BMS Interview Flashcards

Question

What would you do in the event of a spillage?

Answer 1

-Locate nearest spillage kit -Follow SOP for specific spillage -If unsure, check QPulse or senior -Ensure no harm has come to staff and clear up so safety of environment is maintained - Ensuring to put a wet floor sign up and wearing appropriate PPE

Answer 2

-Designed to keep you safe whilst working with hazardous substances -Gloves, goggles and aprons

Answer 3

-Reviewed annually and updated as needed to ensure accuracy and compliance -Access is restricted, most documents available only through QPulse -Helps maintain clear audit trail -Paper documents can easily be lost due to high volume received in lab -All documents scanned and securely stored digitally, with most professional practice documents uploaded to QPulse.

Answer 4

-Process of identifying hazards in workplace and determine likelihood of causing a potential incident -Affects me in this role as there are loads of hazards around the lab therefore need to follow the guidance of risk assessments to minimize potential risks -Always wearing PPE in the lab is a way of protecting ourselves from risk -All risk assessments can be viewed on QPulse

Answer 5

-GDPR is data protection legislation governs use, processing and storage of data -Important as may be sensitive information received and patient results should be kept confidential -Lab access with key cards -Smart cards for summary care that are password protected -All of the systems are password protected -Sign in book for audit trails of who has been in and out of the lab -Samples are barcoded and referred to as their barcode -Patient samples should not be discussed outside of the lab -Confidential waste bins - shredded -Document control – all systems password protected -Important for anyone working in medical setting understand to maintain patient confidentiality following the GDPR laws and data protection act and the consequences if this isn’t followed

Answer 6

-Check for clots, if the sample was clotted, reject it ensuring no false results are released and call the ward to request a repeat sample -Check if there is any record of the patient being a platelet clumper or having cold agglutination -If they are a platelet clumper, request a citrate or fluoride sample for the full blood count to be performed on -If unsure, make a film to look for platelet clumping, giant platelets or platelet satellitism and if any of these were present request a citrate or fluoride sample -If the patient has cold agglutination or I have a suspicion as you can often see small clots within the sample, put sample in incubator to warm up and perform the full blood count and make a film on the warm sample -Important that these checks are performed, and no false results are released that could compromise patient care

Answer 7

-Sample labelling – ensure the sample meets the labelling policy (3 identifiers) -Correct sample type – citrate -Sample overfilled – Citrate is a chelating agent of calcium; overfilling will cause too little calcium to be removed from the sample affecting the clotting time. Calcium is added into the sample during the testing process in order to analyse clotting time, so the right amount needs to be removed to produce accurate and reliable results -Sample underfilled – too much calcium removed -Haemolysis – visual haemolysis check as haemolysis affects the quality of the sample often caused when the sample is being taken and this can affect clotting time, the coagulation analysers use turbidimetry to detect cloudiness within the sample for clot formation and haemolysis will compromise this -Lipemic – sample becoming too opaque for Turbidimetric testing affecting clotting time -Sample stability – 12-hour stability for coag screen, 8 hours for DDIM, 4 for special coag to be spun and frozen. If the coag sample is unstable deranged clotting can occur due to the half life of some of the factors in the coagulation cascade being short e.g factor 5 = 12hrs. Special coag samples need to be double centrifuged within 4 hours as platelets can interfere with lupus anticoagulant

Answer 8

- Check sample quality -Check if patient is on antioags -Ccorrection studies can be performed using a normal for corrections -If clotting time corrects it is most likely a factor deficiency so factor testing should be performed -If doesn’t correct, most likely lupus anticoagulant or potentially a factor 8 inhibitor -Lupus screen should be performed -I would not release any prolonged coagulation results without justification or further testing to identify the cause

Answer 9

-Disseminated Intravascular Coagulation -Rare serious condition that causes abnormal blood clotting throughout the bodies blood vessels -Proteins that control blood clotting become overactive causing excess clotting -DDIM will be elevated along with PT and APTT -Fibrinogen will be decreased and the patient will be thrombocytopenic

