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University of Virginia Medical Center (UVaMC)

Clinical Practice Guidelines


Transfusion Guidelines
A transfusion medicine physician is always available for consultation and may be reached by calling the Blood Bank
and Transfusion Medicine Services (BBTMS) at 924-2273. More information is available at the BBTMS website:
http://www.healthsystem.virginia.edu/pub/medlabs/lab-handbook-test-directory/labgeneral/labspecific/bloodbank.html/?searchterm=blood bank

Guidelines are general and cannot take into account all of the circumstances of a particular patient. Judgment regarding
the propriety of using any specific procedure or guideline with a particular patient remains with that patients physician,
nurse, or other health care professional, taking into account the individual circumstances presented by the patient.

SECTION INDEX
Transfusion Consent
UVa Health System Blood Product Transfusion Audit Criteria
Transfusion Needs for Special Populations
Transfusion Reactions
Frequently Asked Questions (FAQ topics: compatibility, turn-around-times, blood alert, adjunct treatment for
anticoagulant reversal, platelet refractoriness, cryoprecipitate dose, and operating room storage
requirements)

Transfusion Consent
Informed Consent for Blood Product Transfusion
Required for RBC, plasma (FFP, FP24, thawed plasma, cryopoor plasma), Cryoprecipitate, Platelets
Obtained by MD, DO, PA, or NP and witnessed.
Requires discussion of risks, benefits, alternatives (with associated risks and benefits), an opportunity to ask questions with
provision of answers, and final decision whether to proceed or refuse the transfusion.
Be sure that I do or I do not consent has been checked off on the completed consent form.
Caution: form includes option I do not consent (e.g., Jehovahs Witnesses).
Additional UVaMC informed consent is available from the Clinical Portal under Policies and Procedures:
For more information about informed consent criteria see Medical Center Policy Manual, Chapter VIII, Section 2: Policy
0024 Informed Decision-making:
http://www.healthsystem.virginia.edu/docs/manuals/policies/mc/A70A3C0F-110A-2E68-14CB7CA516FAE39D/A70A4045-1
10A-2E68-14F10CE9F86EB918/A70A5718-110A-2E68-145AA803FC022180
For the consent form see Forms & Documentation, Forms, Clinical Care Forms, 2: Consents, Section 1: Consents - Form
033025A Blood Transfusion Consent or Refusal:
http://www.healthsystem.virginia.edu/docs/manuals/forms/clinicalforms/0B7E95A8-110A-2E68-14497C0832531598

Current Transfusion Transmitted Disease Rates


Etiology
HIV (Human immunodeficiency virus)
HCV (Hepatitis C virus)
HBV (Hepatitis B virus)
HTLV (Human T-lymphotropic virus)
TRALI (transfusion related acute lung injury)

Bacterial contamination of Apheresis Platelets


West Nile Virus (WNV)

Approximate Transfusion Risk*


1 per 1.4 million
1 per 1.1 million
1 per 765,000 to 1.01 million
1 per 2.36 million
RBC: 1 per 25,000
Plasma: 1 per 4,000 to 12,000
Apheresis Platelets: 1 per 100,000
1 per 109,000
Risk varies by year, location and season

References
1. HIV & HCV: Zou S, Dorsey KA, Notari EP, Foster GA, Krysztof DE, Musavi F, Dodd RY, et al. Prevalence, incidence, and residual risk of human immunodeficiency
virus and hepatitis C virus infections among United States blood donors since the introduction of nucleic acid testing. Transfusion 2010;50:1495-1504.
2. HBV: Stramer SL, Notari EP, Krysztof DE, Dodd RY. Hepatitis B virus testing by minipool nucleic acid testing: Does it improve blood safety? Transfusion. 2013;
53:2449-58.
3. HTLV: Stramer SL, Notari EP 4th, Zou S, Krysztof DE, Brodsky JP, Tegtmeier GE, Dodd RY. Human T-lymphotropic virus antibody screening of blood donors:
rates of false-positive results and evaluation of a potential donor reentry algorithm. Transfusion 2011;51:692-701.
4. TRALI: Eder AF, Herron RM,Jr, Strupp A, et al. Effective reduction of transfusion-related acute lung injury risk with male-predominant plasma strategy in the
American Red Cross (2006-2008). Transfusion. 2010; 50:1732-1742.
Guidelines are general and cannot take into account all of the circumstances of a particular patient. Judgment regarding the propriety of using any
specific procedure or guideline with a particular patient remains with that patients physician, nurse, or other health care professional, taking into account
the individual circumstances presented by the patient.
Original: 02/06 Revised: 7/2014 Approved: Transfusion Committee 8/14/2014 Approved: Patient Care Committee 11/6/14
Page 1 of 10

University of Virginia Medical Center (UVaMC)


