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S A F E T Y A N D Q U A L I T Y I N AC T I O N
od
mponentThis is a quick reference guide only
Please use your health service policies and procedures, relevant national
and local standards, guidelines and specific product information for
DISCLAIMER
Whilst the material in this flip chart has been carefully prepared by the authors,
it is not tailored to any particular patients circumstances. It may be used as a
rmation
further guidance. guide and is not a substitute for expert opinion in the making of any decisions
Flippin Blood contains most, but not all transfused products. The range of in relation to the clinical indications for blood products, procedures for their
products available in different states/territories and between hospitals may vary. administration and for management of any adverse reactions. It is the intent
The first edition of this publication was prepared by Ms Trudi Verrall and of the authors to provide evidence-based best practice where this exists.
Dr Kathryn Robinson, in conjunction with Mr Ken Davis and other members Readers are encouraged to seek information and advice regarding local
of the South Australian Department of Health funded BloodSafe Program. practices in their own institutions.
It was reviewed by Dr Ben Saxon, Dr Erica Wood and other members of the The authors of the flip chart do not make any express or implied representation
Australian Red Cross Blood Service Transfusion Medicine Team. or warranty in relation to the completeness, accuracy, suitability or currency
This second edition was updated by Mr Russell Hunt, Dr Beverleigh Quested of the information contained in the flip chart. The authors are not liable in
F INFORMATION
and Dr Kathryn Robinson to reflect changes in products and in accordance
with the second edition of the Guidelines for the Administration of Blood
Products (Australian and New Zealand Society of Blood Transfusion and
contract, tort (including negligence) or otherwise, for any direct, indirect, special
or consequential loss or damages in connection with this flip chart, its use, its
contents or any products or services referred to herein. It is intended that this
Royal College of Nursing Australia, 2011). Refer to these guidelines for further document will be updated periodically.
information including a glossary.
Updated information related to blood products in Australia is available at
The members of the BloodSafe Program would like to thank staff from www.transfusion.com.au
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
Contents
BASICS BOTTLES
4 Summary of Changes to Flippin Blood, Second Edition 38 General Information on Recombinant and Fractionated Products
6 General Transfusion Practices and Equipment including Rh(D) Immunoglobulin (Anti-D)
14 Pre-administration Identity Checks of Patient and Blood Product 40 Intravenous Immunoglobulin INTRAGAM P 6%
16 Product Types for Patients with Special Requirements 44 Intravenous Immunoglobulin KIOVIG 10%
48 Intravenous Immunoglobulin OCTAGAM 5% and OCTAGAM 10%
52 Human Albumin ALBUMEX 4 and ALBUMEX 20
BAGS
54 Human Prothrombin Complex Concentrate PROTHROMBINEX-VF
20 Red Cells 56 Coagulation Factor VIII Recombinant and Plasma-derived
24 Platelets 58 Coagulation Factor IX Recombinant and Plasma-derived
28 Fresh Frozen Plasma (FFP), Extended Life Plasma and Cryodepleted Plasma
32 Cryoprecipitate (Cryo)
REACTIONS AND RESOURCES
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
Summary of changes to Flippin Blood, Second Edition
Although many of the significant changes from n Updated guidance related to bedside n Additional information related to fractionated blood
the first edition of Flippin Blood are highlighted checking procedures. products including intramuscular immunoglobulins
below, this list does NOT include all changes n Updated information on typical infusion rates such as Rh(D) immunoglobulin (Anti-D).
made to this second edition. for blood products. n Updated information related to specific product
n Updated information on the 4 hour rule. types for patients with special requirements.
The following changes to Flippin Blood, Second
Blood components SHOULD be infused within n Deletion of information related to specific models
Edition reflect changes to the Australian and New
four hours of leaving controlled storage. of pumps as this should be verified and detailed in
Zealand Society of Blood Transfusion and the Royal
In certain clinical situations such as transfusion health service policies/procedures.
College of Nursing Australia, Guidelines for the
of neonates, where a slow infusion rate is n Updated Resources pages.
Administration of Blood Products, Second Edition
indicated, transfusion MUST be completed within
(2011), Sydney, Australia (www.anzsbt.org.au/ n Use of the International Organization for
four hours of commencement and no longer
publications). For a detailed list of changes and their Standardization hazard severity panels
than four-and-a-half (4) hours following
rationale refer to pages 79 of that document. (ISO-3864-2:2004 [E]):
release of the product from controlled storage.
n Updated information on the process of informed This exception to standard practice must be DANGER indicates a hazard
DANGER
consent and the decision to transfuse. documented in health service policy/procedure. with a high level of risk which, if
For more information see pages 8 and 9 of WARNING not avoided, will result in death
n The duration before changing the blood
Guidelines for the Administration of Blood DANGER or serious injury.
administration set has been increased from CAUTION
Products, Second Edition (2011).
8 to 12 hours, however as individual product WARNING WARNING indicates a hazard
information varies between administration sets, n More extensive directions about the frequency with a medium level of risk
of patient monitoring during transfusion, DANGER
CAUTION
the manufacturers guidelines must be followed. which, if not avoided, could
with the recommendation that the observations WARNING result in death or serious injury.
n A change to the number of units recommended
of temperature, pulse, respiratory rate (TPR)
to be transfused per blood administration set CAUTION CAUTION indicates a hazard
and blood pressure (BP) be recorded at
which was previously 24 red cells, depending with a low level of risk which,
15 minutes after commencement (with the
on urgency. The current edition does not limit the if not avoided, could result in
exception that continuous visual observation
number of units as long as flow is maintained and minor or moderate injury.
in specialist areas with transfusion expertise
the manufacturers recommendations are followed.
may suffice). Patients should still be under
n Changes to the use of bedside leucocyte close observation for up to 30 minutes after
depletion filters due to the introduction of universal commencement of transfusion.
pre-storage leucocyte depletion at the Australian
n Updated reaction management section.
Red Cross Blood Service.
n Updated information on patient identification Other changes to Flippin Blood, Second Edition
requirements in line with national guidelines reflect changes to product availability, transfusion
including the current Australian Commission on practice, and national guidelines and include:
Safety and Quality in Health Care Standards n Updated information to reflect the range of blood
(see Resources on page 67). products currently available in Australia.
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
BASICS
Flippin Blood, Second Edition, June 2012
Decision To transfuse
National Patient Blood Management Guidelines are available covering different
patient groups/settings. For the full guideline and quick reference guide of each
module, as well as updates on the progress of other modules (Medical, Critical
Care, Obstetric, Paediatric and Neonatal), see www.nba.gov.au/guidelines
Standard precautions
Standard Precautions must
be used when administering/
disposing of blood products
(this includes gloves and
eye protection).
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
General Transfusion Practices and Equipment
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
Examples: General Transfusion Practices and Equipment continued
3 7
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
General Transfusion Practices and Equipment continued
BLOOD ADMINISTRATION SETS n Change blood administration set every 12 hours RAPID INFUSION DEVICES
n Blood components must be transfused using an if continuing to transfuse, OR with new IV fluids, n Rapid infusion devices are used to warm and
administration set (blood giving set) approved and with platelets or on completion of transfusion, administer blood rapidly (eg. during critical bleeding/
manufactured for this purpose which incorporates whichever comes first. massive transfusion).
a standard filter (recommended pore size of n Any number of red cell packs may be transfused n Health service policy should outline criteria for use.
170200 microns) to remove clots and debris. during a 12-hour period provided the flow rate n These devices must be operated strictly according
n These MUST be used when administering blood remains adequate. However specific manufacturers
to the manufacturers instructions and health
components such as red cells, platelets, fresh recommendations defining the maximum number
service procedures.
frozen plasma (FFP)/cryodepleted plasma/extended of packs per blood administration set must not
n The detailed use of rapid infusion devices is outside
life plasma and cryoprecipitate. Refer to individual be exceeded.
the scope of this document.
product information for other products such as
fractionated and recombinant products. LEUCOCYTE DEPLETION FILTERS
n When blood components are being administered n All red cells and platelets issued by the Australian
by syringe to small infants or neonates, the blood Red Cross Blood Service are leucocyte depleted
must be drawn into the syringe via an approved and therefore additional bedside leucocyte
blood filter (170200 micron). depletion filters are not required. However, all blood
n Platelets must be transfused through a new blood components still require administration through an
administration set unless administered in the setting approved blood administration set incorporating
of critical bleeding/massive transfusion when a filter (170200 micron) to remove clots and
platelets, plasma and cryoprecipitate may need to clumps of debris.
be transfused through the same administration set. n In rare cases when blood components have
However platelets must not be transfused through been collected within a local health service
a blood administration set which has been used for (eg. autologous units or directed donation) bedside
red cells, as red cell debris may trap the platelets. leucocyte depletion filters may be indicated.
Red cells may follow platelets through the same This must be verified with the provider/local health
blood administration set, but not precede platelets.
service policy. Product information on the correct
n Blood transfusion sets must not be piggy-backed
into other lines.
DANGER
use of these filters must be followed.
n Flushing blood lines with a small amount Stem cell, bone marrow
of 0.9% Sodium Chloride solution (Normal Saline)
WARNING or granulocyte infusions
between red cell packs is not evidence-based and MUST NEVER be infused through a leucocyte
may be unnecessary (however it may be required CAUTION
depletion filter.
to maintain IV access if the next red cell pack is not
readily available). On completion of the transfusion
episode, blood administration sets may be flushed
with 0.9% Sodium Chloride solution (Normal Saline)
using the minimum volume to clear line and ensure
patient receives entire product. Exercise caution in
neonates/paediatric patients or others at risk of fluid
overload refer to health service/unit policy.
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
Examples: General Transfusion Practices and Equipment continued
Syringe drivers
Syringe drivers may be useful
for continuous infusion of
Pumps coagulation factors or for
transfusion in the paediatric
Refer to health service policy for guidance on the use setting (eg. neonates/infants).
of pumps for blood product administration. For red If a syringe driver is used, the
cells and platelets a pump may be used only if the configuration must ensure that
manufacturer has documented evidence that it does blood components pass
not damage the red cells or platelets. See page 11. through an approved blood
filter (170200 micron).
Always maintain aseptic
technique and carefully label
the syringe with correct patient
details if detached from the bag.
Follow health service guidelines
for user-applied labelling.
