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It is a mandatory requirement for all Serious Adverse Reactions (SAR) and Serious Adverse Events (SAE) to be reported to the National Haemovigilance Office (NHO) as required by the EU directive 2002/98/EC. All transfusion reactions reported and investigated will be forwarded to the NHO.
On discovery of a suspected transfusion reaction:
- Stop transfusion of blood product immediately where a suspected reaction has occurred and verify patient ID, ABO group of patient and donor unit immediately.
- Medical advice should be sought immediately from the patient’s team and/or the haematology team.
- Contact the Blood Transfusion laboratory during both routine and on-call hours.
- Contact the Haemovigilance Officer during routine hours.
Laboratory Investigation
When a transfusion reaction is suspected it has to be reported using the ‘Report of a Suspected Adverse Transfusion Reaction/Event’ form WRH-BT-HF-006.
This outlines sample requirements and patient transfusion details required for the investigation to be carried out in the laboratory including –
- Implicated Unit with attached giving set
- Repeat Group & X-match sample
- Blood Cultures on the patient if Temperature rise ≥ 1.5ºC above the baseline temperature together with chills or rigors
- Blood Culture from implicated treatment pack as per instructions below if high likelihood of bacterial contamination
- Full Blood Count
- Renal Profile
- MSU
Procedure for Blood Culturing of implicated Red Cell Pack/ Blood component.
Requirements:
- Clean tray containing sterile gloves, alcohol swabs, 20ml syringe and 23g needle (blue)
- Sharps container
- Blood Culture bottles X 2 sets (Aerobic and Anaerobic)
- Microbiology Request form
Carry out this procedure at the patient’s bedside using an aseptic technique. Ensure that both the patient and the implicated unit of blood are cultured at the same time and that both sets of bottles are clearly differentiated.
- Wash and dry hands. Apply sterile gloves.
- Collect a set of blood cultures from patient as per normal procedure. Refer to 6.13 Blood Culture in manual, ‘Specimen Collection and Handling Handbook’ WRH-PATH-PD-001. Label bottles with patient’s labels and write “Peripheral blood” on both labels.
- Wash and dry hands. Apply sterile gloves.
- Remove the cover of the blood culture bottles. Wipe the rubber bung on the bottle tops with an alcohol swab. Allow to dry.
- Swab the un-opened port of the blood unit. Allow to dry.
- Attach needle and syringe to un-opened port of blood unit using aseptic technique.
- Withdraw approx. 20mls of blood into a syringe maintaining asepsis.
- Place 8 – 10mls of blood into each blood culture bottle.
- Label blood culture bottles with patient’s labels and write: “Blood from blood pack and Donor Unit No.”
- Complete the Microbiology Request Form with the following details (see sample form below):
- Patient’s Addressograph label plus name of Consultant Haematologist and address for reporting.
- Fill in Specimen as “Blood culture X 2. Peripheral blood + Blood from pack”
- Fill in Clinical details as “Transfusion reaction. Donor Unit No: XXXXXX”. Send bottles and accompanying request form immediately to the Microbiology Department in a bio-hazard bag.
- Fill in Tests Required as “C/S
- Send bottles and accompanying request form immediately to the Microbiology department in a biohazard bag.
- Dispose of sharps in the correct manner and wash hands.
- Ensure Blood Cultures are taken from the patient as Blood Cultures from a blood pack cannot be processed unless both sets arrive in lab with details on the one form.
Sample of completed Microbiology request form
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