Module - Core Transfusion (SLS123)

STP

Aim of this module

This module will provide the trainee with an in-depth knowledge of blood groups and their clinical significance in transfusion medicine. It will also provide the knowledge and skills required to work at a basic level within the transfusion hospital laboratory, operating within regulatory requirements, and providing safe and compatible blood and components for patients.

Work-based learning outcomes


  1. Perform routine pre-transfusion procedures and serological tests, correctly interpret results and investigate anomalies to ensure provision of compatible blood for patients.
  2. Select and issue appropriate blood, components and products for patients with a wide range of clinical conditions, in routine and emergency settings.
  3. Investigate suspected adverse reactions and events according to clinical presentation.
  4. Manage blood stocks, including full traceability and maintenance of the cold chain.
  5. Interpret and comply with national guidelines for transfusion, applicable regulatory requirements (e.g. Blood Safety and Quality Regulations) and quality management systems in the hospital transfusion laboratory.

Work-based Competencies


Learning outcome Title Knowledge
1 1

Apply sample acceptance criteria for samples for pre-transfusion testing.

  • Sample acceptance criteria for transfusion and risks associated with mislabelled samples and incomplete paperwork.
  • Value of linking to historical records.
  • Security afforded by automation and IT, and risks of manual testing and transcription steps in pre-transfusion testing.
  • Specifications, performance characteristics and limitations of reagents used for patient blood grouping, and specific reagent controls required.
  • Principles of routine, manual and automated tests for grouping and antibody screening, and controls required.
  • Principles behind different indirect antiglobulin test (IAT) technologies (e.g. column agglutination, tube, solid phase) and potential sources of error in each.
  • BCSH guidelines for compatibility testing or national equivalent.
  • ABO subgroups (A2, Ax, etc.).
  • Partial D and weak D (especially DVI).
  • Selection of reagents and techniques to investigate ABO/D grouping anomalies.
  • Recognition of mixed field reactions and of the clinical significance of multiple populations of cells.
  • Process for systematic exclusion of clinically significant red cell antibodies, and positive identification of antibodies present.
  • Patient/request criteria for electronic issue.
  • System criteria for electronic issue.
2 1

Perform manual and automated serological tests, with appropriate controls, and recognise discrepant results in:

  • ABO/D typing
  • antibody screening
  • antibody identification
  • serological cross-matching
  • red cell phenotyping.
  • Sample acceptance criteria for transfusion and risks associated with mislabelled samples and incomplete paperwork.
  • Value of linking to historical records.
  • Security afforded by automation and IT, and risks of manual testing and transcription steps in pre-transfusion testing.
  • Specifications, performance characteristics and limitations of reagents used for patient blood grouping, and specific reagent controls required.
  • Principles of routine, manual and automated tests for grouping and antibody screening, and controls required.
  • Principles behind different indirect antiglobulin test (IAT) technologies (e.g. column agglutination, tube, solid phase) and potential sources of error in each.
  • BCSH guidelines for compatibility testing or national equivalent.
  • ABO subgroups (A2, Ax, etc.).
  • Partial D and weak D (especially DVI).
  • Selection of reagents and techniques to investigate ABO/D grouping anomalies.
  • Recognition of mixed field reactions and of the clinical significance of multiple populations of cells.
  • Process for systematic exclusion of clinically significant red cell antibodies, and positive identification of antibodies present.
  • Patient/request criteria for electronic issue.
  • System criteria for electronic issue.
3 1

Select further tests to investigate ABO/D typing anomalies, and to recognise situations where conclusive results cannot be obtained ‘in-house’ and referral for further testing is required.

