TRANSPORT OF BLOOD AND BLOOD COMPONENTS TO OTHER SITES

Introduction

This procedure must be followed, to ensure that there is a complete audit trail for blood
components to be transfused at hospitals other than QAH. The procedure satisfies the “cold
chain“ requirements as laid down in the Blood Safety and Quality regulations (50) 2005.

This covers the full process from provision of compatible blood components to the final fate and
documentation of every product.

The following hospitals / care centres are routinely served:

 Petersfield Hospital*

 Rowans Hospice

 Spire Portsmouth Hospital (ex BUPA) Havant

 Gosport War Memorial Hospital*

 St.Mary’s Hospital

 ISTC – Portsmouth*

* These hospitals have suitably validated blood storage fridges

Transport procedure

Commencement

 Contact the Senior Nurse at the intended destination to confirm that blood components
are ready for dispatch. State the patient’s details and the amount and type of product to
be dispatched
 Sign the compatibility labels
 Organise suitable transport
 Place the blood components in a validated transport box with sufficient cool packs to fill
any ‘dead space’
 Fill in the “Blood in Transit Form” clearly stating the destination, date and time packed,
expiry time and person who packed the box
 Label the box – “URGENT BLOOD FOR (NAMED) HOSPITAL”
 Seal the box

On arrival

 Inspect seal and reject if broken, confirm with documentation that cold chain has been
maintained correctly. Any deviations contact bloodbank immediately
 On arrival at destination the box MUST be unpacked and the units placed in to the
designated blood fridge. In the absence of a designated blood fridge, the product can be
stored in the insulated box for an absolute maximum of 4 hours from packing
 Transfused blood - All units that are transfused MUST have the middle part of the
compatibility label completed and returned to the issuing blood bank as soon as
possible
 Unused blood - Any used blood MUST be returned to the issuing blood bank in a sealed
transport box as above
 Appendix 5 - Renal Transfusions

Administration: Adults on Haemodialysis/Haemofiltration.

Patients:
 Requiring transfusion of Packed Red Cells who have Acute Kidney Injury, Chronic Kidney Disease or
Established Kidney Failure.
 Require Haemodialysis/Haemodiafiltration therapy.
 Requiring the transfusion of Packed Red Cells which is planned and non emergency.

Routine Checks before Administration:

 The following checks should be undertaken
 The details on the patient’s identification band and prescription chart match exactly
 The patient’s blood group can be confirmed with the patient details on apex.
 If for any reason the patient cannot confirm identity, two nurses should do so by the patient’s bedside.
 The Packed Cells unit ‘use before’ date is current.
 Should any of the above checks highlight a discrepancy, the Packed Cells unit should not be used and
returned to the Blood Bank immediately.
 The patient is in an observable bed/dialysis station to allow close monitoring during transfusion.

Observations
 For Isle of Wight Renal Care Centre refer to local Policy
 Document the patient’s baseline observations, temperature, pulse, blood pressure and respirations
prior to the start of Haemodialysis/Haemodiafiltration.
 Baseline observations should be recorded and documented 15 minutes after the start of transfusing
the first unit, and each subsequent unit.
 Standard Monitoring and documentation required of the patient on Haemodialysis/Haemodiafiltration
should continue in addition to the transfusion observations.

Administration of Blood Transfusion:

 For Isle of Wight Renal Care Centre refer to local policy
 The Registered Nurse should check the patient’s identity with the Patient to confirm their details
against their identification band, the Prescription Chart and the unit of Packed Cells. If the patient is
unable to confirm their details then two nurses should check the details of the patient with the Packed
Cells to be administered.
 The fluid volume of the total number of units to be transfused during the
Haemodialysis/Haemodiafiltration session is to be added to the fluid loss removal prescription unless
otherwise instructed by the medical team. The total volume should be checked by two nurses.
 The Unit of Packed Cells should be administered using a volumetric pump and appropriate infusion set.
 The infusion set should be connected to a port on the ‘arterial’ line of the dialysis circuit before the
dialysis filter. This is to allow for the clearance of potassium within the unit of Packed Cells.
 A maximum of three units can be administered within a 4 hour Haemodialysis/Haemodialfiltration
session. Each unit should be infused over a minimum of one hour and should take no more than 2
hours to transfuse due to the possibility of bacterial growth. If possible the transfusion should be
completed 30 minutes prior to the end of the Haemodialysis/Haemodiafiltration session to allow for
fluid and potassium clearance.
 One unit of Packed Cells should be removed from the Blood Fridge at a time. This is in the event of
further units not being used.