10
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General Transfusion Practices and Equipment continued
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY 11
11
Examples: General Transfusion Practices and Equipment continued
12
12 Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
General Transfusion Practices and Equipment continued
DANGER
WARNING
MEDICATION The following exception has been shown not to DOCUMENTATION
adversely affect red cells: The following must be documented in the
Medication must NOT be
CAUTION added to the blood pack or
n Co-administration of morphine, pethidine and/or medical record:
ketamine diluted ONLY in Normal Saline solution n Indication for blood product transfusion.
blood administration set prior to, or during the
(0.9% Sodium Chloride) for patient-controlled
transfusion. Medication may interact with the n Consent for blood product transfusion.
analgesia or by continuous side arm infusion,
anticoagulant, additive solutions, or the blood n Blood product prescription.
incorporating a non-reflux valve.
component contained in the bag. A break in n Unique donation/batch number of blood product
n Follow health service policy regarding the
integrity of the infusion line may also increase the (Patient Compatibility Label/Product Label or
risk of bacterial contamination of the component. co-administration of patient-controlled analgesia
Transfusion Report where in use).
and blood products.
n While medication can be administered via a separate n Names and signatures of both staff members
n Further evidence from clinical studies is required
IV access or separate lumen, caution should be checking the blood product.
to inform clinical practice on the safety and efficacy
exercised if the medication is associated with of co-administration of other medications and n Blood product administration start and finish times.
adverse effects or it is the first time it has been blood components. n Patient observations, including occurrence and
given. If a reaction occurs, it is difficult to ascertain management of any adverse reactions.
whether the medication or the blood component COMPLETING THE TRANSFUSION n Volume of product administered.
was responsible for the adverse effect. n Any equipment used (eg. pumps/blood warming
n Adverse effects may manifest after the transfusion
If IV medication needs to be given: has finished. The patient must be advised to report devices including operating temperatures).
n Use another lumen of a multi-lumen central venous any adverse effects experienced after transfusion. n Outcome of the transfusion in terms of
access device if available. n For patients transfused in a day treatment centre, desired effect.
n Use or insert another cannula (eg. continuous drug follow health service guidelines/policy regarding a
administration required). period of continued observation after the transfusion
n Or for medications administered intermittently: is complete in case of a delayed adverse event.
Stop the transfusion. Additional information such as a contact sheet or
Flush the line with 0.9% Sodium Chloride card may be given on discharge to advise patients
solution (Normal Saline) using the injection port how to obtain appropriate clinical advice at any time.
closest to the patient (to clear blood from IV n If there is any suspicion of a transfusion reaction,
port and tubing). Ensure the line is clamped the transfusion service provider must be informed of
above injection port. the clinical details and the product (pack or bottle)
Administer the medication. should be returned.
Flush the line again with 0.9% Sodium Chloride n If the transfusion is completed uneventfully, discard
solution (Normal Saline). the empty pack according to health service policy for
Unclamp the line and restart the transfusion. disposal of clinical waste (or return to the transfusion
Ensure that this manoeuvre does not result in service provider if required by health service policy).
the transfusion exceeding the four hour rule Glass bottles are not suitable for recycling.
(see page 4). n Ensure documentation is complete.
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY 13
13
Examples: Pre-administration Identity Checks of Patient and Blood Product
DANGER
ENSURE RIGHT PATIENT Right Patient full name, date of birth,
WARNING RIGHT BLOOD medical record number.
CAUTION
A final identity check of the patient and blood product Right Blood Product for example, red
AT THE PATIENTS SIDE immediately before blood cells, platelets, FFP, cryoprecipitate and any special
requirements (eg. CMV negative, irradiated etc.). laide
administration is vital to ensure the right blood is given e
Ad
to the right patient. Right Pack compatible blood group of patient EN 5
and donor, identical blood donation number, expiry ITIZ /199
If there are any discrepancies detected during the C /01 33
checking process DO NOT PROCEED contact the date and time not exceeded. 01 3 33
transfusion service provider. 33
DANGER
Blood group compatibility
The blood group on the Blood
WARNING Pack Label MUST be
compatible with the patients blood group as
CAUTION
indicated on the Patient Compatibility Label
attached to the pack. If the blood group of the
blood pack and the patient are not identical,
the transfusion service provider MUST make a
specific comment to indicate that it is compatible
(or the most suitable available). This information may
be contained on the Patient Compatibilty Label or on a
separate sticker (see example above) or both.
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14 Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
Pre-administration Identity Checks of Patient and Blood Product
DANGER
ENSURE RIGHT PATIENT n One of the two people involved in the checking Blood Product Checks:
WARNING RIGHT BLOOD process MUST spike and hang the blood pack/ Blood product type is the same on the prescription,
product immediately after checking. If there is a on the product and the Patient Compatibility Label.
CAUTION
A final identity check of the patient and blood product delay, the checking process MUST be repeated.
AT THE PATIENTS SIDE immediately before blood Special product requirements on the prescription are
met (eg. irradiated, CMV negative).
administration is vital to ensure the right blood is given THE PRE-ADMINISTRATION CHECKS MUST
to the right patient. Blood group and donation number on the Patient
INCLUDE THE FOLLOWING STEPS AT THE
Compatibility Label are identical to that on the
If there are any discrepancies detected during the PATIENTS SIDE:
Pack Label.
checking process DO NOT PROCEED contact the Confirmation of patient identification:
Blood group on the Pack Label is compatible with
transfusion service provider. Check the ID band is securely attached to the the blood group of the patient as indicated on the
patients body. Patient Compatibility Label attached to the pack; if
POSITIVE PATIENT IDENTIFICATION Ask the patient (if conscious and rational) to state not identical, the transfusion service provider MUST
n All patients (inpatients, outpatients, day patients) and spell their family name and given name in full, make a specific comment to indicate it is compatible
MUST be positively identified prior to transfusion and date of birth (whenever possible). If the patient (or most suitable available).
AND have an ID band attached to their body (or is unable to state and spell their name, ask a parent, Pack has not passed its crossmatch expiry or pack
alternative identification) that complies with national guardian or carer (if present and able to do so), to expiry date and time.
guidelines refer to health service policy. verify the patients identity.
Pack has no signs of leakage or damaged
n UNCONFIRMED IDENTITY: When a patients
Ensure that the stated full name and date of birth are packaging, clumping of the contents, evidence of
identity cannot be reliably confirmed, (eg. temporary identical to those on the ID band and confirm correct DANGER
haemolysis, unusual discolouration or turbidity.
or long-term intellectual impairment, inability to spelling of names.
DO NOT proceed if any
communicate or loss of consciousness), he or she Ensure that ALL details on the ID band (full name, WARNING discrepancies are found
must be registered according to the documented date of birth, medical record number) are:
identical to those on the prescription, and during the checking process or there is any
health service procedure as, for example, Unknown CAUTION
concern regarding the integrity of the product
Male or Unknown Female using an emergency identical to those provided on the Patient
Compatibility Label attached to the pack contact the transfusion service provider.
medical record number.
(family and given name, date of birth, and The blood group on the Blood Pack Label MUST
STAFF RESPONSIBILITY medical record number if included). be compatible with the patients blood group
NOTE: The Blood Transfusion Compatibility Report, as indicated on the Patient Compatibility Label
n Two staff members (as per health service policy)
where used, should NOT form part of the final patient attached to the pack. If the blood group of the
MUST undertake the identity checks of the patient
identity check at the patients side, but may be used blood component and the patient are not identical,
and blood product AT THE PATIENTS SIDE (not
to check blood pack information once identity has the transfusion service provider MUST make a
in a remote clinic/treatment room or at the nursing
been established. specific comment to indicate that it is compatible
station) immediately prior to administration. Each of
(or the most suitable available).
these two staff is responsible for the accuracy of the
checking procedure. Although commonly performed
co-operatively, consideration should be given to
independent checking.
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY 15
15
Examples: Product Types for Patients with Special Requirements
Irradiated Stickers
n Irradiated stickers are placed on red cell and platelet packs before irradiation.
n Shown below is an example of an irradiated sticker. Prior to irradiation it has a red area where
the word NOT can be seen. The operator and date areas remain blank. Once the pack has
been irradiated the red area turns black and the sticker will be signed and dated by the operator.
16
16 Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
Product Types for Patients with Special Requirements
DANGER
Special blood product IRRADIATION of cellular blood components (red cells, dependent on the patients CMV status (evidence or not
WARNING requirements MUST be platelets and granulocytes) prevents the proliferation of past infection). If CMV negative blood is not available,
communicated to the transfusion service provider of donor T-lymphocytes in the recipient, the immediate leucocyte depleted blood may be considered as an
CAUTION
as soon as they become known to allow a cause of transfusion-associated graft versus host alternative consult medical officer/transfusion service
record to be made in the laboratory information disease (TA-GVHD). TA-GVHD is usually fatal, so the provider or Australian Red Cross Blood Service.
system. The special requirements MUST also be main aim is prevention. Irradiation of blood components
documented on the prescription each time the is performed at Australian Red Cross Blood Service or WASHED RED CELLS are sometimes required for
product is prescribed. in some health services. Irradiated products are used in use in certain patient groups. Washing removes
certain patient groups with impaired immune function or unwanted plasma (containing plasma proteins, which
SPECIAL REQUIREMENTS in situations where the recipients immune system (even may be the cause of allergic reactions), white cells
if competent) may not recognise the T-lymphocytes and platelets. Some patients with a history of transfusion
n Check patients special requirements against
as foreign (such as when the donation is from a blood reactions, despite receiving leucocyte depleted blood,
health service policy/guidelines. Health services
relative or matched for HLA tissue type). Refer to may benefit from washed red cells. Washed red cells
determine which patient groups will receive special
local guidelines for indications and timeframes: some need to be ordered in advance. Washing will reduce
products based on both guidelines and practical
are indefinite, others are for specific periods. Typical the shelf-life (expiry) of the product. For more
considerations and in consultation with the treating
examples include: intrauterine (including neonates who information on indications for washed red cells
medical officer. For more information contact your
have received an intrauterine transfusion) and exchange see www.transfusion.com.au
health service haematologist/transfusion service
transfusions, recipients of directed donations from
provider or the Australian Red Cross Blood Service HLA (Human Leucocyte Antigen) MATCHED
blood relatives, stem cell and bone marrow transplant
transfusion medicine team in your capital city. platelet transfusions are sometimes required for
recipients, patients with congenital immune deficiencies,
n The prescriber is responsible for documenting
Hodgkin Lymphoma or patients receiving certain types patients with HLA alloimmunisation (antibodies) causing
special requirements; however it is important to be of immunosuppressive drugs (such as purine analogues refractoriness (suboptimal increase in platelet count) to
aware of patient conditions that necessitate them. and related agents, and specific types of antibody random donor platelets. HLA matched platelets need to
Check against health service policy and with the therapy) as well as recipients of granulocyte transfusions be ordered in advance.
treating medical officer/specialist if not prescribed. or HLA-matched platelets. HPA (Human Platelet Antigen) MATCHED platelet
n The staff checking the pack must check for special For more information refer to ANZSBT Guidelines for the transfusions are sometimes required for patients with
requirements on the Prescription, Blood Pack Label, Prevention of Transfusion-Associated Graft-Versus-Host fetomaternal alloimmune thrombocytopenia (FMAIT)
Patient Compatibility Label and Blood Transfusion Disease, 2011 (see Resources on page 67). or post-transfusion purpura (PTP).
