Blood bank manual

Page 1

LABORATORY

BLOOD

(1st Edition, Revised 2014

Unit Tabung

Jabatan

Hospital

EXT :

Page 2

2

Page 3

3

INTRODUCTION

The purpose of having a laboratory manual for transfusion service is to improve

the overall quality of the blood transfusion service in this hospital.

In this laboratory manual, topics such as consent for transfusion, procedures for re-

questing blood transfusion, sample taking and labeling, proper storage and transportation

of blood products, Clinical guidelines in blood transfusion and blood transfusion reaction

will be discussed.

This laboratory manual is for use within Hospital Batu Pahat only. This manual is

mainly based on guidelines from National Blood Center (PDN) and The Clinical Use of

Blood Products by WHO. It is intended to promote better and safer transfusion practice in

this hospital.

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TABLE OF CONTENTS

CONTENTS

PAGE NO

INTRODUCTION

3

TABLE OF CONTENTS

4 – 5

CONSENT FOR TRANSFUSION

6

MSBOS

6

GSH

6

BLOOD TAKING AND LABELING

6

FILLING REQUEST FORM

7

BLOOD REQUEST IN NEWBORN / CHILDREN

7

COLLECTING BLOOD / BLOOD COMPONENTS

7

ADMINISTRATION OF BLOOD / BLOOD COMPONENTS

8

PRETRANSFUSION MEDICATION

8

PATIENT MONITORING DURING TRANSFUSION

8

NIGHT TIME TRANSFUSION

8

USAGE OF BLOOD WARMER

9

DRUGS / FLUID ADMINISTRATION DURING TRANSFUSION

9

BLOOD TRANSFUSION REACTION

9 – 10

TRANSFUISON OF BLOOD PRODUCTS FROM CLOSED FAMILY MEMBERS / RELATIVE

11

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GUIDELINES IN CLINICAL USE OF BLOOD / BLOOD PRODUCTS

RED BLOOD CELL TRANSFUSION ---------------------------------------------------------------------------- TRANSFUSION IN ANEMIA ---------------------------------------------------------------------------------------- TRANSFUSION TRIGGERS ------------------------------------------------------------------------------------------ GUIDELINES IN NEONATAL EXCHANGE TRANSFUSION ----------------------------------------------- SELECTION OF NON RED CELL PRODUCTS --------------------------------------------------------------- GUIDELINE IN PLATELETS TRANSFUSION ----------------------------------------------------------------- GUIDELINE IN FFP TRANSFUSION -------------------------------------------------------------------------- GUIDELINES IN CRYOPRECIPITATE TRANSFUSION ------------------------------------------------------ GUIDELINE IN MANAGEMENT OF DISSEMINATED INTRAVASCULAR COAGULATION ----------

12 – 13

14

14

15 - 16

16

17 - 18

19

20

21

CT RATIO

WHAT IS CT RATIO ? --------------------------------------------------------------------------------------------------

CT RATIO OF HOSPITAL BATU PAHAT -----------------------------------------------------------------------

22 - 23

24

APPENDIX

1. TRANSFUSION OF RH D NEGATIVE PATIENT IN LIFE THREATENING SITUATION ----------------

2. MSBOS OF HOSPITAL BATU PAHAT ----------------------------------------------------------------------------

3. CONSENT FORM -------------------------------------------------------------------------------------------------------

4. CHECK LIST FOR TAKING BLOOD FOR GXM ---------------------------------------------------------------

5. BLOOD REQUEST FORM ---------------------------------------------------------------------------------------------

6. CHECK LIST FOR GIVING BLOOD OR BLOOD COMPONENT TO A PATIENT ------------------------

7. SUMMARY OF BLOOD REQUEST TILL BLOOD ISSUING ---------------------------------------------------

8. COLLECTION OF BLOOD / BLOOD PRODUCTS ---------------------------------------------------------------

9. STORAGE OF BLOOD PRODUCT PRIOR TO TRANSFUSION -----------------------------------------------

10. TIME LIMITS FOR TRANSFUSION ----------------------------------------------------------------------------------

11. HOW TO USE BLOOD STICKER -------------------------------------------------------------------------------------

12. BLOOD TRANSFUSION REACTION REPORT FORM ----------------------------------------------------------

13. S L I P P E N G A M BI L A N D A RA H -----------------------------------------------------------------------------

14. BORANG PEMULANGAN DARAH / KOMPONEN DARAH ----------------------------------------------------

26

27

28

29

30

31

32 - 34

35

36

37

38

39 – 40

41

42

REFERENCES

43

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CONSENT FOR TRANSFUSION—Refer to APPENDIX 3 (Page 28)

The patient must give informed consent for transfusion. The clinician in charge of the patient has a responsi-

bility to explain the benefits, risk and alternative to transfusion therapy and ensure that the patient comprehends the

issues discussed. Other than in emergency, the patient should be given opportunity to ask questions, and his/her

informed decision be documented. If the patient is unable to give consent, a responsible family member must

be asked to do so. If no family member is available or in emergency when the need for transfusion leaves no time

for consent, it is prudent to note this in the patient’s medical note. The informed consent for blood transfusion is valid from the time the patient is admission till the time of dis-

charge. If the patient requires multiple transfusions during the same admission, no additions inform consent is required.

MSBOS(Maximum Surgical Blood Order Schedule)—Refer to APPENDIX 2 (Page 27)

MSBOS is a table of elective surgical procedures which list the number of units of blood routinely requested

and cross matched for them preoperatively.

The schedule is base on retrospective analysis of actual blood usage associated with the individual surgi-cal procedure.

Please see attachment of MSBOS of Hospital Batu Pahat.

