Administration of Blood Products

Pre-Transfusion

• Positive, accurate patient identification.
  • All patients receiving transfusion must wear a patient ID wristband. Minimum identifiers:
    • Last name
    • First name
    • Date of birth
    • Unique patient identification number
• Clear indication to transfused, based on assessment of the individual patient and their specific clinical situation.
• Clear documentation of indication and symptoms
• Clear authorisation for transfusion, including component to be transfused, date of transfusion, volume / number of units to be transfused, the transfusion rate and blood product specifications.
• Patients must provide informed consent for transfusion, where possible.
• Pre-transfusion samples must be positively identified. Sample collection and labelling must be done as one continuous uninterrupted event by a trained, competent member of staff.
• Clear and unambiguous communication of the above between clinical and laboratory staff.

Blood Product Administration

• Blood components must only be administered by trained, competent, registered healthcare practitioners.
• Transfusion should only take place if adequate facilities for monitoring throughout the transfusion are available.
• Patients must be positively identified before transfusion.
• Identifiers on the patient’s ID band must matched the laboratory-generated label attached to the component.
• The donation number, blood group and expiry date on the blood component pack must match the information on the laboratory-generated label.
• Additional clinical requirements for blood products (e.g. irradiated blood) must be checked.
• 4ml/kg of RBCs will raise the Hb by 1g/dL (1 unit = 1g/dL is only true for a 70-80kg patient).
• Monitoring should include the pulse rate, blood pressure, temperature and respiratory rate of the patient. Minimum monitoring includes:
  • Pre-transfusion
  • 15 minutes after the start of each component unit
  • Post-transfusion, not more than 60 minutes after the completion of transfusion
  • Regular visual observation throughout the transfusion
• The time each unit was completed and post-transfusion symptom resolution should be documented.

Return of Unused Blood

• RBCs: transfuse within 4h of removal from controlled temperature.
  • Up to 30 min outside controlled temperature storage: can return directly to issue location. No restriction on how many times this can happen.
  • 30-60 min: return to a separate storage refrigerator. Store for at least 6h (to allow blood to return to 2-6°C) before re-issue. Maximum three times out of storage for 30-60min.
  • >60 min: dispose of bag.
• FFP: use ASAP on thawing, and transfuse within 4h of issue. If delay unavoidable:
  • Can be return to issuing location if out of controlled storage for <30min on one occasion.
  • >30min out of storage: only for re-issue if transfusion can be completed within 4h of the original issue time.
  • 4h at 20-24°C (8h for SD-FFP)
  • 24h at 2-6°C
  • 120h at 2-6°C, only for use in major haemorrhage where delays in FFP are unacceptable.
• Cryoprecipitate: use ASAP on thawing and transfuse within 4h of issue
  • Cannot be refrigerated.
  • Any returned units can only be re-issued if transfusion can be completed within 4h of original issue.
• Platelets
  • Each interruption to agitation should be no longer than 8hrs.
  • Total interruption no more than 24hrs.
  • Normally stored at 20-24°C with constant gentle agitation.