Presentation
- Resuspended Red Cells - 220-340mL
- Paediatric Packs - each donation is divided into 4 paediatric doses - 55-85mL
- Haematocrit-adjusted blood is used for neonatal exchange transfusions and intrauterine transfusion
- Whole Blood - 405-513mL
ABO & RhD Compatibility
ABO
- a group O patient can receive only group O red cells
- a group A patient can receive group A or O red cells
- a group B patient can receive group B or O red cells
- a group AB patient can receive group AB, A, B or O red cells
- ABO incompatible transfusions can be fatal. Always check the the red cells against the patient at the bedside.
Rh(D)
- Transfusion of red cells are normally Rh(D) identical
- Rh(D) negative red cells may be given to Rh(D) positive recipients without creating any risk for immunisation
- In life threatening emergencies, Rh(D) positive cells may be given to an Rh(D) negative recipient but there is a risk that this will stimulate the production of anti-D. The Blood Bank will provide guidance. The Clinician must be notified.
- Rh(D) positive red cells may be provided by the Blood Bank for males, and for females beyond reproductive years, if supplies of Rh(D) negative red cells are low.
Storage
- Must be stored in an appropriately monitored (2-6°C) blood refrigerator according to Blood Bank standards. Never store in a drug or food fridge.
- If the transfusion can not be started within 30 minutes, return the component to the Blood Bank immediately for appropriate storage.
Filter
- Use a standard blood infusion set that has a 170-200 micron filter.
- One standard (170-200 micron filter) administration set may be used for the administration of 2-4 units of red blood cells provided the flow rate remains adequate. In an emergency or theatre situation 8-10 units may be transfused before the set is changed provided the set is changed every 8 hours. Administration sets should be changed on completion of the red cell transfusion or every 8 hours due to the risk of bacterial contamination. An administration set used for red cells should never be subsequently used for platelet transfusion as the red cells debris trapped in the filter could trap the platelets.
- All fresh components, including FFP and cryoprecipitate, are leucodepleted at source by NZBS. No bedside leucodepletion is necessary.
Pump
- If necessary, approved infusion pump devices may be used.
Rate and Duration
- Paediatrics:
- top-up transfusion in a non-bleeding patient is typically given at 5mL/kg/hr
- exchange transfusion: depends on stability of the baby - discuss with NICU consultant
- resuscitation: rapid infusion based on the patient's haemodynamics
- Adults:
- top-up transfusion in a non-bleeding patient: most adults will tolerate one unit every 90 minutes. Consider a slower rate in patients with or at risk of congestive cardiac failure
- resuscitation: rapid infusion based on the patient's haemodynamics
- Infusion of all components should be completed within 4 hours of leaving refrigerated storage.
Monitoring
- See page on Observations
DO NOT
- DO NOT add medication to red cell components
- DO NOT use 5% Dextrose solutions (may induce haemolysis)
- DO NOT use Lactated Ringer's or other balanced salt solutions that contain Calcium, as this may induce clot formation in the blood bag and / or administration set.
Dose
- 4-5mL/kg will raise the patient's Haemoglobin level by approximately 10g/L.
- It is recommended that the patient's haemoglobin be checked between units if giving multiple units.
- For paediatric patients, the dose should be written in mL, not units.
Dose calculator
More Info