GSH (Group, Screen & Hold)

GSH is for cases that are unlikely to be transfused during surgery, however when antibody screen is positive, compatible blood must be made available.

After GSH the sample will keep for 72hours, if blood is requires within 72hours, will proceed for further cross matching.

A GSH should be used in conjunction with a Maximum Surgical Blood Order Schedule (MSBOS).

BLOOD TAKING AND LABELING—Refer to APPENDIX 4 (Page29)

The process of taking and labeling blood samples must be done in one process at the bedside, one patient only at any time. The doctor performing this must ensure:

1. The patient is correctly identified. The doctor taking the blood sample must read the wristband, if available,

and whenever possible, ask the patient to state his/her full name. This information must be checked against the

case notes.

2. Unconscious patient MUST be identified by the information given on the identity band, such as the

wristband.

3. An emergency casualty who cannot be reliable identified must be given and identity band with a unique num-ber. This number must be used to identify this patient until full and correct personal details are available

4. The person who takes the blood and the person who labeled the blood sample must be same person.

5. The sample must be labeled clearly and accurately at patient’s bedside immediately after blood taking. Use only hand written label and never use preprinted label for labeling sample. The label should include the patient’s full name, hospital registration number or Identity card number.

6. Never label samples from 2 or more patients at the same time.

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FILLING BLOOD REQUST FORM—Refer to APPENDIX (Page 30)

Prescribing blood and blood products is the responsibility of the doctor managing the patient. However, the doctor is encouraged to consult the doctor in-charge of the Blood Bank on the products to be given, the quantity, the duration of infusion, the precautions to be taken and any other related matters

1. The request form should be completely filled and contain relevant patient information(Full name, IC,

Sex, Reason for transfusion, blood group if known, previous transfusion reaction and etc). No preprinted

label is allowed. Please make sure your hand writing is clearly written and not confusing.

2. The hospital registration number (R/N) should be used on the request form for patients who, at the time

of admission, cannot be reliably identified. This R/N must be ‘unique’ and any investigations for this

patient must be identified using this number. When the patient’s full and correct details are available the

ward personnel should accurately communicate this information to the Blood Bank.

3. The quantity and the approximate time when the blood and blood component would be required must be

stated. Requests for blood to be made available “as soon as possible / STAT” should be avoided as this

would not assist the blood bank personnel in determining priorities.

4. he request form should be signed by the requesting doctor and his/her name should be stamped or written

clearly in block letters.

BLOOD REQUEST IN NEWBORN / CHILDREN

1. For infant less than 4 month of age, blood sample must be accompanied by mother’s blood sample.

2. For baby /child using parent’s IC, please filled up the detail of the infant as shown below:

Nama : B/O Kamariah Bt Othman / Name of the child (Father/Mother’s name)

Kad Pengenalan : 840223-01-5029M2

COLLECTING BLOOD / BLOOD COMPONENTS—Refer to APPENDIX 7, 8 & 9 (Page 32 – 36)

The person collecting the blood must bring documentary proof of the patient’s identity. At the time of collection, both blood bank personnel and the person collecting the blood must check that these details match those of the blood unit to be collected. Date and time of issues & collection, name of blood bank personnel & per-son collecting must be recorded.

STORAGE AND TRANSPORT OF BLOOD / BLOOD COMPONENTS —Refer to APPENDIX 8 & 9 (Page 35-37)

M1 — 1st child M2 — 2nd child M3 — 3rd child Note:

Please write down the child’ date of birth /

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Notes: First 50ml of each unit should be transfused slowly as it serves as an in vivo compatibility testing.

Major blood transfusion reaction will develop within seconds after the transfusion started.

ADMINISTRATION OF BLOOD / BLOOD COMPONENTS

—Refer to APPENDIX 6, 7, 10 (Page 32 – 37)

Each unit of blood component supplied from the Blood Bank should be accompanied by a compatibility label. This should carry the following information.

1. At the time of transfusion the information on the compatibility label accompanying the blood component must be checked carefully against the patient’s identification details on the blood request from and patient’s case notes, including the patient’s wristband.

2. Blood should not be transfused if any of the details; especially the name and identification card number of

the patient does not match exactly with that given on the accompanying compatibility label or the blood

request form.

3. Blood should not be transfused if there is deviation from the usual condition. Blood should be checked

macroscopically for any alteration in color of the blood, presence of clot, leakage, etc. The blood bank

should be informed immediately for appropriate measures to be taken and the blood must be returned to the

blood bank. PRETRANSFUSION MEDICATIONS

Prophylactic medication to prevent transfusion reaction is still controversial.

Premedication such as antipyretic, antihistamine or corticosteroid can be administer (oral/IV route) 30-60minutes before transfusion for individual with history allergic or urticarial reactions to transfu-sions in the past.

PATIENT MONITORING DURING TRANSFUSION The patient’s vital signs, including temperature, pulse rate and blood pressure should be recorded during:

Before starting the transfusion (As a baseline)

As soon as the transfusion is started

15 minutes after starting transfusion

At least every hour of transfusion

On completion of transfusion

4 hour after completion of transfusion

TIME LIMITS FOR INFUSION OF BLOOD COMPONENTS—Refer to APPENDIX 10 (Page 37)

NIGHT TIME TRANSFUSION

Where the clinical condition permits, then transfusion at night must be avoided whenever possible, except for emergency cases as:

There is difficulty in visually detecting reactions.

Lower staffing levels make it difficult to carry out the observations in a timely fashion.

Risk of Blood Transfusion Reaction might be happen unnoticed If Transfusion must occur at night,

The light above the patient must remain on while the patient is being transfused.

