Guidelines for Frozen Plasma Transfusion
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Guidelines for Transfusions
Guidelines for Transfu- sion Prepared by: Community Transfusion Committee Lincoln, Nebraska CHAIR: Aina Silenieks, MD MEMBERS: L. Bausch, M.D. R. Burton, M.D. S. Dunder, M.D. D. Voigt, M.D. B. J. Wilson, M.D. COMMUNITY Becky Croner REPRESENTATIVES: Ellen DiSalvo Christa Engel Phyllis Ericson Kelly Gillaspie Pat Gilles Vic Grdina Jessica Henrichs Kelly Jensen Laurel McReynolds Christina Nickel Angela Novotny Kelley Thiemann Janet Wachter Jodi Wikoff Guidelines For Transfusion Community Transfusion Committee INTRODUCTION The Community Transfusion Committee is a multidisciplinary group that meets to monitor blood utilization practices, establish guidelines for transfusion and discuss relevant transfusion related topics. It is comprised of physicians from local hospitals, invited guests, and community representatives from the hospitals’ transfusion services, nursing services, perfusion services, health information management, and the Nebraska Community Blood Bank. These Guidelines for Transfusion are reviewed and revised biannually by the Community Trans- fusion Committee to ensure that the industry’s most current practices are promoted. The Guidelines are the standard by which utilization practices are evaluated. They are also de- signed to provide helpful information to assist physicians to provide appropriate blood compo- nent therapy to patients. Appendices have been added for informational purposes and are not to be used as guidance for clinical decision making. ADULT RED CELLS A. Indications 1. One of the following a. Hypovolemia and hypoxia (signs/symptoms: syncope, dyspnea, postural hypoten- sion, tachycardia, angina, or TIA) secondary to surgery, trauma, GI tract bleeding, or intravascular hemolysis, OR b. Evidence of acute loss of 15% of total blood volume or >750 mL blood loss, OR c. -
27. Clinical Indications for Cryoprecipitate And
27. CLINICAL INDICATIONS FOR CRYOPRECIPITATE AND FIBRINOGEN CONCENTRATE Cryoprecipitate is indicated in the treatment of fibrinogen deficiency or dysfibrinogenaemia.1 Fibrinogen concentrate is licenced for the treatment of acute bleeding episodes in patients with congenital fibrinogen deficiency, including afibrinogenaemia and hypofibrinogenaemia,2 and is currently funded under the National Blood Agreement. Key messages y Fibrinogen is an essential component of the coagulation system, due to its role in initial platelet aggregation and formation of a stable fibrin clot.3 y The decision to transfuse cryoprecipitate or fibrinogen concentrate to an individual patient should take into account the relative risks and benefits.3 y The routine use of cryoprecipitate or fibrinogen concentrate is not advised in medical or critically ill patients.2,4 y Cryoprecipitate or fibrinogen concentrate may be indicated in critical bleeding if fibrinogen levels are not maintained using FFP. In the setting of major obstetric haemorrhage, early administration of cryoprecipitate or fibrinogen concentrate may be necessary.3 Clinical implications y The routine use of cryoprecipitate or fibrinogen concentrate in medical or critically ill patients with coagulopathy is not advised. The underlying causes of coagulopathy should be identified; where transfusion is considered necessary, the risks and benefits should be considered for each patient. Specialist opinion is advised for the management of disseminated intravascular coagulopathy (MED-PP18, CC-PP7).2,4 y Cryoprecipitate or fibrinogen concentrate may be indicated in critical bleeding if fibrinogen levels are not maintained using FFP. In patients with critical bleeding requiring massive transfusion, suggested doses of blood components is 3-4g (CBMT-PP10)3 in adults or as per the local Massive Transfusion Protocol. -
Stem Cells and Artificial Substitutes Could Ease the Dependence on Blood Donations