  • Sample acceptance criteria for transfusion and risks associated with mislabelled samples and incomplete paperwork.
  • Value of linking to historical records.
  • Security afforded by automation and IT, and risks of manual testing and transcription steps in pre-transfusion testing.
  • Specifications, performance characteristics and limitations of reagents used for patient blood grouping, and specific reagent controls required.
  • Principles of routine, manual and automated tests for grouping and antibody screening, and controls required.
  • Principles behind different indirect antiglobulin test (IAT) technologies (e.g. column agglutination, tube, solid phase) and potential sources of error in each.
  • BCSH guidelines for compatibility testing or national equivalent.
  • ABO subgroups (A2, Ax, etc.).
  • Partial D and weak D (especially DVI).
  • Selection of reagents and techniques to investigate ABO/D grouping anomalies.
  • Recognition of mixed field reactions and of the clinical significance of multiple populations of cells.
  • Process for systematic exclusion of clinically significant red cell antibodies, and positive identification of antibodies present.
  • Patient/request criteria for electronic issue.
  • System criteria for electronic issue.
4 1

Interpret the results of simple antibody identification investigations (i.e. single antibody or two antibodies reacting distinctly by different techniques) and recognise cases requiring additional tests or clinical advice.

  • Sample acceptance criteria for transfusion and risks associated with mislabelled samples and incomplete paperwork.
  • Value of linking to historical records.
  • Security afforded by automation and IT, and risks of manual testing and transcription steps in pre-transfusion testing.
  • Specifications, performance characteristics and limitations of reagents used for patient blood grouping, and specific reagent controls required.
  • Principles of routine, manual and automated tests for grouping and antibody screening, and controls required.
  • Principles behind different indirect antiglobulin test (IAT) technologies (e.g. column agglutination, tube, solid phase) and potential sources of error in each.
  • BCSH guidelines for compatibility testing or national equivalent.
  • ABO subgroups (A2, Ax, etc.).
  • Partial D and weak D (especially DVI).
  • Selection of reagents and techniques to investigate ABO/D grouping anomalies.
  • Recognition of mixed field reactions and of the clinical significance of multiple populations of cells.
  • Process for systematic exclusion of clinically significant red cell antibodies, and positive identification of antibodies present.
  • Patient/request criteria for electronic issue.
  • System criteria for electronic issue.
5 1

Perform routine pre-transfusion compatibility testing by serological cross-matching, and apply criteria for use of electronic issue (if used). Interpret results and identify cases requiring additional tests or clinical advice. Complete relevant documentation on paper and using IT systems as appropriate.

  • System criteria for electronic issue.
6 2

Provide safe blood components for patients (if clinically necessary) before a confirmed ABO/D result can be established.

  • Principles of expected values for haematology and tests used to determine the need for blood components.
  • Appropriate use of blood and transfusion triggers.
  • Use of maximum blood ordering schedules.
  • Use of IT to record and check for patient special requirements.
  • Clinical risks where special requirements are not met and value of clinical/transfusion history.
  • Minimum requirements for pre-transfusion testing in emergency situations.
  • Appropriate use and risks associated with ‘flying squad’ group O RhD negative units.
  • Testing and labelling criteria to be met before issuing group-specific blood in an emergency.
  • Value of ‘trauma packs’ and rationale behind ratios of red cells: fresh frozen plasma (FFP): platelets used in major haemorrhage.
  • Thawing of frozen components such as FFP and cryoprecipitate for issue, and understanding of changed storage conditions/expiry once thawed.
  • Reasons why blood components may be visually not fit for use, e.g. haemolysed, lipaemic or bacterially contaminated units.
  • Appropriate actions if a component is rejected for issue.
7 2

Interpret requests for blood, components and products to determine what tests are required before issue.