It should be ensured that sufficient number of staff is available to monitor the patient.

Major Transfusion Reaction is life threatening, qualified Medical personal must be available imme-diately in this situation.

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USAGE OF BLOOD WARMER

There is no evidence that warming blood is beneficial to patient when infusion is slow (1unit over 2 hour). Blood warmers are used to minimize the incidence of cardiac arrest and arrhythmias associated with mas-sive transfusion of cold blood components. Use of blood warmers should be limited to patients receiving multiple, rapid transfusion at rates of >50ml/kg/hr in adults and 15ml/kg/hr in children, and infants undergoing ex-change transfusion. Blood warmer to be used must have a visible thermometer and audible warning service. How-ever keeping the patient warm is probably more important than warming the infused blood.

DRUGS / FLUIDS ADMINSTRATION DURING TRANSFUSION

Red cell concentrates may be diluted with sodium chloride 0.9% to improve the flow rate. This is most simply achieved by using a Y pattern blood administration set. No solutions should be added to any blood compo-nent. This may contain additives such as calcium which can cause citrated blood to clot. Dextrose solution can ly-ses red cells.

Medicines should never be added directly to any blood components, if there is an adverse reaction during

transfusion, it may be impossible to determine whether this is due to the blood, to the added drug or to an interaction of the two.

If an intravenous fluid other than normal saline, or a colloid, has to be given at the same time as blood com-

ponents, it should preferably be given through a separate IV line to avoid any risk of these problems. In a

situation when the transfusion line is the only venous access available and a medication has to be given, the trans-

fusion must be stopped and the tubing should be flush with 0.9% normal saline before and after injecting the medi-

cation to prevent direct mixing of the blood and medication. The transfusion can then be resumed.

BLOOD TRANSFUSION REACTION—Refer to APPENDIX 12 (Page 40 – 41)

Classification Acute Complication (Mild, Moderate Severe, Life Threatening)

Delayed Complication

Sign &Symptoms (Acute Complication)

Mild Moderate Life Threatening

Sy

mp

tom

s

Pruritus

Anxiety,

SOB,

Palpitation,

Headache,

Chest pain,

Pain at infusion site,

Respiratory distress ,

Loin/back pain S

ign

s

Rashes, Urticaria

Flushing,

Rigor, Fever,

Tachycardia,

Restlessness

Hypotension,

Hematuria,

Unexplained Bleeding (DIC)

Po

ssible C

au

ses

Hypersensitivity

Hypersensitivity , Non hemolytic Transfusion Reaction, Contamination

Acute Intravascular haemolysis

*Major ABO incompatible

Septic Shock,

Fluid overload,

RALI

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FLOWCHART IN MANGEMENT OF TRANSFUSION REACTION

A ) Mild Reaction

B) Moderate Reaction

C) Severe Life Threatening Reaction

b) Moderate Severe

Stop Transfusion

Administer

Antihistamine / Corticosteroid

No Improvement Symptoms Improve

(30mins) (30mins)

Continue Transfusion

(At Slower rate)

Stop Transfusion

Maintain ABC

Inform respective MO immediatelty May required ICU Backup

Administer Adrenaline / Frusemide

Corticosteroid / Bronchodilator Inotrope / Antibiotic

According to Type of reaction

Mild Transfusion reaction must be reported

Collection of sample for further Investigation is

not required

Please call MO blood bank for further clarifica-

tion.

Moderate Severe Transfusion Reaction must be

reported

Samples for investigation

*EDTA Tube, Plain Tube & Urine

*Other blood sample (if indicated)

*Resent same sample 24hour later

All the blood products must be sent together with the IV drip set to the blood bank for in-vestigation.

Please call MO blood bank for further clarifica-tion.

All Life Threatening Transfusion Reaction must be reported

*Samples for investigation

*EDTA Tube, Plain Tube & Urine

*Other blood sample (if indicated)

Resent same sample 24hour later

All the blood products must be sent together with the IV drip set to the blood bank for investigation.

Please call MO blood bank for further clarifica-tion.

Stop Transfusion

Administer

Antihistamine / Antipyretic

Corticosteroid / Bronchodilator

No Improvement Symptoms Improve

(15mins) Withhold any transfusion for 24 hour

Restart transfusion with new blood products

According to Type of reaction

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TRANSFUSION OF BLOOD PRODUCT FROM CLOSED FAMILY MEMBERS / RELATIVE

Blood transfusion within closed family / relative is not advisable.

There is risk of develop of delayed type of blood transfusion complication(Graft versus host disease)

Graft versus host disease occurs in situations.

Blood donor is homozygous and the recipient is heterozygous for an HLAhalotype (usually relative blood)

Immunodeficient patients

This type of delayed type of transfusion complication is cause by donor T Lymphocytes prolifera-

tion and attacking recipient’s tissues.

Prevention of Graft versus host disease in blood transfusion :

Avoid Transfusion of blood products from closed family members / relatives.

Gamma irradiation of blood products before transfusion (Facility not available in Hospital Batu

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GUIDELINES IN CLINICAL USE OF BLOOD / BLOOD COMPONENTS

RED BLOOD CELL TRANSFUSION

In deciding whether to transfuse red blood cells, the patient’s hemoglobin level, although important, should

not be the sole deciding factor. Patient signs and symptoms of hypoxia, ongoing blood loss, the risk to the pa-

tient of anemia and the risk or transfusion should be considered. Please refer to the following checklist be-

fore making any decision for blood transfusion:

Tak-en from: “The

Clinical Use of Blood by World Health Organization, Blood Transfusion Safety”

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Taken from: “The Clinical Use of Blood by World Health Organization, Blood Transfusion Safety”

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TRANSFUSION IN ANEMIA

Blood transfusion should only be considered when the anemia is likely to cause or has already reduced the

oxygen supply to a level that is inadequate for the patient’s needs.

