sign in sign up
<<
Home , Blood product, Blood transfusion, Cryoprecipitate, Fresh frozen plasma, Platelet transfusion

ADULT TRANSFUSION GUIDELINES ORDERED PREPARATION INDICATIONS FOR USE ABO-RH COMPATIBILITY ADMINISTRATION SPECIAL COMPONENT AND CONSIDERATIONS COMPOSITION

Packed red cells RBCs, WBCs, Increase red mass and Recipient Donor Filter - standard filter Expected outcome - (RBCs) & plasma carrying capacity; increase Hg by one (minimal) generally indicated when Hgb is O O Preferred needle gauge - 16-20; gram/unit or Hct 3% 7 gm or Hct 21 unless active 22 gauge for limited venous A A, O cardiac disease is present. access AB AB, A, B, O Rate – approximately 2 mL/minute (120mL/hour) for 1st B B, O 15 minutes, then increase rate to infuse over 1 to 2 hours (150-250 Rh+ Rh+, Rh- mL/hr), or as ordered. Do NOT Rh- Rh- hang longer than 4 hours.

In some cases, Rh+ blood Volume - 300-350 mL can be given to Rh- recipients.

11/2017 Legacy Laboratory Services Page 1 of 18

ORDERED PREPARATION INDICATIONS FOR USE ABO-RH COMPATIBILITY ADMINISTRATION SPECIAL COMPONENT AND CONSIDERATIONS COMPOSITION

Leukocyte- RBCs, WBCs Same as RBCs plus decreases Same as RBCs Filter Same as RBCs Reduced packed (negligible), risk for alloimmunization to red cells (RBCs) platelets & plasma leukocyte or HLA antigens and • If product is not leukocyte (minimal) CMV transmission; reduces reduced, use leukocyte incidence of febrile transfusion removal filter. • Otherwise standard blood reactions filter. Preferred needle gauge – Same as RBC’s

Rate - Same as RBCs

Volume - Same as RBCs

Red blood cells- RBCs, minimal Same as RBCs plus decrease Same as RBCs Same as RBCs Expiration time of unit is washed WBCs, no plasma, risk for alloimmunization to 24 hours after no platelets leukocyte or HLA antigens; washing; Hct of product is reduce incidence of urticarial and 70-80%; contains viable anaphylactic reactions to plasma lymphocytes and can ; only ordered when induce GVHD reactions not controllable with meds and leukodepleted products

Autologous RBCs, WBCs, and Increase red cell mass and Complete ABO-Rh Filter - Same as RBCs Same as RBCs; 2-hour plasma; patient oxygen carrying capacity compatibility since blood reinfusion is OK unless blood has donated own was donated by patient Preferred needle gauge - Same patient is volume blood prior to prior to procedure as RBC’s sensitive; surgical procedure Rate - Same as RBCs

Volume - 200-500 mL

11/2017 Legacy Laboratory Services Page 2 of 18

ORDERED PREPARATION INDICATIONS FOR USE ABO-RH COMPATIBILITY ADMINISTRATION SPECIAL COMPONENT AND CONSIDERATIONS COMPOSITION

Plasma: Plasma, with Hemorrhagic condition Recipient Donor Filter - standard blood filter Expiration time of product clotting factors associated with a clotting factor is 24 hours after thawing: Fresh frozen deficiency; with (PT 18, INR > O O, A, B, AB Preferred needle gauge - 18-20 usual starting dose is 2-4 plasma (FFP), 1.5, or PTT  60) reverse units. frozen plasma (FP) excessive therapy; A A, AB Rate - TKO x 15 minutes, then complications due to as fast as tolerated B B, AB liver disease (5-10 mL/min). Do NOT hang AB AB longer than 4 hours.

