clinical practice guidelines _ blood product prescription

8/16/2019 Clinical Practice Guidelines _ Blood Product Prescription

1/5

23/05/2016 Clinical Practice Guidelines : Blood Product Prescription

http://www.rch.org.au/clinicalguide/guideline_index/Blood_Product_Prescription/ 1/5

Blood Product Prescription

Ind ications for transf usions:Red Blood CellsPlateletsFresh Frozen PlasmaCryoprecipitate

Pre-transfusion assessmentTable: Transfusion Volumes and Rates

Management of transfusionComplications

After transfusionWhen patients or families refuse a blood product transfusi on RCH PolicyOther resources

Please read in conjunction with: Massive transfusion and critical bleeding procedure

Blood transfusion procedure

Backgrou ndBlood and blood product transfusions may be required for acute blood loss, or for failure of productionsuch as bone marrow suppression.Blood pr oduct therapy sho uld only be given when the expected benefits to the patient are likely tooutweigh the potentia l hazards.

All blood transfusion activ ity within the RCH must occur in compliance with the relevant policies (needslink) and hospital clinical guidelines (link needed).

Indications for TransfusionRed blood cellsPlateletsFresh Frozen PlasmaCryoprecipitate

Indications for Red Blood Cells

Hb


2/5



transportHb


3/5



All immuno-compromised patients, including all oncology patients, cardiac neonates andall patients in ICU, to prevent graft-versus host disease.

CMV negative products:Leucocyte depleted blood products, are considered an acceptable alternative to CMVseronegative products at RCH

5. Calculate & prescribe the transfusion volume with consideration to pack sizesUnstable patient - See Massive transfusion and critical bleeding procedureStable patient (see Table 2 below)

6. Prescribe the blood product and rate of administration on the fluid order chart (see Table 2 below) All transfusions must be completed within 4 hours of spiking a pack.

Table 2: Transfusion volumes and rates

Blood product Formula for calculatingtransfusion

volume

Pack sizes Rate

RedBlood Cells

Packed cells(mls)= wt (kg) x Hbriserequired(g/L) x0.4

(eg.10kg

child requiringHb to rise from60 to 110g/L: 10x 50 x0.4=200ml)

250-300ml/pack;

50 -60ml/Pedipack

Transfusion will be started at a slower rate (eg.Half the rate) for the first 15minutes. If noadverse effects occur, increase the transfusionto a 2-4hourly rate depending on the patient'scondition and fluid balance

Platelets 5 - 20 ml/kg

(5 - 10 ml/kg willraise plateletcount by 50 -100x 10 /L)

Neonatal/paediatric


4/5



Paediatric >40kg or adult:

Apheresis(singledonor)>200mlor split

into 2 x >100mlpacksPooledfrom 4-5donors ->160ml

FFP 10 - 20 ml/Kg 300ml/pack

50ml/pack (for neonatal use)

Start at no more than 5ml/min.

Cryoprecipitate 5-10 ml/kg 30-40 ml/pack Start at no more than 5ml/min.

Management of Transfusion Administer as per Blood transfusion procedure

The key steps include:

1. A formal checking process prior to commencement of transfusion2. The use of correct equipment (filters, pump, consideration of blood warmer)3. Correct transfusion documentation including patient observations, start and finish times

Complications during transfusion:The most common immediate adverse reactions to transfusion are fever, chills and urticaria.The most potentially significant reactions include acute haemolytic transfusion reactions, bacterialcontamination of blood products and transfusion related acute lung injury.During the early stages of a reaction it may be difficult to ascertain the cause.

All suspected transfusion reactions must be reported to the issuing blood bank immediately. The on-call haematologist will contact the clinical area to provide advice regarding investigation and ongoingtransfusion support.

After transfusion:Document the effect of transfusion on the patient's condition including Hb if repeated.

Other resourcesRCH Blood transfusion website

http://www.rch.org.au/bloodtrans/about_blood_productshttp://www.rch.org.au/policy/policies/Blood_Product_Transfusion/


5/5



Content authorised by: Webmaster. Enquiries: Webmaster.
mailto:[email protected]:[email protected]

clinical practice guidelines _ blood product prescription

Documents