How to administer Red Cells - Quick Guide



Presentation

  • Resuspended Red Cells - 220-340mL

  • Paediatric Packs - each donation is divided into 4 paediatric doses - 55-85mL
  • Haematocrit-adjusted blood is used for red cell exchanges and intrauterine transfusion
  • Autologous Whole Blood - 405-513mL, provided by an intended recipient prior to surgery
A unit of red cells

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.
  • Blood giving sets should be changed after every 4 units of red cells. In emergencies or in theatre, 8-10 units of red cells may be infused before changing the giving sets provided the set is changed every 8 hours or when the filter becomes clogged. Platelets should never be transfused through a giving set that has already been used for red cells.
  • 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

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

This calculator will compute the number of units of adult red cells your patient may need.


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