Blood Products Administration and Monitoring As Attachment #2]
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Legacy Laboratory Services: Blood Banks/Transfusion Services
ADULT TRANSFUSION GUIDELINES [Also found in 915.4282 Blood and Blood Products Administration and Monitoring as Attachment #2]
Always follow patient and blood unit identification protocol. ORDERED PREPARATION INDICATIONS FOR USE ABO-RH ADMINISTRATION SPECIAL COMPONENT AND COMPATIBILITY CONSIDERATIONS COMPOSITION Packed red cells RBCs, WBCs, Increase red cell mass and oxygen Recipient Donor Filter - standard blood filter Expected outcome - (RBCs) platelets & plasma carrying capacity; generally O O Preferred needle gauge - 16-20; increase Hg by one (minimal) indicated when Hgb is 7 gm or Hct A A, O 22 gauge for limited venous gram/unit or Hct 3% 21 unless active cardiac disease is AB AB, A, B, O access present. B B, O Rate – approximately 2 Rh+ Rh+, Rh- mL/minute (120mL/hour) for 1st Rh- Rh- 15 minutes, then increase rate to In some cases Rh+ blood infuse over 1 to 2 hours (150-250 can be given to Rh – mL/hr), or as ordered. Do NOT recipients. hang longer than 4 hours. Volume - 300-350 mL Leukocyte- RBCs, WBCs Same as RBCs plus decreases risk Same as RBCs Filter Same as RBCs Reduced packed (negligible), for alloimmunization to leukocyte or If product is not leukocyte red cells (RBCs) platelets & plasma HLA antigens and CMV reduced, use leukocyte (minimal) transmission; reduces incidence of removal filter. febrile transfusion reactions Otherwise standard blood 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 risk Same as RBCs Same as RBCs Expiration time of unit is 24 washed WBCs, no plasma, for alloimmunization to leukocyte or hours after saline washing; no platelets HLA antigens; reduce incidence of Hct of product is 70-80%; urticarial and anaphylactic reactions contains viable lymphocytes to plasma proteins; only ordered and can induce GVHD when reactions not controllable with meds and leukodepleted products Autologous RBCs, WBCs, and Increase red cell mass and oxygen Complete ABO-Rh Filter - Same as RBCs Same as RBCs; 2 hour blood plasma; patient has carrying capacity compatibility since blood Preferred needle gauge - Same reinfusion is OK unless donated own blood was donated by patient as RBC’s patient is volume sensitive; prior to surgical prior to procedure Rate - Same as RBCs procedure Volume - 200-500 mL Plasma: Plasma, with Hemorrhagic condition associated Recipient Donor Filter - standard blood filter Expiration time of product is Fresh frozen clotting factors with a clotting factor deficiency; with O O, A, B, AB Preferred needle gauge - 18-20 24 hours after thawing: plasma (FFP), (PT 18, INR > 1.5, or PTT 60) A A, AB Rate - TKO x 15 minutes, then usual starting dose is 2-4 frozen plasma reverse excessive anticoagulant B B, AB as fast as tolerated units. (FP) therapy; bleeding complications due AB AB (5-10 mL/min). Do NOT hang to liver disease longer than 4 hours. Volume - actual volume is printed on product bag
Revised 9/2014 Legacy Laboratory Services: Blood Banks/Transfusion Services
ORDERED PREPARATION INDICATIONS FOR USE ABO-RH ADMINISTRATION SPECIAL COMPONENT AND COMPATIBILITY CONSIDERATIONS COMPOSITION Platelet Platelets, plasma, To control or prevent bleeding Recipient Donor Filter - standard blood filter or Prophylactic pre-transfusion pheresis small numbers of associated with deficiencies in O O, A, B, AB leukocyte reduction filter (per medications (e.g., RBCs and WBCs platelet number (count < 5,000 - A A, AB, O, B physician order). antihistamine and/or 10,000 chronic, < 50,000 preop) or B B, AB, O, A Preferred needle gauge - 20-22 acetaminophen) may be function; not usually effective in AB AB, A, B, O Rate - TKO - first 15 minutes, ordered to decrease conditions of rapid platelet ABO incompatible then remaining volume within 20- incidence of chills, fever and destruction (e.g., ITP and DIC). platelets can be used if 30 minutes (5-10 mL/min). May allergic reactions; one unit of not grossly contaminated be placed on infusion device