1

Clinical

Use of Blood and Blood Components Policy

Policy Manager Dr Catriona Connelly Eleanor Hazra

Policy Group Hospital Transfusion Committee

Policy Established

Policy Review PeriodExpiry October 2014

Last Updated

September 2013

UNCONTROLLED WHEN PRINTED

Item 613 Appendix

2

Version Control

Version Number

PurposeChange Author Date

10

Version Control was introduced in July 2011 and the previous versions of this policy prior to this date are available in the Electronic Document Store

Catriona Connelly Eleanor Hazra

August 2011

20 Changes made following review of principal policy areas bull Amendment to Appendix 2 NHS Tayside Maximum Blood 0rdering Schedule(MSBOS) bull Amendment to Appendix 3a Transfusion Reaction Flowchart

bull Removal of Six Step Guide

Dr Catriona Connolly Eleanor Hazra

September 2013

3

CONTENTS 1 PURPOSE AND SCOPE

2 STATEMENT OF POLICY 3 RESPONSIBILITIES 4 ORGANISATIONAL ARRANGEMENTS 5 PROCEDURAL GUIDANCE amp MANAGEMENT RISK 6 KEY CONTACTS amp LINKS TO LABORATORY USER HANDBOO KS 7 REFERENCES amp OTHER USEFUL LINKS 8 APPENDICES Appendix 1 NHS Tayside Adult Transfusion guideline

Appendix 2

Ninewells Hospital amp Perth Royal Infirmary Maximum Surgical Blood Ordering Schedule (MSBOS) Appendix 3a Flow-chart for management of a transfusion reaction

Appendix 3b Procedural document for management of a transfusion reaction

Appendix 4 UK Blood Safety and Quality Regulations (2005)

Appendix 5a Jehovah Witness Consent

Appendix 5b Decision to Transfuse

Appendix 6 Requesting Transfusion Support

Appendix 7 Authorisation ndash Prescription of Transfusion Support

Appendix 8 Taking the Blood Sample

Appendix 9 Collection and Delivery of Blood and Blood Components

Appendix 10 Administration of Red Cells Appendix 11

Administration of other Blood Components FFP Cryoprecipitate Platelets PCC and Anti-D

Appendix 12 Other Components available from ESBTC Transfusion Laboratory Ninewells

4

Appendix 13 Monitoring during a Transfusion of Blood or Blood Components

Appendix 14 Paediatric - Neonatal considerations

Appendix 15 SBAR posters for Emergency Obstetric and Neonatal Transfusion Support

Appendix 15a - Mother Appendix 15b ndash Baby Appendix 16 Transfusion Record Document v 04 9 RAPID IMPACT CHECKLIST

5

1 PURPOSE AND SCOPE

11 This policy has been developed in response to the identified need to raise awareness in the management of patients receiving blood components or blood products Blood transfusion by definition is the introduction of prepared compatible donor blood components or blood products into the circulation of a recipient patient

12 Since 2005 all blood components have been excluded from the UK Medicines Act (1968) and therefore supplied as unlicensed non-medicinal products The term ldquoauthorisationrdquo rather than ldquoprescriptionrdquo should be used

13 It is imperative that any member of staff involved in the transfusion process adheres to this policy in particular

bull Phlebotomy staff who have a critical duty to carry out required identity checks before taking blood

transfusion samples from the patient bull Nursing and Midwifery staff who have a critical duty to carry out required checks before taking

blood transfusion samples collection and delivery of blood components administering the component and observation of the patient during and after the transfusion

bull Portering staff who are involved the safe collection and transport of blood components

bull Medical staff and advanced neonatal nurse practitioners who have undergone appropriate training who assess the patient take blood transfusion samples authorise and order transfusion support

2 STATEMENT OF POLICY 21 The aim of the policy is to ensure the correct componentproduct is given at the correct time in

the appropriate way to the correct patient

22 Any member of staff involved in the transfusion process should be conversant with the sections of this document that pertain to their role and have access to appropriate education training and support in its implementation NHS Quality Improvement Scotland Blood Transfusion Standards (2006) recommend that only staff who have completed an appropriate education programme appropriate to their role can participate in the transfusion process

23 The administration of blood and blood components must only be carried out by suitably trained practitioners Only staff that have completed transfusion training can collect and deliver blood transfusion products and components

This policy should be read in conjunction with the following documents (Please click on the links below to access)

bull British Committee for Standards in Haematology(BCSH) Guideline on the Administration of Blood Components (2009)

httpwwwbcshguidelinescomdocumentsAdmin_blood_components_bcsh_05012010pdf

bull National Health Service Quality Improvement Scotland (2006) Clinical Standards for Blood Transfusion httpwwwhealthcareimprovementscotlandorgprevious_resourcesstandardsblood_transfusion aspx

bull NHS Tayside Establishing Patient Identity Policy

httpedstaysidescotnhsukNHSTaysideDocsgroupscorporatedocumentsdocumentsprod_162299pdf

bull NHS Tayside Informed Consent Policy

httpedstaysidescotnhsukNHSTaysideDocsgroupsworking_safelydocumentsdocumentsdocs_016304pdf

2

Version Control

Version Number

PurposeChange Author Date

10

Version Control was introduced in July 2011 and the previous versions of this policy prior to this date are available in the Electronic Document Store

Catriona Connelly Eleanor Hazra

August 2011

20 Changes made following review of principal policy areas bull Amendment to Appendix 2 NHS Tayside Maximum Blood 0rdering Schedule(MSBOS) bull Amendment to Appendix 3a Transfusion Reaction Flowchart

bull Removal of Six Step Guide

Dr Catriona Connolly Eleanor Hazra

September 2013

3

CONTENTS 1 PURPOSE AND SCOPE

2 STATEMENT OF POLICY 3 RESPONSIBILITIES 4 ORGANISATIONAL ARRANGEMENTS 5 PROCEDURAL GUIDANCE amp MANAGEMENT RISK 6 KEY CONTACTS amp LINKS TO LABORATORY USER HANDBOO KS 7 REFERENCES amp OTHER USEFUL LINKS 8 APPENDICES Appendix 1 NHS Tayside Adult Transfusion guideline

Appendix 2

Ninewells Hospital amp Perth Royal Infirmary Maximum Surgical Blood Ordering Schedule (MSBOS) Appendix 3a Flow-chart for management of a transfusion reaction

Appendix 3b Procedural document for management of a transfusion reaction

Appendix 4 UK Blood Safety and Quality Regulations (2005)

Appendix 5a Jehovah Witness Consent

Appendix 5b Decision to Transfuse

Appendix 6 Requesting Transfusion Support

Appendix 7 Authorisation ndash Prescription of Transfusion Support

Appendix 8 Taking the Blood Sample

Appendix 9 Collection and Delivery of Blood and Blood Components

Appendix 10 Administration of Red Cells Appendix 11

Administration of other Blood Components FFP Cryoprecipitate Platelets PCC and Anti-D

Appendix 12 Other Components available from ESBTC Transfusion Laboratory Ninewells

4

Appendix 13 Monitoring during a Transfusion of Blood or Blood Components

Appendix 14 Paediatric - Neonatal considerations

Appendix 15 SBAR posters for Emergency Obstetric and Neonatal Transfusion Support

Appendix 15a - Mother Appendix 15b ndash Baby Appendix 16 Transfusion Record Document v 04 9 RAPID IMPACT CHECKLIST

5

1 PURPOSE AND SCOPE

11 This policy has been developed in response to the identified need to raise awareness in the management of patients receiving blood components or blood products Blood transfusion by definition is the introduction of prepared compatible donor blood components or blood products into the circulation of a recipient patient

12 Since 2005 all blood components have been excluded from the UK Medicines Act (1968) and therefore supplied as unlicensed non-medicinal products The term ldquoauthorisationrdquo rather than ldquoprescriptionrdquo should be used

13 It is imperative that any member of staff involved in the transfusion process adheres to this policy in particular

bull Phlebotomy staff who have a critical duty to carry out required identity checks before taking blood

transfusion samples from the patient bull Nursing and Midwifery staff who have a critical duty to carry out required checks before taking

blood transfusion samples collection and delivery of blood components administering the component and observation of the patient during and after the transfusion

bull Portering staff who are involved the safe collection and transport of blood components

bull Medical staff and advanced neonatal nurse practitioners who have undergone appropriate training who assess the patient take blood transfusion samples authorise and order transfusion support

2 STATEMENT OF POLICY 21 The aim of the policy is to ensure the correct componentproduct is given at the correct time in

the appropriate way to the correct patient

22 Any member of staff involved in the transfusion process should be conversant with the sections of this document that pertain to their role and have access to appropriate education training and support in its implementation NHS Quality Improvement Scotland Blood Transfusion Standards (2006) recommend that only staff who have completed an appropriate education programme appropriate to their role can participate in the transfusion process

23 The administration of blood and blood components must only be carried out by suitably trained practitioners Only staff that have completed transfusion training can collect and deliver blood transfusion products and components

This policy should be read in conjunction with the following documents (Please click on the links below to access)

bull British Committee for Standards in Haematology(BCSH) Guideline on the Administration of Blood Components (2009)

httpwwwbcshguidelinescomdocumentsAdmin_blood_components_bcsh_05012010pdf

bull National Health Service Quality Improvement Scotland (2006) Clinical Standards for Blood Transfusion httpwwwhealthcareimprovementscotlandorgprevious_resourcesstandardsblood_transfusion aspx

bull NHS Tayside Establishing Patient Identity Policy

httpedstaysidescotnhsukNHSTaysideDocsgroupscorporatedocumentsdocumentsprod_162299pdf

bull NHS Tayside Informed Consent Policy

httpedstaysidescotnhsukNHSTaysideDocsgroupsworking_safelydocumentsdocumentsdocs_016304pdf

3

CONTENTS 1 PURPOSE AND SCOPE

2 STATEMENT OF POLICY 3 RESPONSIBILITIES 4 ORGANISATIONAL ARRANGEMENTS 5 PROCEDURAL GUIDANCE amp MANAGEMENT RISK 6 KEY CONTACTS amp LINKS TO LABORATORY USER HANDBOO KS 7 REFERENCES amp OTHER USEFUL LINKS 8 APPENDICES Appendix 1 NHS Tayside Adult Transfusion guideline

Appendix 2

Ninewells Hospital amp Perth Royal Infirmary Maximum Surgical Blood Ordering Schedule (MSBOS) Appendix 3a Flow-chart for management of a transfusion reaction

Appendix 3b Procedural document for management of a transfusion reaction

Appendix 4 UK Blood Safety and Quality Regulations (2005)

Appendix 5a Jehovah Witness Consent

Appendix 5b Decision to Transfuse

Appendix 6 Requesting Transfusion Support

Appendix 7 Authorisation ndash Prescription of Transfusion Support

Appendix 8 Taking the Blood Sample

Appendix 9 Collection and Delivery of Blood and Blood Components

Appendix 10 Administration of Red Cells Appendix 11

Administration of other Blood Components FFP Cryoprecipitate Platelets PCC and Anti-D

Appendix 12 Other Components available from ESBTC Transfusion Laboratory Ninewells

4

Appendix 13 Monitoring during a Transfusion of Blood or Blood Components

Appendix 14 Paediatric - Neonatal considerations

Appendix 15 SBAR posters for Emergency Obstetric and Neonatal Transfusion Support

Appendix 15a - Mother Appendix 15b ndash Baby Appendix 16 Transfusion Record Document v 04 9 RAPID IMPACT CHECKLIST

5

1 PURPOSE AND SCOPE

11 This policy has been developed in response to the identified need to raise awareness in the management of patients receiving blood components or blood products Blood transfusion by definition is the introduction of prepared compatible donor blood components or blood products into the circulation of a recipient patient

12 Since 2005 all blood components have been excluded from the UK Medicines Act (1968) and therefore supplied as unlicensed non-medicinal products The term ldquoauthorisationrdquo rather than ldquoprescriptionrdquo should be used

13 It is imperative that any member of staff involved in the transfusion process adheres to this policy in particular

bull Phlebotomy staff who have a critical duty to carry out required identity checks before taking blood

transfusion samples from the patient bull Nursing and Midwifery staff who have a critical duty to carry out required checks before taking

blood transfusion samples collection and delivery of blood components administering the component and observation of the patient during and after the transfusion

bull Portering staff who are involved the safe collection and transport of blood components

bull Medical staff and advanced neonatal nurse practitioners who have undergone appropriate training who assess the patient take blood transfusion samples authorise and order transfusion support

2 STATEMENT OF POLICY 21 The aim of the policy is to ensure the correct componentproduct is given at the correct time in

the appropriate way to the correct patient

22 Any member of staff involved in the transfusion process should be conversant with the sections of this document that pertain to their role and have access to appropriate education training and support in its implementation NHS Quality Improvement Scotland Blood Transfusion Standards (2006) recommend that only staff who have completed an appropriate education programme appropriate to their role can participate in the transfusion process

23 The administration of blood and blood components must only be carried out by suitably trained practitioners Only staff that have completed transfusion training can collect and deliver blood transfusion products and components

This policy should be read in conjunction with the following documents (Please click on the links below to access)

bull British Committee for Standards in Haematology(BCSH) Guideline on the Administration of Blood Components (2009)

httpwwwbcshguidelinescomdocumentsAdmin_blood_components_bcsh_05012010pdf

bull National Health Service Quality Improvement Scotland (2006) Clinical Standards for Blood Transfusion httpwwwhealthcareimprovementscotlandorgprevious_resourcesstandardsblood_transfusion aspx

bull NHS Tayside Establishing Patient Identity Policy

httpedstaysidescotnhsukNHSTaysideDocsgroupscorporatedocumentsdocumentsprod_162299pdf

bull NHS Tayside Informed Consent Policy

httpedstaysidescotnhsukNHSTaysideDocsgroupsworking_safelydocumentsdocumentsdocs_016304pdf

4

Appendix 13 Monitoring during a Transfusion of Blood or Blood Components

Appendix 14 Paediatric - Neonatal considerations

Appendix 15 SBAR posters for Emergency Obstetric and Neonatal Transfusion Support

Appendix 15a - Mother Appendix 15b ndash Baby Appendix 16 Transfusion Record Document v 04 9 RAPID IMPACT CHECKLIST

5

1 PURPOSE AND SCOPE

11 This policy has been developed in response to the identified need to raise awareness in the management of patients receiving blood components or blood products Blood transfusion by definition is the introduction of prepared compatible donor blood components or blood products into the circulation of a recipient patient

12 Since 2005 all blood components have been excluded from the UK Medicines Act (1968) and therefore supplied as unlicensed non-medicinal products The term ldquoauthorisationrdquo rather than ldquoprescriptionrdquo should be used

13 It is imperative that any member of staff involved in the transfusion process adheres to this policy in particular

bull Phlebotomy staff who have a critical duty to carry out required identity checks before taking blood

transfusion samples from the patient bull Nursing and Midwifery staff who have a critical duty to carry out required checks before taking

blood transfusion samples collection and delivery of blood components administering the component and observation of the patient during and after the transfusion

bull Portering staff who are involved the safe collection and transport of blood components

bull Medical staff and advanced neonatal nurse practitioners who have undergone appropriate training who assess the patient take blood transfusion samples authorise and order transfusion support

2 STATEMENT OF POLICY 21 The aim of the policy is to ensure the correct componentproduct is given at the correct time in

the appropriate way to the correct patient

22 Any member of staff involved in the transfusion process should be conversant with the sections of this document that pertain to their role and have access to appropriate education training and support in its implementation NHS Quality Improvement Scotland Blood Transfusion Standards (2006) recommend that only staff who have completed an appropriate education programme appropriate to their role can participate in the transfusion process

23 The administration of blood and blood components must only be carried out by suitably trained practitioners Only staff that have completed transfusion training can collect and deliver blood transfusion products and components

This policy should be read in conjunction with the following documents (Please click on the links below to access)

bull British Committee for Standards in Haematology(BCSH) Guideline on the Administration of Blood Components (2009)

httpwwwbcshguidelinescomdocumentsAdmin_blood_components_bcsh_05012010pdf

bull National Health Service Quality Improvement Scotland (2006) Clinical Standards for Blood Transfusion httpwwwhealthcareimprovementscotlandorgprevious_resourcesstandardsblood_transfusion aspx

bull NHS Tayside Establishing Patient Identity Policy

httpedstaysidescotnhsukNHSTaysideDocsgroupscorporatedocumentsdocumentsprod_162299pdf

bull NHS Tayside Informed Consent Policy

httpedstaysidescotnhsukNHSTaysideDocsgroupsworking_safelydocumentsdocumentsdocs_016304pdf

5

1 PURPOSE AND SCOPE

11 This policy has been developed in response to the identified need to raise awareness in the management of patients receiving blood components or blood products Blood transfusion by definition is the introduction of prepared compatible donor blood components or blood products into the circulation of a recipient patient

12 Since 2005 all blood components have been excluded from the UK Medicines Act (1968) and therefore supplied as unlicensed non-medicinal products The term ldquoauthorisationrdquo rather than ldquoprescriptionrdquo should be used

13 It is imperative that any member of staff involved in the transfusion process adheres to this policy in particular

bull Phlebotomy staff who have a critical duty to carry out required identity checks before taking blood

transfusion samples from the patient bull Nursing and Midwifery staff who have a critical duty to carry out required checks before taking

blood transfusion samples collection and delivery of blood components administering the component and observation of the patient during and after the transfusion

bull Portering staff who are involved the safe collection and transport of blood components

bull Medical staff and advanced neonatal nurse practitioners who have undergone appropriate training who assess the patient take blood transfusion samples authorise and order transfusion support

2 STATEMENT OF POLICY 21 The aim of the policy is to ensure the correct componentproduct is given at the correct time in

the appropriate way to the correct patient

22 Any member of staff involved in the transfusion process should be conversant with the sections of this document that pertain to their role and have access to appropriate education training and support in its implementation NHS Quality Improvement Scotland Blood Transfusion Standards (2006) recommend that only staff who have completed an appropriate education programme appropriate to their role can participate in the transfusion process

23 The administration of blood and blood components must only be carried out by suitably trained practitioners Only staff that have completed transfusion training can collect and deliver blood transfusion products and components

This policy should be read in conjunction with the following documents (Please click on the links below to access)

bull British Committee for Standards in Haematology(BCSH) Guideline on the Administration of Blood Components (2009)

httpwwwbcshguidelinescomdocumentsAdmin_blood_components_bcsh_05012010pdf

bull National Health Service Quality Improvement Scotland (2006) Clinical Standards for Blood Transfusion httpwwwhealthcareimprovementscotlandorgprevious_resourcesstandardsblood_transfusion aspx

bull NHS Tayside Establishing Patient Identity Policy

httpedstaysidescotnhsukNHSTaysideDocsgroupscorporatedocumentsdocumentsprod_162299pdf

bull NHS Tayside Informed Consent Policy

httpedstaysidescotnhsukNHSTaysideDocsgroupsworking_safelydocumentsdocumentsdocs_016304pdf

6

3 RESPONSIBILITIES

Indications for Blood Transfusion 31 An infusion of blood components may be given to bull Manage acute blood loss bull Replace a deficiency of specific blood components such as erythrocytes platelets or clotting factors bull Increase the oxygen carrying capacity of the blood The final decision to transfuse rests with the clinician in charge of the patientrsquos care 32 An NHS Tayside Adult Blood Transfusion Guideline (Appendix 1 ) provides guidance on when

blood transfusion is likely to beneficial 33 The Ninewells and PRI Maximum Surgical Blood Ordering Schedule (Appendix 2 ) provides

further guidance on the recommended amount of red cells to order for different surgical procedures

Both of these guidelines are available electronically and copies should be available in all clinical areas Additional copies are available from Transfusion Practitionersthe hospital transfusion laboratory 4 ORGANISATIONAL ARRANGEMENTS

41 Hospital Transfusion Laboratory Contact Information

bull East of Scotland Blood Transfusion Centre Hospital Transfusion Laboratory

Ninewells - Extension 32953 Remit covers all clinical areas medical centres and community hospitals in Dundee and Angus

bull Perth Royal Infirmary Hospital Transfusion Laborato ry

PRI- Extension 13338 or Pager 5122

Remit covers all clinical areas medical centres and community hospitals in Perth and Kinross

42 Blood supply in an emergency situation

Communication with the local Hospital Transfusion Laboratory (HTL) is key to allowing the department to provide the highest standard of care Under normal circumstances red cells are only issued from the Hospital Transfusion laboratory after full compatibility testing However in the presence of a life-threatening situation in which there is insufficient time to complete these tests clinician responsible for the care of the patient may decide that the situation warrants the use of un-cross matched blood

When this occurs it is preferable to give blood of the patients own ABO and Rh D group If the urgency of the situation makes this impossible Group O Rh D negative blood may be used Supplies of un-cross matched group specific or Group O Rh D Negative blood are obtainable from the local Hospital Transfusion Laboratory

In Ninewells Emergency Group O Rh D negative blood is held in

bull Main Theatre Blood Fridge ndash 2 units

7

bull Accident and Emergency Blood Fridge ndash 6 units

bull Transfusion Laboratory Fridges 4 units

In Perth Royal Infirmary Group O Rh D negative bloo d is held in bull Main Theatre Blood Fridge ndash 2 units bull Transfusion Laboratory- 2 units

It is imperative that when these supplies are accessed the Hospital Transfusion Laboratory is informed immediately so that arrangements can be made to replenish stocks

Supplies of Group O Rh D Negative blood for emergen cy use are also available in

bull Arbroath Infirmary Blood Fridge ndash 2 units bull Stracathro Hospital Blood Fridge ndash 4 units bull Fernbrae BMI Hospital Blood Fridge- 2 units

Stracathro Hospital has 4 units of O Rh D negative blood for emergency use for inpatients or theatre cases If the emergency blood is used on a patient in Stracathro then the Hospital Transfusion Laboratory in Ninewells must be informed immediately and elective surgery suspended until replacement emergency blood is in place at the hospital

It must be remembered that when using un-cross matched blood there is an increased risk of a severe haemolytic transfusion reaction as the patient may have antibodies that react with one of the other blood groups Appendix 3a and 3b contain further information about transfusion reactions and their management Appendix 4 is the UK Blood Safety and Quality Regulations guidance on reporting serious adverse events and reactions Massive Haemorrhage Protocol

NHS Tayside Guide to Massive Transfusion Blood Loss httpedstaysidescotnhsukNHSTaysideDocsgroupssnbtsdocumentsdocumentsprod_174661pdf

5 PROCEDURAL GUIDANCE AND MANAGEMENT OF RISK

There are several key considerations when administering blood products or components

bull The patient receives an appropriate and safe transfusion of blood or blood products bull The patients risk of transfusion reactioncomplications is minimised bull Changes in the patients condition are detected at an early stage bull Adverse events are reported to the hospital transfusion laboratory in a timely manner 51 Decision to Transfuse The decision to transfuse must be based on a thorough clinical assessment of the patient and their individual needs A checklist with additional information for doctors gaining consent from Jehovah Witnesses on blood products that they may accept can be found at appendix 5a

7

bull Accident and Emergency Blood Fridge ndash 6 units

bull Transfusion Laboratory Fridges 4 units

In Perth Royal Infirmary Group O Rh D negative bloo d is held in bull Main Theatre Blood Fridge ndash 2 units bull Transfusion Laboratory- 2 units

It is imperative that when these supplies are accessed the Hospital Transfusion Laboratory is informed immediately so that arrangements can be made to replenish stocks

Supplies of Group O Rh D Negative blood for emergen cy use are also available in

bull Arbroath Infirmary Blood Fridge ndash 2 units bull Stracathro Hospital Blood Fridge ndash 4 units bull Fernbrae BMI Hospital Blood Fridge- 2 units

Stracathro Hospital has 4 units of O Rh D negative blood for emergency use for inpatients or theatre cases If the emergency blood is used on a patient in Stracathro then the Hospital Transfusion Laboratory in Ninewells must be informed immediately and elective surgery suspended until replacement emergency blood is in place at the hospital

It must be remembered that when using un-cross matched blood there is an increased risk of a severe haemolytic transfusion reaction as the patient may have antibodies that react with one of the other blood groups Appendix 3a and 3b contain further information about transfusion reactions and their management Appendix 4 is the UK Blood Safety and Quality Regulations guidance on reporting serious adverse events and reactions Massive Haemorrhage Protocol

NHS Tayside Guide to Massive Transfusion Blood Loss httpedstaysidescotnhsukNHSTaysideDocsgroupssnbtsdocumentsdocumentsprod_174661pdf

5 PROCEDURAL GUIDANCE AND MANAGEMENT OF RISK

There are several key considerations when administering blood products or components

bull The patient receives an appropriate and safe transfusion of blood or blood products bull The patients risk of transfusion reactioncomplications is minimised bull Changes in the patients condition are detected at an early stage bull Adverse events are reported to the hospital transfusion laboratory in a timely manner 51 Decision to Transfuse The decision to transfuse must be based on a thorough clinical assessment of the patient and their individual needs A checklist with additional information for doctors gaining consent from Jehovah Witnesses on blood products that they may accept can be found at appendix 5a

8

The decision process leading to transfusion should be documented in the patientrsquos clinical record

Links to guidance on transfusion issues issued by the British Committee for Standards in Haematology (BCSH) can be found in appendix 5b - Procedural document on decision to transfuse 52 Requesting Transfusion Support

The request for transfusion support for patients under the care of NHS Tayside should be in accordance with BCSH guidelines

The procedure for requesting transfusion support can be found in appendix 6 of this document and includes details on consent and documentation availability of patient information leaflets and additional information that is required by the transfusion laboratory before blood is prepared for transfusion

Appendix 6 also contains indications for Irradiated Blood

53 Written authorisation (formerly known as prescr iption) of Transfusion Support

Section130 of the 1968 Medicines Act has been amended by regulation 25 of the Blood Safety and Quality Regulations 2005 (SI 2005 no 50) Blood components are now excluded from the act and the term prescription does not apply as they are not medicinal products the term authorisation should be used

The authorisation must be signed by the responsible clinician or advanced neonatal nurse practitioner It must specify the blood component to be administered the number of units duration and any special requirements or instructions (BCSH 2009) Blood and blood components must always be authorised prescribed prior to commencement of treatment The procedure is outlined in appendix 7

54 Taking the blood sample

The blood sample should be taken in accordance with BCSH guideline on administration of blood components (2009) which takes into account the Blood Safety and Quality Regulations (BSQR (2005) Statutory Instrument 200550 as amended) the National Patient Safety Agency (NPSA) Safer Practice Notices SHOT recommendations and the NHS Quality Improvement Scotland (QIS) 2006 Clinical Standards for Blood Transfusion

Both the East of Scotland Blood Transfusion Centre and Perth Royal Infirmary Blood Transfusion Laboratory have a zero-tolerance policy in place for incorrectly or inadequately labelled sample request forms and sample bottles The procedure for taking a blood sample is detailed in appendix 8

55 Collection and Delivery of Blood and Blood Comp onents Collection and delivery of blood and components must be in accordance with BCSH guideline on administration of blood components (2009)

All staff involved in the collection and delivery of blood components from the storage area to the clinical area should be competency assessed to NPSA SPN 14 (2006) or NHS QIS (2006) and BSQR (SI 2005 No50 as amended) standards The procedure for collecting and delivering blood components is described in appendix 9 56 Administration of Red Cells Blood components must be administered by a registered healthcare professional

9

As a minimum all staff involved in the administration process must have completed Level 1 Safe Transfusion Practice or equivalent (NHS QIS 2006) Staff involved in administration of blood should be competency assessed to NPSA SPN 14 (2006) or NHS QIS (2006) standards (see section 9) Transfusion must only take place when there are enough staff available to monitor the patient and when the patient can be readily observed Overnight transfusions should be avoided unless clinically essential The procedure for administration of red cells is attached in appendix 10 57 Use of Blood Warmers The use of a CE -marked commercial blood warmer may be indicated

a In adults receiving a blood transfusion at a rate greater than 50mlkghour or 100mlmin b In infants undergoing an exchange transfusion c In some cases of severe cold agglutinins disease

The initials CE do not stand for any specific words but are a declaration by the manufacturer that his product meets the requirements of the applicable European Directive(s) Blood warmers must be serviced and used according to the manufacturers instructions The warming of blood by other methods is potentially dangerous and is strictly prohibited

58 Administration of Fresh Frozen Plasma (FFP) FFP should be administered in accordance with BCSH guideline (2004) and amendments (2007) The details of the procedure are contained in appendix 11

59 Administration of Cryoprecipitate Cryoprecipitate should be administered in accordance with BCSH guideline (2004) and amendments (2007) The details of the procedure are contained in appendix 11

510 Administration of Platelets Platelets should be stored and administered in accordance with BCSH guideline on the use of platelet transfusions 2003 The procedure for platelet transfusion is contained in appendix 11 of this document

511 Monitoring All patients must be monitored appropriately throughout transfusion therapy Details of minimum required monitoring for each component transfused is contained in appendix 13

512 Management of Transfusion Reactions

In the event that the patient becomes unwell the transfusion must be stopped and appropriate treatment commenced

Appendix 3a and 3b provide information on the management of transfusion reactions including the procedure of returning the blood to the transfusion laboratory

10

Appendix 4 provides information on the reporting of adverse transfusion incidents reactions

513 PaediatricNeonatal Considerations The procedure for paediatric transfusion in NHS Tayside is outlined in appendix 14 The procedure for emergency neonatal transfusion is attached as appendix 15b Paediatric and neonatal transfusions should be carried out in accordance with BCSH guidance on transfusion for neonates and older children (2004) and the amendments (2005 and 2007) 514 Documentation The NHS Tayside Documentation for Transfusion of Blood Components record should be used for documentation associated with transfusion episodes This is attached as appendix 16

6 KEY CONTACTS

Perth Royal Infirmary Hospital Transfusion Laboratory Extension 13338Pager 5122 Consultant Haematologist Ninewells Hospital Bleep 4798 Laboratory Manager Perth Laboratory Ext 13338 Biomedical Scientist Perth Laboratory Ext 13338 Bleep 5122 Transfusion Practitioner NHS Tayside Ext Bleep 5082 East of Scotland Blood Transfusion Service -Ninewel ls Hospital

Extension 32953 Clinical Director East of Scotland Blood Transfusion Centre Tel ext 74437 Laboratory Manager East of Scotland Blood Transfusion Centre Tel ext 74435 Transfusion Practitioner NHS Tayside Tel ext 74423 or Bleep 5099 Chair Hospital Transfusion Committee Bleep 4864

NHS Tayside - Department of Haematology User Guide 2013 httpedstaysidescotnhsukNHSTaysideDocsgroupsblood_sciencesdocumentsdocumentsstaffnet01_haematologypdf East of Scotland Blood Transfusion Centre Laborato ry Users Handbook httpstaffnettaysidescotnhsukNHSTaysideDocsgroupssnbtsdocumentsdocumentsdocs_017112pdf