Compatibility Report (if used). DANGER
CMV NEGATIVE blood products minimise the risk of
Specialist products can be
LEUCOCYTE DEPLETION of red cells and platelets transfusion-transmitted cytomegalovirus (CMV) which WARNING difficult to source.
removes 99% of the leucocytes which reduces is a common virus typically carried by leucocytes.
Where possible, advance notice of anticipated
the risk of transmission of CMV (see CMV negative) CMV infection may lead to severe or fatal disease in CAUTION
needs should be communicated to the transfusion
and specific types of transfusion reactions (such as immunosuppressed patients. CMV negative products
service/product provider so they can plan
febrile non-haemolytic transfusion reactions and HLA should be considered for use in certain patient groups
ahead. This also applies to patients with red cell
alloimmunisation). All red cells and platelets supplied (eg. patients receiving intrauterine and exchange
antibodies or rare blood groups.
nationally by the Australian Red Cross Blood Service are transfusions, neonates, pregnant women and the
now leucocyte depleted (pre-storage) prior to issue. immunosuppressed including transplant recipients,
haematology and oncology patients). The need may be
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY 17
17
BAGS
Flippin Blood, Second Edition, June 2012
20 Red Cells
24 Platelets
28 Fresh Frozen Plasma (FFP), Extended Life Plasma and Cryodepleted Plasma
32 Cryoprecipitate (Cryo)
Examples: Red Cells
Storage
Red cells MUST be stored in a monitored blood
refrigerator (as per current Australian Standard).
NEVER store blood in a domestic/ward refrigerator.
20
20 Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
Red Cells
DANGER
PRIOR TO COLLECTION OF RED CELL PACK Pre-administration checks at patients DO NOT proceed if any
side MUST include:
WARNING discrepancies are found
n Ensure prescription complete and informed
consent documented. Check ID band is securely attached to patients body. during the checking process or there is any
CAUTION
concern regarding the integrity of the product
n Explain procedure to patient, including symptoms Ask the patient (if conscious and rational) to state
contact the transfusion service provider.
of possible transfusion reactions. and spell their family name and given name in full,
n Ensure IV access patent. and date of birth (whenever possible). If the patient IV BLOOD LINE
n Record baseline observations (TPR and BP) and
is unable to state and spell their name, ask a parent, n Use a new blood administration set
guardian or carer (if present and able to do so), to (with 170200 micron filter).
general patient status including pre-existing rashes.
verify the patients identity. n Blood administration sets must not be
n Ensure circumstances/situation appropriate to
Ensure that the stated full name and date of birth are piggy-backed into other lines.
proceed, including staff availability.
identical to those on the ID band and confirm correct n Change blood administration set every 12 hours if
n Check resuscitation equipment, including oxygen continuing to transfuse, or with new IV fluids, with
spelling of names.
and adrenaline are available and in working order platelet transfusion or on completion of transfusion
Ensure that ALL details on the ID BAND (full name,
and emergency medical support is readily available. of the pack(s), whichever comes first.
date of birth, medical record number) are:
Note: Overnight/out-of-hours transfusion should be identical to those on the PRESCRIPTION, and n One blood administration set may be used for
avoided unless clinically indicated. identical to those provided on the PATIENT administration of multiple packs of red cells provided
COMPATIBILITY LABEL attached to the pack flow rate remains adequate and manufacturers
Always check urgency with the medical officer. If there is
recommendations are not exceeded.
doubtDANGER
DO NOT delay the transfusion. (family and given name, date of birth, and medical
record number if included). COMPATIBLE IV SOLUTIONS
ENSURE RIGHT PATIENT
WARNING RIGHT BLOOD
Blood product type is the same on the prescription, n 0.9% Sodium Chloride solution (Normal Saline),
on the product and the Patient Compatibility Label. albumin 4% or ABO compatible plasma.
CAUTION
n The patients identity MUST always be confirmed Special product requirements on the prescription n The
DANGER
current formulation of GELOFUSINE (available
prior to transfusion. are met (eg. irradiated, CMV negative). in Australia) as stated in the product information.
n The patient MUST be wearing an ID band Blood group and donation number on the WARNINGIV SOLUTIONS
INCOMPATIBLE
(or equivalent as per health service policy) Patient Compatibility Label are identical to that
on the Pack Label. DO NOT infuse with or through a
containing the correct patient details. CAUTION line that has previously contained:
n Two staff members (as per health service policy) Blood group on the red cell pack is compatible with
n Electrolyte and colloid solutions containing any
MUST undertake the identity checks of the the blood group of the patient as indicated on the
calcium (eg. HAEMACCEL, Hartmans solution or
patient and red cell pack AT THE PATIENTS SIDE Patient Compatibility Label attached to the pack; if
lactated Ringers solution or GELAFUSAL [available
immediately prior to administration. Each of these not identical, the transfusion service provider MUST
in New Zealand]) these should not be administered
two staff is responsible for the accuracy of the make a specific comment to indicate it is compatible
with blood components collected in an anticoagulant
checking procedure. Although commonly performed (or most suitable available).
containing citrate as they may cause clotting of the
co-operatively, consideration should be given to Red cell pack has not passed its crossmatch expiry infusion line.
independent checking. or pack expiry date and time. n 5% glucose (dextrose) in water or hypotonic sodium
n One of the two people involved in the checking Red cell pack has no signs of leakage or damaged solutions, as they may cause red cells to haemolyse.
process MUST spike and hang the red cell pack packaging, clumping of the contents, evidence of
immediately after checking. haemolysis, unusual discolouration or turbidity. CONTINUED ON PAGE 23
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY 21
21
Examples: Red Cells continued
Rh(D)
n Red cells should be Rh(D) compatible.
n Rh(D) negative red cells can be given to Rh(D)
positive patients.
Note: In certain circumstances, such as critical bleeding
or in times of low blood stocks, Rh(D) positive red cells
may be issued to Rh(D) negative patients, specifically
men and post-menopausal women (after consultation
with the haematologist/treating medical officer).
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22 Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
Red Cells continued
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY 23
23
Examples: Platelets
Platelets
Platelets are usually a cloudy yellow colour.
Visually inspect pack to ensure:
n Bag intact no leaks including at the ports
and pack seams or evidence of tampering.
n No clots, unusual discolouration or turbidity
which could indicate bacterial contamination.
n Contact and return to the transfusion service
provider if any of the above are detected.
DANGER
Storage
DO NOT refrigerate platelets.
WARNING Refrigeration can render
platelets ineffective.
CAUTION
n Kept at room temperature (200C240C).
24
24 Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
Platelets
DANGER
PRIOR TO COLLECTION OF PLATELET PACK Pre-administration checks at patients DO NOT proceed if any
side MUST include:
WARNING discrepancies are found
n Ensure prescription complete and informed consent
Check ID band is securely attached to patients body. during the checking process or there is any
documented. CAUTION
concern regarding the integrity of the product
n Explain procedure to patient, including symptoms of Ask the patient (if conscious and rational) to state and
contact the transfusion service provider.
possible transfusion reactions. spell their family name and given name in full, and date
n Ensure IV access patent. of birth (whenever possible). If the patient is unable IV BLOOD LINE
to state and spell their name, ask a parent, guardian n Use a NEW blood administration set (with 170200
n Record baseline observations (TPR and BP) and
or carer (if present and able to do so), to verify the micron filter). A blood administration set used for red
general patient status including pre-existing rashes.
patients identity. cells should never be subsequently used for platelets
n Ensure circumstances/situation appropriate to since red cell debris trapped in the filter will trap the
Ensure that the stated full name and date of birth are
proceed, including staff availability. platelets. In the setting of critical bleeding/massive
identical to those on the ID band and confirm correct
n Check resuscitation equipment, including oxygen spelling of names. transfusion, platelets, plasma and cryoprecipitate may
and adrenaline are available and in working order need to be given through the same administration set.
Ensure that ALL details on the ID BAND (full name, n Blood administration sets must not be piggy-backed
and emergency medical support is readily available.
DANGER date of birth, medical record number) are: into other lines.
identical to those on the PRESCRIPTION, and n Change blood administration set every 12 hours
ENSURE RIGHT PATIENT
WARNING RIGHT BLOOD
identical to those provided on the PATIENT (if continuing to transfuse), OR with new IV fluids
COMPATIBILITY LABEL attached to the pack or on completion of transfusion of the pack(s),
CAUTION
n The patients identity MUST always be confirmed
(family and given name, date of birth, and medical whichever comes first.
record number if included).
prior to transfusion.
Blood product type is the same on the prescription, COMPATIBLE IV SOLUTIONS
n The patient MUST be wearing an ID band (or
on the product and the Patient Compatibility Label.
equivalent as per health service policy) containing DANGER
n 0.9% Sodium Chloride solution (Normal Saline).
Special product requirements on the prescription are
the correct patient details.
met (eg. CMV negative, HLA matched).
n Two staff members (as per health service policy) WARNING
INCOMPATIBLE IV SOLUTIONS
Blood group and donation number on the
MUST undertake the identity checks of the DO NOT infuse with or
Patient Compatibility Label are identical to that on CAUTION
patient and platelet pack AT THE PATIENTS SIDE through a line that has
the Pack Label.
immediately prior to administration. Each of these previously contained:
two staff is responsible for the accuracy of the Blood group on the blood pack is compatible with
the blood group of the patient as indicated on the n Electrolyte and colloid solutions containing any
checking procedure. Although commonly performed
Patient Compatibility Label attached to the pack; if not calcium (eg. HAEMACCEL, Hartmans solution
co-operatively, consideration should be given to
identical, the transfusion service provider MUST make or lactated Ringers solution or GELAFUSAL
independent checking.
a specific comment to indicate it is compatible (or [available in New Zealand]) these should not be
n One of the two people involved in the checking administered with blood components collected in
most suitable available).
process MUST spike and hang the platelet pack an anticoagulant containing citrate as they may
immediately after checking. Platelet pack has not passed its pack expiry date
cause clotting of the infusion line.
and time.