if pheresis platelets should with red cells. RH factor ordered over a specific amount increase platelet count by is significant only when of time. 20,000 to 30,000/ul platelets from Rh+ donor Volume -. Approximately 270 mL. are used in an Rh- female (< 50 years). Platelets Same as pheresis Same as random-donor platelets; Same as platelet pheresis Same as platelet pheresis Advance scheduling to HLA-matched platelets but product used for patients unresponsive to concentrates concentrates obtain HLA-matched is tissue matched random donor platelet concentrates platelets is required; all HLA because of HLA alloimmunization; matched platelets must be used for patients who have had irradiated transplant within last year or are scheduled for future transplant Platelets Same as pheresis Same as random donor platelets Same as platelet pheresis Same as platelet pheresis 24 hour advanced crossmatched platelets but but used for patients who are concentrates concentrates scheduling required; new crossmatched with unresponsive to random donor clot tube specimen required patient’s serum pheresis or HLA matched platelet for each order products; platelet antibody screen is positive Cryoprecipitate Factor VIII, von Treatment of hypofibrinogenemia ABO grouping may be Filter - standard blood filter Maximum patient benefit if (AHF) Willebrand’s factor, (fibrinogen < 100 mg/dl) and Von disregarded; product has Preferred needle gauge - 18-22 used within 2 hours; usual factor XIII, Willebrand’s disease; may be used negligible amounts of Rate - TKO x 15 minutes, then starting dose for fibrinogen; product in hemophilia A but Factor VIII plasma as fast as tolerated (5-10 hypofibrinogenemia is 10 is frozen concentrate preferred. One unit mL/min) units yields 100-350 mg of 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 (hemophilia Not required Filter - filtered during preparation; Product is obtained from (antihemophilic VIII A); some products can be used in follow package instructions to Pharmacy; each bottle of factor) von Willebrand’s disease reconstitute. AHF is labeled with activity Preferred needle gauge - 22-24 expressed in international Rate – over 5 –10 minutes; if units; there is a risk of patient complains of headache, transmission of infectious flushing, or changes in pulse disease rate, slow infusion; if symptoms do not subside, discontinue and notify physician Volume - 10-30 mL
Revised 9/2014 Legacy Laboratory Services: Blood Banks/Transfusion Services
ORDERED PREPARATION INDICATIONS FOR USE ABO-RH ADMINISTRATION SPECIAL COMPONENT AND COMPATIBILITY CONSIDERATIONS COMPOSITION Factor IX Freeze dried Factor IX deficiency (hemophilia B), Not required Filter - Same as Factor VIII Product is obtained from concentrations of also known as Christmas disease Preferred needle gauge - 22-24 Pharmacy; each bottle of factor IX Rate - slow IV injection or factor IX is labeled with infusion; activity expressed in Volume - 10-30 mL international units Normal serum Plasma proteins Hypovolemic shock associated with Not applicable Filter - none required Product is obtained from albumin (NSA) available in 5% or or without acute blood loss; Preferred needle gauge - 18-20 Pharmacy 25% and 5% 25% cerebral edema; cardiopulmonary Rate - dependent on product, and plasma bypass concentration and patient’s protein fraction condition; see package insert. (PPF) 5% 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 Irradiated blood Irradiated at a dose Congenital immunodeficiency Product specific; see Product specific; see packed red Crossmatch compatibility products: of 25 Gy (2,500 states: severe combined packed red cells or cells or platelet pheresis and HLA match take RBCs, RBCs rads) immunodeficiency syndrome, platelet concentrates administration preference over ABO and (leukodepleted thymic hypoplasia, Wiskott-Aldrich RH for platelets. and washed), syndrome, Lenier’s disease, 5’ platelets 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
Revised 9/2014 Legacy Laboratory Services: Blood Banks/Transfusion Services
