Transfusion Medicine Department Information
Specimens for pre-transfusion testing
Specimen
| Type | 6 mL Pink Top (Crossmatch) |
| Volume | Normally 6mL. Greater volumes may be required for certain individuals.
Minimum 2mL (generally paediatric) |
| Haemolysis | Sample must not be grossly haemolysed |
Specimen Collection and Labelling
Correctly identifying the patient before collection of the blood sample is essential.
• If the patient is in hospital and does not have a wristband, ask the ward staff to apply one before collecting the sample.
• At the time of sample collection ask the patient to state (if able) their family name, given name(s) and date of birth.
• If a wristband is not provided (for example: in an outpatient setting) ask the patient to state and spell (if able) their family name, given name(s) and date of birth.
• In an extreme emergency a Red Bracelet number with unique NHI may be used. This number must be copied from the patient’s wristband.
• In the case of an unconscious patient or person unable to comply with the request for information, copy the patient identification details from the patient’s wristband, and if possible confirm with a relative.
• Check all the information supplied (by patient or relative, on wristband and on request form) to ensure they match. DO NOT proceed with sample collection if there are discrepancies.
• The patient’s identity must be re-established if the collector leaves the patient’s location prior to initiating the blood collection procedure.
Sample tubes must not be labelled in advance of the sample collection.
The sample tubes must be accurately labelled BEFORE leaving the patient.
DO NOT copy patient details from the patient’s notes or charts.
DO NOT apply a computer generated Bradma label to the sample.
Legible hand written patient details must be recorded on the sample tube(s) with pen.
The following information MUST be included on the sample tube(s):
Surname (unabbreviated)
First name (unabbreviated)
Date of Birth
NHI Number
Time and date of collection
Signature of person who collected the sample
Failure to provide any of this information will result in the specimen being rejected for processing.
In an Emergency:
Unique ED Red Bracelet Identification Code Number may be used along with the Hospital Number allocated to this unique number. (This information should be attached to the patient, for example: wristband).
Time and date of collection
Signature of person who collected the sample
Following specimen labelling:
• Check the request form and the sample tube have identical patient information.
• Complete Step 4: “Specimen Collector Declaration” on the request form with the time and date, your name and signature.
Completion of the NZ Blood Request for Blood Bank Tests & Blood Components or Products Form
Full and accurate completion of the request form is essential for ensuring that the right test or quantity of blood component or product, is available at the right place at the right time.
Patient details are to be recorded on NZ Blood Request for Blood Bank Tests & Blood Components or Products Form using preferably a computer generated label or legible handwriting.
The request form MUST contain the following patient information:
• Patient’s registered surname name and given name/s (unabbreviated).
• Hospital number (NHI) and/or date of birth.
• Name of patient’s consultant/practitioner.
• Name and signature of the person completing the request form. This may be a nurse on behalf of the requesting doctor.
• Details of tests required and/or indication of the quantity and time that blood components or products are required (such as date and type of planned surgery).
• Any special requirements for components, for example: Irradiated.
• Signed declaration by the collector confirming that the patient was positively identified at the time of collection and that the samples were labelled before leaving the patient.
• Date and time of collection of blood sample.
The request form should also include:
• Clinical diagnosis and indication for transfusion.
• Record of any known previous transfusions or pregnancy within the last three months.
• Patient’s location.
• Gender.
• Date of surgical procedure (if applicable).
Note: The actual prescription for the blood component is the charting of the blood by the attending Medical Officer in the patient’s medical record.
Requirements for pre-transfusion testing
Important: It is not possible to over-emphasise the importance of proper patient identification.
Most errors relating to transfusion practice arise from administrative and clerical error. These errors can have serious consequences for patients and are sometimes fatal.
Blood Products and Components Available
| Blood Products and Components | Special Requirements |
| Red Cells Resuspended | Irradiated Red Cells by special request |
| Fresh Frozen Plasma (FFP) | |
| Platelet Concentrates | Enquire about availability before requesting |
| Cryoprecipitate | |
| Biostate (Recombinant Factor VIII also available)
Recombinant Factor IX available |
By special request |
| Privigen NZ
Albumex 4 Albumex 20 Rh(D) Immunoglobulin - VF Hepatitis B Immunoglobulin - Neonatal Dose Tetanus Immunoglobulin - VF Prothrombinex - VF |
|
| Normal Immunoglobulin - VF
Hepatitis B Immunoglobulin - VF (Adult dose) Zoster Immunoglobulin - VF Hizentra NZ |
By special request |
A NZ Blood Request for Blood & Blood Components or Products Form is required for plasma products. Request the name of the product and quantity required. The patient’s full details need to be included along with the date required and time if applicable.
