Role of the hospital blood bank
Quality in transfusion practice must apply to the hospital blood bank or equivalent, because it plays a vital role in ensuring that the correct blood is supplied for the patient.The laboratory aspect of the transfusion process is carried out in different ways . In some settings a local hospital blood bank manages the blood component inventory and the clinical blood transfusion laboratory services.
The hospital blood banks implement a quality management system. To maintain a high level of performance in the laboratory, it is essential to monitor the functioning of reagents, equipment, techniques and procedures. Good record keeping and documentation, use of standard operating procedures and laboratory worksheets, and implementation of safety guidelines further improve the quality of performance.
The hospital blood bank is responsible for:
- Rapid response to urgent requests for blood
- Checking pre-transfusion samples and requests
- Assessing of immunological compatibility between donor and patient
- Selecting of suitable blood component for each clinical condition
- Safe delivery and handling of blood
- Inventory and stock management
All urgent requests for blood should be notified to the laboratory by telephone. Blood bank staff should be given as much notice as possible to organize the work and assign appropriate priority to requests. The handling of any emergency situation benefits from clear and frequent communication with the hospital blood bank about the blood. A full cross match will take approximately 40-45 minutes from receiving the patient sample and request. In very urgent cases the time can be reduced to 20 minutes.
This allows tests to exclude ABO incompatibility. In extremely urgent critical situations where blood is needed in less than 20 minutes, non-crossmatched group O blood should generally be made available for immediate use. Females of childbearing age should receive group O RhD negative red cells if the patient’s RhD type is not known.
Blood sampling and clerical checking
In pre-transfusion testing, careful checking is essential. Correctly identified and correctly labelled blood samples from the correct patient are fundamental to the provision of blood that is safe for transfusion. When a sample is received in the blood bank, a member of the staff must confirm that the information on the label and on the transfusion request are identical. The patient’s serological and transfusion history must also be checked and the results of current testing compared with those of previous tests. Any discrepancies must be resolved before any blood can be released for transfusion.
This involves testing the blood of the intended recipient to determine the ABO group and RhD type and to detect any clinically significant red cell antibodies (this procedure may be called “group and screen” or “type and screen”). If the screening test is positive further tests may be needed to identify the red cell antibodies so that compatible donor units can be selected. The patient’s serum is directly tested in the blood bank for compatibility with the donor red cells before transfusing RBC components (cross match). Some countries also require a further blood group check immediately before the blood is transfused.
Selection of blood
The hospital blood bank will use the test results together with the information provided on the request form to select and label the correct blood for the patient.
Safe delivery and handling of blood
Errors at this stage of the clinical transfusion process are an important source of adverse reactions and events. Hospitals should have a policy that ensures that correct units are withdrawn from the storage location. Blood must only be stored in designated blood storage refrigerators with temperature monitoring charts and an alarm system.
Inventory and stock management
The hospital blood bank is responsible for management of the hospital’s blood stock. This includes maintaining an inventory for each blood group, ensuring an average age of blood at time of issue, and monitoring the amount of blood that becomes out dated or is not used for other reasons. Stock levels should be set in conjunction with weekly use and activity in order to avoid over stocking and wastage. The hospital blood bank should develop a partnership working agreement with their Blood Establishment provider on how to deal with shortages of blood.
Blood Donation Camp
Blood donation camp is conducted rottenly twice in a month. Blood donation is carried out under the supervision of trained, skilled technicians. The entire procedure, from start to finish, does no t take more than 45 minutes.
The first and the most common method is when whole blood is drawn from the donor and is collected in a plastic bag that contains anticoagulants and preservatives such as sodium citrate,phosphate, dextrose or adenine.
Whole blood, when kept in CPDA anti coagulant solution at 2 – 4 deg C, can be stored up to 35 days, But the demand is far greater than the supply and the collected blood is used up much before its expiry date