martin maley reference laboratory manager [email protected] rci 0191 2194416 title...

Pre-op Assessment Nurses Day 24/09/13

Martin MaleyReference Laboratory Manager

NHBST


Red cell Immunohaematology (RCI)Patient testing laboratoryReferral service18 hospitals


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


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


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


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


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 referred routinelyRCI has 5 working days TRT

Day of op referred urgentlyCan take 2+ hoursNot including travel


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


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


Zero toleranceEssentials;

NameDOBHospital / NHS numberDate taken


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


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


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


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


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


1 in 1000 units compatible


Caucasians No units availableBlacks 1 in 15 units compatible


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


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


[email protected] 0191 2194416

martin maley reference laboratory manager [email protected] rci 0191 2194416 title...

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