient s notes or patient s addressograph label as a form of the patient s ID Provision of inaccurate patient data on this slip may result in unnecessary delay in provision of blood Guidelines The administration of blood and blood components and management of transfused patients Ref Trans Med 1999 9 227 238 BTM 12th Edition 2013 31 Blood Transfusion Manual 5 2 Aberdeen Maternity Hospital AMH At all times matched blood must be collected from the Blood Bank by the AMH porter as para 5 1 5 3 Royal Aberdeen Children s Hospital RACH A RACH porter will deliver blood to the blood storage refrigerator as required RACH staff will make arrangements for delivery of matched blood 5 4 Woodend Hospital WE The BTC driver visits Woodend at 0700 Monday to Saturday Matched blood is delivered to the blood storage refrigerator where blood samples for grouping and crossmatching are picked up Arrangements for delivery of matched blood outwith the stated times are made by the Blood Bank 5 5 Dr Gray s Hospital Elgin Ward staff make arrangements for collection of matched blood from the Blood Bank storage refrigerator one unit at a time collected as instructed by local procedures 5 6 Blood Deliveries to Community Hospitals See also Transfusion Procedures page 39 para 9
91. tify FMH gt 2 ml red cells additional anti D 10 should be given as required see page 64 para 6 7 A further dose will be required at delivery of an RhD positive infant even if antenatal prophylaxis has been given and the Kleihauer test is negative 6 2 Protocol for Antepartum Anti D Prophylaxis The routine antenatal anti D prophylaxis RAADP protocol has been drawn up to comply with the Guidelines Recommendations for the use of anti D immunoglobulin for Rh prophylaxis Transfusion Medicine 1999 9 93 97 and The Royal College of Obstetricians and Gynaecologists Guideline No 22 October 1999 www nice org uk 58 2013 BTM 12th Edition Blood Transfusion Manual All RhD Negative Women eligible for the RhD prevention programme have no RhD antibodies antibodies other than anti D e g E c Kell and Duffy Exclusion Criteria women with pre existing immune anti D Administration If an RhD negative woman meets the above criteria she will automatically be eligible for the RAADP this protocol should be explained to her The BTC will also forward an RhD negative Card directly to the patient A single dose of 1500 IU anti D Ig is administered at approximately 28 weeks gestation The anti D Ig dosage depends upon the availability of the anti D lg product Antibody screening is still carried out as per BTC protocol at 28 weeks by taking an EDTA blood sample prior to administration of anti D 10 to check for antibo
92. tion and then switchboard will contact Porter and Haematology Lab Give Group O neg unmatched units until group specific blood available 20 min group specific unmatched 30 min emergency crossmatched More than 4 units of packed red cells in the first hour of blood loss 1500mls with ongoing bleeding Standard management of clinical condition Give consider Initial Give 4 units of FFP lt P laboratory 2 units of cryoprecipitate if 1 unit adult dose of platelets results fibrinogen lt 1 0g after FFP Bleeding Stops Ongoing Massive Bleeding Give 4 units of FFP plus 1 unit adult dose of platelets per 4 units of RCCs Monitor FBC PT APTT If platelets lt 20 give 1 adult dose of platelets If fibrinogen lt 1 0g I give When bleeding is coming under control Give 4 units of FFP if PT or APTT prolonged gt 3s above upper limit of normal values 1 unit adult dose platelets if platelets 50 A 1 unit of adult dose of platelets is equivalent 2 units of cryoprecipitate if fibrinogen 1 0g to 4 5 single donations Any communication with Blood Bank after the initial activation call phone 50522 2 pooled bags of cryoprecipitate No further FFP unless bleeding restarts REMEMBER TO ADVISE BLOOD BANK PORTER AND HAEMATOLOGY LAB WHEN DEACTIVATION OCCURS 2012 BTM 12th Edition BTM 12th Edition 2012 73 Blood Transfusion Manual Blood Transfusion Manual AIDE M
