NUCL 166 – TRANSFUSION SERVICES PART ONE MIDTERM
The transfusion services subdivision of the lab is also referred to as the blood bank and is responsible for the key functions;
· Ordering blood products from the Canadian Blood Services (CBS)
· Safely storing blood products in a temperature controlled environment
· Distributing blood products to patients in the hospital
Common Blood Products
· Packed red blood cells (PRBC) also known as packed cells (PC) or unit packed cells (UPC) = administered to patient’s who have significant blood loss or critically low hemoglobin levels
· Albumin = a protein found in blood serum to help maintain blood volume and pressure by stopping plasma leakage from capillaries
· Platelets = used to promote blood clotting, typically given to patients with low platelet count
· Fresh frozen plasma (FFP) = liquid portion of blood (devoid of cells) used to aid in blood clotting and is helpful for patients with clotting deficiencies
· Cryoprecipitate = derived from plasma, administered to people with specific clotting disorders such as “hemophilia”
NUC ROLE IN PROCESSING ORDERS FOR TRANSFUSION
1. Correct patient identification – ID label
2. Correct test selection – select/write appropriate tests on requisition in correct subdivision of the lab
EXAMPLE :
· Albumin (CHEM) = orders chemistry test for venous blood samples
· Albumin (TS) = requests units of albumin blood product for transfusion
3. Date/Time – if order is not specific consider routine analysis collected @ next collection round
4. Additional relevant information – include pertinent details such as
· Medication the patient takes that could affect test results
· Time sensitive need for results
Completing the Order Processing
Once a test is submitted the NUC will;
1. Notate the order = RMO, OE
2. Kardex the order = transcribe to lab section and write K on physicians order
3. Double check and sign off = review for accuracy
· If processed orders need to be checked by the nurse
· Pull up nurses attention flag
· Place chart in correct area at the station for the nurse
Nurses do not verify electronic entries made by the NUC so always double check for any errors
Completing a Requisition
1. Apply ID label
2. Complete blood order section
· Type/amount of blood ordered
3. Record date of requisition – enter the date the order is being processed
4. Enter patients diagnosis on designated area of requisition form
There are three priority levels when ordering packed red blood cells
· Routine
· STAT
· Quick spin
** the section below diagnosis line containing info regarding the patients previous blood product administration history is completed by a lab tech/RN
Transcribing To The Kardex
Orders for blood products go in two sections of the Kardex
1. LABORTORY SECTION = indicate request was sent to the lab
2. IV THERAPY = document the administration of blood products to the patient
Physicians Order Transcription to K
July 9,2019 @ 0940 Lab Section
Give 2 units of packed cells Jul 9 / 2 units of packed cells /RMO
today Dr Gill
Iv Therapy
Jul 9 / give 2 units of packed cells today
#1, #2
THE RN WILL CROSS OF # 1, # 2 AFTER EACH UNIT IS TRANSFUSED TO SHOW COMPLETED
OTHER TASKS
Same Day Transfusion = when blood products are ordered for the same day the NUC notifies the patients nurse and the nurse will ensure that an IV line is done in preparation for the transfusion
Vital Signs = during blood transfusions the patients vital signs are monitored closely. The NUC is responsible for applying an ID label to “blood product transfusion clinical record” form and providing it to the nurse for documentation
Procedures for Transfusion Orders
When an order is received for blood products such as albumin, platelets, fresh frozen plasma (FFP) or cryoprecipitate to be transfused the NUC will fill out the appropriate section of the requisition form with number of units ordered.
Albumin = is available in two concentrations 5% or 25% and the order will specify which concentration is ordered and beside Albumin on the requisition there is a space % to write it
Plasma = frozen plasma must be thawed prior to transfusion which can cause a delay of approximately 30 minutes before its ready. The lab will notify the NUC when available and the NUC will relay to the RN who will pick it up from the blood bank
Blood Transfusion
· Units of blood used for transfusion are referred to as packed red blood cells (PRBC) also known as “units of PC” or AB+ packed cells (PC) or acronym UPC = unit of packed cells
· Before a patient can receive blood transfusions the lab must collect a venous blood sample. Blood specimens are tested as follows:
1. Blood typing & Rh Factor
- Patients blood type (A,B,O, OR AB) determined along with Rh factor (positive or negative)
- Blood is then screened for antibodies
2. Compatibility Testing
- Patients blood will be matched with compatible units of donor blood
The tests performed on a patients blood are commonly referred to as:
- Type & Screen (Group & Screen)
- Crossmatch (Match)
Blood Available for Transfusion
Blood can either be homologous or autologous
Homologous = is blood from donors given at blood collection clinics/centers. Donor blood given to a patient is called Homologous Transfusion. The majority of blood transfusions are homologous (donor) blood
Autologous = is when a patient is scheduled for surgical procedures and donates their own blood for transfusion
Testing in not required for a patient to receive their own blood; type, screen, crossmatch is unnecessary
Type & Screen (Group & Screen)
· Testing for T&S determines a patients blood type (A,B,AB OR O) and Rh factor (positive or negative) then the specimen is screened for antibodies. This test can take 2 hours.
