Blood Transfusions & Iron infusions

NBT

Blood transfusions

Blood transfusions may be required in patients with severe anaemia or symptomatic anaemia.

As a guide NBT advise the following:

Requests for blood transfusions should be considered in patients with:

Hb < 70g/l

or

Hb < 80g/l with history of cardiovascular disease or with symptoms e.g. chest pain, breathlessness, hypotension, tachycardia, cardiac failure. (consider discussion with Weekday IUC Professional Line if immediate concerns).

Cross matches should be done within 48 hours of the planned transfusion

Requests for transfusions should be made directly to the day unit (see referral section below) except in the following patients:

Oncology patients requiring transfusion should be discussed with the appropriate oncology team or via the on call oncologist.

Renal patients requiring transfusion should be discussed with the renal team at Southmead hospital.

Iron Infusions

See the Treatment of iron deficiency in adults pathway - BNSSG Formulary.(1) before considering iron infusion. 

Please Note: Iron infusions can lead to complications such as allergic reactions and extravasation injuries. Referrals for IV iron should only be made where oral treatments have been unsuccessful or are not appropriate.

Referral

Referrals for a blood transfusion or iron infusion at NBT should be made via email: MedicalDayCare@nbt.nhs.uk  If advice is required then please call the Day Unit on 0117 4143205 or 0117 414 3206. Please use their proforma and pathway when referring. Referrals sent without a proforma will be rejected.

 Referrals should include:

• Patient contact details.
• The diagnosis/ cause of anaemia.
• Recent FBC and ferritin (within last month).
• List of symptoms and examination findings.

All referrals are triaged and then the patient contacted by the hospital to arrange the infusion.

The Anaemia page  also has details on investigation of anaemia.

UHBW

BRI:

Blood transfusions

Referrals for blood transfusions can be discussed on a case by case basis with the Acute Medicine Consultant (as below).

Requests for blood transfusions in Oncology and Renal patients should be made directly to the Oncology/Renal teams.

Cross matches should be done in primary care within 48 hours of the planned transfusion.

Iron infusions

See the Treatment of iron deficiency in adults pathway - BNSSG Formulary.(1) before considering iron infusion.

Iron infusions can lead to complications such as allergic reactions and extravasation injuries. Referrals for IV iron should only be made where oral treatments have been unsuccessful or are not appropriate.

Indications for IV iron:

1. Demonstrable iron deficiency anaemia:

• Hb <110g/l.
• Microcytic or normocytic anaemia.
• Low ferritin or transferrin saturation

AND

2. An indication for Parenteral iron therapy

• Where oral iron is poorly absorbed e.g. inflammatory bowel disease, malabsorption, short gut syndrome.
• Iron deficiency in the context of significant heart failure.
• Where oral iron results in unacceptable side effects; however, IV iron should not routinely be offered without trial of at least two preparations of oral iron (sulphate, fumarate, gluconate, available in tablet and/or liquid form). Please try feraccru tablets before referring as these are generally better tolerated.
• Where administration of oral iron has proven ineffective; a therapeutic trial of 2 months of oral iron should be offered in the first instance before referring for IV iron. Consider concurrent administration of ascorbic acid to improve absorption.

NB. Contraindications to IV iron therapy: 1^st trimester of pregnancy/previous hypersensitivity to IV iron preparation/non-iron deficiency anaemia/conditions associated with, or evidence of iron overload/Thalassaemia or sickle cell disease/Hepatic impairment/Acute or chronic bacterial infection/Acute Kidney Injury.

Please ensure where the cause of the iron deficiency is not known or already under investigation, that appropriate referrals are being made from primary care. It is not the responsibility of the Acute Medicine department to investigate iron deficiency anaemia in patients referred for iron or blood transfusions.

The Anaemia page also has details on investigation of anaemia.

If the patient is under the Renal team with CKD Stage IIIb or above and iron deficiency anaemia, please contact the Renal Unit at NBT for IV iron treatment. If the patient is already under haematology, please contact them for further assessment and management.

Referral

Where indicated, iron infusions and blood transfusions can be requested from primary care to take place on the Acute Medical Unit on A307 (SDEC). This area is managed and staffed by the Acute Medicine department and it is primarily for the medical take, Same Day Emergency Care (SDEC) and the Acute Medicine Clinic. 

Please e-mail sdecironreferrals@uhbw.nhs.uk with the following information:

• Patient name, date of birth, NHS number and contact number.
• Why the iron is needed – have they tried oral iron and feraccru, etc
• An up-to-date haemoglobin within 2-3 weeks. This is needed for the prescription.
• A reasonably up-to-date weight, this is needed for the prescription.
• Their history of allergy and that at the time of referral they had no contra-indications (see above) and no acute infection. We will check them for signs of infection when they come in.

Blood transfusions will continue to come in during the week and can be organised by discussion with the acute medical consultant on 0117 342 6860 (phone manned Mon-Thurs 09:00 – 19:00, Friday 09:00 – 17:00).

For full information at UHBW - Bristol please see: Blood Transfusions and Iron infusions in Same Day Emergency Care (SDEC) Standard Operating Procedure

WGH:

Referrals for Blood Transfusion & Iron Infusion should be sent by email to the Medical Day Care Unit at MDUWeston@uhbw.nhs.uk

The department can be contacted on tel: 01934 63 63 63 ext: 7931.

Please note that WGH are unable to see patients who need to use a hoist or patients with severe dementia in this service.

Blood transfusions in the Community - North Somerset only

Update 18/07/22 - This service is currently unavailable

Community Blood Transfusions are currently only available to patients registered with a North Somerset GP and are given at Clevedon Community Hospital.

Additionally, for a patient to receive a blood transfusion in the community, the patient should have had:

• At least one transfusion in the acute setting with no severe reactions
• Two previous group and antibody screen tests (UHBristol, WGH or NBT).

How to refer:

The NS Blood Transfusion Patient Specific Direction form is available, in North Somerset GP Practices, as an EMIS template

Please see the GP Referral Protocol

Send referrals to Sirona care & health Single Point of Access (SPA) Email: sirch.northsomersetspa@nhs.net Tel: 0300 125 6789

For referral advice or guidance contact the Sirona care & health IV service on 07500 225 283 / 01275 546 992

or NBT Specialist Practitioner of Transfusion on 07718 575 469 / 0117 414 8358

Resources

(1) Treatment of iron deficiency in adults pathway - BNSSG Formulary.

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