Answer 10

-Order of draw is one of the main causes of contamination in chemistry samples -EDTA before chemistry, cause Hyperkalaemia and Hypocalcaemia ( chelates calcium ions) level to be presented -Citrate contamination raises sodium however often dry anticoagulants are used within the citrate bottles to avoid this -Taking blood sample from arm of IV drip will cause results to be diluted and all results will be decreased by roughly 1/3 -Saline raises sodium -Glucose IV raises glucose -Check correct patient, look at previous result and delta check, compare Hb with prev sample if have FBC to see if also diluted -Results not released and repeats requested

Answer 11

-Respond within 24 hours -Check location of unit on apex checking whether still in stock or transfused -If not transfused, issue another unit and collect the old -Make sure the product is quarantined -Complete Temp-22 on Q-pulse (Notification of recall) -If been transfused, inform NHSBT and find out why it has been recalled and inform clinician -Complete non-conformance -Inform senior -Return product to NHSBT is requested or wasted if not -Requirement of blood safety and quality regulations that all products and components considered risk to patients are withdrawn from use -If unit has been transfused and causes a transfusion reaction SHOT must also be informed

Answer 12

-Sample not mixed -Poor renal function -Severely dehydrated -If Hb raised with no indication of why and not similar to patients previous results, mix well and rerun -If did not correct it look at patients renal function if chemistry sample was received -Request a new sample if no indication of reasoning -I would not release results that I was not comfortable are valid as this could affect patient care

Answer 13

-Calibration is the reference point -Configures instrument to provide result within an acceptable range -Quality control used to monitor performance of testing procedures and check accuracy -Data collected plotted on a Levi Jennings chart -Acceptance criteria must meet the Westgard rules -QC run at intervals throughout day -Allows detection of drifts and trends in reagent values if a reagent is drifting calibration materials used to bring it into the curve -Calibration and qc values are constantly run and monitored to ensure patient results being produced are accurate and reliable -If failure, must be rectified as soon as possible, and reagent not used in the meantime as it could affect patient treatment

Answer 14

-SHOT stands for serious hazards of transfusion -UKs hemovigilance scheme -Any confirmed transfusion reactions must be reported to them -Allows assess the leading causes of transfusion reactions and produce annual reports providing recommendations to improve patient care -SABRE stands for serious adverse blood reactions and events -MHRAs system for reporting blood safety incidents -Provide registered reporters the option to submit hemovigilance reports online to the MRHA and SHOT -The MHRA (Medicines and Healthcare products Regulatory Agency) is UK government body responsible for regulating medicines, medical devices, and blood components for transfusion -Ensures products meet strict safety, quality, and efficacy standards to protect public health -Oversee adverse event reporting through its Yellow Card Scheme -Allowing healthcare professionals and the public to report side effects or defects in medical products -Regular inspections and audits by the MHRA help maintain high standards, ensuring that laboratories and healthcare institutions follow best practices and operate safely

Answer 15

-Evidence gathering process which must be objective, impartial and independent within a systematic and documented process -Should be performed in line with ISO15189 -All audit documentation should be maintained appropriately -External audits conducted by external parties such as UKAS assessing the services of the lab -Internal audits conducted internally by a member of staff -E.g. health and safety or quality control audits -Vertical audits look at all processes in combination such as following one sample through the whole process from the request all the way to result validation -Horizontal audits look at one process in isolation such as specimen transport -Examination audits examine staff undertaking a process -example are the competency assessments staff complete before being signed off for each task ensuring that the staff is capable of performing the task to the best of their ability within their scope of practice so our service users receive the best care

Answer 16

-MRHP protocol; in case of emergency, ward staff set off alarm alerting the transfusion laboratory there is a major haemorrhage -Always Oneg red cells on standby in case of emergency -A FFP ready to be defrosted as well as platelets and cyro -Packed immediately in a 4-hour transport box and a porter comes to collect -Once emergency units have been used, they are replaced -First pack, 2 units of red cells and 2 units of FFP are issued- changed from 4 units of red cells in the first pack to a 1:1 ratio as many patients going into DIC due to the lack of FFP -Second pack contains the same with platelets -Third pack also contains cryoprecipitate. -RCCs are packed separately to platelets due to different storage processes (RCC 4 degrees, plts 22)