Clinical Practice Guidelines
Transfusion Guidelines
A transfusion medicine physician is always available for consultation and may be reached by calling the BBTMS
at 924-2273. More information is available at the BBTMS website:
http://www.healthsystem.virginia.edu/pub/medlabs/lab-handbook-test-directory/labgeneral/labspecific/bloodbank.html/?searchterm=blood bank
Toy P, Gajic O, Bacchetti P, et al. Transfusion-related acute lung injury: Incidence and risk factors. Blood. 2012; 119:1757-1767.
5. Bacterial contamination: Eder AF, Kennedy JM, Dy BA, Notari EP, Skeate R, Bachowski G, Mair DC, et al. Limiting and detecting bacterial contamination of
apheresis platelets: inlet-line diversion and increased culture volume improve component safety. Transfusion 2009;49:1554-1563.

Autologous and Patient Selected (Directed) Blood Donations


Please contact Virginia Blood Services at (800) 989-4438 for detailed information and/or the BBTMS physician.
Keep in mind adequate lead time is necessary and there are specific criteria for these donors to give blood.
Physician order is required

UVa Health System Blood Product Transfusion Audit Criteria

These criteria are used by the Transfusion Medicine Committee for targeted blood utilization audits.
Many patients who meet the criteria may not require transfusion.
Similarly, a few patients who do not meet the criteria may experience a benefit from transfusion.
These are not meant as a substitute for clinical judgment.
Please call the BBTMS physicians at any time for consults and/or to answer questions.

Key
Hgb = hemoglobin
FFP = Fresh Frozen Plasma
Hct = hematocrit
FP24 = Plasma Frozen Within 24 Hours
Plt = Platelets
TP = Thawed Plasma
RBC = Red Blood Cells
Neonate = up to 4 months old
CNS = central nervous system
ECMO = extracorporeal membrane oxygenation

Blood
Product

Red Blood
Cells
(shelf life
35-42 days)

Dose

Response

Criteria

Adult dose:
1 unit

Adult dose:
Increases Hgb 1g/dL
(Hct 3%)

Pediatric dose:
10-15mL/kg up to
15-20kg total body
weight
Then use adult dosing

Pediatric dose:
Variable depending
on patients blood
volume and amount
transfused

Adult and Pediatric:


Hgb < 8g/dL (Hct < 25%)
Acute blood loss > 20% of total blood volume
Hgb < 10g/dL (Hct < 30%) & coronary or cerebral vascular
disease
Hct < 30% & > 10% body surface area burns
SCT patients:
Hgb < 8g/dL give 2 RBC
Hgb < 9g/dL, signs, & symptoms, give 2 RBC
Neonate:
Hct < 30%
Hct < 40% & respiratory distress
Blood loss > 10% of total blood volume
Hct < 40% on ECMO
Hct < 45% on ECMO & bleeding
Adult and Pediatric:
Plt < 10,000 - 20,000/L
Plt < 50,000/L & bleeding
Plt < 50,000/L & immediately prior to invasive
procedure
Plt < 100,000/L & CNS or retinal bleeding
Plt < 100,000/L & immediately prior to invasive CNS or
retinal procedure
Platelet dysfunction (e.g. documented aspirin)
Patient has received > 1 blood volume of fluids, including
transfusions, within past 24 hours

Neonate dose:
5-15mL/kg

Platelets
(shelf life 5
days)

SCT = stem cell transplant


mL = milliliter
g = gram
dL = deciliter
kg = kilogram
L = microliter
HLA = human leukocyte antigen
CMV = cytomegalovirus
HUS = hemolytic uremic syndrome
TTP = thrombotic thrombocytopenic purpura

Adult dose:
3x10 Plt
1 Platelets Pheresis
unit
Pool of 4 whole blood
derived Platelets
Pediatric dose:
10mL/kg up to
10-15kg total body
weight

Neonate dose:
Increases Hgb
2-3g/dL
Adult dose:
Increases platelets
30,000 60,000/L
Obtain platelet
count 15 to 60
minutes post
transfusion
Pediatric dose:
Variable depending

Guidelines are general and cannot take into account all of the circumstances of a particular patient. Judgment regarding the propriety of using any
specific procedure or guideline with a particular patient remains with that patients physician, nurse, or other health care professional, taking into account
the individual circumstances presented by the patient.
Original: 02/06 Revised: 8/2014 Approved: Transfusion Committee 8/14/2014 Approved: Patient Care Committee 11/6/2014
Page 2 of 10

University of Virginia Medical Center (UVaMC)


Clinical Practice Guidelines
Transfusion Guidelines
A transfusion medicine physician is always available for consultation and may be reached by calling the BBTMS
at 924-2273. More information is available at the BBTMS website:
http://www.healthsystem.virginia.edu/pub/medlabs/lab-handbook-test-directory/labgeneral/labspecific/bloodbank.html/?searchterm=blood bank