93. tit Clinically Sensitising significant prophylactic antibodies other anti D than anti D Anti D positive Test at 4 week intervals Father K positive uncertain Father K negative Repeat ABO D type and antibody screen Reassessment of antibody levels D negative women without immune anti D ine antenatal anti D prophylaxis detected anti D c detected anti K Father K Father K Test at ositive 2 week i intervals ncertain Normally test at 2 week intervals Cord sample for DAT and D No further tests After 20 weeks Group screen and Kleihauer test are required Modified from Transfusion Medicine 2006 17 252 262 54 2013 BTM 12th Edition Blood Transfusion Manual PROTOCOL FOR THE MANAGEMENT OF ALLOANTIBODIES IN PREGNANCY e g ANTI KELL SEROLOGICAL TESTING Routine Antenatal testing Yes Kell type father Father Kell ve Father Kell ve heterozygous only Antibody monitoring as advised by the Kell type fetus by PCR NIPD Fetus Kell ve Fetus Kell ve Previous affected pregnancy or other adverse history scan Monthly ultrasound Signs of No signs of Refer to Glasgow for Fetal Anaemia Fetal Anaemia possible IUT at 20 weeks BTM 12th Edition 2013 55 Blood Transfusion Manual 4 REPORTING OF RESULTS On completion of laboratory tests results wil
94. uirements for Surgical Procedures on Neonates Infants Use RCC RCCS dependant on clinical need follow the same criteria as top ups see above Fresh Frozen Plasma and Cryoprecipitate Neonates and children born after 1 January 1996 should be treated with Fresh Frozen Plasma FFP and Cryoprecipitate that has been virally inactivated with Methylene Blue Treatment MBT and imported from outside the UK page 46 alternatively Octaplas may be issued used page 46 NEONATAL ALLOIMMUNE THROMBOCYTOPENIA NAIT NAIT is a transient but potentially life threatening thrombocytopenic disorder limited to fetal and neonatal life It is caused by maternal IgG alloantibodies that cross the placenta resulting in the premature destruction of platelets bearing paternally derived platelet antigens analogous to haemolytic disease of the fetus amp newborn NAIT occurs in approximately 1 to 1 5 1000 live births and the commonest cause is anti HPA1a Special samples pages 7 amp 66 for laboratory investigations are required BTM 12th Edition 2013 21 Blood Transfusion Manual For advice on clinical indications contact On Call Duty MO via the Blood Bank 52322 52512 8 12474 For Summary Table of Blood and Blood Components for Neonates and Infants up to One Year old see page 23 BCSH Guideline Transfusion guidelines for neonates and older children BrJ Haemotol 2004 124 433 453 BCSH Guideline Guidelines
95. very samples from the mother and baby should be sent to BTC from the following cases 1 All RhD negative women 2 All women whose blood group is unknown e g concealed pregnancy 62 2013 BTM 12th Edition Blood Transfusion Manual a Delivery samples from RhD negative women should be accompanied by an anti D 10 form orange form and sent to BTC 1 staff will collect samples from the AMH refrigerator twice daily at 0700 and 1300 Monday to Friday and at 0700 on Saturday 2 Dr Gray s and outlying hospitals samples should be sent to BTC by either taxi or hospital van 3 Home Deliveries the attending midwife should deliver samples to BTC or the AMH blood sample refrigerator b The same arrangements apply when the mother is RhD positive and her plasma contains antibodies that could be associated with HDFN Department of Transfusion Medicine request form should accompany these blood samples Delivery Blood Samples should consist of Maternal Blood Two venous samples 2 x 4 5ml EDTA of maternal blood both labelled with the full details of the mother taken soon after the third stage of labour These samples are for blood group serology and Kleihauer test Cord Baby Blood An umbilical cord sample of 4 5 ml of blood in an EDTA tube labelled with the Baby s maternal surname Baby s Hospital CHI DOB and Gender This sample is for ABO RhD grouping and DAT BTM 12th Edition 2013 63 Blood
96. zod pue dnoip 219121590 1 1 1 suonoeei s jdwes 614 uoyeuissoJo pue QOO 18 yueg A10je10qe1 SNOILVOILS3ANI 1V219010H3S ANY NOISQnHSNVHI SLNAWAYINOAY 5 2013 BTM 12th Edition BTM 12th Edition 2013 Blood Transfusion Manual Clinical Notes Comments 2013 BTM 12th Edition Blood Transfusion Manual SECTION I BLOOD BANK SERVICES Ext 52322 52512 8 12474 LABORATORY HOURS See also Delivery amp Distribution of Matched Blood to Grampian Hospitals pages 31 33 ARI Blood Bank Laboratory operates a 24 hour service Ext 52322 52512 8 12474 DGH Blood Bank Laboratory operates a 24 hour service Ext 67320 67479 1 GENERAL INFORMATION 1 1 The Role of the Duty Medical Officer MO A BTC On Call MO is available at all times to deal with clinical situations that require advice This may include release of certain blood components products and arrangement of special investigation procedures The Duty MO can be contacted via the Blood Bank Ext 52322 52512 8 12474 1 2 Patient Identification Guide Six steps for positive Patient Identification In order to improve patien

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