Blood Transfusion for Doctors

1. Blood Transfusionfor Doctors

2. My transfusion knowledge is… PROFICIENT PATCHY POOR

3. Rate your transfusion knowledge IN AN EMERGENCY What to request? How long will it take? PROCEDURES Sampling & labelling Indications for blood, platelets, FFP, cryoprecipitate TRANSFUSION REACTIONS Identifying Managing & reporting WHO CAN HELP? Who’s in the transfusion lab? Who else is there? SPECIAL REQUIREMENTS Irradiated CMV negative Phenotyped Which patients?

4. IN AN EMERGENCY Extreme emergency only Group specific ABO & RhD compatible Important antibodies may cause reaction Crossmatched Fully screened for antibodies ~30-60 mins from sample arriving Group O RhD Neg Important antibodies may cause reaction Valuable resource ASSESS URGENCY Choose the right products COMMUNICATE Allocate a lead to liaise with lab & porters AVOID ERRORS Careful bedside labelling G&S, FBC, DIC screen – swiftly to lab ~15mins from sample arriving Safest product if time allows Preempt need for FFP (30mins to thaw; 12-15mL/kg = 4 units for average adult) Preempt need for platelets (eg 1-2 adult therapeutic doses; d/w Haem Reg)

5. CONTACTS Laboratory Technician / Biomedical Scientist / Senior Transfusion BMS Adults x64400 Bleep 2525 Paeds x12234 Bleep 1345 Porters x4850 Emergency x11597 Doctors Clinical Haematologist Haem Reg Bleep 4445 or via switch after hours On-Call General Haem Consultant – via switch On-Call Paeds Haem Reg/Consultant – via switch Doctors should ask for help when they realise their own knowledge & skills are inadequate Transfusion Team (working hours) Transfusion Practitioners Mary – Bleep 2010 Carmel – Bleep 8041 Transfusion Consultant Haematologist Dr Kate Pendry – working hours via switch Paed Consultant Haematologist – Dr Andrew Will Annual Report 2008

6. SAMPLING & PRESCRIBING Tell me your name and d.o.b. positive identification label at bedside consent & leaflet entry in medical notes “No band, no blood” “Right blood, right patient, right time, right place”

7. BLOOD “1 unit RBC” Usual time: 3hrs 4hr limit from removal from cold storage to end of transfusion Blood warmer for rapid transfusions COMMON INDICATIONS Acute blood loss Only with significant blood volume loss Consider cell salvage Anaemia Hb < 7.0 g/dL Likely requires transfusion Consider correctible causes Anaemia Hb 7.0 - 10.0 g/dL Consider correctible causes Transfuse if symptoms/needs eg IHD Pre-operative assessment Correction of anaemia reduces need for transfusion MBOS (Maximum Blood Ordering Schedule) ? ? ? ? Refer to Trust Blood Transfusion Policy

8. BLOOD PRODUCTS Fresh Frozen Plasma “1 unit FFP” Usual time: 30 mins/unit Needs 30 mins to thaw in lab Usual dose 12-15 mL/kg (4-6 units for average adult) Main indications: coagulopathy with bleeding/surgery, massive haemorrhage, TTP. Not warfarin reversal. Cryoprecipitate “1 pool cryoprecipitate” Usual time: 30 mins/bag Needs 30 mins to thaw in lab Adults: 1 pool = 5 donor units Usual adult dose: 2 pools (10 donor units) Main indication: coagulopathy with fibrinogen < 1.0 g/L Platelets “1 ATD platelets” Usual time: 30 mins 1hr limit Usual dose: 1 adult treatment dose (ATD) Shelf-life only 5 days from donation Valuable resource with restricted indications Prothrombin Complex Concentrate (PCC) Plasma-derived Vit K dependent factors: II VII IX X For emergency reversal of life-threatening warfarin over-anticoagulation (do not use FFP) Issued by transfusion lab – supply in A&E See trust policy

9. SPECIAL REQUIREMENTS Fairly specific indications… Paeds, Haem, Onc, O&G… …but “it is the responsibility of the prescribing doctor” CMV NEGATIVE To keep at-risk patients CMV free (~50% of us are CMV negative) Children < 1yr Intrauterine transfusions Congenital immunodeficiency and unless known to be CMV IgG +ve: Stem cell / marrow transplant patients Potential transplant patients (eg most leukaemia, some lymphoma) HIV patients Pregnant women IRRADIATED To prevent transfusion-associated graft versus host disease (rare) in specific T-cell immunodeficiency cases Intrauterine transfusions Congenital immunodeficiency Hodgkin Lymphoma Stem cell / marrow transplant patients After purine analogue chemo (fludarabine) Refer to Trust Blood Transfusion Policy

10. TRANSFUSON REACTIONS Mild reaction Temp rise < 1.5°C Urticaria Rash Pruritis STOP TRANSFUSION Review obs Paracetamol Chlorpheniramine? Restart cautiously Trust Blood Transfusion Policy Intranet ➞ Documents ➞ Transfusion OR www.transfusionguidelines.org.uk OR Ask for help Suspected severe reaction Pyrexia, rigors Hypotension Loin / back pain Increasing anxiety Pain at the infusion site Respiratory distress Dark urine Severe tachycardia Unexpected bleeding (DIC) STOP TRANSFUSION Right patient? Right blood product? Whole set to lab New set with saline Full bloods as policy Checklist (see policy) Incident form Refer to Trust Blood Transfusion Policy

11. RESOURCES Trust Policies Intranet ➞ Documents ➞ Transfusion Blood Transfusion Policy (Central) Blood Transfusion Policy (Paeds) Maximum Blood Ordering Schedule for Surgery Massive Haemorrhage Policy The Transfusion Handbook www.transfusionguidelines.org.uk National Online Training www.learnbloodtransfusion.org.uk

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