Volume - actual volume is printed on product bag

Platelet Platelets, plasma, To control or prevent bleeding Recipient Donor Filter - standard blood filter or Prophylactic pre- small numbers of associated with deficiencies in leukocyte reduction filter (per transfusion medications RBCs and WBCs number (count < 5,000 - O O, A, B, AB physician order). (e.g., and/or 10,000 chronic, < 50,000 preop) acetaminophen) may be A A, AB, O, B or function; not usually effective Preferred needle gauge - 20-22 ordered to decrease in conditions of rapid platelet incidence of chills, fever B B, AB, O, A Rate - TKO - first 15 minutes, destruction (e.g., ITP and DIC). and allergic reactions; one then remaining volume within 20- AB AB, A, B, O unit of pheresis platelets 30 minutes (5-10 mL/min). May should increase platelet ABO incompatible be placed on infusion device if count by 20,000 to platelets can be used if ordered over a specific amount 30,000/ul not grossly contaminated of time. with red cells. RH factor Volume -. Approximately 270 mL. is significant only when platelets from Rh+ donor are used in a Rh- female (< 50 years).

Platelets Same as Same as random-donor Same as platelet Same as platelet apheresis Advance scheduling to apheresis platelets platelets; used for patients apheresis concentrates concentrates obtain HLA-matched HLA-matched but product is unresponsive to random donor platelets is required; all tissue matched platelet concentrates because of HLA matched platelets HLA alloimmunization; used for must be irradiated patients who have had transplant within last year or are scheduled for future transplant

11/2017 Legacy Laboratory Services Page 3 of 18

ORDERED PREPARATION INDICATIONS FOR USE ABO-RH COMPATIBILITY ADMINISTRATION SPECIAL COMPONENT AND CONSIDERATIONS COMPOSITION

Platelets Same as Same as random donor platelets Same as platelet Same as platelet apheresis 24-hour advanced apheresis platelets but used for patients who are apheresis concentrates concentrates scheduling required; new crossmatched but crossmatched unresponsive to random donor clot tube specimen with patient’s pheresis or HLA matched required for each order serum platelet products; platelet screen is positive

Cryoprecipitate Factor VIII, von Treatment of hypofibrinogenemia ABO grouping may be Filter - standard blood filter Maximum patient benefit if Willebrand’s ( < 100 mg/dl) and Von disregarded; product has used within 2 hours; usual (AHF) factor, factor XIII, Willebrand’s disease; may be negligible amounts of Preferred needle gauge - 18-22 starting dose for fibrinogen; product used in hemophilia A but Factor plasma hypofibrinogenemia is 10 Rate - TKO x 15 minutes, then is frozen VIII concentrate preferred. One units as fast as tolerated (5-10 unit yields 100-350 mg of mL/min) fibrinogen. Volume - 10 mL/bag; volume is

recorded on each bag. The usual adult dose is ten (10) units or approximately 100 mL.

Factor VIII Freeze dried factor Factor VIII deficiency Not required Filter –none required, filtered Product is obtained from Antihemophilic VIII (hemophilia A); some products during preparation by pharmacy; Pharmacy; each bottle of can be used in von Willebrand’s follow package instructions to AHF is labeled with factor(AHF) disease reconstitute at room temperature. activity expressed in international units. Von Willibrand Use disposable factor (Humate P) as proteins adhere to glass. There is a risk of Visually inspect for particulate transmission of infectious

matter or discoloration prior to disease administration. Do not refrigerate after reconstitution. Administer within 3 hours of reconstitution. Slowly infuse the solution (max rate 4mL/Min) with suitable intravenous set.

Preferred needle gauge - 22-24

Volume - 10-30 mL

11/2017 Legacy Laboratory Services Page 4 of 18

ORDERED PREPARATION INDICATIONS FOR USE ABO-RH COMPATIBILITY ADMINISTRATION SPECIAL COMPONENT AND CONSIDERATIONS COMPOSITION

Factor IX Freeze dried Factor IX deficiency (hemophilia Not required Filter - none required, filtered Product is obtained from concentrations of B), also known as Christmas during preparation by pharmacy. Pharmacy; each bottle of Recombinant factor IX disease factor IX is labeled with factor For IV use only. Visually inspect activity expressed in IX for particulate matter or international units discoloration prior to (Benefit) administration. Administer using tubing provided. Adjust the rate of administration based on the patient’s comfort level.

Preferred needle gauge - 20-24

Volume - 10-30 mL

Normal serum Plasma proteins Hypovolemic associated Not applicable Filter – Some products may Product is obtained from albumin (NSA) available in 5% or with or without acute blood loss; require filtration; refer to package Pharmacy 25% cerebral edema; insert. For IV use only. Visually 25% and 5% and cardiopulmonary bypass inspect for particulate matter or There is a risk of plasma discoloration prior to infectious disease fraction (PPF) 5% administration. Do not begin transmission administration more than 4 hours Albumin after the container has been entered. Once the transfusion is started it must be completed within 4 hours.