OUTLOOK BLOOD DOING WITHOUT DONORS Stem cells and artificial substitutes could ease the dependence on blood donations. ANDREW BAKER BY ELIE DOLGIN S12 | NATURE | VOL 549 | 28 SEPTEMBER©2017 Ma c2017millan Publishers Li mited, part of Spri nger Nature. All ri ghts reserved. ©2017 Mac millan Publishers Li mited, part of Spri nger Nature. All ri ghts reserved. BLOOD OUTLOOK ach year, at about 13,000 collection centres worldwide, phlebotomists stick needles in the veins of healthy vol- unteers and amass in excess of 110 million donations of blood. The volume collected is enough to fill 20 Olympic- sized swimming pools — but it’s nowhere near to meeting the medical demand for whole blood or its components. To fill the gap, an enterprising group of stem-cell biologists and bio- Eengineers hopes to produce a safe, reliable and bottomless supply of on-demand blood substitutes in the laboratory. According to Robert Lanza, a pioneer of stem cell therapies and head IMAGES IWM VIA GETTY CHETWYN/ SGT. of global regenerative medicine at Astellas Pharma in Marlborough, Massachusetts, current technologies are not yet ready to compete with the real stuff. “We’re not going to put blood banks out of business any time soon,” he says. But in the near future, artificial blood products could be approved for use when transfusions are not otherwise an option, such as during combat or in people with a religious objection to receiving blood transfusions. And therapies that rely on reprogrammed stem cells to produce components of blood might also help transfusion centres to relieve shortages or to avoid donor-derived contamination. -
Blood Product Replacement: Obstetric Hemorrhage
CMQCC OBSTETRIC HEMORRHAGE TOOLKIT Version 2.0 3/24/15 BLOOD PRODUCT REPLACEMENT: OBSTETRIC HEMORRHAGE Richard Lee, MD, Los Angeles County and University of Southern California Medical Center Laurence Shields, MD, Marian Regional Medical Center/Dignity Health Holli Mason, MD, Cedars-Sinai Medical Center Mark Rollins, MD, PhD, University of California, San Francisco Jed Gorlin, MD, Innovative Blood Resources/Memorial Blood Center, St. Paul, Minnesota Maurice Druzin, MD, Lucile Packard Children’s Hospital Stanford University Jennifer McNulty, MD, Long Beach Memorial Medical Center EXECUTIVE SUMMARY • Outcomes are improved with early and aggressive intervention. • Both emergency blood release and massive transfusion protocols should be in place. • In the setting of significant obstetric hemorrhage, resuscitation transfusion should be based on vital signs and blood loss and should not be delayed by waiting for laboratory results. • Calcium replacement will often be necessary with massive transfusion due to the citrate used for anticoagulation in blood products. • During massive transfusion resuscitation, the patient’s arterial blood gas, electrolytes, and core temperature should be monitored to guide clinical management and all transfused fluids should be warmed; direct warming of the patient should be initiated as needed to maintain euthermia and to avoid added coagulopathy. BACKGROUND AND LITERATURE REVIEW After the first several units of packed red blood cells (PRBCs) and in the face of continuing or worsening hemorrhage, aggressive transfusion therapy becomes critical. This report covers the experience with massive transfusion protocols. Lessons from military trauma units as well as civilian experience with motor vehicle accidents and massive obstetric hemorrhage have identified new principles such as earlier use of plasma (FFP/thawed plasma/plasma frozen within 24 hours/liquid plasma) and resuscitation transfusion while laboratory results are pending. -
Cryosupernatant Plasma
Cryosupernatant Plasma APPLICABILITY: This document applies to Other Names: Cryopoor Plasma AHS, Covenant Health, and all other health Class: Human blood component care professionals involved in the transfusion of blood components and products in Alberta INTRAVENOUS OTHER Intermittent Continuous ROUTES DIRECT IV SC IM OTHER Infusion Infusion Acceptable No Yes No No No N/A Routes* * Professionals performing these restricted activities have received authorization from their regulatory college and have the knowledge and skill to perform the skill competently. DESCRIPTION OF PRODUCT: . Cryosupernatant Plasma (CSP) is prepared from slowly thawed Frozen Plasma that is centrifuged to separate the insoluble cryopreciptate from the plasma. The remaining Cryosupernatant plasma is then refrozen. The approximate volume of a unit is 273 mL . CSP has reduced levels of Factor VIII and von Willebrand Factor (vWF), and does not contain measurable amounts of Factor VIII or fibrinogen. Donors are screened and blood donations are tested for: . ABO/Rh and clinically significant antibodies . Antibodies to human