Blood Transfusion

The Blood Transfusion Department performs transfusion-related testing and provides a range of blood products for the Royal Stoke University hospital (RSUH) and County Hospital (CH).

The Blood Transfusion Department provides a range of tests, which are available over the two sites, Royal Stoke university hospital (RSUH) and County Hospital (CH).

To maintain the performance of laboratory testing at the required high level the department participates in external quality assurance schemes.

The blood transfusion department strives for the safe and timely provision of blood components.

For Major haemorrhage activation alert the laboratory without delay on:

Major Haemorrhage Bleep (RSUH) 77 or 78 175

The Blood Transfusion laboratory at UHMN operates a zero tolerance policy on sample labelling.

Sample must be handwritten with the minimum details stated below:

  • Surname (spelt correctly)
  • Forename (spelt correctly)
  • Date of Birth
  • Unique identifier- this could be the hospital number or NHS number
  • Signature of the person taking the sample

Ideally the sample should also include the patient’s sex and date and time of collection

Any samples not meeting the minimum requirements will be rejected and this will be recorded on the laboratory system

Poorly venepunctured blood samples can dramatically affect the results of a test. Some of the more common issues are listed below:

  • Insufficient sample – appropriate volume blood tubes are supplied. Insufficient samples will mean an inability to test and delay in results and provision of blood products.
  • Haemolysed sample - if the blood sample has been venepunctured using needle and syringe and a small gauge needle is used to pierce the lid of the Vacutainer tube, haemolysis may occur especially if the blood is forced into the tube by pushing the plunger. Vacutainer tubes contain a vacuum that will naturally draw sufficient blood into the tube. Changing to a wider gauge needle before piercing the Vacutainer lid may prevent haemolysis. Haemolysed samples cannot be tested as signs of incompatibility between patient and donor may be masked.
  • Samples delayed in transit – testing and therefore provision of blood products will be delayed. Significant delays may mean the sample is no longer suitable for testing.
  • Clotted samples – samples not taken directly into the Vacutainer and mixed sufficiently may clot. Once clotted the red cells cannot be tested for the blood group and the sample will be unsuitable for testing.

In the event of an acute transfusion reaction, stop the transfusion immediately and report the incidence to the MO who will contact Haematology Medical Staff. 

Refer to the Guidelines on the Administration of Blood and Blood Components within the Medical and Surgical handbooks regarding the management of adverse reactions. 

The blood component which appears to have caused the reaction plus all other used or partially used products from the transfusion episode must be returned to the Transfusion Laboratory along with a post-transfusion group & save request detailing the transfusion reaction.

This will facilitate an investigation into the possible causes of the reaction.

All potential transfusion reactions must be reported to Transfusion nurse/practitioner to ensure appropriate actions are taken.

Any cases of suspected bacterial contamination must be immediately reported to NHSBT.

Royal Stoke University Hospital:

Medical advice on Haematological, Blood transfusion or related issues can be obtained at all times;

  • By contacting the duty clinician on bleep 723 between 09:00 and 17:30 on weekdays.
  • Outside these hours, by contacting switchboard (Internal 0, External 01782 715444), and asking for the Medical Haematologist on call.

County Hospital:

Medical advice on Haematological, Blood transfusion or related issues can be obtained at all times;

  • Contact switchboard (Internal 0, External 01785 257731), and ask for the Medical Haematologist on call

It is essential that blood and blood products are stored correctly to minimise any adverse incidents from occurring:

  • Blood must only be stored in authorised blood refrigerators
  • Blood transfusions should be commenced no longer than 30 minutes from the time the unit was taken from the Blood fridge. 
  • Fresh Frozen plasma must be used within 4 hours of thawing if stored at room temperature or within 24 hours if stored in an authorised blood fridge.
  • Platelets should be kept agitated in The Blood Transfusion laboratory. They should not be collected until the department is able to administer them to the patient.

Avoidable wastage of blood and blood products will generate a 'Wastage Report' and the units will be charged for. This is monitored by the Hospital Transfusion Committee.