Blood
Product

Dose
Then use adult dosing
Neonate dose:
10 mL/kg

Plasma
(includes
FFP, FP24
& Thawed
Plasma)
(shelf life
after
thawing
1-5 days,
frozen 1
year)

Adult dose:
2-4 units (or
10-20mL/kg) for
nonspecific factor
replacement
2-4 units (or
10-20mL/kg) for
warfarin reversal (plus
vitamin K, see FAQs)

(shelf life
after
thawing
4-6 hours,
frozen 1
year)

on patients blood
volume and amount
transfused
Neonate dose:
Increases platelets
50,000-100,000/L

Adult and Pediatric


dose:
Increases
coagulation factors
by:
20% at
10-20mL/kg
Decreases PT and
INR

Pediatric dose:
10mL/kg up to
10-15kg total body
weight
Then 1 unit
Neonate dose:
10-15 mL/kg

Cryoprecipitate

Response

Adult dose:
1 pre-pooled adult
dose (equals a pool of
five to six units)
Neonate dose:
1-3 mL/kg up to 10kg
total body weight then
pediatric dose
Pediatric dose:
1 unit/10kg total body
weight up to 50kg
total body weight then
adult dose

Neonate dose:
Increases
coagulation factors
by 15-20%
Increases fibrinogen
Increases von
Willebrand factor
Increases factor VIII
Increases factor XIII

Criteria
SCT patients:
Plt < 10,000/L & inpatient
Plt < 20,000/L & outpatient
Plt < 20,000/L & fever
Plt < 30,000-50,000/L & bleeding
Neonate:
Plt < 30,000/L
Plt < 50,000/L & bleeding
Plt < 50,000/L & immediately prior to invasive
procedure
Plt < 100,000/L on ECMO
Plt < 150,000/L on ECMO & bleeding
INR > 1.5 & bleeding
INR 1.5 & immediately prior to invasive procedure
INR > 1.3 & CNS or retinal bleeding
INR 1.3 & immediately prior to invasive CNS or retinal
procedure
Factor deficiency if no factor concentrate available (e.g.
factor II, V, X or XI deficiency) & bleeding
Factor deficiency if no factor concentrate available (e.g.
factor II, V, X or XI deficiency) & immediately prior to
invasive procedure
Patient has received > 1 blood volume of fluids, including
transfusions, within past 24 hours
Undergoing therapeutic plasma exchange for TTP/HUS

Fibrinogen < 150mg/dL


Fibrinogen < 200mg/dL with massive hemorrhage (i.e.,
acute blood loss >20% of total blood volume)
Uremic platelet dysfunction & bleeding
Documented Factor XIII deficiency & bleeding
Documented Factor XIII deficiency & immediately prior to
invasive procedure
Von Willebrand Disease only if other safer, factor
concentrate products are not available

Guidelines are general and cannot take into account all of the circumstances of a particular patient. Judgment regarding the propriety of using any
specific procedure or guideline with a particular patient remains with that patients physician, nurse, or other health care professional, taking into account
the individual circumstances presented by the patient.
Original: 02/06 Revised: 8/2014 Approved: Transfusion Committee 8/14/2014 Approved: Patient Care Committee 11/6/2014
Page 3 of 10

University of Virginia Medical Center (UVaMC)


Clinical Practice Guidelines
Transfusion Guidelines
A transfusion medicine physician is always available for consultation and may be reached by calling the BBTMS
at 924-2273. More information is available at the BBTMS website:
http://www.healthsystem.virginia.edu/pub/medlabs/lab-handbook-test-directory/labgeneral/labspecific/bloodbank.html/?searchterm=blood bank

TRANSFUSION NEEDS FOR SPECIAL POPULATIONS


Premedications (e.g., antipyretic and/or antihistamine):
Premedication should be given only when indicated as directed by the ordering physician, not as a routine for all patients.
Premedication is typically not recommended as these may mask or delay signs such as fever, which is often the first indication
of an acute hemolytic transfusion reaction, endotoxin infusion, or acute lung injury.