Answer 17

-2 samples on record -One must be sent to the lab for a confirmed group and antibody screen before units can be issued -Sample is then valid for 7 days but then 3 days if a transfusion has been given in the last 3 months. -No antibodies detected -Results have not been manually edited by member of staff

Answer 18

-Immunocompromised; chemotherapy or had an organ transplant -CMV neg blood is almost always given but should always be given to pregnant women, babies -Immunocompromised patients and patients with low high titre antibodies -Irradiation destroys white cells preventing them causing harm

Answer 19

-Assess situation and escalate to a senior and IT -Find out whether sitewide issue -Determine whether samples can be sent away -Alert site manager and some major wards such as A&E that there is going to be a delay -Ensure I delegate tasks to ensure the team is going to work together to still deliver the best possible care to our service users -See if I can find out a timeframe -If not a sitewide issue assess where I can send samples for patients to get their results most efficiently so they can receive the care they need -Prioritise samples, urgent samples can be manually tested through the analysers and results printed -Ensure staff aware of their roles and what need to do but still not breaching the limit of their practice as patient safety is key -Samples may need centrifuging to ensure stability.

Answer 20

-Assess the situation and try and find out if this is a sitewide issue -Inform on-call site manager and urgent wards informing them there may be a delay -See if find out a time frame and start prioritising samples -Urgent samples manually tested on the analysers and results printed -Sort samples to be sent away by taxi or blood bike if necessary if they cannot wait until the morning -Ensure samples are centrifuged and stable but using a systematic approach to maintain organisation -Ensure that I remain calm and practice safely and effectively to deliver the best service to our service users. -Maintain record of any samples sent away for audit trail

Answer 21

-Assess the situation -Delegate jobs ensuring everyone is working as a team to keep the service flowing -If the other chemistry line isn’t up, see where the process is at and get it up and running as soon as possible -Speak to urgent wards and warn them there may be a delay in patient results -Assess how long the delay may be and whether samples are going to have to be sent to other sites -Arrange and engineer to come and look at the analyser at their next opportunity

Answer 22

-Reject, PathLinks zero-tolerance policy for not having all identifiers that meet PathLinks legislation -Call ward and explain and ask if they can repeat -If they don’t understand why, explain implications and dangers of transfusion reactions if units not issued correctly -Make sure practising safely within my scope of practice

Answer 23

-Set of quality control guidelines used in laboratories to identify potential errors in testing -Help ensure accuracy and precision of results -Detecting systematic and random errors before they impact patient care -Use standard deviations to determine whether a test result is within acceptable limits -If rule is violated, corrective actions must be taken before reporting patient results to prevent inaccurate diagnoses and treatment -1_2s Rule: A warning when a single control result exceeds 2 standard deviations from the mean

Answer 24

-Follow SOP to troubleshoot -Check if failure is random or systematic by reviewing previous QC results and applying Westgard Rules -inspect reagent integrity (including the stability, mixing if latex reagent and how much is left onboard) and QC preparation (adequate mixing and how long it has been out for) -If any of these issues, rerun QC when problem was rectified -If QC started to trend away from accepted standard deviation, run a calibration and re-QC -If problem persists, escalate it to a senior colleague for further investigation, ensure that no tests are run on failed QC by masking the test or not using the analyser until it was fixed -Ensuring accurate QC results is crucial for maintaining reliable patient outcomes

Answer 25

-Routine blood test measures different components of blood, including red blood cells (RBCs), white blood cells (WBCs), haemoglobin (Hb), haematocrit (Hct), platelets, and various indices such as Mean Cell Volume (MCV) -Helps assess patient’s general health and detect conditions like anaemia, infections, and clotting disorders -Results provide valuable insight into how well the body is functioning and if further investigation is needed