Preferred needle gauge - 18-24 age and patient dependent.

Rate - dependent on product, concentration and patient’s condition; see package insert. Do NOT hang longer than 4 hours.

Volume - 25% NSA, 50 and 100 mL; 5% NSA, 250 and 500 mL; 5% PPF, 250 and 500 mL

11/2017 Legacy Laboratory Services Page 5 of 18

ORDERED PREPARATION INDICATIONS FOR USE ABO-RH COMPATIBILITY ADMINISTRATION SPECIAL COMPONENT AND CONSIDERATIONS COMPOSITION

Irradiated blood Irradiated at a Congenital immunodeficiency Product specific; see Product specific; see packed red Crossmatch compatibility products: dose of 25 Gy states: severe combined packed red cells or cells or platelet apheresis and HLA match take (2,500 rads) immunodeficiency syndrome, platelet concentrates administration preference over ABO and RBCs, RBCs thymic hypoplasia, Wiskott- RH for platelets (leukodepleted and Aldrich syndrome, Lenier’s washed), platelets disease, 5’ Nucleotidase deficiency

Infants less than 4 months old:

Neonatal transfusions, intrauterine transfusions, exchange transfusions, cardiac (except ECMO)

Acquired immunodeficiency states: ANC < 500 (any reason),

highly immunosuppressive chemo, BMT (mobilization to 100 days post- transplant, then check with physician)

Other: directed donor products from relatives, any HLA matched platelet product

11/2017 Legacy Laboratory Services Page 6 of 18

PEDIATRIC TRANSFUSION GUIDELINES

ORDERED PREPARATION INDICATIONS FOR USE ABO-RH COMPATIBILITY ADMINISTRATION SPECIAL COMPONENT AND CONSIDERATIONS COMPOSITION

Packed red cells RBCs, Increase red cell mass and Recipient Donor Filter - standard pediatric blood All pediatric packs of (RBCs) leukocyte oxygen carrying capacity; filter RBCs are pre-storage reduced WBCs (negligible), generally indicated when Hgb is O O leukodepleted so platelets and 8 gm or Hct 24 Preferred needle gauge - 18-24 leukofilter is not required A A, O plasma (minimal) age and patient dependent. for transfusion Decrease risk for AB AB, A, B, O alloimmunization to leukocyte or Rate - TKO x 15 minutes, then infuse remaining volume over 1 HLA antigens and CMV B B, O transmission; reduce incidence to 2 hours, or as ordered. Each mL/Kg given should of febrile transfusion reactions. Rh+ Rh+, Rh- Transfusion time is increase the by approximately 2-5 mL/Kg hr for 1% or 10mL/Kg should Rh- Rh- children Do NOT hang longer raise the Hgb 3g/dL than 4 hours. In some cases, Rh+ blood can be given to Rh- Volume - as ordered. Maximum recipients dose for single transfusion is 15 mL/Kg

Red blood cells- RBCs, minimal Same as RBCs plus decrease Same as RBCs Same as RBCs Expiration time of unit is washed WBCs, no plasma, risk for alloimmunization to 24 hours after saline no platelets leukocyte or HLA antigens; washing; Hct of product is reduce incidence of urticarial and 70-80%; contains viable anaphylactic reactions to plasma lymphocytes and can proteins; only ordered when induce GVHD reactions not controllable with meds and leukodepleted products

11/2017 Legacy Laboratory Services Page 7 of 18

ORDERED PREPARATION INDICATIONS FOR USE ABO-RH COMPATIBILITY ADMINISTRATION SPECIAL COMPONENT AND CONSIDERATIONS COMPOSITION

Autologous blood RBCs, WBCs, and Increase red cell mass and Complete ABO-Rh Filter - standard pediatric blood Same as RBCs; 2-hour plasma; patient oxygen carrying capacity compatibility since blood filter reinfusion is OK unless has donated own was donated by patient patient is volume sensitive blood prior to prior to procedure Preferred needle gauge - 18-24 surgical procedure age and patient dependent. Rate - TKO x 15 minutes, then infuse remaining volume over 1 to 2 hours, or as ordered. Do NOT hang longer than 4 hours.

