Pretransfusion Testing Flashcards
What are the aims of Pre-transfusion Testing
To select blood components that will not harm the recipient
To select blood components that will have acceptable survival when transfused
What are the seven steps in Pre transfusion testing
1) the request for transfusion
2) positive identification of recipient and recipient’s blood sample
3) Blood grouping- determination of the ABO and Rhesus types of both recipient and blood components
4) Screening of components of ABO and Rh types appropriate for recipient
5) selection of components of ABO and Rh types appropriate for the recipient
6) Performance of a crossmatch (for RBC recipient only) between the recipient’s plasma and the donor cells (done to determine whether the donor cells are compatible with the recipient’s plasma)
7) Label blood component
In Pre transfusion testing what is done after the request for transfusion
2)positive identification of recipient and recipient’s blood sample
In Pre transfusion testing what is done after 2) positive identification of recipient and recipient’s blood sample
3) Blood grouping- determination of the ABO and Rhesus types of both recipient and blood components
In Pre-transfusion testing, what is done after
3) Blood grouping- determination of the ABO and Rhesus types of both recipient and blood components
4) Screening of components of ABO and Rh types appropriate for recipient
In pre-transfusion testing what is done after
4) Screening of components of ABO and Rh types appropriate for recipient
5) selection of components of ABO and Rh types appropriate for the recipient
In pre-transfusion testing, what is done after
5) selection of components of ABO and Rh types appropriate for the recipient
6) Performance of a crossmatch (for RBC recipient only) between the recipient’s plasma and the donor cells (done to determine whether the donor cells are compatible with the recipient’s plasma)
In pre transfusion testing what is done after
6) Performance of a crossmatch (for RBC recipient only) between the recipient’s plasma and the donor cells (done to determine whether the donor cells are compatible with the recipient’s plasma)
7) Label blood component
What are the two main requirements for Pre-transfusion testing
One anticoagulated (EDTA) sample (plasma)
Request form
1 requirement of Pre-transfusion testing is anti-coagulated (EDTA) sample (plasma), which other sample may be used
Serum from clotted sample
(Plasma is preferred)
NB// Serum and plasma both come from the liquid portion of the blood that remains once the cells are removed, but that’s where the similarities and. Serum is the liquid that remains after the blood has clotted. Plasma is the liquid that remains when clotted is prevened with the addition of an anticoagulant.
In pretransfusion testing what should be done if a patient was pregnant or recieved a blood transfusion within the past 3months
A fresh plasma sample should be collected 3 days (or less) before the intended transfusion
In pretransfusion testing if a patient was pregnant or recieved a blood transfusion within the past 3months A fresh plasma sample should be collected 3 days (or less) before the intended transfusion.
Why
To allow time for antibody production and detection
Are verbal requests for pre-transfusion testing accepted?
Yes in urgent situations but should be documented according to local policies
What are the pre-transfusion request requirements
a) Detailed identification of the patient
b) Details of the diagnosis as well as indication for transfusion
c) Blood Group, if known
d) Details of potentially sensitizing episodes (for example pregnancy, previous transfusion or transplantation
e) identification of component needed
f) the degree of urgency/ expected date of transfusion
g) location of the patient
h) name and or signature of the clinician responsible for pt
Accurate Recipient identification is required for Pretransfusion Request Form.
This includes
First and last names
Hospital registration /ID number
Date of birth
(If pt is unconscious then the minimum information required is the hospital registration/ID number and gender)
Identification of component needed is required for Pretransfusion request form .
This includes
Type
Quantity
Special request (leukocyte reduction,irradiation)
What should be done with Pre-transfusion requests that lack the required information or have inaccurate or illegible information?
Should be rejected as it is extremely risky for anyone to correct identifying information on an incorrectly labelled form
What are the four steps to Sample Collection and Processing
1) There should be no doubt about the identity of the specimen and the recipient
2) The specimen tubes appropriately labelled, after blood collection and preferably at the pts bedside
3) There should be no discrepancy between the information on the request form and that on the specimen tubes
4) Pretransfusion blood specimens are retained for a minimum of 7 days post-transfusion in the Blood Bank
Blood submitted for compatibility testing must be tested for what blood types
ABO and Rh in order to transfuse ABO and Rh compatible components.
Also for unexpected antibodies to red cell antigen using the Indirect Coombs test
What is the Compatibility test process for pts with previous blood bank records
They should have ABO and Rh type checked against the current information
Describe the selection of Blood and Plasma for transfusion
For whole blood
ABO identical to recipient
Describe the selection of Blood and Plasma for transfusion in
For red cells
Group O packed red cells (lack A and B antigens)
Red cells compatible with the recipients plasma
Describe the selection of Blood and Plasma for transfusion in
For plasma
Group AB plasma (contains no anti-A or Anti-B)
Plasma compatible with recipient’s RBC
Describe the selection of Blood and Plasma for transfusion in
For platelets
All ABO groups acceptable
Components compatible with recipient RBC preferred
Describe the selection of Blood and Plasma for transfusion in
For cryoprecipitate
ABO compatibility preferred
When in doubt of Rh D type, which Rh D type should be used
Rh D-negative blood
What Rh-D type blood component should be selected for D-positive recipients?
