23/05/2016

ClinicalPracticeGuidelines:BloodProductPrescription

BloodProductPrescription
Indicationsfortransfusions:
RedBloodCells
Platelets
FreshFrozenPlasma
Cryoprecipitate
Pretransfusionassessment
Table:TransfusionVolumesandRates
Managementoftransfusion
Complications
Aftertransfusion
WhenpatientsorfamiliesrefuseabloodproducttransfusionRCHPolicy
Otherresources
Pleasereadinconjunctionwith:

Massivetransfusionandcriticalbleedingprocedure

Bloodtransfusionprocedure

Background
Bloodandbloodproducttransfusionsmayberequiredforacutebloodloss,orforfailureofproduction
suchasbonemarrowsuppression.
Bloodproducttherapyshouldonlybegivenwhentheexpectedbenefitstothepatientarelikelyto
outweighthepotentialhazards.
AllbloodtransfusionactivitywithintheRCHmustoccurincompliancewiththerelevantpolicies(needs
link)andhospitalclinicalguidelines(linkneeded).

IndicationsforTransfusion
Redbloodcells
Platelets
FreshFrozenPlasma
Cryoprecipitate

IndicationsforRedBloodCells
Hb<70g/Lalthoughlowerthresholdsmaybeacceptableinpatientswithoutsymptomsandwhere
specifictherapy(egiron)isavailable.

Transfusionmaybeindicatedathigherthresholdsforspecificsituations:
Hb<70100g/Lduringsurgeryassociatedwithmajorbloodlossorifevidenceofimpairedoxygen

http://www.rch.org.au/clinicalguide/guideline_index/Blood_Product_Prescription/

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ClinicalPracticeGuidelines:BloodProductPrescription

transport
Hb<80g/Lpatientsonachronictransfusionregimenorduringmarrowsuppressivetherapy(for
symptomcontrolandappropriategrowth)
Hb<100g/Lonlyforveryselectpopulations(eg.neonates)

IndicationsforPlatelets
Table1:IndicationsforPlatelettransfusion
ClinicalSituation

IndicationforPlateletTransfusion

Bonemarrowfailure

Plt<10x109/Lifnootherriskfactorsforbleeding(seebelow)
Plt<20x109/Lifriskfactorspresent(fever,antibiotics,haemostaticfailure,riskof
intracranialhaemorrhage)

Surgery/invasive
procedure

Plt<50x109/L.However,highercountsmaybeneededinsurgerywithhighriskof
bleedingeg.neurosurgery

Plateletfunction
Defects

Transfuseifthereisbleedingorhighriskofbleeding,regardlessofactualplatelet
count

Bleeding/Massive
transfusion

MaintainPlt>50x109/Lifthrombocytopaenialikelycontributingtobleeding
MaintainPlt>100x109/Linthepresenceofdiffusemicrovascularbleeding(DIC)
orCNStrauma

IndicationsforFreshFrozenPlasma
FFPisappropriateforthefollowing:
Warfarineffect,inthepresenceoflifethreateningbleedinginadditiontotheuseofvitaminKand
vitaminkdependentclottingfactorconcentratesforbleedingwithabnormalcoagulation
Liverdisease,ifbleedingwithabnormalcoagulation.
AcuteDICwhenthereisbleedingandabnormalcoagulation
Followingmassivetransfusionorcardiacbypassforbleedinginthepresenceofabnormalcoagulation

IndicationsforCryoprecipitate
Cryoprecipitateisindicatedfor:
Fibrinogendeficiency,inthesettingofclinicalbleeding,aninvasiveprocedure,traumaorDIC.

