Source: MANAGEMENT OF BLOOD COMPONENT AND TEST REQUEST HJ/PAT/BB/QP-002

Source: MANAGEMENT OF BLOOD COMPONENT AND TEST REQUEST HJ/PAT/BB/QP-002

1. Elective surgery

   • Blood Bank should be provided with operation schedule by Operation theatre by weekly basis (if available).

   • Request for blood component must reach the Blood Bank 24-hour prior operation except for rare blood groups and/or RhD negative where the Blood Bank should be informed at least 5 working days in advance.

   • Late request (after office hour) will be proceeded after 8am next morning. Requester will be advised to re-arrange the operation schedule by prioritizing operation with complete preparation.

2. Emergency surgery

   • Emergency surgery that requires urgent Red Cell component, refer Emergency Blood Component (Red Cell) Request.

Source: MANAGEMENT OF ADVERSE TRANSFUSION REACTION HJ/PAT/ BB/WI-002

Note: 

*1. Only one blood bag collection is allowed at one time. 

*2. Red cells should be transfused within 30 minutes of removal from blood refrigerator. The transfusion of each unit of red cells shall not exceed 4 hours from removal from the blood refrigerator. 

**3. Patient with antibody screening positive result – refer GXM Request with Positive Antibody Case Flow Chart 

1. Request must be made through Blood Bank Medical Officer.

2. 1 EDTA tubes of patient sample with request form are required.

3. Each additional request must be accompanied with new request form. No additional sample are required for further blood component request unless requested by Blood Bank staff such as insufficient for testing.

4. Choice of blood for transfusion in case of life-threatening bleeding is dependent on the urgency for transfusion and the time available. The Option available are:

   • Uncrossmatched Group O RhD positive packed Red Cell (Safe O).

     1. The requesting doctor shall clearly state the reasons for the transfusion in the request form.

     2. Blood component can be issued before blood grouping is performed.

     3. Clinician will be informed if patient is Rh Negative to stop the transfusion.

   • Uncrossmatched group specific packed cells.

     1. If the blood group of the patient is known, uncrossmatched group specific blood maybe given.

   • Emergency crossmatch

     1. If the blood is required within 30 minutes, units of blood that are found to be compatible at immediate spin after 5 minutes incubation at room temperature may be issued.

     2. Blood bank shall proceed to completion of the compatibility testing.

     3. Any incompatibility detected,  clinician concerned will be informed for appropriate action.

5. Safe O will be supplied a maximum of 2 units and the remaining blood components will be supplied based on the progress of the test that will be decided by requester after discussion with Blood Bank Medical Officer.

6. Each emergency blood component request (red cell) must undergo a full GXM even if the blood component has been issued before the GXM is completed.

Instructions for Transfusion Reaction Investigation (Blood & Blood Components)

1.   When a patient has an adverse reaction to any blood or blood component, STOP transfusion immediately. URGENTLY inform the doctor in charge of the patient and Unit Patologi.

2.   Report all reactions and do the following:

2.1                Preserve the blood bag and giving set with all attached labels. Seal it securely and send immediately to Seksyen Transfusi Unit Patologi.

2.2                Send the following samples for Transfusion Reaction Investigation to Seksyen Transfusi Unit Patologi.

a.       Post-transfusion 1 (immediately)

I.                     1 plain tube of 4.0 mL of blood for BUSE / Creatinine / Bilirubin / LDH

II.                   2 EDTA tubes of 2.0 mL of blood in each tube for immunohaematology test

III.                  1 EDTA tube of 2.0 mL of blood for Full blood count / Full blood picture (if symptoms & signs suggestive of hemolysis)

Label all the above samples as “Post-transfusion 1” with the patient’s name and identification card number. Fill up the “Post-transfusion 1” PER.PAT 301 request forms with complete history.

2.3              Please complete the Reporting Form for Adverse Transfusion Event (HAG/BB/WI-005/04).

2.4              Send the request forms, Reporting Form for Adverse Transfusion Event (HAG/BB/WI-005/04) and “Post-transfusion 1” samples to Unit Patologi immediately (ext. 161 / 163 / 269 / 166).

2.5              After 24 hours, please send:

a.       Post-transfusion 2 (after 24 hours)

I.                     1 plain tube of 4.0 mL of blood for BUSE / Creatinine / Bilirubin /LDH    

II.                   2 EDTA tubes of 2.0 mL of blood in each tube for immunohaematology test

Label all the above samples as “Post-transfusion 2” with the patient’s name and identification card number. Fill up the “Post-transfusion 2” PER.PAT 301 request form with complete history. Send the request form and “Post-transfusion 2” samples to Unit Patologi.

2.6              All patients who develop febrile reactions during a transfusion or shortly after, please take patient blood samples for culture (aerobic and anaerobic bottles). Repeat culture if fever persists for 2 days. Please send for other appropriate investigations if necessary.

Measurand /Analyte : Detection of Allo & Auto Antibody of the platelet cell

Test Description : Platelet antibody test for diagnosis as below :

1. Neonatal alloimmune thrombocytopenia (NAIT)

2. Platelet Transfusion Refractoriness (PTR)

3. Platelet Transfusion Purpura (PTP)

4. Immune thrombocytopenia (ITP)

Specific Instruction Note:

1. This is a specialized test and requires approval from a Transfusion Medicine Specialist on-duty (PDN).

2. Collect fresh sample before delivery; do not collect and store.

3. Sample reception is available during office hours only. Please plan carefully for sample collection and delivery. Samples from outstation should arrive within 48 hours.

4. For NAIT (Neonatal Alloimmune Thrombocytopenia) investigation, the test will be conducted on the maternal sample and will include a parental crossmatch test. For these tests, please send the biological parents' samples.

5. If a NAIT case is positive for anti-HPA, HPA genotyping family study is indicated.

   • For KKM hospitals, NAIT investigation will be extended to HPA genotyping family study.

Test Approver: Transfusion Medicine Specialist (TMS) on-duty (PDN)

Specimen Type: Whole Blood (do not separate the plasma/serum from cell)

Sample Requirement:

1. NAIT case : (note : mother/father = biological parents)

   • • Mother sample :

       • EDTA (non gel tube) : 10ml AND

       • Plain (non gel tube) : 10ml

     • Father sample  : EDTA (non gel tube) : 10ml

     • Baby sample : EDTA (non gel tube) : 1ml

2. PTR and PTP case :

   • • EDTA (non gel tube) : 10ml

     • Plain (non gel tube) : 10ml

3. ITP case :

   • Plain (non gel tube) : 10ml, and

   • EDTA (non gel tube) :-

     • 10ml : if plt > 20 x 10^9/L)

     • 15-20ml  : if plt 10-20 x 10^9/L)

     • 2ml : if plt <9 x 10^9/L

Request Form

1. Platelet Immunology Test Request form PDN/IH/QP-05/02

2. Hospital referral form (whenever possible)

LTAT (working day):

• Serology : 10 working days

• With molecular : 20 working days

• LTAT may vary depending on complexity of case

Report: KKM hospital : please retrieve the report from your blood bank (Makmal Transfusi Darah)