Introduction to Transfusion: Ordering Blood Products Kathleen Madden MD Department of Pathology

Objectives Highlight key details about Type and Screen Briefly discuss indications for blood product transfusions Review UNMH policy on Emergency release RBCs Describe how to activate the Massive Transfusion Protocol (MTP)

Type and Screen Basics FDA requires two type and screen (T&S) samples to ensure the correct patient before giving type-specific blood. T&S is an automated test that takes 30-60 minutes if no antibodies are present Additional time required to identify any antibodies

Type and Screen Expiration Dates T&S is drawn in a pink or lavender tube Inpatient T&S results are good for 72 hours after the lab is drawn plus whatever time is left in that calendar day until 2359 (midnight).

Ordering Blood Products Prepare vs. Transfuse: Prepare: unit is allocated (set aside) for patient Transfuse: unit is allocated, crossmatched, and issued to the patient so it can be picked up and transfused Can order products for a future date/time → change the date/time when ordering to desired date/time Leukoreduction: all cellular products (RBCs, platelets) are leukoreduced Irradiation: see handout

Blood Components & Indications Plasma Cryoprecipitate Packed RBCs Platelets Bleeding w/INR >1.5 – 2.0 (coagulopathic) Massive hemorrhage Plasma exchange Factor deficiency w/o concentrate Low fibrinogen <10K prevent spontaneous bleed <50K active bleed/major surgery <100K CNS/eye injury/surgery Massive hemorrhage Aspirin/Plavix use with active bleed When not to use plasma: INR >1.5-2 but not bleeding, for volume, as a protein source for nutrition Decreased tissue oxygenation Symptomatic anemia Massive hemorrhage

Why does it seem like it takes so long to get blood products? RBCs may be delayed significantly if the patient has antibodies Plasma takes about 30 minutes to thaw before it can be allocated and issued Platelets only have about 3-3.5 day window to be transfused after collection and before expiration On a good day, we have 7-9 platelets on the shelf Cryoprecipitate takes about 15 minutes to thaw before it can be allocated and issued

UNMH Policy on Emergency Release RBCs As of August 28, 2017, the new Hospital Policy on Emergency Release RBCs by the Hospital’s Transfusion, Tissue, and Autopsy Committee has been in effect O-Negative RBCs Women and girls of childbearing potential should receive RhD negative RBCs Prevents future/current mothers from making anti-D antibodies that can cause HDFN O-Positive RBCs For all males and women who appear greater than 50 years old

Important Points to Remember If Ordering Any Massive Transfusion Protocol You MUST initiate and sign the power plan order to activate the MTP You MUST also call the blood bank (272-2591) to notify them that you are activating the MTP Blood Bank is NOT staffed to run the blood to your location, it must be picked up Please bring the request for blood products slip with at least two patient identifiers on it You may also bring a patient sticker if you don’t have access to the request for blood products slip in an emergency

Remember: If your patient is bleeding and you’re concerned it is already uncontrolled or may become uncontrolled, activate the MTP

Questions?