  • Principles of expected values for haematology and tests used to determine the need for blood components.
  • Appropriate use of blood and transfusion triggers.
  • Use of maximum blood ordering schedules.
  • Use of IT to record and check for patient special requirements.
  • Clinical risks where special requirements are not met and value of clinical/transfusion history.
  • Minimum requirements for pre-transfusion testing in emergency situations.
  • Appropriate use and risks associated with ‘flying squad’ group O RhD negative units.
  • Testing and labelling criteria to be met before issuing group-specific blood in an emergency.
  • Value of ‘trauma packs’ and rationale behind ratios of red cells: fresh frozen plasma (FFP): platelets used in major haemorrhage.
  • Thawing of frozen components such as FFP and cryoprecipitate for issue, and understanding of changed storage conditions/expiry once thawed.
  • Reasons why blood components may be visually not fit for use, e.g. haemolysed, lipaemic or bacterially contaminated units.
  • Appropriate actions if a component is rejected for issue.
8 2

Select, handle and issue blood components with additional specifications including:

  • irradiated
  • HbS negative
  • phenotyped red cells
  • washed components.
  • Principles of expected values for haematology and tests used to determine the need for blood components.
  • Appropriate use of blood and transfusion triggers.
  • Use of maximum blood ordering schedules.
  • Use of IT to record and check for patient special requirements.
  • Clinical risks where special requirements are not met and value of clinical/transfusion history.
  • Minimum requirements for pre-transfusion testing in emergency situations.
  • Appropriate use and risks associated with ‘flying squad’ group O RhD negative units.
  • Testing and labelling criteria to be met before issuing group-specific blood in an emergency.
  • Value of ‘trauma packs’ and rationale behind ratios of red cells: fresh frozen plasma (FFP): platelets used in major haemorrhage.
  • Thawing of frozen components such as FFP and cryoprecipitate for issue, and understanding of changed storage conditions/expiry once thawed.
  • Reasons why blood components may be visually not fit for use, e.g. haemolysed, lipaemic or bacterially contaminated units.
  • Appropriate actions if a component is rejected for issue.
9 2

Select appropriate blood components or product in accordance with patient special requirements, including for the following:

  • Intrauterine transfusion
  • neonates
  • post stem cell transplant (SCT)/ bone marrow transplant (BMT)
  • autoimmune haemolytic anaemia (AIHA)
  • post solid organ transplant
  • sickle cell disease
  • red cell antibodies.
  • Principles of expected values for haematology and tests used to determine the need for blood components.
  • Appropriate use of blood and transfusion triggers.
  • Use of maximum blood ordering schedules.
  • Use of IT to record and check for patient special requirements.
  • Clinical risks where special requirements are not met and value of clinical/transfusion history.
  • Minimum requirements for pre-transfusion testing in emergency situations.
  • Appropriate use and risks associated with ‘flying squad’ group O RhD negative units.
  • Testing and labelling criteria to be met before issuing group-specific blood in an emergency.
  • Value of ‘trauma packs’ and rationale behind ratios of red cells: fresh frozen plasma (FFP): platelets used in major haemorrhage.
  • Thawing of frozen components such as FFP and cryoprecipitate for issue, and understanding of changed storage conditions/expiry once thawed.
  • Reasons why blood components may be visually not fit for use, e.g. haemolysed, lipaemic or bacterially contaminated units.
  • Appropriate actions if a component is rejected for issue.
10 2

Provide safe and effective blood and components for emergency use, and provide transfusion support in cases of major haemorrhage, demonstrating the ability to communicate effectively with all parties involved.

  • Principles of expected values for haematology and tests used to determine the need for blood components.
  • Appropriate use of blood and transfusion triggers.
  • Use of maximum blood ordering schedules.
  • Use of IT to record and check for patient special requirements.
  • Clinical risks where special requirements are not met and value of clinical/transfusion history.
  • Minimum requirements for pre-transfusion testing in emergency situations.
  • Appropriate use and risks associated with ‘flying squad’ group O RhD negative units.
  • Testing and labelling criteria to be met before issuing group-specific blood in an emergency.
  • Value of ‘trauma packs’ and rationale behind ratios of red cells: fresh frozen plasma (FFP): platelets used in major haemorrhage.
  • Thawing of frozen components such as FFP and cryoprecipitate for issue, and understanding of changed storage conditions/expiry once thawed.
  • Reasons why blood components may be visually not fit for use, e.g. haemolysed, lipaemic or bacterially contaminated units.
  • Appropriate actions if a component is rejected for issue.
11 2

Evaluate the requirement for routine blood components, e.g. platelets, FFP, and prepare FFP for issue.

