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Transfusion Medicine Best Practices: Indications for Blood Components

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Transfusion Medicine Best Practices: Indications for Blood Components Transfusion Medicine Best Practices: Indications for Blood Components Indications for Blood Components Provincial Blood Coordinating Program 1.0 Policy Statements 1.1 Regional Health Authorities (RHAs) shall develop policies, processes and procedures for ordering, distribution, storage, transfusion and administration of blood components that comply with Provincial Blood Coordinating Program policies. 1.2 Blood components shall be prescribed by a physician or other authorized health professional. 1.3 Blood components shall be utilized for appropriate indications. 1.4 Red Blood Cells – Indications: 1.4.1 Decreased oxygen carrying capacity (e.g. acute blood loss, symptomatic anemia); 1.4.2 Exchange transfusion. 1.5 Platelets – Indications: 1.5.1 Deficient platelet count due to production failure and/or dysfunction; 1.5.2 Prophylaxis of bleeding for invasive procedures in thrombocytopenic patients; and 1.5.3 Massive hemorrhage. 1.6 Plasma – Indications: 1.6.1 Management of bleeding: 1.6.1.1 In patients with INR > (greater than) 1.7 who require replacement of multiple coagulation factors. 1.6.1.2 In patients with INR > (greater than) 1.7 who are treated with vitamin K antagonist (warfarin) therapy when prothrombin complex concentrates are not indicated or not available. 1.6.2 Reversal of INR > (greater than) 1.7: 1.6.2.1 In preoperative/pre-invasive procedure patients who require replacement of multiple coagulation factors. 1.6.2.2 In preoperative/pre-invasive procedure patients who are treated with vitamin k antagonist therapy (warfarin) when prothrombin complex concentrates are not indicated or not available. _______________________________________________________________________ This document may be incorporated into each Regional Policy/Procedure Manual. NL2015-053-TMP Version: 1.0 Effective Date: 2015-03-20 Page 2 of 10 Indications for Blood Components Provincial Blood Coordinating Program 1.6.2.3 Operative or invasive procedure must be imminent within six (6) hours due to the labile nature of some coagulation factors in plasma. 1.6.3 Massive transfusion for replacement of coagulation factors; 1.6.4 Therapeutic plasma exchange for thrombotic thrombocytopenic purpura (TTP) or hemolytic uremic syndrome (HUS); and 1.6.5 Management of selected coagulation deficiencies (congenital or acquired) for which no specific coagulation concentrates are available. *Plasma should not be used to correct mildly elevated INR (≤ 1.7) or aPTT prior to an invasive procedure. 1.7 Cryoprecipitate – Indications: 1.7.1 Treatment of fibrinogen deficiency; 1.7.2 Factor XIII supplementation if Factor XIII concentrate not available; and 1.7.3 Control of massive bleeding. 1.8 Cryosupernatant Plasma – Indications: 1.8.1 Treatment of thrombotic thrombocytopenicpurpura, and hemolytic uremic syndrome undergoing plasma exchange; and 1.8.2 Emergent warfarin reversal when time constraints preclude vitamin K therapy or when PCC is not indicated or not available. 2.0 Linkages Consent or refusal to transfusion of blood components or administration of plasma- derived blood products. Available at: http://www.health.gov.nl.ca/health/bloodservices/pdf/consent_form.pdf Guidelines for appropriate use and administration of frozen plasma components in adults. Available at: http://www.health.gov.nl.ca/health/bloodservices/pdf/guidelines_for_administration_of_f fp.pdf Guidelines for blood component substitution in adults. Available at: http://www.health.gov.nl.ca/health/bloodservices/pdf/guidelines_for_blood_component_s ubstitution_in_adults_ver4.pdf _______________________________________________________________________ This document may be incorporated into each Regional Policy/Procedure Manual. NL2015-053-TMP Version: 1.0 Effective Date: 2015-03-20 Page 3 of 10 Indications for Blood Components Provincial Blood Coordinating Program Guidelines for initiation and termination of blood components and blood products. Available at: http://www.health.gov.nl.ca/health/bloodservices/pdf/guidelines_for_initiation_and_termi nation_of_blood_components_and_products_vers1.pdf Policy for blood component and blood product administration. Available at: http://www.health.gov.nl.ca/health/bloodservices/pdf/blood_component_and_blood_prod uct_administration_ver_4.pdf Policy for patient notification of transfusion of blood components or blood products. Available at: http://www.health.gov.nl.ca/health/bloodservices/pdf/patient_notification.pdf 3.0 Scope This policy applies to: 3.1 All health care professionals who prescribe transfusion of blood components. 3.2 All health care professionals who participate in transfusion of blood components. 3.3 All transfusion medicine laboratory technologists. 