TDOC

Question 1

Name clinical indications for blood transfusion

Answer 1

Acute blood loss (esp >1.5L in an adult)
Symptomatic anaemia with no reversible cause
Long term transfusion dependent anaemia
Radiotherapy pts (Hb <100)
Chemotherapy pts (Hb <90)

Question 2

Name the UK independent, professionally-led haemovigilance scheme

Answer 2

SHOT - collects and analyses anonymised information on adverse events and reactions in blood transfusion

Question 3

Name errors that are known to occur

Answer 3

• Patient has blood sample taken which is intended for another patient as a result of failure to identify
• Failure in communication
• Patient is given the wrong treatment as a result of failure to positively identify them correctly whilst obtaining a blood sample

Question 4

What is sample validity according to BCSH?

Answer 4

at least 2 separate samples must be processed pre transfusion prior to release of blood components.

MUST be from 2 distince phlebotomy episodes, not 2 samples taken and labelled at the same time.

to avoid wrong blood in tube incidents where sample has not been taken from patient it is labelled for

signif reduces risk of an ABO complication

Question 5

NAme some complications and adverse effects that may occur?

Answer 5

Acute haemolytic reaction

anaphylaxis

Transfusion related acute lung injury (TRALI)

Hon-haemolytic reaction

allergic reaction

fluid overload

Question 6

how would you manage Acute Haemolytic Reaction

Answer 6

stop transfusion

check identity of patient and label on unit.

inform haematologis.

Send unit + FBC, U&E, clotting, cultures and urine to lab.

Treat DIC

Question 7

how would you manage anaphylaxis?

Answer 7

stop transfusion.

maintain airway, O2

contact anaesthetist

IV fluids

adrenaline/chorpheniramine/hydrocortisone

Question 8

how would you manage Transfusion Related Acute Lung Injury?

Answer 8

Stop transfusion

Give 100% O2, treat as ARDS

donor should be removed from donor panel

Question 9

how would you manage non-haemolytic reaction

Answer 9

Slow or Stop transfusion.

give paracetamol.

monitor - no improvement then get senior help

Question 10

how would you manage allergic reaction?

Answer 10

Slow or stop transfusion

give chlorpheniramine and monitor closely

Question 11

how would you manage fluid overload?

Answer 11

Slow or stop transfusion

give 100% O2 + a diuretic (furosemids 40mg IV), monitor

Question 12

Consent

Answer 12

verbal and written consent when patient has capacity

valid consent for actual or potential blood transfusion should be obtained and documented in the patient’s records

Question 13

SABTO (safety of blood, tissues and organs) made the following recommendations to DoH…?

Answer 13

• There should be a standardised info resource for clinicians listing key issues to be discussed when obtaining valid consent from a patient for a blood transfusion
• Patients who have received a blood transfusion in their best interests and who were not able to give valid consent prior to transfusion should be provided with info retrospectively

Question 14

Patient ID

Answer 14

must be positively identified at ALL times, no exceptions.

Question 15

What are the minimum requirements on blood specimens (sample tube)?

Answer 15

Patient Surname + first name 
DOB
Hospital number
Gender
Collector's details
date + time specimen taken

Question 16

prescription time and cannula size?

Answer 16

For elective transfusions- blood must be prescribed over 3hrs 30mins or less

All blood components must be slowly infused through small bore cannula or butterfly needles e.g. 20G pink

For rapid infusion, large bore cannula e.g. 14G orange or 16G grey

Question 17

Patient monitoring during transfusion, what vital signs must be monitored and when?

Answer 17

15mins prior to transfusion of each unit of blood

15 mins following transfusion start time

on completion of infusion of each unit of blood

must measure: temp, pulse, resp rate, blood pressure

Question 18

what are the symptoms patient should be told to report during transfusion?

Answer 18

• Feeling unwell in any way
• Flushing, feeling hot & bothered
• Rash
• Shivering or agitation
• Pain at cannula site
• Shortness of breath
• Acute diarrhoea or vomitting
• passing red urine
• severe pain esp loin/lower back, abdo or chest

Question 19

Explain the transfusion procedure?

Answer 19

All staff involved MUST have received inhouse training before becoming involved.

• Confirm blood has been prescribed and written consent has been gained.
• If patient cannot give valid consent, consultant must act in BI
• Ensure pt has received a blood transfusion information leaflet
• Ensure obs are done 15 mins before commencing
• Check cannula is secure and patent before collecting blood from blood bank. Ensure sterile dressing and no signs of infection
• Only remove one unit of blood at a time from the blood bank
• In the clinical area, blood MUST be checked against the black cross match slip. Check compatibility tag and unit of blood to be infused against the black cross match slip.

Ensure the following correspond:
-Pt Name, DOB, Hosp no, gender, pt blood group, donor blood group, blood unit no., expiry date

• Check integrity and content of the bag of blood - expiry date, integrity of the pack, discolouration or clouding, presence of clots or any foreign particles, integrity of all ports
• Final identity check must be done next to the patient by matching the blood pack with patient’s wristband, by 2 qualified employees (wristband + verbal + blood pack)