How to administer Red Cells - Quick Guide

Presentation *

• Resuspended Red Cells - 220-340mL
• Paediatric Packs - each donation is divided into 4 paediatric doses - 55-85mL
• Haematocrit-adjusted blood is used for neonatal exchange transfusions and intrauterine transfusion
• Whole Blood - 405-513mL
• 

• ABO & RhD Compatibility

• ABO

• a group O patient can receive only group O red cells
• a group A patient can receive group A or O red cells
• a group B patient can receive group B or O red cells
• a group AB patient can receive group AB, A, B or O red cells
  
• ABO incompatible transfusions can be fatal. Always check the the red cells against the patient at the bedside. Rh(D)
• Transfusion of red cells are normally Rh(D) identical
• Rh(D) negative red cells may be given to Rh(D) positive recipients without creating any risk for immunisation
• In life threatening emergencies, Rh(D) positive cells may be given to an Rh(D) negative recipient but there is a risk that this will stimulate the production of anti-D. The Blood Bank will provide guidance. The Clinician must be notified.
• Rh(D) positive red cells may be provided by the Blood Bank for males, and for females beyond reproductive years, if supplies of Rh(D) negative red cells are low.

• Storage

• Must be stored in an appropriately monitored (2-6°C) blood refrigerator according to Blood Bank standards. Never store in a drug or food fridge.
• If the transfusion can not be started within 30 minutes, return the component to the Blood Bank immediately for appropriate storage.

• Filter

• Use a standard blood infusion set that has a 170-200 micron filter.
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• All fresh components, including FFP and cryoprecipitate, are leucodepleted at source by NZBS. No bedside leucodepletion is necessary.

• Pump

• If necessary, approved infusion pump devices may be used.

• Rate and Duration

• Paediatrics:
• top-up transfusion in a non-bleeding patient is typically given at 5mL/kg/hr
• exchange transfusion: depends on stability of the baby - discuss with NICU consultant
• resuscitation: rapid infusion based on the patient's haemodynamics
• Adults:
• top-up transfusion in a non-bleeding patient: most adults will tolerate one unit every 90 minutes. Consider a slower rate in patients with or at risk of congestive cardiac failure
• resuscitation: rapid infusion based on the patient's haemodynamics
• Infusion of all components should be completed within 4 hours of leaving refrigerated storage.
• • Monitoring See page on ?>Observations

• DO NOT

• DO NOT add medication to red cell components
• DO NOT use 5% Dextrose solutions (may induce haemolysis)
• DO NOT use Lactated Ringer's or other balanced salt solutions that contain Calcium, as this may induce clot formation in the blood bag and / or administration set.

• Dose

• 4-5mL/kg will raise the patient's Haemoglobin level by approximately 10g/L.
• It is recommended that the patient's haemoglobin be checked between units if giving multiple units.
• For paediatric patients, the dose should be written in mL, not units.

• Dose calculator

• This calculator will compute the number of units of adult red cells your patient may need.
• Patient's weight (kg)
• Current haemoglobin (g/L)
• Desired haemoglobin (g/L)
• Approximate no. of mL of red cells needed
• No. of adult units of red cells needed (± 275mL)
  or
• No. of paediatric units of red cells needed (± 70mL)
• Comment

• More Info

• ?>Patient Information Leaflet
• Datasheets
• {{tdata('TMH location}
• ANZSBT Guidelines on how to administer blood products
• <a href="https://www.nzblood.co.nz/assets/Transfusion-Medicine/PDFs/111I165.pdf" target=_blank">TACO Pre-Transfusion Risk Assessment Tool
• NZBS policy on the provision of CMV antibody negative blood components
• NZBS policy on the use of fresh blood
• NZBS Clinical Compendium
• Patient Blood Management guidelines