Blood Product Administration
For patients with a negative antibody screen, no antibodies, no history of clinically significant antibodies and no history of transfusion reactions and without any blood product modification (ie washed or plasma reduced):
| Product | Time to be prepared by the Blood Bank | Must be transfused within | Expiration Time after the product leaves the Blood Bank (cannot be returned to the Blood Bank) |
|---|---|---|---|
| Red Blood Cells (stored at 4 C) |
60 min for STAT orders if patient has current T&S 2 hours for routine orders |
4 hrs | 30 min (except if kept in an OR refrigerator then product expires 30 min after taken out of the OR refrigerator) |
| Platelets (stored at room temp) |
60 min for STAT orders 2 hours for routine orders |
4 hrs | 30 min; should NOT be placed into a refrigerator |
| Plasma (stored frozen & must be thawed) |
60 min for STAT orders 2 hours for routine orders |
4 hrs | 30 min (except if kept in an OR refrigerator then product expires 30 min after taken out of the OR refrigerator) |
| Cryoprecipitate (stored frozen & must be thawed) |
60 min for STAT orders 2 hours for routine orders |
4 hrs | 30 min; should NOT be placed into a refrigerator |
For patients with a new antibody or a history of clinically significant antibodies or a history of transfusion reactions, it may take more time to prepare the blood product.
In Vivo Crossmatch Protocol
If you transfuse cross match incompatible blood, the in vivo crossmatch protocol must be followed. During the transfusion, please monitor the patient’s vital signs carefully to watch for signs of hemolysis (hypotension, fever, tachycardia).
- Prior to the beginning the transfusion, draw a pink top tube 6 ml from the patient for a Type and Screen.
- Start the transfusion using a Y transfusion set and give a moderate bolus (30 to 50 ml over the first 15 minutes for adults) of the crossmatch incompatible unit. The volume of a standard 170 micron blood filter and tubing is approximately 40 mL.
- Stop the transfusion and keep the intravenous line patent by slow infusion of 0.9% normal saline through other branch of the Y.
- After 20 minutes, draw a repeat 6 ml pink top tube from the arm opposite used for blood infusion.
- Send both the pre and post transfusion sample to the Blood Bank. A DAT (Coombs test) and a check for visible hemolysis will be performed and compared to each other on both samples.
- Continue the transfusion after verifying with the Blood Bank that there is not visible hemolysis or an increase in the strength of the DAT (Coombs test).
- 30 minutes after the completion of the transfusion, draw another 6 ml pink top specimen for a Type & Screen to the Blood Bank.
Administration of Rh Immune Globulin after Rh+ platelet transfusion to a Rh- individual
Rh immune globulin (RhIG) is given to Rh negative individuals to prevent immunization to D antigen and subsequent formation of anti-D. This can pose a problem if a woman becomes pregnant with a Rh positive fetus. RhIG should be administered within 72 hours of Rh+ platelet transfusion.
How to Administer Rh Immune Globulin
- For platelet count > 50,000/mm3 inject RhIG by IM (intramuscularly) in the upper, outer quadrant of the buttock with the needle directed anteriorly to minimize the possibility of injury to the sciatic nerve.
- For platelet count < 50.000/mm3 inject RhIG by SQ (subcutaneously) in the fat of the lateral aspect of the thigh. Avoid IM inject to prevent hematoma of the buttock.
FEIBA VH Administration
FEIBA VH is an activated prothrombin complex concentrate (aPCC) which is made from pooled human plasma used to control spontaneous bleeding episodes or to cover surgical interventions in hemophilia A and B patients with inhibitors.
In addition, the use of FEIBA has been described in a few non-hemophiliacs with acquired inhibitors to Factors VIII, XI and XII.
Please click here to download the protocol to administer FEIBA
Administration of Granulocyte Concentrates
Granulocytes should NOT be administered within 4 hours of Amphotericin infusion since there have been reports of adverse pulmonary events with co-administration.
Should be administered through a standard 170 micron filter.
Do not refrigerate.