Volume - as ordered

Plasma: Plasma, with Hemorrhagic condition Recipient Donor Filter - standard pediatric blood Expiration time of product clotting factors associated with a clotting factor filter is 24 hours after thawing if Fresh frozen deficiency; with (PT 18, INR > O O, A, B, AB used for Factor VIII plasma (FFP), Preferred needle gauge - 18-24 1.5, or PTT  60) reverse replacement; must be frozen plasma (FP) A A, AB age and patient dependent. excessive anticoagulant therapy; used within 5 days of thawing for other bleeding complications due to B B, AB Rate - TKO x 15 minutes, then indications liver disease as fast as tolerated AB AB

(5-10 mL/min). Do NOT hang longer than 4 hours. Dose is determined based on laboratory assays of Volume - actual volume is printed coagulation function on product bag.

11/2017 Legacy Laboratory Services Page 8 of 18

ORDERED PREPARATION INDICATIONS FOR USE ABO-RH COMPATIBILITY ADMINISTRATION SPECIAL COMPONENT AND CONSIDERATIONS COMPOSITION

Platelet Platelets, plasma, To control or prevent bleeding Recipient Donor Filter - standard pediatric blood Prophylactic pre- small numbers of associated with deficiencies in filter or leukocyte reduction filter transfusion medications apheresis RBCs and WBCs platelet number (count < 5,000 - O O, A, B, AB (per physician order) (e.g., antihistamine and/or 10,000 chronic, < 50,000 preop) acetaminophen) may be A A, AB, O, B or function; not usually effective Preferred needle gauge - 18-24 given to decrease age and patient dependent in conditions of rapid platelet B B, AB, O, A incidence of chills, fever destruction (e.g., ITP and DIC) and allergic reactions; Rate - TKO x 15 minutes, then AB AB, A, B, O repeated transfusions may remaining volume within 20-30 lead to alloimmunization ABO incompatible minutes (5-10 mL/min) to HLA and other antigens platelets can be used if Volume - as ordered and result in development not grossly contaminated of a refractory state with red cells. RH factor manifested by is significant only when unresponsiveness to platelets from Rh+ donor ; are used in a Rh- female expect an increase in of childbearing age (≤50 platelet count from 20,000 years) - 30,000 per pheresis unit

Platelets Same as Same as random-donor platelets; Same as platelet Same as platelet apheresis Prophylactic pre- apheresis used for patients unresponsive to apheresis concentrates concentrates transfusion medications HLA-matched platelets but with random donor platelet may be given; advance some donor HLA concentrates because of HLA scheduling to obtain HLA- antigen in alloimmunization; used for matched platelets is common with patients who have had transplant required; plateletapheresis recipient; product within last year or are scheduled products expire five days is tissue matched for future transplant after collection; HLA typing should be drawn before immunosuppressive therapy is started; all HLA matched platelets must be irradiated

11/2017 Legacy Laboratory Services Page 9 of 18

ORDERED PREPARATION INDICATIONS FOR USE ABO-RH COMPATIBILITY ADMINISTRATION SPECIAL COMPONENT AND CONSIDERATIONS COMPOSITION

Platelets Same as Same as random donor platelets Same as platelet Same as platelet apheresis Advanced scheduling apheresis but used for patients who are apheresis concentrates concentrates required - 24 hours to crossmatched platelets but unresponsive to random donor process and test product; crossmatched with apheresis or HLA matched compatible products not patient’s serum platelet products; platelet always available; HLA antibody screen is positive antibody and platelet antibody screens should be done prior to transfusion; new clot tube specimen required for each order

Cryoprecipitate Factor VIII, von Treatment of hypofibrinogenemia ABO grouping may be Filter - standard pediatric blood Cryoprecipitate is stored Willebrand’s (fibrinogen < 100 mg/dl) and Von disregarded; product has filter frozen and must be (AHF) factor, factor XIII, Willebrand’s disease; may be negligible amounts of thawed prior to use; fibrinogen; product used in hemophilia A but Factor plasma Preferred needle gauge - 18-24 maximum patient benefit if is frozen VIII concentrate preferred age and patient dependent used within 2 hours; one unit (bag) yields a Rate - TKO x 15 minutes, then minimum of 80 units of as fast as tolerated (5-10 Factor VIII and 100-350 mL/min) mg of fibrinogen Volume - as ordered; preparations are reconstituted with NS; total volume is recorded on bag

