Pre-transfusion compatibility testing prior to transfusion involves:

1. Determining the ABO and Rh group of the recipient
2. An antibody screen to detect the presence or absence of clinically significant red cell antibodies
   1. A computer crossmatch, the electronic selection and release of blood, applies only for transfusion recipients with a negative antibody screen and with no known history of antibodies of clinical significance.
   2. A full serological crossmatch applies for transfusion recipients whose antibody screen is positive or there is a history of antibodies of clinical significance or previous laboratory investigations have suggested a full crossmatch.

 

72 hour rule & Extended Expiry

72 HOUR RULE. A crossmatch specimen expires after 72 hours therefore another specimen will be required for any units not administered within the 72 hour period. The 72 hour rule applies to any patient who has been transfused or is/has been pregnant within the previous 3 months. This international rule is to safeguard patients against possible transfusion reactions as a result of developed red cell antibodies in response to previous transfusion and/or pregnancy

EXTENDED EXPIRY. Extended expiry requests for pre-operative day of surgery admissions (DOSA) is a special request where the GS episode is held for up to one month. It applies to patients who satisfy the following criteria;

• No blood transfusion in the past 3 months
• No pregnancy in the past 3 months
• No history of clinically significant antibodies
• No other serological anomalies or laboratory instructions that require follow-up repeat testing or where the IAT crossmatch has been suggested.

EXTENDED EXPIRY IN PREGNANCY. Under special circumstances, a one week extension of the standard group and screen is allowed in pregnancy. Conditions such as placenta previa and accreta have the potential for sudden and life-threatening blood loss. Similarly, pregnant patients may be requested an extension of their group and screen in late pregnancy to meet the requirement for late obstetrical interventions such as caesarean section.

 

Request Form

Request for Blood/Blood Products form

The medical officer ordering testing should provide the following information:

1. Clear identification of the patient: FULL name (surname and given name(s)), UR number and date of birth. Gender (if unclear from other information)
2. Name and signature of the practitioner completing the form
3. Details of the test(s) requested and/or type of blood component/product required
4. Clinical diagnosis and indications for blood/blood product
5. Transfusion history
6. Known red cell antibodies
7. Previous or current pregnancy [including Rh(D)-Immunoglobulin administration]
8. Date and time required
9. Location

Mandatory labelling of the request form to be accepted for processing

• FULL Name (surname and given name(s))
• UR number and/or date of birth
• Completed and signed collector's declaration statement
• Date and time of specimen collection

 

Specimen Required

Mandatory labelling of the specimen to be accepted for processing

• FULL Name (surname and given name(s))
• UR number and/or date of birth
• Collector's signature or initial on the specimen
• Date and time of specimen collection

The Blood Bank has zero tolerance for mislabelled specimens and request forms. Specimens and request forms that do not meet the mandatory labelling criteria will not be accepted for processing and a new specimen and request form will be required.
 

Why ZERO TOLERANCE?

Errors during the collection of a pre-transfusion specimen can be devastating because they can initiate a chain of events leading to ABO incompatible blood transfusion. During specimen collection, failure to identify the patient correctly and label specimens accurately has resulted in the blood being taken from a completely different patient .  There is evidence that a zero tolerance policy reduces this risk.

How to GET IT RIGHT!

Identify the patient accurately before taking the sample. How?

Ask the patient to state their FULL name and date of birth. Cross check the details provided (including UR number) against the pathology request form & wristband If there are any discrepancies (no matter how minor) DO NOT PROCEED. Rectify the problem immediately

In the unconscious / confused / infant patient, the wristband must be used to verify the patient's identity. Check the patient's surname, given name(s), UR number and date of birth on the identification wristband. It is also important to verify the patient's identity with a carer/spouse/parent if available.  Be aware that wristbands are sometimes wrong!

How to LABEL THE SPECIMEN PROPERLY!

	ALWAYS label the specimen tube at the patient's bedside immediately after collection and before leaving the patient.
	Have all your equipment prepared before you start
	DO NOT label the specimen tube prior to collecting the blood.
	DO NOT walk around with an unlabelled specimen tube
	DO NOT label a specimen tube for someone else

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How soon is blood available?