Transfusion Therapy
Please refer to Blood Transfusion - Minimum Orders Policy HBDHB/IVTG/626
Procedures:
Antibody Screen (ABS)
Specimen required: 6mL Pink Top (Crossmatch) tube.
Blood Group
Specimen required: 6mL Pink Top (Crossmatch) tube.
Cold Agglutinin Screen
Specimen required: 6mL Pink Top (Crossmatch) tube.
Cord Blood Screen
Specimen required: 4mL Purple Top (EDTA) tube.
Crossmatch (X Match)
Specimen required: 6mL Pink Top (Crossmatch) tube.
Use NZ Blood Request for Blood & Blood Components or Products Form.
• Fill in the areas on the form especially previous transfusions or pregnancies within the last 3 months and Clinical Details (Pre-op is not helpful!).
• Start date and time when blood may be required. Failure to supply any of this information may cause unnecessary delays.
• Cross-matched units will only be held for 24 hours except by special arrangement with the Transfusion Medicine Department.
• In the event of postponement or cancellation of surgery, please notify the Transfusion Medicine Department.
Direct Antiglobulin Test (DAT)
Specimen required: 6 mL Pink Top (Crossmatch) tube.
Group, Screen and Hold (GSH)
Specimen required: 6 mL Pink Top (Crossmatch) tube.
Use NZ Blood Request for Blood & Blood Components or Products Form.
Transfusion Reaction Investigations
| Specimens Required | Consider Need For |
| 6 mL Pink top (Crossmatch) tube | Blood cultures if sepsis suspected |
| 10 mL Red top (plain) tube | Blood gases if respiratory distress present |
| 4 mL Purple (EDTA) tube | Urine to check for haemoglobinuria |
| 4.5 mL Lithium heparin (Pale green top) tube | Coagulation screen if bleeding |
| Blood unit(s) implicated in reaction investigation |
After hours - investigations are only generally performed if the reaction is considered serious and the laboratory is contacted.
Specimen Validity
Samples from patients for red cell transfusion are valid for 72 hours, 7 days or 21 days depending on transfusion history, pregnancy and information supplied on the request form.
| Clinical Situation | Specimen Validity Time |
| Patient transfused with red cell, platelet or allogeneic HPC components in the last 3 months. |
Transfusion must be commenced within 72 hours of the sample being taken. |
| Patient is pregnant or has been pregnant within the last 3 months (excluding placenta praevia and planned caesarean sections - see below). | |
| Patient with placenta praevia. | Sample valid for 7 days unless patient transfused red cell or platelet components within the last 3 months.
Once transfusion occurs, units not commenced within 72 hours or before the expiry time of the sample (whichever is earlier) shall be subjected to pretransfusion testing on a new sample. |
| Patient with planned caesarean section. | Sample valid for 72 hours, however if the section is planned Monday, the sample may be collected on the preceding Friday and valid for 96 hours. |
| Transfusion request form does not clearly exclude transfusion or pregnancy within the last 3 months (i.e. history section of form not completed). | Transfusion must be commenced within 72 hours of the sample being taken. |
| Transfusion request form clearly excludes a history of transfusion, current pregnancy or pregnancy within the last 3 months. | Sample valid for 7 days but only 72 hours after transfusion has commenced. |
| Elective procedures (pre-admission samples), where the transfusion request form clearly excludes a history of transfusion, current pregnancy or pregnancy within the past three months and clearly indicates the date that blood transfusion could occur, is more than 7 days after sample collection. | On request, the sample may be valid for up to 21 days provided history is validated (for example: the eTraceline transfusion file shows no evidence of transfusion in past 3 months).
Once transfusion occurs units not commenced within 72 hours or before the expiry time of the sample (whichever is earlier) shall be subjected to pretransfusion testing on a new sample. Plasma/serum will be separated as soon as possible (and no more than 7 days following collection) and frozen to 20°C or below. |
If unsure of the validity that will be applied in a specific scenario, contact Transfusion Medicine Department for advice.
Contact
Transfusion Medicine (Blood Bank) Laboratory - (06) 878 1692 ext 2645
Tony Morgan (Head of Department) - ext 2629
Related Links
Blood Transfusion Minimum Orders (IVTG626)
NZ Blood Service Resource Folder