Irradiated Cellular Blood Components (RBCs and Platelets)


Severely immunocompromised patients are subject to engraftment by transfused lymphocytes and subsequent transfusion
associated graft versus host disease (TA-GVHD). Gamma irradiation prevents lymphocyte replication and thus prevents
engraftment of viable lymphocytes. Since cellular blood products (e.g., RBCs and Platelets) contain a sufficient number of viable
lymphocytes to cause TA-GVHD, it is necessary to irradiate each cellular blood component for these patients to prevent
proliferation of transfused lymphocytes. Notify the Blood Bank at 924-2273 to enter instructions for irradiated products if your
patient meets criteria.
A. Blood products must be irradiated prior to administration in the following circumstances:
1. all cellular blood products for intrauterine transfusion
2. all cellular blood products for neonates less than 4 months old (except in case of emergency)
3. all granulocyte concentrates (unless the granulocyte product has been collected from stem/progenitor cell donor for
transfusion to the stem/progenitor cell transplant recipient)
4. cellular products collected from all designated/directed (patient selected) donors
5. all platelet products which are selected because of HLA and/or crossmatch compatibility with the intended recipient
B. All cellular blood products must be irradiated prior to administration in the following circumstances. The Blood Bank will
rely on the clinician to order the products irradiated. If Blood Bank staff is aware of any patient with a diagnosis defined in
section B, for whom irradiated blood has not been ordered, they should immediately contact a transfusion medicine
physician
1. hematopoietic SCT recipient, beginning at the time of myeloablative or non-myeloablative preparation for transplant
2. patients with neuroblastoma
3. patients with Hodgkins disease
4. patients with congenital T-cell immune-deficiency
5. patients receiving or history of receiving fludarabine or another purine analog
6. patients receiving or history of receiving alemtuzumab
7. pediatric cardiac surgery patients (less than 18 years of age)
8. patients with aplastic anemia
C. All cellular blood products must be irradiated prior to administration for patients with other malignancies (e.g., solid organ
tumors, hematologic malignancies, etc.) if ordered by a clinician. Irradiation in these cases may not be clinically mandatory,
but must be performed if ordered.
D. If irradiated blood products are requested by a physician for a patient with diagnoses not defined above in A, B, or C then
the request must be approved by a transfusion medicine physician.
Note the following:
For patient indications listed in sections A, B, & C approval by a transfusion medicine physician is not required Irradiation of
non-cellular products (e.g., plasma or cryoprecipitate) must always be approved by a transfusion medicine physician.
If any patient has been receiving irradiated blood products, and a new order is received for the same products without
irradiation, then the products will continue to be irradiated.

Guidelines are general and cannot take into account all of the circumstances of a particular patient. Judgment regarding the propriety of using any
specific procedure or guideline with a particular patient remains with that patients physician, nurse, or other health care professional, taking into account
the individual circumstances presented by the patient.
Original: 02/06 Revised: 8/2014 Approved: Transfusion Committee 8/14/2014 Approved: Patient Care Committee 11/6/2014
Page 4 of 10

University of Virginia Medical Center (UVaMC)


Clinical Practice Guidelines
Transfusion Guidelines
A transfusion medicine physician is always available for consultation and may be reached by calling the BBTMS
at 924-2273. More information is available at the BBTMS website:
http://www.healthsystem.virginia.edu/pub/medlabs/lab-handbook-test-directory/labgeneral/labspecific/bloodbank.html/?searchterm=blood bank

TRANSFUSION NEEDS FOR SPECIAL POPULATIONS


Sickledex Negative Red Cells
Indication: to prevent the transfusion of abnormal Hgb S red blood cells in high risk populations
Notify Blood Bank at 924-2273 to enter instruction for Hgb S negative red blood cells if your patient meets the criteria
below
Patients at high risk include the following:
Neonate < 4 months old
Sickle cell disease patient
Intrauterine or exchange transfusion patient
ECMO patient < 2 years old
Open heart surgery patient < 2 years old

Cytomegalovirus (CMV) SeroNegative Cellular Blood Products (RBCs and Platelets)


These products reduce exposure to cytomegalovirus (CMV) for patients in whom a primary CMV infection would be life
threatening (immunosuppressed patients who have not been exposed to CMV; i.e., CMV seronegative)
CMV SeroNegative
All intrauterine transfusions
Neonate (< 4 months old) transfusions including exchange transfusions
Women known to be pregnant
Granulocyte transfusions
CMV SeroNegative Preferred, Leukoreduced Acceptable
Neonate (< 4 months old) platelet transfusions
Heart or lung transplant recipients
Patients who are scheduled for ventricular assist device (VAD) placement as a bridge to heart transplant will be provided
with CMV reduced-risk products
Note the following:
Other CMV seronegative requests must be referred to a transfusion medicine physician for approval
All granulocyte concentrations must be from a CMV seronegative donor. Never leukoreduce a granulocyte concentrate.
Plasma (FFP, FP24, thawed plasma and cryopoor plasma) and cryoprecipitate are not known to contain sufficient amounts of
cellular elements to be of concern, and therefore can be used without being tested for CMV. Requests for these non-cellular
products to be CMV reduced-risk must be referred to a transfusion medicine physician for approval.

