Core Transfusion

Module details

Title

Core Transfusion

Type

Specialist

Module code

SLS123

Credits

10

Requirement

Compulsory

Aim of this module

This module will provide the trainee with an in-depth knowledge of blood groups and their clinical significance in transfusion medicine. It will also provide the knowledge and skills required to work at a basic level within the transfusion hospital laboratory, operating within regulatory requirements, and providing safe and compatible blood and components for patients.

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1	Competency Apply sample acceptance criteria for samples for pre-transfusion testing.	Action View
# 2	Learning outcome 1	Competency Perform manual and automated serological tests, with appropriate controls, and recognise discrepant results in: ABO/D typing antibody screening antibody identification serological cross-matching red cell phenotyping.	Action View
# 3	Learning outcome 1	Competency Select further tests to investigate ABO/D typing anomalies, and to recognise situations where conclusive results cannot be obtained ‘in-house’ and referral for further testing is required.	Action View
# 4	Learning outcome 1	Competency Interpret the results of simple antibody identification investigations (i.e. single antibody or two antibodies reacting distinctly by different techniques) and recognise cases requiring additional tests or clinical advice.	Action View
# 5	Learning outcome 1	Competency Perform routine pre-transfusion compatibility testing by serological cross-matching, and apply criteria for use of electronic issue (if used). Interpret results and identify cases requiring additional tests or clinical advice. Complete relevant documentation on paper and using IT systems as appropriate.	Action View
# 6	Learning outcome 2	Competency Provide safe blood components for patients (if clinically necessary) before a confirmed ABO/D result can be established.	Action View
# 7	Learning outcome 2	Competency Interpret requests for blood, components and products to determine what tests are required before issue.	Action View
# 8	Learning outcome 2	Competency Select, handle and issue blood components with additional specifications including: irradiated HbS negative phenotyped red cells washed components.	Action View
# 9	Learning outcome 2	Competency Select appropriate blood components or product in accordance with patient special requirements, including for the following: Intrauterine transfusion neonates post stem cell transplant (SCT)/ bone marrow transplant (BMT) autoimmune haemolytic anaemia (AIHA) post solid organ transplant sickle cell disease red cell antibodies.	Action View
# 10	Learning outcome 2	Competency Provide safe and effective blood and components for emergency use, and provide transfusion support in cases of major haemorrhage, demonstrating the ability to communicate effectively with all parties involved.	Action View
# 11	Learning outcome 2	Competency Evaluate the requirement for routine blood components, e.g. platelets, FFP, and prepare FFP for issue.	Action View
# 12	Learning outcome 2	Competency Recognise the potential need for specialist components, e.g. cryopecipitate.	Action View
# 13	Learning outcome 2	Competency Visually inspect blood, component or product to ensure it is fit for use. Label and issue via local computer system to ensure full traceability.	Action View
# 14	Learning outcome 3	Competency Respond to the report of a suspected transfusion-related adverse reaction or event according to local protocol. Identify the probable ‘type’ of reaction and refer or perform the appropriate investigations.	Action View
# 15	Learning outcome 3	Competency Perform repeat serological testing on pre- and post-transfusion samples in cases of suspected haemolytic reactions. Interpret results in clinical context and report to clinical and transfusion specialist staff.	Action View
# 16	Learning outcome 3	Competency Assist in completion of relevant internal documentation relating to adverse reactions/events and external incident reporting, including: serious adverse blood reactions and events (SABRE) serious hazards of transfusion (SHOT).	Action View
# 17	Learning outcome 4	Competency Demonstrate compliance with regulations and guidance for the labelling, storage and transport of blood.	Action View
# 18	Learning outcome 4	Competency Be able to advise non-laboratory staff on safe collection, transport and administration of blood.	Action View
# 19	Learning outcome 4	Competency Participate in ordering of blood and components in routine and urgent situations and for patient with special requirements.	Action View
# 20	Learning outcome 4	Competency Manage blood stocks in order to ensure the most efficient use within a hospital setting.	Action View
# 21	Learning outcome 4	Competency Assist in collection, analysis and audit of data relating to the use of blood components.	Action View
# 22	Learning outcome 5	Competency Apply national guidelines for transfusion practice (e.g. BCSH) relevant to own scope of practice.	Action View
# 23	Learning outcome 5	Competency Demonstrate compliance with applicable regulatory requirements for transfusion services (e.g. BSQR and successor regulations).	Action View
# 24	Learning outcome 5	Competency Participate in audit of the departmental quality management system for transfusion services.	Action View
# 25	Learning outcome 5	Competency Perform and interpret results of internal quality control and external quality assessment relating to patient pre-transfusion testing.	Action View

Assessments

You must complete:

• 2 case-based discussion(s)
• 2 of the following DOPS/ OCEs:

