Level 1

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BETTER BLOOD TRANSFUSION PROGRAMME
Continuing Education Programme Level 1 - Safe
Transfusion Practice for Health Support
Workers Diane Creighton Susan Bateman
Transfusion Practitioners
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Level 1 - Learning Outcomes

• By the end of this session you will be able to
• Identify the main hazard of transfusion
• Understand basic ABO blood serology in the
  context of ensuring the patient receives
  the right blood at the right time
• Store blood components correctly
• Collect blood components safely
• Take initial action to manage a transfusion
  adverse event

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Further Information

• Blood Transfusion Policy
• The Handbook of Transfusion Medicine 3rd Ed
  (2001)
• web site www. transfusionguidelines.org.uk
• BCSH Guidelines
• web site www. bcshguidelines.org.uk
• Serious Hazards of Transfusion Annual Report
  (2002)
• web site www. Shot.uk.org
• Local Transfusion Practitioner
• GRI/STOHBILL Susan Bateman pg. 07623619620
• WIG/GGH Diane Creighton pg. 07623612852
• Hospital Laboratory Staff

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Serious Hazards of Transfusion Reporting Scheme
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Serious Hazards of Transfusion Reporting Scheme
Overview of cases from 2004 Report (n541)
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Serious Hazards of Transfusion Reporting Scheme
Distribution of Errors in IBCT Category (2004
Report)
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Storage of Blood Products
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Red Blood Cells

• Carry oxygen around body
• Have a shelf life of up to 35 days
• Blood Refrigerator
• 2 - 6oC
• Must be used within 30 min
• of removal from fridge
• Must be infused within 4hrs
• of spiking bag

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FFP and Cryoprecipitate

• Aid blood to clot
• Have a shelf life of 2 year
• MUST NOT BE STORED in a
• Blood Refrigerator
• Must be used within 4 hrs of
• spiking the bag

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Platelets

• Aid clot to form
• Have a shelf life of 5days
• MUST NOT BE STORED
• in a Blood Refrigerator
• Must be used within 4 hrs
• of spiking pack

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Blood Group Serology
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ABO Serology the essential facts

• Four ABO blood groups

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ABO Serology the essential facts

• Each patient can receive blood of their own ABO
  Group or Group O

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Rh the essential facts

• 1. Red cells which carry the Rh D antigen are
  Rh-positive
• 2. Rh-negative patients can make anti-D if they
  are exposed to Rh D positive cells by transfusion
  or pregnancy
• 3. Rh-positive patients can receive any Rh type
  blood
• 4. Rh-positive blood will occasionally be issued
  to certain Rh-negative patients

NB Rh-negative female patients of child bearing
potential MUST NEVER be transfused with
Rh-positive cells
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Collection Process - Case Study

• ODA collected 2 units group A red cells from
  satellite fridge

• Incorrect components name DOB Hospital Number

• Bedside formal identity check not undertaken

• Group O patient received Group A red cells

• Patient admitted to ITU

• Died as a result of incompatible transfusion

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Collection Procedure - Step 1
Complete the Blood Collection Form (or follow
your local collection procedure) with the
following information

• Forename
• Surname
• Date of Birth
• Hospital number

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NB Follow procedure for each blood component
collected
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Collection Procedure - Steps 2 3

• Step 2 Check the patients ID
• details against compatibility/
• traceability label attached to
• the blood bag
• Step 3 Document removal
• of unit on blood fridge register
• or electronic release system

Ensure prompt delivery of the blood component to
the clinical area
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Collection Process - Case Study

• HSW sent to fridge to collect blood with
  blank
• collection form
• Completed patient ID details on the collection
  form after
  collecting the blood
• Unfortunately she collected the wrong unit
• Unit checked by 2 nurses and transfused to
• patient
• Further 2 units collected using the original
• collection form with the wrong patient ID
  details
• Error not detected until 3 units of blood
  transfused

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Monitoring Procedure

• Communicate with patient
• Record vital signs
• Early Check
• Each unit must be infused within 4 hours
• Complete documentation

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Signs Symptoms of a Transfusion Reaction
A mild reaction may be the early stages of a
severe reaction - DONT IGNORE IT!
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Management of a Mild Acute Transfusion Reaction
1. Stop the transfusion check patient and
component. 2. Seek medical advice 3. Assess
patient 4. Commence appropriate treatment
If signs symptoms worsen within 15
minutes treat as a severe reaction
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Management of a Severe Transfusion Reaction

• 1. Stop the transfusion - Replace administration
  set and keep the IV line open with normal saline
• 2. Call the doctor to see the patient urgently
• 3. Assess patient - resuscitate as required
• 4. Inform the HTL and return the component
• 5. Document event in patient case notes

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Safer Practice Takes Seconds
A consistent, professional approach to safe
transfusion practice can save lives. Id like
to know who I can blame I still feel hate. I
am furious and angry someone couldnt be
bothered to treat my child in a professional and
safe manner. Mrs Green 15/12/98
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