Rh-D positive
Should you reserve Rh D- negative components for D-negative recipients?
Nope
Why is a crossmatch done in the Compatibility Process of Pre-transfusion testing
This is performed to detect ABO incompatibility and clinically significant immune antibodies in the plasma of the recipient that will react with donor red cell antigens
Which blood group is administered if the ABO/Rhesus D status is unknown
Group O Rh D negative
And the physician must provide a signed statement that the clinical situation required the urgent release of blood
Crossmatchibg is not routinely done for which three types of transfusion
Platelet
Plasma
Cryoprecipitate
Blood group compatibility is still done
The method for crossmatching involves mixing donor red cells with recipient plasma. What are the steps in this method
1) Select a unit of donor blood (whole or packed RBC) that has the same ABO and rhesus blood group as the recipient
2) Centrifuge A mixture of recipients serum or plasma and doing a red cells at room temperature. Examined for agglutination. If present, this indicates ABO incompatibility. Absence of agglutination indicates a compatible immediate spin crossmatch
3) The sample is been incubated at 37°C, washed, followed by the Addition of the cools reagent and examined for agglutination. Agglutination indicates incompatibility and the blood should not be transfused.
In the cross matching test during centrifugation, if agglutination between the plasma of the recipient and the donors red blood cells is present what does this indicate
Incompatiblility
What are the two steps in Issuing of Blood for Transfusion
Blood Transfusion Compatibility label
Final inspection of blood component for any abnormal colour or appearance and expiration date should be performed before issue
What information is included in the Blood Transfusion Compatibility label
Recipient’s name, hospital registration/ID number, ABO and Rh type
Donor unit number, ABO and Rh type
Identification of person who performed the compatibility test
Type and amount of blood component contained in the unit
Special transfusion requirements e.g leukoreduction
What are the four phases of Administration of Blood Components
Consent
Pre-transfusion
During Transfusion
Post Transfusion
What is done in the CONSENT phase of administration of transfusion
- obtain the consent
- consent form includes: risks of transfusion, indications and benefits as well as alternative treatment discussed
- consent form where available signed by recipient
The patient has the right to refuse or accept the transfusion
List the 7 steps in the Pre-transfusion phase of Administration of transfusion
- Treatment chart reviewed
- Patient identity checked
- Blood and components stored correctly prior to transfusion
- The unit to be given should be checked for compatibility-and infectious screen labels
- inspect the unit for leaks, haemolysis, large clots, clumping
- expiry date of the unit of blood
- The transfusionist must determine the catheter size required to access the vein
Catheter size in transfusion depends on what factors
On how quickly the blood needs to be administered
How should Blood components be warmed?
Certified blood warmers (For s with Cold AIHA)
NOT by putting in warm water or under the hot water pipe or in a microwave!!!
Can drugs be added to blood during transfusion??
Nope, never, not under any circumstance
Which intravenous fluids may be added to blood during transfusion ?
Normal Saline
Dextrose
Ringer lactate
Normal Saline to packed RBC
Why isn’t Dextrose allowed to be added to blood during transfusion
May cause red cells to agglutinate or haemolyze
Why isn’t Ringer lactate or other solutions containing calcium allowed to be added to blood during transfusion
The calcium present will lead to coagulation
How are the vital signs monitored during blood transfusion
Temperature, Pulse, Respiration - documented before, then 15mins after starting each unit and after the transfusion
Unconscious pt( pulse, temperature and urine)
What is the rate of transfusion of Red cells
One unit of Red cells is given within 2-3hrs
infusion longer than 4hrs is not recommended
Why isn’t administration of blood transfusion longer that 4hrs recommended
Bacterial Proliferation because the opened unit is at room temperature
Can platelets be stored in the freezer
Never
Stored at room temperature
What is the dosage of platelet for transfusion
1 unit /10kg
What is the rate of infusion of platelets in nin emergency settings
200-300 ml/hr
What is the infusion rate of plasma and cryoprecipitate
200-300 ml/hr
What is the plasma dose in transfusion
10-15ml/kg
What is the cryoprecipitate dose in transfusion
1-2 units /10kg
What is done Post blood transfusion
Documentation of the transfusion event should be made in the patient’s medical record
Documentation of the transfusion event should be made in the patient’s medical record, these details include:
The medical request for the transfusion Recipient’s signed consent form The transfusion tag/compatibility label Date and time of transfusion Pre- and post-Transfusion vital signs Any adverse events related to the blood transfusion The clinical response to the transfusion
