Blood Transfusion

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

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

Who's who and contact details

Laboratory locations and opening hours

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

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

Blood transfusion requests

For blood to be cross matched:

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

Sample labelling

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

All samples must be:

• legibly handwritten
• have 4 identifiers:

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

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

Two sample policy

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

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

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

Sample Validity

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

Samples from patients with antibodies are only valid for 72 hours.  

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

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

A&E numbers

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

Blood transfusion request forms

Blood transfusion request forms must:

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

Timing of transfusion requests

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

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

Blood required in an emergency

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

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

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

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