PretransfusionAssessment
1.Theindicationtotransfuse(seeabove)
2.Documentreasonfortransfusionanddiscussionofconsent
3.Collectpretransfusionsample(exceptininfantsonASBTprotocol).
Asampleforcrossmatchingmustbecollectedina1.4mlredEDTAtube(NOTbullettubes).
Patientsknowntohaveredcellantibodiesorhaemolyticanaemiawillrequirealargersample.
Correctlyidentifythepatientduringthecollectionofthepretransfusionsample.Labelin
accordancewithRCHspecimencollectionpolicy.
4.Requesttheappropriatebloodcomponentandspecialrequirements:
Irradiatedbloodproductsshouldbegivento:

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Allimmunocompromisedpatients,includingalloncologypatients,cardiacneonatesand
allpatientsinICU,topreventgraftversushostdisease.
CMVnegativeproducts:
Leucocytedepletedbloodproducts,areconsideredanacceptablealternativetoCMV
seronegativeproductsatRCH
5.Calculate&prescribethetransfusionvolumewithconsiderationtopacksizes
UnstablepatientSeeMassivetransfusionandcriticalbleedingprocedure
Stablepatient(seeTable2below)
6.Prescribethebloodproductandrateofadministrationonthefluidorderchart(seeTable2below)
Alltransfusionsmustbecompletedwithin4hoursofspikingapack.

Table2:Transfusionvolumesandrates
Bloodproduct

Formulafor
calculating
transfusion
volume

Packsizes

Rate

Red
BloodCells

Packedcells
(mls)
=wt(kg)xHb
rise
required(g/L)x
0.4

250300ml/pack

Transfusionwillbestartedataslowerrate(eg.
Halftherate)forthefirst15minutes.Ifno
adverseeffectsoccur,increasethetransfusion
toa24hourlyratedependingonthepatient's
conditionandfluidbalance

5060
ml/Pedipack

(eg.10kg
childrequiring
Hbtorisefrom
60to110g/L:10
x50x
0.4=200ml)
Platelets

520ml/kg
(510ml/kgwill
raiseplatelet
countby50
100x109/L)

Neonatal/
paediatric
<40kgpatients:
Paediatric
(single
donor)
4060
ml
Apheresis
(single
donor)
splitinto
48x40
60ml
packs

http://www.rch.org.au/clinicalguide/guideline_index/Blood_Product_Prescription/

3ml/kg/hrover23hours.
(occasionallyplateletsare
givenover30minutes,but
thismaycontributetoan
increasedriskofsomereactions(fever/chills)
and
fluidoverload)

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Paediatric>
40kgoradult:
Apheresis
(single
donor)
>200ml
orsplit
into2x>
100ml
packs
Pooled
from45
donors
>160ml

FFP

1020ml/Kg

300ml/pack

Startatnomorethan5ml/min.

50ml/pack(for
neonataluse)
Cryoprecipitate

510ml/kg

3040ml/pack

Startatnomorethan5ml/min.

ManagementofTransfusion
AdministerasperBloodtransfusionprocedure
Thekeystepsinclude:
1.Aformalcheckingprocesspriortocommencementoftransfusion
2.Theuseofcorrectequipment(filters,pump,considerationofbloodwarmer)
3.Correcttransfusiondocumentationincludingpatientobservations,startandfinishtimes

Complicationsduringtransfusion:
Themostcommonimmediateadversereactionstotransfusionarefever,chillsandurticaria.
Themostpotentiallysignificantreactionsincludeacutehaemolytictransfusionreactions,bacterial
contaminationofbloodproductsandtransfusionrelatedacutelunginjury.
Duringtheearlystagesofareactionitmaybedifficulttoascertainthecause.
Allsuspectedtransfusionreactionsmustbereportedtotheissuingbloodbankimmediately.Theon
callhaematologistwillcontacttheclinicalareatoprovideadviceregardinginvestigationandongoing
transfusionsupport.

Aftertransfusion:
Documenttheeffectoftransfusiononthepatient'sconditionincludingHbifrepeated.

Otherresources
RCHBloodtransfusionwebsite

http://www.rch.org.au/clinicalguide/guideline_index/Blood_Product_Prescription/

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