7.4 Urgent and emergency transfusion – major bleeding

A single patient with catastrophic bleeding can be a major challenge for the clinical and blood bank teams. When blood is required very rapidly it is extremely important to have clear communications between clinicians and the blood bank. Clinical and blood bank experience indicates that delays in providing blood in a life-threatening emergency can occur for various reasons and contribute to mortality in critical situations such as obstetric haemorrhage. www.cmace.org.uk

Hospitals should have a Major Haemorrhage Procedure that identifes roles, responsibilities and communication routes. (Example downloadable from end of page)

There should also be a clinical transfusion guideline for management of major bleeding. (example: PMID 17107347, 19135193)

Rehearsals (‘fre practices’) to familarise medical, nursing, laboratory and transport staff and to test the procedure.

Following road traffc accidents and other disasters several unconscious injured patients may arrive at the hospital within a short period, creating risks due to problems in identifying the patients. These are situations when it is vital for all the team to know and use the Major Haemorrhage Procedure (table 7.1).

Table 7.1 Example of a Major Haemorrhage Procedure

There should also be a clinical transfusion guideline for management of major bleeding.

Major Haemorrhage Procedure
Example of a Major Haemorrhage Procedure
  1. If there are several staff working with emergency cases, one person should take charge of ordering blood and communicating with the Blood Bank. This is especially important if several injured patients are involved at the same time.
  1. Insert an intravenous cannula, and take blood sample for crossmatching. Set up the intravenous infusion and get the blood sample and blood request form to the Blood Bank as quickly as possible.
  1. For each patient, the crossmatch sample tube and the blood request form must be clearly labelled. If the patient is unidentifed, some form of emergency identifcation number should be used. Use the patient’s name only if you are sure you have correct information.
  1. Tell the Blood Bank how quickly the blood is needed for each patient. Communicate using words that have been previously agreed with the Blood Bank to explain how urgently blood is needed.
  1. If there is a special stock of ‘emergency O negative’ blood, e.g. in the labour ward, use this frst in an emergency for girls and for women of child bearing age
  1. Do not wait for crossmatched blood if the patient is exsanguinating.
  1. If another request for blood is needed for the same patient within a short period, use the same identifers, as on the frst request form and blood sample, so Blood Bank staff will know it is the same patient.
  1. Do not ask for ‘crossmatched blood’ in an emergency. Ask the Blood Bank to supply what can be provided most quickly with reasonable safety according to the local policy. For girls and women of child bearing age, RhD negative red cells should be used until the RhD type is known.
  1. Make sure that the Blood Bank staff know
    • who is going to take the blood to the clinical area
    • where the blood should be delivered to, for example, if the patient is about to be transferred to another part of the hospital for an X-ray.