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TABLE OF CONTENTS - Blood Transfusion Procedures Manual


CHANGE CONTROL 6
REQUIRED READING: STAFF RECORDS 7
1.0 SPECIMEN REGISTRATION 8
1.1 Registration 9
1.2 Patient/Request/Specimen Identification 10
1.3 “Unknown” Patients 11
1.4 Telephone Requests 11
1.5 Blood Transfusion Superset Test Codes 11
1.6 Work Pending Lists 12
2.0 ACCEPTANCE AND REJECTION OF SPECIMENS 13
2.1 Acceptance Requirements 13
2.1.1 Identification 13
2.1.2 Specimen Criteria 14
2.2 Criteria for Specimen Rejection 16
2.2.1 Incorrect or Inadequate Identification 16
2.2.2 Inadequate Sample 17
3.0 REPORTING MISMATCHED SPECIMENS 18
4.0 SPECIMEN PROCESSING 19
4.1 Specimen Handling 19
4.2 Specimen Preparation 19
4.3 Work Pending Lists, Results Not Authorised Lists, Daily Result Summary, Worksheets and Workbooks
19 4.4 Creating Work Pending Lists or Worksheets 20
4.5 Clerical Check – Work Pending List /Worksheet Versus Request Forms 21
4.6 Work Pending Computer Result Entry 21
4.6.1 ABO and Rh(D) Group Results 21
4.6.2 Antibody Screen Results 21
4.7 Result Entry – Individual Test Set Mode 22
A Crossmatch and Single Group Test Sets 22
B Blood Issue 23
4.8.1 Group & Hold, Routine and Antenatal Batches 24
4.8.2 Crossmatching 24
4.9 Verification of Abnormal test Results 25
4.9.1 Blood Groups 25
4.9.2 Antibody Screens 25
4.9.3 Direct Antiglobulin Test 25
4.10 Validation and Authorisation of Work 25
4.10.1 Routine Blood Group and Antibody Screens 25
4.10.2 Crossmatches 26
4.10.3 Antibody Identifications 27
4.10.4 Sendaway Results 27
5.0 GENERATING REPORTS 28
5.1 Routine, Antenatal, Antibody Identification and Sendaway Reports 28
5.2 Crossmatch, FFP, Platelet and Cryoprecipitate Issue Reports 28
5.3 Crossmatch and Cord Blood Group/DAT Reports. 28
5.4 Urgent Crossmatch Requests 28
6.0 AMENDED REPORTS 30
6.1 Authority to Deauthorise 30
6.2 Procedure for Report Amendment 30
7.0 SPECIMEN TRANSPORT, STORAGE AND DISPOSAL 31
7.1 Specimen Preservation During Transport 31
7.2 Storage of Specimens Pending Testing 31
7.3 Storage of Specimens After Testing 31
7.3.1 Crossmatch Samples 31
7.3.2 Group & Hold Samples 32
7.3.3 Antibody Investigation Samples 32
7.3.4 Other Samples 32
7.4 Disposal of Specimens and Consumables 33
9.0 PATHOLOGY PROCESS IMPROVEMENT (PPI) 34
9.1 “OUR HOSPITAL” Pathology Process Improvement Forms 34
9.2 ARCBS Continuous Improvement Forms 35
10.0 METHOD VALIDATION 36
10.1 Preliminary Investigations 36
10.2 Method Selection 36
10.3 Introduction of New Method 36
11.0 INSTRUMENT EVALUATION 36
12.0 MAXIMUM BLOOD ORDER SCHEDULE (MBOS) 38
12.1 Orthopaedic Surgery 39
12.2 Obstetrics and Gynaecological
12.3 Vascular/Cardiac/Thoracic 40
12.4 Gastrointestinal/Abdominal 41
12.5 Genito-Urinary/Renal 42
12.6 Head/Neck 43
12.7 Wounds/Excisions/Grafts 43
13.0 READING HAEMAGGLUTINATION 44
13.1 General Considerations 44
13.2 Procedure 45
13.3 Reading Haemagglutination 45
13.3.1 Tube Haemagglutination 45
13.3.2 BioVue Cassette Haemagglutination 45
14.0 GROUP & HOLDS 47
14.1 Protocols 47
14.1.1 ABO and Rh(D) Grouping 47
14.1.2 Antibody Screen 48
14.1.3 Sample Validity for Crossmatch 48
14.2 Procedure – Computer on Line 48
14.3 Verification and Authorisation of Results 49
15.0 GROUP AND HOLD CONVERTED TO CROSSMATCH 51
15.1 Protocols 51
15.2 Procedure 52
16.0 ROUTINE FULL CROSSMATCH PROCEDURE 54
16.1 Protocols 54
16.1.1 ABO and Rh(D) Typing 55
16.1.2 Antibody Screen and Crossmatch 55
16.1.3 Incompatible Crossmatch 55
16.1.4 Time Blood held on Crossmatch 57
16.2 Procedure – BioVue Method 57
16.2 Procedure – Tube Method 58
17.1 Procedure – BioVue Method 59
18.0 CROSSMATCH IN THE PRESENCE OF AUTOANTIBODIES 60
18.1 Procedure for Cold-Reactive Autoantibodies 60
18.2 Procedure for Warm-Reactive Autoantibodies 61