Platelet pack has no signs of leakage or damaged
packaging, clumping of the contents, unusual CONTINUED ON PAGE 27
discolouration or turbidity.
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY 25
25
Examples: Platelets continued
26
26 Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
Platelets continued
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY 27
27
Examples: Fresh Frozen Plasma (FFP), *Extended Life Plasma
and **Cryodepleted Plasma
DANGER
WARNING
FFP/cryodepleted plasma/
CAUTION extended life plasma may
have two expiry dates/times one from the time
of freezing and the other from the time of thawing.
Carefully check expiry dates/times on the Pack
Label and Patient Compatibility Label.
Some transfusion service providers will place an
updated expiry label over the expiry date from freezing
as shown in the example on the left.
Some health services have a Blood Transfusion
Compatibility Report which may include expiry date/
Storage
time from thawing. If unsure of expiry date and time
contact the transfusion service provider. FFP/cryodepleted plasma is stored frozen. Some transfusion
service providers keep extended life plasma (thawed FFP) in a
Plasma is separated from whole blood donations or
monitored blood fridge for up to 5 days for use in specific patients.
collected by apheresis. A single apheresis donation
may be divided into up to 3 adult bags, which have
the same donation number and are labelled 1 of 3, Thawing Equipment
2 of 3, 3 of 3, for example. Specialised warming equipment is used for thawing FFP/
Adult plasma bags can also be divided into four small cryodepleted plasma. Thawing should ONLY be performed by the
volume paediatric packs by the Australian Red Cross DANGER
transfusion service provider and typically takes around 30 minutes.
Blood Service or transfusion service provider.
NEVER improvise by using
FFP/Cryodepleted Plasma/ The term kextended life plasma is used for FFP that
WARNING other methods such as
Extended Life Plasma has been thawed and kept in a monitored blood fridge hot water or a microwave as this could damage
by the transfusion service provider for up to 5 days. It is
CAUTION
the product and make it unsafe.
FFP/cryodepleted plasma/extended life
plasma is usually a clear yellow colour not kept by all transfusion service providers, only those
when thawed. where it is considered important to maintain a limited
inventory of pre-thawed plasma which can be provided
Visually inspect pack to ensure:
with minimal delay to specific patients in time-critical or
n Bag intact no leaks including at the ports emergency situations.
and pack seams or evidence of tampering. kkCryodepleted plasma is fresh frozen plasma that
n No clots, unusual discolouration has had the cryoprecipitate component removed. It
or turbidity which could indicate may be indicated for plasma exchange in thrombotic
bacterial contamination. thrombocytopenic purpura (TTP) and can be substituted
n Contact/return to the transfusion service for FFP in some situations such as warfarin reversal.
provider if any of the above are detected.
28
28 Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
Fresh Frozen Plasma (FFP), Extended Life Plasma
and Cryodepleted Plasma
DANGER
PRIOR TO COLLECTION OF THE PACK Pre-administration Checks at Patients DO NOT proceed if any
Side MUST Include:
WARNING discrepancies are found
n Ensure prescription complete and informed
consent documented. Check ID band is securely attached to patients body. during the checking process or there is any
CAUTION
concern regarding the integrity of the product
n Explain procedure to patient, including symptoms Ask the patient (if conscious and rational) to state and
spell their family name and given name in full, and date contact the transfusion service provider.
of possible transfusion reactions.
n Ensure IV access patent.
of birth (whenever possible). If the patient is unable IV BLOOD LINE
to state and spell their name, ask a parent, guardian
n Record baseline observations (TPR and BP) and n Use a new blood administration set (with 170200
or carer (if present and able to do so), to verify the
general patient status including pre-existing rashes. micron filter) unless administered in the setting of
patients identity.
n Ensure circumstances/situation appropriate to
critical bleeding/massive transfusion when platelets
Ensure that the stated full name and date of birth and plasma may need to be given through the same
proceed, including staff availability. are identical to those on the ID band and confirm administration set.
n Check resuscitation equipment, including oxygen correct spelling of names.
n Blood administration sets must not be
and adrenaline are available and in working order Ensure that ALL details on the ID BAND (full name,
and emergency medical support is readily available. piggy-backed into other lines.
date of birth, medical record number) are:
DANGER identical to those on the PRESCRIPTION, and n Change blood administration set every 12 hours
identical to those provided on the PATIENT (if continuing to transfuse), OR with new IV fluids
ENSURE RIGHT PATIENT
WARNING RIGHT BLOOD COMPATIBILITY LABEL attached to the pack or on completion of transfusion of the pack(s),
(family and given name, date of birth, and medical whichever comes first.
CAUTION
n The patients identity MUST always be confirmed record number if included).
COMPATIBLE IV SOLUTIONS
prior to transfusion. Blood product type is the same on the prescription,
n The patient MUST be wearing an ID band
DANGER
n 0.9% Sodium Chloride solution (Normal Saline).
on the product and the Patient Compatibility Label.
(or equivalent as per health service policy) Special product requirements on the prescription
containing the correct patient details.
WARNING
INCOMPATIBLE IV SOLUTIONS
are met.
n Two staff members (as per health service policy) Blood group and donation number on the DO NOT infuse with or
CAUTION through a line that has
MUST undertake the identity checks of the patient Patient Compatibility Label are identical to that on
and pack AT THE PATIENTS SIDE immediately the Pack Label. previously contained:
prior to administration. Each of these two staff Blood group on the blood pack is compatible with n Electrolyte and colloid solutions containing any
is responsible for the accuracy of the checking the blood group of the patient as indicated on the calcium (eg. HAEMACCEL, Hartmans solution
procedure. Although commonly performed co- Patient Compatibility Label attached to the pack; if not or lactated Ringers solution or GELAFUSAL
operatively, consideration should be given to identical, the transfusion service provider MUST make [available in New Zealand]) these should not be
independent checking. a specific comment to indicate it is compatible administered with blood components collected in
n One of the two people involved in the checking (or most suitable available). an anticoagulant containing citrate as they may
process MUST spike and hang the pack Pack has not passed its pack expiry date and time. cause clotting of the infusion line.
immediately after checking. Pack has no signs of leakage or damaged packaging,
clumping of the contents, unusual discolouration CONTINUED ON PAGE 31
or turbidity.
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY 29
29
Examples: Fresh Frozen Plasma (FFP), Extended Life Plasma
and Cryodepleted Plasma continued
ABO
n Plasma should be ABO compatible.
n Plasma compatibility is as follows:
Rh(D)
n Plasma may be transfused without regard to
Rh(D) type.
30
30 Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
Fresh Frozen Plasma (FFP), Extended Life Plasma
and Cryodepleted Plasma continued
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY 31
31
Examples: Cryoprecipitate (Cryo)
Cryoprecipitate Packs
A cryoprecipitate dose in adults usually includes more than one
pack. The volume of each pack and dose may vary. One unit
of cryoprecipitate collected from an apheresis donation is currently
equivalent to approximately 2 units of cryoprecipitate collected
from whole blood donation. For updated information on current
pack sizes/dosing see www.transfusion.com.au or contact the
transfusion service provider.
Cryoprecipitate
Cryoprecipitate is usually a cloudy yellow colour. Storage
Visually inspect pack to ensure: Cryoprecipitate is stored frozen. DO NOT refrigerate once thawed.
n Bag intact no leaks including at the ports and pack
seams or evidence of tampering. Thawing Equipment
n No clots, unusual discolouration or turbidity which
Specialised warming equipment is used for thawing cryoprecipitate.
Thawing should ONLY be performed by the transfusion service provider
could indicate bacterial contamination.
n Contact/return to the transfusion service provider if
DANGER
and typically takes around 1530 minutes.
any of the above are detected. NEVER improvise by using other methods
DANGER WARNING such as hot water or a microwave as this
could damage the product and make it unsafe.
WARNING
Thawed Cryoprecipitate CAUTION
Cryoprecipitate may have
CAUTION two expiry dates/times
one from the time of freezing and the other from
the time of thawing. Carefully check expiry dates/
times on the cryoprecipitate Pack Label and
Patient Compatibility Label.
32
32 Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
Cryoprecipitate (Cryo)
DANGER
PRIOR TO COLLECTION OF CRYOPRECIPITATE Pre-administration Checks at Patients DO NOT proceed if any
PACK(S) Side MUST Include:
WARNING discrepancies are found
n Ensure prescription complete and informed Check ID band is securely attached to patients body. during the checking process or there is any
CAUTION
concern regarding the integrity of the product
consent documented. Ask the patient (if conscious and rational) to state and
contact the transfusion service provider.
n Explain procedure to patient, including symptoms spell their family name and given name in full, and date
of possible transfusion reactions. of birth (whenever possible). If the patient is unable
n Ensure IV access patent. to state and spell their name, ask a parent, guardian IV BLOOD LINE
or carer (if present and able to do so), to verify the n Use a new blood administration set (with 170200
n Record baseline observations (TPR and BP) and
patients identity. micron filter) unless administered in the setting of
general patient status including pre-existing rashes.
Ensure that the stated full name and date of birth are critical bleeding/massive transfusion when platelets,
n Ensure circumstances/situation appropriate to
identical to those on the ID band and confirm correct plasma and cryoprecipitate may need to be given
proceed, including staff availability. through the same administration set.
spelling of names.
n Check resuscitation equipment, including oxygen
Ensure that ALL details on the ID BAND (full name, n Blood administration sets must not be
and adrenaline are available and in working order date of birth, medical record number) are: piggy-backed into other lines.
DANGER
and emergency medical support is readily available. identical to those on the PRESCRIPTION, and n Change blood administration set every 12 hours
ENSURE RIGHT PATIENT identical to those provided on the PATIENT (if continuing to transfuse), OR with new IV fluids
WARNING RIGHT BLOOD COMPATIBILITY LABEL attached to the pack or on completion of transfusion of the pack(s),
(family and given name, date of birth, and medical whichever comes first.