11/2017 Legacy Laboratory Services Page 10 of 18

ORDERED PREPARATION INDICATIONS FOR USE ABO-RH COMPATIBILITY ADMINISTRATION SPECIAL COMPONENT AND CONSIDERATIONS COMPOSITION

Factor VIII Freeze dried Factor VIII deficiency (hemophilia Not required Filter - filtered during preparation; Product is obtained from Antihemophilic factor VIII A); some of newer concentrates follow package instructions to Pharmacy; each bottle of Factor (AHF) can be used in von Willebrand’s reconstitute at room temperature. AHF is labeled with disease; prepared from pooled Use plastic disposable syringes, activity expressed in Von Willibrand plasma, heat treated as proteins adhere to glass. international units Factor Visually inspect for particulate matter or discoloration prior to There is a risk of (Humate P) administration. Administer within infectious disease 3 hours of reconstitution. Slowly transmission infuse the solution (max rate 4

mL/min) with suitable intravenous administration set. 1 Unit/Kg of Factor VIII should increase plasma Preferred needle gauge - 22-24 Factor VIII level 2 % Volume - 10-30 mL

Factor IX Freeze dried Factor IX deficiency (hemophilia Not required Filter - none required, filtered Product is obtained from concentrations of B), also known as Christmas during preparation by pharmacy. Pharmacy; each bottle of Recombinant factor IX disease factor IX is labeled with coagulation factor For IV use only. Visually inspect activity expressed in IX for particulate matter or international units; risk of discoloration prior to transmission of infectious (Benefit) administration. Administer using disease is reduced, but tubing provided. Adjust the rate not eliminated by of administration based on the processing patient’s comfort level.

unit/Kg of Factor IX should Preferred needle gauge - 20-24 increase plasma Factor IX level 1%. Volume -10-30 mL

11/2017 Legacy Laboratory Services Page 11 of 18

ORDERED PREPARATION INDICATIONS FOR USE ABO-RH COMPATIBILITY ADMINISTRATION SPECIAL COMPONENT AND CONSIDERATIONS COMPOSITION

Normal serum Plasma proteins Hypovolemic shock associated Not applicable Filter - Some products may Product is obtained from available in 5% or with or without acute blood loss; require filtration; refer to package Pharmacy albumin (NSA) 25% 25% cerebral edema; insert. For IV use only. Visually and 5% and cardiopulmonary bypass inspect for particulate matter or There is a risk of plasma protein discoloration prior to infectious disease fraction (PPF) 5% administration. Do not begin transmission administration more than 4 hours Albumin after the container has been entered. Once the transfusion is started it must be completed within 4 hours.

Preferred needle gauge - 18-24 age and patient dependent

Rate - dependent on product, concentration and patient’s condition; see package insert. 5% solution: 1 - 10 cc/minute or more rapidly if patient in shock; 25% solution: 0.2 - 0.4 cc/minute Do NOT hang longer than 4 hours.

Volume - 25% NSA, 50 and 100 mL; 5% NSA, 250 and 500 mL; 5% PPF, 250 and 500 mL.

Peds: 1g/kg = 20 mL/Kg (5% sol.) or 4 mL/Kg (25% sol.)

11/2017 Legacy Laboratory Services Page 12 of 18

ORDERED PREPARATION INDICATIONS FOR USE ABO-RH COMPATIBILITY ADMINISTRATION SPECIAL COMPONENT AND CONSIDERATIONS COMPOSITION

Irradiated blood Irradiated at a Congenital immunodeficiency Product specific; see Product specific; see packed red Crossmatch compatibility products: dose of 25 Gy states: severe combined packed red cells or cells or platelet pheresis and HLA match take (2,500 rads) immunodeficiency syndrome, platelet concentrates administration preference over ABO and RBCs, RBCs thymic hypoplasia, Wiskott- RH for platelets (leukodepleted and Aldrich syndrome, Lenier’s washed), platelets disease, 5’ Nucleotidase deficiency

Infants less than 4 months old:

Neonatal transfusions, intrauterine transfusions, exchange transfusions, cardiac surgery (except ECMO)

Acquired immunodeficiency states: ANC < 500 (any reason),

highly immunosuppressive chemo, BMT (mobilization chemotherapy to 100 days post- transplant, then check with physician)

Other: directed donor products from relatives, any HLA matched platelet product

11/2017 Legacy Laboratory Services Page 13 of 18

Granulocytes Will be irradiated, count below Same as for RBCs since Will be given on several High risk for transfusion (WBCs) usually contain 500l/mL, failure of antibiotic the transfusion will have consecutive days to raise WBC reaction. Patient can some RBCs resolution of bacterial , RBCs count. have a severe transfusion (product will look fever for 24-48 hours reaction to any WBC red) unresponsive to appropriate Product must be Do not use leukopore or transfusion, not just the antibiotic therapy crossmatched microaggregate filter first transfusion

Use standard 170 - 260 micron Shelf life of WBCs after blood filter donor collection is 24 hours Resuspend cells every 30 minutes during transfusion Prophylactic pre- transfusion medications (antihistamine and/or acetaminophen) may be given to decrease the incidence of allergic reactions

Aburetrol should be used when transfusing WBCs if tubing is not compatible with

Patient should be in an intensive care setting. VS to include T, P, R, and BP should be taken before the transfusion, every 15 minutes during the transfusion and at completion of the transfusion

Separate administration of WBC and amphotericn B by at least 6 hours from the completion of one product to the start of the second product

11/2017 Legacy Laboratory Services Page 14 of 18

NEONATAL TRANSFUSION GUIDELINES

ORDERED PREPARATION INDICATIONS FOR USE ABO-RH ADMINISTRATION SPECIAL COMPONENT AND COMPATIBILITY CONSIDERATIONS COMPOSITION

Packed red cells RBCs, 1. <13 g/dl or Recipient Donor Filter - If packaged in a , All packs of RBCs for (RBCs) leukocyte hematocrit 40% in an infant: has been filtered neonates are pre- reduced WBCs (negligible), a. requiring assisted O O by leukodepleted so platelets and ventilation and leukofilter is not required A A, O plasma (minimal) supplemental oxygen Preferred needle gauge – 24 - 26 for transfusion. Standard b. with severe pulmonary gauge and patient dependent filter is still required if the disease, cyanotic heart AB AB, A, B, product has not been disease, or heart Rate - Infuse volume over 2 to 4 B B, O filtered by blood bank NeoRBC28 is failure hours, or as ordered. Start rate at leukoreduced, c. ECMO Rh+ Rh+, Rh- slowest rate possible for first 15 irradiated blood 2. Hemoglobin/hematocrit < 10 minutes and then increase rate product > 5 days < g/dl or 30% Rh- Rh- 28 days a. significant apnea Volume – 10-15 mL/kg or as b. poor weight gain ordered 3. Hemoglobin/hematocrit < 8 g/dl or 24% in stable newborn with clinical manifestations of 4. Acute blood loss > 10% of total blood volume 5. Phlebotomy losses >5-10% of blood volume Red blood cells- RBCs, minimal Decrease risk for alloimmunization Same as RBCs Same as RBCs Expiration time is 24 hours washed WBCs, no plasma, to leukocyte or HLA antigens; after saline wash. no platelets ECMO circuit priming; rarely for Contains viable hyperkalemic patient lymphocytes and can induce GVHD

11/2017 Legacy Laboratory Services Page 15 of 18

ORDERED PREPARATION INDICATIONS FOR USE ABO-RH ADMINISTRATION SPECIAL COMPONENT AND COMPATIBILITY CONSIDERATIONS COMPOSITION