9

As a minimum all staff involved in the administration process must have completed Level 1 Safe Transfusion Practice or equivalent (NHS QIS 2006) Staff involved in administration of blood should be competency assessed to NPSA SPN 14 (2006) or NHS QIS (2006) standards (see section 9) Transfusion must only take place when there are enough staff available to monitor the patient and when the patient can be readily observed Overnight transfusions should be avoided unless clinically essential The procedure for administration of red cells is attached in appendix 10 57 Use of Blood Warmers The use of a CE -marked commercial blood warmer may be indicated

a In adults receiving a blood transfusion at a rate greater than 50mlkghour or 100mlmin b In infants undergoing an exchange transfusion c In some cases of severe cold agglutinins disease

The initials CE do not stand for any specific words but are a declaration by the manufacturer that his product meets the requirements of the applicable European Directive(s) Blood warmers must be serviced and used according to the manufacturers instructions The warming of blood by other methods is potentially dangerous and is strictly prohibited

58 Administration of Fresh Frozen Plasma (FFP) FFP should be administered in accordance with BCSH guideline (2004) and amendments (2007) The details of the procedure are contained in appendix 11

59 Administration of Cryoprecipitate Cryoprecipitate should be administered in accordance with BCSH guideline (2004) and amendments (2007) The details of the procedure are contained in appendix 11

510 Administration of Platelets Platelets should be stored and administered in accordance with BCSH guideline on the use of platelet transfusions 2003 The procedure for platelet transfusion is contained in appendix 11 of this document

511 Monitoring All patients must be monitored appropriately throughout transfusion therapy Details of minimum required monitoring for each component transfused is contained in appendix 13

512 Management of Transfusion Reactions

In the event that the patient becomes unwell the transfusion must be stopped and appropriate treatment commenced

Appendix 3a and 3b provide information on the management of transfusion reactions including the procedure of returning the blood to the transfusion laboratory

10

Appendix 4 provides information on the reporting of adverse transfusion incidents reactions

513 PaediatricNeonatal Considerations The procedure for paediatric transfusion in NHS Tayside is outlined in appendix 14 The procedure for emergency neonatal transfusion is attached as appendix 15b Paediatric and neonatal transfusions should be carried out in accordance with BCSH guidance on transfusion for neonates and older children (2004) and the amendments (2005 and 2007) 514 Documentation The NHS Tayside Documentation for Transfusion of Blood Components record should be used for documentation associated with transfusion episodes This is attached as appendix 16

6 KEY CONTACTS

Perth Royal Infirmary Hospital Transfusion Laboratory Extension 13338Pager 5122 Consultant Haematologist Ninewells Hospital Bleep 4798 Laboratory Manager Perth Laboratory Ext 13338 Biomedical Scientist Perth Laboratory Ext 13338 Bleep 5122 Transfusion Practitioner NHS Tayside Ext Bleep 5082 East of Scotland Blood Transfusion Service -Ninewel ls Hospital

Extension 32953 Clinical Director East of Scotland Blood Transfusion Centre Tel ext 74437 Laboratory Manager East of Scotland Blood Transfusion Centre Tel ext 74435 Transfusion Practitioner NHS Tayside Tel ext 74423 or Bleep 5099 Chair Hospital Transfusion Committee Bleep 4864

NHS Tayside - Department of Haematology User Guide 2013 httpedstaysidescotnhsukNHSTaysideDocsgroupsblood_sciencesdocumentsdocumentsstaffnet01_haematologypdf East of Scotland Blood Transfusion Centre Laborato ry Users Handbook httpstaffnettaysidescotnhsukNHSTaysideDocsgroupssnbtsdocumentsdocumentsdocs_017112pdf

10

Appendix 4 provides information on the reporting of adverse transfusion incidents reactions

513 PaediatricNeonatal Considerations The procedure for paediatric transfusion in NHS Tayside is outlined in appendix 14 The procedure for emergency neonatal transfusion is attached as appendix 15b Paediatric and neonatal transfusions should be carried out in accordance with BCSH guidance on transfusion for neonates and older children (2004) and the amendments (2005 and 2007) 514 Documentation The NHS Tayside Documentation for Transfusion of Blood Components record should be used for documentation associated with transfusion episodes This is attached as appendix 16

6 KEY CONTACTS

Perth Royal Infirmary Hospital Transfusion Laboratory Extension 13338Pager 5122 Consultant Haematologist Ninewells Hospital Bleep 4798 Laboratory Manager Perth Laboratory Ext 13338 Biomedical Scientist Perth Laboratory Ext 13338 Bleep 5122 Transfusion Practitioner NHS Tayside Ext Bleep 5082 East of Scotland Blood Transfusion Service -Ninewel ls Hospital

Extension 32953 Clinical Director East of Scotland Blood Transfusion Centre Tel ext 74437 Laboratory Manager East of Scotland Blood Transfusion Centre Tel ext 74435 Transfusion Practitioner NHS Tayside Tel ext 74423 or Bleep 5099 Chair Hospital Transfusion Committee Bleep 4864

NHS Tayside - Department of Haematology User Guide 2013 httpedstaysidescotnhsukNHSTaysideDocsgroupsblood_sciencesdocumentsdocumentsstaffnet01_haematologypdf East of Scotland Blood Transfusion Centre Laborato ry Users Handbook httpstaffnettaysidescotnhsukNHSTaysideDocsgroupssnbtsdocumentsdocumentsdocs_017112pdf

11

7 References and useful links Advisory Committee on the Safety of Blood Tissues and Organs (SaBTO) Report Patient consent for transfusion (2011) httpswwwgovukgovernmentpublicationspatient-consent-for-blood-transfusion Blood Safety and Quality Regulations (BSQR) 2005 Statutory Instrument 200550 (ISBN 0110990412) wwwopsigovuksisi200520050050htm British Committee for Standards in Haematology Blood Transfusion Taskforce (2006) Guidelines for management of massive blood loss The British Journal of Haematology 135 634-641 httponlinelibrarywileycomdoi101111j1365-2141200606355xfull British Committee for Standards in Haematology Blood Transfusion Taskforce (2004) Guidelines for the Use of Fresh-Frozen Plasma Cryoprecipitate and Cryosupernatant The British Society for Haematology 126 11 ndash 28 httponlinelibrarywileycomdoi101111j1365-2141200404972xfull British Committee for Standards in Haematology Blood Transfusion Taskforce (2007) Addendum to the Guidelines for the Use of Fresh-Frozen Plasma Cryoprecipitate and Cryosupernatant 2004 httpwwwbcshguidelinescomdocumentsFFPAmendment_2_17_Oct_2007pdf httpwwwbcshguidelinescomdocumentsFFPAmendment_2_17_Oct_2007pdf British Committee for Standards in Haematology Blood Transfusion Taskforce (2004) Transfusion Guidelines for Neonates and Older Children British Journal of Haematology 124 433-453 httponlinelibrarywileycomdoi101111j1365-2141200404815xfull British Committee for Standards in Haematology Blood Transfusion Taskforce (2005) Amendment to the Transfusion Guidelines for Neonates and Older Children 2004 wwwbcshguidelinescompdfamendments_neonates_091205pdf British Committee for Standards in Haematology Blood Transfusion Taskforce (2007) Amendment to the Transfusion Guidelines for Neonates and Older Children 2004 httpwwwbcshguidelinescomdocumentsFFP_neonate_Amendment_1_17_Oct_2007pdf British Committee for Standards in Haematology Blood Transfusion Taskforce (2003) Guidelines for the Use of Platelet Transfusions British Journal of Haematology122(1) 10-23 httponlinelibrarywileycomdoi101046j1365-2141200304468xfull British Committee for Standards in Haematology Blood Transfusion Taskforce (2001) The Clinical Use of Red Cell Transfusion British Journal of Haematology 113(1) 24-31 httponlinelibrarywileycomdoi101046j1365-2141200102701xfull British Committee for Standards in Haematology (2009) Guidelines on the Administration of Blood Components

12

httpwwwbcshguidelinescomdocumentsAdmin_blood_components_bcsh_05012010pdf British Committee for Standards in Haematology (BCSH) Guideline on the Administration of Blood Components Addendum August 2012 Avoidance of Transfusion Associated Circulatory Overload (TACO) and Problems Associated with Over-transfusion httpwwwbcshguidelinescom Guidelines on the Use of Irradiated Blood Components prepared by the British Committee for Standards in Haematology Blood Transfusion Task Force (2010) httponlinelibrarywileycomdoi101111j1365-2141201008444xfull British Committee for Standards in Haematology Blood Transfusion Taskforce (2012) Amendment to the Guidelines on the Use of Irradiated Blood Components 2010 httpwwwbcshguidelinescomdocumentsBCSH_TTF_addendum_irradiation_guidelines_final_6_11_12pdf Guideline on the Investigation and Management of Acute Transfusion Reactions Prepared by the BCSH Blood Transfusion Task Force (2012) httponlinelibrarywileycomdoi101111bjh12017full Guidelines on the Management of Anaemia and Red Cell Transfusion in Adult Critically Ill Patients (2012) httponlinelibrarywileycomdoi101111bjh12143full McClelland DBL (ed) (2007) Handbook of Transfusion Medicine (4th edition) The Stationery Office London wwwtransfusionguidelinesorgukdocspdfshtm_edition-4_all-pagespdf National Health Service Quality Improvement Scotland (2006) Clinical Standards for Blood Transfusion httpwwwhealthcareimprovementscotlandorgprevious_resourcesstandardsblood_transfusionaspx http Further Resources Better Blood Transfusion Safe Transfusion e-Learning SCOTBLOOD wwwscotbloodcouk Serious Hazards of Transfusion (SHOT) wwwshotukorg

13

Appendix 1 Adult Blood Transfusion Guideline

ADULT BLOOD TRANSFUSION GUIDELINE

bull Blood transfusion will always be associated with some risk bull Patients under 40 years will tolerate anaemia better than the elderly bull Young patients are at greatest risk of long term complications bull Blood is a scarce and valuable resource and has to be used wisely

Is Blood Transfusion likely to be beneficial bull bull Known Cardiovascular Disease bull Symptoms indicating myocardial or cerebral hypoperfusion bull Continuing acute blood loss

Remember

bull Transfusion of a single unit of blood may be sufficient bull Red cell transfusions should not be used for blood volume replacement bull Post-operative transfusion is unjustified if Hbgt10gdl bull Some anaemias Will respond to treatment of a deficiency eg iron B12 folate ndash always

consider the cause

References SIGN Guideline 54 Perioperative Blood Transfusion for Elective Surgery 2001 http

BCSH Guidelines for the clinical use of red cell Tr ansfusions 2001 Br J Haematol 11324-31

Transfusion Triggers 2002 Carson et al Transfusion Medicine Reviews 16187-199

This is a Guideline to aid clinical practice final decision to transfuse remains with the clinician

Haemoglobin Less than 8 gdl

Haemoglobin 8 to 10 gdl

Haemoglobin Greater than 10gdl

Yes Possibly if No

14

Appendix 2

Ninewells Hospital and Perth Royal Infirmary Maximum Surgical Blood Ordering Schedule (MSBOS) 20 13

Tariff for Elective Procedures

2013-09-26 NW amp PRI MSBOS V30

Procedure

Tariff

Procedure

Tariff

Abdomino -Peroneal Resec tion 2 Laparoscopy GampS Amputation GampS Laparotomy GampS Aortic Aneurysm ndash Elective 2 Liver Biopsy GampS Aortic iliac surgery GampS Liver Resection 3 Appendicectomy 0 Mastectomy or wide local

excision GampS

AV Shunt for Haemodialysis GampS Maxillofacial Surgery ( major cases)

If surgery for malignancy and pre-op Hblt120 L gdL

If pre-op Hbgt 120L gdL

2

GampS

Bile Duct StrictureTumour 2 Myomectomy 2 Bowel Resection (inc large bowel)

2 Nephrectomy - OPEN 2

Breast Biopsy Lump Excision 0 Nephrectomy - Laparosc opic GampS Caesarean Section GampS Nephrolithotomy 2 Carotid Endarterectomy GampS Oesophagectomy 3 Cholecystectomy GampS Ovarian Cystectomy 2 Cone Biopsy 0 Pacemaker Insertion GampS Cystectomy (Total) 2 Panproctocolectomy 2 Cystoscopy GampS Prolapse Repair (inc

Colposuspension) GampS

Dilatation and Curettage 0 Prostatectomy - Open GampS Endovascular Aortic Aneurysm Repair

GampS Pyeloplasty GampS

Femoral Popliteal Bypass GampS Splenectomy (Elective) GampS Fracture Neck of Femur GampS Termination of Pregnancy GampS Gastrec tomy Partial GampS THR GampS Gastrectomy Total 3 THR - Revision 3 Haemorrhoidectomy GampS Thyroidectomy GampS Hernia Repair 0 TKR GampS Laparoscopic fundoplication GampS TKR - Revision 2 Hysterectomy - VaginalAbdominal

GampS Total Proctocolectomy 2

Hysterectomy (Radical) GampS Translumbar Aortogram GampS Ileostomy GampS TUR Biopsy 0 IM Nail for NOF GampS TURP GampS IM Nail for Tibia GampS Varicose Vein Strip 0 Laminectomy GampS Vulvectomy (Radical) 1

15

Appendix 3a Flowchart Management of a Transfusion Reaction

Symptoms Signs of Acute Transfusion Reaction

Fever chills tachycardia hyper or hypotension collapse rigors flushing urticaria pain (bone muscle

chest andor abdominal) shortness of breath nausea generally feeling unwell respiratory distress

Stop the transfusion and call a doctor

Measure temperature pulse blood pressure respiratory rate amp O2 saturation

Check identity of the recipient with the details on the unit and compatibility label or tag

Any discrepancy noted call the transfusion laboratory

Febrile non-haemolytic transfusion

reaction

If temperature rise less than

20˚C the observations are stable

and the patient is otherwise well

give paracetamol

Restart infusion at slower rate

and observe more frequently

Mild allergic reaction

Give Chlopheniramine 10mg

slowly iv and restart the

transfusion at a slower rate and

observe more frequently

Reaction

involves mild

fever or

urticarial

rash only

Mild fever

Urticaria

ABO incompatibility

Stop transfusion

Remove unit keeping IV giving set

attached and c lamped off for return

to Blood Transfusion Laboratory

Commence iv saline infusion through

a NEW IV administration set

Monitor blood pressure pulse urine

output (catheterise) frequently Seek

help from experts in management of

shock where appropriate

Treat any DIC with appropriate blood

components

Inform Hospital Transfusion

Laboratory immediately

Suspected ABO

incompatibility

No

Haemolytic reaction bacterial

infection of unit

Stop transfusion

Take down unit and giving set

Return intact to blood bank with all

other usedunused units

Take blood cultures repeat blood

group crossmatch FBC coagulation

screen biochemistry urinalysis

Monitor urine output

Commence broad spectrum

antibiotics if suspected bacterial

infection

Commence oxygen and fluid support

Seek haematological and intensive

Severe allergic reaction

Other haemolytic reaction bacterial

contamination

Severe allergic reaction

Bronchospasm angioedema

abdominal pain hypotension

Stop transfusion Call for help

Maintain airway give 100 O2

If severe hypotension lie patient flat

with legs elevated Give adrenaline

(05ml of 1 in 1000 intramuscular )

NEVER give undiluted epinephrine

intravascularly

Paediatric doses depend on the age of

the child Intramuscular 1 in 1000

epinephrine should be administered as

follows

12 years

05 milligrams (05 ml)

6-12 years

025 milligrams (025ml)

gt6 months to 6 years 012

milligrams( 012 ml)

lt6 months 005 milligrams

( 005ml)

Take down unit and giving set

Start infusion of crystalloid or colloid

through a new iv fluid administration

set

Secondary therapy

Chlopheniramine 10mg slow iv

Salbutamol nebuliser

Corticosteroids 100-500mg

Adapted from Handbook of transfusion medicine 4th edition DBL McClelland Ed The Stationery Office London 2007

Fluid overload

Give oxygen

Diuretic iv

TRALI

Clinical features of acute LVF with

fever and chills

Discontinue transfusion

Give 100 Oxygen

Treat as ARDS ndash ventilate if hypoxia

indicates

Acute dyspnoea

hypotension

Monitor blood gases

Perform CXR

Measure CVP

Pulmonary capillary

pressure

Raised

CVP

Normal

CVP

No

Yes

Yes

Yes

No

No

16

Appendix 3b Mild Acute Transfusion Reaction Signs amp Symptoms

bull Allergic reactions are not uncommon minor urticarial skin reactions or pruritis bull Rise in temperature less than 20 0C above baseline

Management of a Mild Acute Transfusion Reaction 1 Stop the transfusion (check patient and component compatibility) 2 Seek medical advice 3 Assess patient 4 Commence appropriate treatment If signs amp symptoms worsen within 15 minutes treat as a severe reaction When treating a mild reaction you should advise the practitioner to continue transfusion at the normal rate if there is no progression of symptoms after 30 minutes It is important that you continue to monitor your patient Severe Transfusion Reaction Signs amp Symptoms More serious reactions are associated with

bull Pyrexia of more than 20 0C above baseline bull Rigors Hypotension LoinBack Pain Increasing anxiety Severe Tachycardia Pain at infusion

site Dark urine Respiratory Distress Unexpected bleeding (DIC) Management of a Severe Transfusion Reaction 1 Stop and disconnect the transfusion - ensure IV giving set remains intact in the outlet port of the unit pack and the regulating clamp is firmly closed (return pack + giving set to Hospital Transfusion Laboratory(HTL) in a plastic disposal bag clearly marked ldquotransfusion reaction investigationrdquo) 2 Replace the administration set IV access should be maintained with normal saline 3 Call the doctor to see the patient urgently 4 Assess patient - resuscitate as required 5 Check compatibility of unit with patient documentation and ID band 6 Inform the Hospital Transfusion Laboratory and request a Transfusion Reaction Report form 7 Contact on call Medical Officer Haematologist for Hospital Transfusion Laboratory giving details of the reaction indicating the degree of urgency of further transfusion(s) 8 Reassess patient and treat appropriately 9 Check urine for signs of Haemoglobinuria 10 Document event in patient case notes 11 Report via NHS Tayside Adverse Incident Management reporting scheme(DATIX) 12 Maintain airway and give high flow Oxygen Administer adrenaline andor diuretic The clinician should seek expert advice if patientrsquos condition continues to deteriorate

17

The following must be completed as part of reaction Investigation Report reaction to Hospital transfusion Laboratory and request a Transfusion Reaction form

The component unit and any remaining contents with the clamped off IV giving set attached

should be sent to the transfusion laboratory clearly marked with ldquotransfusion reaction investigationrdquo include patients name date amp time and clinical area

Any empty used unit packs from this transfusion episode or unused units of blood issued for

the patient should be returned to Hospital Transfusion Laboratory clearly marked with ldquotransfusion reaction investigationrdquo include patients name date amp time and clinical area

Completed Transfusion Reaction form should be returned to the hospital transfusion

laboratory with a post transfusion sample 6ml EDTA pink top ndash for serological investigation The following post transfusion samples must also be obtained

o Aerobic and anaerobic blood cultures should be sent to Microbiology o 4ml Sodium Citrate light blue top ndash for Coagulation screen o 5ml SST gold top - for haptoglobin haemoglobinaemia investigations o 4ml EDTA purple top ndash for full blood count

Also obtain o First available MSU after the reaction ndash for culture o Next available MSU for haemoglobinuria investigations

Incident Reporting The health care practitioner who discovers or deals with any transfusion reaction or incident is also responsible for reporting through the elect ronic NHS Tayside Adverse Incident Management System (ie DATIX)

bull Under the Blood Safety and Quality Regulations (2005 as amended) the Transfusion Laboratory is legally responsible for the reporting of all serious adverse events and reactions to the Government identified competent authority currently the Medicines and Healthcare products Regulatory Agency (MHRA)

bull The Blood Transfusion Laboratory will notify SHOT or SABRE as appropriate when they

receive notification of the incident Transmissible Disease following Transfusion Report to the Blood Transfusion Service any patient showing evidence of unexpected hepatic dysfunction clinical or sub-clinical particularly within six months of any transfusion of blood components or blood products Report any other condition which you think may have been transmitted by blood or blood products

18

Appendix 4

20

21

22

23

24

25

Appendix 5a Jehovah Witness Consent

CONSENT FOR PATIENTS WHO MAY REFUSE SOME BLOOD COMP ONENTS AND PRODUCTS I (Name amp CHIAddressograph) I confirm that the doctor named on this form has explained to me the potential for major haemorrhage associated with pregnancy labour and delivery I have been advised that in some cases major haemorrhage if not controlled can be fatal I have agreed to the use of non- blood volume expanders and pharmaceuticals that control haemorrhage andor stimulate the production of red blood cells However I have told the doctor that I am a Jehovahlsquos Witness with firm religious convictions With full realization of the implications of this position and knowledge that it may pose additional risks to my health or life I have decided to impose the following further restrictions on what the doctors may do in the course of my treatment I do so exercising my own choice I expressly withhold my consent to the following

WILLING TO HAVE IF REQUIRED

REFUSE UNDER ANY CIRCUMSTANCES

Blood Components Red cells Platelets

Fresh frozen plasma Cryoprecipitate

Cell Salvage

Cell saver- Standard set up

Cell saver- set up in continuity only

Blood Products Octaplas (Prothrombin complex

Concentrate)

Anti-D Immunoglobulin Albumin

Factor VIII concentrate Factor IX concentrate

Fibrinogen Concentrate Recombinant Products

Erythropoietin Factor VIIa

I understand that I am free to delete any of the words which appear above in order to modify these restrictions I understand that this limitation of consent will remain in force and bind all those treating me unless and until I expressly revoke it I understand that I may not be managed by the doctor who is treating me so far and that the express limitation of my consent as described above will be regarded as absolute by all the doctors who treat me and will not be overridden in any circumstances by a purported consent of a relative or other person or body I understand that such refusal will be regarded as remaining in force and binding upon those who care for me even though I may be unconscious or affected by medication or medical condition rendering me incapable of

26

expressing my wishes and that doctors treating me will continue to be bound by my refusal even though they may believe that the treatment is immediately necessary in order to save my life I further understand that details of my treatment and any consequences resulting will not be disclosed to any other person without my express consent unless required by law Signature Namehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Dated Witnessed by Signature helliphellip Name Dated

DOCTOR ndash (this part to he completed by Registered Medical Practitioner) I confirm that I have explained the potential for major haemorrhage associated with pregnancy labour and delivery to helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip in terms which in my judgment are suited to the understanding of the person named above I have spoken to this individual alone I further confirm that I have emphasised my clinical judgment of the potential risks to the patient who nonetheless understood and imposed the limitation expressed above I acknowledge that this limited consent will not be over-ridden unless revoked or modified Signature Date Name of Registered Medical Practitioner Witnessed by helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Signaturehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

27

Appendix 5b - Decision to Transfuse bull The decision to transfuse must be based on a thorough clinical assessment of the patient and their individual

needs bull The decision process leading to transfusion should be documented in the patientrsquos clinical record bull If you anticipate any difficulties in transfusing a blood component or blood product eg you require smaller units

to be supplied or the patient is known to have irregular red cell antibodies you should inform the Hospital Transfusion Laboratory of this as early as possible so that they can act or advise appropriately

bull Arrangements should be made locally to ensure that any communication from the Hospital Transfusion

Laboratory regarding a delay in the provision of transfusion support due to antibodies is disseminated appropriately

bull Prior to commencing a transfusion it is essential to ensure that any patient who refuses consent to a blood

transfusion or administration of blood products on religious or other grounds is sensitively advised of the implications and alternatives

bull Please refer to the NHS Tayside Informed Consent Policy for specific guidance on how these circumstances

must be managed Patients who do not wish to receive blood products or components should be identified using a red identity band in accordance with the NHS Tayside Es tablishing Patient Identity Policy Information relating to the appropriate use of blood components is not included in this guideline For more detailed guidance refer to the following BCSH guidelines bull The Clinical Use of Red Cell Transfusion (2001) httponlinelibrarywileycomdoi101046j1365-2141200102701xfull British Committee for Standards in Haematology (2009) Guidelines on the Administration of Blood Components httpwwwbcshguidelinescomdocumentsAdmin_blood_components_bcsh_05012010pdf bull Guidelines for the Use of Platelet Transfusions (2003) httponlinelibrarywileycomdoi101046j1365-2141200304468xfull bull Guidelines for the Use of Fresh-Frozen Plasma Cryoprecipitate and Cryosupernatant (2004) and amendment

(2007) httponlinelibrarywileycomdoi101111j1365-2141200404972xfull httpwwwbcshguidelinescomdocumentsFFPAmendment_2_17_Oct_2007pdf bull Transfusion Guidelines for Neonates and Older Children (2004) and amendments (2005 and 2007) httponlinelibrarywileycomdoi101111j1365-2141200404815xfull wwwbcshguidelinescompdfamendments_neonates_091205pdf httpwwwbcshguidelinescomdocumentsFFP_neonate_Amendment_1_17_Oct_2007pdf bull Guidelines for Management of Massive Blood Loss (2006) httponlinelibrarywileycomdoi101111j1365-2141200606355xfull Advice is also available in the Handbook of Transfusion Medicine (4th Edition McClelland (ed) 2007) wwwtransfusionguidelinesorgukdocspdfshtm_edition-4_all-pagespdf

15

Appendix 3a Flowchart Management of a Transfusion Reaction

Symptoms Signs of Acute Transfusion Reaction

Fever chills tachycardia hyper or hypotension collapse rigors flushing urticaria pain (bone muscle

chest andor abdominal) shortness of breath nausea generally feeling unwell respiratory distress

Stop the transfusion and call a doctor

Measure temperature pulse blood pressure respiratory rate amp O2 saturation

Check identity of the recipient with the details on the unit and compatibility label or tag

Any discrepancy noted call the transfusion laboratory

Febrile non-haemolytic transfusion

reaction

If temperature rise less than

20˚C the observations are stable

and the patient is otherwise well

give paracetamol

Restart infusion at slower rate

and observe more frequently

Mild allergic reaction

Give Chlopheniramine 10mg

slowly iv and restart the

transfusion at a slower rate and

observe more frequently

Reaction

involves mild

fever or

urticarial

rash only

Mild fever

Urticaria

ABO incompatibility

Stop transfusion

Remove unit keeping IV giving set

attached and c lamped off for return

to Blood Transfusion Laboratory

Commence iv saline infusion through

a NEW IV administration set

Monitor blood pressure pulse urine

output (catheterise) frequently Seek

help from experts in management of

shock where appropriate

Treat any DIC with appropriate blood

components

Inform Hospital Transfusion

Laboratory immediately

Suspected ABO

incompatibility

No

Haemolytic reaction bacterial

infection of unit

Stop transfusion

Take down unit and giving set

Return intact to blood bank with all

other usedunused units

Take blood cultures repeat blood

group crossmatch FBC coagulation

screen biochemistry urinalysis

Monitor urine output

Commence broad spectrum

antibiotics if suspected bacterial

infection

Commence oxygen and fluid support

Seek haematological and intensive

Severe allergic reaction

Other haemolytic reaction bacterial

contamination

Severe allergic reaction

Bronchospasm angioedema

abdominal pain hypotension

Stop transfusion Call for help

Maintain airway give 100 O2

If severe hypotension lie patient flat

with legs elevated Give adrenaline

(05ml of 1 in 1000 intramuscular )

NEVER give undiluted epinephrine

intravascularly

Paediatric doses depend on the age of

the child Intramuscular 1 in 1000

epinephrine should be administered as

follows

12 years

05 milligrams (05 ml)

6-12 years

025 milligrams (025ml)

gt6 months to 6 years 012

milligrams( 012 ml)

lt6 months 005 milligrams

( 005ml)

Take down unit and giving set

Start infusion of crystalloid or colloid

through a new iv fluid administration

set

Secondary therapy

Chlopheniramine 10mg slow iv

Salbutamol nebuliser

Corticosteroids 100-500mg

Adapted from Handbook of transfusion medicine 4th edition DBL McClelland Ed The Stationery Office London 2007

Fluid overload

Give oxygen

Diuretic iv

TRALI

Clinical features of acute LVF with

fever and chills

Discontinue transfusion

Give 100 Oxygen

Treat as ARDS ndash ventilate if hypoxia

indicates

Acute dyspnoea

hypotension

Monitor blood gases

Perform CXR

Measure CVP

Pulmonary capillary

pressure

Raised

CVP

Normal

CVP

No

Yes

Yes

Yes

No

No

16

Appendix 3b Mild Acute Transfusion Reaction Signs amp Symptoms

bull Allergic reactions are not uncommon minor urticarial skin reactions or pruritis bull Rise in temperature less than 20 0C above baseline

Management of a Mild Acute Transfusion Reaction 1 Stop the transfusion (check patient and component compatibility) 2 Seek medical advice 3 Assess patient 4 Commence appropriate treatment If signs amp symptoms worsen within 15 minutes treat as a severe reaction When treating a mild reaction you should advise the practitioner to continue transfusion at the normal rate if there is no progression of symptoms after 30 minutes It is important that you continue to monitor your patient Severe Transfusion Reaction Signs amp Symptoms More serious reactions are associated with

bull Pyrexia of more than 20 0C above baseline bull Rigors Hypotension LoinBack Pain Increasing anxiety Severe Tachycardia Pain at infusion

site Dark urine Respiratory Distress Unexpected bleeding (DIC) Management of a Severe Transfusion Reaction 1 Stop and disconnect the transfusion - ensure IV giving set remains intact in the outlet port of the unit pack and the regulating clamp is firmly closed (return pack + giving set to Hospital Transfusion Laboratory(HTL) in a plastic disposal bag clearly marked ldquotransfusion reaction investigationrdquo) 2 Replace the administration set IV access should be maintained with normal saline 3 Call the doctor to see the patient urgently 4 Assess patient - resuscitate as required 5 Check compatibility of unit with patient documentation and ID band 6 Inform the Hospital Transfusion Laboratory and request a Transfusion Reaction Report form 7 Contact on call Medical Officer Haematologist for Hospital Transfusion Laboratory giving details of the reaction indicating the degree of urgency of further transfusion(s) 8 Reassess patient and treat appropriately 9 Check urine for signs of Haemoglobinuria 10 Document event in patient case notes 11 Report via NHS Tayside Adverse Incident Management reporting scheme(DATIX) 12 Maintain airway and give high flow Oxygen Administer adrenaline andor diuretic The clinician should seek expert advice if patientrsquos condition continues to deteriorate

17

The following must be completed as part of reaction Investigation Report reaction to Hospital transfusion Laboratory and request a Transfusion Reaction form

The component unit and any remaining contents with the clamped off IV giving set attached

should be sent to the transfusion laboratory clearly marked with ldquotransfusion reaction investigationrdquo include patients name date amp time and clinical area

Any empty used unit packs from this transfusion episode or unused units of blood issued for

the patient should be returned to Hospital Transfusion Laboratory clearly marked with ldquotransfusion reaction investigationrdquo include patients name date amp time and clinical area