Transfusion is rarely needed for patients with chronic anemia. Many transfusion are given that:

Do not give the patient any benefit and may do harm.

Could have been avoided by rapid and effective treatment not involving transfusion.

DO NOT TRANSFUSE MORE THAN NECESSARY. IF ONE UNIT OF RED CELLS IS ENOUGH TO CORRECT SYMPTOMS, DO NOT GIVE TWO UNITS.

Patient with severe anemia may be precipitate into cardiac failure by infusion of blood. If transfusion is

necessary, give one unit, preferable of red cell concentrate, over 2 to 4 hours and give rapid acting diuretic.

TRANSFUSION TRIGGERS

Taken From: “Guidelines For Rational Use of Blood and Blood Products by National Blood

Bank, Minister of Health, Malaysia”

Hb

Consideration

< 70g/L

Lower thresholds may be acceptable in patients without symptoms.

70 – 100g/L

Likely to be appropriate during surgery associated with major blood loss or if there are signs or symptoms of impaired oxygen transport.

> 80g/L

May be appropriate to control anemia-related symptoms on a chronic transfusion regimen or during marrow suppressive therapy.

> 100 g/L

Not likely to be appropriate unless there are specific indications.

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GUIDELINES IN NEONATAL EXCHANGES TRANSFUSION

CALCULATIONS FOR NEONATAL EXCHANGE TRANSFUSION

SELECTION OF BLOOD GROUP FOR NEONATAL EXCHANGE TRANSFUSION

Taken From: “Transfusion Practice Guidelines for Clinical and Laboratory Personnel 3rd edition March 2008”

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PROCEDURE

Taken from “ The Clinical Use of Blood by World Health Oraganization, Blood Transfusion

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NON RED CELL PRODUCTS

SELECTION OF NON RED CELL PRODUCTS

Recommended ABO group for plasma products (FFP, Cryoprecipitate)

Platelet Concentrates in order preference should be:

Patient’s own ABO group

ABO antigen compatible (but plasma incompatible)

ABO antigen incompatible GUIDELINES IN PLATELETS TRANSFUSION

1 unit random platelet will increases platelet count up to 5-10 x 109

Cut off values of platelet count for platelet transfusion :

Taken From: “Guidelines For Rational Use of Blood and Blood Products by National Blood Bank, Minis-

ter of Health, Malaysia”

Clinical Indication Cut off values of platelet count

Hematological Malignancies <20x109

PROCEDURE

Bone marrow Aspiration <20x109, providing adequate surface pressure is applied

Lumbar Puncture, Epidural, OGDS, Indwelling lines, Biopsy, Laparotomy

<50x109

Brain & Eye operation <100x109

MASSIVE TRANSFUSION

Acute Bleeding <50x109

Multiple Trauma / CNS Injury <100x109

DISSEMINATED INTRASCULAR COAGULATION

Acute DIVC <50x109

DIVC with absence of bleeding Platelet transfusion should not be given

IMMUNE THROMBOCYTOPENIA

Autoimmune

Thrombocytopenia Only for life – threatening bleeding form GIT/GUT/CNS and other con-

ditions with severe thrombocytopenia (<10x109 )

Neonatal Autoimmune Thrombocytopenia (NAITP)

Transfuse compatible platelet ASAP, ideally HPA-1a neg, HPA-5b neg. Platelet prepared from mother should be irradiated and washed

Post Transfusion Purpura Platelet transfusion usually ineffective, maybe used in acute phase e.g opera-

tion

PLATELET TRANSFUSION IN DENGUE FEVER – Please refer to latest CPG in Management of Dengue

PLATELET FUNCTION DISORDERS

Platelet only indicated if other measures fail to control bleeding

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Decision for platelet Transfusion

Tak- en

from :New York State Council on Human Blood and Transfusion Services ( http://www.gosh.nhs.uk/health-professionals/clinical-guidelines/platelet-ordering/?locale=en )

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GUIDELINES IN FFP TRANSFUSION (10 - 15ml/kg)

Taken From: “Guidelines For Rational Use of Blood and Blood Products by National Blood Bank, Min-

ister of Health, Malaysia”

NOTES

FFP is not indicated in DIC without evidence of bleeding.

There is no evidence that prophylactic replacement regimens prevent DIC or reduce transfusion

requirement

When used for surgical or traumatic bleeding, FFP usage should be guided by coagulation profiles.

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GUIDELINES OF CRYOPRECIPITATE TRANSFUSION (5-10ML/kg)

Indicated if the plasma fibrinogen is < 1g/L

Taken From: “Guidelines For Rational Use of Blood and Blood Products by National Blood Bank, Minister of Health,

Malaysia”

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GUIDELINES IN MANAGEMEN OF DISSEMINATED INTRAVASCULAR COAGUALATION

Taken from : “The Clinical Use of Blood by World Health Organisation, Blood Transfusion Safety”

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WHAT IS CT RATIO ?

CT RATIO

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Laboratory QA Programme - National Indicator Approach

PROGRAMME : Laboratory QA Programme (Transfusion)

AREA OF CONCERN : Transfusion for Group and Crossmatch blood .

INDICATOR : CROSSMATCH : TRANSFUSION (C:T) RATIO

Rationale : This indicator is to assess the app ropriateness of crossmatching of blood in comparison to

the unit s of blood transfused. A C/T ratioof more than 2.5:1 reflects inappropriateness of crossmatching and thus lead to the increase in workload, cost, wastage and compromises in the quality of blood.

