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TRANSFUSION MEDICINE SERVICES

A) INTRODUCTION

Transfusion Medicine Service Hospital Melaka is the sole

provider of blood and blood component to Hospital Melaka as

well as all district and private hospitals within the state.

Headed by a Transfusion Medicine Specialist, the

Transfusion Medicine Service is responsible for collecting,

processing and microbiology screening of all blood intended

for transfusion.

B) SERVICES

Transfusion Medicine Laboratory Hospital Melaka offers a 24

hour services to provide blood and blood components for elec-

tive and emergency transfusions of in and out-patients.

Pre- transfusion tests offered are:

1) ABO & Rh D grouping

2) Antibody screening

3) Antibody identification

4) Direct and Indirect Antiglobulin Test (DAT & IAT)

5) Anti-D titre

6) Red cell phenotyping

7) Cross matching

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Other services offered:

1) Investigations of all adverse transfusion reactions.

2) Investigation of discrepancy of forward and reverse grouping

3) Leuco depletion of red cells (selected patients only) by prior

arrangement with medical officer/specialist.

4) Irradiation of red cells and platelets (selected patients only) by

prior arrangement with Pusat Darah Negara.

5) Pathogen inactivation of plasma (selected patients only) by

prior arrangement with Pusat Darah Negara.

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1. PRE-ANALYTICAL REQUIREMENTS.

A) ORDERING BLOOD FOR TRANSFUSION

The decision to transfuse shall be made base on clinical

judgment. The benefits and risk shall be assessed and

alternative therapy considered. The clinician managing the

patient shall be responsible for prescribing blood for that

patient.

In order to ensure patient safety, sampling and labelling of

sample shall follow the following steps:

THESE STEPS ARE CRITICAL & IMPORTANT

i) Positive patient identification by asking the patient to state their full name and IC number.

ii) Check the answer givens against the information stated on the patient’s identification wristband and /or case notes.

iii) The process of taking and labeling blood samples must be done at the bedside, one patient at a time.

iv) The person who takes the blood sample must filled up the form and label the blood tube him or herself.

v) Never label 2 or more patient’s sample at the same time.

vi) Use plain label (empty label) to label blood samples. Please do not use pathology label for blood samples.

• For further details, please refer to Transfusion Practice

Guidelines for Clinical and Laboratory Personnel, 4th

edition 2016.

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B) REQUEST FORM

1. For GSH and GXM request, Borang Permohonan Transfusi

Darah PER-SS-BT105 (Pin.1/2016) shall be used (Refer

Appendix 1).

2. For ABO and Rh D grouping, Anti-D titre, DAT & IAT and

also red cell phenotyping, PER-PAT-301 form shall be used

(Refer Appendix 2).

3. All request forms must be filled in legibly. The following

information must be provided in the request form.

i) Patient’s detail.

a) Full name (in capital letter)

b) Identity card number/Passport number/Police or

Army number/EDHM number (for unknown patient).

c) Registration number for blood and blood

component request (exception for unregistered

patient from emergency department and

emergency case from O & G Patient Admission

Centre).

d) Sex & age

ii) Source: Ward, Clinic and Name of Hospital/Health

Centers.

iii) Patient’s clinical summary/Diagnosis /Reason of trans-

fusion.

iv) Test request.

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v) Select product and write number of product required

( for blood and blood component request)

vi) Name of the personnel who obtained and labelled the

samples (for blood and blood component request)

vii) The requested doctor’s name, signature and stamp.

C) SAMPLES/SPECIMENS/TYPE OF CONTAINERS

All patient samples must be in EDTA tube which is labeled

with at least two identifiers (i.e. full name of the patient and

patient’s I.C number). Volume of blood required for each test is

at least 2 ml.

TYPE OF CONTAINER FOR SPECIMENS.

NO.

CONTAINER

SPECIMEN

ADDITIVES

TEST

VOLUME

1.

