Haematology and Blood Transfusion / Haematology and Blood Transfusion Handbook
Version 11 April 2017
Page 1 of 44
Manual
Haematology and Blood Transfusion Handbook
Haematology &
Blood Transfusion
Handbook
The Pennine Acute Hospitals NHS Trust
The Central Pathology Facility at the Royal Oldham Hospital
Contents
Page Section Content
5 1 General Information
7 2 Contact Information
9 3 Hospital Blood Transfusion Practitioner
11 4 Blood Transfusion Tests and Procedures
15 5 Anticoagulant Service
16 6 Haematology and Blood Transfusion Test Repertoire, Specimen
Requirements and Reference Ranges
22 7 Specimen Collection System
27 8 Results
28 9 Specialist Tests and Procedures
33 10 Quality Control, Assurance and
Measurement Uncertainty
34 11 Referred Tests
1. General Information
Haematology and Blood Transfusion Laboratory
The Haematology and Blood Transfusion Laboratories within The Pennine Acute Hospitals NHS Trust are IBMS (Institute of Biomedical Sciences) and HCPC (Health & Care Professions Council) approved for Training Biomedical scientists.
The Royal Oldham, North Manchester General and Fairfield General Hospitals operate a 24 hour shift system 365 days a year. HCPC registered members of Haematology / Blood Transfusion staff are always available on site. Samples originating from Rochdale Infirmary are transported and processed at the Central Facility at Oldham, apart from the Clinical Assessment Unit that have on site ‘point of care’ (PoCT) full blood count (FBC), INR and D-Dimer testing facilities.
Details of the more common tests, their sample requirements and turnaround times can be found in section 6 of this document.
Haematology test requests
Pennine Acute Hospitals NHS Trust laboratories provide a comprehensive Haematology and Blood Transfusion service. The laboratoriesprovide a full service between 09:00 hours and 17:00 hours, Monday to Friday excluding public holidays.
Haematology requests can be made either through HealthViews electronic ward ordering application which is becoming the normal procedure within the hospital or by using one of the red Haematology/Biochemistry/Immunology request cards. GP requesting is normally made through TQuest electronic GP ordering system or by the Haematology/Biochemistry/Immunology request cards. In the event of any of the electronic systems being unavailable the request card should be used.
On the Haematology request card a mark should be made clearly in the box opposite the required test. There is additional space for writing any additional test which is not listed. Request forms must bear theprintedname and bleep number of the Medical Officer making the requests & the requesting source. To permit processing by the departmental computer and facilitate enquiry for results on ward terminals, the patient's date of birth, hospital number (including any prefix letter with a total of 8 numeric characters) and name must be printed clearly. With Health Views or TQuest, labels printed in the presence of the patient containing the barcode must be used; when using the request card independent of an electronic ordering system, addressograph labels can be used for the card, but the sample bottle should be filled in by hand.
A/E routine tests are processed in less than 60 minutes. This is in line with our Key Performance Indicator (KPI’s). KPI 6.1 Critical results communication is set by the Royal College of Pathology. KPIs have been developed to assist laboratories in demonstrating their contribution to patient management pathways. The KPIs should provide evidence of conformity with standards of accreditation and, through discussion with users of the service, will facilitate demand management and support a clinically effective service.
Information / Results
For inpatients the test results should be accessed via HealthViews electronic patient management system or via the Pathology Results Enquiry portal on the Interactive link on the Pennine Intranet homepage. For tests not requested via HealthViews a computer generated paper report will be dispatched in the post. The Introduction of the HealthViews ward order requesting should eliminate the need to have a paper record. Further information provided in section 8.
Results, which are markedly abnormal and / or require urgent attention, will be communicated via telephone or rarely by facsimile to a safe haven fax machine.
All requests must conform to the Pathology Sample & Request Card Labeling Policy CPDI061 which can be found on the Trust Intranet.
The laboratories may be contacted directly using the telephone numbers contained in the section below;
2. Contact Information
The Clinical Haematology Service
The department of Haematology and Blood Transfusion provides a complete clinical referral service for all the hospitals within Pennine Acute Hospitals NHS Trust and an outpatient referral service for General Practitioners.
The Clinical lead for Haematology is Dr. David Osborne (71914)
The Consultant Haematologists within Pennine Acute are:-
Dr. Martin Rowlands, (71650/NMGH 42483)
Dr. Allameddine Allameddine (75033)
Dr. Hayley Greenfield (71259)
Dr. Antonina Zhelyazkova, (75033)
Dr. Satarupa Choudhuri (78387)
Dr Mohammad Pervaiz (78374)
All requests for Clinical Haematology advice can be made via switchboard who will contact an appropriate member of the Clinical Haematology team through the Trust paging system. This applies to all times of the day and not just outside of normal working hours.
