Issuing Blood Products

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Concentrated red cells	Cryoprecipitate	Frozen plasma

Several important protocols relate to issuing and transfusing blood products. Below are some of the more relevant guidelines.

Serious, life-threatening consequences can result from issuing donor units to the wrong patient. These protocols are meant to prevent such misidentification errors.

Compare the recipient's name and identification number with information on the blood tag and on the request form brought to the transfusion service. Information must be identical.

Confirm that the recipient's ABO and Rh(D) type are compatible with the group and Rh of donor units.

Confirm that the donor ABO and Rh groups and unit numbers on all blood tags are identical to the donor units to which they are attached.

Confirm that each donor unit has been crossmatched and interpreted as crossmatch-compatible, and that this is also recorded on the donor tags.

Ensure that the ABO and Rh(D) type of donors have been confirmed.

Confirm that donor units are in-date.

Record the details of the transaction, e.g., the initials of the technologist issuing the blood, the initials of the person to whom the blood is issued, date and time of issue.

Before donor blood is released from the hospital transfusion service, each unit must be examined to detect conditions which may harm the patient. These same conditions are examined at the blood centers that supply the products, but some may go undetected. Also, the characteristics of donor units may change between the blood center and the transfusion service. The conditions which are examined are briefly described below. If any abnormality is found, the donor unit is NOT issued for transfusion.

Flaws in donor bag: The bag may have small holes in it which means that it is an "open system" and may be bacterially contaminated.

Increased icterus in plasma: The presence of icterus (icterogenic plasma) indicates increased bilirubin in the plasma. This may be caused by a variety of conditions in the donor, e.g., increased red cell destruction, liver disease, or viral hepatitis. Hepatitis is the most serious possibility and requires that the unit not be used.

Lipemic plasma: Excessively fatty plasma may indicate high levels of cholesterol in the donor or may indicate that the donor ate a fatty meal prior to donation. In either case, the bag should not be used because the fat particles can clog up the transfusion filter and cause the blood to stop flowing, in which case the donor unit would be wasted.

Clots in donor bag: Clots can be caused by several conditions, including improper mixing of blood with anticoagulant during the donation procedure and bacterial contamination. The bag should not be used because of the possibility of bacterial contamination. Also, if they pass through the transfusion filter, the clots can cause an embolism in the patient.

Red cell mass is purplish/blackish: Discolored red cells may indicate bacterial contamination, as well as outdated or improperly stored units in which the cells have died.

Several issuing and transfusing guidelines pertain to time limits.

To minimize the likelihood of bacterial growth at RT, refrigerated components such as red cells should be transfused as soon as possible after being issued. Specifically, the time that blood is removed from the refrigerator to the time that the transfusion is started should be no longer than 30 minutes.

Once a red cell transfusion has begun, it must be completed within 4 hours, preferably sooner.

To preserve Factor VIII, cryoprecipitate should be thawed rapidly at a maximum of 37^o C for no longer that 10 minutes.

Once thawed, cryoprecipitate to be used as a source of Factor VIII must be transfused within 6 hours.

Fresh frozen plasma (FFP) should be thawed rapidly at a maximum of 37^o C. Once thawed, FFP to be used as a source of labile coagulation factors must be transfused within 24 hours.

Emergencies

Issuing Blood Products

Clinical Significance