Answer 26

-anemia can have multiple causes - assess MCV, RBC, Hct alongside history and symptoms -Determine exact cause, additional iron studies, B12 and folate levels, reticulocyte counts, and blood film analysis may be required -Microcytic anemia (e.g., iron deficiency) may show hypochromic, small RBCs on a -Macrocytic anemia (e.g., B12 or folate deficiency- pernicious) characterized by large RBCs and hypersegmented neutrophils, run a BFER to confirm -Investigations help guide appropriate diagnosis and treatment, ensuring optimal patient care by identifying and addressing the root cause while managing symptoms. For example, iron-deficient anaemia is caused by iron-deficiency whereas pernicious anaemia is caused by a B12 or folate deficiency. On a blood film, iron-deficient anaemia appears as microcytic hypochromic red blood cells, whereas pernicious anaemia is characterised with hyper segmented neutrophils, with a B12, folate and ferritin run to confirm this -Affects treatment as unit would have little improvement in pernicious anaemia until iron infused

Answer 27

-infections, inflammation, stress, or hematological disorders -Type elevated provides further clues about the underlying cause -Bacterial infections, neutrophilia -Viral, lymphocytosis -Persistent leukocytosis could indicate serious condition like leukaemia, require further investigation through film, bone marrow analysis or flow CT (differentiate reactive and malignant leukocytosis using CD markers)

Answer 28

- Crucial screening tool but several limitations -Doesn't provide specific diagnosis, may require further testing, such as blood film analysis, iron studies, or flow cytometry, to determine underlying cause of abnormalities -Factors like platelet clumping, RBC fragmentation, and physiological variations can lead to misleading results -FBC results should always be interpreted in the context of patient history and clinical presentation.

Answer 29

- Measures immature red blood cells providing insight into bone marrow activity and red blood cell production -Helps assess bone marrow function -High reticulocyte count suggests active RBC production, hemolytic anemia or acute blood loss -Low count indicates impaired erythropoiesis, bone marrow disorders or nutrient deficiencies -Provides essential information to differentiate between different causes of anemia and assess marrow recovery after treatment

Answer 30

-Complex sequence of events leads to blood clotting -Intrinsic and extrinsic pathways, converge at the common pathway -Extrinsic triggered by tissue injury and involves Factor 7 activating Factor 10 -Intrinsic amplifies this response -Common culminates in the activation of prothrombin to thrombin, which converts fibrinogen to fibrin and stabilizes clot -Cascade is tightly regulated to prevent excessive clotting -Defects in factors can lead to bleeding or clotting disorders

Answer 31

-PT measures the extrinsic and common pathways -Commonly used to monitor warfarin therapy and diagnose bleeding disorders related to liver disease or Vitamin K deficiency -aPTT assesses the intrinsic and common pathways -Monitor heparin therapy or diagnose conditions like hemophilia -INR is standardized version of PT -Helps ensure consistent results across different laboratories, especially for patients on warfarin therapy, helping to maintain therapeutic anticoagulation levels and reduce clotting or bleeding risks

Answer 32

-Prolonged PT, Vitamin K deficiency, liver disease, or warfarin therapy -Defect in the extrinsic or common coagulation pathways -Prolonged aPTT issue with intrinsic pathway; hemophilia, lupus anticoagulant, or heparin therapy -Both can be prolonged in conditions like Vitamin K deficiency, severe liver disease, or disseminated intravascular coagulation (DIC), which impair multiple clotting factors

Answer 33

-Check for anticoagulant therapy -If on warfarin, PT is expected to be prolonged, and INR can help monitor therapy -If no anticoagulant use, assess liver function as liver disease can impair clotting factor production, resulting in prolonged PT -Vitamin K deficiency can also prolong PT, as it affects clotting factors -Factor assays or liver function tests can help confirm the diagnosis -DIC is another potential cause, tests like fibrinogen levels, D-dimer, and platelet count should be checked -If necessary, a lupus anticoagulant test could be performed to rule out antiphospholipid syndrome.

