This protocol is designed to supplement the existing Trust blood transfusion policy for both adults and paediatric patients which should continue to be followed alongside this guideline.

This guideline is for use by hospitals within the Berkshire and Surrey Pathology Network which includes Frimley Health Trust hospitals, Ashford and St Peters Hospitals (ASPH),

Royal Surrey (RS) and Royal Berkshire Hospital (RBH) and Surrey and Sussex Hospitals only. Any use outside these locations will not be supported by the Trust and will be at the risk of the individual using it.

This protocol should only be used for specific patient groups, who have been identified as a candidate for a one hour per unit red blood cell transfusion, by their Haematology or Paediatric consultant. The candidate’s suitability assessment should be completed prior to the one-hour transfusion plan being commenced. This should be documented in the electronic patient record (EPR)

The patient’s suitability for this protocol should be reviewed regularly, e.g., at each clinic review appointment with their consultant and recorded in the patients notes.

The maximum number of red blood cell units transfused during one session using this protocol is three. Any additional units should be transfused at the 2 or 3 hourly rate (note that prescription of more than 3 units in one session would be exceptionally unusual practice).

• Patients with Haemoglobinopathies or congenital red cell disorders.

• Transfusion dependent patients with marrow failure due to acquired haematological disease.

• Patients requiring supportive care transfusion whilst undergoing cancer therapies

(Conditions that would exclude the above patient groups from a 1 hour per red cell unit transfusion):

• Prior history of a moderate or severe transfusion reaction including transfusion associated circulatory overload.

• Previous history of heart failure or fluid overload

• Significant renal impairment – eGFR <50

• Body weight below 50Kg

• Abnormal Albumin

Ensure the patient/person with parental responsibility has given verbal consent for transfusion and this has been documented in the relevant part of the patient’s notes and care pathway/care plan where one is in use.

Check the suitability assessment has been completed and the patient still meets the requirements of the plan. Check baseline blood tests (FBC, Ferritin, U&E’s, LFT’s, Albumin) have been completed and assessed by a competent clinician within the time frame of one month. If outside these limits this should be repeated before transfusion commences.

• Check patient’s weight - this should be re-checked at 6 monthly intervals and documented in the relevant part of the patients notes.

Check the patient’s vital signs (BP, PR, RR, saturations, and temperature) as per trust transfusion policy and document in the relevant part of the patient’s notes and care pathway/care plan where one is in use.

• Check if the patient requires any pre-medications prior to the commencement of the transfusion

• Ensure positive patient identification has been completed, and the unit has been checked by two trained and competent practitioners in accordance with the trust transfusion policy

• Ask the patient about previous/current signs and symptoms of fluid overload, such as a tight chest, breathlessness, swelling of the legs/ankles

• Review the patient’s previous experience; was the 1 hour per unit transfusion protocol beneficial?

For each unit of red blood cells, give the blood at the rate of a 2-hourly transfusion for the first 15 minutes of the transfusion.

1. Check the vital signs 15 minutes after the transfusion starts.

2. If the vital signs are stable and the patient feels well proceed to give the remainder of the blood over 45 minutes, performing additional observations as indicated/per transfusion policy

3. Repeat this procedure (steps 1-3) for each unit of red blood cells given.

4. The transfusion rate should be slowed down to a 2-3 hourly rate and the patient should be reviewed by a doctor, outreach team or Haematology specialist/clinical nurse practitioner if:

• The patient’s BP increases to > 140/90 or 30mmHg above or below baseline

• The pulse rate increases to > 100 bpm or 20 above or below baseline

• The patient’s respiratory rate 20 or above and/or the oxygen saturations fall to 94% or below

• The patient reports feeling unwell or breathless even if the vital signs are within normal limits.

A NEWS call should be triggered according to the NEWS trigger thresholds.

• Check and review the vital signs post transfusion and then as clinically indicated.

• Ask the patient about signs and symptoms of fluid overload, such as a tight chest, breathlessness, swelling of the legs/ankles

• If no concerns, discharge the patient and document how many red blood cell units have been given and the speed at which they were given.

Audied as part of monthly key performance Indicators.

• United Kingdom Thalassaemia Society (UKTS) (2016) Standards for the clinical care of children and adults with thalassaemia in the UK. 3rd edn. Available at: https://ukts.org/3d-flip-book/standards/.

• Sinclair, A., Trompeter, S. and Al-Khafeji, Z. (2013) ‘Speed of transfusions in thalassaemia major’, Abstracts of the 53rd Annual Scientific Meeting of the British Society for Haematology. April 15-17, 2013. Liverpool, United Kingdom. doi.org/10.1111/bjh.12263.

This guideline has been registered with the Trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt, contact a senior colleague or expert. Caution is advised when using guidelines after the review date.

This guideline is for use in Frimley Health NHS Foundation Trust hospitals only. Any use outside this location will not be supported by the Trust and will be at the risk of the individual using it.

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