Pretransfusion Testing

Question 1

What are the aims of Pre-transfusion Testing

Answer 1

To select blood components that will not harm the recipient

To select blood components that will have acceptable survival when transfused

Question 2

What are the seven steps in Pre transfusion testing

Answer 2

1) the request for transfusion
2) positive identification of recipient and recipient’s blood sample
3) Blood grouping- determination of the ABO and Rhesus types of both recipient and blood components
4) Screening of components of ABO and Rh types appropriate for recipient
5) selection of components of ABO and Rh types appropriate for the recipient
6) Performance of a crossmatch (for RBC recipient only) between the recipient’s plasma and the donor cells (done to determine whether the donor cells are compatible with the recipient’s plasma)
7) Label blood component

Question 3

In Pre transfusion testing what is done after the request for transfusion

Answer 3

2)positive identification of recipient and recipient’s blood sample

Question 4

In Pre transfusion testing what is done after 2) positive identification of recipient and recipient’s blood sample

Answer 4

3) Blood grouping- determination of the ABO and Rhesus types of both recipient and blood components

Question 5

In Pre-transfusion testing, what is done after

3) Blood grouping- determination of the ABO and Rhesus types of both recipient and blood components

Answer 5

4) Screening of components of ABO and Rh types appropriate for recipient

Question 6

In pre-transfusion testing what is done after

4) Screening of components of ABO and Rh types appropriate for recipient

Answer 6

5) selection of components of ABO and Rh types appropriate for the recipient

Question 7

In pre-transfusion testing, what is done after

5) selection of components of ABO and Rh types appropriate for the recipient

Answer 7

6) Performance of a crossmatch (for RBC recipient only) between the recipient’s plasma and the donor cells (done to determine whether the donor cells are compatible with the recipient’s plasma)

Question 8

In pre transfusion testing what is done after
6) Performance of a crossmatch (for RBC recipient only) between the recipient’s plasma and the donor cells (done to determine whether the donor cells are compatible with the recipient’s plasma)

Answer 8

7) Label blood component

Question 9

What are the two main requirements for Pre-transfusion testing

Answer 9

One anticoagulated (EDTA) sample (plasma)

Request form

Question 10

1 requirement of Pre-transfusion testing is anti-coagulated (EDTA) sample (plasma), which other sample may be used

Answer 10

Serum from clotted sample
(Plasma is preferred)

NB// Serum and plasma both come from the liquid portion of the blood that remains once the cells are removed, but that’s where the similarities and. Serum is the liquid that remains after the blood has clotted. Plasma is the liquid that remains when clotted is prevened with the addition of an anticoagulant.

Question 11

In pretransfusion testing what should be done if a patient was pregnant or recieved a blood transfusion within the past 3months

Answer 11

A fresh plasma sample should be collected 3 days (or less) before the intended transfusion

Question 12

In pretransfusion testing if a patient was pregnant or recieved a blood transfusion within the past 3months A fresh plasma sample should be collected 3 days (or less) before the intended transfusion.

Why

Answer 12

To allow time for antibody production and detection

Question 13

Are verbal requests for pre-transfusion testing accepted?

Answer 13

Yes in urgent situations but should be documented according to local policies

Question 14

What are the pre-transfusion request requirements

Answer 14

a) Detailed identification of the patient
b) Details of the diagnosis as well as indication for transfusion
c) Blood Group, if known
d) Details of potentially sensitizing episodes (for example pregnancy, previous transfusion or transplantation
e) identification of component needed
f) the degree of urgency/ expected date of transfusion
g) location of the patient
h) name and or signature of the clinician responsible for pt

Question 15

Accurate Recipient identification is required for Pretransfusion Request Form.

This includes

Answer 15

First and last names
Hospital registration /ID number
Date of birth

(If pt is unconscious then the minimum information required is the hospital registration/ID number and gender)

Question 16

Identification of component needed is required for Pretransfusion request form .

This includes

Answer 16

Type
Quantity
Special request (leukocyte reduction,irradiation)

Question 17

What should be done with Pre-transfusion requests that lack the required information or have inaccurate or illegible information?

Answer 17

Should be rejected as it is extremely risky for anyone to correct identifying information on an incorrectly labelled form

Question 18

What are the four steps to Sample Collection and Processing

Answer 18

1) There should be no doubt about the identity of the specimen and the recipient
2) The specimen tubes appropriately labelled, after blood collection and preferably at the pts bedside
3) There should be no discrepancy between the information on the request form and that on the specimen tubes
4) Pretransfusion blood specimens are retained for a minimum of 7 days post-transfusion in the Blood Bank

Question 19

Blood submitted for compatibility testing must be tested for what blood types

Answer 19

ABO and Rh in order to transfuse ABO and Rh compatible components.

Also for unexpected antibodies to red cell antigen using the Indirect Coombs test

Question 20

What is the Compatibility test process for pts with previous blood bank records

Answer 20

They should have ABO and Rh type checked against the current information

Question 21

Describe the selection of Blood and Plasma for transfusion

For whole blood

Answer 21

ABO identical to recipient

Question 22

Describe the selection of Blood and Plasma for transfusion in

For red cells

Answer 22

Group O packed red cells (lack A and B antigens)

Red cells compatible with the recipients plasma

Question 23

Describe the selection of Blood and Plasma for transfusion in

For plasma

Answer 23

Group AB plasma (contains no anti-A or Anti-B)

Plasma compatible with recipient’s RBC

Question 24

Describe the selection of Blood and Plasma for transfusion in

For platelets

Answer 24

All ABO groups acceptable

Components compatible with recipient RBC preferred

Question 25

Describe the selection of Blood and Plasma for transfusion in For cryoprecipitate

Answer 25

ABO compatibility preferred

Question 26

When in doubt of Rh D type, which Rh D type should be used

Answer 26

Rh D-negative blood

Question 27

What Rh-D type blood component should be selected for D-positive recipients?