Haematology Management Team - All Sites
Michael Heaton - Haematology & Blood Transfusion Services Manager
0161 656 1678 (Internal 71678)
Jane Uttley - Technical Manager Blood Transfusion
0161 656 1761 (Internal 71761)
Jennie Rogers - Technical Manager Haematology
0161 778 5439 (Internal 75439)
Jane Nelson - Technical Manager Haematology
0161 656 1762 (Internal 71762)
Hospital Site / Address / Telephone No - Haematology / Telephone No - Blood TransfusionRoyal Oldham Hospital / Postal Address:
Rochdale Rd
Oldham
OL1 2JH / For Technical Queries:
Haematology Lab:
0161 627 8370 or 8371 (Internal 78370/1) / Lab:
0161 627 8372 (Internal 78372)
North Manchester General Hospital / The ESL Laboratory is located on the main hospital corridor.
Postal Address:
Delaunays Rd
Crumpsall
Manchester
M8 5RB / For General Enquiries:
0161 604 5386 (Internal 45386)
For Technical Queries:
Haematology Lab
0161 604 5387 (Internal 45387) / Lab:
0161 720 2100 (Internal 42100)
Fairfield General Hospital / The Laboratory is located behind the Broadoak Suite adjacent to Fairfield House.
Postal Address:
Rochdale Old Rd
Bury
BL9 7TD / For Technical Queries:
Haematology Lab
0161 778 2597 (Internal 82597) / Blood Transfusion lab
0161 778 2598 (Internal 82598)
3. Hospital Blood Transfusion Practitioner
The Blood Transfusion Practitioners Contact numbers:-
Royal Oldham Hospital: Sue Andrews- 78790/ 07870692823
Fairfield General and Rochdale Infirmary: Bev Sedman- 83825/ 07976313807
North Manchester General: Christopher Porada- 42797/ 07870693110
Assistant Transfusion Practitioner: Deborah Curley- 07854764557
Cell Salvage Jo Ann Bayliss- Bleep #7755
Blood Transfusion Secretary: Margaret Hardy- ext. 71260
The Trust Transfusion Committee (TTC) aims to achieve better co-operation, communication and closer working relationships between the Blood Transfusion Department and the users of the service to improve Transfusion practice and improve patient safety.
Each of the Trust Clinical Divisions are represented to ensure that relevant transfusion related issues are raised, discussed and where appropriate policies amended or produced to maintain and improve quality standards and patient safety.
The role of the Transfusion Practitioner is to educate and train Trust staff in Transfusion Practice and promote a safe and effective service for all patients who require the transfusion of blood and blood products.
Duties include: -
Provision of education Competency Assessment and practical support to all staff involved in the transfusion chain.
Act as the key person relating to the Trusts Risk Management Strategy.
Identifying areas suitable for research and audit and taking appropriate action in accordance with the findings of the audit.
Development and implementation of policies following national and local guidelines that are designed to ensure the delivery of a safe and effective transfusion service.
The policies that have been produced are available on the Trust Intranet Documents in the Blood Transfusion folder and are as follows - list not exhaustive;
Indications for red cell transfusion - the green policy: EDC007 Version: 7
Requesting, collecting and labeling of a blood sample for transfusion tests, which generate a blood group. EDC012 V10
The Administration of Blood Components Policy: EDC006 V9
Management of Massive Blood Loss: EDC 009 v9.0
Guidelines for the Use of Platelet Transfusions in adults & children/neonates: CPDI011 V8
Policy for the use of Fresh Frozen Plasma Components CPDI 012 Version 9.0
Irradiated Blood Components Policy: CPDI035 Version 6
Policy - Management of Transfusion Reactions: EDC 005 V10.2
Policy for the use of Blood and Blood Components on the Neonatal Unit CPDI026 V1.1
Protocol for the use of Human Albumin 4.5% & 20%. CPDI 137 Version 2
Policy – Transfer of Blood and blood components between hospitals within the Trust and other hospitals: CPDI043, v6.0
Guideline – Management of bleeding in patients receiving antithrombotic agents or who require emergency/elective anticoagulant reversal – CPDI 201, v1.0
Policy - The Management of all Patients Who Decline Blood Components, including Jehovah’s Witnesses: CPDI064 v5.1
Policy for the collection of red cells from the blood bank fridge, EDC011, V10
Cell Salvage
Intra operative cell salvage services are now available within the Trust. For further information please contact Jo-Ann Bayliss, Cell Salvage Coordinator via Trust switchboard on bleep #7755.