immunodeficiency virus (HIV-1 and HIV-2), hepatitis C virus (HCV), human T-cell lymphotropic virus type I and II (HTLV-I/II), hepatitis B core antigen (HBcore) . Hepatitis B Surface Antigen (HBsAg) . Presence of viral RNA (HIV-1 and HCV) and viral DNA (hepatitis B virus (HBV)) . Syphilis AVAILABILITY: . Not all laboratories/transfusion services stock CSP. Product is stored frozen, and as a result requires preparation time prior to issuing. Patient blood type should be determined when possible to allow for ABO specific/compatible plasma transfusion INDICATIONS FOR USE: . Plasma exchange in patients with Thrombotic Thrombocytopenic Purpura (TTP) or Hemolytic Uremic Syndrome (HUS). -
Platelet-Rich Plasmapheresis: a Meta-Analysis of Clinical Outcomes and Costs
THE jOURNAL OF EXTRA-CORPOREAL TECHNOLOGY Original Article Platelet-Rich Plasmapheresis: A Meta-Analysis of Clinical Outcomes and Costs Chris Brown Mahoney , PhD Industrial Relations Center, Carlson School of Management, University of Minnesota, Minneapolis, MN Keywords: platelet-rich plasmapheresis, sequestration, cardiopulmonary bypass, outcomes, economics, meta-analysis Presented at the American Society of Extra-Corporeal Technology 35th International Conference, April 3-6, 1997, Phoenix, Arizona ABSTRACT Platelet-rich plasmapheresis (PRP) just prior to cardiopulmonary bypass (CPB) surgery is used to improve post CPB hemostasis and to minimize the risks associated with exposure to allogeneic blood and its components. Meta-analysis examines evidence ofPRP's impact on clinical outcomes by integrating the results across published research studies. Data on clinical outcomes was collected from 20 pub lished studies. These outcomes, DRG payment rates, and current national average costs were used to examine the impact of PRP on costs. This study provides evidence that the use of PRP results in improved clinical outcomes when compared to the identical control groups not receiving PRP. These improved clinical out comes result in subsequent lower costs per patient in the PRP groups. All clinical outcomes analyzed were improved: blood product usage, length of stay, intensive care stay, time to extu bation, incidence of cardiovascular accident, and incidence of reoperation. The most striking differences occur in use of all blood products, particularly packed red blood cells. This study provides an example of how initial expenditure on technology used during CPB results in overall cost savings. Estimated cost savings range from $2,505.00 to $4,209.00. -
Guidelines for Transfusion and Patient Blood Management, and Discuss Relevant Transfusion Related Topics
Guidelines for Transfusion and Community Transfusion Committee Patient Blood Management Community Transfusion Committee CHAIR: Aina Silenieks, M.D., [email protected] MEMBERS: A.Owusu-Ansah, M.D. S. Dunder, M.D. M. Furasek, M.D. D. Lester, M.D. D. Voigt, M.D. B. J. Wilson, M.D. COMMUNITY Juliana Cordero, Blood Bank Coordinator, CHI Health Nebraska Heart REPRESENTATIVES: Becky Croner, Laboratory Services Manager, CHI Health St. Elizabeth Mackenzie Gasper, Trauma Performance Improvement, Bryan Medical Center Kelly Gillaspie, Account Executive, Nebraska Community Blood Bank Mel Hanlon, Laboratory Specialist - Transfusion Medicine, Bryan Medical Center Kyle Kapple, Laboratory Quality Manager, Bryan Medical Center Lauren Kroeker, Nurse Manager, Bryan Medical Center Christina Nickel, Clinical Laboratory Director, Bryan Medical Center Rachael Saniuk, Anesthesia and Perfusion Manager, Bryan Medical Center Julie Smith, Perioperative & Anesthesia Services Director, Bryan Medical Center Elaine Thiel, Clinical Quality Improvement/Trans. Safety Officer, Bryan Med Center Kelley Thiemann, Blood Bank Lead Technologist, CHI Health St. Elizabeth Cheryl Warholoski, Director, Nebraska Operations, Nebraska Community Blood Bank Jackie Wright, Trauma Program Manager, Bryan Medical Center CONSULTANTS: Jed Gorlin, M.D., Innovative Blood Resources [email protected] Michael Kafka, M.D., LifeServe Blood Center [email protected] Alex Smith, D.O., LifeServe Blood Center [email protected] Nancy Van Buren, M.D., Innovative -
Blood Products for Neonatal Transfusion