CAUTION
n The patients identity MUST always be confirmed
record number if included).
prior to transfusion. Blood product type is the same on the prescription, COMPATIBLE IV SOLUTIONS
on the product and the Patient Compatibility Label. n 0.9% Sodium Chloride solution (Normal Saline).
n The patient MUST be wearing an ID band DANGER
(or equivalent as per health service policy) Blood group and donation number on the
Patient Compatibility Label are identical to that on
containing the correct patient details.
the Pack Label.
WARNINGIV SOLUTIONS
INCOMPATIBLE
n Two staff members (as per health service policy)
Blood group on the blood pack is compatible with DO NOT infuse with or
MUST undertake the identity checks of the patient CAUTION through a line that has
and cryoprecipitate pack AT THE PATIENTS SIDE the blood group of the patient as indicated on the
Patient Compatibility Label attached to the pack; if not previously contained:
immediately prior to administration. Each of these
two staff is responsible for the accuracy of the identical, the transfusion service provider MUST make n Electrolyte and colloid solutions containing any
checking procedure. Although commonly performed a specific comment to indicate it is compatible (or calcium (eg. HAEMACCEL, Hartmans solution
co-operatively, consideration should be given to most suitable available). or lactated Ringers solution or GELAFUSAL
independent checking. Cryoprecipitate pack has not passed its pack expiry [available in New Zealand]) these should not be
date and time. administered with blood components collected in
n One of the two people involved in the checking
Cryoprecipitate pack has no signs of leakage or an anticoagulant containing citrate as they may
process MUST spike and hang the cryoprecipitate
damaged packaging, clumping of the contents, cause clotting of the infusion line.
pack immediately after checking.
unusual discolouration or turbidity.
CONTINUED ON PAGE 35
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY 33
33
Examples: Cryoprecipitate (Cryo) continued
ABO
n Cryoprecipitate should preferably be
ABO compatible.
n In adults ABO incompatible cryoprecipitate can be
used with caution (particularly with large volumes).
n Cryoprecipitate compatibility is as follows:
Rh(D)
n Cryoprecipitate may be transfused without regard to
Rh(D) type.
34
34 Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
Cryoprecipitate (Cryo) continued
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY 35
35
BOTTLES
Flippin Blood, Second Edition, June 2012
38
38 Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
Bottles General Information
Recombinant Products
Some genetically engineered (recombinant) clotting
factors are now available.
The functions of plasma-derived immunoglobulins have
yet to be replicated by recombinant products.
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY 39
39
Examples: INTRAGAM P 6% Intravenous Immunoglobulin (IVIg)
40
40 Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
INTRAGAM P 6% Intravenous Immunoglobulin (IVIg)
DANGER
DO NOT administer BloodDANGER
Glucose Testing DANGER
ENSURE RIGHT PATIENT RIGHT PRODUCT
WARNING INTRAGAM P 6% using
infusion protocols for ANY other brands of IVIg WARNING Some types of blood glucose
testing systems may falsely WARNING Verify correct patient,
CAUTION
(including OCTAGAM 5%, OCTAGAM 10% and
product (including brand
interpret the maltose contained in and concentration) and prescription.
KIOVIG 10%). ONLY administer INTRAGAMP6% CAUTION
INTRAGAM P 6% as glucose. This may CAUTION
using the infusion rates for this specific n The patients identity MUST always be confirmed
result in falsely elevated glucose readings and,
concentration of INTRAGAM. DO NOT confuse consequently, in the inappropriate administration prior to administration. See page 15.
with INTRAGAM 10 NF (10% IVIg) which may be of insulin. If measurement of blood glucose n Check as per IV medication/health service policy.
available in the future. is required, test prior to the infusion or
measure with a glucose-specific method IV LINE/PUMPS
CONTRAINDICATIONS AND PRECAUTIONS (see product information). n The use of a pump is recommended to ensure
constant delivery of accurate rates.
n Always refer to the full product information.
n A new standard IV line or blood administration set
n Patients with rare total IgA deficiency should
(170200 micron filter) may be used.
have the IVIg product with the lowest IgA content
INTRAGAM P 6% is the preferred product. n Administration from a glass bottle requires a vented
DANGER
system. See page 40.
PRIOR TO ADMINISTRATION
n Correct reversible risk factors for adverse reactions
WARNING IV FLUIDS
MEDICATION/OTHER
(such as dehydration) before infusion is given. DO NOT mix/piggy back this
n Ensure prescription is complete, including the
CAUTION product with other
BRAND and CONCENTRATION of IVIg prescribed. medications or IV fluids.
n Check informed consent is documented as per n Administer via a separate IV line.
health service policy.
n Premedication may be prescribed (eg. for a history
n Explain procedure to patient, including symptoms
of reaction as per treating doctor).
of possible reactions.
n Consider clearing the line with
n Ensure IV access patent.
0.9% Sodium Chloride solution (Normal Saline)
n Record baseline observations (TPR and BP) and
on completion of infusion. See page 9.
general patient status including pre-existing rashes.
n Ensure circumstances/situation appropriate COMPATIBLE IV SOLUTIONS
to proceed.
n IV line can be cleared with 0.9% Sodium Chloride
n Check resuscitation equipment, including oxygen
solution (Normal Saline) or 5% Glucose.
and adrenaline are available and in working order.
n Read the product information in the box.
n Allow the product to reach room temperature.
CONTINUED ON PAGE 43
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY 41
41
Examples: INTRAGAM P 6% Intravenous Immunoglobulin (IVIg) continued
DANGER
DO NOT administer INTRAGAM P 6% INFUSION RATES
WARNING INTRAGAM P 6% using The following example of infusion information is taken from the South Australian BloodSafe Administration Guide.
infusion protocols for ANY other brands of IVIg ALWAYS refer to local health service guidelines/protocols and product information, and seek advice from the
CAUTION
(including OCTAGAM 5%, OCTAGAM 10% and treating doctor.
KIOVIG 10%). ONLY administer INTRAGAMP6% n Start slowly, increase rate gradually only if tolerated.
using the infusion rates for this specific
n If line is primed with 0.9% Sodium Chloride solution (Normal Saline) rather than the product, consider this
concentration of INTRAGAM. DO NOT confuse
volume in timing of rate increases.
with INTRAGAM 10 NF (10% IVIg) which may be
available in the future. PAEDIATRIC Infusion Rates* ADULT Infusion Rates*
NOTE: RATES for paediatric infusions are in mL/kg/hr NOTE: RATES for adult infusions are in mL/hr
(medical officer to calculate use ideal body weight (or mL/min) and are not weight-based.
in obese patients).
1 mL/kg/hr for 1530 minutes 60 mL/hr (1 mL/min) for 15 min (15 mL)
2 mL/kg/hr for 1530 minutes 120 mL/hr (2 mL/min) for 15 min (30 mL)
4 mL/kg/hr thereafter with a maximum rate of 240 mL/hr 240 mL/hr (4 mL/min) until complete
*obese,
In high-risk patients (eg. > 65 years, diabetics,
those with pre-existing or risk factors for
cardiac disease, renal failure or arterial or venous
thromboembolic events, hyperviscosity, paraprotein
or dehydration), consideration should be given
to reducing the rate of infusion. See product
information and consult treating doctor.
n In septic patients or those with multiple risk factors
discuss timing of IVIg administration with an expert.
n During an infusion, subsequent vials may commence
at same rate that the preceding vial finished.
n Each bottle should be completed within 4 hours.
n It is recommended that subsequent infusions are
given according to the same protocol (consult
treating doctor if there has been a change in health
status or reaction to a previous infusion).
42
42 Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
INTRAGAM P 6% Intravenous Immunoglobulin (IVIg) continued
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY 43
43
Examples: KIOVIG 10% Intravenous Immunoglobulin (IVIg)
44
44 Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
KIOVIG 10% Intravenous Immunoglobulin (IVIg)
DANGER
WARNING
DO NOT administer DANGER
ENSURE RIGHT PATIENT RIGHT PRODUCT
KIOVIG 10% using
Verify correct patient,
infusion protocols for any other concentrations
CAUTION WARNING product (including brand
or brands of IVIg (including OCTAGAM 10%,
and concentration) and prescription.
OCTAGAM 5% and INTRAGAM P 6%). CAUTION
n The patients identity MUST always be confirmed
CONTRAINDICATIONS AND PRECAUTIONS prior to administration. See page 15.
n Always refer to the full product information. DANGER
n Check as per IV medication/health service policy.
n Patients with rare total IgA deficiency should
have the IVIg product with the lowest IgA content WARNING
IV LINE/PUMPS
INTRAGAM P 6% is the preferred product. DO NOT mix/piggy back
CAUTION this product with other
PRIOR TO ADMINISTRATION medications or IV fluids.
n Correct reversible risk factors for adverse reactions
(such as dehydration) before infusion is given. n The use of a pump is recommended to ensure
constant delivery of accurate rates.
n Ensure prescription is complete, including the
n A new standard IV line or blood administration set
BRAND and CONCENTRATION of IVIg prescribed.
(170200 micron filter) may be used.
n Check informed consent is documented
n Administration from a glass bottle requires
as per health service policy.
a vented system. See page 44.
n Explain procedure to patient, including symptoms
of possible reactions.
MEDICATION/OTHER IV FLUIDS
n Ensure IV access patent.
n Administer via a separate IV line.
n Record baseline observations (TPR and BP) and
n Premedication may be prescribed (eg. for a history
general patient status including pre-existing rashes.
of reaction as per treating doctor).
n Ensure circumstances/situation appropriate
n Consider clearing the line with
to proceed.
0.9% Sodium Chloride solution (Normal Saline)
n Check resuscitation equipment, including oxygen on completion of infusion. See page 9.
and adrenaline are available and in working order.
n Read the product information in the box. COMPATIBLE IV SOLUTIONS
n Allow the product to reach room temperature. n IV line can be cleared with 0.9% Sodium Chloride
solution (Normal Saline) or 5% Glucose.
CONTINUED ON PAGE 47
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY 45
45
Examples: KIOVIG 10% Intravenous Immunoglobulin (IVIg) continued
DANGER
DO NOT administer KIOVIG 10% INFUSION RATES
WARNING KIOVIG 10% using The following example of infusion information is taken from the South Australian BloodSafe Administration Guide.
infusion protocols for any other concentrations ALWAYS refer to local health service guidelines/protocols and product information, and seek advice from
CAUTION
or brands of IVIg (including OCTAGAM 10%, the treating doctor.