Leukocytes Reduced (Leukoreduced) Cellular Blood Components (RBCs and Platelets)


General information
RBCs and platelets are issued as leukoreduced at the University of Virginia Medical Center
Leukoreduced components require a standard blood administration set
Plasma and Cryoprecipitate do not need to be leukoreduced
Granulocyte transfusions must not be leukoreduced
Leukoreduction reduces the incidence of the following:
HLA alloimmunization and related platelet refractoriness
Febrile transfusion reactions, recurrent
CMV transmission
For more information, please call a transfusion medicine physician at 924-2273

Guidelines are general and cannot take into account all of the circumstances of a particular patient. Judgment regarding the propriety of using any
specific procedure or guideline with a particular patient remains with that patients physician, nurse, or other health care professional, taking into account
the individual circumstances presented by the patient.
Original: 02/06 Revised: 8/2014 Approved: Transfusion Committee 8/14/2014 Approved: Patient Care Committee 11/6/2014
Page 5 of 10

University of Virginia Medical Center (UVaMC)


Clinical Practice Guidelines
Transfusion Guidelines
A transfusion medicine physician is always available for consultation and may be reached by calling the BBTMS
at 924-2273. More information is available at the BBTMS website:
http://www.healthsystem.virginia.edu/pub/medlabs/lab-handbook-test-directory/labgeneral/labspecific/bloodbank.html/?searchterm=blood bank

TRANSFUSION REACTIONS
Clinical response for all reactions:
1. ALWAYS STOP THE TRANSFUSION IMMEDIATELY
a. Keep IV open with 0.9% NaC1
b. Check patient identification against the pink transfusion record tag
c. Monitor and document all vital signs (blood pressure, heart rate, respiratory rate, temperature and
oxygen saturation)
2. Immediately notify both the patients physician and the transfusion medicine resident (PIC 1426).
3. Document assessment, decision process and treatments in medical record.
4. Order transfusion reaction work up
a. Complete the transfusion reaction form on back of pink transfusion record tag
b. Notify Blood Bank at 924-2273
c. Send a Typenex labeled EDTA tube and the remaining blood component unit with any attached
tubing and solutions to Blood Bank.

Reaction
Type
Nonsystemic
Allergic
(mild)

Systemic
Allergic
(moderate
to severe)

Inflammatory
including
Febrile
NonHemolytic
Transfusion
Reactions
(FNHTR)

Acute
Hemolytic

Signs and Symptoms

Etiology

Clinical Action

Limited to skin signs and symptoms such


as flushing, itching (pruritis) and/or
urticaria (hives). No other signs or
symptoms.
Skin signs and symptoms described above
plus respiratory, cardiovascular and/or
gastrointestinal systemic signs and
symptoms such as:
Bronchospasm, stridor and/or dyspnea
Hypotension (20mm Hg decline in
diastolic and/or systolic)
Abdominal pain, diarrhea, nausea
and/or vomiting
Anaphylaxis
Temperature increase 1C, chills and/or
rigors within 6 hours of start of
transfusion. May occur after transfusion
complete (temperature increase may be
absent in these reactions)

Antibodies to
transfused plasma
proteins

Administer antihistamines.
Monitor for anaphylaxis
Resume transfusion if improved.

Antibodies to plasma
proteins, sometimes
caused by recipient
anti-IgA antibody

Administer fluids, antihistamines,


epinephrine, vasopressors and
corticosteroids as needed.
Provide respiratory support as needed
Do not use unit of blood.
Notify Blood Bank.

Cytokines released
from WBC in
transfused unit or
recipient antibodies
that react with
transfused, donors
WBCs or plasma
proteins leading to
pyrogenic cytokine
production
Intravascular
hemolysis usually
due to ABO
incompatibility;
Check for clerical
error (compare
patient
identification,

Administer antipyretics as needed.


Fever may be first sign of a hemolytic
transfusion reaction or bacterial
contamination. If fever occurs.
Order blood cultures from patient.
Do not use unit of blood.
Notify Blood Bank.

Hemoglobinemia/-uria, fever, chills,


anxiety, hypotension, shock, flank pain,
back pain, chest pain, pain at IV site,
nausea, flushing, dyspnea, oliguria, anuria,
generalized bleeding, cardiac arrest

Treat hypotension and/or shock with


vasopressors
Administer corticosteroids
Administer oxygen and maintain airway if
needed
Monitor for and prevent acute renal
failure; Give fluids and maintain diuresis
as needed.

