Instructions for Blood Transfusion Requests

1.1 Completing the Request Form

All test requests are made by registered Medical Doctors. The request form may be completed by a nurse, based on either a prescription or protocol.

A full Blood group and antibody screen (for irregular red cell antibodies) is performed on all samples requesting a Group and screen and / or Crossmatch. The sample is held for crossmatching for 72 hrs from venepuncture.

1.2 Two Sample Requirement

Group Specific Blood Products will only be issued when the Laboratory has confirmed the patient blood group on a second independently taken sample. Patients who have no previous group on record in Blackrock and are likely to need products, or are scheduled to go to theatre should have a second sample taken. Group and Screen reports on first time samples will indicate that another sample will be required. In an emergency situation Group O red cells may be issued without a confirmatory patient group. Samples used for first groups include any Blackrock Clinic inpatients or outpatients tested since 2000.

1.3 Electronic Issue / Serological Crossmatch

The majority of patients grouped twice will qualify for Electronic Issue (EI) of Red Cells. These patients are issued group specific red cells without actual serological testing which only takes a few minutes. Some patients don’t qualify for EI (including those with antibodies, some clinical conditions, those with anomalous groups). These need to be serologically crossmatched which takes approximately 40 mins once the required RCs are in stock.

1.4 Ordering Products

A registered Medical Doctor must prescribe all blood components and products for transfusion. Platelets must be ordered by a Consultant or Registrar (exception – emergencies or after discussion with the Consultant). Staff permitted to place the request with the laboratory after viewing the written prescription are defined in PP/C/HW-59: Ordering of Blood components and Blood products on hospital Q pulse (Resident Medical Officer (RMO), Registrar, Consultant, Perfusionist or Nurse).

1.5 Correct Specimen Type

The correct specimen type for blood transfusion is a plastic 6ml, pink-topped K2EDTA sample. The sample must not be grossly haemolysed.

The sample must be fully labelled as per section 1.7.2. Pre-printed labels may not be used.  Samples with missing or incorrect details will be rejected.  The blood transfusion request form (LF-BT-0039) must be completed as per section 1.7.1. Samples will not be processed if the relevant information is not completed on the request card.

All inpatient samples (i.e., those which may be used for crossmatching) must be labelled immediately from the patient wristband. Samples taken from outpatients or external patients are not used for crossmatching / product issue.

Specimen types for other test requests are listed in the appendices. Section 19.4 for Blood Transfusion.

1.6 Valid Sample Age

Samples used for crossmatching must be less than 72 hrs old at time of transfusion. A fresh sample must be taken for Group, Screen and Crossmatch if more than 72 hrs have elapsed (or will have elapsed by the time of infusion) since the patient was previously bled, regardless of previous transfusions/pregnancies.

1.7 Blood Transfusion Specimen and Request Form Labelling

1.7.1 on the specimen

Sample labels must be handwritten, pre-printed addressograph labels are not acceptable. Crossmatch / Group and Screen samples must be labelled immediately after taking, from the patient wristband.

All of the following essential information is required:

• Full name of patient, correctly spelt as it appears on their wristband

(e.g., Joe P Bloggs)

• Hospital number

• Date of birth

• Date & time of venepuncture

• The initials or signature of the person taking the sample

Samples which are inadequately or incorrectly labelled will be rejected and a repeat requested.

Alterations to essential sample information will not be accepted for transfusion purposes.

1.7.2 on the request card

All of the following essential information is required:

• Full name of patient (exactly as on sample)

• Hospital Number and Date of Birth (exactly as on sample)

• Gender

• Name of Consultant

• Name of Ward/Department

• Signature, date and time of specimen collection

• Test and/or product required with date and time

• Specific requirements, e.g., CMV negative, irradiated products.

1.7.3 the following important information to be given where available

• Reason for transfusion or relevant clinical details

• “Important Transfusion History” section complete

If the “Essential Information” section has not been completed, only the Venepuncturist can amend it. Significant Patient Demographics cannot be amended on Request forms – a new sample will be required.

Laboratory staff can add or cancel test requests and Transfusion History on the request form when informed by Clinical Staff.

1.8 Patient Information Leaflet (Information on Blood Transfusion):

With the exception of emergency transfusions, all patients that are Group and Screened/Crossmatched in Blackrock Clinic receive a copy of the Patient Information Leaflet. This leaflet contains information regarding the reason for the transfusion, risks, alternatives and possible reactions to transfusions.  The declaration form is signed by the patient and stapled to either the consent form or the blood prescription form in the patient’s chart.

Before blood or blood products are administered the doctor or the nurse hanging the blood must ensure that verbal consent is obtained from the patient and the appropriate box is ticked on the prescription form. (Exception - emergencies)

Ref: PP/C/HW-54 Hospital Q pulse