PEDIATRIC TRANSFUSION GUIDELINES [Also found in 915.4282 Blood and Blood Products Administration and Monitoring as Attachment #3]
Always follow patient and blood unit identification protocol. ORDERED PREPARATION INDICATIONS FOR USE ABO-RH COMPATIBILITY ADMINISTRATION SPECIAL COMPONENT AND CONSIDERATIONS COMPOSITION Packed red cells RBCs, Increase red cell mass and oxygen Recipient Donor Filter - standard pediatric blood All pediatric packs of RBCs (RBCs) WBCs (negligible), carrying capacity; generally O O filter are pre-storage leukocyte platelets and indicated when Hgb is 8 gm or Hct A A, O Preferred needle gauge - 18-24 leukodepleted so leukofilter reduced plasma (minimal) 24 AB AB, A, B, O age and patient dependent. is not required for Decrease risk for alloimmunization B B, O Rate - TKO x 15 minutes, then transfusion. to leukocyte or HLA antigens and Rh+ Rh+, Rh- infuse remaining volume over 1 CMV transmission; reduce Rh- Rh- to 2 hours, or as ordered. Each mL/Kg given should incidence of febrile transfusion In some cases Rh+ blood Transfusion time is approximately increase the hematocrit by reactions. can be given to Rh – 2-5 mL/Kg hr for children Do 1% or 10mL/Kg should raise recipients NOT hang longer than 4 hours. the Hgb 3g/dL Volume - as ordered. Maximum dose for single transfusion is 15 mL/Kg Red blood cells- RBCs, minimal Same as RBCs plus decrease risk Same as RBCs Same as RBCs Expiration time of unit is 24 washed WBCs, no plasma, for alloimmunization to leukocyte or hours after saline washing; no platelets HLA antigens; reduce incidence of Hct of product is 70-80%; urticarial and anaphylactic reactions contains viable lymphocytes to plasma proteins; only ordered and can induce GVHD when reactions not controllable with meds and leukodepleted products Autologous RBCs, WBCs, and Increase red cell mass and oxygen Complete ABO-Rh Filter - standard pediatric blood Same as RBCs; 2 hour blood plasma; patient has carrying capacity compatibility since blood filter reinfusion is OK unless donated own blood was donated by patient Preferred needle gauge - 18-24 patient is volume sensitive; prior to surgical prior to procedure age and patient dependent. procedure 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 clotting Hemorrhagic condition associated Recipient Donor Filter - standard pediatric blood Expiration time of product is Fresh frozen factors with a clotting factor deficiency; with O O, A, B, AB filter 24 hours after thawing if plasma (FFP), (PT 18, INR > 1.5, or PTT 60) A A, AB Preferred needle gauge - 18-24 used for Factor VIII frozen plasma reverse excessive anticoagulant B B, AB age and patient dependent. replacement; must be used (FP) therapy; bleeding complications due AB AB Rate - TKO x 15 minutes, then as within 5 days of thawing for to liver disease fast as tolerated other indications. (5-10 mL/min). Do NOT hang longer than 4 hours. Dose is determined based Volume - actual volume is printed on laboratory assays of on product bag. coagulation function
Revised 9/2014 Legacy Laboratory Services: Blood Banks/Transfusion Services
ORDERED PREPARATION INDICATIONS FOR USE ABO-RH COMPATIBILITY ADMINISTRATION SPECIAL COMPONENT AND CONSIDERATIONS COMPOSITION Platelet pheresis Platelets, plasma, To control or prevent bleeding Recipient Donor Filter - standard pediatric blood Prophylactic pre-transfusion small numbers of associated with deficiencies in O O, A, B, AB filter or leukocyte reduction filter medications (e.g., RBCs and WBCs platelet number (count < 5,000 - A A, AB, O, B (per physician order) antihistamine and/or 10,000 chronic, < 50,000 preop) or B B, AB, O, A Preferred needle gauge - 18-24 acetaminophen) may be function; not usually effective in AB AB, A, B, O age and patient dependent given to decrease incidence conditions of rapid platelet ABO incompatible Rate - TKO x 15 minutes, then of chills, fever and allergic destruction (e.g., ITP and DIC). platelets can be used if remaining volume within 20-30 reactions; repeated not grossly contaminated minutes (5-10 mL/min) transfusions may lead to with red cells. RH factor Volume - as ordered