Guidelines are general and cannot take into account all of the circumstances of a particular patient. Judgment regarding the propriety of using any
specific procedure or guideline with a particular patient remains with that patients physician, nurse, or other health care professional, taking into account
the individual circumstances presented by the patient.
Original: 02/06 Revised: 8/2014 Approved: Transfusion Committee 8/14/2014 Approved: Patient Care Committee 11/6/2014
Page 6 of 10

University of Virginia Medical Center (UVaMC)


Clinical Practice Guidelines
Transfusion Guidelines
A transfusion medicine physician is always available for consultation and may be reached by calling the BBTMS
at 924-2273. More information is available at the BBTMS website:
http://www.healthsystem.virginia.edu/pub/medlabs/lab-handbook-test-directory/labgeneral/labspecific/bloodbank.html/?searchterm=blood bank

Reaction
Type

Signs and Symptoms

Etiology
transfusion record
tag, product label)

Fever, unexplained anemia and jaundice


occurring 2-14 days after a transfusion
Delayed
Hemolytic

Septic

Transfusion
Associated
Circulatory
Overload
(TACO)

Transfusion
Related
Acute Lung
Injury
(TRALI)

Temp increase, often of


> 2C.
Sudden hypotension or hypertension,
shock, DIC, renal failure

Hemolysis due to red


cell antibodies other
than ABO. Hemolysis
is primarily
extra-vascular but
intra-vascular
hemolysis may occur
as well
Bacteria/bacterial
toxin in donor blood

Shortness of breath, pulmonary edema,


productive cough (pink, frothy sputum)
tachycardia, headache, acute
hypertension, increased BNP, increased
pulmonary capillary wedge pressure

Rapid transfusion
rate
Excess volume
Underlying clinical
condition (e.g., CHF,
renal failure, liver
failure)

Severe dyspnea and bilateral infiltrates


on chest x-ray occurring during or within
6 hours of transfusion completion
PaO2/FiO2 ratio < 300
SpO2 < 90% on room air
May be accompanied by fever,
tachypnea, SOB, tachycardia,
hypotension or rarely hypertension.
Often no pre-existing or alternate risk
factor for acute lung injury
Normal central venous pressure and
normal pulmonary capillary wedge
pressure
STAT CBC may show WBC decline for
2-16 hours
Post BNP < 250 helps rule in TRALI
Ratio of Post to Pre BNP > 1.5 suggests
TACO, but does not rule out TRALI as
these two (TACO and TRALI) may coexist

Neutrophil or HLA
antibodies in the
donor unit that
react with patients
neutrophils,
monocytes, and/or
endothelial cells.
Rarely, patients
neutrophil or HLA
antibodies react
with transfused
donor WBCs.
Accumulated lipids
or other
inflammatory
mediators in stored
blood component
may also cause
TRALI

Clinical Action
Monitor for DIC and treat appropriately.
Do not use unit of blood.
Notify Blood Bank (if more blood products
are necessary, Group O negative red cells
and group AB plasma may be provided
until etiology is clear).
Supportive therapy;
All future Red Blood Cell transfusions
require units which are negative for
antigen(s) to which patient has made a
clinically significant antibody

Pressor support if necessary


Order blood cultures from patient
Broad spectrum antibiotics
Do not use unit of blood.
Notify Blood Bank.
Order a chest x-ray
Administer diuretics; monitor intake and
output
Decrease transfusion rate, (A typical
transfusion rate of 200mL/hour, could
slow to 100mL/hour or even slower. For
very slow rates, the BB will split a unit
upon request.)
Supportive treatment.
Order a STAT chest x-ray, CBC and BNP
Monitor oxygen saturation (pulse
oximetry) and give supplemental oxygen
until symptoms resolve.
Intubation may be necessary.
Diuretics not indicated as patient is not
volume overloaded.
Symptoms usually resolve over 48-72
hours.
Do not use blood.
Notify Blood Bank.

Guidelines are general and cannot take into account all of the circumstances of a particular patient. Judgment regarding the propriety of using any
specific procedure or guideline with a particular patient remains with that patients physician, nurse, or other health care professional, taking into account
the individual circumstances presented by the patient.
Original: 02/06 Revised: 8/2014 Approved: Transfusion Committee 8/14/2014 Approved: Patient Care Committee 11/6/2014
Page 7 of 10

University of Virginia Medical Center (UVaMC)


Clinical Practice Guidelines
Transfusion Guidelines
A transfusion medicine physician is always available for consultation and may be reached by calling the BBTMS
at 924-2273. More information is available at the BBTMS website:
http://www.healthsystem.virginia.edu/pub/medlabs/lab-handbook-test-directory/labgeneral/labspecific/bloodbank.html/?searchterm=blood bank

FREQUENTLY ASKED QUESTIONS


1. What blood groups are compatible for my patient?
Group
Compatible Red Blood Cell units
O
O
A
A, O
B
B, O
AB
AB, A, B, O
D (Rh) Type
Compatible Type
D Positive
D positive or D negative
D Negative
D negative
Universally compatible Red Blood Cell units are Group O
Universally compatible plasma is Group AB

