BLOOD TRANSFUSION SOP

HDN DUE TO RHESUS INCOMPATIBILITY

Rhesus HDN is usually caused by immune anti-D and less commonly by other Rhesus antibodies. It occurs when a Rh negative mother with circulating IgG anti-D antibody (formed from a previous Rhesus
incompatible pregnancy) becomes pregnant with a Rh positive infant and IgG anti-D passes into the fetal circulation, destroying fetal cells. The infant can
be born severely anaemic and jaundiced.

The severity of disease increases with each Rh positive pregnancy. Infants with Rhesus HDN are usually more severely affected than infants with ABO HDN.
Note: In most cases of Rhesus HDN, maternal IgG anti-D will have been detected by the laboratory during routine antenatal visits, and the strength of the antibody (titre), monitored.
When Rhesus testing is not performed routinely (due to low frequency of Rh negative persons in the population) and an infant is born severely anaemic
and jaundiced, the laboratory may be asked to investigate the possibility of Rhesus HDN.

SOP REQUIREMENTS IN BLOOD TRANSFUSION (PART 2)

Compatibility testing (cross-matching) of blood SOPs should include:

Details of the request form and patient’s
blood sample.
Procedure for compatibility testing including use of controls, interpretation and recording of test results.
Procedure for emergency compatibility testing.
Labelling compatible blood.
Preparation of concentrated red cells.
Procedure for investigating a transfusion reaction.

Safety issues SOPs should include:

Safe handling of blood and blood products.
Decontamination of work surfaces and laboratory-ware and preparation of sodium hypochlorite solutions
Disposal of ‘sharps’
Disposal of contaminated and expired blood.

Procurement of supplies SOPs should include:

Procedures for ordering essential reagents, HIV and other test kits.
Recording expenditures and keeping financial accounts.
Reliable systems for transporting essential supplies.
Checking expiry date and specifications, and recording supplies upon their receipt.
Storage requirements of antisera reagents.

See also:

SOP REQUIREMENTS PART 1

SOP REQUIREMENTS IN BLOOD TRANSFUSION (PART 1)

Use of blood, blood products and blood substitutes SOPs should contain:

Information which must accompany a request for blood.
How to calculate the volume of blood to use, particularly when the patient is a child.
Identity checks and documentation required when collecting blood from a patient, from the blood bank and before setting up a blood transfusion at the bedside of a patient.
Procedure to follow when a patient is being transfused and what action to take should there be an adverse reaction to the blood.
System for auditing how blood is used.

Donation of blood SOPs should contain:

Criteria for accepting a person as a blood donor and details of medical screen and pretesting procedures.
Questionnaire to be used with potential donors covering personal medical history and life style.
Policy and procedure for counselling donors with regard to HIV screening, testing and maintaining the confidentiality of blood donor information.
Details of how to collect blood from a donor.
Labelling donor blood.
Care of the donor following donation and frequency of donation.
Special requirements of mobile blood donation and transportation of blood.
Blood donation records.

Storage of blood SOPs should contain:

Temperature requirement, checking and recording the temperature of the blood bank refrigerator.
Sectioning of refrigerator and location of prescreened, screened, and crossmatched blood.
Procedure for checking the appearance of blood for signs of contamination before it is issued and documentation checks to be performed.
Blood bank records.
Locally important procedures, pertaining to the use and security of a blood bank refrigerator.

See also:

SOP REQUIREMENTS PART 2