2.0 REQUESTING BLOOD PRODUCTS
The patient is transfused with the appropriate blood product, in the appropriate amount, at the right time where benefits of transfusion far outweigh the risks.
PERSONNEL ABLE TO PERFORM
Western Diagnostic Pathology Request Form (ordering product/service)
Western Diagnostic Pathology printed result form (administration of product)
NHMRC Clinical Practice Guidelines
· All requests for Crossmatch / Group and Hold must be written and signed by the requesting medical officer.
· A request for crossmatched blood may be placed by telephone where a Group & Hold has been requested prior and a valid sample is available in the laboratory.
· Telephone requests must be followed up by written requests and forwarded to the respective transfusion service provider.
The following SHALL be documented on the request form.
· Patient’s first name, surname, gender
· DOB &/or Hospital UR number
· Name & signature of requesting doctor
· Number and type of blood component to be transfused – any special requirements eg: leucodepleted
· Date & time product required (Elective transfusions should NOT take place between 2100hrs and 0700hrs.)
· Clinical diagnosis and indication for transfusion with supporting clinical and laboratory data eg: Hb result
· History of previous transfusions / pregnancies and any known red cell antibodies
· Signature of collector certifying they have positively identified the patient, at the bed-side and also signed the crossmatch blood tube.
It is essential that both patient and specimen are correctly identified.
Sample must have at least 3 positive identifiers:
· First name
· Date of Birth / UR number
Where patient identity “unknown” refer to 14.0 Emergency Transfusion Protocol
These 3 identifiers MUST be identical to those on the request form.
In addition collector must sign sample and the “certifier” on request form must contain the same signature.
· All blood products are requested through the Blood Bank (Western Diagnostic Pathology)
· Packed cells, filtered cells, autologous blood, fresh frozen plasma, platelets, cryoprecipitate
· Intragam: the Australian Red Cross Blood Service (ARCBS) Haematologist must authorize the initial request. All requests must be on the ARCBS IVIg form including all relevant details. Once authorization is obtained, phone Blood Bank to ask lab staff to fax the request to Red Cross. Subsequent orders must be made by medical staff or clinical unit staff in advance (at least 24 hours). Either telephone Blood Bank or complete the ARCBS blood product request and send to Blood Bank.
· All other blood products (eg AHF, Prothrombinex) – Discuss with Haematologist on site or via the Lab(9818) or via the main lab Duty Haematologist (08 9317 0999)
2.2 MSBOS (Maximum Surgical Blood Order Schedule)
· Each hospital has a Maximum Surgical Blood Order Schedule (MSBOS).
This is the standard number of units required for various operations. This is a general guide and unusual circumstances may require more blood to be available. Inform blood bank on the request form if the number of units requested differs from the MSBOS. (Refer Appendix: MSBOS 18.0)
For many procedures a group & screen is all that is required, as blood is rarely needed.
Remember blood is not without hazard
· DO NOT transfuse for asymptomatic mild anaemia
· DO NOT routinely transfuse post-op patients with Hb >80g/L
· DO NOT transfuse simple iron deficiency if asymptomatic, no matter how low the Hb. With iron therapy the Hb will rise 10g/L per week.
· DO NOT transfuse B12 or folate deficient patients - use the vitamin.
2.3 Definitions & timeframes
Group & Hold (G&H) = ABO and Rh (D) blood group identification + screen for red cell antibodies.
Serum is held for up to 7 days (72 hr rule exception) to allow cross-matching if required. This allows the rapid issue of compatible blood should additional blood be required.
Crossmatched (XM) = ABO & Rh (D) blood group identification + screen for red cell antibodies + serologically matching patient plasma to donor units.
· Routine Crossmatch: 45 minutes
· Urgent Crossmatch: 20 minutes
· Super-Urgent: Uncrossmatched Group specific (remember transport time)
· Life Threatening: Emergency uncrossmatched Group O Negative
If blood group is known, group specific (uncross-matched) blood can be issued immediately otherwise O negative blood is issued immediately.
Clear communication is vital to facilitate safe/effective transfusion
· Telephone Blood Bank to liaise with scientists to ensure urgent requests are dealt with appropriately, and priorities known.
· If further stocks required contact transfusion service provider
· Platelets are not held on-site, requests should be discussed with Blood Bank
· Where laboratory is not on site remember to factor in transport time when requesting blood components
2.4 Suitable Blood products for each blood groups
*Where blood group is unknown components for transfusion are:
*Plasma Products (FFP, Cryo) Group AB
*Cellular Products (Red cells) Group O (either Rh D negative as first choice & where patient female child bearing years)