Compatible plasma
O, AB, A, B
A, AB
B, AB
AB

2. What are the turn-around times for patient testing and blood component preparation?
Turn-around-times (TAT) for testing a patients sample.
Test
1. Group and Type (ABO/Rh)
2. Antibody Screen
3. Antibody Panel
4. Direct Antiglobulin Test (DAT)
5. Elution and Eluate Testing
6. Crossmatch of RBC unit (not including time for #1-5 above)
7. Platelet unit dispense
8. Plasma unit thaw and dispense a single unit
9. Cryoprecipitate unit thaw and dispense a prepooled unit
10. Phenotype for a single red cell antigen
11. Genotype for red cell antigens

Approximate TAT*
10 to 45 minutes
30 to 60 minutes
1 to 24 hours
15 minutes
2 to 4 hours
15 to 45 minutes**
10 minutes
25 minutes
25 minutes
10 to 45 minutes
Send out test, 2-7 days

TAT listed are approximate testing times after an appropriately collected and labeled patient sample has been
received and accessioned in the BBTMS. RBC unit crossmatch TAT does not include time to identify antigen
matched RBC units for patients needing antigen negative RBC units (e.g., sickle cell disease patients or patients with
an alloantibody such as anti-Kell).

3. How to activate, to discontinue and what is included in the Blood Alert protocol when a patient is
experiencing massive, life threatening bleeding?
a. Requires attending approval and activated by calling 4-2012.
b. Discontinued by activating attending physician calling 4-2012
c. Each set includes:
4 plasma units in a cooler
6 RBC units in a cooler
1 Apheresis Platelets unit (no cooler)
1 unit of pre-pooled cryoprecipitate (no cooler) is added to every other set starting with the
second set
Guidelines are general and cannot take into account all of the circumstances of a particular patient. Judgment regarding the propriety of using any
specific procedure or guideline with a particular patient remains with that patients physician, nurse, or other health care professional, taking into account
the individual circumstances presented by the patient.
Original: 02/06 Revised: 8/2014 Approved: Transfusion Committee 8/14/2014 Approved: Patient Care Committee 11/6/2014
Page 8 of 10

University of Virginia Medical Center (UVaMC)


Clinical Practice Guidelines
Transfusion Guidelines
A transfusion medicine physician is always available for consultation and may be reached by calling the BBTMS
at 924-2273. More information is available at the BBTMS website:
http://www.healthsystem.virginia.edu/pub/medlabs/lab-handbook-test-directory/labgeneral/labspecific/bloodbank.html/?searchterm=blood bank

4. What are some adjunct treatment options for rapid warfarin reversal or other oral anticoagulant in a
bleeding patient?
a. Please see the following Clinical Practice Guidelines
(http://www.healthsystem.virginia.edu/docs/manuals/guidelines/cpgguidelines):
2.195 Prothrombin Complex Concentrate, Human (Kcentra) Adult Guidelines
(http://www.healthsystem.virginia.edu/docs/manuals/guidelines/cpgguidelines/02-clinical-pra
ctice-guidelines/2.195-prothrombin-complex-concentrate-faxtors-ii-ix-x-only)
2.196 Prothrombin Complex Concentrate (Profilnine SD) Management of Bleeding on Oral
Anticoagulants
(http://www.healthsystem.virginia.edu/docs/manuals/guidelines/cpgguidelines/02-clinical-pra
ctice-guidelines/2.196-prothrombin-complex-concentrate-profilnine-sd-management-of-bleed
ing-on-oral-anticoagulants)
2.280 Warfarin Reversal Vitamin K1 (Phytonadione) Therapy Guideline
(http://www.healthsystem.virginia.edu/docs/manuals/guidelines/cpgguidelines/02-clinical-pra
ctice-guidelines/2.280-warfarin-reversal-vitamin-k1-phytonadione-therapy-guideline)
5. What should I do if my patient might be refractory to Platelet transfusions?
a. Check the patients platelet count immediately prior to a Platelet transfusion and within 15-60 minutes
post transfusion.
b. Contact the BBTMS physician for a consult.
c. Review information at the BBTMS website, see Platelet Information and Evaluating for Platelet
Refractoriness:
http://www.healthsystem.virginia.edu/pub/medlabs/lab-handbook-test-directory/labgeneral/labspeci
fic/bloodbank.html/?searchterm=blood%20bank
6. How do I determine an appropriate Cryoprecipitate dose for increasing fibrinogen?
a. Contact the BBTMS physician for a consult.
b. Review information at the BBTMS website, see Cryoprecipitate Information:
http://www.healthsystem.virginia.edu/pub/medlabs/lab-handbook-test-directory/labgeneral/labspeci
fic/bloodbank.html/?searchterm=blood%20bank

