Safe Transfusion Practice Flashcards
What is the BSQR Act (2005)?
Blood Safety and Quality Regulations Act
- sets standards for quality and safety of human blood and blood components
- includes training, administration, traceability requirements and notification of adverse reactions and events
- governed by the Medical Health Care Regulatory Agency (MHRA)
- must comply with act 100% of time
Patient Blood Management (PBM) is an evidence based multidisciplinary approach to optimising the care of patients who may need a blood transfusion. What does it include?
Patient and staff education
Active management of anaemia
Minimise the volume of blood samples taken
Use restrictive thresholds
One unit transfusion in non bleeding patients then reassess
Active management of abnormal haemostasis
Use alternatives to transfusion where appropriate
Surgical patients: detect and treat anaemia pre op, be aware of drug interactions that increase anaemia risk
Transfusion incidents and reactions are reported to what 2 external agencies?
MHRA/SABRE - legal reporting system
SHOT - voluntary BUT required by CQC/NHSLA
What is a never event?
Transfusion of ABO incompatible blood components
What is the most common cause of death and major morbidity (with regards to transfusions)?
Transfusion associated circulatory overload (TACO)
What were the highlights of the SHOT report 2016?
Human factor played a part in 87% of reports to SHOT
TACO = most common cause of death
Number of reports of delayed transfusion has increased
Missed specific requirements (irradiated blood products, CMV neg) continues to be leading cause of patients not receiving the correct components
What are the indications for gamma irradiated blood components?
Patients treated with certain chemotherapy drugs e.g Alemtuzumab, Bendamustine, Fludarabine
Hodgkin’s disease - indefinitely from time of diagnosis
Intrauterine transfusions
What do irradiated blood products reduce the risk of?
Graft vs host disease in at risk population
- destroys any T lymphocytes remaining in donated blood
What are the indications for CMV seronegative blood components?
All pregnant mothers until establish labour
Intrauterine transfusion
Neonates
What are the indications for HLA- matched platelets?
If patient has poor response to 2 or more platelet transfusions
What are the indications for HbS negative RBCs?
Patients with sickle cell disease
Infants up to 1 year of age
Where CMV status is unknown what should you assume?
The patient is CMV neg
What is the irradiation indicator on the RADTAG labels?
If central dot white = not irradiated
If central dot blue = irradiated
What does a group and save determine?
Patient’s blood group and rhesus status
Screens for atypical antibodies
How long is a group and save valid for?
Maximum of 3 days
How long does a group and save take?
Approximately 40 minutes
Is blood issued with a group and save?
No
It is done if blood loss not anticipated, but maybe required if loss more than expected
How many group and save samples are needed?
2 separate group and save results required before blood can be issued.
G&S sample 1 - results can be used from past 10 years
G&S sample 2 - must be current (max 3 days)
What should you do if you are unsure if you need to take 1 or 2 samples from patient for G&S?
Phone/ bleep blood bank
What is a crossmatch?
Physically mixing patient’s blood with donor’s blood to see if immune reaction occurs
In general should second sample for GandS be taken at same or different time as first?
Different time
BUT in life threatening emergency (major haemorrhage) two samples may be drawn from same venepuncture provided: two trained and competent members or staff independently positively identify patient, witness the blood drawn and independently label and sign the sample and request forms
The decision to transfuse should be based on…
Careful assessment of patient’s clinical state and must be justified as essential to prevent major morbidity and mortality
What general principles should prescribing clinicians follow when deciding to transfuse?
Consider all alternatives before prescribing blood products
Discuss risk and benefits
Provide written patient information leaflets
Document consent on prescription or in medical notes
Inform patient they can no longer be blood donor
All patients should be assessed for their risk of TACO. This should include…
Consideration of their weight Review med history (especially cardiac and respiratory) Review of fluid balance Consider infusion rates Consider need for diuretics Consider one unit transfusions Review of patient in between units Add to fluid balance chart
This assessment should be documented in patient notes
What falls under cardiac part of TACO checklist?
Does patient have diagnosis of HF, severe AS or moderate to severe LVD?
Is the patient on a regular diuretic?
What fall under the respiratory part of TACO assessment?
Is the patient known to have pulmonary oedema?
Doe the patient have respiratory symptoms of undiagnosed cause?
What fall under the fluid part of TACO assessment?
Is the fluid balance clinically significantly positive?
Is the patient on concomitant fluids or have they in past 24 hours?
Is there peripheral oedema?
If the answer is yes to any of the 3 main TACO criteria, what should be done?
Review the need for transfusion - do benefits outweighed risk?
Can the transfusion be safely deferred until the issue can be investigated, treated or resolved?
Consider body weight dosing for red cells especially if low body weight
Transfusion one unit and review symptoms
Measure fluid balance
Consider prophylactic diuretic
Monitor vital signs closely, including O2 sats
Each unit transfused is an independent clinical decision. True or false?
True
Need to clinically re assess your patient after each unit is transfused - is patient still symptomatic, is further transfusion appropriate?
Should you only order one unit at a time for non bleeding patients?
Yes
Most near miss incorrect blood component transfused were due to what? (SHOT 2017)
Wrong blood in tube errors
What measures should be taken to avoid sampling errors?
The person who takes the blood must positively identify the patient by checking the wrist band and wherever possible speak to the patient
Blood sample tubes must be clearly labelled with patient full name, hospital number/NHS number, DOB, date and time sample taken and signed by person taking blood
One patient should be bled at a time and tubes should be labelled after they are filled with blood at patient bedside
No discrepancies allowed between info on request form and on tubes
What is on the request form?
ID of patient Blood group if known Previous transfusions Antibodies if known Reason for request and which components How much, when is it needed and where Special requirements Operation date and type Consultant - samples not accepted without this
When collecting emergency blood, do you need any documentation?
No
Speak to blood bank before you take it as may not be suitable for everybody - they need patient name and hospital number
Must be scanned out from fridge
What should you know when collecting emergency blood?
Whether you need emergency O neg or emergency O positive blood
If I doubt take the emergency O negative
When are the critical points for patient ID in the transfusion process?
Patient admission and identity band application
Taking blood sample and labelling at patients bedside
Collection of correct blood product from storage fridge
Pre administration checks at patient bedside
What is the administration procedure?
1) prepare all equipment
2) two qualified members of staff check the compatibility/traceability label with the blood bag label and the pathology report form
3) both staff sign the pathology report form when checks completed
4) check transfusion prescription chart against blood products
5) check to patient’s: first name, surname, DOB, hospital number match the patient details on the blood product
6) ask patient to tell you their: full name and DOB, check against patient ID wristband
7) both staff sign prescription chart to confirm checks have been performed at patient bedside
What should be done with traceability label?
Must be retained on ward for collection
Must not be torn in half
Must be completed, this includes emergency blood
This is a legal requirement (records have to be kept for 30 years)
Can patients refuse blood products?
If they have filled out an advanced decision to refuse specified medical treatment.
For any adult patient refusing blood/blood products that has capacity to make decisions but does not have an advanced directive, they have to fill out refusal of blood products - consent form 5
When reporting severe transfusion reactions, what should you do?
Send to lab: Remains of donation unit Repeat Gand save samples FBC, clotting and chemistry First urine sample post reaction Blood culture if considering sepsis Complete transfusion reaction form Complete Datix incident report
Can night time transfusions occur?
Where there is clear indication and as long as night staffing is sufficient to permit transfusion according to required standard e.g
- adequate pre transfusion assessment
- observations are 15 mins after start of each component
- regular visual observations throughout
- education and competency
