Blood Book Australian Blood Administration Handbook, 1st .

StoragePlatelets are kept at room temperature(20–24 C). Do not refrigerate platelets, asrefrigeration can affect platelet reactivity.Before issue, platelets are stored on a single-layerrocker with continuous agitation to ensureoptimal gas transport and to minimise plateletaggregation (clumping). Due to the storage atroom temperature, platelets are susceptible tobacterial growth.Transfusion of platelets should occur as soonas possible after issue from the TransfusionService Provider.Screening for bacterial contaminationPlatelets are susceptible to bacterial growth dueto being stored at room temperature.Platelets from Lifeblood in Australia are tested forbacterial contamination. Screening detects many ofthe contaminated packs, however, a negative resultdoes not exclude the possibility of contamination.Platelets are issued as ‘negative to date’; thecultures continue to be incubated over theirfull shelf life.Preliminary positive results initiates a recall of packsand prompt medical review of patients if alreadytransfused. Additional communication is providedas soon as further results are available.Platelet compatibilityPatientABO typeBestoptionOK touseAvoidUnknownO or A neg-B, ABOOAB, ABAAB, OABBBA, OABABAB (notroutinelyavailable)A, BOABO identical and RhD compatible plateletsare usually preferred. ABO non-identical plateletsmay be issued to patients by the TransfusionService Provider when ABO identical plateletsare unavailable.In some circumstances, the need for specialrequirements such as Human Leucocyte Antigen(HLA) or Human Platelet Antigen (HPA) matchingmay be more important than providing the sameABO group.If the blood group of the platelet pack and thepatient are not identical, the Transfusion ServiceProvider must make a specific comment to indicatethat it is compatible, or the most suitable available.Platelets do not express Rh antigens but some Rhantigens are present in a pack of platelets.RhD negative platelets can be given to RhD positivepatients. RhD negative patients, especially womenof child-bearing potential, where possible, shouldreceive RhD negative platelets.If RhD positive platelets are given to RhD negativepatients, the use of RhD immunoglobulin (anti-D)may be required – consult the treating medicalofficer or haematologist.2020 Edition11

Component therapyPlasma componentsPlasma is the liquid part of blood and contains antibodies,clotting proteins and albumin. It is processed to make freshfrozen plasma (FFP), cryoprecipitate, and cryodepleted plasma.Types of plasma componentsPart APart BPart CPart D1. Fresh frozen plasma3. Paediatric fresh frozen plasmaPatients may require a fresh frozen plasma (FFP)transfusion to replace clotting factors. This may bedue to massive transfusion, invasive surgery, acutedisseminated intravascular coagulation (DIC), orsome anticoagulants.Plasma derived from a single pack of whole blood isdivided into four packs of smaller but equal volume.This reduces the donor exposure for small paediatrictransfusions and minimises wastage. All unitshave the same donation number and are labelledPart A, B, C and D.FFP can be derived from either a collection of wholeblood or apheresis plasma. These are equivalentcomponents. Apheresis donations may be dividedinto two or three packs. These units have the samedonation number but are labelled Part A, B and C.2. Extended life plasmaSome Transfusion Service Providers may thaw andkeep FFP in a monitored blood fridge for up tofive days. This is to enable the issuing of thawedplasma in time-critical situations and is nowcalled extended life plasma (ELP). A label mustbe attached to the ELP showing the change incomponent name, new component code, thawingdate and time, expiry date andtime and the identity(initials) of person who re-labelled the pack.12Blood Book: Australian Blood Administration Handbook4. CryoprecipitatePatients may require cryoprecipitate transfusionsto treat low fibrinogen caused by critical bleedingor DIC. One unit of apheresis cryoprecipitate isequivalent to approximately two whole bloodderived units of cryoprecipitate.5. Cryodepleted plasmaCryodepleted plasma is the plasma remainingafter cryoprecipitate has been removed fromFFP. Cryodepleted plasma can be a substitute insome situations for warfarin reversal and duringplasma exchange used to treat thromboticthrombocytopenic purpura.

