Massive Transfusion

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Martha Jefferson Hospital Laboratory Services 459 Locust Avenue Charlottesville, Virginia 22902 Blood Bank Procedure Manual
Massive Transfusion Principle Massive transfusion is defined as infusion, within a 24 hour period, of a volume of blood approximating the recipient's total blood volume. Past history will not be used to issue type specific "Emergency Release" blood. Issue "O" Positive PRBCs and "AB" Plasma. Following a massive transfusion, the pre-transfusion sample no longer represents the blood currently in the patient's circulation and its use for crossmatching has limited benefit. It is only important to confirm ABO compatibility of units administered subsequently. Switching back: If less than 10 units have been issued, and a pre-transfusion sample is available, issue units that are ABO group specific if inventory allows - notify Pathologist. If greater than 10 units have been issued a post-transfusion sample must be drawn and tested against A1 and/or B cells by the indirect AHG method.

If the result of this testing is negative, group-specific RBCs compatible by immediate spin crossmatch, may be issued. If the result of this testing is positive, transfusion should be continued with RBCs of the previously administered compatible ABO group. If the patient has a positive antibody screen and, due to time or availability, it is impossible to provide antigen-negative RBCs, issue blood on an "Emergency Release" basis until antigen-negative RBCs are available. Notify the Pathologist on call and the patient's Physician immediately. Rh-negative recipients may be transfused with Rh-positive blood. The Pathologist will notify the patient's Physician. The following criteria we use prior to making this decision: Patient does not have, or have a history of, circulating Anti-D. There is no known history of Rh-positive transfusion prior to the current event.

Specimen Requirements EDTA anticoagulated whole blood drawn in a pink top tube from a properly identified patient. Serum and cells drawn in a plain red top tube may be used, if necessary, providing the tube is properly labeled. Reject hemolyzed or improperly labeled specimens. Reagents, Supplies and Equipment Appropriate Blood Grouping Serum 12 x 75 mm test tubes

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Transfer pipets Incubator, 37C (when needed) Immufuge Centrifuge Rh control sera Step-by-step Directions Observe universal precautions for the handling of biohazardous materials when performing this procedure. WEAR GLOVES WHEN HANDLING BODY FLUIDS AND QUALITY CONTROL MATERIALS. If a nurse or doctor calls or comes to the Blood Bank wanting multiple blood products on a patient who is massively bleeding follow these steps (these guidelines are also posted on the Blood Bank bulletin board above workstation #2): Crossmatched PRBCs / FFP / Plts / Cryo

Obtain sticker / record unit number(s) Record nurse's initials and employee number 2 units or less: small cooler with bag of ice (temp indicator required) Greater than 2 units: large cooler with 3 ice packs (up to 6 PRBCs and / or FFP in one cooler) (temp indicator required) Cryo and Plts remain at room temp If requested - give all products that are ready Call Pathologist

No Sample in Blood Bank

Use "O" Positive PRBCs & "AB" Plasma Pull segment and sticker (or record unit number) Put "Uncrossmatched" sticker on each PRBC Record nurse's initials and employee number 2 units or less: small cooler with bag of ice (temp indicator required) Greater than 2 units: large cooler with 3 ice packs (up to 6 PRBCs and / or FFP in one cooler) (temp indicator required) Cryo and Plts remain at room temp If requested - give all products that are ready Call Pathologist "Emergency Request for Uncrossmatched Blood" to Doctor and Nurse for signatures as time permits

Refer to "Emergency Crossmatch Procedure" Interpretation of Test Results 1. No agglutination or hemolysis indicates ABO compatibility. 2. Agglutination or hemolysis indicates ABO incompatibility. Notes

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Never do crossmatch on 2 different patients at the same time. Do all crossmatches singularly, having only 1 patient sample in the rack. FFP or PLTs should not be administered in a fixed ratio to the number of RBC units given.

PLT counts, Fibrinogen level, PT and aPTT should guide the need for PLT transfusion, FFP and CRYO. Example: PLT count <50,000 & Fibrinogen <100 are better predictors of hemorrhage than PT & aPTT.

References AABB Technical Manual, 14th ed., 2002, Chapter 18, pp 390-391; Chapter 21, pp 476-477; Chapter 22, pp. 486-487. UVA "Massive Transfusion Procedure" 10/10/02. AABB Standards for Blood Banks, 25th ed., 2008, 5.17.5., p 50 AABB Technical Manual, 15th Edition, 2005, Chap 18, p 419, Chap 21, p 510-511

Adopted Date Procedure Author

March 2003 Cathy Goodrow, MT(ASCP) Sara Hoffman, MT(ASCP) Nancy N. Lewis, MT(ASCP) Thomas H. Dudley, M.D. R. Hunt MacMillan III, M.D.

Blood Bank Section Leader Director of Laboratories BB Associate Medical Director Blood Bank Medical Director

Documentation of policy/procedure review is filed with the print copy of the applicable manual and located in the respective laboratory department.

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