Completed Transfusion Reaction form should be returned to the hospital transfusion

laboratory with a post transfusion sample 6ml EDTA pink top ndash for serological investigation The following post transfusion samples must also be obtained

o Aerobic and anaerobic blood cultures should be sent to Microbiology o 4ml Sodium Citrate light blue top ndash for Coagulation screen o 5ml SST gold top - for haptoglobin haemoglobinaemia investigations o 4ml EDTA purple top ndash for full blood count

Also obtain o First available MSU after the reaction ndash for culture o Next available MSU for haemoglobinuria investigations

Incident Reporting The health care practitioner who discovers or deals with any transfusion reaction or incident is also responsible for reporting through the elect ronic NHS Tayside Adverse Incident Management System (ie DATIX)

bull Under the Blood Safety and Quality Regulations (2005 as amended) the Transfusion Laboratory is legally responsible for the reporting of all serious adverse events and reactions to the Government identified competent authority currently the Medicines and Healthcare products Regulatory Agency (MHRA)

bull The Blood Transfusion Laboratory will notify SHOT or SABRE as appropriate when they

receive notification of the incident Transmissible Disease following Transfusion Report to the Blood Transfusion Service any patient showing evidence of unexpected hepatic dysfunction clinical or sub-clinical particularly within six months of any transfusion of blood components or blood products Report any other condition which you think may have been transmitted by blood or blood products

18

Appendix 4

20

21

22

23

24

25

Appendix 5a Jehovah Witness Consent

CONSENT FOR PATIENTS WHO MAY REFUSE SOME BLOOD COMP ONENTS AND PRODUCTS I (Name amp CHIAddressograph) I confirm that the doctor named on this form has explained to me the potential for major haemorrhage associated with pregnancy labour and delivery I have been advised that in some cases major haemorrhage if not controlled can be fatal I have agreed to the use of non- blood volume expanders and pharmaceuticals that control haemorrhage andor stimulate the production of red blood cells However I have told the doctor that I am a Jehovahlsquos Witness with firm religious convictions With full realization of the implications of this position and knowledge that it may pose additional risks to my health or life I have decided to impose the following further restrictions on what the doctors may do in the course of my treatment I do so exercising my own choice I expressly withhold my consent to the following

WILLING TO HAVE IF REQUIRED

REFUSE UNDER ANY CIRCUMSTANCES

Blood Components Red cells Platelets

Fresh frozen plasma Cryoprecipitate

Cell Salvage

Cell saver- Standard set up

Cell saver- set up in continuity only

Blood Products Octaplas (Prothrombin complex

Concentrate)

Anti-D Immunoglobulin Albumin

Factor VIII concentrate Factor IX concentrate

Fibrinogen Concentrate Recombinant Products

Erythropoietin Factor VIIa

I understand that I am free to delete any of the words which appear above in order to modify these restrictions I understand that this limitation of consent will remain in force and bind all those treating me unless and until I expressly revoke it I understand that I may not be managed by the doctor who is treating me so far and that the express limitation of my consent as described above will be regarded as absolute by all the doctors who treat me and will not be overridden in any circumstances by a purported consent of a relative or other person or body I understand that such refusal will be regarded as remaining in force and binding upon those who care for me even though I may be unconscious or affected by medication or medical condition rendering me incapable of

26

expressing my wishes and that doctors treating me will continue to be bound by my refusal even though they may believe that the treatment is immediately necessary in order to save my life I further understand that details of my treatment and any consequences resulting will not be disclosed to any other person without my express consent unless required by law Signature Namehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Dated Witnessed by Signature helliphellip Name Dated

DOCTOR ndash (this part to he completed by Registered Medical Practitioner) I confirm that I have explained the potential for major haemorrhage associated with pregnancy labour and delivery to helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip in terms which in my judgment are suited to the understanding of the person named above I have spoken to this individual alone I further confirm that I have emphasised my clinical judgment of the potential risks to the patient who nonetheless understood and imposed the limitation expressed above I acknowledge that this limited consent will not be over-ridden unless revoked or modified Signature Date Name of Registered Medical Practitioner Witnessed by helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Signaturehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

27

Appendix 5b - Decision to Transfuse bull The decision to transfuse must be based on a thorough clinical assessment of the patient and their individual

needs bull The decision process leading to transfusion should be documented in the patientrsquos clinical record bull If you anticipate any difficulties in transfusing a blood component or blood product eg you require smaller units

to be supplied or the patient is known to have irregular red cell antibodies you should inform the Hospital Transfusion Laboratory of this as early as possible so that they can act or advise appropriately

bull Arrangements should be made locally to ensure that any communication from the Hospital Transfusion

Laboratory regarding a delay in the provision of transfusion support due to antibodies is disseminated appropriately

bull Prior to commencing a transfusion it is essential to ensure that any patient who refuses consent to a blood

transfusion or administration of blood products on religious or other grounds is sensitively advised of the implications and alternatives

bull Please refer to the NHS Tayside Informed Consent Policy for specific guidance on how these circumstances

must be managed Patients who do not wish to receive blood products or components should be identified using a red identity band in accordance with the NHS Tayside Es tablishing Patient Identity Policy Information relating to the appropriate use of blood components is not included in this guideline For more detailed guidance refer to the following BCSH guidelines bull The Clinical Use of Red Cell Transfusion (2001) httponlinelibrarywileycomdoi101046j1365-2141200102701xfull British Committee for Standards in Haematology (2009) Guidelines on the Administration of Blood Components httpwwwbcshguidelinescomdocumentsAdmin_blood_components_bcsh_05012010pdf bull Guidelines for the Use of Platelet Transfusions (2003) httponlinelibrarywileycomdoi101046j1365-2141200304468xfull bull Guidelines for the Use of Fresh-Frozen Plasma Cryoprecipitate and Cryosupernatant (2004) and amendment

(2007) httponlinelibrarywileycomdoi101111j1365-2141200404972xfull httpwwwbcshguidelinescomdocumentsFFPAmendment_2_17_Oct_2007pdf bull Transfusion Guidelines for Neonates and Older Children (2004) and amendments (2005 and 2007) httponlinelibrarywileycomdoi101111j1365-2141200404815xfull wwwbcshguidelinescompdfamendments_neonates_091205pdf httpwwwbcshguidelinescomdocumentsFFP_neonate_Amendment_1_17_Oct_2007pdf bull Guidelines for Management of Massive Blood Loss (2006) httponlinelibrarywileycomdoi101111j1365-2141200606355xfull Advice is also available in the Handbook of Transfusion Medicine (4th Edition McClelland (ed) 2007) wwwtransfusionguidelinesorgukdocspdfshtm_edition-4_all-pagespdf

16

Appendix 3b Mild Acute Transfusion Reaction Signs amp Symptoms

bull Allergic reactions are not uncommon minor urticarial skin reactions or pruritis bull Rise in temperature less than 20 0C above baseline

Management of a Mild Acute Transfusion Reaction 1 Stop the transfusion (check patient and component compatibility) 2 Seek medical advice 3 Assess patient 4 Commence appropriate treatment If signs amp symptoms worsen within 15 minutes treat as a severe reaction When treating a mild reaction you should advise the practitioner to continue transfusion at the normal rate if there is no progression of symptoms after 30 minutes It is important that you continue to monitor your patient Severe Transfusion Reaction Signs amp Symptoms More serious reactions are associated with

bull Pyrexia of more than 20 0C above baseline bull Rigors Hypotension LoinBack Pain Increasing anxiety Severe Tachycardia Pain at infusion

site Dark urine Respiratory Distress Unexpected bleeding (DIC) Management of a Severe Transfusion Reaction 1 Stop and disconnect the transfusion - ensure IV giving set remains intact in the outlet port of the unit pack and the regulating clamp is firmly closed (return pack + giving set to Hospital Transfusion Laboratory(HTL) in a plastic disposal bag clearly marked ldquotransfusion reaction investigationrdquo) 2 Replace the administration set IV access should be maintained with normal saline 3 Call the doctor to see the patient urgently 4 Assess patient - resuscitate as required 5 Check compatibility of unit with patient documentation and ID band 6 Inform the Hospital Transfusion Laboratory and request a Transfusion Reaction Report form 7 Contact on call Medical Officer Haematologist for Hospital Transfusion Laboratory giving details of the reaction indicating the degree of urgency of further transfusion(s) 8 Reassess patient and treat appropriately 9 Check urine for signs of Haemoglobinuria 10 Document event in patient case notes 11 Report via NHS Tayside Adverse Incident Management reporting scheme(DATIX) 12 Maintain airway and give high flow Oxygen Administer adrenaline andor diuretic The clinician should seek expert advice if patientrsquos condition continues to deteriorate

17

The following must be completed as part of reaction Investigation Report reaction to Hospital transfusion Laboratory and request a Transfusion Reaction form

The component unit and any remaining contents with the clamped off IV giving set attached

should be sent to the transfusion laboratory clearly marked with ldquotransfusion reaction investigationrdquo include patients name date amp time and clinical area

Any empty used unit packs from this transfusion episode or unused units of blood issued for

the patient should be returned to Hospital Transfusion Laboratory clearly marked with ldquotransfusion reaction investigationrdquo include patients name date amp time and clinical area

Completed Transfusion Reaction form should be returned to the hospital transfusion

laboratory with a post transfusion sample 6ml EDTA pink top ndash for serological investigation The following post transfusion samples must also be obtained

o Aerobic and anaerobic blood cultures should be sent to Microbiology o 4ml Sodium Citrate light blue top ndash for Coagulation screen o 5ml SST gold top - for haptoglobin haemoglobinaemia investigations o 4ml EDTA purple top ndash for full blood count

Also obtain o First available MSU after the reaction ndash for culture o Next available MSU for haemoglobinuria investigations

Incident Reporting The health care practitioner who discovers or deals with any transfusion reaction or incident is also responsible for reporting through the elect ronic NHS Tayside Adverse Incident Management System (ie DATIX)

bull Under the Blood Safety and Quality Regulations (2005 as amended) the Transfusion Laboratory is legally responsible for the reporting of all serious adverse events and reactions to the Government identified competent authority currently the Medicines and Healthcare products Regulatory Agency (MHRA)

bull The Blood Transfusion Laboratory will notify SHOT or SABRE as appropriate when they

receive notification of the incident Transmissible Disease following Transfusion Report to the Blood Transfusion Service any patient showing evidence of unexpected hepatic dysfunction clinical or sub-clinical particularly within six months of any transfusion of blood components or blood products Report any other condition which you think may have been transmitted by blood or blood products

18

Appendix 4

20

21

22

23

24

25

Appendix 5a Jehovah Witness Consent

CONSENT FOR PATIENTS WHO MAY REFUSE SOME BLOOD COMP ONENTS AND PRODUCTS I (Name amp CHIAddressograph) I confirm that the doctor named on this form has explained to me the potential for major haemorrhage associated with pregnancy labour and delivery I have been advised that in some cases major haemorrhage if not controlled can be fatal I have agreed to the use of non- blood volume expanders and pharmaceuticals that control haemorrhage andor stimulate the production of red blood cells However I have told the doctor that I am a Jehovahlsquos Witness with firm religious convictions With full realization of the implications of this position and knowledge that it may pose additional risks to my health or life I have decided to impose the following further restrictions on what the doctors may do in the course of my treatment I do so exercising my own choice I expressly withhold my consent to the following

WILLING TO HAVE IF REQUIRED

REFUSE UNDER ANY CIRCUMSTANCES

Blood Components Red cells Platelets

Fresh frozen plasma Cryoprecipitate

Cell Salvage

Cell saver- Standard set up

Cell saver- set up in continuity only

Blood Products Octaplas (Prothrombin complex

Concentrate)

Anti-D Immunoglobulin Albumin

Factor VIII concentrate Factor IX concentrate

Fibrinogen Concentrate Recombinant Products

Erythropoietin Factor VIIa

I understand that I am free to delete any of the words which appear above in order to modify these restrictions I understand that this limitation of consent will remain in force and bind all those treating me unless and until I expressly revoke it I understand that I may not be managed by the doctor who is treating me so far and that the express limitation of my consent as described above will be regarded as absolute by all the doctors who treat me and will not be overridden in any circumstances by a purported consent of a relative or other person or body I understand that such refusal will be regarded as remaining in force and binding upon those who care for me even though I may be unconscious or affected by medication or medical condition rendering me incapable of

26

expressing my wishes and that doctors treating me will continue to be bound by my refusal even though they may believe that the treatment is immediately necessary in order to save my life I further understand that details of my treatment and any consequences resulting will not be disclosed to any other person without my express consent unless required by law Signature Namehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Dated Witnessed by Signature helliphellip Name Dated

DOCTOR ndash (this part to he completed by Registered Medical Practitioner) I confirm that I have explained the potential for major haemorrhage associated with pregnancy labour and delivery to helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip in terms which in my judgment are suited to the understanding of the person named above I have spoken to this individual alone I further confirm that I have emphasised my clinical judgment of the potential risks to the patient who nonetheless understood and imposed the limitation expressed above I acknowledge that this limited consent will not be over-ridden unless revoked or modified Signature Date Name of Registered Medical Practitioner Witnessed by helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Signaturehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

27

Appendix 5b - Decision to Transfuse bull The decision to transfuse must be based on a thorough clinical assessment of the patient and their individual

needs bull The decision process leading to transfusion should be documented in the patientrsquos clinical record bull If you anticipate any difficulties in transfusing a blood component or blood product eg you require smaller units

to be supplied or the patient is known to have irregular red cell antibodies you should inform the Hospital Transfusion Laboratory of this as early as possible so that they can act or advise appropriately

bull Arrangements should be made locally to ensure that any communication from the Hospital Transfusion

Laboratory regarding a delay in the provision of transfusion support due to antibodies is disseminated appropriately

bull Prior to commencing a transfusion it is essential to ensure that any patient who refuses consent to a blood

transfusion or administration of blood products on religious or other grounds is sensitively advised of the implications and alternatives

bull Please refer to the NHS Tayside Informed Consent Policy for specific guidance on how these circumstances

must be managed Patients who do not wish to receive blood products or components should be identified using a red identity band in accordance with the NHS Tayside Es tablishing Patient Identity Policy Information relating to the appropriate use of blood components is not included in this guideline For more detailed guidance refer to the following BCSH guidelines bull The Clinical Use of Red Cell Transfusion (2001) httponlinelibrarywileycomdoi101046j1365-2141200102701xfull British Committee for Standards in Haematology (2009) Guidelines on the Administration of Blood Components httpwwwbcshguidelinescomdocumentsAdmin_blood_components_bcsh_05012010pdf bull Guidelines for the Use of Platelet Transfusions (2003) httponlinelibrarywileycomdoi101046j1365-2141200304468xfull bull Guidelines for the Use of Fresh-Frozen Plasma Cryoprecipitate and Cryosupernatant (2004) and amendment

(2007) httponlinelibrarywileycomdoi101111j1365-2141200404972xfull httpwwwbcshguidelinescomdocumentsFFPAmendment_2_17_Oct_2007pdf bull Transfusion Guidelines for Neonates and Older Children (2004) and amendments (2005 and 2007) httponlinelibrarywileycomdoi101111j1365-2141200404815xfull wwwbcshguidelinescompdfamendments_neonates_091205pdf httpwwwbcshguidelinescomdocumentsFFP_neonate_Amendment_1_17_Oct_2007pdf bull Guidelines for Management of Massive Blood Loss (2006) httponlinelibrarywileycomdoi101111j1365-2141200606355xfull Advice is also available in the Handbook of Transfusion Medicine (4th Edition McClelland (ed) 2007) wwwtransfusionguidelinesorgukdocspdfshtm_edition-4_all-pagespdf

17

The following must be completed as part of reaction Investigation Report reaction to Hospital transfusion Laboratory and request a Transfusion Reaction form

The component unit and any remaining contents with the clamped off IV giving set attached

should be sent to the transfusion laboratory clearly marked with ldquotransfusion reaction investigationrdquo include patients name date amp time and clinical area

Any empty used unit packs from this transfusion episode or unused units of blood issued for

the patient should be returned to Hospital Transfusion Laboratory clearly marked with ldquotransfusion reaction investigationrdquo include patients name date amp time and clinical area

Completed Transfusion Reaction form should be returned to the hospital transfusion

laboratory with a post transfusion sample 6ml EDTA pink top ndash for serological investigation The following post transfusion samples must also be obtained

o Aerobic and anaerobic blood cultures should be sent to Microbiology o 4ml Sodium Citrate light blue top ndash for Coagulation screen o 5ml SST gold top - for haptoglobin haemoglobinaemia investigations o 4ml EDTA purple top ndash for full blood count

Also obtain o First available MSU after the reaction ndash for culture o Next available MSU for haemoglobinuria investigations

Incident Reporting The health care practitioner who discovers or deals with any transfusion reaction or incident is also responsible for reporting through the elect ronic NHS Tayside Adverse Incident Management System (ie DATIX)

bull Under the Blood Safety and Quality Regulations (2005 as amended) the Transfusion Laboratory is legally responsible for the reporting of all serious adverse events and reactions to the Government identified competent authority currently the Medicines and Healthcare products Regulatory Agency (MHRA)

bull The Blood Transfusion Laboratory will notify SHOT or SABRE as appropriate when they

receive notification of the incident Transmissible Disease following Transfusion Report to the Blood Transfusion Service any patient showing evidence of unexpected hepatic dysfunction clinical or sub-clinical particularly within six months of any transfusion of blood components or blood products Report any other condition which you think may have been transmitted by blood or blood products

18

Appendix 4

20

21

22

23

24

25

Appendix 5a Jehovah Witness Consent

CONSENT FOR PATIENTS WHO MAY REFUSE SOME BLOOD COMP ONENTS AND PRODUCTS I (Name amp CHIAddressograph) I confirm that the doctor named on this form has explained to me the potential for major haemorrhage associated with pregnancy labour and delivery I have been advised that in some cases major haemorrhage if not controlled can be fatal I have agreed to the use of non- blood volume expanders and pharmaceuticals that control haemorrhage andor stimulate the production of red blood cells However I have told the doctor that I am a Jehovahlsquos Witness with firm religious convictions With full realization of the implications of this position and knowledge that it may pose additional risks to my health or life I have decided to impose the following further restrictions on what the doctors may do in the course of my treatment I do so exercising my own choice I expressly withhold my consent to the following

WILLING TO HAVE IF REQUIRED

REFUSE UNDER ANY CIRCUMSTANCES

Blood Components Red cells Platelets

Fresh frozen plasma Cryoprecipitate

Cell Salvage

Cell saver- Standard set up

Cell saver- set up in continuity only

Blood Products Octaplas (Prothrombin complex

Concentrate)

Anti-D Immunoglobulin Albumin

Factor VIII concentrate Factor IX concentrate

Fibrinogen Concentrate Recombinant Products

Erythropoietin Factor VIIa

I understand that I am free to delete any of the words which appear above in order to modify these restrictions I understand that this limitation of consent will remain in force and bind all those treating me unless and until I expressly revoke it I understand that I may not be managed by the doctor who is treating me so far and that the express limitation of my consent as described above will be regarded as absolute by all the doctors who treat me and will not be overridden in any circumstances by a purported consent of a relative or other person or body I understand that such refusal will be regarded as remaining in force and binding upon those who care for me even though I may be unconscious or affected by medication or medical condition rendering me incapable of

26

expressing my wishes and that doctors treating me will continue to be bound by my refusal even though they may believe that the treatment is immediately necessary in order to save my life I further understand that details of my treatment and any consequences resulting will not be disclosed to any other person without my express consent unless required by law Signature Namehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Dated Witnessed by Signature helliphellip Name Dated

DOCTOR ndash (this part to he completed by Registered Medical Practitioner) I confirm that I have explained the potential for major haemorrhage associated with pregnancy labour and delivery to helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip in terms which in my judgment are suited to the understanding of the person named above I have spoken to this individual alone I further confirm that I have emphasised my clinical judgment of the potential risks to the patient who nonetheless understood and imposed the limitation expressed above I acknowledge that this limited consent will not be over-ridden unless revoked or modified Signature Date Name of Registered Medical Practitioner Witnessed by helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Signaturehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

27

Appendix 5b - Decision to Transfuse bull The decision to transfuse must be based on a thorough clinical assessment of the patient and their individual

needs bull The decision process leading to transfusion should be documented in the patientrsquos clinical record bull If you anticipate any difficulties in transfusing a blood component or blood product eg you require smaller units

to be supplied or the patient is known to have irregular red cell antibodies you should inform the Hospital Transfusion Laboratory of this as early as possible so that they can act or advise appropriately

bull Arrangements should be made locally to ensure that any communication from the Hospital Transfusion

Laboratory regarding a delay in the provision of transfusion support due to antibodies is disseminated appropriately

bull Prior to commencing a transfusion it is essential to ensure that any patient who refuses consent to a blood

transfusion or administration of blood products on religious or other grounds is sensitively advised of the implications and alternatives

bull Please refer to the NHS Tayside Informed Consent Policy for specific guidance on how these circumstances

must be managed Patients who do not wish to receive blood products or components should be identified using a red identity band in accordance with the NHS Tayside Es tablishing Patient Identity Policy Information relating to the appropriate use of blood components is not included in this guideline For more detailed guidance refer to the following BCSH guidelines bull The Clinical Use of Red Cell Transfusion (2001) httponlinelibrarywileycomdoi101046j1365-2141200102701xfull British Committee for Standards in Haematology (2009) Guidelines on the Administration of Blood Components httpwwwbcshguidelinescomdocumentsAdmin_blood_components_bcsh_05012010pdf bull Guidelines for the Use of Platelet Transfusions (2003) httponlinelibrarywileycomdoi101046j1365-2141200304468xfull bull Guidelines for the Use of Fresh-Frozen Plasma Cryoprecipitate and Cryosupernatant (2004) and amendment

(2007) httponlinelibrarywileycomdoi101111j1365-2141200404972xfull httpwwwbcshguidelinescomdocumentsFFPAmendment_2_17_Oct_2007pdf bull Transfusion Guidelines for Neonates and Older Children (2004) and amendments (2005 and 2007) httponlinelibrarywileycomdoi101111j1365-2141200404815xfull wwwbcshguidelinescompdfamendments_neonates_091205pdf httpwwwbcshguidelinescomdocumentsFFP_neonate_Amendment_1_17_Oct_2007pdf bull Guidelines for Management of Massive Blood Loss (2006) httponlinelibrarywileycomdoi101111j1365-2141200606355xfull Advice is also available in the Handbook of Transfusion Medicine (4th Edition McClelland (ed) 2007) wwwtransfusionguidelinesorgukdocspdfshtm_edition-4_all-pagespdf

18

Appendix 4

20

21

22

23

24

25

Appendix 5a Jehovah Witness Consent

CONSENT FOR PATIENTS WHO MAY REFUSE SOME BLOOD COMP ONENTS AND PRODUCTS I (Name amp CHIAddressograph) I confirm that the doctor named on this form has explained to me the potential for major haemorrhage associated with pregnancy labour and delivery I have been advised that in some cases major haemorrhage if not controlled can be fatal I have agreed to the use of non- blood volume expanders and pharmaceuticals that control haemorrhage andor stimulate the production of red blood cells However I have told the doctor that I am a Jehovahlsquos Witness with firm religious convictions With full realization of the implications of this position and knowledge that it may pose additional risks to my health or life I have decided to impose the following further restrictions on what the doctors may do in the course of my treatment I do so exercising my own choice I expressly withhold my consent to the following

WILLING TO HAVE IF REQUIRED

REFUSE UNDER ANY CIRCUMSTANCES

Blood Components Red cells Platelets

Fresh frozen plasma Cryoprecipitate

Cell Salvage

Cell saver- Standard set up

Cell saver- set up in continuity only

Blood Products Octaplas (Prothrombin complex

Concentrate)

Anti-D Immunoglobulin Albumin

Factor VIII concentrate Factor IX concentrate

Fibrinogen Concentrate Recombinant Products

Erythropoietin Factor VIIa

I understand that I am free to delete any of the words which appear above in order to modify these restrictions I understand that this limitation of consent will remain in force and bind all those treating me unless and until I expressly revoke it I understand that I may not be managed by the doctor who is treating me so far and that the express limitation of my consent as described above will be regarded as absolute by all the doctors who treat me and will not be overridden in any circumstances by a purported consent of a relative or other person or body I understand that such refusal will be regarded as remaining in force and binding upon those who care for me even though I may be unconscious or affected by medication or medical condition rendering me incapable of

26

expressing my wishes and that doctors treating me will continue to be bound by my refusal even though they may believe that the treatment is immediately necessary in order to save my life I further understand that details of my treatment and any consequences resulting will not be disclosed to any other person without my express consent unless required by law Signature Namehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Dated Witnessed by Signature helliphellip Name Dated

DOCTOR ndash (this part to he completed by Registered Medical Practitioner) I confirm that I have explained the potential for major haemorrhage associated with pregnancy labour and delivery to helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip in terms which in my judgment are suited to the understanding of the person named above I have spoken to this individual alone I further confirm that I have emphasised my clinical judgment of the potential risks to the patient who nonetheless understood and imposed the limitation expressed above I acknowledge that this limited consent will not be over-ridden unless revoked or modified Signature Date Name of Registered Medical Practitioner Witnessed by helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Signaturehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

27

Appendix 5b - Decision to Transfuse bull The decision to transfuse must be based on a thorough clinical assessment of the patient and their individual

needs bull The decision process leading to transfusion should be documented in the patientrsquos clinical record bull If you anticipate any difficulties in transfusing a blood component or blood product eg you require smaller units

to be supplied or the patient is known to have irregular red cell antibodies you should inform the Hospital Transfusion Laboratory of this as early as possible so that they can act or advise appropriately

bull Arrangements should be made locally to ensure that any communication from the Hospital Transfusion

Laboratory regarding a delay in the provision of transfusion support due to antibodies is disseminated appropriately

bull Prior to commencing a transfusion it is essential to ensure that any patient who refuses consent to a blood

transfusion or administration of blood products on religious or other grounds is sensitively advised of the implications and alternatives

bull Please refer to the NHS Tayside Informed Consent Policy for specific guidance on how these circumstances

must be managed Patients who do not wish to receive blood products or components should be identified using a red identity band in accordance with the NHS Tayside Es tablishing Patient Identity Policy Information relating to the appropriate use of blood components is not included in this guideline For more detailed guidance refer to the following BCSH guidelines bull The Clinical Use of Red Cell Transfusion (2001) httponlinelibrarywileycomdoi101046j1365-2141200102701xfull British Committee for Standards in Haematology (2009) Guidelines on the Administration of Blood Components httpwwwbcshguidelinescomdocumentsAdmin_blood_components_bcsh_05012010pdf bull Guidelines for the Use of Platelet Transfusions (2003) httponlinelibrarywileycomdoi101046j1365-2141200304468xfull bull Guidelines for the Use of Fresh-Frozen Plasma Cryoprecipitate and Cryosupernatant (2004) and amendment

(2007) httponlinelibrarywileycomdoi101111j1365-2141200404972xfull httpwwwbcshguidelinescomdocumentsFFPAmendment_2_17_Oct_2007pdf bull Transfusion Guidelines for Neonates and Older Children (2004) and amendments (2005 and 2007) httponlinelibrarywileycomdoi101111j1365-2141200404815xfull wwwbcshguidelinescompdfamendments_neonates_091205pdf httpwwwbcshguidelinescomdocumentsFFP_neonate_Amendment_1_17_Oct_2007pdf bull Guidelines for Management of Massive Blood Loss (2006) httponlinelibrarywileycomdoi101111j1365-2141200606355xfull Advice is also available in the Handbook of Transfusion Medicine (4th Edition McClelland (ed) 2007) wwwtransfusionguidelinesorgukdocspdfshtm_edition-4_all-pagespdf

20

21

22

23

24

25

Appendix 5a Jehovah Witness Consent

CONSENT FOR PATIENTS WHO MAY REFUSE SOME BLOOD COMP ONENTS AND PRODUCTS I (Name amp CHIAddressograph) I confirm that the doctor named on this form has explained to me the potential for major haemorrhage associated with pregnancy labour and delivery I have been advised that in some cases major haemorrhage if not controlled can be fatal I have agreed to the use of non- blood volume expanders and pharmaceuticals that control haemorrhage andor stimulate the production of red blood cells However I have told the doctor that I am a Jehovahlsquos Witness with firm religious convictions With full realization of the implications of this position and knowledge that it may pose additional risks to my health or life I have decided to impose the following further restrictions on what the doctors may do in the course of my treatment I do so exercising my own choice I expressly withhold my consent to the following

WILLING TO HAVE IF REQUIRED

REFUSE UNDER ANY CIRCUMSTANCES

Blood Components Red cells Platelets

Fresh frozen plasma Cryoprecipitate

Cell Salvage

Cell saver- Standard set up

Cell saver- set up in continuity only

Blood Products Octaplas (Prothrombin complex

Concentrate)

Anti-D Immunoglobulin Albumin

Factor VIII concentrate Factor IX concentrate

Fibrinogen Concentrate Recombinant Products

Erythropoietin Factor VIIa

I understand that I am free to delete any of the words which appear above in order to modify these restrictions I understand that this limitation of consent will remain in force and bind all those treating me unless and until I expressly revoke it I understand that I may not be managed by the doctor who is treating me so far and that the express limitation of my consent as described above will be regarded as absolute by all the doctors who treat me and will not be overridden in any circumstances by a purported consent of a relative or other person or body I understand that such refusal will be regarded as remaining in force and binding upon those who care for me even though I may be unconscious or affected by medication or medical condition rendering me incapable of

26

expressing my wishes and that doctors treating me will continue to be bound by my refusal even though they may believe that the treatment is immediately necessary in order to save my life I further understand that details of my treatment and any consequences resulting will not be disclosed to any other person without my express consent unless required by law Signature Namehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Dated Witnessed by Signature helliphellip Name Dated

DOCTOR ndash (this part to he completed by Registered Medical Practitioner) I confirm that I have explained the potential for major haemorrhage associated with pregnancy labour and delivery to helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip in terms which in my judgment are suited to the understanding of the person named above I have spoken to this individual alone I further confirm that I have emphasised my clinical judgment of the potential risks to the patient who nonetheless understood and imposed the limitation expressed above I acknowledge that this limited consent will not be over-ridden unless revoked or modified Signature Date Name of Registered Medical Practitioner Witnessed by helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Signaturehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

27

Appendix 5b - Decision to Transfuse bull The decision to transfuse must be based on a thorough clinical assessment of the patient and their individual

needs bull The decision process leading to transfusion should be documented in the patientrsquos clinical record bull If you anticipate any difficulties in transfusing a blood component or blood product eg you require smaller units

to be supplied or the patient is known to have irregular red cell antibodies you should inform the Hospital Transfusion Laboratory of this as early as possible so that they can act or advise appropriately

bull Arrangements should be made locally to ensure that any communication from the Hospital Transfusion