Blood

EDTA

All test

2 ml

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D) TRANSPORTATION OF SPECIMEN.

1) The specimen should be transported to the laboratory as

soon as possible/ in appropriate time frame.

2) Please do not store the specimen in ward fridge.

E) REJECTION CRITERIA

List of common/primary rejection criteria is as follows:

1) Leaking specimen

2) Wrong container

3) No specimen received for the intended test.

4) Information on request form and specimen do not tally

5) Incomplete request form

6) Insufficient sample/excess volume.

7) The specimen not suitable for analysis e.g hemolysed blood sample.

8) Sample clotted

9) Duplicate request

Note:

1. Lab staff will call and inform the requesting unit/ward/clinic/hospital.

2. The lab staff also will dispatch the printed rejection form and the copy of request form (GSH and GXM request) to the

requesting unit/ward/clinic/hospital through pigeon hole.

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2. POST ANALYTICAL

TEST RESULTS/REPORTS

1. Majority of the test results will be placed in the “pigeon hole” of the respective wards, clinic and health clinic at the central

Reception Counter in the Pathology Department.

GUIDE OF TEST/LABORATORY TURN –

AROUND TIME

NO

TEST CONTAINER SPECIMEN VOLUME LTAT

1 ABO and Rhesus (D) grouping

EDTA Blood 2 ml 1 working

day

2 Group, Screen and hold (GSH)

EDTA Blood 2 ml 4 hours

3 Antibody identification

EDTA Blood 2 ml 3 working

days

4 Anti-D titre EDTA Blood 2 ml 1 working

day

5 Routine Cross-match (GXM)

EDTA Blood 2 ml 2 hours

6 Direct Antiglobulin (DAT)

EDTA Blood 2 ml

1 working day

(if not required

further test)

7 Indirect Antiglobulin (IAT)

EDTA Blood 2 ml

1 working day

(if not required

further test)

8 Red cell phenotyping

EDTA Blood 2 ml 1 working

day

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URGENT TEST REQUEST.

Definition:

A test should be ordered URGENT when it is required for immediate

patient management and if there is a delay in treatment, this might

result in patient morbidity and mortality. The sample must reach the

laboratory as soon as possible.

Urgent requests:

1. Must be justified by clinical summary, diagnosis and reason for

the urgency.

2. Urgent request shall be separated from the non-urgent request

and must be sent to the laboratory immediately either by ward/

OT.

3. All urgent request should be accompanied by a phone call to

the transfusion laboratory to facilitate the process. Details of

the communication shall be documented, including the names

of the caller and the receiver.

Note: For further details, please refer to Transfusion Practice

Guidelines for Clinical and Laboratory Personnel 4th edition, 2016.

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LIST OF URGENT TESTS AND THE LABORATORY TURN

AROUND TIME (LTAT)

NO TEST LTAT

1. Safe O 15 minutes

2. GSH convert GXM (urgent) 30 minutes

3. Urgent GXM (2 unit) Saline phase

crossmatch only 30 minutes

4. Urgent GXM (2 unit)

Full crossmatch 45 minutes

5. DIVC regime 45 minutes

APPENDIX 1

No. Makmal: BORANG PERMOHONAN TRANSFUSI DARAH

PERKHIDMATAN TRANSFUSI PERUBATAN

(Mesti dipenuhi dalam dua salinan. Tulis dengan pen mata bulat dan sila tandakan √ dalam petak yang berkenaan.)

PER-SS-BT 105

(Pind. 1/2016)

APPENDIX 2

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“Menyediakan perkhidmatan trans fus i yang

efis yen, e fekt i f dan berterusan bagi

memenuhi keper luan penjagaan kes ihatan

mas yarakat , pesakit dan penderma darah

me la lu i amalan perubatan trsns fus i yang

terkin i”

Vis i Jabatan Perubatan Trans fus i

Prepared by : DR . NOR AZLIN A B INTI H AM ZAH

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