Answer 34

-Rule out heparin therapy -If not on heparin, mixing study is performed to determine if due to clotting factor deficiency or inhibitor -If corrects, test for specific factor deficiencies for hemophilia -If it doesn't correct, lupus anticoagulant should be considered, and tests for anticardiolipin antibodies or anti-β2-glycoprotein I antibodies should be ordered -Vitamin K levels or fibrinogen levels, may also be necessary depending on the clinical scenario

Answer 35

-Rule out warfarin therapy, can cause a prolonged PT due to inhibition of Vitamin K-dependent clotting factors -If not on warfarin, investigate for Vitamin K deficiency by checking Vitamin K levels and performing Factor assays -Review liver function tests, can affect PT -Assess Factor 7 deficiency, can cause isolated PT prolongation -Explore other conditions like DIC or antiphospholipid syndrome by checking fibrinogen levels, D-dimer, and lupus anticoagulant testing

Answer 36

-Most widely available blood type. -Approximately 85% of the population is Rh-positive -Can be safely transfused to most patients without causing an immune reaction -Unlike O negative, universally compatible but less readily available, O positive commonly stocked in hospitals and provides an efficient and quick option for transfusion -Rh compatibility not as critical for men (as it is for women of childbearing age) -O positive blood ensures that the patient receives the necessary transfusion without delay, which is crucial in emergency situations

Answer 37

-Indirect Antiglobulin Test (IAT) -Detects alloantibodies against red blood cell antigens -Positive result indicates presence of antibodies, which can potentially lead to a transfusion reaction -Gel Column Agglutination is more modern, automated method with high sensitivity -Antibody identification panels used to identify specific antibodies in cases where the screening test is positive -Results are interpreted based on the presence or absence of agglutination, with positive results indicating the need for further investigation and careful selection of blood products for transfusion

Answer 38

-Direct Antiglobulin Test used to detect antibodies or complement proteins attached to a patient's red blood cell -Used to investigate causes of immune-mediated hemolysis, such as autoimmune hemolytic anemia (AIHA), or transfusion reactions -If antibodies or complement are bound to the RBCs, agglutination will occur when anti-human globulin added, positive result. -Positive DAT indicate AIHA or newborn hemolytic disease (HDN) -Negative, suggests that hemolysis is not due immune cause, other factors like mechanical hemolysi -If pos, further investigations like elution or antibody identification performed to determine the specific cause.

Answer 39

- Acute hemolytic reactions -Febrile reactions -Allergic reactions -Graft-versus-host disease (GVHD) -Iron overload -Transfusion-related acute lung injury (TRALI) -Bacterial contamination -Prevent crucial to follow strict SOPs to ensure proper blood typing and crossmatching -Using leukodepleted or irradiated when necessary

Answer 40

-Immediately advise ward to stop transfusion -Request blood sample for DAT to assess for hemolysis or antibody-mediated reactions -Ask for a full blood count to monitor signs of hemolysis or anemia and urine analysis to check for hemoglobinuria -Ensure blood bag and transfusion set sent for crossmatch and culture, especially if bacterial contamination is suspected -Repeat the group, antibody screen, and crossmatch on pre-transfusion and post-transfusion samples to confirm compatibility and identify any discrepancies -Important to identify issues with the unit or rare antibodies that may have gone undetected to prevent any future reactions and allow for the appropriate management of the reaction

Answer 41

-Begins with request for appropriate blood product, based on patient's clinical needs -Blood type confirmed with at least 2 groups on file for blood issued and fully filled out request sent -If patient has negative antibody screen, eligible for electronic issue -Compatible blood type issued -If they have antibodies, crossmatch performed to ensure compatibility with donor blood -Documentation crucial for traceability

Answer 42

- Follow strict SOP - Verify patient's identity and ensure the correct blood group is matched to the donor blood -EI units can issued with compatible units selected -Crossmatching performed on those with identified antibodies to confirm compatibility -Blood product carefully inspected and properly labelled with the patient's details -Accurate documentation maintained throughout the process -Regular training and competency assessments ensure that safety protocols are always followed and reviews to procedures are conducted regularly to ensure that transfusions are as safe as possible

Answer 43

-Ensure patient's details and sample are correctly labelled -Carefully review both forward and reverse grouping results to identify where the discrepancy lies -Possible causes could include weak or missing antibodies/antigens, cold agglutinins, or rare blood group subgroups. -Repeat the blood typing with fresh reagents and check for cold agglutinins -Send the sample to NHSBT for further testing of rare groups -Perform additional tests such as an antibody screen or weak D testing, and consult with a senior or a consultant haematologist for further guidance -Document all steps thoroughly and communicate with the clinical team to ensure patient safety before proceeding with any transfusion

