If you have any questions about the policies listed below, please contact the Transfusion Laboratory on Ext 8451/8452 (bleep 1151 out of hours)

Group & Screen

This test consists of 3 processes:

1.    ABO and RhD group of the patient's blood - if the patient has not been grouped before then the initial sample is grouped using 2 different reagents.

2.    Antibody screen of patient's plasma - this is to check whether the patient has acquired atypical antibodies as a result of a previous transfusion or pregnancy. Though it can identify the presence of these atypical antibodies, if they are detected then further testing is required on that sample to determine the specific types.

3.    Retain the sample at 4°C for 7 days, in case the patient has a future transfusion and has problems which necessitate re-examining the patient's original sample. The length of time that a sample can be stored and be viable for future release of blood is determined by National Guidelines:  

For major haemorrhages, group and screen and crossmatches are processed according to the Management of Massive Blood Loss policy available on SharePoint.

For preadmission bloods, it is the responsibility of the preadmission clinic to ensure that a sample is taken to cover the date of the operation.

In other situations, it is the requesting clinician’s responsibility to know the status of the sample.

Patients with complex antibody pictures may require the laboratory to ask NHSBT to deliver phenotyped units for local crossmatch, or in extreme circumstances require extra samples to be taken, so the laboratory can refer them to NHSBT for the crossmatch to be performed remotely. These can cause significant delays, so clinical areas are encouraged to check G&S reports promptly and discuss with the laboratory any mentioned potential delays.

If a patient is being taken to theatre, a check should be made immediately to ensure that a viable sample is available so that the on demand system can be used if required. If it is discovered that there is no sample, a fresh one should be sent to the lab without delay.

It should be noted here that there will be a minimum 50 minute delay in supplying compatible blood if no sample has been tested prior to the operation.

Care should be taken to ensure that any changes to the date of the operation also involve considering whether any current Group & Screen sample will still be valid. If not, a new sample would be required before a crossmatch could be performed. If you are not sure whether you need to take a new specimen or not, contact the laboratory on ext. 8451/8452 (during on-call periods bleep 1151 instead). If a crossmatch is postponed due to a change of operation date, a new request form will still need to be generated via Sunquest ICE, to ensure that the patient identity is confirmed and it is clear exactly which blood products are required (even if a new Group & Save sample is not required). This is all part of our mandatory audit trail.

Confirmation of blood group prior to issue of transfusion components

All blood groups require confirmation by 2 separate samples (one of which may be a historic test result) prior to issuing crossmatched blood components.

On receipt of a Group & Screen or crossmatch request, the transfusion laboratory will identify which patients need a further sample for confirmation of blood group. If the laboratory can find a historic sample with a blood group result on the laboratory systems, only one current sample will need processing.

The confirmatory sample must be taken by a venepuncture that is separate from that of the initial sample, ideally by a different member of staff.

For G&S only samples - if the patient has no historic blood group on the laboratory system, a comment informing the clinical area that a further sample is required before crossmatched blood can be issued will be included on the report form and on Sunquest ICE as below:

For G&S samples with Crossmatch requests - If the patient has no historic blood group on record, the laboratory will phone the clinical area to inform them that a second sample is needed before crossmatched blood can be issued. The date, time and the name of the person informed will be recorded.

For Crossmatch only requests - If the patient has only one historic blood group on record, the laboratory will phone the clinical area to inform them that a second sample is needed before crossmatched blood can be issued. If there is no historic blood group on record, the clinical area will instead be informed that two samples are needed, taken by separate venepunctures, before crossmatched blood can be issued. The date, time and the name of the person informed will be recorded.

Until the second sample is received, no crossmatched blood will be issued, so confirmatory samples should be sent to transfusion as a matter of urgency.

In dire emergencies, Group O blood will be issued to support the immediate management of the patient, until the confirmatory sample is processed.

This policy has been implemented after discussion at the Hospital Transfusion Committee and QGOC meetings, as the Department of Health has identified transfusion of ABO incompatible blood components as a ‘Never Event’ and the British Society of Haematology (BSH) Guidelines 2012 for Pre-transfusion Compatibility Procedures in Blood Transfusion accept the recommendations made in the 2012 SHOT report that a second sample should be requested for confirmation of the blood group of a first-time patient prior to transfusion.

Electronic issue and Manual Crossmatch
Red cell units that are ABO and RhD compatible can be quickly issued for a patient on the basis of information in the blood bank information system, with no direct serological testing, provided there are procedures in place to ensure that:

·         The patient’s ABO and RhD type have been tested and also confirmed on a second sample

·         The patient has no irregular red cell antibodies

·         The grouping of the patient sample is fully automated

·         The patient’s previous results can be correctly identified and retrieved

 Our electronic issue system is fully MHRA compliant and has been in place for over 10 years.

 Electronic issue takes 5 minutes from receipt of the request form.

If there are current or historical antibodies, or the group/antibody screen required manual editing in order for the results to be interpreted, then electronic issue is inappropriate and a serological crossmatch should take place (i.e. checking the patient's plasma does not react with red blood cells from each donor unit). Some antibodies make the patient incompatible with blood from a significant proportion of the random population (e.g. anti-Fy^a) and may require liaison with the National Blood Service for delivery of specially selected units which can take time - if you are in doubt please contact the laboratory on ext. 8451/8452 for advice.

Blood crossmatched for routine surgery will be dereserved at 09:00 the following morning unless the requester contacts the blood bank to discuss the possibility of extending the reservation date.

Blood on demand system
Blood on demand is a system in which no blood is issued prior to a procedure commencing. To use the Blood on Demand system, the laboratory must have tested a Group & Screen sample within 7 days of the procedure and found it suitable for electronic issue. If blood is required, a phoned request backed up by a paper request is required. The laboratory will issue blood electronically within 5 minutes of the request form being received. The blood would then need to be collected from the issue fridge on the 4th floor.

The Transfusion laboratory is responsible for testing the samples in a timely manner and identifying patients who are not suitable for the on demand system. Any patient requiring blood but who is not suitable for the on demand system will have a manual crossmatch performed.

Maximum Surgical Blood Order Schedule (MSBOS)
Where electronic issue is not appropriate, the laboratory will liaise with the requestor and ensure that blood is manually crossmatched (in advance of the procedure for preadmission bloods). Unless there are extenuating circumstances, the number of units crossmatched will be based on the Maximum Surgical Blood Order Schedule. This is a hospital policy agreed between the blood bank, clinicians and hospital transfusion committee. It specifies the number of units of blood that should normally be crossmatched for planned surgical procedures. The schedule is based on a retrospective analysis of actual blood usage associated with an individual surgical procedure using the C:T ratio. (Cross-matched: actually transfused).

Surgical Blood Ordering Tariff