OCTAGAM 5% and INTRAGAM P 6%). n Infusion rates should be calculated and prescribed by the treating doctor.
Use ideal body weight to calculate infusion rates in obese patients.
n Start slowly, increase rate gradually only if tolerated.
n If line is primed with 0.9% Sodium Chloride solution (Normal Saline) rather than the product,
consider this volume in timing of rate increases.
Infusion Rates*
NOTE: RATES below are in mL/kg/hr:
*obese,
In high-risk patients (eg. > 65 years, diabetics,
those with pre-existing or risk factors for
n In septic patients or those with multiple risk factors
discuss timing of IVIg administration with an expert.
cardiac disease, renal failure or arterial or venous n During an infusion, subsequent vials may commence
thromboembolic events, hyperviscosity, paraprotein or at same rate that the preceding vial finished.
dehydration), a more conservative maximum rate
n Each bottle should be completed within 4 hours.
of less than 2 mL/kg/hr (maximum 200 mL/hr)
n It is recommended that subsequent infusions are
is recommended. For more information on high risk
patients see product information and consult given according to the same protocol (consult
treating doctor. treating doctor if there has been a change in health
status or reaction to a previous infusion).
46
46 Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
KIOVIG 10% Intravenous Immunoglobulin (IVIg) continued
n Tend to be related to the rate of the infusion and are l hourly once maximum rate is achieved
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY 47
47
Examples: OCTAGAM 5% and OCTAGAM 10%
Intravenous Immunoglobulin (IVIg)
n Removal from remote storage must be documented Administration from Glass Bottles
in the register or electronic system for the purposes of Administration from glass bottles requires a vented
tracking as per health service procedures/transfusion system. A vented system can be in the form of a
service provider requirements. vented spike adaptor, a side air vent in an IV line or
n Do not use after the expiry date. an airway needle.
n Store protected from light.
n OCTAGAM 5% and OCTAGAM 10% contain no
Standard IV Line (pictured below, left)
antimicrobial preservative. Use in one patient, on one Some standard IV lines have a side air vent.
occasion only. The side air vent must be open to allow adequate air
n Contact transfusion service/product provider for flow when administering fluid from a glass bottle.
OCTAGAM 5% formulation OCTAGAM 10% formulation advice re handling/return of any unused bottles Vented Spike Adaptor (pictured below,
(not opened). centre and right)
OCTAGAM 5% AND OCTAGAM 10% n Used bottles MUST be discarded in medical waste The vented spike adaptor provides an efficient and
and are not suitable for recycling. safe vented system. Unlike airway needles there are
OCTAGAM is a human intravenous immunoglobulin (IVIg)
solution for infusion. OCTAGAM 5% is available in 1 g no risks of needle stick injuries or filters becoming
Visually Inspect Product wet and causing inadequate flow rates.
(20 mL) 2.5 g (50 mL), 5 g (100 mL) and 10 g (200 mL) vials.
n OCTAGAM 5% and OCTAGAM 10% should be
OCTAGAM 10% is available in 2 g (20 mL), 5 g (50 mL),
a clear or slightly opalescent, colourless to
10 g (100 mL) and 20 g (200 mL) vials.
pale yellow liquid.
Always read the product information contained in the box n Do not use solutions that are cloudy or have deposits
before commencing. (any sediment or particles) contact the transfusion
Storage service provider.
n OCTAGAM 5% must be refrigerated between 2C to Documentation of
8C (do not freeze) or stored below 25C. Batch Number
n OCTAGAM 10% must be refrigerated between Peel Off Label
2C to 8C (do not freeze). Once removed from n All product batch numbers
refrigeration, it may be stored below 25C for a single must be documented in the
period of 3 months, in which case the product expires patients medical record.
at the end of the 3-month period. Do not return to
n Products have a
refrigeration after storage below 25C.
peel off label with the
n When refrigerated, OCTAGAM 5% and
batch number making
OCTAGAM 10% should be stored in a monitored
documentation easy.
blood fridge (in transfusion service where available).
n The transfusion service
It must not be stored in a domestic/ward refrigerator.
provider may also attach
peel off label(s).
48
48 Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
OCTAGAM 5% and OCTAGAM 10% Intravenous Immunoglobulin (IVIg)
DANGER
DO NOT administer BloodDANGER
Glucose Testing DANGER
ENSURE RIGHT PATIENT RIGHT PRODUCT
WARNING OCTAGAM using infusion Some types of blood glucose
protocols for ANY other brands of IVIg (including WARNING testing systems may falsely WARNING Verify correct patient,
CAUTION
KIOVIG 10% and INTRAGAM P 6%). ONLY
product (including brand
interpret the maltose contained in OCTAGAM5%
and CAUTION
and concentration) and prescription.
administer OCTAGAM using the infusion rates OCTAGAM 10% as glucose. This may CAUTION
specific for the concentration: OCTAGAM 5% and result in falsely elevated glucose readings and, n The patients identity MUST always be confirmed
OCTAGAM 10% have DIFFERENT infusion rates. consequently, in the inappropriate administration prior to administration. See page 15.
of insulin. If measurement of blood glucose n Check as per IV medication/health service policy.
is required, test prior to the infusion or
CONTRAINDICATIONS AND PRECAUTIONS measure with a glucose-specific method IV LINE/PUMPS
n Always refer to the full product information. (see product information).
n The use of a pump is recommended to ensure
n Patients with rare total IgA deficiency should constant delivery of accurate rates.
have the IVIg product with the lowest IgA content
n A new standard IV line or blood administration set
INTRAGAM P 6% is the preferred product.
(170200 micron filter) may be used.
PRIOR TO ADMINISTRATION n Administration from a glass bottle requires
aDANGER
vented system. See page 48.
n Correct reversible risk factors for adverse reactions
(such as dehydration) before infusion is given.
n Ensure prescription is complete, including the
WARNING IV FLUIDS
MEDICATION/OTHER
BRAND and CONCENTRATION of IVIg prescribed. DO NOT mix/piggy back this
CAUTION product with other
n Check informed consent is documented as per
health service policy. medications or IV fluids.
n Explain procedure to patient, including symptoms of n Administer via a separate IV line.
possible reactions.
n Premedication may be prescribed (eg. for a history
n Ensure IV access patent. of reaction as per treating doctor).
n Record baseline observations (TPR and BP) and
n Consider clearing the line with
general patient status including pre-existing rashes.
0.9% Sodium Chloride solution (Normal Saline)
n Ensure circumstances/situation appropriate on completion of infusion. See page 9.
to proceed.
n Check resuscitation equipment, including oxygen COMPATIBLE IV SOLUTIONS
and adrenaline are available and in working order.
n IV line can be cleared with 0.9% Sodium Chloride
n Read the product information in the box. solution (Normal Saline) or 5% Glucose.
n Allow the product to reach room temperature.
CONTINUED ON PAGE 51
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY 49
49
Examples: OCTAGAM 5% and OCTAGAM 10% Intravenous
Immunoglobulin (IVIg) continued
DANGER
DO NOT administer DANGER
OCTAGAM
5% and OCTAGAM 10% INFUSION RATES
WARNING OCTAGAM using infusion
protocols for ANY other brands of IVIg (including WARNING Infusion rates for OCTAGAM5% and OCTAGAM 10% are DIFFERENT.
CAUTION
KIOVIG 10% and INTRAGAM P 6%). ONLY
The following example of infusion information is taken from the South Australian BloodSafe Administration Guide.
administer OCTAGAM using the infusion rates CAUTION
ALWAYS refer to local health service guidelines/protocols and product information, and seek advice from
specific for the concentration: OCTAGAM 5% and
the treating doctor.
OCTAGAM 10% have DIFFERENT infusion rates.
n Infusion rates should be calculated and prescribed by the treating doctor. Use ideal body weight
to calculate infusion rates in obese patients.
n Start slowly, increase rate gradually only if tolerated.
n If line is primed with 0.9% Sodium Chloride solution (Normal Saline) rather than the product,
consider this volume in timing of rate increases.
The routine use of higher rates is not recommended. The routine use of higher rates is not recommended.
*In high risk
patients a more conservative maximum *In high risk patients a more conservative maximum
rate of less than 4 mL/kg/hr (maximum 300 mL/hr) rate of less than 2 mL/kg/hr (maximum 200 mL/hr) is
is recommended. Refer to product information. recommended. Refer to product information.
High risk patients: eg. > 65 years, diabetics, obese, those with pre-existing or risk factors for cardiac disease,
renal failure or arterial or venous thromboembolic events, hyperviscosity, paraprotein or dehydration.
For more information see product information and consult treating doctor.
n In septic patients or those with multiple risk factors discuss timing of IVIg administration with an expert.
n During an infusion, subsequent vials may commence at same rate that the preceding vial finished.
n Each bottle should be completed within 4 hours.
n It is recommended that subsequent infusions are given according to the same protocol (consult treating doctor
if there has been a change in health status or reaction to a previous infusion).
50
50 Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
OCTAGAM 5% and OCTAGAM 10% Intravenous Immunoglobulin (IVIg)
continued
more common in certain patient groups refer to l if the patient experiences new
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY 51
51
Examples: ALBUMEX 4 and ALBUMEX 20 Human Albumin
DANGER
ALBUMEX
Human Albumin Solution
ALBUMEX is available in
WARNING two concentrations,
ALBUMEX 4% and ALBUMEX 20% albumin
whichCAUTION
come in a number of different volume
bottles. Care should be taken to ensure the
correct concentration is administered.
Storage
n ALBUMEX is stored below 30C and should not
be frozen.
n ALBUMEX may be stored in a refrigerator
(however this is not essential if room temperature
is always below 30C).
n Removal from remote storage must be documented
in the register or electronic system for the purposes Documentation of Batch Number
of tracking as per health service procedures/ Peel Off Label
transfusion service provider requirements. n All product batch numbers must be documented
n Do not use after the expiry date. in the patients medical record.
n Store protected from light. n Products have a peel off label with the batch number
n Used bottles MUST be discarded in medical waste making documentation easy.
and are not suitable for recycling. n The transfusion service provider may also attach
peel off label(s).