Laboratory regarding a delay in the provision of transfusion support due to antibodies is disseminated appropriately

bull Prior to commencing a transfusion it is essential to ensure that any patient who refuses consent to a blood

transfusion or administration of blood products on religious or other grounds is sensitively advised of the implications and alternatives

bull Please refer to the NHS Tayside Informed Consent Policy for specific guidance on how these circumstances

must be managed Patients who do not wish to receive blood products or components should be identified using a red identity band in accordance with the NHS Tayside Es tablishing Patient Identity Policy Information relating to the appropriate use of blood components is not included in this guideline For more detailed guidance refer to the following BCSH guidelines bull The Clinical Use of Red Cell Transfusion (2001) httponlinelibrarywileycomdoi101046j1365-2141200102701xfull British Committee for Standards in Haematology (2009) Guidelines on the Administration of Blood Components httpwwwbcshguidelinescomdocumentsAdmin_blood_components_bcsh_05012010pdf bull Guidelines for the Use of Platelet Transfusions (2003) httponlinelibrarywileycomdoi101046j1365-2141200304468xfull bull Guidelines for the Use of Fresh-Frozen Plasma Cryoprecipitate and Cryosupernatant (2004) and amendment

(2007) httponlinelibrarywileycomdoi101111j1365-2141200404972xfull httpwwwbcshguidelinescomdocumentsFFPAmendment_2_17_Oct_2007pdf bull Transfusion Guidelines for Neonates and Older Children (2004) and amendments (2005 and 2007) httponlinelibrarywileycomdoi101111j1365-2141200404815xfull wwwbcshguidelinescompdfamendments_neonates_091205pdf httpwwwbcshguidelinescomdocumentsFFP_neonate_Amendment_1_17_Oct_2007pdf bull Guidelines for Management of Massive Blood Loss (2006) httponlinelibrarywileycomdoi101111j1365-2141200606355xfull Advice is also available in the Handbook of Transfusion Medicine (4th Edition McClelland (ed) 2007) wwwtransfusionguidelinesorgukdocspdfshtm_edition-4_all-pagespdf

21

22

23

24

25

Appendix 5a Jehovah Witness Consent

CONSENT FOR PATIENTS WHO MAY REFUSE SOME BLOOD COMP ONENTS AND PRODUCTS I (Name amp CHIAddressograph) I confirm that the doctor named on this form has explained to me the potential for major haemorrhage associated with pregnancy labour and delivery I have been advised that in some cases major haemorrhage if not controlled can be fatal I have agreed to the use of non- blood volume expanders and pharmaceuticals that control haemorrhage andor stimulate the production of red blood cells However I have told the doctor that I am a Jehovahlsquos Witness with firm religious convictions With full realization of the implications of this position and knowledge that it may pose additional risks to my health or life I have decided to impose the following further restrictions on what the doctors may do in the course of my treatment I do so exercising my own choice I expressly withhold my consent to the following

WILLING TO HAVE IF REQUIRED

REFUSE UNDER ANY CIRCUMSTANCES

Blood Components Red cells Platelets

Fresh frozen plasma Cryoprecipitate

Cell Salvage

Cell saver- Standard set up

Cell saver- set up in continuity only

Blood Products Octaplas (Prothrombin complex

Concentrate)

Anti-D Immunoglobulin Albumin

Factor VIII concentrate Factor IX concentrate

Fibrinogen Concentrate Recombinant Products

Erythropoietin Factor VIIa

I understand that I am free to delete any of the words which appear above in order to modify these restrictions I understand that this limitation of consent will remain in force and bind all those treating me unless and until I expressly revoke it I understand that I may not be managed by the doctor who is treating me so far and that the express limitation of my consent as described above will be regarded as absolute by all the doctors who treat me and will not be overridden in any circumstances by a purported consent of a relative or other person or body I understand that such refusal will be regarded as remaining in force and binding upon those who care for me even though I may be unconscious or affected by medication or medical condition rendering me incapable of

26

expressing my wishes and that doctors treating me will continue to be bound by my refusal even though they may believe that the treatment is immediately necessary in order to save my life I further understand that details of my treatment and any consequences resulting will not be disclosed to any other person without my express consent unless required by law Signature Namehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Dated Witnessed by Signature helliphellip Name Dated

DOCTOR ndash (this part to he completed by Registered Medical Practitioner) I confirm that I have explained the potential for major haemorrhage associated with pregnancy labour and delivery to helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip in terms which in my judgment are suited to the understanding of the person named above I have spoken to this individual alone I further confirm that I have emphasised my clinical judgment of the potential risks to the patient who nonetheless understood and imposed the limitation expressed above I acknowledge that this limited consent will not be over-ridden unless revoked or modified Signature Date Name of Registered Medical Practitioner Witnessed by helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Signaturehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

27

Appendix 5b - Decision to Transfuse bull The decision to transfuse must be based on a thorough clinical assessment of the patient and their individual

needs bull The decision process leading to transfusion should be documented in the patientrsquos clinical record bull If you anticipate any difficulties in transfusing a blood component or blood product eg you require smaller units

to be supplied or the patient is known to have irregular red cell antibodies you should inform the Hospital Transfusion Laboratory of this as early as possible so that they can act or advise appropriately

bull Arrangements should be made locally to ensure that any communication from the Hospital Transfusion

Laboratory regarding a delay in the provision of transfusion support due to antibodies is disseminated appropriately

bull Prior to commencing a transfusion it is essential to ensure that any patient who refuses consent to a blood

transfusion or administration of blood products on religious or other grounds is sensitively advised of the implications and alternatives

bull Please refer to the NHS Tayside Informed Consent Policy for specific guidance on how these circumstances

must be managed Patients who do not wish to receive blood products or components should be identified using a red identity band in accordance with the NHS Tayside Es tablishing Patient Identity Policy Information relating to the appropriate use of blood components is not included in this guideline For more detailed guidance refer to the following BCSH guidelines bull The Clinical Use of Red Cell Transfusion (2001) httponlinelibrarywileycomdoi101046j1365-2141200102701xfull British Committee for Standards in Haematology (2009) Guidelines on the Administration of Blood Components httpwwwbcshguidelinescomdocumentsAdmin_blood_components_bcsh_05012010pdf bull Guidelines for the Use of Platelet Transfusions (2003) httponlinelibrarywileycomdoi101046j1365-2141200304468xfull bull Guidelines for the Use of Fresh-Frozen Plasma Cryoprecipitate and Cryosupernatant (2004) and amendment

(2007) httponlinelibrarywileycomdoi101111j1365-2141200404972xfull httpwwwbcshguidelinescomdocumentsFFPAmendment_2_17_Oct_2007pdf bull Transfusion Guidelines for Neonates and Older Children (2004) and amendments (2005 and 2007) httponlinelibrarywileycomdoi101111j1365-2141200404815xfull wwwbcshguidelinescompdfamendments_neonates_091205pdf httpwwwbcshguidelinescomdocumentsFFP_neonate_Amendment_1_17_Oct_2007pdf bull Guidelines for Management of Massive Blood Loss (2006) httponlinelibrarywileycomdoi101111j1365-2141200606355xfull Advice is also available in the Handbook of Transfusion Medicine (4th Edition McClelland (ed) 2007) wwwtransfusionguidelinesorgukdocspdfshtm_edition-4_all-pagespdf

22

23

24

25

Appendix 5a Jehovah Witness Consent

CONSENT FOR PATIENTS WHO MAY REFUSE SOME BLOOD COMP ONENTS AND PRODUCTS I (Name amp CHIAddressograph) I confirm that the doctor named on this form has explained to me the potential for major haemorrhage associated with pregnancy labour and delivery I have been advised that in some cases major haemorrhage if not controlled can be fatal I have agreed to the use of non- blood volume expanders and pharmaceuticals that control haemorrhage andor stimulate the production of red blood cells However I have told the doctor that I am a Jehovahlsquos Witness with firm religious convictions With full realization of the implications of this position and knowledge that it may pose additional risks to my health or life I have decided to impose the following further restrictions on what the doctors may do in the course of my treatment I do so exercising my own choice I expressly withhold my consent to the following

WILLING TO HAVE IF REQUIRED

REFUSE UNDER ANY CIRCUMSTANCES

Blood Components Red cells Platelets

Fresh frozen plasma Cryoprecipitate

Cell Salvage

Cell saver- Standard set up

Cell saver- set up in continuity only

Blood Products Octaplas (Prothrombin complex

Concentrate)

Anti-D Immunoglobulin Albumin

Factor VIII concentrate Factor IX concentrate

Fibrinogen Concentrate Recombinant Products

Erythropoietin Factor VIIa

I understand that I am free to delete any of the words which appear above in order to modify these restrictions I understand that this limitation of consent will remain in force and bind all those treating me unless and until I expressly revoke it I understand that I may not be managed by the doctor who is treating me so far and that the express limitation of my consent as described above will be regarded as absolute by all the doctors who treat me and will not be overridden in any circumstances by a purported consent of a relative or other person or body I understand that such refusal will be regarded as remaining in force and binding upon those who care for me even though I may be unconscious or affected by medication or medical condition rendering me incapable of

26

expressing my wishes and that doctors treating me will continue to be bound by my refusal even though they may believe that the treatment is immediately necessary in order to save my life I further understand that details of my treatment and any consequences resulting will not be disclosed to any other person without my express consent unless required by law Signature Namehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Dated Witnessed by Signature helliphellip Name Dated

DOCTOR ndash (this part to he completed by Registered Medical Practitioner) I confirm that I have explained the potential for major haemorrhage associated with pregnancy labour and delivery to helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip in terms which in my judgment are suited to the understanding of the person named above I have spoken to this individual alone I further confirm that I have emphasised my clinical judgment of the potential risks to the patient who nonetheless understood and imposed the limitation expressed above I acknowledge that this limited consent will not be over-ridden unless revoked or modified Signature Date Name of Registered Medical Practitioner Witnessed by helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Signaturehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

27

Appendix 5b - Decision to Transfuse bull The decision to transfuse must be based on a thorough clinical assessment of the patient and their individual

needs bull The decision process leading to transfusion should be documented in the patientrsquos clinical record bull If you anticipate any difficulties in transfusing a blood component or blood product eg you require smaller units

to be supplied or the patient is known to have irregular red cell antibodies you should inform the Hospital Transfusion Laboratory of this as early as possible so that they can act or advise appropriately

bull Arrangements should be made locally to ensure that any communication from the Hospital Transfusion

Laboratory regarding a delay in the provision of transfusion support due to antibodies is disseminated appropriately

bull Prior to commencing a transfusion it is essential to ensure that any patient who refuses consent to a blood

transfusion or administration of blood products on religious or other grounds is sensitively advised of the implications and alternatives

bull Please refer to the NHS Tayside Informed Consent Policy for specific guidance on how these circumstances

must be managed Patients who do not wish to receive blood products or components should be identified using a red identity band in accordance with the NHS Tayside Es tablishing Patient Identity Policy Information relating to the appropriate use of blood components is not included in this guideline For more detailed guidance refer to the following BCSH guidelines bull The Clinical Use of Red Cell Transfusion (2001) httponlinelibrarywileycomdoi101046j1365-2141200102701xfull British Committee for Standards in Haematology (2009) Guidelines on the Administration of Blood Components httpwwwbcshguidelinescomdocumentsAdmin_blood_components_bcsh_05012010pdf bull Guidelines for the Use of Platelet Transfusions (2003) httponlinelibrarywileycomdoi101046j1365-2141200304468xfull bull Guidelines for the Use of Fresh-Frozen Plasma Cryoprecipitate and Cryosupernatant (2004) and amendment

(2007) httponlinelibrarywileycomdoi101111j1365-2141200404972xfull httpwwwbcshguidelinescomdocumentsFFPAmendment_2_17_Oct_2007pdf bull Transfusion Guidelines for Neonates and Older Children (2004) and amendments (2005 and 2007) httponlinelibrarywileycomdoi101111j1365-2141200404815xfull wwwbcshguidelinescompdfamendments_neonates_091205pdf httpwwwbcshguidelinescomdocumentsFFP_neonate_Amendment_1_17_Oct_2007pdf bull Guidelines for Management of Massive Blood Loss (2006) httponlinelibrarywileycomdoi101111j1365-2141200606355xfull Advice is also available in the Handbook of Transfusion Medicine (4th Edition McClelland (ed) 2007) wwwtransfusionguidelinesorgukdocspdfshtm_edition-4_all-pagespdf

23

24

25

Appendix 5a Jehovah Witness Consent

CONSENT FOR PATIENTS WHO MAY REFUSE SOME BLOOD COMP ONENTS AND PRODUCTS I (Name amp CHIAddressograph) I confirm that the doctor named on this form has explained to me the potential for major haemorrhage associated with pregnancy labour and delivery I have been advised that in some cases major haemorrhage if not controlled can be fatal I have agreed to the use of non- blood volume expanders and pharmaceuticals that control haemorrhage andor stimulate the production of red blood cells However I have told the doctor that I am a Jehovahlsquos Witness with firm religious convictions With full realization of the implications of this position and knowledge that it may pose additional risks to my health or life I have decided to impose the following further restrictions on what the doctors may do in the course of my treatment I do so exercising my own choice I expressly withhold my consent to the following

WILLING TO HAVE IF REQUIRED

REFUSE UNDER ANY CIRCUMSTANCES

Blood Components Red cells Platelets

Fresh frozen plasma Cryoprecipitate

Cell Salvage

Cell saver- Standard set up

Cell saver- set up in continuity only

Blood Products Octaplas (Prothrombin complex

Concentrate)

Anti-D Immunoglobulin Albumin

Factor VIII concentrate Factor IX concentrate

Fibrinogen Concentrate Recombinant Products

Erythropoietin Factor VIIa

I understand that I am free to delete any of the words which appear above in order to modify these restrictions I understand that this limitation of consent will remain in force and bind all those treating me unless and until I expressly revoke it I understand that I may not be managed by the doctor who is treating me so far and that the express limitation of my consent as described above will be regarded as absolute by all the doctors who treat me and will not be overridden in any circumstances by a purported consent of a relative or other person or body I understand that such refusal will be regarded as remaining in force and binding upon those who care for me even though I may be unconscious or affected by medication or medical condition rendering me incapable of

26

expressing my wishes and that doctors treating me will continue to be bound by my refusal even though they may believe that the treatment is immediately necessary in order to save my life I further understand that details of my treatment and any consequences resulting will not be disclosed to any other person without my express consent unless required by law Signature Namehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Dated Witnessed by Signature helliphellip Name Dated

DOCTOR ndash (this part to he completed by Registered Medical Practitioner) I confirm that I have explained the potential for major haemorrhage associated with pregnancy labour and delivery to helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip in terms which in my judgment are suited to the understanding of the person named above I have spoken to this individual alone I further confirm that I have emphasised my clinical judgment of the potential risks to the patient who nonetheless understood and imposed the limitation expressed above I acknowledge that this limited consent will not be over-ridden unless revoked or modified Signature Date Name of Registered Medical Practitioner Witnessed by helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Signaturehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

27

Appendix 5b - Decision to Transfuse bull The decision to transfuse must be based on a thorough clinical assessment of the patient and their individual

needs bull The decision process leading to transfusion should be documented in the patientrsquos clinical record bull If you anticipate any difficulties in transfusing a blood component or blood product eg you require smaller units

to be supplied or the patient is known to have irregular red cell antibodies you should inform the Hospital Transfusion Laboratory of this as early as possible so that they can act or advise appropriately

bull Arrangements should be made locally to ensure that any communication from the Hospital Transfusion

Laboratory regarding a delay in the provision of transfusion support due to antibodies is disseminated appropriately

bull Prior to commencing a transfusion it is essential to ensure that any patient who refuses consent to a blood

transfusion or administration of blood products on religious or other grounds is sensitively advised of the implications and alternatives

bull Please refer to the NHS Tayside Informed Consent Policy for specific guidance on how these circumstances

must be managed Patients who do not wish to receive blood products or components should be identified using a red identity band in accordance with the NHS Tayside Es tablishing Patient Identity Policy Information relating to the appropriate use of blood components is not included in this guideline For more detailed guidance refer to the following BCSH guidelines bull The Clinical Use of Red Cell Transfusion (2001) httponlinelibrarywileycomdoi101046j1365-2141200102701xfull British Committee for Standards in Haematology (2009) Guidelines on the Administration of Blood Components httpwwwbcshguidelinescomdocumentsAdmin_blood_components_bcsh_05012010pdf bull Guidelines for the Use of Platelet Transfusions (2003) httponlinelibrarywileycomdoi101046j1365-2141200304468xfull bull Guidelines for the Use of Fresh-Frozen Plasma Cryoprecipitate and Cryosupernatant (2004) and amendment

(2007) httponlinelibrarywileycomdoi101111j1365-2141200404972xfull httpwwwbcshguidelinescomdocumentsFFPAmendment_2_17_Oct_2007pdf bull Transfusion Guidelines for Neonates and Older Children (2004) and amendments (2005 and 2007) httponlinelibrarywileycomdoi101111j1365-2141200404815xfull wwwbcshguidelinescompdfamendments_neonates_091205pdf httpwwwbcshguidelinescomdocumentsFFP_neonate_Amendment_1_17_Oct_2007pdf bull Guidelines for Management of Massive Blood Loss (2006) httponlinelibrarywileycomdoi101111j1365-2141200606355xfull Advice is also available in the Handbook of Transfusion Medicine (4th Edition McClelland (ed) 2007) wwwtransfusionguidelinesorgukdocspdfshtm_edition-4_all-pagespdf

24

25

Appendix 5a Jehovah Witness Consent

CONSENT FOR PATIENTS WHO MAY REFUSE SOME BLOOD COMP ONENTS AND PRODUCTS I (Name amp CHIAddressograph) I confirm that the doctor named on this form has explained to me the potential for major haemorrhage associated with pregnancy labour and delivery I have been advised that in some cases major haemorrhage if not controlled can be fatal I have agreed to the use of non- blood volume expanders and pharmaceuticals that control haemorrhage andor stimulate the production of red blood cells However I have told the doctor that I am a Jehovahlsquos Witness with firm religious convictions With full realization of the implications of this position and knowledge that it may pose additional risks to my health or life I have decided to impose the following further restrictions on what the doctors may do in the course of my treatment I do so exercising my own choice I expressly withhold my consent to the following

WILLING TO HAVE IF REQUIRED

REFUSE UNDER ANY CIRCUMSTANCES

Blood Components Red cells Platelets

Fresh frozen plasma Cryoprecipitate

Cell Salvage

Cell saver- Standard set up

Cell saver- set up in continuity only

Blood Products Octaplas (Prothrombin complex

Concentrate)

Anti-D Immunoglobulin Albumin

Factor VIII concentrate Factor IX concentrate

Fibrinogen Concentrate Recombinant Products

Erythropoietin Factor VIIa

I understand that I am free to delete any of the words which appear above in order to modify these restrictions I understand that this limitation of consent will remain in force and bind all those treating me unless and until I expressly revoke it I understand that I may not be managed by the doctor who is treating me so far and that the express limitation of my consent as described above will be regarded as absolute by all the doctors who treat me and will not be overridden in any circumstances by a purported consent of a relative or other person or body I understand that such refusal will be regarded as remaining in force and binding upon those who care for me even though I may be unconscious or affected by medication or medical condition rendering me incapable of

26

expressing my wishes and that doctors treating me will continue to be bound by my refusal even though they may believe that the treatment is immediately necessary in order to save my life I further understand that details of my treatment and any consequences resulting will not be disclosed to any other person without my express consent unless required by law Signature Namehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Dated Witnessed by Signature helliphellip Name Dated

DOCTOR ndash (this part to he completed by Registered Medical Practitioner) I confirm that I have explained the potential for major haemorrhage associated with pregnancy labour and delivery to helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip in terms which in my judgment are suited to the understanding of the person named above I have spoken to this individual alone I further confirm that I have emphasised my clinical judgment of the potential risks to the patient who nonetheless understood and imposed the limitation expressed above I acknowledge that this limited consent will not be over-ridden unless revoked or modified Signature Date Name of Registered Medical Practitioner Witnessed by helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Signaturehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

27

Appendix 5b - Decision to Transfuse bull The decision to transfuse must be based on a thorough clinical assessment of the patient and their individual

needs bull The decision process leading to transfusion should be documented in the patientrsquos clinical record bull If you anticipate any difficulties in transfusing a blood component or blood product eg you require smaller units

to be supplied or the patient is known to have irregular red cell antibodies you should inform the Hospital Transfusion Laboratory of this as early as possible so that they can act or advise appropriately

bull Arrangements should be made locally to ensure that any communication from the Hospital Transfusion

Laboratory regarding a delay in the provision of transfusion support due to antibodies is disseminated appropriately

bull Prior to commencing a transfusion it is essential to ensure that any patient who refuses consent to a blood

transfusion or administration of blood products on religious or other grounds is sensitively advised of the implications and alternatives

bull Please refer to the NHS Tayside Informed Consent Policy for specific guidance on how these circumstances

must be managed Patients who do not wish to receive blood products or components should be identified using a red identity band in accordance with the NHS Tayside Es tablishing Patient Identity Policy Information relating to the appropriate use of blood components is not included in this guideline For more detailed guidance refer to the following BCSH guidelines bull The Clinical Use of Red Cell Transfusion (2001) httponlinelibrarywileycomdoi101046j1365-2141200102701xfull British Committee for Standards in Haematology (2009) Guidelines on the Administration of Blood Components httpwwwbcshguidelinescomdocumentsAdmin_blood_components_bcsh_05012010pdf bull Guidelines for the Use of Platelet Transfusions (2003) httponlinelibrarywileycomdoi101046j1365-2141200304468xfull bull Guidelines for the Use of Fresh-Frozen Plasma Cryoprecipitate and Cryosupernatant (2004) and amendment

(2007) httponlinelibrarywileycomdoi101111j1365-2141200404972xfull httpwwwbcshguidelinescomdocumentsFFPAmendment_2_17_Oct_2007pdf bull Transfusion Guidelines for Neonates and Older Children (2004) and amendments (2005 and 2007) httponlinelibrarywileycomdoi101111j1365-2141200404815xfull wwwbcshguidelinescompdfamendments_neonates_091205pdf httpwwwbcshguidelinescomdocumentsFFP_neonate_Amendment_1_17_Oct_2007pdf bull Guidelines for Management of Massive Blood Loss (2006) httponlinelibrarywileycomdoi101111j1365-2141200606355xfull Advice is also available in the Handbook of Transfusion Medicine (4th Edition McClelland (ed) 2007) wwwtransfusionguidelinesorgukdocspdfshtm_edition-4_all-pagespdf

25

Appendix 5a Jehovah Witness Consent

CONSENT FOR PATIENTS WHO MAY REFUSE SOME BLOOD COMP ONENTS AND PRODUCTS I (Name amp CHIAddressograph) I confirm that the doctor named on this form has explained to me the potential for major haemorrhage associated with pregnancy labour and delivery I have been advised that in some cases major haemorrhage if not controlled can be fatal I have agreed to the use of non- blood volume expanders and pharmaceuticals that control haemorrhage andor stimulate the production of red blood cells However I have told the doctor that I am a Jehovahlsquos Witness with firm religious convictions With full realization of the implications of this position and knowledge that it may pose additional risks to my health or life I have decided to impose the following further restrictions on what the doctors may do in the course of my treatment I do so exercising my own choice I expressly withhold my consent to the following

WILLING TO HAVE IF REQUIRED

REFUSE UNDER ANY CIRCUMSTANCES

Blood Components Red cells Platelets

Fresh frozen plasma Cryoprecipitate

Cell Salvage

Cell saver- Standard set up

Cell saver- set up in continuity only

Blood Products Octaplas (Prothrombin complex

Concentrate)

Anti-D Immunoglobulin Albumin

Factor VIII concentrate Factor IX concentrate

Fibrinogen Concentrate Recombinant Products

Erythropoietin Factor VIIa

I understand that I am free to delete any of the words which appear above in order to modify these restrictions I understand that this limitation of consent will remain in force and bind all those treating me unless and until I expressly revoke it I understand that I may not be managed by the doctor who is treating me so far and that the express limitation of my consent as described above will be regarded as absolute by all the doctors who treat me and will not be overridden in any circumstances by a purported consent of a relative or other person or body I understand that such refusal will be regarded as remaining in force and binding upon those who care for me even though I may be unconscious or affected by medication or medical condition rendering me incapable of

26

expressing my wishes and that doctors treating me will continue to be bound by my refusal even though they may believe that the treatment is immediately necessary in order to save my life I further understand that details of my treatment and any consequences resulting will not be disclosed to any other person without my express consent unless required by law Signature Namehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Dated Witnessed by Signature helliphellip Name Dated

DOCTOR ndash (this part to he completed by Registered Medical Practitioner) I confirm that I have explained the potential for major haemorrhage associated with pregnancy labour and delivery to helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip in terms which in my judgment are suited to the understanding of the person named above I have spoken to this individual alone I further confirm that I have emphasised my clinical judgment of the potential risks to the patient who nonetheless understood and imposed the limitation expressed above I acknowledge that this limited consent will not be over-ridden unless revoked or modified Signature Date Name of Registered Medical Practitioner Witnessed by helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Signaturehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

27

Appendix 5b - Decision to Transfuse bull The decision to transfuse must be based on a thorough clinical assessment of the patient and their individual

needs bull The decision process leading to transfusion should be documented in the patientrsquos clinical record bull If you anticipate any difficulties in transfusing a blood component or blood product eg you require smaller units

to be supplied or the patient is known to have irregular red cell antibodies you should inform the Hospital Transfusion Laboratory of this as early as possible so that they can act or advise appropriately

bull Arrangements should be made locally to ensure that any communication from the Hospital Transfusion

Laboratory regarding a delay in the provision of transfusion support due to antibodies is disseminated appropriately

bull Prior to commencing a transfusion it is essential to ensure that any patient who refuses consent to a blood

transfusion or administration of blood products on religious or other grounds is sensitively advised of the implications and alternatives

bull Please refer to the NHS Tayside Informed Consent Policy for specific guidance on how these circumstances

must be managed Patients who do not wish to receive blood products or components should be identified using a red identity band in accordance with the NHS Tayside Es tablishing Patient Identity Policy Information relating to the appropriate use of blood components is not included in this guideline For more detailed guidance refer to the following BCSH guidelines bull The Clinical Use of Red Cell Transfusion (2001) httponlinelibrarywileycomdoi101046j1365-2141200102701xfull British Committee for Standards in Haematology (2009) Guidelines on the Administration of Blood Components httpwwwbcshguidelinescomdocumentsAdmin_blood_components_bcsh_05012010pdf bull Guidelines for the Use of Platelet Transfusions (2003) httponlinelibrarywileycomdoi101046j1365-2141200304468xfull bull Guidelines for the Use of Fresh-Frozen Plasma Cryoprecipitate and Cryosupernatant (2004) and amendment

(2007) httponlinelibrarywileycomdoi101111j1365-2141200404972xfull httpwwwbcshguidelinescomdocumentsFFPAmendment_2_17_Oct_2007pdf bull Transfusion Guidelines for Neonates and Older Children (2004) and amendments (2005 and 2007) httponlinelibrarywileycomdoi101111j1365-2141200404815xfull wwwbcshguidelinescompdfamendments_neonates_091205pdf httpwwwbcshguidelinescomdocumentsFFP_neonate_Amendment_1_17_Oct_2007pdf bull Guidelines for Management of Massive Blood Loss (2006) httponlinelibrarywileycomdoi101111j1365-2141200606355xfull Advice is also available in the Handbook of Transfusion Medicine (4th Edition McClelland (ed) 2007) wwwtransfusionguidelinesorgukdocspdfshtm_edition-4_all-pagespdf

26

expressing my wishes and that doctors treating me will continue to be bound by my refusal even though they may believe that the treatment is immediately necessary in order to save my life I further understand that details of my treatment and any consequences resulting will not be disclosed to any other person without my express consent unless required by law Signature Namehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Dated Witnessed by Signature helliphellip Name Dated

DOCTOR ndash (this part to he completed by Registered Medical Practitioner) I confirm that I have explained the potential for major haemorrhage associated with pregnancy labour and delivery to helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip in terms which in my judgment are suited to the understanding of the person named above I have spoken to this individual alone I further confirm that I have emphasised my clinical judgment of the potential risks to the patient who nonetheless understood and imposed the limitation expressed above I acknowledge that this limited consent will not be over-ridden unless revoked or modified Signature Date Name of Registered Medical Practitioner Witnessed by helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Signaturehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

27

Appendix 5b - Decision to Transfuse bull The decision to transfuse must be based on a thorough clinical assessment of the patient and their individual

needs bull The decision process leading to transfusion should be documented in the patientrsquos clinical record bull If you anticipate any difficulties in transfusing a blood component or blood product eg you require smaller units

to be supplied or the patient is known to have irregular red cell antibodies you should inform the Hospital Transfusion Laboratory of this as early as possible so that they can act or advise appropriately

bull Arrangements should be made locally to ensure that any communication from the Hospital Transfusion

Laboratory regarding a delay in the provision of transfusion support due to antibodies is disseminated appropriately

bull Prior to commencing a transfusion it is essential to ensure that any patient who refuses consent to a blood

transfusion or administration of blood products on religious or other grounds is sensitively advised of the implications and alternatives

bull Please refer to the NHS Tayside Informed Consent Policy for specific guidance on how these circumstances

must be managed Patients who do not wish to receive blood products or components should be identified using a red identity band in accordance with the NHS Tayside Es tablishing Patient Identity Policy Information relating to the appropriate use of blood components is not included in this guideline For more detailed guidance refer to the following BCSH guidelines bull The Clinical Use of Red Cell Transfusion (2001) httponlinelibrarywileycomdoi101046j1365-2141200102701xfull British Committee for Standards in Haematology (2009) Guidelines on the Administration of Blood Components httpwwwbcshguidelinescomdocumentsAdmin_blood_components_bcsh_05012010pdf bull Guidelines for the Use of Platelet Transfusions (2003) httponlinelibrarywileycomdoi101046j1365-2141200304468xfull bull Guidelines for the Use of Fresh-Frozen Plasma Cryoprecipitate and Cryosupernatant (2004) and amendment

(2007) httponlinelibrarywileycomdoi101111j1365-2141200404972xfull httpwwwbcshguidelinescomdocumentsFFPAmendment_2_17_Oct_2007pdf bull Transfusion Guidelines for Neonates and Older Children (2004) and amendments (2005 and 2007) httponlinelibrarywileycomdoi101111j1365-2141200404815xfull wwwbcshguidelinescompdfamendments_neonates_091205pdf httpwwwbcshguidelinescomdocumentsFFP_neonate_Amendment_1_17_Oct_2007pdf bull Guidelines for Management of Massive Blood Loss (2006) httponlinelibrarywileycomdoi101111j1365-2141200606355xfull Advice is also available in the Handbook of Transfusion Medicine (4th Edition McClelland (ed) 2007) wwwtransfusionguidelinesorgukdocspdfshtm_edition-4_all-pagespdf