Perform appropriately controlled manual ABO and RhD typing antibody screen and crossmatch on a patient sample	DOPS
Perform an antibody identification panel by IAT and with enzyme treated red cells	DOPS
Book in samples for pretransfusion testing	DOPS
Perform manual extended Rh and K phenotyping	DOPS
Perform minimum pretransfusion testing required for issue of group compatible blood within 15 minutes	DOPS
Prepare a range of blood components for issue including frozen components	DOPS
Issue a range components through IT and manual systems	DOPS
Perform serological testing associated with a suspected haemolytic transfusion reaction	DOPS
Pack blood components for transport to different site	DOPS
Order blood and components using online and paper based blood ordering systems	DOPS
Display application of GLP in the blood bank environment	DOPS
Perform audit required for MHRA Validation	DOPS
Communicate to the requesting doctor that a mislabelled sample has been rejected	DOPS
Prioritise simulated requests for blood components where supply is limited	DOPS
Select blood with appropriate group and special requirements for a patients with a range of clinical conditions	OCE
Review requests for red cells for a range of patients to assess suitability for electronic issue	OCE
Take part in a major incident simulation including blood ordering and provision of blood components	OCE
Report an adverse event for a specific patient to SHOT and or SABRE	OCE
Simulate of a range of events where collection transport and administration of blood is not straightforward	OCE
Formulate corrective and preventive action for a simulated QI where an incorrect blood component has been transfused	OCE
Deliver departmental tour for junior doctors nurses members of the public	OCE
Assist transfusion practitioner in the investigation of an incident involving blood administration on a ward	OCE
Respond to telephone calls real or simulated requesting blood in range of situations	OCE
Communicate to the requesting doctor that a mislabelled sample has been rejected	OCE

Learning outcomes

1. Perform routine pre-transfusion procedures and serological tests, correctly interpret results and investigate anomalies to ensure provision of compatible blood for patients.
2. Select and issue appropriate blood, components and products for patients with a wide range of clinical conditions, in routine and emergency settings.
3. Investigate suspected adverse reactions and events according to clinical presentation.
4. Manage blood stocks, including full traceability and maintenance of the cold chain.
5. Interpret and comply with national guidelines for transfusion, applicable regulatory requirements (e.g. Blood Safety and Quality Regulations) and quality management systems in the hospital transfusion laboratory.

Learning outcomes

1. Explain the genetic basis of the major blood groups, and the significance of red cell antigens and antibodies in transfusion medicine.
2. Describe the design, operation and performance of pre-transfusion procedures and serological tests and their use to ensure provision of compatible blood for patients.
3. Discuss and justify the procedures and practices required to select and issue appropriate, blood, components and products for patients.
4. Explain and evaluate the principles of blood stock management, the need for full traceability and maintenance of the cold chain.
5. Discuss and justify the need to work within national guidelines for transfusion, (e.g. BCSH), applicable regulatory requirements (e.g. UK Blood Safety and Quality Regulations [BSQR]) and quality management systems in the hospital transfusion laboratory.
6. Describe the partnership between the hospital blood transfusion laboratory and other clinical specialisms in the transfusion process and patient care.

Indicative content

• Blood group systems, genes antigens, antibodies and their clinical significance in transfusion medicine
• Immunological basis of antibody-mediated red cell destruction
• Factors affecting antigen: antibody reactions in vitro and principles of serological tests
• Intra-operative autologous transfusion technologies
• Pre-transfusion testing protocols to establish compatibility
• IT systems, automation and security
• Indications for and administration of blood components
• Selection of components for patients with special requirements, e.g. sickle cell disease (SCD), neonates
• Transfusion support for transplant patients (bone marrow transplant [BMT], stem cell, solid organ)
• Appropriate use of blood and components
• Novel blood derivatives, therapeutics and their application
• Alternatives to transfusion
• Management of major haemorrhage
• Management of major incidents
• Management of transfusion reactions
• Hospital blood stocks management and traceability
• Haemovigilance and incident/error management
• Cold chain, transport of components and blood tracking systems
• Quality management systems in transfusion
• Transfusion guidelines

Activities

• Attend a multidisciplinary review meeting at which specific cases involving blood transfusion are reviewed.
• Attend a hospital transfusion committee meeting. Reflect and report on your experience, including the importance of these meetings and their impact on the patient and service delivery.
• Attend a unit where blood is collected from donors. Reflect on and discuss the engagement and experience of donors and the role and responsibilities of staff within this unit.
• Review and discuss the role and responsibilities of staff in this unit and the interaction of this unit with other laboratory and patient services.
• Attend a ward round and/or clinic at which patients are being monitored following receipt of blood or blood components.
• Follow the progress of one patient and reflect and discuss the patient pathway and the impact of laboratory services.
• Participate in reporting and investigation of adverse reactions to transfusion. Discuss the possible reactions, outcomes and implications for patient care and management.
• Shadow other staff involved throughout the whole transfusion pathway. Report and discuss the roles, responsibilities and impact on both service delivery and patient care throughout the pathway.