  • Principles of expected values for haematology and tests used to determine the need for blood components.
  • Appropriate use of blood and transfusion triggers.
  • Use of maximum blood ordering schedules.
  • Use of IT to record and check for patient special requirements.
  • Clinical risks where special requirements are not met and value of clinical/transfusion history.
  • Minimum requirements for pre-transfusion testing in emergency situations.
  • Appropriate use and risks associated with ‘flying squad’ group O RhD negative units.
  • Testing and labelling criteria to be met before issuing group-specific blood in an emergency.
  • Value of ‘trauma packs’ and rationale behind ratios of red cells: fresh frozen plasma (FFP): platelets used in major haemorrhage.
  • Thawing of frozen components such as FFP and cryoprecipitate for issue, and understanding of changed storage conditions/expiry once thawed.
  • Reasons why blood components may be visually not fit for use, e.g. haemolysed, lipaemic or bacterially contaminated units.
  • Appropriate actions if a component is rejected for issue.
12 2

Recognise the potential need for specialist components, e.g. cryopecipitate.

  • Principles of expected values for haematology and tests used to determine the need for blood components.
  • Appropriate use of blood and transfusion triggers.
  • Use of maximum blood ordering schedules.
  • Use of IT to record and check for patient special requirements.
  • Clinical risks where special requirements are not met and value of clinical/transfusion history.
  • Minimum requirements for pre-transfusion testing in emergency situations.
  • Appropriate use and risks associated with ‘flying squad’ group O RhD negative units.
  • Testing and labelling criteria to be met before issuing group-specific blood in an emergency.
  • Value of ‘trauma packs’ and rationale behind ratios of red cells: fresh frozen plasma (FFP): platelets used in major haemorrhage.
  • Thawing of frozen components such as FFP and cryoprecipitate for issue, and understanding of changed storage conditions/expiry once thawed.
  • Reasons why blood components may be visually not fit for use, e.g. haemolysed, lipaemic or bacterially contaminated units.
  • Appropriate actions if a component is rejected for issue.
13 2

Visually inspect blood, component or product to ensure it is fit for use. Label and issue via local computer system to ensure full traceability.

  • Principles of expected values for haematology and tests used to determine the need for blood components.
  • Appropriate use of blood and transfusion triggers.
  • Use of maximum blood ordering schedules.
  • Use of IT to record and check for patient special requirements.
  • Clinical risks where special requirements are not met and value of clinical/transfusion history.
  • Minimum requirements for pre-transfusion testing in emergency situations.
  • Appropriate use and risks associated with ‘flying squad’ group O RhD negative units.
  • Testing and labelling criteria to be met before issuing group-specific blood in an emergency.
  • Value of ‘trauma packs’ and rationale behind ratios of red cells: fresh frozen plasma (FFP): platelets used in major haemorrhage.
  • Thawing of frozen components such as FFP and cryoprecipitate for issue, and understanding of changed storage conditions/expiry once thawed.
  • Reasons why blood components may be visually not fit for use, e.g. haemolysed, lipaemic or bacterially contaminated units.
  • Appropriate actions if a component is rejected for issue.
14 3

Respond to the report of a suspected transfusion-related adverse reaction or event according to local protocol. Identify the probable ‘type’ of reaction and refer or perform the appropriate investigations.

  • Process for systematic investigation of a suspected adverse transfusion reaction.
  • Reporting for SHOT and SABRE – how and what to report to each, and in which category.
15 3

Perform repeat serological testing on pre- and post-transfusion samples in cases of suspected haemolytic reactions. Interpret results in clinical context and report to clinical and transfusion specialist staff.