27

Appendix 5b - Decision to Transfuse bull The decision to transfuse must be based on a thorough clinical assessment of the patient and their individual

needs bull The decision process leading to transfusion should be documented in the patientrsquos clinical record bull If you anticipate any difficulties in transfusing a blood component or blood product eg you require smaller units

to be supplied or the patient is known to have irregular red cell antibodies you should inform the Hospital Transfusion Laboratory of this as early as possible so that they can act or advise appropriately

bull Arrangements should be made locally to ensure that any communication from the Hospital Transfusion

Laboratory regarding a delay in the provision of transfusion support due to antibodies is disseminated appropriately

bull Prior to commencing a transfusion it is essential to ensure that any patient who refuses consent to a blood

transfusion or administration of blood products on religious or other grounds is sensitively advised of the implications and alternatives

bull Please refer to the NHS Tayside Informed Consent Policy for specific guidance on how these circumstances

must be managed Patients who do not wish to receive blood products or components should be identified using a red identity band in accordance with the NHS Tayside Es tablishing Patient Identity Policy Information relating to the appropriate use of blood components is not included in this guideline For more detailed guidance refer to the following BCSH guidelines bull The Clinical Use of Red Cell Transfusion (2001) httponlinelibrarywileycomdoi101046j1365-2141200102701xfull British Committee for Standards in Haematology (2009) Guidelines on the Administration of Blood Components httpwwwbcshguidelinescomdocumentsAdmin_blood_components_bcsh_05012010pdf bull Guidelines for the Use of Platelet Transfusions (2003) httponlinelibrarywileycomdoi101046j1365-2141200304468xfull bull Guidelines for the Use of Fresh-Frozen Plasma Cryoprecipitate and Cryosupernatant (2004) and amendment

(2007) httponlinelibrarywileycomdoi101111j1365-2141200404972xfull httpwwwbcshguidelinescomdocumentsFFPAmendment_2_17_Oct_2007pdf bull Transfusion Guidelines for Neonates and Older Children (2004) and amendments (2005 and 2007) httponlinelibrarywileycomdoi101111j1365-2141200404815xfull wwwbcshguidelinescompdfamendments_neonates_091205pdf httpwwwbcshguidelinescomdocumentsFFP_neonate_Amendment_1_17_Oct_2007pdf bull Guidelines for Management of Massive Blood Loss (2006) httponlinelibrarywileycomdoi101111j1365-2141200606355xfull Advice is also available in the Handbook of Transfusion Medicine (4th Edition McClelland (ed) 2007) wwwtransfusionguidelinesorgukdocspdfshtm_edition-4_all-pagespdf

28

Appendix 6 - Requesting Transfusion Support bull Clearly document within the notes the indication for the transfusion including the rationale for the number of

units to be transfused as per BCSH (2009) guidelines bull Wherever possible and appropriate explain the reason for the proposed treatment outline the procedure and

desired outcome to the patient relative carer Check understanding and obtain verbal consent and document this in the medical andor nursing notes If a pre-transfusion discussion is not possible arrangements must be made to discuss the reasons for transfusion with the patient or relatives at the earliest opportunity

bull Information leaflets written by the Scottish national Blood Transfusion Service (SNBTS) are available through

SNBTS Public Affairs Dept on tel 01413577752 Copies should be available in every clinical area where transfusions take place bull In addition to asking the patient refer to the case notes for evidence of previous transfusion reaction special

requirements and antibodies Certain conditions may also apply with regard to indications for irradiated blood components or CMV antibody negative blood components

Indications for irradiated red cells include - All patients undergoing autologous bone marrow transplant or peripheral blood stem cell transplant should receive irradiated cellular blood components from initiation of conditioning chemoradiotherapy until 3 months post-transplant (6 months if total body irradiation was used in conditioning) - Recipients of allogeneic haemopoietic stem cell transplantation (SCT) must receive irradiated blood components from the time of initiation of conditioning radiotherapy This should be continued while the patient continues to receive graft-versus-host disease prophylaxis ie usually for 6 months post-transplant or until lymphocytes are gt1 middot 109l - Allogeneic blood transfused to Patients undergoing bone marrow or peripheral blood stem cell lsquoharvestingrsquo for future autologous re-infusion should receive irradiated cellular blood components during and for 7 days before the bone marrowstem cell harvest - All adults and children with Hodgkin lymphoma at any stage of the disease should have irradiated red cells and platelets for life - Patients treated with Purine Analogue drugs (Fludarabine Cladribine and Deoxycoformicin) should receive irradiated blood components indefinitely The situation with other Purine Antagonists and new and related agents such as Bendamustine and Clofarabine is unclear but use of irradiated blood components is recommended as these agents have a similar mode of action - Irradiated blood components should be used after Alemtuzumab (anti-CD52) therapy

Neonatal Paediatric Indications for irradiated cel ls - All blood for intrauterine transfusion (IUT) should be irradiated

- It is essential to irradiate blood for neonatal exchange transfusion (ET) if there has been a previous IUT or if the donation comes from a first- or second-degree relative - For other neonatal ET cases irradiation is recommended provided this does not unduly delay transfusion - It is not necessary to irradiate red cells for routine lsquotop-uprsquo transfusions of premature or term infants unless either there has been a previous IUT in which case irradiated components should be administered until 6 months after the expected delivery date (40 weeks gestation)

29

- Platelets transfused in utero to treat alloimmune thrombocytopenia should be irradiated and any subsequent red cell or platelet transfusions irradiated until 6 months after the expected date of delivery (40 weeks gestation) There is no need to irradiate other platelet transfusions for pre-term or term infants All severe T lymphocyte immunodeficiency syndromes should be considered as indications for irradiation of cellular blood components Once a diagnosis of immunodeficiency has been suspected irradiated components should be given while further diagnostic tests are being undertaken Further guidance and information can be sought from the Hospital Transfusion Laboratory It is the responsibility of the clinician requestin g transfusion support to ensure that the laboratory is informed regarding any special requirements Guidelines on the Use of Irradiated Blood Components prepared by the British Committee for Standards in Haematology Blood Transfusion Task Force (2010) httponlinelibrarywileycomdoi101111j1365-2141201008444xfull British Committee for Standards in Haematology Blood Transfusion Taskforce (2012) Amendment to the Guidelines on the Use of Irradiated Blood Components 2010 httpwwwbcshguidelinescomdocumentsBCSH_TTF_addendum_irradiation_guidelines_final_6_11_12pdf Request Forms A request to the blood transfusion laboratory for grouping andor compatibility testing must be made on a request form which contains the following information for identification bull The patients forename (no abbreviations) surname date of birth CHI (Community Health Index) number or

Typenex (use of a unique numbered label system that allows an unambiguous link to be established between the patient and the sample) and casualty number gender

bull Location and clinical details bull Signature and details of the person making the transfusion request and the date and time the sample was

taken bull In addition the Hospital Transfusion Laboratory needs an indication of urgency and any special requirements

Samples taken in the community should specify where and when the patient will attend for transfusion All information should be unambiguous and written i n block capitals as instructed on the request form All transfusion requests must be appropriate accurate and specific bull A request for a group and screen means that samples will be tested but no blood will be made available

unless the Hospital Transfusion Laboratory is contacted to provide transfusion support bull A request for a crossmatch means that the sample will be tested and blood issued for the patient based on

the urgency denoted on the request form bull Requests for emergency transfusion support should include a phone call to the Hospital Transfusion

Laboratory advising them of the situation bull Request for infants under 4 months old should include the full maternal details ie surname forename(s)

date of birth and CHI bull In situations where a unique number is not available the use of the patientrsquos address may be of benefit

Alternatively where the patient cannot be identified the use of the Typenex system must be used please refer to the NHS Tayside Establishing Patient Identity Policy

29

- Platelets transfused in utero to treat alloimmune thrombocytopenia should be irradiated and any subsequent red cell or platelet transfusions irradiated until 6 months after the expected date of delivery (40 weeks gestation) There is no need to irradiate other platelet transfusions for pre-term or term infants All severe T lymphocyte immunodeficiency syndromes should be considered as indications for irradiation of cellular blood components Once a diagnosis of immunodeficiency has been suspected irradiated components should be given while further diagnostic tests are being undertaken Further guidance and information can be sought from the Hospital Transfusion Laboratory It is the responsibility of the clinician requestin g transfusion support to ensure that the laboratory is informed regarding any special requirements Guidelines on the Use of Irradiated Blood Components prepared by the British Committee for Standards in Haematology Blood Transfusion Task Force (2010) httponlinelibrarywileycomdoi101111j1365-2141201008444xfull British Committee for Standards in Haematology Blood Transfusion Taskforce (2012) Amendment to the Guidelines on the Use of Irradiated Blood Components 2010 httpwwwbcshguidelinescomdocumentsBCSH_TTF_addendum_irradiation_guidelines_final_6_11_12pdf Request Forms A request to the blood transfusion laboratory for grouping andor compatibility testing must be made on a request form which contains the following information for identification bull The patients forename (no abbreviations) surname date of birth CHI (Community Health Index) number or

Typenex (use of a unique numbered label system that allows an unambiguous link to be established between the patient and the sample) and casualty number gender

bull Location and clinical details bull Signature and details of the person making the transfusion request and the date and time the sample was

taken bull In addition the Hospital Transfusion Laboratory needs an indication of urgency and any special requirements

Samples taken in the community should specify where and when the patient will attend for transfusion All information should be unambiguous and written i n block capitals as instructed on the request form All transfusion requests must be appropriate accurate and specific bull A request for a group and screen means that samples will be tested but no blood will be made available

unless the Hospital Transfusion Laboratory is contacted to provide transfusion support bull A request for a crossmatch means that the sample will be tested and blood issued for the patient based on

the urgency denoted on the request form bull Requests for emergency transfusion support should include a phone call to the Hospital Transfusion

Laboratory advising them of the situation bull Request for infants under 4 months old should include the full maternal details ie surname forename(s)

date of birth and CHI bull In situations where a unique number is not available the use of the patientrsquos address may be of benefit

Alternatively where the patient cannot be identified the use of the Typenex system must be used please refer to the NHS Tayside Establishing Patient Identity Policy

30

bull It is the responsibility of the person completing the request form to fully complete all details on the request form including the need for any special requirements ie irradiation The requesting medical officer (or suitably trained nurse) must sign and accept the responsibility for completion of the request form

The person who takes the blood sample must sign the sample container They must also initial the form if they are not the same person as completed the request form

31

Appendix 7 Authorising Prescribing Transfusion S upport bull The authorisation prescription must be signed by a medical practitioner or an authorised Advanced Nurse

Practitioner

bull It must specify the blood component to be administered the number of units duration and any special requirements or instructions (BCSH 2009)

bull Blood and blood components must always be authorised prescribed prior to commencement of treatment

32

Appendix 8 Taking the Blood Sample The person collecting the sample is responsible for positive identification of the patient prior to taking sample bull Full legible labelling of the sample in black ballpoint ink (see also Infant Samples) This is a critical step in the transfusion process bull Whenever possible patients should be asked to identify themselves verbally with an open question egrdquo

Please can you tell me your full name and date of birthrdquo bull The details given by the patient must match those written on the patientrsquos wristband (or risk assessed

alternative) and these details in turn must match those on the request form The information must be hand written on the sample tube and must contain a minimum of forename surname date of birth CHI gender and signature o f the person taking the sample Inpatient samples must also include the hospital and wardclinic area bull Collection of the blood sample must be carried out individually for each Patient bull Subsequent labelling of the sample tubes should be performed as one continuous uninterrupted event at the

patientrsquos (bed) side after drawing the sample and before leaving patient bull Please note that as soon as a blood transfusion sample is taken it must be sent to the Hospital Transfusion

Laboratory with a request form bull Blood transfusion samples must not be retained in the clinical area for delivery to the laboratory at a later time

or date bull Request forms must state which hospital ward clinic GP surgery sample was taken and which hospitalclinical area any transfusion is to take place Sample label and request form must bear 1 Full name of patient 2 Date of birth CHI number 3 Gender of patient 4 Time and date of collection 5 Hospital and wardclinic area 6 Both sample and form must be signed and initialled by person taking blood USING ADDRESSOGRAPH LABELS ON TRANSFUSION SAMPLES I S PROHIBITED INADEQUATELY or INCORRECTLY LABELLED SPECIMENS WILL NOT BE ACCEPTED Samples required bull 7 ml EDTA blood (pink top) for adults and large children bull 4 ml EDTA blood (purple top) for small children needing only 1-2 units of blood If patient has been transfused within 3-14 days a sample taken will be valid for 24 hours for provision of cross-matched blood before a new sample is required

33

If patient has been transfused within 15-28 days a sample taken will be valid for 72 hours for provision of cross-matched blood before new sample is required If patient has been transfused more than 29 days before [or never transfused] a sample taken will be valid for 7 days for provision of cross-matched blood before new sample is required Pregnant Women bull A blood sample should be sent to the transfusion laboratory on the day of surgery for a pregnant woman even

if a sample has been taken within 7 days bull Blood will be released based on the group and save sample received within 7 days but the sample taken on

the day of delivery will be used to retrospectively check should a transfusion reaction occur This is accordance with BCSH guidance on blood transfusion support for obstetrics (2004) Infant Samples bull For infants less than 4 months a maternal sample of EDTA blood must accompany the first sample taken

from the infant bull Samples from infants are collected in labelled small plastic vials bull Label must include full name and date of birth bull The sample must be signed and initialled by person taking blood bull Also include name date of birth and CHI number of the mother on babyrsquos request form bull The Blood transfusion Laboratory must be informed in writing if the babyrsquos forename or surname changes Patients carrying Blood Group Antibody Reference Ca rds Please include information given on the Reference Card when requesting group and antibody screen or cross match Unidentified Patients Admitted Via AampE Use TYPENEX (red) identification bands These unique number bands are designed to correlate positive identification of patient sample request form and cross matched blood Instruction (also displayed in AampE) bull Write any identification available (Casualty Number approximate age gender etc) on the red blank part of

the label near the clip bull Peel off and attach to blood sample tube bull The information is duplicated on the band bull Wrap band once round patientrsquos wrist or ankle close tamperproof clip bull Use encoded label from end of band and AampE number to identify request form bull Attach remainder to request form and send it to blood transfusion laboratory

34

bull In the laboratory the labels are used to identify each unit of blood for the Patient bull Before transfusion confirm that the TYPENEX labels on blood pack and report form match code on patientrsquos

identity band bull Match all other identifying information

35

Appendix 9 Collection and Delivery of Blood and Bl ood Components Only members of staff who have completed appropriate transfusion training may collect blood and blood components Prior to collection of blood components clinical st aff should ensure bull Transfusion Authorisationprescription chart has been completed bull Patient has viable venous access and an Intravenous Blood giving-set is available bull Baseline observations of Temperature Pulse Blood Pressure Oxygen Saturation and Respirations have

been completed and recorded no more than 1 hour pre transfusion bull Review the patientrsquos case notes to check for any special requirements and to confirm that the patient has not

had a transfusion reaction in the past Clinical staff are required to complete a blood com ponent collection form for each component bull The person completing the collection form is responsible for positively identifying the patient and ensuring that

the patient identification details written on collection form have been confirmed against the patientrsquos identification wristband (or risk assessed alternative)

bull Whenever possible patients should be asked to identify themselves verbally with an open question egrdquo

Please can you tell me your name and date of birth in fullrdquo bull The details given by the patient must match those written on the patientrsquos wristband (or risk assessed

alternative) and these details in turn must match those written on the collection form Details must include bull Patients full name bull Date of birth and CHI bull Ward clinical area bull Component required bull Record of the date and time and signature of practitioner Collection bull Withdraw component from blood bankblood fridge only immediately before it is due to be administered when

you have 1 confirmed that reliable venous access has been secured 2 confirmed that transfusion has been authorisedprescribed

bull Withdraw only one unit at a time except in a life-threatening emergency bull Ensure fridge door is closed after removal of Red Cell Component prior to completing identification checks bull Patient identification details (forename surname date of birth and CHI) on the Blood Component Collection

form must be checked with the patient identification details on blood pack compatibility tag( visible through the clear outer wrap bag) and the details on fridge register sheet allocated for patient

bull Clear plastic outer wrap bag should remain intact until final bedside checks are complete and administration

is to take place

36

If there is any discrepancy noted inform the Trans fusion Laboratory immediately and reconfirm patient rsquos details before proceeding any further bull Undertake visual inspection of blood component and check for leaks or discolouration bull Check expiry date bull The member of staff who collects the component must complete appropriate fridge register documentation

inventory for the named patient and record against the unique donation number for component removed 1 The date and time of removal from the fridge 2 Sign their initials signature 3 The date and time of returning the unit(s) to the refrigerator if not Transfused Once they have left the Hospital Transfusion Laboratory or Satellite Fridge blood components must not be left unattended and must be received by a member of staff in the clinical area bull On receipt in clinical area the component should be checked to ensure that the correct blood has been

delivered bull The component should then be immediately taken to the patientrsquos bedside and administered appropriately If emergency blood is withdrawn from any of the blo od fridges the Hospital Transfusion Laboratory must be informed immediately in order to supply further transfusion support and to replace the emergency blood

37

Appendix 10 Administration of Red Cells As a minimum all staff involved in the administration process must have completed Level 1 Safe Transfusion Practice or equivalent (QIS 2006) bull The minimum acceptable details required to transfuse are surname forename date of birth gender

unique identifier ie CHI bull The typenex system should always be used for patients for whom no forename surname and date of birth

are available bull Any information supplied on the blood component or compatibility tag must match the patients ID wristband bull Any discrepancies should be queried with the Hospital Transfusion Laboratory bull Do not transfuse overnight unless clinically indica ted for a life threatening situation bull Transfusion must be complete within 4 hours of removing blood component from temperature controlled

storage If blood component is out of temperature controlled storage for bull Less than 30 minutes the intact unit pack may be returned to transfusion laboratory or satellite blood fridge if

no longer required record date and time of return on fridge register and inform transfusion laboratory bull More than 30 minutes it can still be transfused if transfusion is completed within 4 hours of initial removal time bull Where blood has been out of fridge for more than 30 mins and cannot will not be transfused please inform

transfusion laboratory and follow advice given BLOOD MUST NOT BE STORED IN WARD REFRIDGERATORS bull Two registered practitioners are required to perform the administration Checks bull All checks should take place at the patientrsquos side with no interruption bull If staff are interrupted they must start the checking procedure again Pre-Administration bull Confirm blood component has been prescribedauthorised bull Check patient has patent IV access and an IV blood giving set with an integral aggregate micron filter is

available bull Confirm baseline set of observations has been completed and recorded bull Ensure patient can be easily observed and has access to a call bell should they begin to feel unwell bull Do not remove the blood component from the outer plastic bag until you have confirmed the component is the

correct one for the patient and you are ready to administer the component bull While the component is still in the sealed outer bag carry out a visual examination of the blood pack to check

for signs of discoloration clotting and haemolysis Test integrity of pack for leaks by squeezing gently but firmly

38

bull Check expiry date on pack If any discrepancies are found the unit must not b e transfused The Hospital Transfusion Laboratory and relevant me dical staff must be informed immediately Administration bull Ask the patient (or parent guardian) to state his her full name and date of birth Ensure that the patient is

wearing an identity band and that the details correspond Reliance must not be placed on familiarity bull Failure to perform the final bedside check of patient identification details is the commonest cause of incorrect

blood component transfused related incidents bull A silent two person individual checking process is required at this point by the two registered practitioners bull Check patient details on component unit traceability compatibility label against the patientrsquos identification

band ndash full name date of birth CHIunique number gender bull Check traceability compatibility tag details against blood bag label to confirm positive match of donor

component number blood group and Rh D group bull Both practitioners must sign pink adhesive section of traceability compatibility tag to confirm they have

checked blood component against patientrsquos identification band including date and time (this should then be attached to the transfusion record sheet or transfusion pathway document in patient notes)

bull Commence transfusion bull Blood components must be transfused using a giving set with an integral micron aggregate filter Where

infusion devices are to be used special giving sets for transfusion must be used bull Blood transfusion giving sets must be changed every 12 hours in order to prevent bacterial growth (BCSH

2009) bull Only Sodium Chloride 09 may be used to prime the giving set No other infusion fluids or drugs should be

infused through the same venflon whilst a transfusion is in progress bull The duration of the transfusion is entirely dependent on the clinical situation although each red cell

transfusion has to be completed within 4 hours of blood leaving the fridge (taking into consideration the time already elapsed to collectdeliver and complete final identification administration checks)

Blue tear off tags Transfusion Traceability bull The tear off traceability labels should not be detached from the bag nor completed until transfusion has

commenced bull Once transfusion has commenced the blue tear off tag must be fully completed as so on as the patient

receives even a small amount of the blood or blood component bull One of the two registered practitioners undertaking the administration checks must fully complete the

blue tear-off traceability tag( details required include printing amp signing their full name with date amp start time of transfusion )

bull Fully completed traceability tags should be returned to the Hospital Transfusion Laboratory using the

container provided or locally agreed method for outlying hospitals bull The return of the blue tear-off tag to the transfusion laboratory is a legal requirement outlined in the UK

Blood Safety and Quality Regulations (2005)

39

bull If three days after the blood has been issued the laboratory has not received the blue tear-off tag a Letter A will be issued to the Senior Charge Nurse on the ward requesting return of the completed blue tag or confirmation that component transfusion has taken place (photocopy of the completed pink adhesive label is permissible)

bull If after 7 days following issue of letter A the blue tag or a photocopy of the pink label has not been received

a letter B will be issued bull If after another 7 days no reply has been received an NHS Tayside incident report will be generated

40

Appendix 11 Administration of Other Blood Componen tsFFP Cryoprecipitate Platelets Prothrombin Complex Concentrate( PCC) and Anti-D These are ordered for individual patients Return any unused components to BTS without delay Fresh Frozen Plasma (FFP) bull Request FFP using a BTS Request form bull For un-grouped patients send 7 ml of EDTA blood for grouping with the request form bull FFP is stored frozen and needs to be defrosted before it is released from the laboratory This leads to an

inevitable delay from request to delivery of FFP bull It is realistic to expect at least an hour to pass between requesting and receiving FFP bull It supplied ready thawed and should be used immediately bull The infusion rate for FFP is entirely dependent on the clinical circumstances However each unit should be completed in a maximum of 4 hours from the time that the FFP leaves the blood transfusion laboratory

bull FFP should not be infused through a giving set that has been used for bloodother blood components or any other substance

Administration of Cryoprecipitate bull This is as for red cells except that cryoprecipitate is usually administered over 30ndash60 minutes or less

depending on clinical circumstances bull Cryoprecipitate should not be infused through a giving set that has been used for blood or any other

substance Administration of Platelets bull Platelets are used to treat patients who are bleeding or who are at risk of bleeding due to a low platelet count

or platelets that do not function properly bull Platelets are stored in the laboratory at room temperature bull Once platelets have been prepared and received on the ward they should be infused immediately bull They must not be refrigerated bull Platelets are usually given over 15-30 minutes using a standard gravity feed blood giving set bull Platelets should not be infused through a giving set that has been used for blood or any other substance Since platelets may not be immediately available f orward planning of treatment is essential bull Contact haematology on call medical staff stating name of patient diagnosis platelet count degree of

urgency and likely duration of treatment bull Send request on BTS request form together with a grouping sample if patientrsquos group is not yet known

41

bull Maintenance treatment should be planned ahead in consultation with haematology medical staff bull Use a standard gravity feed blood giving set for infusion pre-primed with 09 sodium chloride solution Coagulation Factors bull Prothrombin complex concentrate for warfarin reversal ndash only issued after discussion with on call

haematology medical staff bull Dose required is dependent on INR patientrsquos weight product used and clinical circumstances Specific immunoglobulins (Anti-D) This can be requested after discussion with haematology lab staff Hyperimmune immunoglobulins are obtained through pharmacy

42

Appendix 12 Blood Components Available from ESBTC Transfusion Laboratory bull Platelets bull Fresh Frozen Plasma bull Fresh Frozen Plasma Methylene Blue Treated and Removed bull Cryoprecipitate (Pooled Frozen) bull Cryoprecipitate Methylene Blue Treated and Removed For all blood component requests please complete a Blue Blood Transfusion Request Form

bull To request FFP and platelets contact Compatibility Laboratory on Ex 32953

bull In certain cases requests for FFP and platelets may be referred to the BTS Duty Medical Officer

bull All requests for cryoprecipitate must be discussed with BTS Duty Medical Officer Unless otherwise specified all components are leucodepleted and conform to the UKBTSNIBSC Guidelines for the Blood Transfusion Service and any nationally agreed revisions Special Requirements For patients with special requirements (eg CMV negative or irradiated) these must be stated on the request form for each request for blood components Blood Product Requests ESBTC provides the following blood products bull bull Anti D Immunoglobulin bull Factor VIII Concentrates bull Factor IX Concentrates bull Octaplex bull Berinet P (C1-esterase inhibitor) bull NovoSeven (factor Vila) bull Octoplas (solvent detergent treated human plasma) All the products listed are licensed by the MHRA For all blood product requests please complete a Blood Transfusion Request Form To request human immunoglobulin for intravenous use human normal immunoglobulin or specific immunoglobulin contact Compatibility Laboratory on Ext 32953 Requests for Factor VIII and Factor IX concentrates should be discussed with the Regional Haemophilia Centre

43

Appendix 13 Monitoring For each blood component transfused bull Record pre-transfusion observations no more than 60 minutes before start of transfusion -

Temperature Pulse Blood Pressure Respiration rate and Oxygen Saturation rate bull Record observations at 15 minutes and again at 30 minutes after transfusion has commenced Temperature Pulse Blood Pressure Respiration rate and Oxygen Saturation rate bull Thereafter record Temperature Blood Pressure and Pulse hourly until completion of component unit (If recordings have changed from baseline values also record respiration rate) bull If patient shows signs or symptoms of a transfusion reaction STOP transfusion (see Appendix 3a and 3b on Adverse Reaction to Transfusion ) bull Record post-transfusion observations within 60 minutes of completion of transfusion -Temperature Pulse

Blood Pressure Respiration rate and Oxygen Saturation rate bull Record post-transfusion full blood count and clinical outcome in patient records bull Further measurement and recording of vital signs may be undertaken at the discretion of clinical staff and with

regard to the patients clinical status bull Urine output should also be monitored at regular intervals throughout the Transfusion

44

Appendix 14 PaediatricNeonatal Considerations Blood for Infants bull Red cell paediatric unitsrsquo dosing is based on patientrsquos weight ndash seek paediatric advice bull Paediatric blood is supplied in packs which usually contain a quarter of the volume of an adult pack bull Paediatric giving sets should be used for transfusion in infants microbore tubing is used in the neonatal unit bull Micro-aggregate filters should be used in neonates bull Volume of blood to be given is usually dependent on the childrsquos weight (BJH 2004) bull Certain conditions may also apply with regard to indications for irradiated blood components or CMV antibody

negative blood components Further guidance and information may be sought from the Hospital Transfusion Laboratory bull Transfusion guidelines for neonates and older children (2004) and amendments (2005 and 2007) httponlinelibrarywileycomdoi101111j1365-2141200404815xfull wwwbcshguidelinescompdfamendments_neonates_091205pdf httpwwwbcshguidelinescomdocumentsFFP_neonate_Amendment_1_17_Oct_2007pdf

31

Appendix 7 Authorising Prescribing Transfusion S upport bull The authorisation prescription must be signed by a medical practitioner or an authorised Advanced Nurse

Practitioner

bull It must specify the blood component to be administered the number of units duration and any special requirements or instructions (BCSH 2009)

bull Blood and blood components must always be authorised prescribed prior to commencement of treatment

32

Appendix 8 Taking the Blood Sample The person collecting the sample is responsible for positive identification of the patient prior to taking sample bull Full legible labelling of the sample in black ballpoint ink (see also Infant Samples) This is a critical step in the transfusion process bull Whenever possible patients should be asked to identify themselves verbally with an open question egrdquo

Please can you tell me your full name and date of birthrdquo bull The details given by the patient must match those written on the patientrsquos wristband (or risk assessed

alternative) and these details in turn must match those on the request form The information must be hand written on the sample tube and must contain a minimum of forename surname date of birth CHI gender and signature o f the person taking the sample Inpatient samples must also include the hospital and wardclinic area bull Collection of the blood sample must be carried out individually for each Patient bull Subsequent labelling of the sample tubes should be performed as one continuous uninterrupted event at the

patientrsquos (bed) side after drawing the sample and before leaving patient bull Please note that as soon as a blood transfusion sample is taken it must be sent to the Hospital Transfusion

Laboratory with a request form bull Blood transfusion samples must not be retained in the clinical area for delivery to the laboratory at a later time

or date bull Request forms must state which hospital ward clinic GP surgery sample was taken and which hospitalclinical area any transfusion is to take place Sample label and request form must bear 1 Full name of patient 2 Date of birth CHI number 3 Gender of patient 4 Time and date of collection 5 Hospital and wardclinic area 6 Both sample and form must be signed and initialled by person taking blood USING ADDRESSOGRAPH LABELS ON TRANSFUSION SAMPLES I S PROHIBITED INADEQUATELY or INCORRECTLY LABELLED SPECIMENS WILL NOT BE ACCEPTED Samples required bull 7 ml EDTA blood (pink top) for adults and large children bull 4 ml EDTA blood (purple top) for small children needing only 1-2 units of blood If patient has been transfused within 3-14 days a sample taken will be valid for 24 hours for provision of cross-matched blood before a new sample is required

33

If patient has been transfused within 15-28 days a sample taken will be valid for 72 hours for provision of cross-matched blood before new sample is required If patient has been transfused more than 29 days before [or never transfused] a sample taken will be valid for 7 days for provision of cross-matched blood before new sample is required Pregnant Women bull A blood sample should be sent to the transfusion laboratory on the day of surgery for a pregnant woman even

if a sample has been taken within 7 days bull Blood will be released based on the group and save sample received within 7 days but the sample taken on

the day of delivery will be used to retrospectively check should a transfusion reaction occur This is accordance with BCSH guidance on blood transfusion support for obstetrics (2004) Infant Samples bull For infants less than 4 months a maternal sample of EDTA blood must accompany the first sample taken

from the infant bull Samples from infants are collected in labelled small plastic vials bull Label must include full name and date of birth bull The sample must be signed and initialled by person taking blood bull Also include name date of birth and CHI number of the mother on babyrsquos request form bull The Blood transfusion Laboratory must be informed in writing if the babyrsquos forename or surname changes Patients carrying Blood Group Antibody Reference Ca rds Please include information given on the Reference Card when requesting group and antibody screen or cross match Unidentified Patients Admitted Via AampE Use TYPENEX (red) identification bands These unique number bands are designed to correlate positive identification of patient sample request form and cross matched blood Instruction (also displayed in AampE) bull Write any identification available (Casualty Number approximate age gender etc) on the red blank part of

the label near the clip bull Peel off and attach to blood sample tube bull The information is duplicated on the band bull Wrap band once round patientrsquos wrist or ankle close tamperproof clip bull Use encoded label from end of band and AampE number to identify request form bull Attach remainder to request form and send it to blood transfusion laboratory