Guidelines are general and cannot take into account all of the circumstances of a particular patient. Judgment regarding the propriety of using any
specific procedure or guideline with a particular patient remains with that patients physician, nurse, or other health care professional, taking into account
the individual circumstances presented by the patient.
Original: 02/06 Revised: 8/2014 Approved: Transfusion Committee 8/14/2014 Approved: Patient Care Committee 11/6/2014
Page 9 of 10

University of Virginia Medical Center (UVaMC)


Clinical Practice Guidelines
Transfusion Guidelines
A transfusion medicine physician is always available for consultation and may be reached by calling the Blood Bank and Transfusion Medicine Services
(BBTMS) at 924-2273. More information is available at the BBTMS website:
http://www.healthsystem.virginia.edu/pub/medlabs/lab-handbook-test-directory/labgeneral/labspecific/bloodbank.html/?searchterm=blood bank

7. What are the special requirements for blood component storage in the operating rooms?
a. Orders for blood components are often placed prior to a patient going to the Operating Room (OR).
b. When you are ready to transfuse the patient, call the BBTMS and request that the product be prepared for transport.
c. Transport Coolers (aka Igloos) for Red Blood Cells (RBC) units and Plasma units:
These quality control (QC) monitored to maintain 1-10 degrees Celsius (1-10 C) for up to 4 hours (4 hrs) if the lid is kept closed.
No more than 6 RBC units per cooler. Cooler must be properly packed with 3 frozen blue bottles and 1 refrigerated polar gel pack.
The cooler will maintain the proper storage temperature for up to 4 hrs if the lid is kept closed.
No more than 6 Plasma units per cooler. Cooler must be properly packed with 3 frozen blue bottles and 1 refrigerated polar gel pack.
The cooler will maintain the proper storage temperature for up to 4 hrs if the lid is kept closed.
d. The ORs Core Refrigerator is remotely monitored by the BBTMS to maintain 1-6 C
BLOOD
REQUESTING & PREPARATION
TRANSPORT REQUIREMENTS
TEMPORARY STORAGE in OR
SHELF-LIFE LIMITS
COMPONENT TIME (times are approximate)
from BBTMS to OR
RBC

PLASMA

Call BBTMS: ~15-30 minutes to


prepare for OR.
NOTE: Patient must have a current
TYHD sample Typenex labeled

Call BBTMS: ~15-30 minutes to


prepare for OR.

CHILLED: Maintain at 1-10 C


Best: go directly from BBTMS to ORs
Core Refrigerator (1-6 C)
Transport Cooler (1-10 C up to 4 hrs)
CHILLED: Maintain at 1-10 C (once
thawed for patient use).
NOTE: Limited supply of Transport Coolers
for plasma are available for unstable
trauma patients

PLATELETS

Call BBTMS: ~15-30 minutes to


prepare for OR.

ROOM TEMPERATURE: Maintain at 20-24


C.
Note: Never put Platelets in a Transport
Cooler

CRYOPRECIPITATE

Call BBTMS: ~30 minutes to prepare


for OR.
NOTE: Once Cryoprecipitate is
ordered, thawed and prepared it must
be used within 4 hrs or it will be
wasted.

ROOM TEMPERATURE: must be


maintained at 20-24 C (once thawed for
patient use).
NOTE: Never put Cryoprecipitate in
contact with chilled products.

Place in ORs Core Refrigerator ( 1-6 C)


Transport Cooler (1-10 C up to 4 hrs)

Place in ORs Core Refrigerator ( 1-6 C)


Transport Cooler (1-10 C up to 4 hrs)

Room Temperature (20 -24 C)


Note: Never put Platelets in contact with
chilled products.

Room Temperature (20-24 C)


NOTE: Never put Cryoprecipitate in
contact with chilled products.

CHILLED: Maintain at 1- 10 C
CHILLED: Maintain at 1- 10 C
NOTE: If plasma was issued from the
BBTMS immediately after thawing at 37
C, i.e.warm, a sticker will be placed on
the plasma showing Issued Warm and
the plasma can be reissued if brought
back to the BBTMS within 2 hours of
issue.
ROOM TEMPERATURE: Maintain at
20-24 C
NOTE: If not transfusing the Platelets,
then it must be returned to BBTMS
within 2 hours of issue, and must not
have been refrigerated
ROOM TEMPERATURE: Maintain at
20-24 C
NOTE: If not transfusing the
Cryoprecipitate, then it must be returned
to BBTMS within 2 hours of issue, and
must not have been allowed to warm
above 37 C or below 1 C.

Guidelines are general and cannot take into account all of the circumstances of a particular patient. Judgment regarding the propriety of using any specific procedure or guideline with a particular patient remains
with that patients physician, nurse, or other health care professional, taking into account the individual circumstances presented by the patient.
Original: 02/06 Revised: 7/2014 Approved: Transfusion Committee 8/14/2014 Approved: Patient Care Committee 11/6/14
Page 10 of 10