Definition of Terms :

Crossmatch Is a compatibility test carried out on patient’s serum with donor red blood cells before

blood is transfused.

Transfusion Is the infusion of crossmatched whole blood or red cell concentrate to the pa-

tient.

C:T Ratio C:T ratio is: Number of units of blood

Number of units of blood

Inclusion criteria : All crossmatches done in blood bank

Exclusion criteria : Safe Group O blood given without crossmatch in an emergency.

Type of Indicator : Efficiency.

Numerator : Number of units of blood crossmatched

Denominator : Number of units blood transfused

Standard : No greater than 2.5 : 1

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“CT RATIO”

HOSPITAL BATU PAHAT STANDARD = < 2.5

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25

APPENDIX

Page 26

26

APPENDIX 1

Page 27

27

APPENDIX 2

GENENRAL SURGICAL

GSH GXM

Cholecystectomy Colectomy Colostomy Closure Hemicolectomy Small Bowel Resection Hiatus Hernia Repair Inguinal Hernia Repair Thyroidectomy

Parathyroidectomy Vagotomy Varicose Veins Mastectomy Laparotomy

4 PINTS

Abdominal Perineal Resection Oesophagectomy Pancreatectomy Portocaval Shunt Whipple’s Procedure Laporatomy for intrabdominal haemorrhage / Perforated

Viscus 2 PINTS

Gastrectomy Hiatus Hernia Repair - Transthoracic Splenectomy

OBSTECTRIC & GYNAECOLOGY

GSH GXM

Induction of labour High risk pregnancy in labour Diagnostic Laparoscopy For Ectopic pregnancy All LSCS except bleeding All Other Gynaecological Operations

Termination D&C Vaginal Repair Manual Removal Of Placenta Evacuation Under Anesthesia Vaginal Hysterectomy

2 PINTS

Hysterectomy - Wertheim Bleeding Placenta Previa Abruptio Placenta Myomectomy Vulvectomy Severe Endometriosis For TAH Molar Pregnancy Ectopic Pregnancy For Laparotomy High risk LSCS

Anaemia cases Hb < 9g% Classical Caesarian Section Placenta Previa with Previous scar

ORTHOPAEDIC DEPARTMENT

GSH GXM

Trauma - Upper Limb

Shoulder And Humerus Shaft Surgery

Trauma - Lower Limb

Tibia shaft/Plateau (Plating/

Interlocking)

Femur Interlocking /Plating/IMN

Trauma - Hip

Hemiarthroplasty

Dynamic Hip Screw Fixation

Arthroplasty Total Knee Arthroplasty

Paediatric Orthopaedic

All surgeries with tourniquet Spine

Laminectomy Spinal Fusion

Miscellaneous Elective Below knee Amputation

(BKA) Elective Above knee Amputation

(AKA) Arthrodesis of major joints

1 PINT

Trauma – Pelvic

Pelvic Surgery- Acetabulum

2PINTS Total Knee Replacement

3 PINTS

Total Hip Replacement Tumor Surgery Endosprosthesis Tumor resection

EAR, NOSE & THROAT

GSH

Rhinoplasty Parotidectomy

Tonsilectomy Adenoidectom

Adenotonsilectomy Drainage of retropharyneal & Parapharyngeal abscess

MAXIMUM SURGICAL BLOOD ORDER SCHEDULE (MSBOS) UNIT TABUNG DARAH

HOSPITAL BATU PAHAT

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APPENDIX 3

Page 29

29

APPENDIX 4

CHECKLIST FOR TAKING BLOOD FOR GROUP AND CRO

Taken From: Transfusion Practice Guidelines For Clinical and Laboratory Personnel, 3rd Edition 2008 by National

Blood Centre, Ministry Of Health Malaysia.

Page 30

30

APPENDIX 5

Page 31

31

APPENDIX 6

Page 32

32

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mat

ed d

ura

tion

of

pro

cess

ing

on

ly v

alid

if

no p

roble

ms

fou

nd

duri

ng A

nti

bod

y S

cree

nin

g /

Cro

ss m

atch

ing &

avai

labil

ity

of

com

pat

ible

blo

od.

3.

Ref

erra

l to

HS

AJB

/ P

usa

t D

arah

Neg

ara

wil

l be

req

uir

ed f

or

any

dif

ficu

lt c

ross

mat

chin

g. In

th

is s

ituat

ion, it

may

req

uir

e 2

-3

or

more

work

ing d

ays

for

the

pro

cess

.

< 3

0 m

in

1 –

2 h

ours

or

mor

e, d

epen

d o

n

avai

labil

ity o

f co

mpati

-ble

blo

od

<

30 m

in

If

pat

ien

t hav

e his

tory

of

blo

od t

ran

sfusi

on

duri

ng

curr

ent

adm

issi

on, n

o b

lood s

ample

is

req

uir

ed.