alloimmunization to HLA and is significant only when other antigens and result in platelets from Rh+ donor development of a refractory are used in an Rh- female state manifested by of childbearing age (< 50 unresponsiveness to platelet years). transfusion; expect an increase in platelet count from 20,000 - 30,000 per pheresis unit Platelets Same as pheresis Same as random-donor platelets; Same as platelet pheresis Same as platelet pheresis Prophylactic pre-transfusion HLA-matched platelets but with used for patients unresponsive to concentrates concentrates medications may be given; some donor HLA random donor platelet concentrates advance scheduling to antigen in common because of HLA alloimmunization; obtain HLA-matched with recipient; used for patients who have had platelets is required; product is tissue transplant within last year or are plateletpheresis products matched scheduled for future transplant expire five days after collection; HLA typing should be drawn before immunosuppressive therapy is started; all HLA matched platelets must be irradiated Platelets Same as pheresis Same as random donor platelets but Same as platelet pheresis Same as platelet pheresis Advanced scheduling crossmatched platelets but used for patients who are concentrates concentrates required - 24 hours to crossmatched with unresponsive to random donor process and test product; patient’s serum pheresis or HLA matched platelet compatible products not products; platelet antibody screen is always available; HLA positive antibody and platelet antibody screens should be done prior to transfusion; new clot tube specimen required for each order
Revised 9/2014 Legacy Laboratory Services: Blood Banks/Transfusion Services
ORDERED PREPARATION INDICATIONS FOR USE ABO-RH COMPATIBILITY ADMINISTRATION SPECIAL COMPONENT AND CONSIDERATIONS COMPOSITION Cryoprecipitate Factor VIII, von Treatment of hypofibrinogenemia ABO grouping may be Filter - standard pediatric blood Cryoprecipitate is stored (AHF) Willebrand’s factor, (fibrinogen < 100 mg/dl) and Von disregarded; product has filter frozen and must be thawed factor XIII, Willebrand’s disease; may be used negligible amounts of Preferred needle gauge - 18-24 prior to use; maximum fibrinogen; product in hemophilia A but Factor VIII plasma age and patient dependent patient benefit if used within is frozen concentrate preferred. Rate - TKO x 15 minutes, then as 2 hours; one unit (bag) yields fast as tolerated (5-10 mL/min) a minimum of 80 units of Volume - as ordered; Factor VIII and 100-350 mg preparations are reconstituted of fibrinogen. with NS; total volume is recorded on bag Factor VIII Freeze dried factor Factor VIII deficiency (hemophilia Not required Filter - filtered during preparation; Product is obtained from (antihemophilic VIII A); some of newer concentrates can follow package instructions to Pharmacy; each bottle of factor) be used in von Willebrand’s reconstitute. AHF is labeled with activity disease; prepared from pooled Preferred needle gauge - 22-24 expressed in international plasma, heat treated Rate - over 5 - 15 minutes; if units; there is a risk of patient complains of headache, transmission of infectious flushing, or changes in pulse disease rate, slow infusion; if symptoms do not subside, discontinue and 1 Unit/Kg of Factor VIII notify physician should increase plasma Volume - 10-30 mL Factor VIII level 2 % Factor IX Freeze dried Factor IX deficiency (hemophilia B), Not required Filter - none required, filtered Product is obtained from concentrations of also known as Christmas disease during preparation by pharmacy Pharmacy; each bottle of factor IX Preferred needle gauge - 20-24 factor IX is labeled with Rate - slow IV injection or activity expressed in infusion; if patient complains of international units; risk of headache, flushing, or changes transmission of infectious in pulse rate, slow infusion; if disease is reduced, but not symptoms do not subside, eliminated by processing discontinue and notify physician Volume -10-30 mL unit/Kg of Factor IX should increase plasma Factor IX level 1%.