StoragePlasma components are stored at -25 C or belowfor up to 12 months. Once thawed, FFP andELP are stored in a blood fridge. Once thawed,cryoprecipitate should be maintained at roomtemperature between 20–24 C (do not refrigerate).Transfusion of thawed plasma components shouldbe started as soon as possible after issue from theTransfusion Service Provider.Expiry dates of plasmaPlasma components have two expiry dates – onefrom the time of freezing and the other fromthe time of thawing. Some Transfusion ServiceProviders will place an updated expiry label over orin addition to the expiry date from freezing. Checkthe updated expiry date and time on the pack labeland patient compatibility label carefully prior toadministration and always ensure that the shortestexpiry has not been breached.Thawing devicesSpecialised warming equipment is used forthawing plasma components. Thawing shouldonly be performed by the Transfusion ServiceProvider and typically takes around 30 minutes.Plasma compatibilityPatientABO typeBestoptionOK touseAvoidUnknownABABOOA, B, AB-AAABBBBABAABAB-A, BPlasma components should be compatible withthe patient’s ABO group. If the blood group of theplasma pack and the patient are not identical, theTransfusion Service Provider must make a specificcomment to indicate that it is compatible, or themost suitable available.Group AB plasma may be used for all patientABO groups and may be transfused withoutregard to RhD type.In an emergency, adult patients may receive groupA plasma if AB plasma is unavailable or in shortsupply as per local health service policies.Low titre productsPlasma components that have low titre anti-Aand/or anti-B pose a lower risk of causing clinicallysignificant haemolysis when transfusing ABOincompatible plasma components. Where Lifebloodtesting indicates a low titre of anti-A and/or anti-B,the clinical plasma components have a modifier,“Low anti-A/B”, printed on the plasma pack label toenable selection of the components. The modifierwill not be applied to group AB components asthese donations do not have anti-A or anti-B.2020 Edition13

Component therapySpecialrequirementsIn some circumstances, patients require additional testing ormodifications to blood components. The treating physician is responsiblefor prescribing and documenting a patient’s special requirements.Always remember to check national guidelines and your local healthservice policy about which patient groups have special requirements.Always notify the Transfusion Service Provider as soon as possible,as some special components are difficult to source.1. Leucocyte depletionWashed red cellsAll red cells and platelets issued by Lifeblood inAustralia are leucocyte (white cell) depleted. Thisprocess removes 99% of the leucocytes, reducingthe risk of transmission of cytomegalovirus (CMV),febrile non-haemolytic transfusion reactions, andHLA alloimmunisation.This is a special requirement needed by patientswho have repeated transfusion reactions.2. Cytomegalovirus (CMV) seronegativeCMV is a common virus carried by white cells.CMV infections may lead to severe or fatal diseasein immunosuppressed patients. CMV negativecomponents are usually only needed for certainpatient groups and neonates. Some donors havenever been exposed to CMV and are seronegative.Selected donations are tested for CMV antibodiesand are labelled CMV negative.3. IrradiationIrradiation kills any residual T-lymphocytes in redcell or platelet components. All platelets issuedby Lifeblood in Australia are irradiated. Irradiationprevents transfusion-associated graft-versus-hostdisease (TA-GVHD).Irradiation increases damage to the red cells andreduces shelf life and is only used in some patientssuch as: premature and small neonates, neonateswho require exchange transfusions or who havehad intrauterine transfusions, bone marrow or stemcell transplant recipients, patients receiving certainimmune-suppressing drugs, and patients withsome congenital immunodeficiencies.Washing of red cells removes unwanted plasmaproteins, including antibodies. The plasma proteinscan cause allergic reactions and/or the developmentof red cell antibodies. Washing also removes whiteblood cells and platelets. Washing will reduce theshelf life of the product.IgA deficientImmunoglobulin A (IgA) deficient componentsare used in consultation with a haematologistor immunologist for IgA deficient patients witha history or risk of anaphylactic transfusionreactions. Red cells are washed to provide IgAdeficient product. IgA deficient platelet and plasmacomponents are sourced from IgA deficient donors.Human leucocyte antigen matchedHLA-matched platelet transfusions aresometimes required for patients with HLAalloimmunisation (antibodies) causing refractoriness(suboptimal increase in platelet count) to randomdonor platelets. HLA-matched platelets need to beordered in advance.Human platelet antigen matchedHPA-matched platelet transfusions are sometimesrequired for patients with fetomaternal alloimunethrombocytopenia or post-transfusion purpura.HPA platelets need to be ordered in advance.A radiation sticker on the component has theword “not” in the red area prior to irradiation.Once the pack has been irradiated, the red areaturns black. The component label also denotes thatit has been irradiated.14Blood Book: Australian Blood Administration Handbook