P

late

le/F

FP

/CR

YO

wil

l be

sup

pli

ed d

irec

t-ly

acc

ord

ing t

o b

lood g

roupin

g

F

FP

& C

ryo w

ill

be

thaw

ed b

efore

supply

APPENDIX 7

PR

OC

ED

UR

E I

N B

LO

OD

TR

AN

SF

US

ION

LA

B

Page 33

33

G

rou

p,

Scre

en

& H

old

(G

SH

)

Em

erg

en

cy B

lood

Pa

cked

Cel

l (C

om

ple

ted

GX

M)

F

FP

/ C

RY

O

Pla

tele

t C

on

cen

trati

on

Du

ra

tion

of

rese

r-va

tion

24

hours

bef

ore

rel

ease

No r

eser

vat

ion

is

allo

w

R

equ

est

wh

en r

equir

e

Su

pp

ly

Aft

er b

lood

gro

up

ing

and s

alin

e cr

oss

-

mat

chin

g

D

oct

or

/ st

aff

mu

st r

ush

to

blo

od

ban

k w

ith

ice

box

im

med

iate

ly

Aft

er c

ross

-mat

chin

g

A

fter

Gro

upin

g

N

o c

ross

-mat

chin

g r

equir

ed

R

equ

est

on

ly w

hen

req

uir

ed

Coll

ecti

on

B

lood

Box

wit

h I

ce

B

lood

Box

wit

hou

t Ic

e

Use

/ T

ra

nsf

use

d

Mu

st b

e tr

ansf

use

im

med

iate

ly w

ith

in 3

0 a

fter

coll

ec-

tion

, p

leas

e re

turn

im

med

iate

ly t

o b

lood

ban

k i

f n

ot

tran

sfu

se

C

om

ple

ted

Tra

nsf

usi

on

wit

hin

4 h

our

FF

P/C

RY

O

P

lease

in

form

th

e b

lood

ban

k

befo

re

coell

ecti

on

(th

aw

ing)

T

ran

sfuse

im

med

iate

ly a

fter

thaw

ing , t

o c

om

ple

te t

ran

sfusi

on

wit

hin

4

hours

PL

AT

EL

ET

S

Tra

nsf

use

im

med

iate

ly,

to c

om

ple

te t

ran

sfusi

on a

s so

on

as

poss

ible

Sto

ra

ge

Sto

re a

t le

ss t

han

-25°C

S

hou

ld n

ot

be

store

d o

r

kep

t in

th

e w

ards

M

ust

be

tran

sfu

sed a

s so

on

as p

oss

ible

aft

er t

haw

ing

C

oag

ula

tion

fac

tor

wil

l be

deg

rad

ed r

apid

ly a

fter

thaw

-in

g

R

oom

Tem

per

ature

+20°C

+2

4°

C o

n a

git

ator

N

ever

sto

re i

n r

efri

ger

ator

S

tore

at

tem

per

ature

+2

°C t

o +

6°C

B

lood

sh

ou

ld n

ot

be

store

in

war

d f

or

more

th

an 4

h

our.

Sta

ndby

blo

od

for

surg

ery

in O

per

atio

n T

hea

ter

mu

st

be

store

in

wel

l m

onit

ore

d t

emp

erat

ure

blo

od

fri

dge.

Page 34

34

G

rou

p,

Scre

en

& H

old

(G

SH

)

FF

P /

CR

YO

P

late

let

Con

cen

trati

on

Pa

ck

ed

Cell

Retu

rn

Ret

urn

im

med

iate

ly i

f n

ot

use

d

Aft

er

use

F

ill

up t

he

Blo

od

Tag

an

d r

eturn

tog

eth

er w

ith e

mpty

bag

to b

lood b

ank a

s so

on

as

poss

ible

Imp

orta

nce n

ote

s :

C

hec

kli

st b

efore

dec

ided

to c

oll

ect

blo

od

pro

du

cts

from

blo

od

ban

k

Con

sen

t fo

r tr

ansf

usi

on

Pre

sen

t of

fun

ctio

nin

g I

V a

cces

s

Vit

als

sign

of

the

pat

ient

is s

table

P

leas

e tr

ansf

use

blo

od p

rodu

cts

imm

edia

tely

, b

lood

mu

st N

EV

ER

be

stored

in

a w

ard

or

cli

nic

al/

dom

est

ic r

efr

iger

ato

r u

nd

er a

ny

cir

cu

mst

an

ces.

S

tan

d b

y B

lood f

or

pat

ien

ts d

uri

ng s

urg

ery

and in th

e im

med

iate

post

-op

erat

ive

per

iod

mu

st b

e st

ore

d in th

e T

HE

AT

RE

blo

od

frid

ge.

Page 35

35

APPENDIX 8

CO

LL

EC

TIO

N &

RE

TU

RN

ING

OF

BL

OO

D P

RO

DU

CT

S

Ple

ase

use

dif

fere

nt

blo

od b

ox f

or

coll

ecti

on

of

blo

od p

roduct

of

dif

fere

nt

pat

ien

t A

bo

ve

pra

ctic

e is

to p

reven

t sw

itch

ing o

f blo

od p

rodu

cts

duri

ng

tra

nsf

u-

sion

, th

us

pre

ven

t m

ajor

tran

sfusi

on c

om

pli

cati

on.

BL

OO

D P

RO

DU

CT

S

PL

EA

SE

US

E S

EP

AR

AT

OR

P

leas

e p

repar

e a

separ

ator

bet

wee

n t

he

ice

pac

k a

nd t

he

blo

od p

roduct

s D

irec

t co

nta

ct o

f blo

od w

ith t

he

ice

wil

l ca

use

red

blo

od c

ell

to l

yses

.

PL

EA

SE

US

E F

RO

ZE

N I

CE

PA

CK

Ple

ase

mak

e su

re y

ou

hav

e a

froze

n i

ce p

ack b

efore

you c

om

e to

coll

ect

blo

od

pro

du

cts

Pa

rti

all

y f

roze

n o

r m

elt

ice p

ack

is

stric

tly n

ot

all

ow

Th

is i

s to

en

sure

the

cold

ch

ang

es i

s w

ell

mai

nta

in d

uri

ng t

he

tran

sport

a-

tion

of

the

blo

od p

roduct

s.

FO

RZ

EN

IC

E P

AC

K

PL

AT

EL

ET

CO

LL

EC

TIO

N !