34

bull In the laboratory the labels are used to identify each unit of blood for the Patient bull Before transfusion confirm that the TYPENEX labels on blood pack and report form match code on patientrsquos

identity band bull Match all other identifying information

35

Appendix 9 Collection and Delivery of Blood and Bl ood Components Only members of staff who have completed appropriate transfusion training may collect blood and blood components Prior to collection of blood components clinical st aff should ensure bull Transfusion Authorisationprescription chart has been completed bull Patient has viable venous access and an Intravenous Blood giving-set is available bull Baseline observations of Temperature Pulse Blood Pressure Oxygen Saturation and Respirations have

been completed and recorded no more than 1 hour pre transfusion bull Review the patientrsquos case notes to check for any special requirements and to confirm that the patient has not

had a transfusion reaction in the past Clinical staff are required to complete a blood com ponent collection form for each component bull The person completing the collection form is responsible for positively identifying the patient and ensuring that

the patient identification details written on collection form have been confirmed against the patientrsquos identification wristband (or risk assessed alternative)

bull Whenever possible patients should be asked to identify themselves verbally with an open question egrdquo

Please can you tell me your name and date of birth in fullrdquo bull The details given by the patient must match those written on the patientrsquos wristband (or risk assessed

alternative) and these details in turn must match those written on the collection form Details must include bull Patients full name bull Date of birth and CHI bull Ward clinical area bull Component required bull Record of the date and time and signature of practitioner Collection bull Withdraw component from blood bankblood fridge only immediately before it is due to be administered when

you have 1 confirmed that reliable venous access has been secured 2 confirmed that transfusion has been authorisedprescribed

bull Withdraw only one unit at a time except in a life-threatening emergency bull Ensure fridge door is closed after removal of Red Cell Component prior to completing identification checks bull Patient identification details (forename surname date of birth and CHI) on the Blood Component Collection

form must be checked with the patient identification details on blood pack compatibility tag( visible through the clear outer wrap bag) and the details on fridge register sheet allocated for patient

bull Clear plastic outer wrap bag should remain intact until final bedside checks are complete and administration

is to take place

36

If there is any discrepancy noted inform the Trans fusion Laboratory immediately and reconfirm patient rsquos details before proceeding any further bull Undertake visual inspection of blood component and check for leaks or discolouration bull Check expiry date bull The member of staff who collects the component must complete appropriate fridge register documentation

inventory for the named patient and record against the unique donation number for component removed 1 The date and time of removal from the fridge 2 Sign their initials signature 3 The date and time of returning the unit(s) to the refrigerator if not Transfused Once they have left the Hospital Transfusion Laboratory or Satellite Fridge blood components must not be left unattended and must be received by a member of staff in the clinical area bull On receipt in clinical area the component should be checked to ensure that the correct blood has been

delivered bull The component should then be immediately taken to the patientrsquos bedside and administered appropriately If emergency blood is withdrawn from any of the blo od fridges the Hospital Transfusion Laboratory must be informed immediately in order to supply further transfusion support and to replace the emergency blood

37

Appendix 10 Administration of Red Cells As a minimum all staff involved in the administration process must have completed Level 1 Safe Transfusion Practice or equivalent (QIS 2006) bull The minimum acceptable details required to transfuse are surname forename date of birth gender

unique identifier ie CHI bull The typenex system should always be used for patients for whom no forename surname and date of birth

are available bull Any information supplied on the blood component or compatibility tag must match the patients ID wristband bull Any discrepancies should be queried with the Hospital Transfusion Laboratory bull Do not transfuse overnight unless clinically indica ted for a life threatening situation bull Transfusion must be complete within 4 hours of removing blood component from temperature controlled

storage If blood component is out of temperature controlled storage for bull Less than 30 minutes the intact unit pack may be returned to transfusion laboratory or satellite blood fridge if

no longer required record date and time of return on fridge register and inform transfusion laboratory bull More than 30 minutes it can still be transfused if transfusion is completed within 4 hours of initial removal time bull Where blood has been out of fridge for more than 30 mins and cannot will not be transfused please inform

transfusion laboratory and follow advice given BLOOD MUST NOT BE STORED IN WARD REFRIDGERATORS bull Two registered practitioners are required to perform the administration Checks bull All checks should take place at the patientrsquos side with no interruption bull If staff are interrupted they must start the checking procedure again Pre-Administration bull Confirm blood component has been prescribedauthorised bull Check patient has patent IV access and an IV blood giving set with an integral aggregate micron filter is

available bull Confirm baseline set of observations has been completed and recorded bull Ensure patient can be easily observed and has access to a call bell should they begin to feel unwell bull Do not remove the blood component from the outer plastic bag until you have confirmed the component is the

correct one for the patient and you are ready to administer the component bull While the component is still in the sealed outer bag carry out a visual examination of the blood pack to check

for signs of discoloration clotting and haemolysis Test integrity of pack for leaks by squeezing gently but firmly

38

bull Check expiry date on pack If any discrepancies are found the unit must not b e transfused The Hospital Transfusion Laboratory and relevant me dical staff must be informed immediately Administration bull Ask the patient (or parent guardian) to state his her full name and date of birth Ensure that the patient is

wearing an identity band and that the details correspond Reliance must not be placed on familiarity bull Failure to perform the final bedside check of patient identification details is the commonest cause of incorrect

blood component transfused related incidents bull A silent two person individual checking process is required at this point by the two registered practitioners bull Check patient details on component unit traceability compatibility label against the patientrsquos identification

band ndash full name date of birth CHIunique number gender bull Check traceability compatibility tag details against blood bag label to confirm positive match of donor

component number blood group and Rh D group bull Both practitioners must sign pink adhesive section of traceability compatibility tag to confirm they have

checked blood component against patientrsquos identification band including date and time (this should then be attached to the transfusion record sheet or transfusion pathway document in patient notes)

bull Commence transfusion bull Blood components must be transfused using a giving set with an integral micron aggregate filter Where

infusion devices are to be used special giving sets for transfusion must be used bull Blood transfusion giving sets must be changed every 12 hours in order to prevent bacterial growth (BCSH

2009) bull Only Sodium Chloride 09 may be used to prime the giving set No other infusion fluids or drugs should be

infused through the same venflon whilst a transfusion is in progress bull The duration of the transfusion is entirely dependent on the clinical situation although each red cell

transfusion has to be completed within 4 hours of blood leaving the fridge (taking into consideration the time already elapsed to collectdeliver and complete final identification administration checks)

Blue tear off tags Transfusion Traceability bull The tear off traceability labels should not be detached from the bag nor completed until transfusion has

commenced bull Once transfusion has commenced the blue tear off tag must be fully completed as so on as the patient

receives even a small amount of the blood or blood component bull One of the two registered practitioners undertaking the administration checks must fully complete the

blue tear-off traceability tag( details required include printing amp signing their full name with date amp start time of transfusion )

bull Fully completed traceability tags should be returned to the Hospital Transfusion Laboratory using the

container provided or locally agreed method for outlying hospitals bull The return of the blue tear-off tag to the transfusion laboratory is a legal requirement outlined in the UK

Blood Safety and Quality Regulations (2005)

39

bull If three days after the blood has been issued the laboratory has not received the blue tear-off tag a Letter A will be issued to the Senior Charge Nurse on the ward requesting return of the completed blue tag or confirmation that component transfusion has taken place (photocopy of the completed pink adhesive label is permissible)

bull If after 7 days following issue of letter A the blue tag or a photocopy of the pink label has not been received

a letter B will be issued bull If after another 7 days no reply has been received an NHS Tayside incident report will be generated

40

Appendix 11 Administration of Other Blood Componen tsFFP Cryoprecipitate Platelets Prothrombin Complex Concentrate( PCC) and Anti-D These are ordered for individual patients Return any unused components to BTS without delay Fresh Frozen Plasma (FFP) bull Request FFP using a BTS Request form bull For un-grouped patients send 7 ml of EDTA blood for grouping with the request form bull FFP is stored frozen and needs to be defrosted before it is released from the laboratory This leads to an

inevitable delay from request to delivery of FFP bull It is realistic to expect at least an hour to pass between requesting and receiving FFP bull It supplied ready thawed and should be used immediately bull The infusion rate for FFP is entirely dependent on the clinical circumstances However each unit should be completed in a maximum of 4 hours from the time that the FFP leaves the blood transfusion laboratory

bull FFP should not be infused through a giving set that has been used for bloodother blood components or any other substance

Administration of Cryoprecipitate bull This is as for red cells except that cryoprecipitate is usually administered over 30ndash60 minutes or less

depending on clinical circumstances bull Cryoprecipitate should not be infused through a giving set that has been used for blood or any other

substance Administration of Platelets bull Platelets are used to treat patients who are bleeding or who are at risk of bleeding due to a low platelet count

or platelets that do not function properly bull Platelets are stored in the laboratory at room temperature bull Once platelets have been prepared and received on the ward they should be infused immediately bull They must not be refrigerated bull Platelets are usually given over 15-30 minutes using a standard gravity feed blood giving set bull Platelets should not be infused through a giving set that has been used for blood or any other substance Since platelets may not be immediately available f orward planning of treatment is essential bull Contact haematology on call medical staff stating name of patient diagnosis platelet count degree of

urgency and likely duration of treatment bull Send request on BTS request form together with a grouping sample if patientrsquos group is not yet known

41

bull Maintenance treatment should be planned ahead in consultation with haematology medical staff bull Use a standard gravity feed blood giving set for infusion pre-primed with 09 sodium chloride solution Coagulation Factors bull Prothrombin complex concentrate for warfarin reversal ndash only issued after discussion with on call

haematology medical staff bull Dose required is dependent on INR patientrsquos weight product used and clinical circumstances Specific immunoglobulins (Anti-D) This can be requested after discussion with haematology lab staff Hyperimmune immunoglobulins are obtained through pharmacy

42

Appendix 12 Blood Components Available from ESBTC Transfusion Laboratory bull Platelets bull Fresh Frozen Plasma bull Fresh Frozen Plasma Methylene Blue Treated and Removed bull Cryoprecipitate (Pooled Frozen) bull Cryoprecipitate Methylene Blue Treated and Removed For all blood component requests please complete a Blue Blood Transfusion Request Form

bull To request FFP and platelets contact Compatibility Laboratory on Ex 32953

bull In certain cases requests for FFP and platelets may be referred to the BTS Duty Medical Officer

bull All requests for cryoprecipitate must be discussed with BTS Duty Medical Officer Unless otherwise specified all components are leucodepleted and conform to the UKBTSNIBSC Guidelines for the Blood Transfusion Service and any nationally agreed revisions Special Requirements For patients with special requirements (eg CMV negative or irradiated) these must be stated on the request form for each request for blood components Blood Product Requests ESBTC provides the following blood products bull bull Anti D Immunoglobulin bull Factor VIII Concentrates bull Factor IX Concentrates bull Octaplex bull Berinet P (C1-esterase inhibitor) bull NovoSeven (factor Vila) bull Octoplas (solvent detergent treated human plasma) All the products listed are licensed by the MHRA For all blood product requests please complete a Blood Transfusion Request Form To request human immunoglobulin for intravenous use human normal immunoglobulin or specific immunoglobulin contact Compatibility Laboratory on Ext 32953 Requests for Factor VIII and Factor IX concentrates should be discussed with the Regional Haemophilia Centre

43

Appendix 13 Monitoring For each blood component transfused bull Record pre-transfusion observations no more than 60 minutes before start of transfusion -

Temperature Pulse Blood Pressure Respiration rate and Oxygen Saturation rate bull Record observations at 15 minutes and again at 30 minutes after transfusion has commenced Temperature Pulse Blood Pressure Respiration rate and Oxygen Saturation rate bull Thereafter record Temperature Blood Pressure and Pulse hourly until completion of component unit (If recordings have changed from baseline values also record respiration rate) bull If patient shows signs or symptoms of a transfusion reaction STOP transfusion (see Appendix 3a and 3b on Adverse Reaction to Transfusion ) bull Record post-transfusion observations within 60 minutes of completion of transfusion -Temperature Pulse

Blood Pressure Respiration rate and Oxygen Saturation rate bull Record post-transfusion full blood count and clinical outcome in patient records bull Further measurement and recording of vital signs may be undertaken at the discretion of clinical staff and with

regard to the patients clinical status bull Urine output should also be monitored at regular intervals throughout the Transfusion

44

Appendix 14 PaediatricNeonatal Considerations Blood for Infants bull Red cell paediatric unitsrsquo dosing is based on patientrsquos weight ndash seek paediatric advice bull Paediatric blood is supplied in packs which usually contain a quarter of the volume of an adult pack bull Paediatric giving sets should be used for transfusion in infants microbore tubing is used in the neonatal unit bull Micro-aggregate filters should be used in neonates bull Volume of blood to be given is usually dependent on the childrsquos weight (BJH 2004) bull Certain conditions may also apply with regard to indications for irradiated blood components or CMV antibody

negative blood components Further guidance and information may be sought from the Hospital Transfusion Laboratory bull Transfusion guidelines for neonates and older children (2004) and amendments (2005 and 2007) httponlinelibrarywileycomdoi101111j1365-2141200404815xfull wwwbcshguidelinescompdfamendments_neonates_091205pdf httpwwwbcshguidelinescomdocumentsFFP_neonate_Amendment_1_17_Oct_2007pdf

32

Appendix 8 Taking the Blood Sample The person collecting the sample is responsible for positive identification of the patient prior to taking sample bull Full legible labelling of the sample in black ballpoint ink (see also Infant Samples) This is a critical step in the transfusion process bull Whenever possible patients should be asked to identify themselves verbally with an open question egrdquo

Please can you tell me your full name and date of birthrdquo bull The details given by the patient must match those written on the patientrsquos wristband (or risk assessed

alternative) and these details in turn must match those on the request form The information must be hand written on the sample tube and must contain a minimum of forename surname date of birth CHI gender and signature o f the person taking the sample Inpatient samples must also include the hospital and wardclinic area bull Collection of the blood sample must be carried out individually for each Patient bull Subsequent labelling of the sample tubes should be performed as one continuous uninterrupted event at the

patientrsquos (bed) side after drawing the sample and before leaving patient bull Please note that as soon as a blood transfusion sample is taken it must be sent to the Hospital Transfusion

Laboratory with a request form bull Blood transfusion samples must not be retained in the clinical area for delivery to the laboratory at a later time

or date bull Request forms must state which hospital ward clinic GP surgery sample was taken and which hospitalclinical area any transfusion is to take place Sample label and request form must bear 1 Full name of patient 2 Date of birth CHI number 3 Gender of patient 4 Time and date of collection 5 Hospital and wardclinic area 6 Both sample and form must be signed and initialled by person taking blood USING ADDRESSOGRAPH LABELS ON TRANSFUSION SAMPLES I S PROHIBITED INADEQUATELY or INCORRECTLY LABELLED SPECIMENS WILL NOT BE ACCEPTED Samples required bull 7 ml EDTA blood (pink top) for adults and large children bull 4 ml EDTA blood (purple top) for small children needing only 1-2 units of blood If patient has been transfused within 3-14 days a sample taken will be valid for 24 hours for provision of cross-matched blood before a new sample is required

33

If patient has been transfused within 15-28 days a sample taken will be valid for 72 hours for provision of cross-matched blood before new sample is required If patient has been transfused more than 29 days before [or never transfused] a sample taken will be valid for 7 days for provision of cross-matched blood before new sample is required Pregnant Women bull A blood sample should be sent to the transfusion laboratory on the day of surgery for a pregnant woman even

if a sample has been taken within 7 days bull Blood will be released based on the group and save sample received within 7 days but the sample taken on

the day of delivery will be used to retrospectively check should a transfusion reaction occur This is accordance with BCSH guidance on blood transfusion support for obstetrics (2004) Infant Samples bull For infants less than 4 months a maternal sample of EDTA blood must accompany the first sample taken

from the infant bull Samples from infants are collected in labelled small plastic vials bull Label must include full name and date of birth bull The sample must be signed and initialled by person taking blood bull Also include name date of birth and CHI number of the mother on babyrsquos request form bull The Blood transfusion Laboratory must be informed in writing if the babyrsquos forename or surname changes Patients carrying Blood Group Antibody Reference Ca rds Please include information given on the Reference Card when requesting group and antibody screen or cross match Unidentified Patients Admitted Via AampE Use TYPENEX (red) identification bands These unique number bands are designed to correlate positive identification of patient sample request form and cross matched blood Instruction (also displayed in AampE) bull Write any identification available (Casualty Number approximate age gender etc) on the red blank part of

the label near the clip bull Peel off and attach to blood sample tube bull The information is duplicated on the band bull Wrap band once round patientrsquos wrist or ankle close tamperproof clip bull Use encoded label from end of band and AampE number to identify request form bull Attach remainder to request form and send it to blood transfusion laboratory

34

bull In the laboratory the labels are used to identify each unit of blood for the Patient bull Before transfusion confirm that the TYPENEX labels on blood pack and report form match code on patientrsquos

identity band bull Match all other identifying information

35

Appendix 9 Collection and Delivery of Blood and Bl ood Components Only members of staff who have completed appropriate transfusion training may collect blood and blood components Prior to collection of blood components clinical st aff should ensure bull Transfusion Authorisationprescription chart has been completed bull Patient has viable venous access and an Intravenous Blood giving-set is available bull Baseline observations of Temperature Pulse Blood Pressure Oxygen Saturation and Respirations have

been completed and recorded no more than 1 hour pre transfusion bull Review the patientrsquos case notes to check for any special requirements and to confirm that the patient has not

had a transfusion reaction in the past Clinical staff are required to complete a blood com ponent collection form for each component bull The person completing the collection form is responsible for positively identifying the patient and ensuring that

the patient identification details written on collection form have been confirmed against the patientrsquos identification wristband (or risk assessed alternative)

bull Whenever possible patients should be asked to identify themselves verbally with an open question egrdquo

Please can you tell me your name and date of birth in fullrdquo bull The details given by the patient must match those written on the patientrsquos wristband (or risk assessed

alternative) and these details in turn must match those written on the collection form Details must include bull Patients full name bull Date of birth and CHI bull Ward clinical area bull Component required bull Record of the date and time and signature of practitioner Collection bull Withdraw component from blood bankblood fridge only immediately before it is due to be administered when

you have 1 confirmed that reliable venous access has been secured 2 confirmed that transfusion has been authorisedprescribed

bull Withdraw only one unit at a time except in a life-threatening emergency bull Ensure fridge door is closed after removal of Red Cell Component prior to completing identification checks bull Patient identification details (forename surname date of birth and CHI) on the Blood Component Collection

form must be checked with the patient identification details on blood pack compatibility tag( visible through the clear outer wrap bag) and the details on fridge register sheet allocated for patient

bull Clear plastic outer wrap bag should remain intact until final bedside checks are complete and administration

is to take place

36

If there is any discrepancy noted inform the Trans fusion Laboratory immediately and reconfirm patient rsquos details before proceeding any further bull Undertake visual inspection of blood component and check for leaks or discolouration bull Check expiry date bull The member of staff who collects the component must complete appropriate fridge register documentation

inventory for the named patient and record against the unique donation number for component removed 1 The date and time of removal from the fridge 2 Sign their initials signature 3 The date and time of returning the unit(s) to the refrigerator if not Transfused Once they have left the Hospital Transfusion Laboratory or Satellite Fridge blood components must not be left unattended and must be received by a member of staff in the clinical area bull On receipt in clinical area the component should be checked to ensure that the correct blood has been

delivered bull The component should then be immediately taken to the patientrsquos bedside and administered appropriately If emergency blood is withdrawn from any of the blo od fridges the Hospital Transfusion Laboratory must be informed immediately in order to supply further transfusion support and to replace the emergency blood

37

Appendix 10 Administration of Red Cells As a minimum all staff involved in the administration process must have completed Level 1 Safe Transfusion Practice or equivalent (QIS 2006) bull The minimum acceptable details required to transfuse are surname forename date of birth gender

unique identifier ie CHI bull The typenex system should always be used for patients for whom no forename surname and date of birth

are available bull Any information supplied on the blood component or compatibility tag must match the patients ID wristband bull Any discrepancies should be queried with the Hospital Transfusion Laboratory bull Do not transfuse overnight unless clinically indica ted for a life threatening situation bull Transfusion must be complete within 4 hours of removing blood component from temperature controlled

storage If blood component is out of temperature controlled storage for bull Less than 30 minutes the intact unit pack may be returned to transfusion laboratory or satellite blood fridge if

no longer required record date and time of return on fridge register and inform transfusion laboratory bull More than 30 minutes it can still be transfused if transfusion is completed within 4 hours of initial removal time bull Where blood has been out of fridge for more than 30 mins and cannot will not be transfused please inform

transfusion laboratory and follow advice given BLOOD MUST NOT BE STORED IN WARD REFRIDGERATORS bull Two registered practitioners are required to perform the administration Checks bull All checks should take place at the patientrsquos side with no interruption bull If staff are interrupted they must start the checking procedure again Pre-Administration bull Confirm blood component has been prescribedauthorised bull Check patient has patent IV access and an IV blood giving set with an integral aggregate micron filter is

available bull Confirm baseline set of observations has been completed and recorded bull Ensure patient can be easily observed and has access to a call bell should they begin to feel unwell bull Do not remove the blood component from the outer plastic bag until you have confirmed the component is the

correct one for the patient and you are ready to administer the component bull While the component is still in the sealed outer bag carry out a visual examination of the blood pack to check

for signs of discoloration clotting and haemolysis Test integrity of pack for leaks by squeezing gently but firmly

38

bull Check expiry date on pack If any discrepancies are found the unit must not b e transfused The Hospital Transfusion Laboratory and relevant me dical staff must be informed immediately Administration bull Ask the patient (or parent guardian) to state his her full name and date of birth Ensure that the patient is

wearing an identity band and that the details correspond Reliance must not be placed on familiarity bull Failure to perform the final bedside check of patient identification details is the commonest cause of incorrect

blood component transfused related incidents bull A silent two person individual checking process is required at this point by the two registered practitioners bull Check patient details on component unit traceability compatibility label against the patientrsquos identification

band ndash full name date of birth CHIunique number gender bull Check traceability compatibility tag details against blood bag label to confirm positive match of donor

component number blood group and Rh D group bull Both practitioners must sign pink adhesive section of traceability compatibility tag to confirm they have

checked blood component against patientrsquos identification band including date and time (this should then be attached to the transfusion record sheet or transfusion pathway document in patient notes)

bull Commence transfusion bull Blood components must be transfused using a giving set with an integral micron aggregate filter Where

infusion devices are to be used special giving sets for transfusion must be used bull Blood transfusion giving sets must be changed every 12 hours in order to prevent bacterial growth (BCSH

2009) bull Only Sodium Chloride 09 may be used to prime the giving set No other infusion fluids or drugs should be

infused through the same venflon whilst a transfusion is in progress bull The duration of the transfusion is entirely dependent on the clinical situation although each red cell

transfusion has to be completed within 4 hours of blood leaving the fridge (taking into consideration the time already elapsed to collectdeliver and complete final identification administration checks)

Blue tear off tags Transfusion Traceability bull The tear off traceability labels should not be detached from the bag nor completed until transfusion has

commenced bull Once transfusion has commenced the blue tear off tag must be fully completed as so on as the patient

receives even a small amount of the blood or blood component bull One of the two registered practitioners undertaking the administration checks must fully complete the

blue tear-off traceability tag( details required include printing amp signing their full name with date amp start time of transfusion )

bull Fully completed traceability tags should be returned to the Hospital Transfusion Laboratory using the

container provided or locally agreed method for outlying hospitals bull The return of the blue tear-off tag to the transfusion laboratory is a legal requirement outlined in the UK

Blood Safety and Quality Regulations (2005)

39

bull If three days after the blood has been issued the laboratory has not received the blue tear-off tag a Letter A will be issued to the Senior Charge Nurse on the ward requesting return of the completed blue tag or confirmation that component transfusion has taken place (photocopy of the completed pink adhesive label is permissible)

bull If after 7 days following issue of letter A the blue tag or a photocopy of the pink label has not been received

a letter B will be issued bull If after another 7 days no reply has been received an NHS Tayside incident report will be generated

40

Appendix 11 Administration of Other Blood Componen tsFFP Cryoprecipitate Platelets Prothrombin Complex Concentrate( PCC) and Anti-D These are ordered for individual patients Return any unused components to BTS without delay Fresh Frozen Plasma (FFP) bull Request FFP using a BTS Request form bull For un-grouped patients send 7 ml of EDTA blood for grouping with the request form bull FFP is stored frozen and needs to be defrosted before it is released from the laboratory This leads to an

inevitable delay from request to delivery of FFP bull It is realistic to expect at least an hour to pass between requesting and receiving FFP bull It supplied ready thawed and should be used immediately bull The infusion rate for FFP is entirely dependent on the clinical circumstances However each unit should be completed in a maximum of 4 hours from the time that the FFP leaves the blood transfusion laboratory

bull FFP should not be infused through a giving set that has been used for bloodother blood components or any other substance

Administration of Cryoprecipitate bull This is as for red cells except that cryoprecipitate is usually administered over 30ndash60 minutes or less

depending on clinical circumstances bull Cryoprecipitate should not be infused through a giving set that has been used for blood or any other

substance Administration of Platelets bull Platelets are used to treat patients who are bleeding or who are at risk of bleeding due to a low platelet count

or platelets that do not function properly bull Platelets are stored in the laboratory at room temperature bull Once platelets have been prepared and received on the ward they should be infused immediately bull They must not be refrigerated bull Platelets are usually given over 15-30 minutes using a standard gravity feed blood giving set bull Platelets should not be infused through a giving set that has been used for blood or any other substance Since platelets may not be immediately available f orward planning of treatment is essential bull Contact haematology on call medical staff stating name of patient diagnosis platelet count degree of

urgency and likely duration of treatment bull Send request on BTS request form together with a grouping sample if patientrsquos group is not yet known

41

bull Maintenance treatment should be planned ahead in consultation with haematology medical staff bull Use a standard gravity feed blood giving set for infusion pre-primed with 09 sodium chloride solution Coagulation Factors bull Prothrombin complex concentrate for warfarin reversal ndash only issued after discussion with on call

haematology medical staff bull Dose required is dependent on INR patientrsquos weight product used and clinical circumstances Specific immunoglobulins (Anti-D) This can be requested after discussion with haematology lab staff Hyperimmune immunoglobulins are obtained through pharmacy

42

Appendix 12 Blood Components Available from ESBTC Transfusion Laboratory bull Platelets bull Fresh Frozen Plasma bull Fresh Frozen Plasma Methylene Blue Treated and Removed bull Cryoprecipitate (Pooled Frozen) bull Cryoprecipitate Methylene Blue Treated and Removed For all blood component requests please complete a Blue Blood Transfusion Request Form

bull To request FFP and platelets contact Compatibility Laboratory on Ex 32953

bull In certain cases requests for FFP and platelets may be referred to the BTS Duty Medical Officer

bull All requests for cryoprecipitate must be discussed with BTS Duty Medical Officer Unless otherwise specified all components are leucodepleted and conform to the UKBTSNIBSC Guidelines for the Blood Transfusion Service and any nationally agreed revisions Special Requirements For patients with special requirements (eg CMV negative or irradiated) these must be stated on the request form for each request for blood components Blood Product Requests ESBTC provides the following blood products bull bull Anti D Immunoglobulin bull Factor VIII Concentrates bull Factor IX Concentrates bull Octaplex bull Berinet P (C1-esterase inhibitor) bull NovoSeven (factor Vila) bull Octoplas (solvent detergent treated human plasma) All the products listed are licensed by the MHRA For all blood product requests please complete a Blood Transfusion Request Form To request human immunoglobulin for intravenous use human normal immunoglobulin or specific immunoglobulin contact Compatibility Laboratory on Ext 32953 Requests for Factor VIII and Factor IX concentrates should be discussed with the Regional Haemophilia Centre

43

Appendix 13 Monitoring For each blood component transfused bull Record pre-transfusion observations no more than 60 minutes before start of transfusion -

Temperature Pulse Blood Pressure Respiration rate and Oxygen Saturation rate bull Record observations at 15 minutes and again at 30 minutes after transfusion has commenced Temperature Pulse Blood Pressure Respiration rate and Oxygen Saturation rate bull Thereafter record Temperature Blood Pressure and Pulse hourly until completion of component unit (If recordings have changed from baseline values also record respiration rate) bull If patient shows signs or symptoms of a transfusion reaction STOP transfusion (see Appendix 3a and 3b on Adverse Reaction to Transfusion ) bull Record post-transfusion observations within 60 minutes of completion of transfusion -Temperature Pulse

Blood Pressure Respiration rate and Oxygen Saturation rate bull Record post-transfusion full blood count and clinical outcome in patient records bull Further measurement and recording of vital signs may be undertaken at the discretion of clinical staff and with

regard to the patients clinical status bull Urine output should also be monitored at regular intervals throughout the Transfusion

44

Appendix 14 PaediatricNeonatal Considerations Blood for Infants bull Red cell paediatric unitsrsquo dosing is based on patientrsquos weight ndash seek paediatric advice bull Paediatric blood is supplied in packs which usually contain a quarter of the volume of an adult pack bull Paediatric giving sets should be used for transfusion in infants microbore tubing is used in the neonatal unit bull Micro-aggregate filters should be used in neonates bull Volume of blood to be given is usually dependent on the childrsquos weight (BJH 2004) bull Certain conditions may also apply with regard to indications for irradiated blood components or CMV antibody

negative blood components Further guidance and information may be sought from the Hospital Transfusion Laboratory bull Transfusion guidelines for neonates and older children (2004) and amendments (2005 and 2007) httponlinelibrarywileycomdoi101111j1365-2141200404815xfull wwwbcshguidelinescompdfamendments_neonates_091205pdf httpwwwbcshguidelinescomdocumentsFFP_neonate_Amendment_1_17_Oct_2007pdf