4. Blood Transfusion Tests and Procedures
Group and Save
Samples sent for Group and Save are processed for a blood group and antibody screen and then retained for seven days for identification and record keeping purposes. However validity of retained samples for blood product issue is dependent upon blood transfusion history and obstetric status. Please see document Requesting, collecting and labeling of a blood sample for transfusion tests, which generate a blood group EDC012 on Trust Intranet Documents for further information.
Pre-operative samples needed for scheduled procedures must have the date of operation clearly indicated on the request card. Samples are kept for 7 days, day one being the day taken.
Specimens for Investigation of a Positive Antibody Screen.
Occasionally when a patient develops an antibody it may be necessary to send further samples to the NHSBT for evaluation and confirmation.
The samples are requested by the laboratory staff, who then arrange the transportation to the appropriate centre. The availability of results depends on the complexity of the testing. NHSBT normally issues 95% of reports for all red cell investigation (RCI) tests within 5 working days of receipt of sample except in cases where more complex antibody investigations are encountered or where extensive testing is required. In these cases the Transfusion laboratory will be notified. RCI will prioritise investigations according to the clinical requirements of the case.
In the case of an antenatal patient, paternal samples may be requested and a regime of follow up testing for the mother may be implemented.
Red blood cells
Allocated blood is kept in the Blood bank issue fridges at various locations. The blood is reserved until the morning of the second day post stated date required, then returned to the laboratory and returned to stock. If the operation is cancelled or delayed, please inform the Blood Transfusion department in order to facilitate any change.
Once a blood transfusion has commenced the total crossmatched blood MUST be used within 48 hours. Timings of samples suitable for crossmatching must comply with BCSH Guidelines 2012.
· Patients transfused within 90 days or pregnant -the sample must be taken no more than 3 days before transfusion.
· Patient’s transfusion more than 90 days-the sample must be taken no more than 7 days before transfusion. This enables the laboratory to assess the antibody status of the patient.
Blood is collected from the Blood bank issue fridges by trained nursing staff and porters who must bring the appropriate patient identification documentation. Refer to document Policy for the collection of red cells from the blood bank fridge, EDC011 on Trust Intranet Documents for further information.
NB: For the issue on any group specific blood product two blood groups are required from two separate samples. If a further sample is required the laboratory will contact the ward to request another group and save sample.
Platelets
Two blood group results from two different group and save samples will be required to be on record before platelets can be issued.
· Pooled platelet concentrate, leucocyte depleted (random donor)
ABO and Rh specific, supplied by NHSBT already pooled from 4 donors, approximate volume 300ml, content of platelets >240 x 109 per donation.
· Platelet apheresis, leucocyte depleted (single donor)
ABO and Rh group specific, supplied as one pack collected by cytophoresis from a single donor. Volume 200-300ml, content of platelets >240 x 10 9 approximately equivalent to 4 single donations. These are also available as HLA/HPA antigen matched donors, which may be effective in patients who do not respond to platelets due to HLA or HPA antibodies. Crossmatched platelets may be indicated in certain instances – donors are selected by a test for reaction with recipients’ plasma. HLA/HPA matched and crossmatched platelets will need at least 24 hours’ notice to order as they are ordered in specifically from NHST.
Refer to document Guidelines for the Use of Platelet Transfusions in adults & children/neonates: CPDI011 on Trust Intranet Documents for further information.
All platelet packs must be stored at room temperature 20-24oC with constant agitation and must not be refrigerated. Platelet packs should be infused over a period of 30 minutes. A fresh standard giving set should be used and will be issued with the platelet pack by the laboratory.
Fresh Frozen Plasma
Two blood group results from two different group and save samples will be required to be on record before FFP can be issued.
· Fresh frozen plasma, leucocyte depleted (random donor)
ABO and Rh group specific, approximate volume 150-300ml plasma containing CPDA, which contains normal plasma levels of stable clotting factors, albumin and immunoglobulin. They do not contain platelets. Stored in the Blood bank at –25oC and 40 minutes is required to defrost each request. Must then be used within 4 hours if stored at room temperature or 24 hrs if stored at 4 oC in a designated Blood bank refrigerator. Refer to document Policy for the use of Fresh Frozen Plasma Components CPDI 012 on Trust Intranet Documents for further information.