Visually Inspect Product
n Do not use if product is turbid or cloudy, or contains
any sediment or particles contact the transfusion
service provider.
n ALBUMEX usually has a clear to pale yellow colour
but may occasionally have a green discolouration
due to small amounts of biliverdin, which is normal
and harmless. Biliverdin is a green-coloured
breakdown product of haemoglobin and is carried
by albumin in human plasma.
Product Information
Always read the product information contained in the
box before commencing.
52
52 Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
ALBUMEX 4 and ALBUMEX 20 Human Albumin
DANGER
ALBUMEX Human Albumin IV LINE OBSERVATIONS
WARNING solution is available in two n A new standard IV line or blood administration set n The patients clinical condition will dictate
concentrations, ALBUMEX 4% and ALBUMEX (170200 micron filter) may be used. the frequency of observation.
20%.CAUTION
Care should be taken to ensure the correct
n DO NOT piggy-back into other lines. n Usually TPR and BP are taken before
concentration is administered. Administration of
n Administration from glass bottles requires a vented commencement, hourly throughout the infusion
20% albumin instead of 4% in error could result
system. See page 48. and on completion. Refer to health service policy.
in severe circulatory overload.
n Consider clearing the line with n Patients should be monitored for circulatory overload
0.9% Sodium Chloride solution (Normal Saline) and hypersensitivity to the product.
PRIOR TO ADMINISTRATION on completion of infusion. See page 9. n Accurate fluid balance documentation is important.
n Ensure prescription complete and informed consent
documented as per health service policy. PUMPS REACTIONS
n Explain procedure to patient, including symptoms n A pump can be used to ensure constant delivery of n Adverse reactions to albumin solution are
of possible reactions. DANGER
accurate rates. uncommon and are usually mild and transient.
n Ensure IV access patent. n Symptoms of adverse reactions may include:
n Record baseline observations (TPR and BP).
WARNING IV FLUIDS
MEDICATION/OTHER chills, fever, allergic reactions (hypotension, urticaria,
n Ensure circumstances/situation appropriate Refer to product information skin rash, anaphylaxis), nausea, vomiting and
CAUTION for details of specific increased salivation.
to proceed.
incompatibilities/interactions. n If a reaction does occur stop administration
n Read the product information contained in the box.
immediately, assess vital signs, notify the medical
COMPATIBLE IV SOLUTIONS officer and provide emergency care as required.
DANGER
ENSURE RIGHT PATIENT RIGHT PRODUCT
Inform transfusion service provider/product provider.
n 0.9% Sodium Chloride solution (Normal Saline). DANGER
WARNING Verify correct patient,
product (including Administration of
concentration) and prescription.
TIME OF INFUSION WARNING concentrated Albumin
CAUTION n The infusion rate/time is as ordered by the medical
(ALBUMEX 20) may cause sudden cardiac failure
n The patients identity MUST always be confirmed officer. Refer to specific product information. CAUTION
in some patients due to circulatory overload.
prior to administration. See page 15. n Each bottle should be completed within 4 hours
n Check as per IV medication/health service policy. (follow health service policy).
n An ALBUMEX bottle must only be accessed once
using an aseptic technique.
n If ALBUMEX is drawn into a syringe and
administered via a syringe pump it must be
completed within 4 hours.
n Follow health service guidelines for user-applied
labelling of injectable medicines, fluids and lines.
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY 53
53
Examples: PROTHROMBINEX-VF Human Prothrombin Complex
Product Information
Additional resources are also available such as this Quick
Reference Guide, Mix2Vial How2Use (available through
www.transfusion.com.au).
54
54 Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
PROTHROMBINEX-VF Human Prothrombin Complex
DANGER
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY 55
55
Examples: Coagulation Factor VIII Recombinant and Plasma-derived
Storage
n Refer to individual product information.
n Removal from remote storage must be documented
in the register or electronic system for the purposes
of tracking as per health service procedures/
transfusion service provider requirements.
n Do not use after the expiry date.
56
56 Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
Coagulation Factor VIII Recombinant and Plasma-derived
DANGER
Prescriptions for plasma- n Check previous treatment history with patient/ INFUSION
WARNING derived Factor VIII should carer (ie. current product type and brand used for n Administered IV either as a bolus dose
clearly specify the active entity of the ordered treatment/prophylaxis of bleeds). or continuous infusion.
doseCAUTION
(ie. whether the dose is in Factor VIII units n Explain procedure to patient, including symptoms n DO NOT mix/piggy back this product with other
or in von Willebrand Factor units) as these are of possible reactions. medications or IV fluids/blood products.
present in different amounts and confusion can n Bolus dose administration refer to individual product
n Read the product information contained in the box.
lead to the wrong dose being given. information for appropriate rate.
n Refer to Haemophilia Treatment Centre (HTC)/health
n Continuous infusion administered via an infusion
FACTOR VIII (ANTI-HAEMOPHILIC FACTOR) service procedures prior to proceeding.
device. Prime line with product. Refer to HTC/health
Factor VIII (anti-haemophilic factor) is a coagulation service procedures. Rate as specified by prescribing
factor concentrate used in the treatment of traumatic
DANGER
ENSURE RIGHT PATIENT RIGHT PRODUCT medical officer.
and spontaneous bleeds, perioperative management Verify correct patient, n Follow health service guidelines for user-applied
and prevention (prophylaxis) of bleeding in patients with WARNING product (including brand labelling of injectable medicines, fluids and lines.
Haemophilia A (Factor VIII deficiency). and strength) and prescription.
n Factor VIII is available as a recombinant or
CAUTION OBSERVATIONS
n The patients identity MUST always be confirmed
plasma-derived product. n Bolus doses are administered under constant visual
prior to administration. See page 15.
n Recombinant Factor VIII is now the preferred observation. Refer to HTC/health service procedures.
DANGER
n Check as per IV medication/health service policy.
n Observe for signs of an adverse reaction
product for Haemophilia A and there are several
different brands available. There may be occasional and tissue infiltration.
patients who have chosen or need to remain on the
WARNING
RECONSTITUTION
plasma-derived product. For instructions on REACTIONS
CAUTION reconstitution/filtration, n Symptoms may include: skin rash, itching,
VON WILLEBRAND FACTOR refer to the individual product information and tightness in throat or chest, shortness of breath,
Plasma-derived Factor VIII contains von Willebrand any other support materials accompanying the chest pain or wheezing.
Factor and is used to treat patients with von Willebrand product. n If a reaction does occur stop administration
Disorder. The current Australian product is BIOSTATE n Failure to reconstitute correctly may result in vacuum
immediately, assess vital signs, notify the medical
which contains Factor VIII and von Willebrand Factor in officer, and provide emergency care as required. Inform
loss or incomplete dissolution of the product.
a 1:2 ratio. Prescriptions should therefore specify the transfusion service provider/product provider.
n DO NOT shake vial/syringe once mixed with diluent.
active entity of the ordered dose (ie. Factor VIII units or n A filter may be incorporated in the reconstitution
von Willebrand Factor units), otherwise the prescribed UPON COMPLETION
device or butterfly infusion set accompanying the
dose should be clarified. n When IV is removed, apply pressure to site until
product. Check the product information for filter
bleeding has completely resolved.
type, location and correct use. If the filter provided
PRIOR TO ADMINISTRATION n Used bottles MUST be discarded in medical waste and
is contained in the butterfly infusion set, but it is not
are not suitable for recycling.
n Verify that the prescription is complete, being used to administer the product, refer to the
including clearly stating the type of Factor VIII product information and any accompanying support A range of guidelines for use of coagulation factors and
(eg. recombinant or plasma-derived and the brand). management of haemophilia and other bleeding disorders
materials for instructions re filtration or contact
(Australian Haemophilia Centre Directors Organisation), are
n Ensure informed consent documented the transfusion service/product provider or HTC
available at www.ahcdo.org.au/publications
as per health service policy. for advice.
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY 57
57
Examples: Coagulation Factor IX Recombinant and Plasma-derived
Product Information
Always read the product information contained
in the box before commencing.
58
58 Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
Coagulation Factor IX Recombinant and Plasma-derived
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY 59
59
REACTIONS
AND
RESOURCES
Flippin Blood, Second Edition, June 2012
66 Useful Resources
Steps in the Management of Suspected Transfusion Reactions*
*NOTE: This is a guide only follow health service procedures/guidelines. Clinical management must be tailored to the patients specific
situation in consultation with medical staff and the transfusion service provider/haematologist/transfusion medicine specialist.
n Each blood product transfused carries a small risk of an acute or delayed adverse effect.
n It is important to RECOGNISE, RESPOND to, and REPORT adverse events.
n Speed is essential because of the possible life-threatening nature of acute transfusion reactions.
n The most common immediate features of a transfusion reaction are fever, chills and urticaria. During the early stages of a reaction it may be difficult to ascertain the
cause. The most serious reactions include acute and delayed haemolytic transfusion reactions, bacterial contamination of blood packs, anaphylaxis, transfusion-related
acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO). See pages 6365 for more information.
62
62 Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
Types of Acute Transfusion Reactions*
*NOTE: This is a guide only follow health service procedures/guidelines. Clinical management must be tailored to the patients specific
situation in consultation with medical staff and the transfusion service provider/haematologist/transfusion medicine specialist.
Features of allergy/anaphylaxis: STOP transfusion. Follow steps on opposite page and see page 65 for more information.
flushing, wheezing, dyspnoea, nausea, Adrenaline
DANGER and/or steroids may be indicated Follow health service anaphylaxis guidelines/protocols and seek expert advice.
Severe Allergic
vomiting, chest/abdominal pain, WARNING May become medical emergency; support blood pressure and maintain open airway. Consult a
angioedema, urticaria, hypotension. haematologist/transfusion
CAUTION medicine specialist/transfusion service provider.
STOP transfusion. Follow steps on opposite page and see page 65 for more information.
Unexpected fever (eg. 38C or 1C Mild febrile reactions usually respond to antipyretics avoid aspirin in thrombocytopenic and paediatric patients. Rule out a septic
Febrile above baseline, if baseline 37C), reaction,
DANGER haemolytic reaction and TRALI.
may be accompanied by chills, rigors.
WARNING Fever alone may be the first manifestation of a life threatening reaction (see reactions below).
CAUTION
STOP transfusion. Follow steps on opposite page and see page 65 for more information.
