Poorly venepunctured blood samples can dramatically affect the results of a test. Some of the more common errors are listed below:
- Insufficient sample – appropriate volume blood tubes are supplied with. Insufficient samples will mean an inability to test and delay in results and provision of blood products.
- Haemolysed sample - if the blood sample has been venepunctured using needle and syringe and a small gauge needle is used to pierce the lid of the Vacutainer tube, haemolysis may occur especially if the blood is forced into the tube by pushing the plunger. Vacutainer tubes contain a vaccuum that will naturally draw sufficient blood into the tube. Change to a wider gauge needle before piercing the Vacutainer lid. Haemolysis will prevent the sample from being tested as assays are light transmission dependant and haemolysis in the plasma will give false positive results.
- Samples delayed in transit – Delays in receipt of the sample in Blood Bank will mean a delay in testing and as a result delay in provision of blood products. Significant delays of may mean the sample is no-longer suitable for testing.
- Clotted samples – Samples not taken directly into the Vacutainer and mixed sufficiently may clot. Once clotted the red cells cannot be tested for the blood group and the sample will be unsuitable for testing.
- Blood grouping.
- Red cell antibody screening and antibody identification.
- Red cell phenotopying.
- Compatibility testing.
- Direct antiglobulin test.
- Kleihauer (estimation of foetal-maternal Haemorrhage).
- ABO Titres
If a transfusion reaction is suspected, stop the transfusion immediately. Follow the trust protocol (internal users only) and inform blood bank. All units which have been used (partially and fully) must be returned to the blood bank along with:
Storage and Wastage of Blood
It is essential that blood and blood products are stored correctly to minimise any adverse incidents from occurring:
- Blood must only be stored in authorised blood refrigerators
- Blood transfusions should be commenced no longer than 30 minutes from the time the unit was taken from the Blood fridge.
- Fresh Frozen plasma must be used within 4 hours of thawing if stored at room temeparture or within 24 hours if stored in an authorised blood fridge.
- Platelets should be kept agitated in Blood Bank until ready for use.
Avoidable wastage of blood and blood products will generate a 'Wastage Report' for the ward to complete and return to Blood Bank. This is monitored by the Hospital Transfusion Committee.
For any clinical advice regarding blood products/transfusion, please contact the on-call Consultant Haematologist/Specialist Registrar through Switchboard.
For advice on interpretation of results or reports please contact Blood Bank in the first instance however we may recommend that you speak to a Consultant/Registrar if the enquiry is of a clinical nature.
Blood Bank Telephone Numbers:
- BHH Ext. 40705 / 40706
- SOL Ext. 44527
- GHH Ext. 49290 / 49213
Monday - Friday:
- Heartlands hospital 08:00 – 21:30
- Good Hope hospital 09:00 – 17:30
- Solihull hospital 09:00 – 17:30
With effect from 1st September 2016, Blood Bank are introducing the two sample rule for requests for blood and blood components (blood, fresh frozen plasma, cryoprecipitate, platelets, granulocytes).
What is the two sample rule?
Blood Bank need to ensure that there are two distinct samples from a patient that have generated the same blood group from both samples. If Blood Bank have seen the patient before and already have a historic blood group (after 20thOctober 2015) then you only need to make a request for group and save or X-match as you normally do. If the patient has no previous records in Blood Bank then you MUST repeat the group and save or X-match with a second sample.
Why is this rule being introduced?
Wrong blood in tube (WBIT) is a 'never event', it should not happen, however on occasions it does. The consequences of transfusing somebody with blood of the incorrect blood group is very serious and can lead to death. WBIT is a SHOT (Serious Hazards of Transfusion) reportable incident. The two sample rule is a national guideline to improve patient safety when receiving transfusions.
How does the two sample rule work?
If the patient is not known to Blood Bank then the two sample rule is invoked. The two samples must come from separate venepuncture events and ideally should be carried out by two different people. Separate request forms should be completed for each sample. It is NOT acceptable to take two samples at one venepuncture event and send them to Blood Bank on separate request forms. This will not negate the possibility of WBIT. There is no limit on the time between samples as long as Blood Bank have a historic blood group on record after 20th October 2015.
How will I know if a second sample is required?
If you are unsure if Blood Bank already have a historic blood group you can check iCare or ICE for requests after 20thOctober 2015. If you are still unsure then please telephone Blood Bank on 40706 (BHH), 47279 (GHH) or 44527 (Sol).
What happens in an emergency situation?
If blood is required in an emergency eg massive bleed procedure invoked, the two sample rule will not apply however a second sample should be sent as soon as possible. Blood will be issued as per the massive bleed procedure and will not be delayed.
For more information and reports relating to transfusion safety please visit www.shotuk.org