Transfusion Laboratory Practice: Routine Haematology Tests and Pre-Transfusion Testing (HLS052)

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Transfusion Laboratory Practice: Routine Haematology Tests and Pre-Transfusion Testing (HLS052)

Module Objective

By the end of the training period with respect to routine haematology tests and pre-transfusion testing, the trainee will be able to:

  • analyse, synthesise, critically evaluate and apply knowledge
  • perform a range of technical procedures and clinical skills
  • demonstrate the attitudes and behaviours necessary for professional practice as a consultant clinical scientist dealing with the complexities, uncertainties and tensions of professional practice at this level

By the end of the training period the trainee will be able to demonstrate the ability to analyse, critically evaluate and synthesise relevant knowledge and its application to their professional practice in relation to:

  • routine haematology tests including:
    • the full blood count
    • reticulocyte count
    • erythrocyte sedimentation rate
    • blood film examination
    • clotting screen
    • management of anticoagulant dosage
    • haemoglobinopathy screening
    • bone marrow examination
  • standards and guidelines for pre-transfusion testing
  • the acquisition and interpretation of historical clinical and laboratory observations
  • criteria for acceptable patient identification, sample labelling, sample condition and timing of samples in relation to requests for components
  • the particular issues and risks associated with neonatal samples including patient identification, twins and other multiple births, small samples and test prioritisation
  • laboratory protocols for:
    • routine blood group and antibody screening
    • detection of red cell alloantibodies in complex cases
    • selection and use of reagent cell panels for confirmation of specificity and exclusion of further antibodies
    • crossmatching in addition to ABO and RhD typing of patient and donation
    • IAT to confirm compatibility
    • documentation of tests and labelling of units
    • system and patient criteria for electronic issue of unitthe significance of a positive DAT
  • minimum testing required before issue of group-specific blood in urgent
  • the selection of safe and appropriate components in emergencies
  • the investigation of acute and delayed haemolytic transfusion reaction
  • the differentiation between delayed haemolytic transfusion reaction and delayed serological transfusion reactions
  • the identification and exclusion of underlying alloantibodies in cases of autoimmune haemolytic anaemia
  • the investigation of neonatal and paediatric samples, including cases of HDFN
  • the significance of a positive DAT

By the end of the training period the trainee will be able to demonstrate a critical understanding of current relevant research, theory and knowledge and its application to the performance of the following technical procedures and laboratory skills and will be able to:

  • perform and master a range of routine haematology tests
  • formulate and evaluate testing algorithms and protocols in light of a patient’s transfusion history, including the recent transfusion of blood components
  • perform unsupervised the laboratory procedures required to safely and efficiently select and cross-match blood components for individual patients including:
    • ABO and RhD phenotyping recognising anomalous results
    • extended red cell phenotyping through direct and indirect haemagglutination, including samples positive by the DAT
    • red cell antibody screening and identification including the use of the IAT
    • the selection and use of procedures to identify and exclude antibody specificities
    • the selection of appropriate controls for tests above
    • the analysis and interpretation of results of blood grouping tests, antibody screening and identification tests, and the DAT
    • the identification of suitable units for crossmatching
    • the performance of crossmatching
    • the proper completion of all documentation for safe laboratory practice and
    • the assessment and resolution of technical issues and anomalies
    • the identification and assessment of potential risks including inadequately completed or non-corresponding request forms and sample labels
    • the identification of patients suitable for electronic issue of units
    • performance of a range of flow cytometric procedures including analysis of cell subpopulations and quantitation of cell-bound immunoglobulins
  • formulate diagnostic approaches for individual patients with an adverse reaction to blood transfusion
  • evaluate the performance and limitations of auto and allo-adsorption, elution and identification of antibody(s) remaining or eluted

By the end of the training period the trainee will apply a broad knowledge of pre-transfusion testing procedures and demonstrate the clinical skills required to perform under supervision and will be able to:

  • provide routine haematology test results, blood films and/or biopsies for review by a consultant haematologist as appropriate
  • assess donor/recipient compatibility for blood transfusion including the interpretation of the clinical significance of incompatibilities
  • provide clinical advice on the significance of test results
  • identify patients at risk of developing red cell antibodies
  • identify patients with special transfusion requirements
  • share patient data with other clinical teams, including through electronic systems adhering to confidentiality and governance regulations
  • provide advice to clinical colleagues on the selection of units for transfusion including where crossmatch compatible rather than antigen negative units would be suitable
  • select safe and appropriate components in an emergency