33

If patient has been transfused within 15-28 days a sample taken will be valid for 72 hours for provision of cross-matched blood before new sample is required If patient has been transfused more than 29 days before [or never transfused] a sample taken will be valid for 7 days for provision of cross-matched blood before new sample is required Pregnant Women bull A blood sample should be sent to the transfusion laboratory on the day of surgery for a pregnant woman even

if a sample has been taken within 7 days bull Blood will be released based on the group and save sample received within 7 days but the sample taken on

the day of delivery will be used to retrospectively check should a transfusion reaction occur This is accordance with BCSH guidance on blood transfusion support for obstetrics (2004) Infant Samples bull For infants less than 4 months a maternal sample of EDTA blood must accompany the first sample taken

from the infant bull Samples from infants are collected in labelled small plastic vials bull Label must include full name and date of birth bull The sample must be signed and initialled by person taking blood bull Also include name date of birth and CHI number of the mother on babyrsquos request form bull The Blood transfusion Laboratory must be informed in writing if the babyrsquos forename or surname changes Patients carrying Blood Group Antibody Reference Ca rds Please include information given on the Reference Card when requesting group and antibody screen or cross match Unidentified Patients Admitted Via AampE Use TYPENEX (red) identification bands These unique number bands are designed to correlate positive identification of patient sample request form and cross matched blood Instruction (also displayed in AampE) bull Write any identification available (Casualty Number approximate age gender etc) on the red blank part of

the label near the clip bull Peel off and attach to blood sample tube bull The information is duplicated on the band bull Wrap band once round patientrsquos wrist or ankle close tamperproof clip bull Use encoded label from end of band and AampE number to identify request form bull Attach remainder to request form and send it to blood transfusion laboratory

34

bull In the laboratory the labels are used to identify each unit of blood for the Patient bull Before transfusion confirm that the TYPENEX labels on blood pack and report form match code on patientrsquos

identity band bull Match all other identifying information

35

Appendix 9 Collection and Delivery of Blood and Bl ood Components Only members of staff who have completed appropriate transfusion training may collect blood and blood components Prior to collection of blood components clinical st aff should ensure bull Transfusion Authorisationprescription chart has been completed bull Patient has viable venous access and an Intravenous Blood giving-set is available bull Baseline observations of Temperature Pulse Blood Pressure Oxygen Saturation and Respirations have

been completed and recorded no more than 1 hour pre transfusion bull Review the patientrsquos case notes to check for any special requirements and to confirm that the patient has not

had a transfusion reaction in the past Clinical staff are required to complete a blood com ponent collection form for each component bull The person completing the collection form is responsible for positively identifying the patient and ensuring that

the patient identification details written on collection form have been confirmed against the patientrsquos identification wristband (or risk assessed alternative)

bull Whenever possible patients should be asked to identify themselves verbally with an open question egrdquo

Please can you tell me your name and date of birth in fullrdquo bull The details given by the patient must match those written on the patientrsquos wristband (or risk assessed

alternative) and these details in turn must match those written on the collection form Details must include bull Patients full name bull Date of birth and CHI bull Ward clinical area bull Component required bull Record of the date and time and signature of practitioner Collection bull Withdraw component from blood bankblood fridge only immediately before it is due to be administered when

you have 1 confirmed that reliable venous access has been secured 2 confirmed that transfusion has been authorisedprescribed

bull Withdraw only one unit at a time except in a life-threatening emergency bull Ensure fridge door is closed after removal of Red Cell Component prior to completing identification checks bull Patient identification details (forename surname date of birth and CHI) on the Blood Component Collection

form must be checked with the patient identification details on blood pack compatibility tag( visible through the clear outer wrap bag) and the details on fridge register sheet allocated for patient

bull Clear plastic outer wrap bag should remain intact until final bedside checks are complete and administration

is to take place

36

If there is any discrepancy noted inform the Trans fusion Laboratory immediately and reconfirm patient rsquos details before proceeding any further bull Undertake visual inspection of blood component and check for leaks or discolouration bull Check expiry date bull The member of staff who collects the component must complete appropriate fridge register documentation

inventory for the named patient and record against the unique donation number for component removed 1 The date and time of removal from the fridge 2 Sign their initials signature 3 The date and time of returning the unit(s) to the refrigerator if not Transfused Once they have left the Hospital Transfusion Laboratory or Satellite Fridge blood components must not be left unattended and must be received by a member of staff in the clinical area bull On receipt in clinical area the component should be checked to ensure that the correct blood has been

delivered bull The component should then be immediately taken to the patientrsquos bedside and administered appropriately If emergency blood is withdrawn from any of the blo od fridges the Hospital Transfusion Laboratory must be informed immediately in order to supply further transfusion support and to replace the emergency blood

37

Appendix 10 Administration of Red Cells As a minimum all staff involved in the administration process must have completed Level 1 Safe Transfusion Practice or equivalent (QIS 2006) bull The minimum acceptable details required to transfuse are surname forename date of birth gender

unique identifier ie CHI bull The typenex system should always be used for patients for whom no forename surname and date of birth

are available bull Any information supplied on the blood component or compatibility tag must match the patients ID wristband bull Any discrepancies should be queried with the Hospital Transfusion Laboratory bull Do not transfuse overnight unless clinically indica ted for a life threatening situation bull Transfusion must be complete within 4 hours of removing blood component from temperature controlled

storage If blood component is out of temperature controlled storage for bull Less than 30 minutes the intact unit pack may be returned to transfusion laboratory or satellite blood fridge if

no longer required record date and time of return on fridge register and inform transfusion laboratory bull More than 30 minutes it can still be transfused if transfusion is completed within 4 hours of initial removal time bull Where blood has been out of fridge for more than 30 mins and cannot will not be transfused please inform

transfusion laboratory and follow advice given BLOOD MUST NOT BE STORED IN WARD REFRIDGERATORS bull Two registered practitioners are required to perform the administration Checks bull All checks should take place at the patientrsquos side with no interruption bull If staff are interrupted they must start the checking procedure again Pre-Administration bull Confirm blood component has been prescribedauthorised bull Check patient has patent IV access and an IV blood giving set with an integral aggregate micron filter is

available bull Confirm baseline set of observations has been completed and recorded bull Ensure patient can be easily observed and has access to a call bell should they begin to feel unwell bull Do not remove the blood component from the outer plastic bag until you have confirmed the component is the

correct one for the patient and you are ready to administer the component bull While the component is still in the sealed outer bag carry out a visual examination of the blood pack to check

for signs of discoloration clotting and haemolysis Test integrity of pack for leaks by squeezing gently but firmly

38

bull Check expiry date on pack If any discrepancies are found the unit must not b e transfused The Hospital Transfusion Laboratory and relevant me dical staff must be informed immediately Administration bull Ask the patient (or parent guardian) to state his her full name and date of birth Ensure that the patient is

wearing an identity band and that the details correspond Reliance must not be placed on familiarity bull Failure to perform the final bedside check of patient identification details is the commonest cause of incorrect

blood component transfused related incidents bull A silent two person individual checking process is required at this point by the two registered practitioners bull Check patient details on component unit traceability compatibility label against the patientrsquos identification

band ndash full name date of birth CHIunique number gender bull Check traceability compatibility tag details against blood bag label to confirm positive match of donor

component number blood group and Rh D group bull Both practitioners must sign pink adhesive section of traceability compatibility tag to confirm they have

checked blood component against patientrsquos identification band including date and time (this should then be attached to the transfusion record sheet or transfusion pathway document in patient notes)

bull Commence transfusion bull Blood components must be transfused using a giving set with an integral micron aggregate filter Where

infusion devices are to be used special giving sets for transfusion must be used bull Blood transfusion giving sets must be changed every 12 hours in order to prevent bacterial growth (BCSH

2009) bull Only Sodium Chloride 09 may be used to prime the giving set No other infusion fluids or drugs should be

infused through the same venflon whilst a transfusion is in progress bull The duration of the transfusion is entirely dependent on the clinical situation although each red cell

transfusion has to be completed within 4 hours of blood leaving the fridge (taking into consideration the time already elapsed to collectdeliver and complete final identification administration checks)

Blue tear off tags Transfusion Traceability bull The tear off traceability labels should not be detached from the bag nor completed until transfusion has

commenced bull Once transfusion has commenced the blue tear off tag must be fully completed as so on as the patient

receives even a small amount of the blood or blood component bull One of the two registered practitioners undertaking the administration checks must fully complete the

blue tear-off traceability tag( details required include printing amp signing their full name with date amp start time of transfusion )

bull Fully completed traceability tags should be returned to the Hospital Transfusion Laboratory using the

container provided or locally agreed method for outlying hospitals bull The return of the blue tear-off tag to the transfusion laboratory is a legal requirement outlined in the UK

Blood Safety and Quality Regulations (2005)

39

bull If three days after the blood has been issued the laboratory has not received the blue tear-off tag a Letter A will be issued to the Senior Charge Nurse on the ward requesting return of the completed blue tag or confirmation that component transfusion has taken place (photocopy of the completed pink adhesive label is permissible)

bull If after 7 days following issue of letter A the blue tag or a photocopy of the pink label has not been received

a letter B will be issued bull If after another 7 days no reply has been received an NHS Tayside incident report will be generated

40

Appendix 11 Administration of Other Blood Componen tsFFP Cryoprecipitate Platelets Prothrombin Complex Concentrate( PCC) and Anti-D These are ordered for individual patients Return any unused components to BTS without delay Fresh Frozen Plasma (FFP) bull Request FFP using a BTS Request form bull For un-grouped patients send 7 ml of EDTA blood for grouping with the request form bull FFP is stored frozen and needs to be defrosted before it is released from the laboratory This leads to an

inevitable delay from request to delivery of FFP bull It is realistic to expect at least an hour to pass between requesting and receiving FFP bull It supplied ready thawed and should be used immediately bull The infusion rate for FFP is entirely dependent on the clinical circumstances However each unit should be completed in a maximum of 4 hours from the time that the FFP leaves the blood transfusion laboratory

bull FFP should not be infused through a giving set that has been used for bloodother blood components or any other substance

Administration of Cryoprecipitate bull This is as for red cells except that cryoprecipitate is usually administered over 30ndash60 minutes or less

depending on clinical circumstances bull Cryoprecipitate should not be infused through a giving set that has been used for blood or any other

substance Administration of Platelets bull Platelets are used to treat patients who are bleeding or who are at risk of bleeding due to a low platelet count

or platelets that do not function properly bull Platelets are stored in the laboratory at room temperature bull Once platelets have been prepared and received on the ward they should be infused immediately bull They must not be refrigerated bull Platelets are usually given over 15-30 minutes using a standard gravity feed blood giving set bull Platelets should not be infused through a giving set that has been used for blood or any other substance Since platelets may not be immediately available f orward planning of treatment is essential bull Contact haematology on call medical staff stating name of patient diagnosis platelet count degree of

urgency and likely duration of treatment bull Send request on BTS request form together with a grouping sample if patientrsquos group is not yet known

41

bull Maintenance treatment should be planned ahead in consultation with haematology medical staff bull Use a standard gravity feed blood giving set for infusion pre-primed with 09 sodium chloride solution Coagulation Factors bull Prothrombin complex concentrate for warfarin reversal ndash only issued after discussion with on call

haematology medical staff bull Dose required is dependent on INR patientrsquos weight product used and clinical circumstances Specific immunoglobulins (Anti-D) This can be requested after discussion with haematology lab staff Hyperimmune immunoglobulins are obtained through pharmacy

42

Appendix 12 Blood Components Available from ESBTC Transfusion Laboratory bull Platelets bull Fresh Frozen Plasma bull Fresh Frozen Plasma Methylene Blue Treated and Removed bull Cryoprecipitate (Pooled Frozen) bull Cryoprecipitate Methylene Blue Treated and Removed For all blood component requests please complete a Blue Blood Transfusion Request Form

bull To request FFP and platelets contact Compatibility Laboratory on Ex 32953

bull In certain cases requests for FFP and platelets may be referred to the BTS Duty Medical Officer

bull All requests for cryoprecipitate must be discussed with BTS Duty Medical Officer Unless otherwise specified all components are leucodepleted and conform to the UKBTSNIBSC Guidelines for the Blood Transfusion Service and any nationally agreed revisions Special Requirements For patients with special requirements (eg CMV negative or irradiated) these must be stated on the request form for each request for blood components Blood Product Requests ESBTC provides the following blood products bull bull Anti D Immunoglobulin bull Factor VIII Concentrates bull Factor IX Concentrates bull Octaplex bull Berinet P (C1-esterase inhibitor) bull NovoSeven (factor Vila) bull Octoplas (solvent detergent treated human plasma) All the products listed are licensed by the MHRA For all blood product requests please complete a Blood Transfusion Request Form To request human immunoglobulin for intravenous use human normal immunoglobulin or specific immunoglobulin contact Compatibility Laboratory on Ext 32953 Requests for Factor VIII and Factor IX concentrates should be discussed with the Regional Haemophilia Centre

43

Appendix 13 Monitoring For each blood component transfused bull Record pre-transfusion observations no more than 60 minutes before start of transfusion -

Temperature Pulse Blood Pressure Respiration rate and Oxygen Saturation rate bull Record observations at 15 minutes and again at 30 minutes after transfusion has commenced Temperature Pulse Blood Pressure Respiration rate and Oxygen Saturation rate bull Thereafter record Temperature Blood Pressure and Pulse hourly until completion of component unit (If recordings have changed from baseline values also record respiration rate) bull If patient shows signs or symptoms of a transfusion reaction STOP transfusion (see Appendix 3a and 3b on Adverse Reaction to Transfusion ) bull Record post-transfusion observations within 60 minutes of completion of transfusion -Temperature Pulse

Blood Pressure Respiration rate and Oxygen Saturation rate bull Record post-transfusion full blood count and clinical outcome in patient records bull Further measurement and recording of vital signs may be undertaken at the discretion of clinical staff and with

regard to the patients clinical status bull Urine output should also be monitored at regular intervals throughout the Transfusion

44

Appendix 14 PaediatricNeonatal Considerations Blood for Infants bull Red cell paediatric unitsrsquo dosing is based on patientrsquos weight ndash seek paediatric advice bull Paediatric blood is supplied in packs which usually contain a quarter of the volume of an adult pack bull Paediatric giving sets should be used for transfusion in infants microbore tubing is used in the neonatal unit bull Micro-aggregate filters should be used in neonates bull Volume of blood to be given is usually dependent on the childrsquos weight (BJH 2004) bull Certain conditions may also apply with regard to indications for irradiated blood components or CMV antibody

negative blood components Further guidance and information may be sought from the Hospital Transfusion Laboratory bull Transfusion guidelines for neonates and older children (2004) and amendments (2005 and 2007) httponlinelibrarywileycomdoi101111j1365-2141200404815xfull wwwbcshguidelinescompdfamendments_neonates_091205pdf httpwwwbcshguidelinescomdocumentsFFP_neonate_Amendment_1_17_Oct_2007pdf

34

bull In the laboratory the labels are used to identify each unit of blood for the Patient bull Before transfusion confirm that the TYPENEX labels on blood pack and report form match code on patientrsquos

identity band bull Match all other identifying information

35

Appendix 9 Collection and Delivery of Blood and Bl ood Components Only members of staff who have completed appropriate transfusion training may collect blood and blood components Prior to collection of blood components clinical st aff should ensure bull Transfusion Authorisationprescription chart has been completed bull Patient has viable venous access and an Intravenous Blood giving-set is available bull Baseline observations of Temperature Pulse Blood Pressure Oxygen Saturation and Respirations have

been completed and recorded no more than 1 hour pre transfusion bull Review the patientrsquos case notes to check for any special requirements and to confirm that the patient has not

had a transfusion reaction in the past Clinical staff are required to complete a blood com ponent collection form for each component bull The person completing the collection form is responsible for positively identifying the patient and ensuring that

the patient identification details written on collection form have been confirmed against the patientrsquos identification wristband (or risk assessed alternative)

bull Whenever possible patients should be asked to identify themselves verbally with an open question egrdquo

Please can you tell me your name and date of birth in fullrdquo bull The details given by the patient must match those written on the patientrsquos wristband (or risk assessed

alternative) and these details in turn must match those written on the collection form Details must include bull Patients full name bull Date of birth and CHI bull Ward clinical area bull Component required bull Record of the date and time and signature of practitioner Collection bull Withdraw component from blood bankblood fridge only immediately before it is due to be administered when

you have 1 confirmed that reliable venous access has been secured 2 confirmed that transfusion has been authorisedprescribed

bull Withdraw only one unit at a time except in a life-threatening emergency bull Ensure fridge door is closed after removal of Red Cell Component prior to completing identification checks bull Patient identification details (forename surname date of birth and CHI) on the Blood Component Collection

form must be checked with the patient identification details on blood pack compatibility tag( visible through the clear outer wrap bag) and the details on fridge register sheet allocated for patient

bull Clear plastic outer wrap bag should remain intact until final bedside checks are complete and administration

is to take place

36

If there is any discrepancy noted inform the Trans fusion Laboratory immediately and reconfirm patient rsquos details before proceeding any further bull Undertake visual inspection of blood component and check for leaks or discolouration bull Check expiry date bull The member of staff who collects the component must complete appropriate fridge register documentation

inventory for the named patient and record against the unique donation number for component removed 1 The date and time of removal from the fridge 2 Sign their initials signature 3 The date and time of returning the unit(s) to the refrigerator if not Transfused Once they have left the Hospital Transfusion Laboratory or Satellite Fridge blood components must not be left unattended and must be received by a member of staff in the clinical area bull On receipt in clinical area the component should be checked to ensure that the correct blood has been

delivered bull The component should then be immediately taken to the patientrsquos bedside and administered appropriately If emergency blood is withdrawn from any of the blo od fridges the Hospital Transfusion Laboratory must be informed immediately in order to supply further transfusion support and to replace the emergency blood

37

Appendix 10 Administration of Red Cells As a minimum all staff involved in the administration process must have completed Level 1 Safe Transfusion Practice or equivalent (QIS 2006) bull The minimum acceptable details required to transfuse are surname forename date of birth gender

unique identifier ie CHI bull The typenex system should always be used for patients for whom no forename surname and date of birth

are available bull Any information supplied on the blood component or compatibility tag must match the patients ID wristband bull Any discrepancies should be queried with the Hospital Transfusion Laboratory bull Do not transfuse overnight unless clinically indica ted for a life threatening situation bull Transfusion must be complete within 4 hours of removing blood component from temperature controlled

storage If blood component is out of temperature controlled storage for bull Less than 30 minutes the intact unit pack may be returned to transfusion laboratory or satellite blood fridge if

no longer required record date and time of return on fridge register and inform transfusion laboratory bull More than 30 minutes it can still be transfused if transfusion is completed within 4 hours of initial removal time bull Where blood has been out of fridge for more than 30 mins and cannot will not be transfused please inform

transfusion laboratory and follow advice given BLOOD MUST NOT BE STORED IN WARD REFRIDGERATORS bull Two registered practitioners are required to perform the administration Checks bull All checks should take place at the patientrsquos side with no interruption bull If staff are interrupted they must start the checking procedure again Pre-Administration bull Confirm blood component has been prescribedauthorised bull Check patient has patent IV access and an IV blood giving set with an integral aggregate micron filter is

available bull Confirm baseline set of observations has been completed and recorded bull Ensure patient can be easily observed and has access to a call bell should they begin to feel unwell bull Do not remove the blood component from the outer plastic bag until you have confirmed the component is the

correct one for the patient and you are ready to administer the component bull While the component is still in the sealed outer bag carry out a visual examination of the blood pack to check

for signs of discoloration clotting and haemolysis Test integrity of pack for leaks by squeezing gently but firmly

38

bull Check expiry date on pack If any discrepancies are found the unit must not b e transfused The Hospital Transfusion Laboratory and relevant me dical staff must be informed immediately Administration bull Ask the patient (or parent guardian) to state his her full name and date of birth Ensure that the patient is

wearing an identity band and that the details correspond Reliance must not be placed on familiarity bull Failure to perform the final bedside check of patient identification details is the commonest cause of incorrect

blood component transfused related incidents bull A silent two person individual checking process is required at this point by the two registered practitioners bull Check patient details on component unit traceability compatibility label against the patientrsquos identification

band ndash full name date of birth CHIunique number gender bull Check traceability compatibility tag details against blood bag label to confirm positive match of donor

component number blood group and Rh D group bull Both practitioners must sign pink adhesive section of traceability compatibility tag to confirm they have

checked blood component against patientrsquos identification band including date and time (this should then be attached to the transfusion record sheet or transfusion pathway document in patient notes)

bull Commence transfusion bull Blood components must be transfused using a giving set with an integral micron aggregate filter Where

infusion devices are to be used special giving sets for transfusion must be used bull Blood transfusion giving sets must be changed every 12 hours in order to prevent bacterial growth (BCSH

2009) bull Only Sodium Chloride 09 may be used to prime the giving set No other infusion fluids or drugs should be

infused through the same venflon whilst a transfusion is in progress bull The duration of the transfusion is entirely dependent on the clinical situation although each red cell

transfusion has to be completed within 4 hours of blood leaving the fridge (taking into consideration the time already elapsed to collectdeliver and complete final identification administration checks)

Blue tear off tags Transfusion Traceability bull The tear off traceability labels should not be detached from the bag nor completed until transfusion has

commenced bull Once transfusion has commenced the blue tear off tag must be fully completed as so on as the patient

receives even a small amount of the blood or blood component bull One of the two registered practitioners undertaking the administration checks must fully complete the

blue tear-off traceability tag( details required include printing amp signing their full name with date amp start time of transfusion )

bull Fully completed traceability tags should be returned to the Hospital Transfusion Laboratory using the

container provided or locally agreed method for outlying hospitals bull The return of the blue tear-off tag to the transfusion laboratory is a legal requirement outlined in the UK

Blood Safety and Quality Regulations (2005)

39

bull If three days after the blood has been issued the laboratory has not received the blue tear-off tag a Letter A will be issued to the Senior Charge Nurse on the ward requesting return of the completed blue tag or confirmation that component transfusion has taken place (photocopy of the completed pink adhesive label is permissible)

bull If after 7 days following issue of letter A the blue tag or a photocopy of the pink label has not been received

a letter B will be issued bull If after another 7 days no reply has been received an NHS Tayside incident report will be generated

40

Appendix 11 Administration of Other Blood Componen tsFFP Cryoprecipitate Platelets Prothrombin Complex Concentrate( PCC) and Anti-D These are ordered for individual patients Return any unused components to BTS without delay Fresh Frozen Plasma (FFP) bull Request FFP using a BTS Request form bull For un-grouped patients send 7 ml of EDTA blood for grouping with the request form bull FFP is stored frozen and needs to be defrosted before it is released from the laboratory This leads to an

inevitable delay from request to delivery of FFP bull It is realistic to expect at least an hour to pass between requesting and receiving FFP bull It supplied ready thawed and should be used immediately bull The infusion rate for FFP is entirely dependent on the clinical circumstances However each unit should be completed in a maximum of 4 hours from the time that the FFP leaves the blood transfusion laboratory

bull FFP should not be infused through a giving set that has been used for bloodother blood components or any other substance

Administration of Cryoprecipitate bull This is as for red cells except that cryoprecipitate is usually administered over 30ndash60 minutes or less

depending on clinical circumstances bull Cryoprecipitate should not be infused through a giving set that has been used for blood or any other

substance Administration of Platelets bull Platelets are used to treat patients who are bleeding or who are at risk of bleeding due to a low platelet count

or platelets that do not function properly bull Platelets are stored in the laboratory at room temperature bull Once platelets have been prepared and received on the ward they should be infused immediately bull They must not be refrigerated bull Platelets are usually given over 15-30 minutes using a standard gravity feed blood giving set bull Platelets should not be infused through a giving set that has been used for blood or any other substance Since platelets may not be immediately available f orward planning of treatment is essential bull Contact haematology on call medical staff stating name of patient diagnosis platelet count degree of

urgency and likely duration of treatment bull Send request on BTS request form together with a grouping sample if patientrsquos group is not yet known

41

bull Maintenance treatment should be planned ahead in consultation with haematology medical staff bull Use a standard gravity feed blood giving set for infusion pre-primed with 09 sodium chloride solution Coagulation Factors bull Prothrombin complex concentrate for warfarin reversal ndash only issued after discussion with on call

haematology medical staff bull Dose required is dependent on INR patientrsquos weight product used and clinical circumstances Specific immunoglobulins (Anti-D) This can be requested after discussion with haematology lab staff Hyperimmune immunoglobulins are obtained through pharmacy

42

Appendix 12 Blood Components Available from ESBTC Transfusion Laboratory bull Platelets bull Fresh Frozen Plasma bull Fresh Frozen Plasma Methylene Blue Treated and Removed bull Cryoprecipitate (Pooled Frozen) bull Cryoprecipitate Methylene Blue Treated and Removed For all blood component requests please complete a Blue Blood Transfusion Request Form

bull To request FFP and platelets contact Compatibility Laboratory on Ex 32953

bull In certain cases requests for FFP and platelets may be referred to the BTS Duty Medical Officer

bull All requests for cryoprecipitate must be discussed with BTS Duty Medical Officer Unless otherwise specified all components are leucodepleted and conform to the UKBTSNIBSC Guidelines for the Blood Transfusion Service and any nationally agreed revisions Special Requirements For patients with special requirements (eg CMV negative or irradiated) these must be stated on the request form for each request for blood components Blood Product Requests ESBTC provides the following blood products bull bull Anti D Immunoglobulin bull Factor VIII Concentrates bull Factor IX Concentrates bull Octaplex bull Berinet P (C1-esterase inhibitor) bull NovoSeven (factor Vila) bull Octoplas (solvent detergent treated human plasma) All the products listed are licensed by the MHRA For all blood product requests please complete a Blood Transfusion Request Form To request human immunoglobulin for intravenous use human normal immunoglobulin or specific immunoglobulin contact Compatibility Laboratory on Ext 32953 Requests for Factor VIII and Factor IX concentrates should be discussed with the Regional Haemophilia Centre

43

Appendix 13 Monitoring For each blood component transfused bull Record pre-transfusion observations no more than 60 minutes before start of transfusion -

Temperature Pulse Blood Pressure Respiration rate and Oxygen Saturation rate bull Record observations at 15 minutes and again at 30 minutes after transfusion has commenced Temperature Pulse Blood Pressure Respiration rate and Oxygen Saturation rate bull Thereafter record Temperature Blood Pressure and Pulse hourly until completion of component unit (If recordings have changed from baseline values also record respiration rate) bull If patient shows signs or symptoms of a transfusion reaction STOP transfusion (see Appendix 3a and 3b on Adverse Reaction to Transfusion ) bull Record post-transfusion observations within 60 minutes of completion of transfusion -Temperature Pulse

Blood Pressure Respiration rate and Oxygen Saturation rate bull Record post-transfusion full blood count and clinical outcome in patient records bull Further measurement and recording of vital signs may be undertaken at the discretion of clinical staff and with

regard to the patients clinical status bull Urine output should also be monitored at regular intervals throughout the Transfusion

44

Appendix 14 PaediatricNeonatal Considerations Blood for Infants bull Red cell paediatric unitsrsquo dosing is based on patientrsquos weight ndash seek paediatric advice bull Paediatric blood is supplied in packs which usually contain a quarter of the volume of an adult pack bull Paediatric giving sets should be used for transfusion in infants microbore tubing is used in the neonatal unit bull Micro-aggregate filters should be used in neonates bull Volume of blood to be given is usually dependent on the childrsquos weight (BJH 2004) bull Certain conditions may also apply with regard to indications for irradiated blood components or CMV antibody

negative blood components Further guidance and information may be sought from the Hospital Transfusion Laboratory bull Transfusion guidelines for neonates and older children (2004) and amendments (2005 and 2007) httponlinelibrarywileycomdoi101111j1365-2141200404815xfull wwwbcshguidelinescompdfamendments_neonates_091205pdf httpwwwbcshguidelinescomdocumentsFFP_neonate_Amendment_1_17_Oct_2007pdf

35

Appendix 9 Collection and Delivery of Blood and Bl ood Components Only members of staff who have completed appropriate transfusion training may collect blood and blood components Prior to collection of blood components clinical st aff should ensure bull Transfusion Authorisationprescription chart has been completed bull Patient has viable venous access and an Intravenous Blood giving-set is available bull Baseline observations of Temperature Pulse Blood Pressure Oxygen Saturation and Respirations have

been completed and recorded no more than 1 hour pre transfusion bull Review the patientrsquos case notes to check for any special requirements and to confirm that the patient has not

had a transfusion reaction in the past Clinical staff are required to complete a blood com ponent collection form for each component bull The person completing the collection form is responsible for positively identifying the patient and ensuring that

the patient identification details written on collection form have been confirmed against the patientrsquos identification wristband (or risk assessed alternative)

bull Whenever possible patients should be asked to identify themselves verbally with an open question egrdquo

Please can you tell me your name and date of birth in fullrdquo bull The details given by the patient must match those written on the patientrsquos wristband (or risk assessed

alternative) and these details in turn must match those written on the collection form Details must include bull Patients full name bull Date of birth and CHI bull Ward clinical area bull Component required bull Record of the date and time and signature of practitioner Collection bull Withdraw component from blood bankblood fridge only immediately before it is due to be administered when

you have 1 confirmed that reliable venous access has been secured 2 confirmed that transfusion has been authorisedprescribed

bull Withdraw only one unit at a time except in a life-threatening emergency bull Ensure fridge door is closed after removal of Red Cell Component prior to completing identification checks bull Patient identification details (forename surname date of birth and CHI) on the Blood Component Collection

form must be checked with the patient identification details on blood pack compatibility tag( visible through the clear outer wrap bag) and the details on fridge register sheet allocated for patient

bull Clear plastic outer wrap bag should remain intact until final bedside checks are complete and administration

is to take place

36

If there is any discrepancy noted inform the Trans fusion Laboratory immediately and reconfirm patient rsquos details before proceeding any further bull Undertake visual inspection of blood component and check for leaks or discolouration bull Check expiry date bull The member of staff who collects the component must complete appropriate fridge register documentation

inventory for the named patient and record against the unique donation number for component removed 1 The date and time of removal from the fridge 2 Sign their initials signature 3 The date and time of returning the unit(s) to the refrigerator if not Transfused Once they have left the Hospital Transfusion Laboratory or Satellite Fridge blood components must not be left unattended and must be received by a member of staff in the clinical area bull On receipt in clinical area the component should be checked to ensure that the correct blood has been

delivered bull The component should then be immediately taken to the patientrsquos bedside and administered appropriately If emergency blood is withdrawn from any of the blo od fridges the Hospital Transfusion Laboratory must be informed immediately in order to supply further transfusion support and to replace the emergency blood