Blood Products for Neonatal Transfusion Transfusion of Red Cell Products A. Red cells for topup transfusion Pedipaks should be used for all red cell topup transfusions in infants. One blood donation is split into four equal volumes (approximately 50ml) and 2 or 4 packs are reserved for an individual baby, depending on weight. The use of pedipaks enables us to minimise patient exposure to multiple donors. Pedipak specifications: • Available in O Positive and O Negative • CMV Negative • Leucocyte Depleted • Suitable for topup transfusion until expiry (42 days from collection) • Commence transfusion within 30 minutes of product receipt Pedipaks and complete transfusion within 4 hours of spiking pack. Volume to be infused: Routine – 15 20ml/Kg over 4 hours. Infants may require IV Frusemide (per RWH Drug Manual) half way through the transfusion – discuss with neonatologist/fellow Emergency – larger volume over shorter time period depending on condition of infant. B. Red cells for Exchange Transfusion Exchange transfusion is generally carried out for hyperbilirubinaemia and/or anaemia usually due to haemolytic disease of the newborn (HDN) or prematurity. ARCBS produces a red cell product specifically for neonatal exchange transfusion. This red cell product has the following specifications: • Group O Negative • Kell negative • CMV negative • Leucocyte Depleted • Fresh (<=5 days) • Known haematocrit (<0.6) • Irradiated at ARCBS (should be transfused within 24 hours of irradiation) • Commence transfusion within 30 minutes of product receipt and complete transfusion within 4 hours of spiking pack. Transfusion of Albumin Volume to be infused: • 4% Albumin as a volume expander. 10 – 20ml/Kg over 30 – 60 minutes • 20% Albumin used for hypoalbuminaemia. -
Blood Product Modifications: Leukofiltration, Irradiation and Washing
Blood Product Modifications: Leukofiltration, Irradiation and Washing 1. Leukocyte Reduction Definitions and Standards: o Process also known as leukoreduction, or leukofiltration o Applicable AABB Standards, 25th ed. Leukocyte-reduced RBCs At least 85% of original RBCs < 5 x 106 WBCs in 95% of units tested . Leukocyte-reduced Platelet Concentrates: At least 5.5 x 1010 platelets in 75% of units tested < 8.3 x 105 WBCs in 95% of units tested pH≥6.2 in at least 90% of units tested . Leukocyte-reduced Apheresis Platelets: At least 3.0 x 1011 platelets in 90% of units tested < 5.0 x 106 WBCs 95% of units tested pH≥6.2 in at least 90% of units tested Methods o Filter: “Fourth-generation” filters remove 99.99% WBCs o Apheresis methods: most apheresis machines have built-in leukoreduction mechanisms o Less efficient methods of reducing WBC content . Washing, deglycerolizing after thawing a frozen unit, centrifugation . These methods do not meet requirement of < 5.0 x 106 WBCs per unit of RBCs/apheresis platelets. Types of leukofiltration/leukoreduction o “Pre-storage” . Done within 24 hours of collection . May use inline filters at time of collection (apheresis) or post collection o “Pre-transfusion” leukoreduction/bedside leukoreduction . Done prior to transfusion . “Bedside” leukoreduction uses gravity-based filters at time of transfusion. Least desirable given variability in practice and absence of proficiency . Alternatively performed by transfusion service prior to issuing Benefits of leukoreduction o Prevention of alloimmunization to donor HLA antigens . Anti-HLA can mediate graft rejection and immune mediated destruction of platelets o Leukoreduced products are indicated for transplant recipients or patients who are likely platelet transfusion dependent o Prevention of febrile non-hemolytic transfusion reactions (FNHTR) . -
Clinical Pharmacology of Infusion Fluids
Clinical pharmacology of infusion fluids Robert G. Hahn Linköping University Post Print N.B.: When citing this work, cite the original article. Original Publication: Robert G. Hahn , Clinical pharmacology of infusion fluids, 2012, Acta Medica Lituanica, (19), 3. Licencee: Lithuanian Academy of Sciences http://www.lmaleidykla.lt/ojs/index.php/actamedicalituanica/index Postprint available at: Linköping University Electronic Press http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-91319 ACTA MEDICA LITUANICA. 