!!

No i

ce p

ack

ed i

s n

eeded

dur

ing p

late

let

coll

ecti

on

Ple

ase

mak

e su

re y

ou h

ave

at l

east

tw

o/m

ore

blo

od

box

(1

wit

h i

ce,

anth

er

wit

hou

t ic

e),

in s

ituat

ion

wh

en y

ou r

equir

e to

coll

ect

oth

er b

lood

pro

d-

uct

s duri

ng t

he

sam

e ti

me.

T

he

pla

tele

t m

ust

be

store

at

room

tem

per

ature

(20C

to 2

4C

) on

agit

ator

to

pre

ven

t p

late

let

clum

pin

g a

nd m

ainta

in i

ts f

un

ctio

n

CO

LL

EC

TIO

N O

F B

LO

OD

/ B

LO

OD

PR

OD

UC

TS

Page 36

36

ST

OR

AG

E O

F B

LO

OD

PR

OD

UC

TS

PR

IOR

TO

TR

AN

SF

US

ION

R

ED

CE

LL

S A

ND

WH

OL

E B

LO

OD

Red

cell

s and w

ho

le b

loo

d m

ust

alw

ays

be

sto

red a

t a

tem

per

atu

re b

etw

een +

2°C

to +

6°C

. T

hey m

ust

never

be

all

ow

ed t

o f

reez

e.

T

he

upper

lim

it o

f 6°C

us

esse

nti

al

to m

inim

ize

the

gro

wth

of

any b

acte

rial

conta

min

atio

n i

n t

he

unit

of

blo

od.

The

low

er l

imit

of

°C

us

esse

nti

al

bec

ause

red

cell

s th

at a

re a

llo

wed

to f

reez

e bec

om

e hae

mo

lyse

d.

If t

hey a

re t

ransf

use

d,

the

pre

sence

of

cell

fg

ments

and

free

hae

mo

glo

bin

can c

ause

fat

al ble

ed

ing p

roble

ms

or

renal fa

ilure

.

T

he

solu

tio

n i

n t

he

blo

od b

ag c

onta

ins

bo

th a

nti

co

agula

nt

(so

diu

m c

itra

te)

to s

top b

loo

d f

rom

clo

ttin

g a

nd d

extr

ose

(glu

cose

) to

‘fe

ed’

the

red c

ell

s duri

ng s

tora

ge.

Sto

rage

at a

tem

per

ature

bet

wee

n 2

°C t

o 6

°C i

s es

senti

al to

mak

e su

re t

he

dextr

ose

is

no

t u

sed t

o q

uic

kly

.

W

ho

le b

loo

d a

nd r

ed c

ells

sho

uld

be

issu

ed f

rom

the

blo

od b

ank

in a

blo

od t

ransp

ort

bo

x o

r in

sula

ted c

arri

er

O

nce

the

Who

le b

loo

d a

nd R

ed c

ell

s ar

e co

llect

ed, it

mu

st b

e in

fuse

d w

ithin

30 m

inute

s.

W

HO

LE

BL

OO

D /

PA

CK

ED

CE

LL

are

not

all

ow

ed t

o k

eep

in

ward

cli

nic

al

refr

igera

tor

at

an

yti

me.

F

or

op

era

tive

case

s, u

nle

ss r

equ

ired

fo

r im

med

iate

tra

nsf

usi

on

, W

HO

LE

BL

OO

D /

PA

CK

ED

CE

LL

fo

r S

TA

ND

BY

PU

R-

PO

SE

sh

ou

ld b

e st

ore

d o

per

ati

ng t

hea

tre

blo

od

ref

rigera

tor

at

a t

emp

era

ture

bet

wee

n 2

°C t

o 6

°C

W

HO

LE

BL

OO

D /

PA

CK

ED

CE

LL

MU

ST

BE

RE

TU

RN

IM

ME

DIA

TE

LY

TO

BL

OO

D B

AN

K I

F N

OT

US

ED

PL

AT

EL

ET

CO

NC

EN

TR

AT

ES

Pla

tele

t co

nce

ntr

ates

must

be

kep

t at

a t

emper

ature

of

20

°C t

o 2

4°C

on a

pla

tele

t ag

itat

or

to m

ain

tain

pla

tele

t fu

nct

ion.

Sin

ce t

her

e is

a r

isk

of

bac

teri

a pro

life

rati

on, th

e st

ora

ge

life

is

rest

rict

ed t

o 3

to 5

days.

Pla

tele

ts t

hat

are

held

at

low

er t

emper

ature

lo

se

heir

blo

od c

lott

ing c

a-

pab

ilit

y.

P

late

let

conce

ntr

ates

sho

uld

be

issu

ed f

rom

the

blo

od b

ank i

n a

blo

od b

ox o

r in

sula

ted c

arri

er t

hat

wil

l keep

the

tem

per

ature

at

abo

ut

20

°C

to 2

4°C

P

late

let

conce

ntr

ates

sho

uld

be

tran

sfuse

d a

s so

on a

s po

ssib

le.

They s

ho

uld

never

be

pla

ce i

n a

refr

igera

tor.

FR

ES

H F

RO

ZE

N P

LA

SM

A /

CR

YO

PR

EC

IPIT

AT

E

F

resh

fro

zen p

lasm

a /C

ryo

must

be

store

d in t

he

blo

od b

ank a

t a

tem

per

ature

of

-25

°C o

r co

lder

unti

l it

is

thaw

ed b

efo

re t

ransf

usi

on.