  • Process for systematic investigation of a suspected adverse transfusion reaction.
  • Reporting for SHOT and SABRE – how and what to report to each, and in which category.
16 3

Assist in completion of relevant internal documentation relating to adverse reactions/events and external incident reporting, including:

  • serious adverse blood reactions and events (SABRE)
  • serious hazards of transfusion (SHOT).
  • Process for systematic investigation of a suspected adverse transfusion reaction.
  • Reporting for SHOT and SABRE – how and what to report to each, and in which category.
17 4

Demonstrate compliance with regulations and guidance for the labelling, storage and transport of blood.

  • Safe storage and transport conditions for blood and components.
  • Rules for packaging of blood samples and blood components when being moved within the hospital and between sites.
  • Application of methods for monitoring temperature storage and documenting evidence of continuity of the cold chain.
  • Availability of blood with special requirements and notice required when ordering.
  • Use of online blood ordering systems.
  • Safe transfer of information on blood components to the IT system and use of Electronic Data Interchange (EDI).
  • ISBT 128 coding, or equivalent labelling systems.
  • Local procedures to minimise blood wastage, e.g. ’first in, first out‘ stock control.
18 4

Be able to advise non-laboratory staff on safe collection, transport and administration of blood.

  • Safe storage and transport conditions for blood and components.
  • Rules for packaging of blood samples and blood components when being moved within the hospital and between sites.
  • Application of methods for monitoring temperature storage and documenting evidence of continuity of the cold chain.
  • Availability of blood with special requirements and notice required when ordering.
  • Use of online blood ordering systems.
  • Safe transfer of information on blood components to the IT system and use of Electronic Data Interchange (EDI).
  • ISBT 128 coding, or equivalent labelling systems.
  • Local procedures to minimise blood wastage, e.g. ’first in, first out‘ stock control.
19 4

Participate in ordering of blood and components in routine and urgent situations and for patient with special requirements.

  • Safe storage and transport conditions for blood and components.
  • Rules for packaging of blood samples and blood components when being moved within the hospital and between sites.
  • Application of methods for monitoring temperature storage and documenting evidence of continuity of the cold chain.
  • Availability of blood with special requirements and notice required when ordering.
  • Use of online blood ordering systems.
  • Safe transfer of information on blood components to the IT system and use of Electronic Data Interchange (EDI).
  • ISBT 128 coding, or equivalent labelling systems.
  • Local procedures to minimise blood wastage, e.g. ’first in, first out‘ stock control.
20 4

Manage blood stocks in order to ensure the most efficient use within a hospital setting.

  • Safe storage and transport conditions for blood and components.
  • Rules for packaging of blood samples and blood components when being moved within the hospital and between sites.
  • Application of methods for monitoring temperature storage and documenting evidence of continuity of the cold chain.
  • Availability of blood with special requirements and notice required when ordering.
  • Use of online blood ordering systems.
  • Safe transfer of information on blood components to the IT system and use of Electronic Data Interchange (EDI).
  • ISBT 128 coding, or equivalent labelling systems.
  • Local procedures to minimise blood wastage, e.g. ’first in, first out‘ stock control.
21 4

Assist in collection, analysis and audit of data relating to the use of blood components.

  • Safe storage and transport conditions for blood and components.
  • Rules for packaging of blood samples and blood components when being moved within the hospital and between sites.
  • Application of methods for monitoring temperature storage and documenting evidence of continuity of the cold chain.
  • Availability of blood with special requirements and notice required when ordering.
  • Use of online blood ordering systems.
  • Safe transfer of information on blood components to the IT system and use of Electronic Data Interchange (EDI).
  • ISBT 128 coding, or equivalent labelling systems.
  • Local procedures to minimise blood wastage, e.g. ’first in, first out‘ stock control.
22 5

Apply national guidelines for transfusion practice (e.g. BCSH) relevant to own scope of practice.

