Standard Operating Procedure

Department of Transfusion Medicine

NIMS Hospital, Jaipur

Emergency use of Blood and Blood Components

Number Effective date Pages Author

05/06/2023 3 Dr Pandeep Kaur

Dr. Davood UB

Version Review period Number of copies Approved by

1.0 1 yrs 2

LOCATION SUBJECT

Immunohaematology lab & Cross match Emergency use of Blood and Blood
laboratory Components

FUNCTION DISTRIBUTION

Rational use of blood in Emergency  Immuno-hematology lab

 Master file

1. PRINCIPLE

 If blood Transfusion needed in Emergency and time taken to process the

Recipient’s blood would cause significant Delay or specific group is
unavailable, O Rh D Negative blood should be issued. If patient is Rh D
positive, select O Rh D Positive units. Be prepared for MTP activation

2. RESPONSIBILITY

 It is responsibility of all blood center personals handling blood requests

in case of emergency cases to provide appropriate unit of safe blood to
patient as early as possible

3. REFERENCES.

1. Transfusion Medicine, Technical Manual. DGHS, Ministry of Health and

Family Welfare, Govt. of India. 3rd Edition.2022.
2. AABB Technical manual, 20th Ed.
3. Denise M. Harmening. Modern Blood Banking and transfusion
practices. 7th Edition
4. DEFINITION

• Emergency request of blood is different than regular blood

transfusions. Often times to handle the situation, O Rh D units to
be used to save time, when situation has subsided and patient
blood sample has been collected, group specific products to be
used.

5. MATERIALS REQUIRED

 O Negative Blood units

 Group Specific Blood units

6. PROCEDURE

 If collection of blood sample was not possible, O Rh D negative Blood to be

issued after doing the blood grouping of the bag on slide
 If collection of Blood sample was possible, select group specific do both the
patient and bag blood group on slide and do CM by IS.
 While using the unit, inform the receiver of blood unit (attendant/ward
boy/doctor) to transfusion in case of incompatibility in AHG phase
 Perform AHG phase CM following issue
 In case of incompatibility, inform the attending doctor immediately to stop the
transfusion
 If blood Transfusion needed in Emergency and time taken to process the
Recipient’s blood would cause significant Delay or specific group is
unavailable, O Rh D Negative blood should be issued. If patient is Rh D
positive, select O Rh D Positive units
 Urgency of blood requirement to be Communicated by clear words
 Blood center may send group O (possibly O Rh D Negative) If there is any
risk of patient identification
 RDPs to be used on demand.
 Be prepared with multiple units of thawed Plasma and cryoprecipitate
 Be prepared for MTP activation
 MTP:
o ≥10 blood unit transfusion within 24 hours / Transfusion of ≥4 blood
units in 1 hour / Replacement of 50% of blood volume in 3-4 hours / A
rate of loss of blood ≥ 150 ml/hour.
o Provide rapid blood replacement for patients with massive blood loss.
 In trauma patients
o 1:1:1 ratio of platelets: plasma: red cells (If apheresis unit available:-
1:6:6)
o Tranexemic acid infusion ASAP
 In obstetric patients
 o 1:1:1 ratio of platelets: plasma: red cells. Cryoprecipitate, if
fibrinogen<2gm/dl
o Tranexamic acid may be considered
 Latest recommendation:-
o Use of TEG (Thrombo-elastography) & ROTEM (Rotational thrombo-
elastometery) for viscoelastic testing.

7. INTERPRETATION

 Transfusion requests must be fulfilled by…..

• Identification of patient
• Identification of component and the Quantity
• Name of treating physician
 Gender/Age/diagnosis, history
• Confirmation of ABO and Rh typing.
• Cross matching

8. DOCUMENTATION

 Record all issued units with unit and segment no on request form of the
patient.