· A type and screen can be ordered independently from a cross match (X-M). A T&S means the comprehensive portion of testing will be done, but no units of donor blood will be matched to the patient. T&S is typically ordered when there is a possibility that the patient may need a blood transfusion
EXAMPLE : pre-operatively for surgical procedures – low hemoglobin, but not dangerously low due to bleeding
Once testing is done a copy of the requisition is sent to the nursing unit to be placed in the patient's chart and the specimen will be held at the lab. Units of donor blood are not tagged. Should they be needed for a transfusion the cross match can be performed quickly as the T&S has already been done. Matching the patients blood to donor blood (the final part) takes only 10 minutes
Requisitioning a T&S
The NUC writes the date/time required next to “type and screen” of requisition, the number of units is not needed on the requisition as units of blood will not be matched or tagged for the patient. The date/time should reflect the patients surgery schedule.
EXAMPLE: Patient is scheduled for surgery @ 1100 on May 9,2025. She attends a pre-surgical screening (PSS) appointment on May 7,2025. The surgeon ordered a T&S pre-op, on the “PSS unit requisition” the NUC would request a pre-op T&S while the patient is at the appointment on May 7,2025 and writes May 9,2025 @ 1100 in the date/time required section of the requisition
CROSS MATCH
· Orders for cross match (X-MATCH OR X-M) mean the doctor wants units of donor blood to be on hand for transfusion for the patient. If the order is written to “transfuse” this means the units are given.
· If T&S has already been done the lab only has to cross match the patients blood with donor blood. If it hasn’t been done the cross match will include, typing, screening, and matching.
· Cross matching (X-M) is only done after typing and screening to ensure compatibility
Requisitioning a Cross Match (X-M)
NUC fills out section of requisition with number of units ordered and date/time the units are required
1. ROUTINE = NUC writes number of units in the routine section and date (possibly time) the units are needed in the date/time section
Examples
- if ordered pre-op, write the date/time of the operating room (OR)
- if ordered for tomorrow morning, write tomorrows date
- if ordered for today’s transfusion, write todays date
Requisition is then sent to lab, if blood isn’t to be transfused right away units are held at the blood bank
Note: the NUC does NOT order blood STAT or quick spin unless directed by the physicians order
2. STAT OR QUICK SPIN = when X-M is ordered stat or quick spin the NUC writes the number of units in the relevant section of the requisition and todays date in the date and time section, as well as informing the lab by phone about stat or quick spin
Same Day Transfusion
· If units are to be transfused as soon as they are ready, the NUC tells the lab via phone or computer entry and writes todays date on the requisition so it is collected and tested promptly. The lab will notify the NUC when the blood is ready. One unit of blood can take several hours to transfuse.
Procedures for Blood Transfusions
When blood is drawn the lab puts a red arm band on the patient with an identification number, this band cannot be removed. Once the blood has been matched to donors blood the donor units are tagged with the same identification number so the RN can check the arm band for the corresponding number on the units of packed cells before transfusion
Completed Req needed for Blood Pick up
During testing the lab completes the bottom section of the requisition, and after testing a copy is sent to the nursing unit to go into the patients chart. The NUC will file it in the lab section of the chart. The RN must take a copy to the lab to pick up units of blood, some hospitals may send the NUC to pick up the units
72 hour outdate
Units of blood are held (matched and tagged for a specific patient) for a maximum of 3 days, after this the cross match is considered outdated and units will be released so they can be used for other patients so no units are wasted
Transfusion Reaction
Adverse reactions/complications can happen occasionally during blood transfusions. If this happens the RN must complete a form describing the adverse reaction. The NUC may have to retrieve the “Clinical Transfusion Reaction Report” form and place an ID label on it for the nurse.
Empty Blood Bags
Once the units are transfused the empty blood containers are returned to the lab. The RN brings the empty bags to the nursing unit and the NUC places them in a plastic bag and send back to the lab or a porter will return them