module 2: request for blood and blood components transfusion training workshop kkm 2012
TRANSCRIPT
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Module 2: Request for blood and blood components
Transfusion Training WorkshopKKM 2012
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Case 1
24 year-old lady
Problem: underbite
Scheduled for orthognathic surgery
Hb is 11.7 g/dL
Packed red cells are requested
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What would you request?
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Group, Screen and Hold (GSH) Group:
ABO, Rh grouping
Screen:
antibody screen and identification
Hold:
hold the sample for 48h
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How to make a request for GSH Inform patient the possibility of a
transfusion Fill in request form Confirm patient’s identity Take blood sample Label sample at bedside
NEVER use pre-printed labels NEVER pre-label tubes
Send sample and request form to BB
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Form: Complete Information COMPLETE INFORMATION
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Case 2
55 year-old man, chronic smoker c/o swelling R buccal mucosa & R neck x 2
months HPE: squamous cell carcinoma Planned for surgery Hb is 12.5 g/dL Packed cells are requested
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What would you request?
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Group cross-match (GXM)
Group: ABO, Rh grouping
Screen: antibody screen and identification
Cross-match: Immediate spin/ RT LISS 370C AHG
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How to make a request for GXM
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Making a request for GXM
Inform patient the likelihood of a transfusion Fill in request form Confirm patient’s identity Take blood sample Label sample at bedside
NEVER use pre-printed labels NEVER pre-label tubes
Send sample and request form to BB Collect blood with blood collection slip and blood
box
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Blood collection slip
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GXM vs. GSH
GSH Blood is not
prepared for patient ONLY the sample is
processed BUT can easily
convert to GXM if required
GXM Blood is prepared for
patient Sample is cross-
matched with donor red cells
BUT this increases workload
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Case 3
En SY, 56 year-old man
Presented to A&E with torrential per-rectal bleeding
O/E: Pale+++ PR: 120 BP: 106/60
Packed cells are requested
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What would you request?
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Emergency Cross-match
Send sample + request form a.s.a.p
Discuss with blood bank MO on call
Doctor or staff to standby at BB with an ice box
Verify blood upon release
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Form: Complete Information COMPLETE INFORMATION
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Case 4
21 year-old lady
Post-stem cell transplant for acute myeloid leukaemia
Platelet count is 10 x 109/L
Platelet concentrates are requested
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Request for platelets
Discuss the case with the blood bank MO on call
Once approved, send request form
NO BLOOD SAMPLE required if blood group is known and in BB records
Collection slip will be issued once platelets are ready
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Form: Complete Information COMPLETE INFORMATION
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Case 5
56 year-old lady
Admitted to ICU for necrotising fascitis of left leg
Prepared for amputation of left leg
Coagulation profile was deranged
Fresh frozen plasma was requested
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Request for fresh frozen plasma Discuss with Blood Bank MO on call
Once approved, send request form
NO BLOOD SAMPLE required if blood group is known and in BB records
Thawing of plasma takes 30 minutes
Collection slip issued once plasma is ready
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Form: Complete Information COMPLETE INFORMATION
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Case 6
26 year-old lady
Elective LSCS for transverse lie
Group B, D negative
GXM 2 units PRBC
Requested for PRBC to be in OT
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Case 7
45 year-old lady
Long-term anticoagulation for recurrent DVT
Admitted for elective knee arthroscopy
Warfarin stopped 5 days
INR 1.6 on day before surgery
2 units FFP requested
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Case 6 – cont’d
LSCS uneventful
PRBC returned
Was GXM necessary?
Why bring PRBCs to OT when it takes only 20 minutes to convert GSH to GXM?
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Case 7 – cont’d
FFP brought to OT
INR 1.3 on day of surgery
Arthroscopy went well
FFP transfused anyway after procedure
Reason: need to write explanation letter to BB
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Returning unused blood
Best practice is NOT to remove blood/ components from BB until needed
Packed red cells, whole blood are stored in blood refrigerators at 4±2°C
Domestic refrigerators are not meant for blood
Plasma products (FFP, CryoP) are kept frozen and thawed ONLY upon request
Once thawed, they cannot be frozen again
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Returning unused blood
However, DO NOT TRANSFUSE if deemed UNNECESSARY
Best to return than to transfuse inappropriately
If returned: Place PRBC, WB and FFP in blood box with ice Return platelets in blood box without ice Fill in ‘borang pemulangan darah’ or brief
explanation letter (memo)
Blood bank WILL NOT reprimand you
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Returning unused blood/ blood components
Call & inform BB
Complete ‘ borang pemulangan darah’ or write a memo
Return blood/ components in separate plastic bags with ‘borang pemulangan darah/ memo’
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Memo
Name of patient and AM no.
Type of blood/ component
Blood bag no.
Reason/s for returning the blood/ component
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Return of Used blood BagProper return of blood components
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Improper return of used blood
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The next time you decide to transfuse
Stop, think and ask yourself …
Is it really necessary?
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Be aware of the risks of transfusion and the morbidity/ mortality associated with it! Febrile/ non-febrile transfusion
reactions
Wrong blood
Bacteremia
Transfusion-related acute lung injury (TRALI)
Transfusion-transmitted infections (TTI)
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The end