4.0 General Information 4.1 Whole blood transports oxygen and nutrients throughout the body and removes waste products. It increases oxygen carrying capacity and expands blood volume. Whole blood is broken down into different blood components and then used for specific clinical indications. The main blood components derived from whole blood include red cells, platelets, plasma, cryoprecipitate, and cryosupernatant. 4.2 Red blood cells are primarily responsible for tissue oxygenation. Oxygen is carried on the hemoglobin molecules. 4.3 Red blood cell units that meet special recipient requirements are available. Special requirements include: autologous, phenotyped, directed donor, cytomegalovirus seronegative, irradiated, or washed. 4.4 Platelets facilitate blood clotting at the site of injury to control or prevent bleeding. They are also significant in blood coagulation, wound healing _______________________________________________________________________ This document may be incorporated into each Regional Policy/Procedure Manual. NL2015-053-TMP Version: 1.0 Effective Date: 2015-03-20 Page 4 of 10 Indications for Blood Components Provincial Blood Coordinating Program and inflammation. Platelet components contain donor plasma. Each dose of platelets should increase the platelet count by 15x109/L. 4.5 Two types of platelet components are available, pooled (buffy coat) platelets and platelets apheresis. 4.6 Several types of platelet modifications are available to meet special requirements of recipients. These include irradiated, apheresis, HLA matched apheresis, CMV seronegative, plasma reduced, and IgA deficient. 4.7 Plasma is the aqueous protein liquid in which red cells, white cells and platelets are suspended. Plasma proteins support clotting. 4.8 Plasma can be processed to produce cryoprecipitate and cryosupernatant. 4.9 Cryoprecipitate is a plasma component produced by slow thaw of the frozen plasma and removal of the insoluble cryoprecipitate using centrifugation. The cryoprecipitate is then refrozen for later use. 4.10 Cryoprecipitate provides fibrinogen, coagulation factors VIII, XIII and von Willebrand’s factor, as well as fibronectin. 4.11 Cryosupernatant provides a source of plasma with reduced levels of vonWillebrand factor. 5.0 Process 5.1 Procedure (N/A) 5.2 Guidelines Red Blood Cells 5.2.1 Red blood cells must be ABO compatible. 5.2.2 Rh negative recipients should receive Rh negative red blood cells except in special circumstances. 5.2.3 Each unit of red blood cells raises the hemoglobin in an average non-bleeding adult by approximately 10 g/L. Platelets 5.2.4 A platelet transfusion is ordered as an adult dose or in mL/kg. 5.2.6 Recipients should receive ABO compatible platelets. _______________________________________________________________________ This document may be incorporated into each Regional Policy/Procedure Manual. NL2015-053-TMP Version: 1.0 Effective Date: 2015-03-20 Page 5 of 10 Indications for Blood Components Provincial Blood Coordinating Program 5.2.7 If Rh positive platelets are given to Rh negative recipients, Rh immune globulin should be considered. Plasma 5.2.8 Recommended dose is 10-15mL/kg. 5.2.9 ABO compatibility is required. Rh compatibility need not be considered. Cryoprecipitate 5.2.10 ABO compatibility is preferred. Cryosupernatant Plasma 5.2.11 Cryosupernatant plasma must be ABO compatible. 6.0 Acronyms aPTT Activated partial thromboplastin time CMV Cytomegalovirus FFPA Fresh frozen plasma apheresis FP Frozen plasma HIT Heparin-induced thrombocytopenia HLA Human leukocyte antigen HUS Hemolytic uremic syndrome INR International normalized ratio ITP Idiopathic thrombocytopenia PCC Prothrombin complex concentrates TTP Thombotic thrombocytopenic purpura vWF vonWillebrand Factor 7.0 Definitions Administration To mete out, dispense; to give as remedy. _______________________________________________________________________ This document may be incorporated into each Regional Policy/Procedure Manual. NL2015-053-TMP Version: 1.0 Effective Date: 2015-03-20 Page 6 of 10 Indications for Blood Components Provincial Blood Coordinating Program Donor blood components that are non-identical ABO and Rh group to the recipient ABO and Rh group. Non-identical blood ABO Compatible components do not have antibodies against blood group antigens on the recipient’s red cells. ABO Identical Donor blood components of the same ABO and Rh group as the recipient. The collection of blood from an individual for the purpose of Autologous transfusion back to the individual at a later date. Blood Component A therapeutic component of blood intended for transfusion. Fresh Frozen Plasma Plasma collected by apheresis from the blood of an individual Apheresis donor and placed at ≤ -18 ˚ C within eight hours of collection. It contains all the clotting factors necessary for hemostasis. Frozen Plasma
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