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Thread: Pre Transfusion sample timings

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  1. #1
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    Question Pre Transfusion sample timings

    Hi just looking some advice on pre-transfusion sample timings.
    A change has been suggested in our lab that I am uneasy about. The proposal is to make all samples suitable/valid for only 72hrs regardless of whether or not the patient has been transfused i.e. samples will be held as valid for 72 hrs then a new sample will be required if the patient requires transfusion.
    The idea is that this will make things easier for lab staff as any sample over 72 hrs old will not be suitable regardless of transfusion history or pregnancy. It is thought that this will also avoid potential errors where the request form is not completed properly e.g. patients transferred from other hospitals could have had a recent transfusion that we are unaware of ; or a recent pregnancy is not recorded on the request form.

    I agree, this would help reduce such errors. However I think these errors are already pretty rare and my additional concerns are;
    • That we are going to start a practice outside the BCSH guidelines that no one else is doing or deeming necessary
    • This will increase the number of samples / workload for blood bank
    • It may cause confusion for clinical staff. Worst case scenario we have a member of staff or locum who assumes we hold samples for 7 days like everyone else and takes someone to theatre without a valid transfusion sample.


    Is anyone else doing this?
    Does anyone have an opinion on this?
    I seem to be the only voice against this here, are my concerns unwarranted?

    Any advice will be welcome.

  2. #2
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    Happy New Year Matt and thanks for the interesting question - gets our little grey cells working after the Christmas break.
    Some thoughts:

    1. If this is to further reduce lab errors ( which you have stated are rare any way), wouldn’t it be better to look at improving LIMS control instead?

    2. We are trying to bring everyone in-line with BSH Guidelines, not create different rules, which, as you say will confuse the clinical staff- the junior doctors especially when they rotate between hospitals find it challenging enough.

    3. What would the impact be on your surgical pre-assessment clinics? Would patients have to be re-bled just before their ops, in which case are there going to be testing delays/ risks of cancellation?

    4. Consider the training/ communication requirements for all cost in terms of time/ resourcing?

    5. Perhaps the change proposer could perform a costing exercise in terms of workload/ re-bleeds etc?

    6. Would the change be likely to impact the patient in terms of number of extra samples taken- consider potential impact of iatrogenic anaemia?

    7. How would this impact your Haematology out-patients- particularly ones on MOABS, that may need referrals for allo-absorptions. Extended testing may exceed the 72hrs to get the patient back in for their transfusion?

    8. If a patient was to bleed during surgery- and the sample was just over 72hrs- would you revert to giving O+/- units only ?

    9. At what point does the 72hrs (T=0) begin. The day the sample is received or the exact time it is received until 72hrs later? This always causes confusion anyway- but something stringent like this may cause further confusion/ frustration for all.

    If your change request is raised and the risk/benefits considered, that may help everyone to see if this is a good idea or not. The clinical areas via HTC would have to be involved.
    Perhaps it would be an idea to discuss with the BSH writing team- I believe the Compatibility guidelines are being updated. NEQAS team would be able to put you in touch with the right people.

    Best wishes

  3. #3
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    HI Rashmi Happy new year to you.
    Thanks for the reply. You have raised some very good. If people are wanting to progress this I I will suggest contacting the BSH writing group, I don't really want to start a practice outside the norm.

    Thanks
    Matt

  4. #4
    Hi Matt and Rashmi

    Thanks for the considered points Rashmi and I agree a change control would help to ensure the correct decision is made according to good practice.

    It is not for MHRA to consider the rights or wrongs in clinical decisions like this, but my only comment would be that in my experience, a 72 hour limit would not be outside of the norm. When assessing SABRE reports I assess them as errors against the local QMS, not the BSH guidelines. I have seen a variety of sample validity timings including 72 hours for all, and even 48 hrs across the board to ensure that issued blood is identified and removed from the supply chain in good time. I couldn't tell you how many labs do what, just that I have seen it through SABRE reports.

    Does anyone else who practices 48 hr or 72 hour validity have any comments?

  5. #5
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    Hi Chris
    this is a bit of a surprise to me I would have thought that the vast majority of people were sticking to the BSH guidelines. When you say that a 72 hr limit for all is not outside the norm, do you mean there are a lot of people doing this? One of the reasons I was concerned about this was because I didn't know of anyone else using this practice. I would be very keen to get a bit of feed back form anyone using such a practice.

  6. #6
    Hi Matt

    I'm afraid it is up to others to come forward. I can't give you exact figures, but all I can say is that looking at SABRE reports, there are some reporters that operate a policy of less than 72 hours so that they are not caught out by samples that expire after 72 hours. For example, they will collect all the units that have reached 48 hours in the morning in case there are some that go beyond 72 hours over night before the next reclaim. Other hospitals may have several reclaims during the day depending on staffing and location of fridges for example, or may bring units back to the lab after 48 hours so they can then control the release of the blood from the lab within the period between the 48 and 72 hours.

    It is for local trusts to decide how to ensure expired or unsuitable units are removed from the supply chain, and there is no "right" or "wrong" answer.

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