37

Appendix 10 Administration of Red Cells As a minimum all staff involved in the administration process must have completed Level 1 Safe Transfusion Practice or equivalent (QIS 2006) bull The minimum acceptable details required to transfuse are surname forename date of birth gender

unique identifier ie CHI bull The typenex system should always be used for patients for whom no forename surname and date of birth

are available bull Any information supplied on the blood component or compatibility tag must match the patients ID wristband bull Any discrepancies should be queried with the Hospital Transfusion Laboratory bull Do not transfuse overnight unless clinically indica ted for a life threatening situation bull Transfusion must be complete within 4 hours of removing blood component from temperature controlled

storage If blood component is out of temperature controlled storage for bull Less than 30 minutes the intact unit pack may be returned to transfusion laboratory or satellite blood fridge if

no longer required record date and time of return on fridge register and inform transfusion laboratory bull More than 30 minutes it can still be transfused if transfusion is completed within 4 hours of initial removal time bull Where blood has been out of fridge for more than 30 mins and cannot will not be transfused please inform

transfusion laboratory and follow advice given BLOOD MUST NOT BE STORED IN WARD REFRIDGERATORS bull Two registered practitioners are required to perform the administration Checks bull All checks should take place at the patientrsquos side with no interruption bull If staff are interrupted they must start the checking procedure again Pre-Administration bull Confirm blood component has been prescribedauthorised bull Check patient has patent IV access and an IV blood giving set with an integral aggregate micron filter is

available bull Confirm baseline set of observations has been completed and recorded bull Ensure patient can be easily observed and has access to a call bell should they begin to feel unwell bull Do not remove the blood component from the outer plastic bag until you have confirmed the component is the

correct one for the patient and you are ready to administer the component bull While the component is still in the sealed outer bag carry out a visual examination of the blood pack to check

for signs of discoloration clotting and haemolysis Test integrity of pack for leaks by squeezing gently but firmly

38

bull Check expiry date on pack If any discrepancies are found the unit must not b e transfused The Hospital Transfusion Laboratory and relevant me dical staff must be informed immediately Administration bull Ask the patient (or parent guardian) to state his her full name and date of birth Ensure that the patient is

wearing an identity band and that the details correspond Reliance must not be placed on familiarity bull Failure to perform the final bedside check of patient identification details is the commonest cause of incorrect

blood component transfused related incidents bull A silent two person individual checking process is required at this point by the two registered practitioners bull Check patient details on component unit traceability compatibility label against the patientrsquos identification

band ndash full name date of birth CHIunique number gender bull Check traceability compatibility tag details against blood bag label to confirm positive match of donor

component number blood group and Rh D group bull Both practitioners must sign pink adhesive section of traceability compatibility tag to confirm they have

checked blood component against patientrsquos identification band including date and time (this should then be attached to the transfusion record sheet or transfusion pathway document in patient notes)

bull Commence transfusion bull Blood components must be transfused using a giving set with an integral micron aggregate filter Where

infusion devices are to be used special giving sets for transfusion must be used bull Blood transfusion giving sets must be changed every 12 hours in order to prevent bacterial growth (BCSH

2009) bull Only Sodium Chloride 09 may be used to prime the giving set No other infusion fluids or drugs should be

infused through the same venflon whilst a transfusion is in progress bull The duration of the transfusion is entirely dependent on the clinical situation although each red cell

transfusion has to be completed within 4 hours of blood leaving the fridge (taking into consideration the time already elapsed to collectdeliver and complete final identification administration checks)

Blue tear off tags Transfusion Traceability bull The tear off traceability labels should not be detached from the bag nor completed until transfusion has

commenced bull Once transfusion has commenced the blue tear off tag must be fully completed as so on as the patient

receives even a small amount of the blood or blood component bull One of the two registered practitioners undertaking the administration checks must fully complete the

blue tear-off traceability tag( details required include printing amp signing their full name with date amp start time of transfusion )

bull Fully completed traceability tags should be returned to the Hospital Transfusion Laboratory using the

container provided or locally agreed method for outlying hospitals bull The return of the blue tear-off tag to the transfusion laboratory is a legal requirement outlined in the UK

Blood Safety and Quality Regulations (2005)

39

bull If three days after the blood has been issued the laboratory has not received the blue tear-off tag a Letter A will be issued to the Senior Charge Nurse on the ward requesting return of the completed blue tag or confirmation that component transfusion has taken place (photocopy of the completed pink adhesive label is permissible)

bull If after 7 days following issue of letter A the blue tag or a photocopy of the pink label has not been received

a letter B will be issued bull If after another 7 days no reply has been received an NHS Tayside incident report will be generated

40

Appendix 11 Administration of Other Blood Componen tsFFP Cryoprecipitate Platelets Prothrombin Complex Concentrate( PCC) and Anti-D These are ordered for individual patients Return any unused components to BTS without delay Fresh Frozen Plasma (FFP) bull Request FFP using a BTS Request form bull For un-grouped patients send 7 ml of EDTA blood for grouping with the request form bull FFP is stored frozen and needs to be defrosted before it is released from the laboratory This leads to an

inevitable delay from request to delivery of FFP bull It is realistic to expect at least an hour to pass between requesting and receiving FFP bull It supplied ready thawed and should be used immediately bull The infusion rate for FFP is entirely dependent on the clinical circumstances However each unit should be completed in a maximum of 4 hours from the time that the FFP leaves the blood transfusion laboratory

bull FFP should not be infused through a giving set that has been used for bloodother blood components or any other substance

Administration of Cryoprecipitate bull This is as for red cells except that cryoprecipitate is usually administered over 30ndash60 minutes or less

depending on clinical circumstances bull Cryoprecipitate should not be infused through a giving set that has been used for blood or any other

substance Administration of Platelets bull Platelets are used to treat patients who are bleeding or who are at risk of bleeding due to a low platelet count

or platelets that do not function properly bull Platelets are stored in the laboratory at room temperature bull Once platelets have been prepared and received on the ward they should be infused immediately bull They must not be refrigerated bull Platelets are usually given over 15-30 minutes using a standard gravity feed blood giving set bull Platelets should not be infused through a giving set that has been used for blood or any other substance Since platelets may not be immediately available f orward planning of treatment is essential bull Contact haematology on call medical staff stating name of patient diagnosis platelet count degree of

urgency and likely duration of treatment bull Send request on BTS request form together with a grouping sample if patientrsquos group is not yet known

41

bull Maintenance treatment should be planned ahead in consultation with haematology medical staff bull Use a standard gravity feed blood giving set for infusion pre-primed with 09 sodium chloride solution Coagulation Factors bull Prothrombin complex concentrate for warfarin reversal ndash only issued after discussion with on call

haematology medical staff bull Dose required is dependent on INR patientrsquos weight product used and clinical circumstances Specific immunoglobulins (Anti-D) This can be requested after discussion with haematology lab staff Hyperimmune immunoglobulins are obtained through pharmacy

42

Appendix 12 Blood Components Available from ESBTC Transfusion Laboratory bull Platelets bull Fresh Frozen Plasma bull Fresh Frozen Plasma Methylene Blue Treated and Removed bull Cryoprecipitate (Pooled Frozen) bull Cryoprecipitate Methylene Blue Treated and Removed For all blood component requests please complete a Blue Blood Transfusion Request Form

bull To request FFP and platelets contact Compatibility Laboratory on Ex 32953

bull In certain cases requests for FFP and platelets may be referred to the BTS Duty Medical Officer

bull All requests for cryoprecipitate must be discussed with BTS Duty Medical Officer Unless otherwise specified all components are leucodepleted and conform to the UKBTSNIBSC Guidelines for the Blood Transfusion Service and any nationally agreed revisions Special Requirements For patients with special requirements (eg CMV negative or irradiated) these must be stated on the request form for each request for blood components Blood Product Requests ESBTC provides the following blood products bull bull Anti D Immunoglobulin bull Factor VIII Concentrates bull Factor IX Concentrates bull Octaplex bull Berinet P (C1-esterase inhibitor) bull NovoSeven (factor Vila) bull Octoplas (solvent detergent treated human plasma) All the products listed are licensed by the MHRA For all blood product requests please complete a Blood Transfusion Request Form To request human immunoglobulin for intravenous use human normal immunoglobulin or specific immunoglobulin contact Compatibility Laboratory on Ext 32953 Requests for Factor VIII and Factor IX concentrates should be discussed with the Regional Haemophilia Centre

43

Appendix 13 Monitoring For each blood component transfused bull Record pre-transfusion observations no more than 60 minutes before start of transfusion -

Temperature Pulse Blood Pressure Respiration rate and Oxygen Saturation rate bull Record observations at 15 minutes and again at 30 minutes after transfusion has commenced Temperature Pulse Blood Pressure Respiration rate and Oxygen Saturation rate bull Thereafter record Temperature Blood Pressure and Pulse hourly until completion of component unit (If recordings have changed from baseline values also record respiration rate) bull If patient shows signs or symptoms of a transfusion reaction STOP transfusion (see Appendix 3a and 3b on Adverse Reaction to Transfusion ) bull Record post-transfusion observations within 60 minutes of completion of transfusion -Temperature Pulse

Blood Pressure Respiration rate and Oxygen Saturation rate bull Record post-transfusion full blood count and clinical outcome in patient records bull Further measurement and recording of vital signs may be undertaken at the discretion of clinical staff and with

regard to the patients clinical status bull Urine output should also be monitored at regular intervals throughout the Transfusion

44

Appendix 14 PaediatricNeonatal Considerations Blood for Infants bull Red cell paediatric unitsrsquo dosing is based on patientrsquos weight ndash seek paediatric advice bull Paediatric blood is supplied in packs which usually contain a quarter of the volume of an adult pack bull Paediatric giving sets should be used for transfusion in infants microbore tubing is used in the neonatal unit bull Micro-aggregate filters should be used in neonates bull Volume of blood to be given is usually dependent on the childrsquos weight (BJH 2004) bull Certain conditions may also apply with regard to indications for irradiated blood components or CMV antibody

negative blood components Further guidance and information may be sought from the Hospital Transfusion Laboratory bull Transfusion guidelines for neonates and older children (2004) and amendments (2005 and 2007) httponlinelibrarywileycomdoi101111j1365-2141200404815xfull wwwbcshguidelinescompdfamendments_neonates_091205pdf httpwwwbcshguidelinescomdocumentsFFP_neonate_Amendment_1_17_Oct_2007pdf

36

If there is any discrepancy noted inform the Trans fusion Laboratory immediately and reconfirm patient rsquos details before proceeding any further bull Undertake visual inspection of blood component and check for leaks or discolouration bull Check expiry date bull The member of staff who collects the component must complete appropriate fridge register documentation

inventory for the named patient and record against the unique donation number for component removed 1 The date and time of removal from the fridge 2 Sign their initials signature 3 The date and time of returning the unit(s) to the refrigerator if not Transfused Once they have left the Hospital Transfusion Laboratory or Satellite Fridge blood components must not be left unattended and must be received by a member of staff in the clinical area bull On receipt in clinical area the component should be checked to ensure that the correct blood has been

delivered bull The component should then be immediately taken to the patientrsquos bedside and administered appropriately If emergency blood is withdrawn from any of the blo od fridges the Hospital Transfusion Laboratory must be informed immediately in order to supply further transfusion support and to replace the emergency blood

37

Appendix 10 Administration of Red Cells As a minimum all staff involved in the administration process must have completed Level 1 Safe Transfusion Practice or equivalent (QIS 2006) bull The minimum acceptable details required to transfuse are surname forename date of birth gender

unique identifier ie CHI bull The typenex system should always be used for patients for whom no forename surname and date of birth

are available bull Any information supplied on the blood component or compatibility tag must match the patients ID wristband bull Any discrepancies should be queried with the Hospital Transfusion Laboratory bull Do not transfuse overnight unless clinically indica ted for a life threatening situation bull Transfusion must be complete within 4 hours of removing blood component from temperature controlled

storage If blood component is out of temperature controlled storage for bull Less than 30 minutes the intact unit pack may be returned to transfusion laboratory or satellite blood fridge if

no longer required record date and time of return on fridge register and inform transfusion laboratory bull More than 30 minutes it can still be transfused if transfusion is completed within 4 hours of initial removal time bull Where blood has been out of fridge for more than 30 mins and cannot will not be transfused please inform

transfusion laboratory and follow advice given BLOOD MUST NOT BE STORED IN WARD REFRIDGERATORS bull Two registered practitioners are required to perform the administration Checks bull All checks should take place at the patientrsquos side with no interruption bull If staff are interrupted they must start the checking procedure again Pre-Administration bull Confirm blood component has been prescribedauthorised bull Check patient has patent IV access and an IV blood giving set with an integral aggregate micron filter is

available bull Confirm baseline set of observations has been completed and recorded bull Ensure patient can be easily observed and has access to a call bell should they begin to feel unwell bull Do not remove the blood component from the outer plastic bag until you have confirmed the component is the

correct one for the patient and you are ready to administer the component bull While the component is still in the sealed outer bag carry out a visual examination of the blood pack to check

for signs of discoloration clotting and haemolysis Test integrity of pack for leaks by squeezing gently but firmly

38

bull Check expiry date on pack If any discrepancies are found the unit must not b e transfused The Hospital Transfusion Laboratory and relevant me dical staff must be informed immediately Administration bull Ask the patient (or parent guardian) to state his her full name and date of birth Ensure that the patient is

wearing an identity band and that the details correspond Reliance must not be placed on familiarity bull Failure to perform the final bedside check of patient identification details is the commonest cause of incorrect

blood component transfused related incidents bull A silent two person individual checking process is required at this point by the two registered practitioners bull Check patient details on component unit traceability compatibility label against the patientrsquos identification

band ndash full name date of birth CHIunique number gender bull Check traceability compatibility tag details against blood bag label to confirm positive match of donor

component number blood group and Rh D group bull Both practitioners must sign pink adhesive section of traceability compatibility tag to confirm they have

checked blood component against patientrsquos identification band including date and time (this should then be attached to the transfusion record sheet or transfusion pathway document in patient notes)

bull Commence transfusion bull Blood components must be transfused using a giving set with an integral micron aggregate filter Where

infusion devices are to be used special giving sets for transfusion must be used bull Blood transfusion giving sets must be changed every 12 hours in order to prevent bacterial growth (BCSH

2009) bull Only Sodium Chloride 09 may be used to prime the giving set No other infusion fluids or drugs should be

infused through the same venflon whilst a transfusion is in progress bull The duration of the transfusion is entirely dependent on the clinical situation although each red cell

transfusion has to be completed within 4 hours of blood leaving the fridge (taking into consideration the time already elapsed to collectdeliver and complete final identification administration checks)

Blue tear off tags Transfusion Traceability bull The tear off traceability labels should not be detached from the bag nor completed until transfusion has

commenced bull Once transfusion has commenced the blue tear off tag must be fully completed as so on as the patient

receives even a small amount of the blood or blood component bull One of the two registered practitioners undertaking the administration checks must fully complete the

blue tear-off traceability tag( details required include printing amp signing their full name with date amp start time of transfusion )

bull Fully completed traceability tags should be returned to the Hospital Transfusion Laboratory using the

container provided or locally agreed method for outlying hospitals bull The return of the blue tear-off tag to the transfusion laboratory is a legal requirement outlined in the UK

Blood Safety and Quality Regulations (2005)

39

bull If three days after the blood has been issued the laboratory has not received the blue tear-off tag a Letter A will be issued to the Senior Charge Nurse on the ward requesting return of the completed blue tag or confirmation that component transfusion has taken place (photocopy of the completed pink adhesive label is permissible)

bull If after 7 days following issue of letter A the blue tag or a photocopy of the pink label has not been received

a letter B will be issued bull If after another 7 days no reply has been received an NHS Tayside incident report will be generated

40

Appendix 11 Administration of Other Blood Componen tsFFP Cryoprecipitate Platelets Prothrombin Complex Concentrate( PCC) and Anti-D These are ordered for individual patients Return any unused components to BTS without delay Fresh Frozen Plasma (FFP) bull Request FFP using a BTS Request form bull For un-grouped patients send 7 ml of EDTA blood for grouping with the request form bull FFP is stored frozen and needs to be defrosted before it is released from the laboratory This leads to an

inevitable delay from request to delivery of FFP bull It is realistic to expect at least an hour to pass between requesting and receiving FFP bull It supplied ready thawed and should be used immediately bull The infusion rate for FFP is entirely dependent on the clinical circumstances However each unit should be completed in a maximum of 4 hours from the time that the FFP leaves the blood transfusion laboratory

bull FFP should not be infused through a giving set that has been used for bloodother blood components or any other substance

Administration of Cryoprecipitate bull This is as for red cells except that cryoprecipitate is usually administered over 30ndash60 minutes or less

depending on clinical circumstances bull Cryoprecipitate should not be infused through a giving set that has been used for blood or any other

substance Administration of Platelets bull Platelets are used to treat patients who are bleeding or who are at risk of bleeding due to a low platelet count

or platelets that do not function properly bull Platelets are stored in the laboratory at room temperature bull Once platelets have been prepared and received on the ward they should be infused immediately bull They must not be refrigerated bull Platelets are usually given over 15-30 minutes using a standard gravity feed blood giving set bull Platelets should not be infused through a giving set that has been used for blood or any other substance Since platelets may not be immediately available f orward planning of treatment is essential bull Contact haematology on call medical staff stating name of patient diagnosis platelet count degree of

urgency and likely duration of treatment bull Send request on BTS request form together with a grouping sample if patientrsquos group is not yet known

41

bull Maintenance treatment should be planned ahead in consultation with haematology medical staff bull Use a standard gravity feed blood giving set for infusion pre-primed with 09 sodium chloride solution Coagulation Factors bull Prothrombin complex concentrate for warfarin reversal ndash only issued after discussion with on call

haematology medical staff bull Dose required is dependent on INR patientrsquos weight product used and clinical circumstances Specific immunoglobulins (Anti-D) This can be requested after discussion with haematology lab staff Hyperimmune immunoglobulins are obtained through pharmacy

42

Appendix 12 Blood Components Available from ESBTC Transfusion Laboratory bull Platelets bull Fresh Frozen Plasma bull Fresh Frozen Plasma Methylene Blue Treated and Removed bull Cryoprecipitate (Pooled Frozen) bull Cryoprecipitate Methylene Blue Treated and Removed For all blood component requests please complete a Blue Blood Transfusion Request Form

bull To request FFP and platelets contact Compatibility Laboratory on Ex 32953

bull In certain cases requests for FFP and platelets may be referred to the BTS Duty Medical Officer

bull All requests for cryoprecipitate must be discussed with BTS Duty Medical Officer Unless otherwise specified all components are leucodepleted and conform to the UKBTSNIBSC Guidelines for the Blood Transfusion Service and any nationally agreed revisions Special Requirements For patients with special requirements (eg CMV negative or irradiated) these must be stated on the request form for each request for blood components Blood Product Requests ESBTC provides the following blood products bull bull Anti D Immunoglobulin bull Factor VIII Concentrates bull Factor IX Concentrates bull Octaplex bull Berinet P (C1-esterase inhibitor) bull NovoSeven (factor Vila) bull Octoplas (solvent detergent treated human plasma) All the products listed are licensed by the MHRA For all blood product requests please complete a Blood Transfusion Request Form To request human immunoglobulin for intravenous use human normal immunoglobulin or specific immunoglobulin contact Compatibility Laboratory on Ext 32953 Requests for Factor VIII and Factor IX concentrates should be discussed with the Regional Haemophilia Centre

43

Appendix 13 Monitoring For each blood component transfused bull Record pre-transfusion observations no more than 60 minutes before start of transfusion -

Temperature Pulse Blood Pressure Respiration rate and Oxygen Saturation rate bull Record observations at 15 minutes and again at 30 minutes after transfusion has commenced Temperature Pulse Blood Pressure Respiration rate and Oxygen Saturation rate bull Thereafter record Temperature Blood Pressure and Pulse hourly until completion of component unit (If recordings have changed from baseline values also record respiration rate) bull If patient shows signs or symptoms of a transfusion reaction STOP transfusion (see Appendix 3a and 3b on Adverse Reaction to Transfusion ) bull Record post-transfusion observations within 60 minutes of completion of transfusion -Temperature Pulse

Blood Pressure Respiration rate and Oxygen Saturation rate bull Record post-transfusion full blood count and clinical outcome in patient records bull Further measurement and recording of vital signs may be undertaken at the discretion of clinical staff and with

regard to the patients clinical status bull Urine output should also be monitored at regular intervals throughout the Transfusion

44

Appendix 14 PaediatricNeonatal Considerations Blood for Infants bull Red cell paediatric unitsrsquo dosing is based on patientrsquos weight ndash seek paediatric advice bull Paediatric blood is supplied in packs which usually contain a quarter of the volume of an adult pack bull Paediatric giving sets should be used for transfusion in infants microbore tubing is used in the neonatal unit bull Micro-aggregate filters should be used in neonates bull Volume of blood to be given is usually dependent on the childrsquos weight (BJH 2004) bull Certain conditions may also apply with regard to indications for irradiated blood components or CMV antibody

negative blood components Further guidance and information may be sought from the Hospital Transfusion Laboratory bull Transfusion guidelines for neonates and older children (2004) and amendments (2005 and 2007) httponlinelibrarywileycomdoi101111j1365-2141200404815xfull wwwbcshguidelinescompdfamendments_neonates_091205pdf httpwwwbcshguidelinescomdocumentsFFP_neonate_Amendment_1_17_Oct_2007pdf

37

Appendix 10 Administration of Red Cells As a minimum all staff involved in the administration process must have completed Level 1 Safe Transfusion Practice or equivalent (QIS 2006) bull The minimum acceptable details required to transfuse are surname forename date of birth gender

unique identifier ie CHI bull The typenex system should always be used for patients for whom no forename surname and date of birth

are available bull Any information supplied on the blood component or compatibility tag must match the patients ID wristband bull Any discrepancies should be queried with the Hospital Transfusion Laboratory bull Do not transfuse overnight unless clinically indica ted for a life threatening situation bull Transfusion must be complete within 4 hours of removing blood component from temperature controlled

storage If blood component is out of temperature controlled storage for bull Less than 30 minutes the intact unit pack may be returned to transfusion laboratory or satellite blood fridge if

no longer required record date and time of return on fridge register and inform transfusion laboratory bull More than 30 minutes it can still be transfused if transfusion is completed within 4 hours of initial removal time bull Where blood has been out of fridge for more than 30 mins and cannot will not be transfused please inform

transfusion laboratory and follow advice given BLOOD MUST NOT BE STORED IN WARD REFRIDGERATORS bull Two registered practitioners are required to perform the administration Checks bull All checks should take place at the patientrsquos side with no interruption bull If staff are interrupted they must start the checking procedure again Pre-Administration bull Confirm blood component has been prescribedauthorised bull Check patient has patent IV access and an IV blood giving set with an integral aggregate micron filter is

available bull Confirm baseline set of observations has been completed and recorded bull Ensure patient can be easily observed and has access to a call bell should they begin to feel unwell bull Do not remove the blood component from the outer plastic bag until you have confirmed the component is the

correct one for the patient and you are ready to administer the component bull While the component is still in the sealed outer bag carry out a visual examination of the blood pack to check

for signs of discoloration clotting and haemolysis Test integrity of pack for leaks by squeezing gently but firmly

38

bull Check expiry date on pack If any discrepancies are found the unit must not b e transfused The Hospital Transfusion Laboratory and relevant me dical staff must be informed immediately Administration bull Ask the patient (or parent guardian) to state his her full name and date of birth Ensure that the patient is

wearing an identity band and that the details correspond Reliance must not be placed on familiarity bull Failure to perform the final bedside check of patient identification details is the commonest cause of incorrect

blood component transfused related incidents bull A silent two person individual checking process is required at this point by the two registered practitioners bull Check patient details on component unit traceability compatibility label against the patientrsquos identification

band ndash full name date of birth CHIunique number gender bull Check traceability compatibility tag details against blood bag label to confirm positive match of donor

component number blood group and Rh D group bull Both practitioners must sign pink adhesive section of traceability compatibility tag to confirm they have

checked blood component against patientrsquos identification band including date and time (this should then be attached to the transfusion record sheet or transfusion pathway document in patient notes)

bull Commence transfusion bull Blood components must be transfused using a giving set with an integral micron aggregate filter Where

infusion devices are to be used special giving sets for transfusion must be used bull Blood transfusion giving sets must be changed every 12 hours in order to prevent bacterial growth (BCSH

2009) bull Only Sodium Chloride 09 may be used to prime the giving set No other infusion fluids or drugs should be

infused through the same venflon whilst a transfusion is in progress bull The duration of the transfusion is entirely dependent on the clinical situation although each red cell

transfusion has to be completed within 4 hours of blood leaving the fridge (taking into consideration the time already elapsed to collectdeliver and complete final identification administration checks)

Blue tear off tags Transfusion Traceability bull The tear off traceability labels should not be detached from the bag nor completed until transfusion has

commenced bull Once transfusion has commenced the blue tear off tag must be fully completed as so on as the patient

receives even a small amount of the blood or blood component bull One of the two registered practitioners undertaking the administration checks must fully complete the

blue tear-off traceability tag( details required include printing amp signing their full name with date amp start time of transfusion )

bull Fully completed traceability tags should be returned to the Hospital Transfusion Laboratory using the

container provided or locally agreed method for outlying hospitals bull The return of the blue tear-off tag to the transfusion laboratory is a legal requirement outlined in the UK

Blood Safety and Quality Regulations (2005)

39

bull If three days after the blood has been issued the laboratory has not received the blue tear-off tag a Letter A will be issued to the Senior Charge Nurse on the ward requesting return of the completed blue tag or confirmation that component transfusion has taken place (photocopy of the completed pink adhesive label is permissible)

bull If after 7 days following issue of letter A the blue tag or a photocopy of the pink label has not been received

a letter B will be issued bull If after another 7 days no reply has been received an NHS Tayside incident report will be generated

40

Appendix 11 Administration of Other Blood Componen tsFFP Cryoprecipitate Platelets Prothrombin Complex Concentrate( PCC) and Anti-D These are ordered for individual patients Return any unused components to BTS without delay Fresh Frozen Plasma (FFP) bull Request FFP using a BTS Request form bull For un-grouped patients send 7 ml of EDTA blood for grouping with the request form bull FFP is stored frozen and needs to be defrosted before it is released from the laboratory This leads to an

inevitable delay from request to delivery of FFP bull It is realistic to expect at least an hour to pass between requesting and receiving FFP bull It supplied ready thawed and should be used immediately bull The infusion rate for FFP is entirely dependent on the clinical circumstances However each unit should be completed in a maximum of 4 hours from the time that the FFP leaves the blood transfusion laboratory

bull FFP should not be infused through a giving set that has been used for bloodother blood components or any other substance

Administration of Cryoprecipitate bull This is as for red cells except that cryoprecipitate is usually administered over 30ndash60 minutes or less

depending on clinical circumstances bull Cryoprecipitate should not be infused through a giving set that has been used for blood or any other

substance Administration of Platelets bull Platelets are used to treat patients who are bleeding or who are at risk of bleeding due to a low platelet count

or platelets that do not function properly bull Platelets are stored in the laboratory at room temperature bull Once platelets have been prepared and received on the ward they should be infused immediately bull They must not be refrigerated bull Platelets are usually given over 15-30 minutes using a standard gravity feed blood giving set bull Platelets should not be infused through a giving set that has been used for blood or any other substance Since platelets may not be immediately available f orward planning of treatment is essential bull Contact haematology on call medical staff stating name of patient diagnosis platelet count degree of

urgency and likely duration of treatment bull Send request on BTS request form together with a grouping sample if patientrsquos group is not yet known

41

bull Maintenance treatment should be planned ahead in consultation with haematology medical staff bull Use a standard gravity feed blood giving set for infusion pre-primed with 09 sodium chloride solution Coagulation Factors bull Prothrombin complex concentrate for warfarin reversal ndash only issued after discussion with on call

haematology medical staff bull Dose required is dependent on INR patientrsquos weight product used and clinical circumstances Specific immunoglobulins (Anti-D) This can be requested after discussion with haematology lab staff Hyperimmune immunoglobulins are obtained through pharmacy

42

Appendix 12 Blood Components Available from ESBTC Transfusion Laboratory bull Platelets bull Fresh Frozen Plasma bull Fresh Frozen Plasma Methylene Blue Treated and Removed bull Cryoprecipitate (Pooled Frozen) bull Cryoprecipitate Methylene Blue Treated and Removed For all blood component requests please complete a Blue Blood Transfusion Request Form

bull To request FFP and platelets contact Compatibility Laboratory on Ex 32953

bull In certain cases requests for FFP and platelets may be referred to the BTS Duty Medical Officer

bull All requests for cryoprecipitate must be discussed with BTS Duty Medical Officer Unless otherwise specified all components are leucodepleted and conform to the UKBTSNIBSC Guidelines for the Blood Transfusion Service and any nationally agreed revisions Special Requirements For patients with special requirements (eg CMV negative or irradiated) these must be stated on the request form for each request for blood components Blood Product Requests ESBTC provides the following blood products bull bull Anti D Immunoglobulin bull Factor VIII Concentrates bull Factor IX Concentrates bull Octaplex bull Berinet P (C1-esterase inhibitor) bull NovoSeven (factor Vila) bull Octoplas (solvent detergent treated human plasma) All the products listed are licensed by the MHRA For all blood product requests please complete a Blood Transfusion Request Form To request human immunoglobulin for intravenous use human normal immunoglobulin or specific immunoglobulin contact Compatibility Laboratory on Ext 32953 Requests for Factor VIII and Factor IX concentrates should be discussed with the Regional Haemophilia Centre

43

Appendix 13 Monitoring For each blood component transfused bull Record pre-transfusion observations no more than 60 minutes before start of transfusion -

Temperature Pulse Blood Pressure Respiration rate and Oxygen Saturation rate bull Record observations at 15 minutes and again at 30 minutes after transfusion has commenced Temperature Pulse Blood Pressure Respiration rate and Oxygen Saturation rate bull Thereafter record Temperature Blood Pressure and Pulse hourly until completion of component unit (If recordings have changed from baseline values also record respiration rate) bull If patient shows signs or symptoms of a transfusion reaction STOP transfusion (see Appendix 3a and 3b on Adverse Reaction to Transfusion ) bull Record post-transfusion observations within 60 minutes of completion of transfusion -Temperature Pulse

Blood Pressure Respiration rate and Oxygen Saturation rate bull Record post-transfusion full blood count and clinical outcome in patient records bull Further measurement and recording of vital signs may be undertaken at the discretion of clinical staff and with

regard to the patients clinical status bull Urine output should also be monitored at regular intervals throughout the Transfusion

44

Appendix 14 PaediatricNeonatal Considerations Blood for Infants bull Red cell paediatric unitsrsquo dosing is based on patientrsquos weight ndash seek paediatric advice bull Paediatric blood is supplied in packs which usually contain a quarter of the volume of an adult pack bull Paediatric giving sets should be used for transfusion in infants microbore tubing is used in the neonatal unit bull Micro-aggregate filters should be used in neonates bull Volume of blood to be given is usually dependent on the childrsquos weight (BJH 2004) bull Certain conditions may also apply with regard to indications for irradiated blood components or CMV antibody

negative blood components Further guidance and information may be sought from the Hospital Transfusion Laboratory bull Transfusion guidelines for neonates and older children (2004) and amendments (2005 and 2007) httponlinelibrarywileycomdoi101111j1365-2141200404815xfull wwwbcshguidelinescompdfamendments_neonates_091205pdf httpwwwbcshguidelinescomdocumentsFFP_neonate_Amendment_1_17_Oct_2007pdf