Blood transfusion

A full acute blood transfusion service is provided from both the Alexandra and Worcestershire Royal hospitals with a blood issue fridge at Kidderminster.

The antenatal blood group serology screening service is provided at Worcestershire Royal Hospital with sample referral to NHS Blood and Transplant if required.

Who’s who and contact details

Position/role	Person/team	Contact details
Consultant Lead for Blood Transfusion	Dr S Hebballi	Secretary x 42028 01527 503030
Laboratory Manager / Head BMS – Blood Transfusion	Camran Khan	x 30632 DDI 01905 760639
Laboratory Enquiries – WRH		x 30635 DDI 01905 760769 Out of hours Bleep 848 / radiopage via switchboard
Laboratory Enquiries – Alex		x 44719 DDI 01527 512179 Out of hours Bleep 0255 / page via switchboard Blood porter Bleep 0208
Transfusion Practitioners	Laura Walters Morissa Bradnick	x 30633 [email protected]

Laboratory locations and opening hours

Address	Opening hours
River level Worcestershire Royal Hospital Charles Hastings Way Worcester WR5 1DD	Core hours Monday – Friday: 8.00am – 8.00pm  Weekends and Bank Holidays: 8.00 am- 8.00pm  Emergency out of hours  Monday – Friday: 8.00pm – 8.00am  Weekends and Bank Holidays: 8.00pm – 8.00am
Alexandra Hospital Woodrow Drive Redditch Worcestershire B98 7UB	Core hours Monday – Friday: 8.00am – 8.00pm  Weekends and Bank Holidays: 8.00 am- 8.00pm Emergency out of hours  Monday – Friday: 8.00pm – 8.00am  Weekends and Bank Holidays: 8.00pm – 8.00am

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.

Blood transfusion requests

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

Sample labelling

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

Samples taken in the community 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.

Samples taken at Worcester Royal/ Kidderminster Treatment Centre/ Alexandra Hospital Redditch MUST be taken through the Blood Tracking System PDA’s

For Blood Track PDA Training please contact Transfusion Practitioners

Two sample policy

The laboratories at WRH and the Alex operate a two sample policy to reduce the potential for incompatible blood transfusion due to wrong blood in tube incidents. Two samples, taken at separate times by two separate licensed persons are required to be processed before any group dependent blood products (i.e. red cells, platelets, plasma) can be issued. This can be a historical sample plus a fresh sample or two fresh samples provided they meet the rules above – namely being taken at separate times by two separate licensed persons. If two samples for the same patient are received in the laboratory together and have been taken by the same person (regardless of the time elapsed between sampling) one sample will be rejected and the requestor informed.

If the sample and request card fails to meet the any of the acceptance criteria, the request is rejected and the requestor informed.

Amendments to samples and request cards are not permitted under any circumstances.

Sample validity

Samples from patients that have been pregnant within the preceding 3 months or are currently pregnant are valid for 72 hours.  

Samples from patients that have been transfused within the last 3 months are valid for 72 hours.

All other group and screen samples from patients over 4 months old are valid for 7 days.

A&E numbers

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

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

Timing of transfusion requests

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.

Blood required in an emergency

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 Emergency Blood.
• 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 and should be conveyed by hand.

Non-Urgent	At least 24 hours notice. This allows time to investigate any unusual serology. This also applies to group and screen requests and cross matching of blood.
Emergency (less than 15 mins)	Emergency uncross matched O negative (Flying Squad) is available on all hospital sites for unidentified patients and patients who have no historical group. Group specific units will be provided for patients with historical group. This will be cross matched retrospectively. Group specific and retrospective cross matching is a better product for the patient. Decision to use must be based on clinical need as it is not risk free. The responsibility rests with the clinician transfusing it. Ensure a blood sample has been sent to the blood transfusion laboratory for grouping and cross matching before transfusing the O negative. Let the laboratory know you are using it so it can be replaced.
Urgent (15 mins – 1 hours)	Patients who are eligible for electronic issue can have blood provided in 15 minutes. For patients who have antibodies or modified groups due to bone marrow transplant fully cross matched blood can be provided in around 45 mins if required. This relies on a valid sample being immediately sent to the blood transfusion laboratory and typed donation unit being on site. Do not use this system for patients with chronic bleeds or chronic anaemia.

Availability of Blood for Patients with Blood Group Antibodies / Special Requirements

For the majority of patients, who have no Blood Group Antibodies and no history of Blood Group Antibodies, Blood can be made available within a few minutes after completing the Antibody Screen using a process called Electronic Issue.

Antibody Screening can take around 30-40 minutes when performed urgently.

Patients who have a current and / or historical Blood Group Antibody present more of a challenge and require extensive testing

• We are required to complete Group and Antibody screen and follow that up with a full antibody panel investigation which can take 1.5 hrs to complete and identify the antibody
• We are required to perform a serological crossmatch, which involves incubating the patient plasma against donor red cells. This process takes around 30 minutes to complete after the initial investigation outlined above
• The Blood may be required to be Negative for the Antigen that corresponds to the patient’s Antibody, to prevent a Haemolytic Transfusion Reaction. This blood may or may not be on site in our Blood Stocks. If we don’t have the Blood in Stock in will need to be ordered in from the NHSBT in Birmingham which can take 2 – 4 hours

There are other Blood Group Antibodies not listed here that can also cause further delays, in some cases the patient sample may need to be sent away to the NHSBT Reference laboratory in Birmingham. They can perform some advance testing and provide the Blood. This process can take around 6 – 8 hours.

In cases where Blood is required more urgently, we can provide ABO matched non crossmatched blood but a patient reaction to challenging or unresolved Blood Group Antibodies is still a very real possibility.

Blood Group Antibody	Blood kept on Site ?
Anti D, Anti C, Anti E, Anti K	Yes
Anti Cw, Anti Kp(a), Anti Le(a), Anti Le(b) Anti Lu(a), Anti N	Yes
Anti c, Anti e, Anti Fy(a) Anti Fy(b) Anti M, Anti S Anti s, Anti Jk(a), Anti Jk(b)	Likely to require ordering from NHSBT Birmingham
All other Antibodies  Combinations of above Unresolved Antibodies or patients on Daratumumab/Isotuximab	May require referral to NHSBT
Special Requirements : IRRADIATED CMV NEGATIVE	Available at Worcester, will require ordering in at Alexandra