martin maley reference laboratory manager nhbst...martin.maley@nhsbt.nhs.uk rci 0191 2194416 title...

Pre-op Assessment Nurses Day 24/09/13

Martin MaleyReference Laboratory Manager

NHBST

Pre-op Assessment Nurses Day 24/09/13

Red cell Immunohaematology (RCI)Patient testing laboratoryReferral service18 hospitals

Pre-op Assessment Nurses Day 24/09/13

200/300 samples per dayHigh pressureHigh throughputShort NoticeStressfulSo what do we do in RCI?

Pre-op Assessment Nurses Day 24/09/13

ABO / RhD anomaliesRed cell alloantibody identificationRed cell autoantibody casesCrossmatching of bloodInvestigation of Transfusion reactionsHelp and advise HTL

Pre-op Assessment Nurses Day 24/09/13

Mix of technologiesFully automated (grouping)Semi automated (antibody titre)Largely manual testing (ID and XM)10-20 samples per day

Pre-op Assessment Nurses Day 24/09/13

Pre-op Assessment Nurses Day 24/09/13

Sample from patientSent to HTLReferred onto RCITested in RCIBlood issued to HTL (if required)Nothing ever goes wrong

Pre-op Assessment Nurses Day 24/09/13

Sample from patientSent to HTLReferred onto RCITested in RCIRecommendations for blood selection given to HTL (or refer 2nd sample closer op date).Nothing ever goes wrong

Pre-op Assessment Nurses Day 24/09/13

Pre-op assessment referred routinelyRCI has 5 working days TRT

Day of op referred urgentlyCan take 2+ hoursNot including travel

Pre-op Assessment Nurses Day 24/09/13

Pre-op Assessment Nurses Day 24/09/13

Name, DOB, unique numberTransfusion historyEsp from other trust / areaInfo to HTL, then to RCI

Pre-op Assessment Nurses Day 24/09/13

21 full oneEDTA (pink top)Hand-written at bedsideSHOTSerious Hazards of Transfusion

Pre-op Assessment Nurses Day 24/09/13

Zero toleranceEssentials;

NameDOBHospital / NHS numberDate taken

Pre-op Assessment Nurses Day 24/09/13

CommunicationAfter the RCI report going in the post / on Sp-ICEChase

Pre-op Assessment Nurses Day 24/09/13

Pre-op Assessment Nurses Day 24/09/13

Pre-op Assessment Nurses Day 24/09/13

Pre-op assessment sample sent to HTLAntibody screen positiveHow far does the HTL go?

Pre-op Assessment Nurses Day 24/09/13

Unable to identifySample referred on to RCIAutoantibody presentBut I/S to complete testsRCI report to HTL

Pre-op Assessment Nurses Day 24/09/13

Day of opSample lands in HTR at 09:303 units requested to cover op.Sample leaves HTR to go to RCI at 09:45Sample arrives in RCI at 10:55RCI complete testing at 13:15Crossmatched blood leaves NHSBT at 13:40Blood arrives at HTR at 14:50Op gone commando / postponed

Pre-op Assessment Nurses Day 24/09/13

Combinations of antibodiesAntibody to high prevalence antigensAutoantibodiesAwkward group (O-)All take time

Pre-op Assessment Nurses Day 24/09/13

1 in 1000 units compatible

Pre-op Assessment Nurses Day 24/09/13

Caucasians No units availableBlacks 1 in 15 units compatible

Pre-op Assessment Nurses Day 24/09/13

From elsewhere in EnglandRegularly for these 2 patients (and others)24 hours+ notice requiredAnnoy Transport and Hospital Services

Pre-op Assessment Nurses Day 24/09/13

Rejects (labelling, volume)Repeats (volume, complexity)Communication

Pre-op Assessment Nurses Day 24/09/13

martin.maley@nhsbt.nhs.ukRCI 0191 2194416