sign in sign up
<<
Home , Blood product, Cryoprecipitate, Cryosupernatant, Platelet transfusion, Whole blood

Transfusion Medicine Best Practices: Indications for 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 .

1.5 – Indications: 1.5.1 Deficient count due to production failure and/or dysfunction; 1.5.2 Prophylaxis of 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 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 – Indications: 1.7.1 Treatment of deficiency; 1.7.2 Factor XIII supplementation if Factor XIII concentrate not available; and 1.7.3 Control of massive bleeding.

1.8 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 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 laboratory technologists.

4.0 General Information

4.1 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 molecules. 4.3 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 . 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 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 apheresis FP Frozen plasma HIT Heparin-induced 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 Plasma separated from the blood of an individual donor and placed at ≤ -18 ˚ C within 24 hours of collection. It contains all the clotting factors necessary for hemostasis. Platelets A blood component prepared by centrifugation of whole blood; consists of a suspension of platelets in plasma or an approved storage solution. Red Blood Cells A blood component containing red cells concentrated by removal of most of the plasma by centrifugation, sedimentation or cytapheresis of whole blood. Transfusion Transfer of blood or blood component from one person (donor) to another person (recipient). Transfusion Medicine Hospital . Laboratory

8.0 Key Words

Blood, component, cryoprecipitate, cryosupernatant, cytomegalovirus, indications, plasma, platelets, red cell, Rh 9.0 Supporting Documents

9.1 Process Flow/Algorithm (N/A) ______This document may be incorporated into each Regional Policy/Procedure Manual.

NL2015-053-TMP Version: 1.0 Effective Date: 2015-03-20 Page 7 of 10

Indications for Blood Components Provincial Blood Coordinating Program

9.2 Tables/Charts

Quick Reference – Blood Components

______This document may be incorporated into each Regional Policy/Procedure Manual.

NL2015-053-TMP Version: 1.0 Effective Date: 2015-03-20 Page 8 of 10

Indications for Blood Components Provincial Blood Coordinating Program

References

Callum, J., Lin, Y., Pinkerton, P.H., Karkouti, K., Pendergast, J.M., Robitaille, N…Webert, K.E. (2011). Bloody easy 3. Toronto, ON: Ontario Regional Blood Coordinating Network.

Clarke, G. & Charge, S. (2013). Canadian Blood Services: Clinical guide to transfusion medicine. Retrieved from www.transfusion medicine.ca

Canadian Blood Services. (2013). Circular of Information for the use of human blood components: Red blood cells, leukocyte reduced. Retrieved from http://www.blood.ca/CentreApps/Internet/UW_V502_MainEngine.nsf/resources/ COI/$file/COI-SAGMReduced+RedBloodCellsLeukocytes-April2013.pdf

Canadian Blood Services. (2012). Circular of Information for the use of human blood components: Pooled platelets LR CPD, apheresis platelets. Retrieved from http://www.blood.ca/CentreApps/Internet/UW_V502_MainEngine.nsf/resources/ COI/$file/COI-PooledApheresisPlatelets-23Oct12.pdf

Canadian Blood Services. (2012). Circular of Information for the use of human blood components: Apheresis fresh frozen plasma, frozen plasma CPD, cryosupernatant plasma, cryoprecipitate. Retrieved from http://www.blood.ca/CentreApps/Internet/UW_V502_MainEngine.nsf/resources/ COI/$file/COI_CPDPlasmaFFPA23Oct12.pdf

Canadian Standards Association (2010). Blood and blood components, Z902- 10. Mississauga (ON): Author.

Canadian Standards Association (2012). Blood and blood components, Z902- 10, Amendments. Mississauga (ON): Author.

Canadian Society for Transfusion Medicine. (2011). CSTM standards for hospital transfusion service. Version 3. Ottawa: Author.

Canadian Society for Transfusion Medicine (2104). Choosing wisely: Five things physicians and patients should question, 3. Retrieved from http://www.choosingwiselycanada.org/recommendations/canadian-society-for- transfusion-medicine-2/

______This document may be incorporated into each Regional Policy/Procedure Manual.

NL2015-053-TMP Version: 1.0 Effective Date: 2015-03-20 Page 9 of 10

Indications for Blood Components Provincial Blood Coordinating Program

Filardo, T.W. (2006). Stedman’s medical dictionary, (28th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

Kulkarni, R., Chitlur, M., & Lusher, J. (2011). Treatment of congenital coagulopathies. In P. D. Mintz (Ed.), Transfusion therapy: clinical principles and practice (3rd ed.), pp.167-207. Bethesda, MD: AABB Press.

Menitove, J.E. (2011). Red cell transfusion therapy in anemia. In M. A. Popovsky (Ed.), Transfusion reactions (4th ed.), pp.37-53. Bethesda, MD: AABB Press.

Ortel, T. L., Lockhart, E., & Humphries, J. (2011). Treatments of acquired disorders of hemostasis. In P. D. Mintz (Ed.), Transfusion therapy: clinical principles and practice (3rd ed.), pp.127-163. Bethesda, MD: AABB Press.

Rote, N.S. (2012). Adaptive immunity. In S.E. Heuther & K.L McCance (Eds), Understanding Pathophysiology (5th ed.), pp.142-164. St Louis MO: Elsevier.

Rote, N.S. & McCance, K.L. (2012). Structure and function of the hematologic system. In S.E. Heuther & K.L McCance (Eds), Understanding Pathophysiology (5th ed.), pp.477-499. St Louis MO: Elsevier.

Sesok-Pizzini, D. (2011). Platelet transfusion. In P. D. Mintz (Ed.), Transfusion therapy: clinical principles and practice (3rd ed.), pp.397-431. Bethesda, MD: AABB Press.

Spence, R.K. (2011). Transfusion therapy in surgery. In P. D. Mintz (Ed.), Transfusion therapy: clinical principles and practice (3rd ed.), pp.265-303. Bethesda, MD: AABB Press.

Transfusion Ontario. (2005). About , information for nurses and other health care professionals, (2nd ed). Toronto ON: Transfusion Ontario Program.

______This document may be incorporated into each Regional Policy/Procedure Manual.

NL2015-053-TMP Version: 1.0 Effective Date: 2015-03-20 Page 10 of 10