Answer 44

-Immunoassays and chemistry tests, including ISE, are commonly used to measure a wide range of analytes -Immunoassays rely on specific interaction between antibodies and antigens to detect substances like hormones, proteins, or drugs -Chemistry tests use chemical reactions and analytical techniques to measure the concentration of various chemical components in body fluids (e.g., blood, urine) for example glucose and lipids -ISE, are more commonly used for measuring electrolytes such as sodium, potassium, and chloride by measuring electrical potential generated by ion-selective membranes in response to specific ions.

Answer 45

-Study of shape, size, and structure of blood cells -Crucial for identifying abnormalities in red blood cells (RBCs), white blood cells (WBCs), and platelets -Allows for diagnosis and classification of various conditions anemia, leukemia, infections, and bone marrow disorders -Film analysis used to assess abnormalities and provide valuable clues that guide further investigations or confirm a diagnosis -Important for monitoring treatment effectiveness and detecting diseases early -Abnormal RBC morphology could suggest iron deficiency anaemia, while irregular WBC shapes might indicate leukaemia or infection

Answer 46

-Teamwork crucial for ensuring smooth processes and high-quality patient care -Work well in team especially in situations when dealing with urgent samples need to be processed in short time frame -Some colleagues focus on routine tests whilst one focuses on managing the urgent samples -Complex range of urgent tests sent with variety of sample processing requirements -Noticed one team member needed support in managing so offered to take over other urgent samples so could focus on that one -Ensuring I communicated effectively with rest of the team so workload was shared between everyone -Ensured that there was no delay in patient care.

Answer 47

-Student mislabelled patient sample -Realized during routine check -Knew would affect accuracy of the results -Immediately informed BMS and team -Correctly re-label the sample -Luckily no test run yet so nothing further to ensure quick processing -Prevent similar mistakes, extra care in double-checking labelling process -Opportunity to suggest to team that we reinforce importance of double-checking labels, especially during high-pressure situations

Answer 48

-Good Manufacturing Practices are set of guidelines -Ensure consistent production of safe and high-quality products -Involve several critical elements -Proper training and health of staff -Maintaining clean and controlled facilities -Standardized procedures -Testing and documentation integral parts ensuring that all processes are traceable and consistent -Protect patients ensuring that processing meets safety and quality standards at all times

Answer 49

-Proper storage critical to ensure integrity and accuracy results, and stability of samples and reagents -Biological samples can degrade or change over time if not stored under correct conditions, leading to inaccurate results -Stability of potassium in blood samples is sensitive to factors like hemolysis, temperature, and time to analysis -Potassium measured as soon as possible after collection -If left at room temperature for too long, risk of potassium being released from cells, -'pseudohyperkalemia.' -Glucose in blood samples prone to consumption by red blood cells -If blood sample isn't separated from cells promptly, glucose levels can decrease by glycolysis, leading to falsely low glucose results -Proper sample handling, timely processing, and appropriate storage vital for ensuring accurate and reliable results -Adhering to correct storage protocols and processing samples promptly= prevent errors might otherwise impact clinical decision-making, especially when managing patients with critical conditions -Steps are essential for maintaining the quality of lab results and supporting effective patient care

Answer 50

-Quality control measure to detect significant changes in patient's test results over time -Compare patient’s current results with previous results for the same test and highlight significant differences -Help identify potential errors in sample handling, processing, or patient misidentification -Flag clinically significant changes in patient's condition that may require further investigation -If patient's hemoglobin level has dropped significantly from previous, could indicate medical issue such as acute blood loss or a problem with the sample collection -Delta checks alert laboratory staff to review results more carefully and investigate whether the change due to true clinical issue or error in the laboratory process, such as a mislabeling or technical issue -Stable parameters, total protein are good to use for comparisons as they don’t fluctuate -Delta checks important tool in ensuring the accuracy of test results, improving patient safety, and preventing misdiagnosis or inappropriate clinical decisions -Help maintaining the integrity oftesting process by identifying any discrepancies that could otherwise go unnoticed