TIMEFRAME	RED BLOOD CELLS
Immediate	Group O Rh negative, Kell negative red blood cells 2 units available in HRH blood fridges - ward 12 and TSC
40 minutes	Crossmatch compatible Red Blood Cells (when antibody screen is negative)
> 1 hour	Group compatible phenotyped Red Blood Cells (when antibody screen is positive)

* Note timeframes do not include transport time to and from the lab

 

TIMEFRAME	OTHER COMPONENTS
30 minutes	Fresh Frozen Plasma - Requires thawing
30 minutes	Cryoprecipitate - Requires thawing
Immediate (if available)	Platelets (only 6 bags in inventory for AH and MHW)

* Note timeframes do not include transport time to and from the lab

 

TIMEFRAME	Fractionated Plasma Products
Immediate	Albumex 4 and 20
Immediate	Clotting Factors e.g. Prothrombinex-VF, Biostate
Immediate	Immunoglobulins
Requires approval from the Blood Service*	Intravenous Immunoglobulins

* Note timeframes do not include transport time to and from the lab

 

Backtotop

Request for Intravenous Immunoglobulin

Complete the following forms and send to the Austin blood bank: Request for Blood/Blood Products and the related IVIG request form of the Australian Red Cross Blood Service. Click here for a link to the IVIG request forms.

* Criteria for the Clinical Use of Intravenous Immunoglobulin (IVIg) in Australia

* Comparison between IVIG products: Intragam, Octagam, Flebogamma

 

Request for Emergency Blood Transfusion

The staff member (medical officer or nurse delegate) requesting blood components for emergency transfusion must call the Austin Blood Bank on ext 5230 and provide the following information:

• Patient details: Surname and Given Name(s) AND UR number or Date of Birth
  (Unknown patient identifiers may be used in the emergency department if the patient’s identity cannot be established)
• Diagnosis / Clinical Indication
• Type of blood component/s
• Quantity required
• Urgency of the situation
• Anticipated ongoing need for emergency transfusion support
• Name of a designated contact person

Heidelberg Repatriation Hospital

2 units of GROUP O Rh NEGATIVE, KELL NEGATIVE PACKED RED CELLS for emergency use only are available in each of the Heidelberg Repatriation Hospital (HRH) blood fridges located on Ward 12 and The Surgery Centre, Flanders Wing. The Austin Blood Bank must be notified when these units are being used so that the fridges can be promptly restocked.

The Mercy Hospital for Women

3 units of GROUP O Rh NEGATIVE, KELL NEGATIVE, CMV NEGATIVE PACKED RED CELLS for emergency use only are available in the MHW theatre blood fridge located on Level 1 MHW. The Austin Blood Bank must be notified when these units are being used so that the fridges can be promptly restocked.

Communication

Austin Blood Bank has a nominated reserve of blood components for non-emergency and emergency transfusion. This reserve can become limited particularly during periods of blood shortage and in the event of massive transfusion. Clear communication between clinical staff and Austin Blood Bank staff is essential in ensuring the timely, safe and appropriate provision of blood for transfusion.

Collecting Blood for Emergency Transfusion

SEND a staff member to collect blood from the blood bank (or remote blood fridge) with the following patient details: FULL name, UR and/or date of birth and ward location. This can be in the form of a printed patient label or can be handwritten.

Blood Sample

Regardless of the urgency of transfusion, a sample for pre-transfusion testing (group and screen / crossmatch) must be taken from the patient prior to blood transfusion to enable the laboratory to efficiently provide the most appropriate units for the patient. This will not lead to unnecessary delays in providing blood because the patient will continue to be supported with emergency units until the sample is processed and crossmatched blood is made available.

 

Massive Transfusion Guidelines

In adults 'massive transfusion' may be defined as a transfusion of half of one blood volume in 4 hours, or more than one blood volume in 24 hours (adult blood volume is approximately 70 mL/kg). Hence in a 70kg person, one blood volume is approximately 5L, or 8 units of red cells

Clear communication between clinical staff and Austin Blood Bank staff is essential in ensuring the timely, safe and appropriate provision of blood for massive transfusion. A Massive Transfusion Clinical Guideline has been developed to help the clinicians manage patients with significant bleeding. It provides information about the use of different blood components and products, including recombinant activated factor VII. 

Policy Links

Massive Transfusion Clinical Guideline

Massive Transfusion Protocol FLOWCHART

Requesting Blood Components for Emergency and Non-emergency Transfusion

External Links

Critical Bleeding/Massive Transfusion Guidelines