Fever, chills, rigors, nausea, vomiting, Administer
DANGER broad spectrum antibiotic coverage after obtaining blood cultures from the patient. Seek expert advice.
hypotension, tachycardia, dyspnoea,
Septic Reaction WARNING May become medical emergency; support blood pressure. Send pack to the transfusion service provider for
bleeding due to disseminated
intravascular coagulation (DIC). urgent culture and Gram stain. Notify transfusion service provider to contact Australian Red Cross Blood Service urgently
CAUTION
to ensure quarantine and testing of related components from the same donation/donor.
Rigors, fever, flank or IV site pain, STOP transfusion. Follow steps on opposite page and see page 65 for more information.
tachycardia, dyspnoea, hypotension, Induce diuresis with fluids and diuretics. Seek expert advice.
Acute DANGER
bleeding due to disseminated
Haemolytic WARNING May become a medical emergency; support blood pressure and maintain open airway. DO NOT administer
intravascular coagulation (DIC), oliguria,
haemoglobinuria, haemoglobinaemia. additional
CAUTION packs until advised safe by the haematologist/transfusion medicine specialist/transfusion service provider.
STOP transfusion. Follow steps on opposite page and see page 65 for more information.
Transfusion- Dyspnoea, respiratory failure, Administer
DANGER supplemental oxygen and employ ventilation support as necessary. Seek expert advice.
Related Acute noncardiogenic pulmonary oedema,
WARNING May become medical emergency; support respiratory function and blood pressure. Notify transfusion service
Lung Injury may be accompanied by hypotension,
(TRALI) chills, fever. provider
CAUTIONto contact Australian Red Cross Blood Service to ensure quarantine and testing of related components from the
same donation/donor.
Transfusion- Symptoms and signs of acute left STOP transfusion. Follow steps on opposite page and see page 65 for more information.
Associated ventricular failure (eg. dyspnoea, Consider TRALI (see above). Position patient upright. Administer standard medical treatment for acute left ventricular failure
Circulatory tachypnoea, tachycardia, raised jugular (eg.DANGER
oxygen and diuretics).
Overload (TACO) venous pressure, basal lung crackles). WARNING Circulatory overload from transfusion may be life-threatening.
CAUTION
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY 63
63
Transfusion Reactions and Other Transfusion-Related Adverse Events
*NOTE: The following information is taken directly from the Australian and New Zealand Society of Blood Transfusion and the Royal College of Nursing Australia,
Guidelines for the Administration of Blood Products, Second Edition (2011), Sydney, Australia (www.anzsbt.org.au/publications).
n Transfusion reactions or other transfusion-related n In an unconscious or anaesthetised patient, n All adverse events related to blood product
adverse events can be associated with significant hypotension and uncontrolled bleeding may be administration must be reported to the local hospital
morbidity and, rarely, with mortality. the only signs of an acute haemolytic transfusion transfusion service provider as well as the
n Many of the serious adverse events following reaction. Australian Red Cross Blood Service or manufacturer
blood transfusion are unpredictable. n Adverse events related to patient identification DANGER
where appropriate.
n A severe haemolytic or septic transfusion reaction errors are the most common cause of preventable If a reaction is a result of a
can occur within a few minutes of infusing even a harm related to transfusion. WARNING suspected ABO mismatch or
small volume of blood. bacterial contamination, the transfusion service
REPORTING OF TRANSFUSION REACTIONS CAUTION
provider must be notified IMMEDIATELY as there
n It is essential to RECOGNISE, REACT and
OR OTHER TRANSFUSION-RELATED ADVERSE may be implications for other patients or products.
REPORT suspected adverse events.
EVENTS
n The most important events include: n Suspected cases of other TTI should be reported
n Some health departments mandate reporting
l Acute and delayed haemolytic transfusion immediately to the transfusion service provider who
reactions of sentinel events related to transfusion,
will notify the product manufacturer or distributor
l Febrile (non-haemolytic) transfusion reactions
eg. acute haemolytic reactions such as due to
(eg. the Australian Red Cross Blood Service,
l Allergy and anaphylaxis (including IgA/anti-IgA
ABO-incompatibility. Similarly it may be necessary
or other supplier).
reactions) to report adverse events particularly those
n Serious near misses and adverse events related to
l Transfusion-related acute lung injury (TRALI)
associated with plasma-derived blood products
blood transfusion, including incorrect blood product
l Transfusion-associated circulatory overload
or recombinant products to the national medicines
transfused, acute and delayed transfusion reactions
(TACO) regulatory agency ie. the Therapeutic Goods
(including anaphylaxis, TA-GVHD, TRALI, PTP) must
l Post-transfusion purpura (PTP)
Administration (TGA) in Australia. In addition, there
be reported to the institutions incident reporting
l Transfusion-associated graft versus host disease
may be voluntary reporting of serious adverse events
system and reviewed by the hospital transfusion
(TA-GVHD) and near misses to a state, territory or national
committee or other defined governance committee.
l Transfusion-transmitted infection (TTI) including
haemovigilance system.
n The reporting and analysis of near miss events is an
sepsis from bacterially contaminated n Irrespective of such a requirement, health services
important aspect of a quality improvement system for
DANGER
blood components. must have a policy and process for recording and blood product therapy.
reviewing adverse events related to blood product
If a transfusion reaction or
WARNING other adverse event is
transfusion, including near misses, which should
take into account:
suspected, other patients may be at risk either l If a moderate or severe reaction is suspected,
CAUTION
because of patient identity error (eg. ABO- the haematologist or transfusion medicine
incompatible transfusion to a second patient) or specialist must be notified for advice on
because other blood components collected from the appropriate clinical intervention and serological
implicated donor may also be affected (eg. in cases investigations.
of bacterially contaminated blood components).
64
64 Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
Management of Possible Transfusion Reactions Based on Severity
*NOTE: The following information is taken directly from the Australian and New Zealand Society of Blood Transfusion and the Royal College of Nursing Australia,
Guidelines for the Administration of Blood Products, Second Edition (2011), Sydney, Australia (www.anzsbt.org.au/publications).
MANAGEMENT OF POSSIBLE TRANSFUSION n If a mild transfusion reaction is suspected: n If a moderate or severe transfusion reaction
REACTIONS l STOP the transfusion. is suspected the following steps MUST
n l Maintain IV access. be undertaken:
The most common adverse transfusion outcome
l Monitor and record the patients temperature, l STOP the transfusion immediately and seek
is a rise in the patients temperature. This may be
due to the transfusion or incidental and as a result pulse, respirations and blood pressure. urgent medical advice; Medical Emergency
ofDANGER
the patients underlying illness. l Repeat all clerical and identity checks of the Team (MET) support may be required
patient and blood pack. depending on the specific clinical situation.
A temperature rise to 38C l Maintain venous access using a new
WARNING or 1C above baseline
l Contact medical staff immediately for further
l Hypotension/shock OR hypertension.
transfusion, will depend on the type and
n The following could be considered signs of a mild
severity of the reaction and results of associated
transfusion reaction: l Tachycardia.
investigations. Further transfusions should not be
l Isolated temperature rise <1.5C above l Tachypnoea, wheeze, stridor.
commenced without the advice or consent of the
baseline without ANY signs of a serious l Rigors or chills.
transfusion service provider/transfusion medicine
reaction (including any of those listed l Nausea, vomiting or pain (local, chest, back).
specialist/consultant haematologist in consultation
under Management of Moderate to
with the managing clinician.
Severe Reactions).
l Localised rash/pruritis.
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY 65
65
Examples: Useful Resources
Australian Red Cross Blood Service Clinical Australian and New Zealand Society of Blood Transfusion
Website www.transfusion.com.au www.anzsbt.org.au
66
66 Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
Useful Resources
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY 67
67
Examples: Useful Resources continued
68
68 Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY
Useful Resources continued
n Clinical Excellence Commission (CEC): C/ Australian Red Cross Blood Service, Australian and New Zealand Society of Blood Transfusion (ANZSBT) and
Transfusion Medicine Services the Royal College of Nursing Australia (RCNA). (2011). Guidelines for the
The transfusion question Administration of Blood Products, Second Edition. Sydney, Australia.
www.thetransfusionquestion.com.au 301 Pirie Street, Adelaide, www.anzsbt.org.au/publications
South Australia 5000 Australia
n iTransfuse Fact Sheets Australian Commission on Safety and Quality in Healthcare (ACSQHC).
www.transfusion.com.au/iTransfuse/fact_sheets Email: bloodsafeflipchart@redcrossblood.org.au (2008). A National Standard for Patient Identification Bands in Australia.
www.safetyandquality.gov.au/our-work/patient-identification/a-national-
Internet: www.health.sa.gov.au/bloodsafe
standard-for-patient-identification-bands-in-australia/
State-Based Transfusion Practice
Australian Red Cross Blood Service clinical website.
Improvement Collaborative Programs www.transfusion.com.au
n South Australian BloodSafe Program Birch, C., Hogan, C., and Mahoney, G. (2001). Co-administration of Drugs
www.health.sa.gov.au/bloodsafe and Blood Products. Anaesthesia and Intensive Care, 29(2):137140.
n Victorian Blood Matters Program British Committee for Standards in Haematology (BCSH). (2009).
www.health.vic.gov.au/bloodmatters Guideline on the Administration of Blood Components. www.bcshguidelines.
com/documents/Admin_blood_components_bcsh_05012010.pdf
n New South Wales Blood Watch Program
Callum, J. L., et al. (2011). Bloody Easy 3 Third Edition: Blood Transfusions,
www.cec.health.nsw.gov.au/programs/blood-watch Blood Alternatives and Transfusion Reactions, A Guide to Transfusion
n Queensland Blood Management Program Medicine. Ontario Regional Blood Coordinating Network, Ontario, Canada.
www.transfusionontario.org/media/HOPE-SUN-BloodyEasy-EN_FINAL-
www.health.qld.gov.au/qhcss/qbmp/default.asp LoRes.pdf
n Western Australian Patient Blood Management
Einsele, H., Northoff, H., and Neumeister, B. (2004). Granulocyte Transfusion.
Program Vox Sanguinis, 87:205208.
www.health.wa.gov.au/bloodmanagement/home Hanan, M., Yousef, R. F., Padmore, D., Neurath, D. and Rock, G. A. (2006).
The Effect of Patient-controlled Analgesia on Co-administered Red Blood
Cells. Transfusion, 46:372376.
Flippin Blood, Second Edition, June 2012 THIS IS A QUICK REFERENCE GUIDE ONLY 69
69