Answer 51

-Ensure the consistency and reliability of results -Performed in various situations, when implementing a new testing method or following instrument maintenance or calibration -Performing regularly, identify and correct any inconsistencies, minimizing random errors and ensuring accurate and reproducible patient results

Answer 52

-Confirm presence and determine severity, and identify the underlying cause -FBC for anaemia -Blood film analysis identify any abnormal red cell morphologies -LDH and bilirubin indicate red cell destruction -If immune-mediated haemolysis suspected, DAT to identify antibodies or complement bound to red blood cells -Coagulation tests determine underlying clotting disorder causing haemolysis due to microvascular thrombi leading to mechanical red cell destruction (schistocytes on a blood film)

Answer 53

-Full blood count for haemoglobin levels and platelet count -Coagulation screen assess clotting function -Liver disease can affect clotting, check LFTs -Kidney dysfunction contribute to platelet abnormalities, UE and creatinine -Fibrinogen and D-dimer to rule out DIC -If bleeding disorder suspected, consider von Willebrand factor assays or clotting factor tests -Request a group and save and crossmatch in case a transfusion is required -Important to determine cause and severity as soon as possible -Communicating with the ward staff to ensure that the patient receives the care that they need as soon as possible

Answer 54

-In non-emergency setting -Blood typing and crossmatching conducted to ensure compatibility between the donor and recipient -Includes antibody screen and, some cases, phenotyping to select most appropriate blood product and prevent transfusion reactions -Pre-transfusion haemoglobin levels are checked to determine clinical necessity -Transfusions carry inherent risks and should only be performed when alternative treatments are insufficient -Type of blood product provided—such as packed red blood cells (RCCs), platelets, or plasma—depends on patient's condition (e.g., anemia, thrombocytopenia, or clotting disorders) -Patient history crucial in decision-making; pernicious anaemia, a red cell transfusion offers limited benefit until the patient receives iron supplementation -Life-threatening situations where immediate transfusion is required, group O blood is used - Women under 52, O Rh-negative, K-negative, and CE-negative blood provided to minimize alloimmunization risks - Men over 18, O Rh-positive blood typically used to preserve Rh-negative supplies for patients who require it -Approximately 85% of the population are Rh-positive and can be transfused in most patients without causing an immune reaction -If patient has suitable transfusion history and previous samples on file, emergency crossmatch performed, or blood issued immediately if electronic issue -Phenotype-specific blood can be provided where necessary, HbS-negative blood for patients in sickle cell crisis -Major haemorrhage, massive haemorrhage protocol activated to ensure rapid delivery of red blood cells, plasma, and platelets in appropriate ratios to maintain clotting function and oxygen delivery - First pack consists of 2 units of red cells and 2 units of fresh frozen plasma (FFP) -Previously, 4 units of red cells were used, but this was adjusted to a 1:1 ratio after found inadequate FFP led to disseminated intravascular coagulation - Second pack includes the same plus platelets - Third pack includes cryoprecipitate in addition to the previous -Red cells and platelets are packed separately due to different storage requirements (RCCs at 4°C, platelets at 22°C) -Priority in emergencies is saving the patient’s life while minimizing transfusion risks

Answer 55

-Essential for accuracy, compliance, and traceability - Version Control: unique version numbers, date stamps, and revision log help track updates and ensure everyone is working with the latest document - Access Control & Security: Role-based permissions restrict editing to authorized personnel, audit trails monitor document modifications -Encryption and password protection further secure sensitive files - Standardized Naming Conventions: clear, consistent filenames include version numbers and keywords improves organization and retrieval - Centralized Document Management Systems (DMS): Qpulse for quick access, alerts for updates and A cloud-based or local DMS ensures quick access, automated alerts for updates, and efficient search functionality - Regular Audits and Reviews: Scheduled reviews keep documents up to date and compliant, with assigned owners responsible for managing updates. - Digital vs. Hard Copy Management: Digital workflows reduce paper reliance, printed documents become uncontrolled and must be securely stored -Implementing strategies, maintain accurate, secure, and accessible documentation while ensuring compliance with regulatory requirements