Module 2: Request for blood and blood components

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

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

3. What would you request?

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

5. How to make a request for GSH • Inform patient the possibility of a transfusion • Fill in request form • Confirm patient’s identity • Take blood sample • Label sample at bedside • NEVER use pre-printed labels • NEVER pre-label tubes • Send sample and request form to BB

6. COMPLETE INFORMATION Form: Complete Information

7. Case 2 • 55 year-old man, chronic smoker • c/o swelling R buccal mucosa & R neck x 2 months • HPE: squamous cell carcinoma • Planned for surgery • Hb is 12.5 g/dL • Packed cells are requested

8. What would you request?

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

10. How to make a request for GXM

11. Making a request for GXM • Inform patient the likelihood of a transfusion • Fill in request form • Confirm patient’s identity • Take blood sample • Label sample at bedside • NEVER use pre-printed labels • NEVER pre-label tubes • Send sample and request form to BB • Collect blood with blood collection slip and blood box

12. Blood collection slip

13. GXM vs. GSH • GSH • Blood is not prepared for patient • ONLY the sample is processed • BUT can easily convert to GXM if required • GXM • Blood is prepared for patient • Sample is cross-matched with donor red cells • BUT this increases workload

14. Case 3 • En SY, 56 year-old man • Presented to A&E with torrential per-rectal bleeding • O/E: Pale+++ PR: 120 BP: 106/60 • Packed cells are requested

15. What would you request?

16. Emergency Cross-match • Send sample + request form a.s.a.p • Discuss with blood bank MO on call • Doctor or staff to standby at BB with an ice box • Verify blood upon release

17. COMPLETE INFORMATION Form: Complete Information

18. Case 4 • 21 year-old lady • Post-stem cell transplant for acute myeloid leukaemia • Platelet count is 10 x 109/L • Platelet concentrates are requested

19. Request for platelets • Discuss the case with the blood bank MO on call • Once approved, send request form • NO BLOOD SAMPLE required if blood group is known and in BB records • Collection slip will be issued once platelets are ready

20. COMPLETE INFORMATION Form: Complete Information

21. Case 5 • 56 year-old lady • Admitted to ICU for necrotising fascitis of left leg • Prepared for amputation of left leg • Coagulation profile was deranged • Fresh frozen plasma was requested

22. Request for fresh frozen plasma • Discuss with Blood Bank MO on call • Once approved, send request form • NO BLOOD SAMPLE required if blood group is known and in BB records • Thawing of plasma takes 30 minutes • Collection slip issued once plasma is ready

23. COMPLETE INFORMATION Form: Complete Information

24. Case 6 • 26 year-old lady • Elective LSCS for transverse lie • Group B, D negative • GXM 2 units PRBC • Requested for PRBC to be in OT

25. Case 7 • 45 year-old lady • Long-term anticoagulation for recurrent DVT • Admitted for elective knee arthroscopy • Warfarin stopped 5 days • INR 1.6 on day before surgery • 2 units FFP requested

26. Case 6 – cont’d • LSCS uneventful • PRBC returned • Was GXM necessary? • Why bring PRBCs to OT when it takes only 20 minutes to convert GSH to GXM?

27. Case 7 – cont’d • FFP brought to OT • INR 1.3 on day of surgery • Arthroscopy went well • FFP transfused anyway after procedure • Reason: need to write explanation letter to BB

28. Returning unused blood • Best practice is NOT to remove blood/ components from BB until needed • Packed red cells, whole blood are stored in blood refrigerators at 4±2°C • Domestic refrigerators are not meant for blood • Plasma products (FFP, CryoP) are kept frozen and thawed ONLY upon request • Once thawed, they cannot be frozen again

29. Returning unused blood • However, DO NOT TRANSFUSE if deemed UNNECESSARY • Best to return than to transfuse inappropriately • If returned: • Place PRBC, WB and FFP in blood box with ice • Return platelets in blood box without ice • Fill in ‘borang pemulangan darah’ or brief explanation letter (memo) • Blood bank WILL NOT reprimand you

30. Returning unused blood/ blood components • Call & inform BB • Complete ‘ borang pemulangan darah’ or write a memo • Return blood/ components in separate plastic bags with ‘borang pemulangan darah/ memo’

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

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

34. Improper return of used blood

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

36. Be aware of the risks of transfusion and the morbidity/ mortality associated with it! • Febrile/ non-febrile transfusion reactions • Wrong blood • Bacteremia • Transfusion-related acute lung injury (TRALI) • Transfusion-transmitted infections (TTI)

37. The end