The Blood Transfusion department will refer samples to the NHS Blood and Transplant Reference (NHSBT) Laboratories for the following tests:

  • Complex antibody identification and complex crossmatches

Red Cell Immunohaematology (RCI)
NHSBT Birmingham
Vincent Drive
Birmingham
West Midlands
B15 2SG

  • Platelet Immunology
  • Heparin Induced Thrombocytopenia screen quantitation (H.I.T)

Histocompatibility & Immunogenetics (H&I)
NHSBT, Filton,
North Bristol Park
Northway
Filton
Bristol
BS34 7QH

In July 2016 the Blood Transfusion laboratory introduced the two sample rule for requests for blood and blood components (blood, fresh frozen plasma, cryoprecipitate, platelets, granulocytes).

What is the two sample rule?

The Blood Transfusion laboratory need to ensure that there are two distinct samples from a patient that have generated the same blood group from both samples.

If the Blood Transfusion laboratory has seen the patient before and already has a historic blood group on file then only one sample is required for either group and save or X-match.

If the patient has no previous blood groups on file then a second sample must be supplied and tested before blood products can be supplied.

Why was this rule introduced?

Wrong blood in tube (WBIT) is a 'never event' i.e. it should not happen; however on rare occasions it does. The consequences of transfusing somebody with blood of an incorrect blood group is very serious and can lead to serious morbidity and even mortality.

WBIT is a SHOT (Serious Hazards of Transfusion) reportable incident. The two sample rule is a national guideline to improve patient safety when receiving transfusions.

How does the two sample rule work?

If the patient is not known to the blood transfusion laboratory then the two sample rule is invoked:

The two samples must come from separate venepuncture events and ideally should be carried out by two different people.

Separate request forms must be completed for each sample.

It is NOT acceptable to take two samples at one venepuncture event and send them to the blood transfusion laboratory on separate request forms. This will not negate the possibility of WBIT.

There is no limit on the time between samples as long as the Blood Transfusion laboratory have a historic blood group on record.

How will I know if a second sample is required?

If the blood transfusion laboratory requires a second sample then a lab comment will be added to the group & save request, this can be checked on ICM or ICE . If you are still unsure then please telephone The Blood Transfusion laboratory on 74946 (RSUH) or 4758(CH).

What happens in an emergency situation?

If blood is required in an emergency e.g. massive haemorrhage protocol being invoked, the two sample rule will still apply and a second sample should be sent as soon as possible. The blood transfusion laboratory will complete all testing on the primary sample without delaying component issue. The second sample will be used for rapid confirmation.

For more information and reports relating to transfusion safety please visit www.shotuk.org 

Specialist Practitioners of Transfusion assist in the development and implementation of the Trust Policy and Procedures for the Administration of Blood and Blood Components C03 designed to improve the safety and effectiveness of blood transfusion medicine within the Trust:

  • Promote and provide advice and support to clinical teams on the appropriate use of blood to ensure that agreed protocols for the indications for transfusion of blood, plasma and platelets are adhered to.
  • Implement the Hospital Transfusion Committee action plans including competency based training and assessment for all staff involved in blood transfusions.
  • Invoke the investigation of blood transfusion-related incidents, monitors trends and introduces appropriate corrective actions through changes in Trust policies and procedures.
  • Provide advice and support to patients (and their carers) requiring blood components.

Contact details

Mon – Fri  (9am – 5pm) (available 8am on Mon, Tues & Thursday)

Pager – either contact switchboard or Ange Salmon on 07623616520, Pam Irving on 07623929358, Dionne Bentley & Angela Wainwright on 07623950511

Email – All queries relating to traceability, training etc. – transfusion.team@uhnm.nhs.uk

Telephone – Transfusion team office - 01782 (6)71909

  • To request a product call your local transfusion laboratory who will take the request verbally and advise if a sample is required
  • Not all products are available on site so some have to be ordered from the National Blood Service for delivery the same day. Please note times for delivery cannot be guaranteed as this is traffic dependent and our nearest national blood centre is located in Birmingham
  • Frozen products will be thawed prior to issue and will be available within 30 minutes