When the Transfusion is Complete

 Keep the empty unit and used line connected to the Haemodialysis/Haemodiafiltration circuit until the
treatment session is complete.
 Dispose of the unit and lines with the Haemodialysis/Haemofiltration lines in the appropriate clinical
waste bin or durable yellow clinical waste bag.
 Complete the middle section of the compatibility label and return it to the Blood Bank as soon as
possible.
 Check the patient’s haemoglobin level the next day if they are an inpatient or on their next
Haemodialysis/Haemofiltration session if they are an outpatient.
Transfusion on Haemodialysis/Haemofiltration without anti-coagulant
 For Isle of Wight Renal Care Centre refer to local policy
 The Registered Nurse should check the patient’s identity with the patient to confirm
their details against their identification band, the Prescription Chart and the unit of
Packed Cells. If the patient is unable to confirm their details then two nurses should
check the details of the patient with the Packed Cells to be administered.
 The fluid volume of the total number of units to be transfused during the
Haemodialysis/Haemodiafiltration session is to be added to the fluid loss removal
prescription unless otherwise instructed by the medical team. The total volume
should be checked by two nurses.
 The Unit of Packed Cells should be administered using a volumetric pump and
appropriate infusion set.
 As patient condition allows the Packed Cells should be transfused through a
peripheral cannula or a third access port on their central access. This is to minimize
the risk of clotting in the dialysis filter. If access cannot be established then the
Packed Cells can be transfused through a port on the ‘arterial’ line. A maximum of
three units can be administered within a 4 hour Haemodialysis/Haemodialfiltration
session. A unit should take no more than 2 hours to transfuse.
 If possible the transfusion should be completed 30 minutes prior to the end of the
Haemodialysis/Haemodiafiltration session to allow for fluid and potassium clearance.
 The Haemodialysis/Haemodiafiltration circuit should be flushed with sodium Chloride
0.9% as stated in the Standard Operating Procedure for Heparin Free
Haemodialysis/Haemodiafiltration within the Wessex Renal & Transplant Service.

When the Transfusion is Complete

 Disconnect the empty unit and used line and dispose of in a Clinical Waste bin or
Clinical Waste durable bag.
 If the unit is transfused via the Haemodialysis/Haemodiafiltration circuit keep the
empty unit and used line connected until the treatment session is complete. Then
dispose of the unit and line with the Haemodialysis/Haemofiltration lines in
appropriate clinical waste bin or Clinical Waste durable bag.
 Flush the peripheral cannula or central access port with Sodium Chloride 0.9%.
 Complete the middle section of the compatibility label and return it to the blood bank
as soon as possible.
 Check the patients’ haemoglobin level the next day if they are an inpatient, or on
their next Haemodialysis/Haemofiltration session if they are an outpatient.

In Case of Transfusion Reaction:

 As per Blood Transfusion Policy. If the Medical team advises discontinue
Haemodialysis/Haemodiafiltration and document in the Medical and Nursing Notes.
 All Transfusion Incidents must be reported on a Trust Adverse Incident Reporting
(AIR) Form.

