In this section
Every patient receiving a fresh blood product needs
valid pretransfusion compatibility testing/blood group and antibody screen performed at the RCH prior to blood transfusion.
All specimen collection and labeling must be done in accordance
with The Royal Children's Hospital specimen collection procedure and blood product transfusion procedure.
testing prior to transfusion involves the following;
Blood group and antibody screen:
If a patient is
having a planned surgery where blood loss is expected, or a planned RBC
transfusion, an order for blood group and antibody screen can be made. The date and type of
surgery or expected date of transfusion can be outlined in the clinical notes
field of the order. Blood bank will then be aware of the potential requirements
for blood products and can make provisions as necessary. If you know your patient has special transfusion requirements, a conversation can still be had with the blood bank to discuss individual transfusion requirements.
A blood group and antibody screen expires 72 hours after collection. A
fresh blood group and antibody screen will be required for any units not
commenced within the 72 hour period. The time and date of
collection of the cross match specimen is indicated in EMR. If a unit of red cells is ordered in EMR without a current blood group and antibody screen, a prompt will appear with the option to order a blood group and antibody screen at the time of ordering the red cells.
The 72 hour rule also applies whenever a patient has been
transfused or is/has been pregnant within the last 3 months. This
internationally accepted safeguard is used to prevent a transfusion
reaction in patients who form antibodies to foreign red cell
antigens in response to pregnancy or transfusion.
exceptions to the 72 hour rule are some neonates and infants during the first four
months of postnatal life (neonatal extended expiry) or those patients who have
extended expiry crossmatching completed prior to having planned surgery
expiry allows patients having a planned admission for spinal,
craniofacial or cardiac surgery to have a blood group and antibody screen performed and remain
valid for 30 days before their planned date of surgery.
the extended expiry blood group antibody screen to remain valid, certain conditions must be met prior to sampling
and maintained throughout the 30 day period.
following conditions must be met:
If any of
these conditions change in the lead up to surgery, the
parents/guardians/patient will have instructions to contact the blood bank to
inform them of these changes. Another blood test will be required to ensure to
confirm the blood group and antibody screen.
Forms are located here:
Refer to the EMR tip sheet for further information.
The ‘prepare’ and ‘transfuse’ orders are the responsibility
of the medical practitioner. It is the authorisation for blood bank to prepare
the blood product and for clinical staff to administer it.
In EMR, complete the ‘transfuse and prepare’ orders only if
there is an intention to transfuse.
The ‘prepare’ order automatically prints in blood bank. It
The ‘transfuse’ order is electronically sent to ‘flowsheets’
and will include
The prescriber is responsible for ensuring:
Neonate: A typical dose for transfusion in
neonates is 10 – 20 mL/kg (where the
upper end of the range applies to severe anaemia, expected ongoing risk factors
or concurrent bleeding)
Patients < 20 kg: Volume to be transfused =
0.5 x patient weight x (desired Hb – patients current Hb).
Patients > 20 kg: Volume to be transfused =
0.5 x patient weight x (desired Hb – patients current Hb) however no more than
1 unit should be transfused before re-testing the patient Hb to assess for
Typically RBC units are 200 – 300 mL in volume.
Platelet dose is normally 5 mL/kg however usual
dose in an adult is 1 unit.
FFP dose is normally 10 – 15 ml/kg
for all patients
Cryoprecipitate dosing is normally 5 – 10 ml/kg for all
transfusions, prescribe one unit/transfusion episode at a time and re-evaluate
the need for further transfusion.
For indications not listed, "other" can be selected. In this instance, the clinical notes section must be completed with an alternate transfusion indication. Consider a discussion with a haematologist if transfusing outside of the listed parameters.