Revised 9/2014 Legacy Laboratory Services: Blood Banks/Transfusion Services
ORDERED PREPARATION INDICATIONS FOR USE ABO-RH COMPATIBILITY ADMINISTRATION SPECIAL COMPONENT AND CONSIDERATIONS COMPOSITION Normal serum Plasma proteins Hypovolemic shock associated with Not applicable Filter - none required Product is obtained from albumin (NSA) available in 5% or or without acute blood loss; cerebral Preferred needle gauge - 18-24 Pharmacy 25% and 5% and 25% edema; cardiopulmonary bypass age and patient dependent plasma protein Rate - dependent on product, fraction (PPF) concentration and patient’s 5% 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.) Irradiated blood Irradiated at a dose Congenital immunodeficiency Product specific; see Product specific; see packed red Crossmatch compatibility products: of 25 Gy (2,500 states: severe combined packed red cells or cells or platelet pheresis and HLA match take RBCs, RBCs rads) immunodeficiency syndrome, thymic platelet concentrates administration preference over ABO and (leukodepleted hypoplasia, Wiskott-Aldrich RH for platelets. and washed), syndrome, Lenier’s disease, 5’ platelets 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
Revised 9/2014 Legacy Laboratory Services: Blood Banks/Transfusion Services
ORDERED PREPARATION INDICATIONS FOR USE ABO-RH COMPATIBILITY ADMINISTRATION SPECIAL COMPONENT AND CONSIDERATIONS COMPOSITION Granulocytes Will be irradiated, Granulocyte count below 500l/mL, Same as for RBCs since Will be given on several High risk for transfusion (WBCs) usually contain failure of antibiotic resolution of the transfusion will have consecutive days to raise WBC reaction. Patient can have a some RBCs bacterial sepsis, fever for 24-48 RBCs. count. severe transfusion reaction (product will look hours unresponsive to appropriate Do not use leukopore or to any WBC transfusion, not red) antibiotic therapy. microaggregate filter. just the first transfusion. Use standard 170 - 260 micron Shelf life of WBCs after blood filter donor collection is 24 hours. Resuspend cells every 30 Prophylactic pre-transfusion minutes during transfusion medications (antihistamine and/or acetaminophen) may be given to decrease the incidence of allergic reactions. A buretrol should be used when transfusing WBCs if blood transfusion tubing is not compatible with infusion pump. 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.
Revised 9/2014 Legacy Laboratory Services: Blood Banks/Transfusion Services
NEONATAL TRANSFUSION GUIDELINES [Also found in 915.4282 Blood and Blood Products Administration and Monitoring as Attachment #4]
Always follow patient and blood unit identification protocol. ORDERED PREPARATION INDICATIONS FOR USE ABO-RH ADMINISTRATION SPECIAL COMPONENT AND COMPATIBILITY CONSIDERATIONS COMPOSITION Packed red cells RBCs, 1. Hemoglobin <13 g/dl or hematocrit Recipient Donor Filter - If packaged in a syringe, All packs of RBCs for (RBCs) WBCs (negligible), 40% in an infant: O A O blood product has been filtered neonates are pre leukocyte platelets and a. requiring assisted AB A, O by blood bank. leukodepleted so leukofilter reduced plasma (minimal) ventilation and AB, A, B, Preferred needle gauge – 24 - is not required for supplemental oxygen B O 26 gauge and patient transfusion. Standard filter NeoRBC28 is b. with severe pulmonary Rh+ B, ORh+, dependent. is still required if the leukoreduced, disease, cyanotic heart Rh- Rh- Rate - Infuse volume over 2 to 4 product has not been irradiated blood disease, or heart failure Rh- hours, or as ordered. Start rate filtered by blood bank. product > 5 days < c. ECMO at slowest rate possible for first 28 days 2. Hemoglobin/hematocrit < 10 g/dl 15 minutes and then increase or 30% rate. 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 anemia. All NeoRBC products are 4. Acute blood loss > 10% of total O neg blood volume. 5. Phlebotomy losses >5-10% of blood volume. Red blood cells- RBCs, minimal Decrease risk for alloimmunization to Same as RBCs Same as RBCs Expiration time is 24 hours washed WBCs, no plasma, leukocyte or HLA antigens; ECMO after saline wash. Contains no platelets circuit priming; rarely for hyperkalemic viable lymphocytes and can patient induce GVHD Plasma: Plasma, with 1. PT INR > 1.5, aPTT>60seconds, Recipient Donor Filter - standard pediatric blood Expiration time of product Fresh frozen clotting factors or factor assay<25% and active O O, A, B, filter is 24 hours after thawing if plasma (FFP) bleeding, or anticipated major AB Preferred needle gauge - 24 – used for Factor VIII surgery/invasive procedure within A A, AB 26 gauge and patient replacement; must be used 24 hours. B B, AB dependent. within 5 days of thawing for 2. Diffuse microvascular bleeding AB AB Rate - other indications. Usual and PT/PTT not available. Infuse volume over 30 min.-2 starting dose is 10 - 15 3. Plasma exchange in TTP/HUS (or hours dependent on patient’s mL/Kg (raises the overall cryo-poor FP) status. (Usual rates as ordered: level of clotting factor 4. Emergency reversal of bleeding Group AB is preferred for 5 mL/Kg/hr or 2 mL/Kg /hr for activity by 20 - 30 %) associated with Coumadin. all neonates cardiac dysfunction & severe 5. Protein C, protein S deficiency, or anemia). May be pushed in ATIII deficiency if purified certain circumstances. concentrate not available. Volume – 10-15 mL/kg every 6. Initial stabilization on ECMO 12-24 hrs as indicated circuit.
