Blood Transfusion

No blood transfusion should be undertaken without careful consideration of the possible risks against the possible benefits to patient outcome. If a decision to proceed with a transfusion is made then the greatest care must be taken at every stage to safeguard the patient. The reason for transfusion must be clearly documented, the associated risks and benefits discussed with the patient and patient informed verbal consent documented. Clerical (human) errors remain the commonest cause of major transfusion incidents. Transfusion reactions of various sorts, transfusion transmitted infection and circulatory overload can all represent serious risks (see Serious Hazards of Transfusion (SHOT) reports).

It is a legal requirement that everyone involved in the transfusion process has been trained and assessed to be competent for the role they perform. Clinical staff must hold a valid WAHT licence.

For blood to be cross matched:

• We must receive two validated group and screen samples (one sample can be an historic ICE record)
• The blood groups must match
• Unconscious trauma patients admitted via A&E are the only exception

We operate a zero tolerance policy for incorrect sample labelling. Amending or adding details to samples is prohibited.

All samples must be:

• legibly handwritten
• have 4 identifiers:

1. first name
2. surname
3. NHS number
4. date of birth

• labelled by the person taking the blood who must also sign, date and time the sample
• labelled next to the patient immediately after being taken

All group and screen samples from patients over 4 months old are valid for 72 hours.

Placenta praevia patient samples can be kept for 7 days but the immunisation risk must be assessed by the clinical team.

A&E number will only be accepted on unidentifiable, eg unconscious patients. All other A&E patients must be identified by their hospital number which is available on Oasis.

Blood transfusion request forms must:

• show identical patient identification details to the sample
• show date and time the sample was collected
• be signed by the person who took the blood, including their licence number (this is a legal requirement)
• indicate if components/products are required, and if so the quantity needed
• show date components/products are required
• the reason for the request
• state special requirements such as irradiated blood
• state any previous transfusions

At least 24 hours notice should be given for all non-urgent requests. This is to allow time to investigate any unusual serological findings such as the presence of antibodies.

For patients who require blood urgently (within 1 hour) you MUST contact the blood transfusion laboratory by telephone and give the details of the patient, what you want and how you soon you need it.

Uncross-matched O Rh D negative (Flying Squad) blood is available on all hospital sites.

The decisions to use this must be based on the patient's clinical needs and because it is not risk free, the responsibility for its use rests with the clinician transfusing it.

• Ensure that a blood sample has been taken and sent to the blood transfusion laboratory for grouping and cross-matching before transfusing the O Rh D negative.

• Let the blood transfusion laboratory know you are using the flying squad so it can be replaced
• Group specific units are preferable to the use of O Rh D negative units and these will be issued if the patient group is known.
• Urgent samples must not be sent in the air-tube.