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ComponentadministrationPreparation for transfusion18Blood component collection22Patient, prescription and pack check24Blood component administration26Post-transfusion processes30Blood component administration checklist312020 Edition17

Component administrationPreparationfor transfusionOrganise yourself and your patient for a safe transfusion. Preparingfor the unexpected may minimise adverse outcomes for the patient.Blood transfusions should be administered in an environmentwhere any problems can be dealt with quickly and appropriately.The preparation processEnsure staff and equipment are available andtransfusion is occurring in a safe clinical areaCheck resuscitation equipment is available and inworking order, and that emergency medical supportis readily available.Ensure all transfusion equipment is: approved for its intended use in bloodcomponent transfusion in date and has been checked used following the manufacturer’srecommendations and specificationsfor use, and used in keeping with local health service policy.See pages 19–21 for detailed equipment information.Ensure informed consent discussion hasoccurred and has been documentedAll blood transfusions must have a valid informedconsent. It can be provided by the patient, parentor legal guardian, or follow the emergency medicalprocedure consent protocols. A dialogue aboutreasons for transfusion and expectations of clinicaloutcomes must take place between the clinicianand the patient or guardian. Any informationprovided should be in line with the patient orguardian’s literacy level and in a way they canunderstand.Consent must be documented in the patient’smedical record and/or on a transfusion-specificconsent form in accordance with local healthservice policy.Refer to your local health service policy regardingconsent processes for blood transfusion, includinginability to obtain consent and for patients whorefuse. All elements of the consent processshould be aligned to local, state or territory andnational requirements.18Blood Book: Australian Blood Administration HandbookEnsure prescription is complete and validThe treating physician is responsible for completingthe prescription and documenting any specialrequirements. If the precription is incomplete,obtain this from the prescribing physician.Ensure IV access is patent and appropriate to useIf uncertain, consult with your senior nurse ormedical officer.Ensure correct patient ID band is attached tothe patientAsk the patient (if conscious and competent) tostate and spell their first and family names in full,state their date of birth (DOB), and ensure theinformation is identical on the identification band.Ensure the patient understands procedureand possible adverse eventsThe person administering the component shouldensure the patient understands the transfusionprocedure, including symptoms of possibletransfusion reactions.Record baseline observationsWithin the 60 minutes before commencementof each pack, record patient temperature, pulse,respirations, blood pressure and general patientstatus including any pre-existing rashes.Administer premedication if orderedIf any premedication has been ordered, ensure it hasbeen administered at the appropriate time prior tocommencing transfusion.Ensure circumstances are appropriate to proceedIf uncertain, consult with your senior nurse ormedical officer.

Transfusion equipmentBlood administration setsApproved blood administration sets mustbe used for all blood components. Bloodadministration sets must incorporate a 170–200micron filter to remove clots and debris.A syringe may be used for paediatrictransfusions provided the component is drawninto the syringe via a 170–200 micron filter.Blood component packs should be mixedthoroughly by gentle inversion prior toadministration.Blood component or 0.9% sodium chloridesolution (normal saline) must be used to primethe blood administration line following themanufacturer’s recommendations.Blood administration sets must be changedwhen transfusion is completed, or every12 hours and in accordance with themanufacturer’s recommendation.Multiple packs of the same component typecan be administered through the sameadministration set.Blood administration sets should not be‘piggy-backed’ into other lines. It is acceptableto attach the set to extension tubing on anIV cannula.Compatible IV solutionsRed cells0.9% sodium chloride solution(normal saline), albumin 4% or ABOcompatible plasma.Current formulation of GELOFUSINE (available in Australia) as stated in theproduct information.Electrolyte and colloid solutionscontaining any calcium (e.g. Hartmann’ssolution or lactated Ringer’s solution).These solutions should not beadministered with blood componentscollected in an anticoagulantcontaining citrate as they may causeclotting in the infusion line.5% glucose (dextrose) in water orhypotonic sodium solutions may causered cells to haemolyse.Platelets and plasma components0.9% sodium chloride solution(normal saline).Electrolyte and colloid solutionscontaining any calcium (e.g. Hartmann’ssolution or lactated Ringer’s solution).These solutions should not beadministered with blood componentscollected in an anticoagulantcontaining citrate as they may causeclotting in the infusion line.2020 Edition19

