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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
[email protected] 0191 2194416