Answer 27

Rh-D positive

Question 28

Should you reserve Rh D- negative components for D-negative recipients?

Answer 28

Nope

Question 29

Why is a crossmatch done in the Compatibility Process of Pre-transfusion testing

Answer 29

This is performed to detect ABO incompatibility and clinically significant immune antibodies in the plasma of the recipient that will react with donor red cell antigens

Question 30

Which blood group is administered if the ABO/Rhesus D status is unknown

Answer 30

Group O Rh D negative And the physician must provide a signed statement that the clinical situation required the urgent release of blood

Question 31

Crossmatchibg is not routinely done for which three types of transfusion

Answer 31

Platelet Plasma Cryoprecipitate Blood group compatibility is still done

Question 32

The method for crossmatching involves mixing donor red cells with recipient plasma. What are the steps in this method

Answer 32

1) Select a unit of donor blood (whole or packed RBC) that has the same ABO and rhesus blood group as the recipient 2) Centrifuge A mixture of recipients serum or plasma and doing a red cells at room temperature. Examined for agglutination. If present, this indicates ABO incompatibility. Absence of agglutination indicates a compatible immediate spin crossmatch 3) The sample is been incubated at 37°C, washed, followed by the Addition of the cools reagent and examined for agglutination. Agglutination indicates incompatibility and the blood should not be transfused.

Question 33

In the cross matching test during centrifugation, if agglutination between the plasma of the recipient and the donors red blood cells is present what does this indicate

Answer 33

Incompatiblility

Question 34

What are the two steps in Issuing of Blood for Transfusion

Answer 34

Blood Transfusion Compatibility label Final inspection of blood component for any abnormal colour or appearance and expiration date should be performed before issue

Question 35

What information is included in the Blood Transfusion Compatibility label

Answer 35

Recipient’s name, hospital registration/ID number, ABO and Rh type Donor unit number, ABO and Rh type Identification of person who performed the compatibility test Type and amount of blood component contained in the unit Special transfusion requirements e.g leukoreduction

Question 36

What are the four phases of Administration of Blood Components

Answer 36

Consent Pre-transfusion During Transfusion Post Transfusion

Question 37

What is done in the CONSENT phase of administration of transfusion

Answer 37

- obtain the consent - consent form includes: risks of transfusion, indications and benefits as well as alternative treatment discussed - consent form where available signed by recipient The patient has the right to refuse or accept the transfusion

Question 38

List the 7 steps in the Pre-transfusion phase of Administration of transfusion

Answer 38

- Treatment chart reviewed - Patient identity checked - Blood and components stored correctly prior to transfusion - The unit to be given should be checked for compatibility-and infectious screen labels - inspect the unit for leaks, haemolysis, large clots, clumping - expiry date of the unit of blood - The transfusionist must determine the catheter size required to access the vein

Question 39

Catheter size in transfusion depends on what factors

Answer 39

On how quickly the blood needs to be administered

Question 40

How should Blood components be warmed?

Answer 40

Certified blood warmers (For s with Cold AIHA) NOT by putting in warm water or under the hot water pipe or in a microwave!!!

Question 41

Can drugs be added to blood during transfusion??

Answer 41

Nope, never, not under any circumstance

Question 42

Which intravenous fluids may be added to blood during transfusion ? Normal Saline Dextrose Ringer lactate

Answer 42

Normal Saline to packed RBC

Question 43

Why isn’t Dextrose allowed to be added to blood during transfusion

Answer 43

May cause red cells to agglutinate or haemolyze

Question 44

Why isn’t Ringer lactate or other solutions containing calcium allowed to be added to blood during transfusion

Answer 44

The calcium present will lead to coagulation

Question 45

How are the vital signs monitored during blood transfusion

Answer 45

Temperature, Pulse, Respiration - documented before, then 15mins after starting each unit and after the transfusion Unconscious pt( pulse, temperature and urine)

Question 46

What is the rate of transfusion of Red cells

Answer 46

One unit of Red cells is given within 2-3hrs | infusion longer than 4hrs is not recommended

Question 47

Why isn’t administration of blood transfusion longer that 4hrs recommended

Answer 47

Bacterial Proliferation because the opened unit is at room temperature

Question 48

Can platelets be stored in the freezer

Answer 48

Never Stored at room temperature

Question 49

What is the dosage of platelet for transfusion

Answer 49

1 unit /10kg

Question 50

What is the rate of infusion of platelets in nin emergency settings

Answer 50

200-300 ml/hr

Question 51

What is the infusion rate of plasma and cryoprecipitate

Answer 51

200-300 ml/hr

Question 52

What is the plasma dose in transfusion

Answer 52

10-15ml/kg

Question 53

What is the cryoprecipitate dose in transfusion

Answer 53

1-2 units /10kg

Question 54

What is done Post blood transfusion

Answer 54

Documentation of the transfusion event should be made in the patient’s medical record

Question 55

Documentation of the transfusion event should be made in the patient’s medical record, these details include:

Answer 55

``` The medical request for the transfusion Recipient’s signed consent form The transfusion tag/compatibility label Date and time of transfusion Pre- and post-Transfusion vital signs Any adverse events related to the blood transfusion The clinical response to the transfusion ```