2012. Vol. 19. No. 3. P. 210–212 © Lietuvos mokslų akademija, 2012 Clinical pharmacology of infusion fluids Robert G. Hahn Fluids are used for intravenous infusion during practically all surgeries, but several different compositions are available on the market. Södertälje Hospital, Crystalloid fluids comprise lactated or acetated Ringer solutions, nor- Södertälje, Sweden; mal saline, Plasma-Lyte, hypertonic saline, and glucose. They lack allergic Anaesthesia and properties but are prone to cause peripheral tissue oedema. Their turn- Intensive Care, over is governed by physiological factors such as dehydration and drug Linköping University, effects. Sweden Colloid fluids include hydroxyethyl starch, albumin, dextran, and gela- tin. These fluids have various degrees of allergic properties and do not promote peripheral oedema. Their half-life is usually about hours. Factors increasing the turnover rate are poorly known but might include inflam- matory states. Current debates include the widespread use of normal saline, which should be replaced by Ringer’s or Plasma-Lyte in most situations, and the kidney damage associated with the use of starch in septic patients. New studies show that hypertonic saline does not improve survival or neuro- logical damage in prehospital care. -
FDA Regulation of Blood and Blood Components in the United States
FDA Regulation of Blood and Blood Components in the United States SLIDE 1 This presentation will review the FDA Regulation of Blood and Blood Components in the U.S. SLIDE 2 The FDA Center for Biologics Evaluation and Research, or CBER, Office of Blood Research and Review, called OBRR, reviews several different types of regulatory applications with respect to blood and blood components. This includes biologics license applications, called BLAs, which represent the regulatory pathway for blood components. The BLA regulatory process also applies to biological drugs such as fractionated plasma products. OBRR also regulates in-vitro diagnostic devices used for screening of collected blood, and does so also using the BLA regulatory pathway. Review of these devices as biologic licenses allows CBER to apply a higher level of manufacturing oversight, including lot release testing and pre-licensure inspection. This regulatory pathway applies to infectious disease tests for blood screening, as well as blood grouping and phenotyping reagents. SLIDE 3 The regulatory pathway for New Drug Applications, or NDAs, is most commonly used within the Center for Drug Evaluation and Research, or CDER. Within the Office of Blood, several NDA applications are reviewed each year, mostly involving solutions used for the collection of blood, such as anticoagulants and red cell nutritive solutions. Interestingly, a blood bag that does not have a solution inside is regulated as a device. If the bag has a solution, then it is a drug-device combination product, but is regulated as a drug. SLIDE 4 OBRR reviews both Class Two and Class Three devices. Class Three devices in OBRR include diagnostic tests for HIV regulated as pre-market approvals, called PMAs. -
CCEMS Whole Blood Protocol
PROCEDURES 31 Revised 8/2016 Assessment Approved: Levon Vartanian, MD Hemoglobin Assessment Indications Equipment Needed Trauma or medical patient with suspected blood CLIAwaived photometer, alcohol swab, gauze loss pad, lancet, Capillary Transfer Tube, Test cartridges Procedure 1. Make sure the meter is ready for use. Turn meter on, and when the on-screen display indicates, insert the testing strip all the way in. 2. Cleanse site for capillary puncture using alcohol pad and allow to dry. 3. Lance side of fingertip. Blot away first drop of blood. 4. Press gently once again to get a 2nd drop of blood. 5. Place the tip of the capillary collection tube against the drop of blood. DO NOT squeeze capillary collection tube. 6. Allow capillary collection tube to draw up blood to the level of the black line. 7. Apply blood sample to the specimen area on the test strip. It should fill the entire test area with blood. 8. The meter will then read hemoglobin and hematocrit values. 9. Document findings in PCR. Dispose of microcuvette and lancet into sharps container. Pearls • The meter requires a code chip packaged with each box of testing strips. This chip must be inserted on the left hand side of the meter in slot provided. • Only capillary blood may be tested. Do not use arterial or venous blood. • Samples should be immediately tested. • Hematocrit values will not display if hemoglobin values are outside of the range 12.3–17.5 g/Dl. • Meter will read LO if test result is < 4.5 g/Dl OR if insufficient blood was applied.