Revised 9/2014 Legacy Laboratory Services: Blood Banks/Transfusion Services
ORDERED PREPARATION INDICATIONS FOR USE ABO-RH ADMINISTRATION SPECIAL COMPONENT AND COMPATIBILITY CONSIDERATIONS COMPOSITION Platelet Platelets, plasma, Infants <=37 weeks gestation: ABO compatible products Filter -If packaged in a syringe, Prophylactic pre- pheresis small numbers of 1. < 50,000/ul in stable infant will be used. blood product has been filtered transfusion medications RBCs and WBCs 2. <100,000/ul in sick infant: by blood bank. may be given; a. ECMO Preferred needle gauge - 24 – NeoPlt is b. Active bleeding 26 gauge and patient Leukoreduced, c. Invasive procedure dependent CMV negative, Rate – Infuse volume within irradiated Infants>=37 weeks: 30-60 minutes 1. <100,000/ul with active bleeding. Volume – 10-15 mL/ kg or as 2. <50,000/ul with need for invasive ordered 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. Cryoprecipitate Factor VIII, von 1. Hypofibrinogenemia (fibrinogen < Group AB is used for all Filter - standard pediatric blood Cryoprecipitate is stored (AHF) Willebrand’s factor, 100 mg/dl)and: neonates. filter If packaged in a syringe, frozen and must be thawed factor XIII, a. active bleeding blood product has been filtered prior to use; maximum fibrinogen; product b. anticipated surgery or major by blood bank. patient benefit if used is frozen invasive procedure Preferred needle gauge – 24 - within 2 hours; one unit = 8- 2. Factor XIII deficiency. 26 gauge and patient 12mL total. Yields a 3. Uremia with bleeding dependent minimum of 80 units of unresponsive to non-transfusion Rate - may be given IV push or Factor VIII and mg of 100- therapy. infuse volume over 1 hour 350 mg of fibrinogen. 4. Fibrin glue Volume - order 1/3 unit for < 1.0 5. Active bleeding and Hemophilia A Kg infants; 1/2 unit for 1.5 kg, 1 or vWD when purified factor unit for Term ECMO patient concentrates not available. Granulocytes: Refer to Pediatric Transfusion Guidelines
Revised 9/2014 Legacy Laboratory Services: Blood Banks/Transfusion Services
ORDERED PREPARATION INDICATIONS FOR USE ABO-RH ADMINISTRATION SPECIAL COMPONENT AND COMPATIBILITY CONSIDERATIONS COMPOSITION Normal serum Plasma proteins 1. Hypoalbunemia Not applicable Filter - none required Product is obtained from albumin (NSA) available in 5% or 2. Cardiopulmonary bypass (ECMO) Preferred needle gauge - 24 – Pharmacy 25% and 5% 25% 3. No clinical benefit of using albumin 26 gauge and patient and plasma over saline for hypovolemia dependent Product in short supply, protein fraction Rate - dependent on product, may no longer be available (PPF) 5% concentration and patient’s in future. condition; Volume - 25% NSA, 50 and 100 mL; 5% NSA, 250 and 500 mL; 5% PPF, 250 and 500 mL Replacement volume is 10- 20mL/kg/dose.
Revised 9/2014