Transfusion equipment continuedPumpsSyringe driversPumps are commonly used when free flow viagravity is unreliable or where controlled flow ratesare required e.g. paediatric transfusion.Syringe drivers may be useful for small volumetransfusions e.g. neonatal transfusion.The pump line must incorporate an approved bloodadministration filter.The device and its settings must be included as partof the standard checking procedure and throughoutthe transfusion.The pump settings and volume being deliveredmust be monitored hourly throughout theadministration process.If a syringe driver is used, the configuration mustensure that blood components pass through anapproved blood administration filter.Aseptic technique must always be maintained andthe syringe must be labelled with correct patientdetails to ensure proper patient identification, andtime of preparation for optimum product viability.Any adverse reactions/outcomes as a result of pumpuse must be notified to the appropriate authority inaccordance with local health service policy.20Blood Book: Australian Blood Administration Handbook

Blood component warmersRapid infusion devicesMost patients can receive blood components at thetemperature provided from the Transfusion ServiceProvider. Indications for using blood warmers include:Rapid infusion devices are used to warm andadminister blood rapidly (e.g. during criticalbleeding/massive transfusion). patients with clinically significant coldagglutinins large-volume rapid transfusions exchange transfusions plasma exchange for therapeutic apheresis inadults intrauterine transfusions (at the discretion of thefeto-maternal specialist) trauma situations in which core-rewarmingmeasures are indicated, and the patient rewarming phase duringcardiopulmonary bypass surgical procedures.These devices must be operated strictly accordingto the manufacturer’s instructions and local healthservice policy.When using blood warmers, ensure the following: Blood warmer administration sets mustincorporate an approved blood administrationfilter. Blood administration sets used with warmersmust be primed prior to use. Only approved blood warming devices should beused - improvised devices must never be used. The operating temperature of the blood warmermust be recorded on the patient’s infusionrecord.2020 Edition21

Component administrationBlood componentcollectionAppropriate checking procedures when collectingblood components reduces the risk of transfusion ofthe wrong component to the wrong patient.The collection processHow and where doescollection occur?22Your TransfusionService ProviderPneumatictubeShipperRemote bloodfridgeBlood Book: Australian Blood Administration HandbookCollection should only take place whenyou are ready to begin the transfusion.Always remember to: Collect one pack at a time (except in anemergency) to avoid wastage and reduce therisk of wrong transfusion. Take documented patient details and producttype to collect pack. Ensure all patient details, including first name,family name, DOB, and medical record number,match the details on the pack. Ensure that you have collected the prescribedcomponent. Ensure the pack is within expiry date andtime and check for any visible leaks at portsand seams, and that there is no evidence ofhaemolysis, unusual discolouration, cloudinessor visible clots. Ensure the attached compatibility label has thesame donation number as the component label. Ensure all documentation for the removal/collection of the blood component has beencompleted. If any discrepancies arise, do not proceed andcontact the Transfusion Service Provider.

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Component administrationPatient, prescriptionand pack checkThis is the last step of the transfusion process to ensurethe right component is transfused to the right patient.OverviewPatient identificationInspect the packEach individual undertakingthe administration of bloodcomponents should have anunderstanding of their roles andresponsibilities.Where possible, involve thepatient in the identificationchecks by asking them to stateand spell their first and familynames in full, state their DOB,ensure the information is identicalon the identification band.Ensure the pack and co

Component administration 17 Preparation for transfusion 18 Blood component collection 22 Patient, prescription and pack check 24 Blood component administration 26 Post-transfusion processes 30 Blood component administration checklist 31 Product therapy and administration 35 Immunoglo