Plasma: Plasma, with 1. PT INR > 1.5, Recipient Donor Filter - standard pediatric blood Expiration time of product clotting factors aPTT>60seconds, or factor filter is 24 hours after thawing if assay<25% and active O O, A, B, AB used for Factor VIII (FFP) bleeding, or anticipated Preferred needle gauge - 24 – 26 replacement; must be A A, AB major surgery/invasive gauge and patient dependent used within 5 days of procedure within 24 hours thawing for other 2. Diffuse microvascular B B, AB Rate - indications. Usual starting bleeding and PT/PTT not AB AB dose is 10 - 15 mL/Kg available Infuse volume over 30 min.-2 hours dependent on patient’s (raises the overall level of 3. Plasma exchange in TTP/HUS (or cryo-poor FP) status. (Usual rates as ordered: clotting factor activity by 4. Emergency reversal of 5 mL/Kg/hr or 2 mL/Kg /hr for 20 - 30 %) bleeding associated with Group AB is preferred for cardiac dysfunction & severe Coumadin anemia). May be pushed in all neonates 5. , certain circumstances deficiency, or ATIII deficiency if purified Volume – 10-15 mL/kg every 12- concentrate not available 24 hrs as indicated 6. Initial stabilization on ECMO circuit

11/2017 Legacy Laboratory Services Page 16 of 18

ORDERED PREPARATION INDICATIONS FOR USE ABO-RH ADMINISTRATION SPECIAL COMPONENT AND COMPATIBILITY CONSIDERATIONS COMPOSITION

Platelet Platelets, plasma, Infants <=37 weeks gestation: ABO compatible Filter -If packaged in a syringe, Prophylactic pre- small numbers of products will be used blood product has been filtered transfusion medications apheresis RBCs and WBCs 1. < 50,000/ul in stable infant by blood bank may be given 2. <100,000/ul in sick infant: a. ECMO Preferred needle gauge - 24 – 26 b. Active bleeding gauge and patient dependent NeoPlt is c. Invasive procedure Leukoreduced, Rate – Infuse volume within 30- CMV negative, Infants>=37 weeks: 60 minutes irradiated 1. <100,000/ul with active Volume – 10-15 mL/ kg or as bleeding ordered 2. <50,000/ul with need for invasive procedure 3. <20,000/ul in non-bleeding patient with failure of platelet production and risk factors such as coagulopathy, sepsis, fever,etc. 4. <20,000 in non-bleeding patient with failure of platelet production 5. Bleeding with qualitative platelet defect regardless of platelet count 6. Diffuse microvascular bleeding following cardiac bypass, regardless of platelet count

11/2017 Legacy Laboratory Services Page 17 of 18

ORDERED PREPARATION INDICATIONS FOR USE ABO-RH ADMINISTRATION SPECIAL COMPONENT AND COMPATIBILITY CONSIDERATIONS COMPOSITION

Cryoprecipitate Factor VIII, von 1. Hypofibrinogenemia Group AB is used for all Filter - standard pediatric blood Cryoprecipitate is stored Willebrand’s (fibrinogen < 100 mg/dl) and: neonates filter If packaged in a syringe, frozen and must be (AHF) factor, factor XIII, a. active bleeding blood product has been filtered thawed prior to use; fibrinogen; product b. anticipated surgery or by blood bank maximum patient benefit if is frozen major invasive procedure used within 2 hours; one 2. Factor XIII deficiency Preferred needle gauge – 24 - 26 unit = 8-12mL total. 3. Uremia with bleeding gauge and patient dependent Yields a minimum of 80 unresponsive to non- units of Factor VIII and mg transfusion therapy Rate - may be given IV push or of 100-350 mg of 4. Fibrin glue infuse volume over 1 hour 5. Active bleeding and fibrinogen Hemophilia A or vWD when Volume - order 1/3 unit for < 1.0 purified factor concentrates Kg infants; 1/2 unit for 1.5 kg, 1 not available unit for Term ECMO patient

Granulocytes

Refer to Pediatric Transfusion Guidelines

Normal serum Plasma proteins 1. Hypoalbunemia Not applicable Filter - Some products may Product is obtained from available in 5% or 2. Cardiopulmonary bypass require filtration; refer to package Pharmacy albumin (NSA) 25% 25% (ECMO) insert. For IV use only. Visually and 5% and plasma 3. No clinical benefit of using inspect for particulate matter or There is a risk of protein fraction albumin over saline for discoloration prior to infectious disease (PPF) 5% administration. Do not begin transmission

administration more than 4 hours Albumin after the container has been entered. Once the transfusion is started it must be completed within 4 hours

Preferred needle gauge - 24 – 26 gauge age and patient dependent

Replacement volume is 10- 20mL/kg/dose

11/2017 Legacy Laboratory Services Page 18 of 18