  • Practical application of BCSH guidelines, including those for:
    • compatibility procedures in blood transfusion laboratories
    • administration of blood components
    • use of irradiated blood components
    • use of fresh frozen plasma, cryoprecipitate and cryosupernatant
    • neonates and older children
    • use of platelet transfusions
    • clinical use of red cell transfusion
    • management of massive blood loss
    • specification and use of information technology (IT) systems in blood transfusion practice
    • validation and qualification, including change control, for hospital transfusion laboratories.
  • Local compliance with BSQR and MHRA standards.
  • Local application of GMP and GLP or equivalent.
  • Participation in the audit cycle and the value of audit in clinical and laboratory settings.
23 5

Demonstrate compliance with applicable regulatory requirements for transfusion services (e.g. BSQR and successor regulations).

  • Practical application of BCSH guidelines, including those for:
    • compatibility procedures in blood transfusion laboratories
    • administration of blood components
    • use of irradiated blood components
    • use of fresh frozen plasma, cryoprecipitate and cryosupernatant
    • neonates and older children
    • use of platelet transfusions
    • clinical use of red cell transfusion
    • management of massive blood loss
    • specification and use of information technology (IT) systems in blood transfusion practice
    • validation and qualification, including change control, for hospital transfusion laboratories.
  • Local compliance with BSQR and MHRA standards.
  • Local application of GMP and GLP or equivalent.
  • Participation in the audit cycle and the value of audit in clinical and laboratory settings.
24 5

Participate in audit of the departmental quality management system for transfusion services.

  • Practical application of BCSH guidelines, including those for:
    • compatibility procedures in blood transfusion laboratories
    • administration of blood components
    • use of irradiated blood components
    • use of fresh frozen plasma, cryoprecipitate and cryosupernatant
    • neonates and older children
    • use of platelet transfusions
    • clinical use of red cell transfusion
    • management of massive blood loss
    • specification and use of information technology (IT) systems in blood transfusion practice
    • validation and qualification, including change control, for hospital transfusion laboratories.
  • Local compliance with BSQR and MHRA standards.
  • Local application of GMP and GLP or equivalent.
  • Participation in the audit cycle and the value of audit in clinical and laboratory settings.
25 5

Perform and interpret results of internal quality control and external quality assessment relating to patient pre-transfusion testing.

  • Application of IQC and EQA in the laboratory environment.
  • Relevance of EQA reports.
  • Corrective and preventive action required where results of IQC or EQA are not as expected.

Work-based assessment


Complete 2 Case-Based Discussion(s)
Complete 2 of the following DOPS and/or OCEs
Type Title
DOPS Perform appropriately controlled manual ABO and RhD typing antibody screen and crossmatch on a patient sample
DOPS Perform an antibody identification panel by IAT and with enzyme treated red cells
DOPS Book in samples for pretransfusion testing
DOPS Perform manual extended Rh and K phenotyping
DOPS Perform minimum pretransfusion testing required for issue of group compatible blood within 15 minutes
DOPS Prepare a range of blood components for issue including frozen components
DOPS Issue a range components through IT and manual systems
DOPS Perform serological testing associated with a suspected haemolytic transfusion reaction
DOPS Pack blood components for transport to different site
DOPS Order blood and components using online and paper based blood ordering systems
DOPS Display application of GLP in the blood bank environment
DOPS Perform audit required for MHRA Validation
DOPS Communicate to the requesting doctor that a mislabelled sample has been rejected
DOPS Prioritise simulated requests for blood components where supply is limited
OCE Select blood with appropriate group and special requirements for a patients with a range of clinical conditions
OCE Review requests for red cells for a range of patients to assess suitability for electronic issue
OCE Take part in a major incident simulation including blood ordering and provision of blood components
OCE Report an adverse event for a specific patient to SHOT and or SABRE
OCE Simulate of a range of events where collection transport and administration of blood is not straightforward
OCE Formulate corrective and preventive action for a simulated QI where an incorrect blood component has been transfused
OCE Deliver departmental tour for junior doctors nurses members of the public
OCE Assist transfusion practitioner in the investigation of an incident involving blood administration on a ward
OCE Respond to telephone calls real or simulated requesting blood in range of situations
OCE Communicate to the requesting doctor that a mislabelled sample has been rejected