Documentation
The following should be documented:
 Completion of the blood compatibility labels. The Registered Practitioner must sign in
the appropriate place and affix to the current continuation sheet in the patient notes
(returning the third section to blood bank).
 The transfusion should be prescribed on an infusion chart and each unit signed and
dated by the nurse setting up the infusion. This is to be kept in the patients notes.
 The reason for the transfusion should be documented prior to requesting the Packed
Cells.
 Document patient consent to treatment, include risks and benefits
 The transfusion should be prescribed on the Haemodialysis/Haemofiltration
prescription chart.
 Any adverse effects.
 The transfusion is recorded on the PROTON record for that patient.
Training Requirements
 Annual updates are mandatory for all staff groups who handle blood products. It is
essential that the e-learning/MOT is completed yearly and the classroom session on
Blood Awareness is attended at 3 yearly intervals.
 Completion of the Trust Generic Competency: Administration of Blood Products,
which is assessed by a Level 3 Assessor every 3 years.
 Achieves Level 1 and 2 of unit 2a of the Renal Staff Development Programme: Care
of a Patient on Haemodialysis.
 Knowledge of the Standard Operating Procedure for, Heparin Free
Haemodialysis/Haemofiltration within the Wessex Renal and Transplant Service.
 Common Complications Associated with Transfusion of a Blood Component

(Definition of a blood component: Red cells, Platelets, FFP, Cryoprecipitate )

Problem Likely Cause Timing of Event Severity Management and Prevention

(A) Acute Event

Intravascular Major ABO Almost Potentially 10% Mortality

Haemolysis incompatibility Immediately Fatal Check for DIC and renal failure
following start of Maintain BP and renal perfusion
transfusion Contact: On-call Haematologist, Transfusion
Practitioner, Bloodbank
Initiate RED adverse incident report

TACO Rapidly Occurs usually Potentially Accurate assessment of patients at risk of

(Transfusion infused, large within 2 - 6 hours Fatal TACO
Associated volume of transfusion Careful attention to fluid balance
Circulatory infusions or Consider appropriateness of transfusion
Overload) high TACO risk Consider rate of transfusion and diuretic
patients cover
Initiate AMBER adverse incident report

TRALI Leucocyte During or within 6 Potentially Manage as for ARDS refer to Critical Care
(Transfusion Antibodies in hours of Fatal Team
Related donor blood transfusion – Chest X-Ray – shows bilateral pulmonary
Acute Lung RARE but can be infiltrates
Injury) confused with Initiate AMBER adverse incident report
ARDS
TAD Transfusion of Respiratory Potentially Assess respiratory distress
(Transfusion donor blood distress within 24 Fatal CXR
Associated and patient hours of Oxygen saturations and ABG’s
Dyspnoea) co-morbidities transfusion and Initiate adverse incident report, grade
no other appropriately
associated cause
Anaphylaxis IgA Antibodies Immediate Potentially Maintain ABC’s and follow Anaphylaxis Policy
in donor or Fatal Initiate adverse incident report, grade
recipient appropriately
Septic Shock Bacterial During transfusion Potentially Manage septicaemia
Contamination Fatal Initiate adverse incident report, grade
appropriately
Febrile, Anti-leucocyte Up to several Unpleasant Treat with Anti-pyretic (e.g. Paracetamol 1g)
Non- Antibodies hours post but not Initiate adverse incident report, grade
haemolytic transfusion usually life appropriately
threatening
Urticaria IgE Antibodies During transfusion Unpleasant Treat or prevent with Antihistamine (Oral or
in donor blood but not IV)
usually life Initiate adverse incident report, grade
threatening appropriately
(B) Delayed Event

Delayed IgG Antibodies 2 – 26 days post Not usually Poor response to transfusion
haemolytic to donor transfusion life Jaundice
reaction blood threatening Send samples for investigation
Review transfusion needs
TA-GvHD Donor Extremely rare up Usually None seen in the last 10 years following
(Transfusion lymphocytes to 30 days fatal leucocyte depletion
Associated following Irradiated blood to ‘at risk’ groups
Graft Versus transfusion
Host
Disease)
Post Recipient 5 – 12 days post Rare but Contact Bloodbank to arrange patient
Transfusion antibodies transfusion treatable investigation at platelet laboratory
Purpura against HPA
(PTP) system
Post Infected donor Post transfusion Rare Depends on virus
Transfusion blood Seek specialist medical advice
Viral
Infection
Iron Multi- Occurs either with Rare but Use iron chelation therapy or venesection
Overload transfused single episode of treatable if Monitor LFT’s and cardiac enzymes
patients multi-units or long diagnosed Consider cardiac scans
term transfusion
therapies

:References

Annual SHOT report 2011 ISBN 978-0-9558648-4-1