19.0 ISSUE OF GROUP SPECIFIC BLOOD 63
19.1 Protocols 63
19.2 Procedure – Emergency Group Specific Issue 63
20.0 ISSUE OF EMERGENCY GROUP “O” BLOOD 65
20.1 Procedure for Issue of “O” Negative Blood 66
20.1.1 Inventory 66
20.1.2 Procedure when the computer is off line 66
Use the “Blood Not Crossmatched Issue/Return” Register. 66
Enter DIN, blood group, expiry and date. 66
20.1.3 Emergency Box “O” Negative Stock Replacement 66
20.1.4 Documentation of “O” Negative Blood Issued from Emergency Box 66
20.2 Procedure for Emergency “O” Positive Blood 67
21.1 Protocols 68
21.1.1 Choice of Donor Blood 68
21.1.2 1st Crossmatch 68
21.1.3 Second and Subsequent Occasions 69
21.2 Procedure 70
21.2.1 First Crossmatch 70
21.2.2 Subsequent Transfusion Episodes 70
21.4 Platelet Issue 71
21.5 FFP Issue 71
22.0 BLOOD TRANSFUSION PRACTICE 72
22.1 Choice of Donor Blood for Transfusion 72
22.2 Alternate Blood Loss Guidelines 73
22.3 Whole Blood 73
22.3.1 “Ultra” Fresh Whole Blood 73
22.3.2 Fresh whole blood less than 5 days old 73
22.4 Red Blood Cells (Packed cells with additive solution) 74
22.4.1 Leucocyte Poor Red Cells 74
22.4.2 CMV Negative Blood/Products 75
22.4.3 Kell Positive Blood 75
22.4.4 Rh(D) Negative Blood Donations with “E” or “C” Antigens Present 75
22.4.5 Irradiated Blood 76
22.4.6 Blood for Thalassaemia Patients 76
22.4.7
Blood for Renal Patients 76
22.4.8 Blood for Neonates 76
22.5 Platelet Concentrates 77
22.5.1 General Considerations 77
22.5.2 Platelet Transfusion Guidelines 77
22.5.3 Effects of Platelet Transfusion 78
22.5.4 Irradiated Platelets 78
22.5.5 Leucocyte - Poor Platelet Concentrates 78
22.6 Fresh Frozen Plasma (FFP) 80
22.6.1 Guidelines for Use 80
22.6.2 FFP Issue 80
22.7 Cryoprecipitate 80
22.7.1 Guidelines for Use: 81
22.7.2 Cryoprecipitate Issue 81
23.0 ISSUE OF CSL BLOOD PRODUCTS 84
23.1 Unrestricted Products 84
23.2 Restricted Blood Products 85
24.0 MASSIVE TRANSFUSIONS 86
24.1 Issue of Emergency Blood - Patient Group Unknown 86
24.2 Issue of Emergency Blood - Patient Group Known 86
24.3 Issue In The Presence of Unexpected Antibodies 86
24.4 Changing Blood Groups 87
24.4.1 Compatible, Non-Group Specific to Patient Group Specific 87
24.4.2 Patient Group Specific to Compatible Non-Group Specific 87
24.4.3 To Convert from Rh (D) Negative Blood to Rh(D) Positive 87
25.0 “LONG HOLD” BLOOD ON CROSSMATCH 88
26.0 AUTOLOGOUS BLOOD TRANSFUSION 89
26.1 Request for Autologous Blood Collection 89
26.2 Autologous Transfusion At “OUR HOSPITAL” 89
26.2.1 Receipt of Autologous Unit 89
26.2.2 Autologous Crossmatching 89
26.2.3 Unused Autologous Units 89
27.0 DIRECTED DONATION TRANSFUSION 90
28.0 ANTENATAL AND ROUTINE TESTING 91
28.1 Protocols 91
28.1.1 ABO and Rh(D) Grouping 91
28.1.2 Antibody Screen 92
28.2 Procedure 92
29.0 NEONATAL CORD BLOOD TESTING 94
29.1 Protocols 94
29.2 Procedure for Cord Blood Group 95
29.3 Procedure for Direct Antiglobulin Test (DAT) 95
30.0 DIRECT ANTIGLOBULIN PROCEDURE (DAT) 96
30.1 Protocols 96
30.2 Procedure - Computer on Line 96
30.3 Drugs Known To Cause Positive DATs and/or Haemolytic Anaemias 97
30.4 Typical Findings Using Antiglobulin Reagents 99
31.0 DONOR UNIT BLOOD GROUP CHECKS 100
31.1 Reagent/Equipment 100
31.2 Procedure 100
31.2.1 “D” Tube Group 100
31.2.2 ABO Tile Group 101
31.3 Validation of Group Check Worksheet and Blood Pack Unit 101
32.0 ANTIBODY IDENTIFICATION 102
32.1 Protocols 102
32.2 Procedure 103
32.3 Blood Group Antibody Characteristics 105
32.4 Resolution of Panel Results That Show Variation in Reaction Strength 106
32.5 Aids to Identifying Antibodies to High Incidence Antigens 107
33.0 ANTIBODY TITRATION 108
33.1 Protocols 108
33.2 Procedure 108
APPENDIX 109
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