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

2. 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)

3. 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 minutes if no antibodies are present
Additional time required to identify any antibodies

4. 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).

5. 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

6. 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

7. 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 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

8. 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

9. 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 ( ) 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

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

12. Questions?