Blood product administration

Safety Transfusion safety

• Starts with a properly labeled pre transfusion specimen
Immediate management of suspected transfusion reaction
Recognise React
Care of transfused patients
• M
 onitor your patient for adverse effects of transfusion,
• M
 ake sure the right patient gets the right blood (always adhere • Fever Stop transfusion (leave IV line in place) then: observe closely during the first 15 minutes
to the bedside pretransfusion check on the back of the Blood • Chills • Provide emergency patient care • R
 ecord vital signs (T, P, RR, BP and O2 saturations also document
Transfusion record) condition of the site being used to transfuse):
• Urticaria (hives) • Arrange immediate medical review
• S
 tart blood products within 30 minutes of issue and complete – before starting
within 4 hours • Hypotension/hypertension • K
 eep IV line open with N/Saline (flush IV cannula
or attach side arm) – 15 minutes after commencement
• T
 he blood transfusion record is a legal document and must be filed • Pain (alone IV site, chest or back)
• Repeat pre-transfusion check – hourly
in the medical record on completion of the transfusion • Acute respiratory distress/stridor/wheeze
– at completion
• B
 lood products should only be stored in approved refrigerators • Dark urine Report
NOT ON THE WARD – 4/24 hourly for 24 hours if inpatient
• Bleeding oozing (DIC) • Telephone RCH blood bank ext 5829
• C
 alculate the transfusion volume as stipulated in the formulas • C
 omplete transfusion reaction form,
in Common Blood Products table document reaction in patient notes

Blood filters & giving sets Common blood products

Standard McGaw in-line blood filter Smart site infusion set Baxter neonatal giving set Tuta blood/solution administration pump set
(170–260µm) Alaris SE pump (contains inline 170–260 µm filter) (contains inline 170–260 µm filter) Formula for calculating
Blood product Pack sizes Irradiation required Rate Maximum infusion/hang time
volume to transfuse

Packed cells (mLs) = wt(kg) ×

Filter type/ Hb rise required (g/L) × 0.4 Start at no more than 5mL/kg/min
250 – 300 mL packs Yes for selected
giving set Red cell products for the first 15 minutes unless 4 hours
MIS prescribed 50 – 60 mL pedipacks patient groups*
Hb rise required = an emergency
wt(KG) × 0.4

Pump blood*
Variable No 4 hours
cell salvage

It enables the pack to remain in-line during

To filter out large clots and aggregates, transfusion – this provides safe identification To administer fresh blood products rapidly,
Purpose Must have the McGaw in line filter added
all fresh products including cells salvaged of the product and the pack can be returned to in an emergency situation
Platelets See separate platelet information poster
blood bank should a transfusion reaction occur
To be used for all transfusions of FFP,
To administer blood in small volumes
Clinical indication cryoprecipitate, & leucocyte depleted For use in transfusion of any blood products Emergency/rapid transfusion
via a syringe
red cells & platelets Start at no more than 5mL/kg/min
300 mLs
FFP*** 10 – 20 mL/kg No can be increased to 10 – 20mL/kg/ 4 hours
50 mL pedipack min if tolerated
Filters how Change when flow rate compromised Change when flow rate compromised Change when flow rate compromised Change when flow rate compromised
many packs? or at least 12 hourly. or at least 12 hourly or at least 12 hourly or at least 12 hourly

Start at no more than 5mL/kg/min

Can be flushed Cryo*** 5 – 10 mL/kg 30 – 40 mL No can be increased to 10 – 20mL/kg/ 4 hours
Yes Yes Yes Yes min if tolerated
with N/saline?

*See section on irradiation below  **Post cardiac bypass  ***Please note blood bank require 30 minutes to defrost FFP and cryo prior to collection

Compatible fluids and medications Irradiation Compatible ABO groups Neonatal testing ASBT (Australian Society
No medications or solutions should be added to or infused What does it do? • G
 roup identical blood products should be given. However in circum­ of Blood Transfusion) protocol
through the same tubing as blood products except for stances where this is not possible, a non-identical but compatible
• Impairs donor lymphocyte’s ability to divide What is it?
0.9% Sodium Chloride, ABO compatible plasma or 4% Albumin. group may be issued
(does not remove/destroy them)
• It has been shown to be safe to co-administer morphine (1mg/mL), • Rh Negative patients should always receive Rh Negative blood products A protocol that allows issue of red cell products to suitable infants
pethidine (10mg/mL) and ketamine (1mg/mL) if diluted in 0.9% Sodium Which products? without repeated crossmatching
• R
 h Positive patients can receive either Rh Negative or Rh Positive
Chloride with red cells. In these situations, the blood product should be • cellular products (platelets, red cells, granulocytes) blood products Which patients?
administered via the closest to the patient (distal lumen).
Why do it? • Under 4 months of age
• If other medications are required during a blood transfusion the ABO group of compatible ABO group of compatible
• Prevents Transfusion-Associated Graft Versus Host Disease (TA-GVHD) Red cells FFP/cryoprecipitate • Ongoing need for blood
transfusion must be stopped and the line flushed with 0.9% Sodium
Chloride before and after administration of the medication. The blood When? Group 0 B A AB Group 0 B A AB Sample requirements
Recipient ABO blood group

transfusion can then recommence. • R

 ing blood bank to request irradiation of unit prior to collection • C
 rossmatch meets lab criteria (blood bank will inform requesting
• F
 luids containing glucose are not compatible with red blood cells, (allow at least 5 minutes) AB     AB  clinician if not eligible):
they cause clumping of the red blood cells. – Sample size: red top EDTA tube >1.5mls in 2.7 tube
Which patients? A   A  
• C
 rystalloid or colloid solutions that contain calcium should never
• All PICU & NNU patients How to request ASBT?
be administered concurrently with any blood product. B   B  
• All immunocompromised patients • Request “ASBT protocol” with first crossmatch
Calcium reverses the anticoagulant citrate causing red blood
cells to clot. • All Children’s Cancer Centre patients O  O     • Indicate if any previous transfusion
What about platelets • O
 rdering Blood – once on ASBT repeated crossmatch not required,
order blood by telephoning hospital blood bank (ext 5829)
ERC: 100404

• See Platelet Product Administration Poster