National Transfusion Record

The National Transfusion Record (NTR) main form is the standard form to be used for the majority of blood component transfusions.

The NTR short form is the form that is available for use ONLY in the following circumstances:

• Your patient having a major haemorrhage and is unable to consent
• You have run out of space to authorise further components during the same patient episode on the NTR main form
• Your patient is on a long-term regular transfusion programme. Use the NTR main form for the initial transfusion episode. The NTR short form can then be used for subsequent transfusions. Consent should be formally renewed if the patient raises any concerns or expresses a wish to review consent, or if new information has become available, for example about the risks of transfusion or any other treatment options. When consent is formally renewed, please start a new NTR main form.

The NTR main form can be found here.

The NTR short form can be found here.

How I order?

The NTR can be ordered via your local Health Board process.

Consent guidance and resources

The pre-transfusion discussion, reason for the transfusion and outcome of each transfusion episode must be documented in the patient’s clinical record.

To access the Guidelines from the expert advisory committee on the Safety of Blood, Tissues and Organs (SaBTO), this can be accessed here.

To access the Consent for Blood Transfusion for Joint UK Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee guidance, which provides information for patients and healthcare practitioners, this can be accessed here.

To access the Patient information leaflets including ‘Receiving a blood transfusion’ and other transfusion information leaflets, this can be accessed here.

Transfusion Associated Circulatory Overload (TACO) guidance and resources

To access the Serious Hazards Of Transfusion (SHOT) TACO definition and TACO risk reduction measures (detailed in), this can be accessed here.

To access the TACO risk assessment tool, this can be accessed here.

The Single Unit Guidance can be accessed here.

Authorisation guidance and resources

Prior to authorising each component, consider:

• Do you need to review or renew consent?
• Has the patient’s TACO risk changed?
• Is the blood component still indicated (consider patient condition)?

To access the NHS, MHRA and UKCA marked blood transfusion Red Cell Dosage Calculator Software App. Please note there is a cost associated to Health Boards that wish to use the Red Cell Calculator. RCC dosage guidance (adults and paediatric) can be found here.

To access the NICE guidline NG 24 ‘Blood Transfusion’ (2015), this can be accessed here.. See section 1.2 for guidance on single unit transfusion approach for non-bleeding patients.

Special Requirements

General guidance regarding special requirements in transfusion can be found here. Please refer to your Board’s transfusion policy.

Administration guidance and resources

To access SHOT pre-administration blood component checking process guidance, this can be accessed here.

Reaction management guidance and resources

To access the British Society for Haematology (BSH) guidance (2023) for investigation and management, this can be accessed here.

Feedback

If you would like to provide feedback on the revised (version 2) of the National Transfusion Record, you can access the survey here.

Red Blood Cell Dosage guidance

Adults

In the absence of active bleeding, use the minimum number of units required to achieve a target Hb.

Transfuse a single unit (or dose) of red cells to alleviate patient symptoms (e.g., dyspnoea, tachycardia, chest pain, hypotension, increased heart rate and decreased oxygen saturation). Remember it may take more than 24 hours for patients to report an improvement in symptoms after a transfusion. Before you consider further transfusions, clinically reassess your patient and check their Hb level after every unit of red cells transfused.

Always consider cardiac comorbidities and risk factors when considering target Hb, in view of the risk of transfusion associated circulatory overload (TACO).

4 mL (RBC) per kg (body weight) will typically give a Hb increment of 10 g/L.

*Total volume of red cells (mL) to transfuse to meet target Hb = target Hb (g/L) – actual Hb (g/L) x [body weight (kg) x 0.4]

*Formula used for RCC dosage calculator can be accessed here.

Children

For babies and children it is important that blood component volumes to be transfused are always calculated as mLs per kg of body weight.

Blood components for children over 16 can be calculated and written according to adult policy (which usually means written in units or bags) unless alternative local guidance exists.

In a non-bleeding infant or child it is important to take into account the pre-transfusion Hb in relation to the transfusion threshold, and it is recommended that a post-transfusion Hb no more than 20 g/L above the threshold be aimed for.

Top-up transfusion: 10-20 mL (RBC) per kg (body weight), (typically 15 mL/kg over 4 hours)

Total volume of red cells (mL) to transfuse to meet target Hb = target Hb (g/L) - actual Hb (g/L) x body weight (kg) x factor* (3 to 5) ÷ 10

*This transfusion formula does not provide a precise prediction of the rise in Hb for a given transfused volume due to variation in the clinical situation and Hct of transfused red cells. Factors between 3 and 5 (divided by 10) have been recommended (see New et al, 2014). It is reasonable to use a factor of 4 (divided by 10) in order to avoid over-transfusion but this should be assessed on an individual patient basis.

Note: the formula has been adapted to the harmonized units for Hb in g/l (previously usually quoted as Hb in g/dl), which requires that the calculation includes a step of division by 10. As this is a change from previous practice, in order to prevent over-transfusion it is recommended that clinicians double-check that the final volume calculated is not more than 20 ml/kg for top-up transfusions.

Guidance based on British Society for Haematology Guideline: Transfusion for fetuses, neonates and older children (2020) can be accessed here.

Reference: New, H.V., Grant-Casey, J., Lowe, D., Kelleher, A., Hennem, S. & Stanworth, S.J. (2014) Red blood cell transfusion practice in children: current status and areas for improvement? A study of the use of red blood cell transfusions in children and infants. Transfusion, 54, 119–127