M

ost

clo

ttin

g f

acto

rs a

re s

table

at

refr

iger

ato

r te

mper

ature

s, e

xce

pt

for

Fac

tor

V a

nd F

acto

r V

III.

If

pla

sma

is n

ot

sto

red f

roze

n a

t -2

5°

C o

r co

lder

, F

acto

r V

III

and

Fac

tor

V f

all

s ra

pid

ly o

ver

24 h

ours

. P

lasm

a w

ith a

red

uce

d F

acto

r V

III

level

is o

f no

use

fo

r tr

eatm

ent.

F

resh

fro

zen p

lasm

a sh

ou

ld b

e th

awed

in b

loo

d b

ank i

n a

wat

er b

ath b

etw

een +

30

°C t

o 3

7°C

and i

ssued

in a

blo

od t

ransp

ort

bo

x i

n

whic

h t

he

tem

per

ature

is

main

tain

ed b

etw

een +

2°C

to

6°C

F

FP

sho

uld

be

infu

sed i

mm

edia

tely

aft

er t

haw

ing f

or

opti

mu

m r

esu

lt

APPENDIX 9

Page 37

37

TIM

E L

IMIT

S F

OR

IN

FU

SIO

NS

ST

AR

T I

NF

US

ION

C

OM

PL

ET

E I

NF

US

ION

WH

OL

E B

LO

OD

(450m

l) /

RE

D C

EL

LS

(1

50-2

00m

l)

W

hit

in 3

0 m

inute

s aft

er c

oll

ect

ion

<

4 h

ours

P

LA

TE

LE

T C

ON

CE

NT

RA

TE

S (

50

-60m

l)

Im

med

iate

ly a

fter

co

llect

ion

A

s so

on a

s po

ssib

le

FR

ES

H F

RO

ZE

N P

LA

SM

A (

200-3

00m

l)

CR

YO

PR

EC

IPIT

AT

E (

10

-20m

l)

Im

med

iate

ly (

aft

er t

haw

ing)

<

4ho

urs

APPENDIX 10

Page 38

38

HO

W T

O U

SE

BL

OO

D S

TIC

KE

R

APPENDIX 11

UP

PE

R S

EC

TIO

N:

Fil

l u

p t

he

deta

ils

of

tran

sfu

sion

com

ple

tely

R

etu

rn

th

e c

ard

togeth

er w

ith

em

pty

blo

od

bags

to

Blo

od

Ban

k a

s so

on

as

poss

ible

L

OW

ER

SE

CT

ION

: F

ill

up

th

e d

eta

ils

of

tran

sfu

sion

com

ple

tely

P

ast

e o

n p

ati

en

t’ f

ile f

or

futu

re r

efe

ren

ce

Page 39

39

APPENDIX 12

Page 40

40

APPENDIX 13

Page 41

41

APPENDIX 14

Page 42

42

UNIT TABUNG DARAH

JABATAN PATOLOGI

HOSPITAL BATU PAHAT

BORANG PEMULANGAN DARAH / KOMPONEN DARAH

Nama Pesakit _____________________________________________ Wad : _________________

K/P : ______________________________________________ R/N : ________________________

Umur : _________________ tahun Bangsa : _____________ Jantina : Lelaki / Perempuan

Nama & Tandatangan Pegawai Yang Memulangkan:

Tarikh :

Masa

Nama & Tandatangan Pegawai Yang Menerima :

Tarikh :

Masa :

BIL TARIKH & MA-

SA DIAMBIL

JENIS DARAH / KOPONEN

(WB/PCPlatelet/FFP/Cryo/dll)

NO SIRI BEG DARAH

SEBAB –SEBAB PEMULANGAN

BOR / HBP / PAT / 005 / Issue 1 /Rev.0 / 21.07.2008

APPENDIX 15

Page 43

43

REFERENCES

TRANSFUSION PRACTICE GUILDLINES FOR CLINICAL AND LABORATORY PERSONNEL,

3RD EDITION 2008 (By National Blood Centre, Ministry Of Health Malaysia)

Website: http://www.pdn.gov.my

GUILDLINES FOR THE RATIONAL USE OF BLOOD AND BLOOD PRODUCTS, 2ND EDITION

2007 (By National Blood Centre, Ministry Of Health Malaysia)

Website: http://www.pdn.gov.my

LABORATORY MANUAL (By Unit Transfusion medicine, HSAJB)

Website: http://hsajb.moh.gov.my/modules/xt_conteudo/index.php?&id=196

THE CLINICAL USE OF BLOOD(By World Health Organization, Blood Transfusion Safety)

Website: http://www.who.int/bloodsafety/clinical_use/en/Manual_EN.pdf

TECHNICAL MANUAL(By American Association of Blood Bank) A PHYSICIAN’S GUIDE TO TRANSFUSION OPTIONS (By New York State Council on Human Blood and Transfusion Services, Second Edition 2008) OTHER REFERENCE / WEBSITE

MOH Dengue Management CPG( http://moh.gov.my/v/id )

MOH Management of Thalassemia( http://moh.gov.my/v/ha )

MOH Management of ITP (http://moh.gov.my/v/hae )

http://www.transfusionguidelines.org.uk/docs/pdfs/htm_edition-4_all-pages.pdf

http://www.gosh.nhs.uk/clinical_information/clinical_guidelines?category=Blood%20transfusion

http://www.sld.cu/galerias/pdf/sitios/anestesiologia/practical_guidelines_blood_transfusion.pdf

http://www.nhmrc.gov.au/publications/synopses/cp77syn.htm

Page 44

44

Page 45

45

Notes

Page 46

46

Notes

Page 47

47

Notes

Page 48

48

TERIMA KASIH DARI UNIT TABUNG DARAH HBP