In this section
Every patient receiving a fresh blood product needs a valid pretransfusion compatibility testing/blood group and antibody screen performed at the Royal Children's Hospital (RCH) prior to blood transfusion.
All specimen collection and labeling must be done in accordance
with The RCH specimen collection procedure and blood transfusion - fresh blood products 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 they may require a planned RBC
transfusion, an order for a blood group and antibody screen should 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 the Electronic Medical Record (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:
extended expiry (ASBT protocol) prevents repeated blood group
antibody screening prior to transfusion for infants during the first 4 months
of life. This protocol recognises that the development of antibodies to red
cell antigens is very uncommon in the first 4 months of life. The protocol
reduces the requirement for repeated sampling of blood.
less than 4 months of age who is likely to require more than one transfusion.
laboratory will make an assessment of suitability according to established
the laboratory will issue a report indicating that a further sample will not be
required for any further blood group and antibody screen samples until the baby is 4 months of age and will a specify this date.
with a positive DAT and/or significant maternal red cell antibody shall be
neonatal extended expiry in EMR.
previous transfusion history, in particular intrauterine transfusion, or
transfusion outside RCH. Indicate transferring hospital.
infant is accepted on the neonatal extended expiry, further samples are not
required for pretransfusion testing. Blood can be ordered as per regular
ordering procedure in EMR.
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 (kg) x (desired Hb – patients current Hb).
Patients > 20 kg: Volume to be transfused =
0.5 x patient weight (kg) x (desired Hb – patients current Hb) however no more than
1 unit should be transfused before re-testing the patient Hb to assess for
Typical RBC units are 260 mL (+/-19 mL) volume.
For patients less than 15 kg the usual dose is 10 mL/kg. Patients over 15 kg can generally have one unit of platelets.
The usual dose in an adult is one unit, either pooled or apheresis.
Platelet count (x 10^9/L)
Clinically stable paediatric patients receiving
chemotherapy for leukaemia or post
haematopoietic stem cell transplantation (HSCT)
Clinically stable patients with solid tumours
* Transfusions at higher levels may be required for bladder,
brain or necrotic tumours
Critically ill patients with no bleeding
& risk factors (e.g. fever, sepsis, minor bleeding, mucositis,
disseminated intravascular coagulopathy (DIC) without bleeding)
injections e.g. Erwinia aspariginase
Insertion of a
non-tunnelled central venous line
Lumbar puncture (LP) and on-going chemotherapy induced thrombocytopenia
LP and new disease induced thrombocytopenia
Major haemorrhage due to trauma or significant post-operative bleeding
(e.g. post cardiac surgery)
Patient undergoing high risk invasive procedure (e.g. neurosurgery/ophthalmology)
Extra-corporeal life support (ECLS) (lower platelets may be acceptable
in stable patients)
Stable patients with chronic, stable, severe thrombocytopenia due to
alloimmunisation, ITP, TTP, aplastic anaemia or MDS should be observed
without prophylactic platelet transfusions. These patients should receive
platelet transfusions with clinically significant bleeding only.
Intravenous cannula insertion
ITP – immune thrombocytopenia, TTP – thrombotic
thrombocytopenic purpura, MDS – myelodysplastic syndrome.
Platelet count (x10^9/L)
term or preterm infant with asymptomatic thrombocytopenia and no bleeding
preterm infant with thrombocytopenia
or preterm infant with symptomatic thrombocytopenia and minor bleeding,
coagulopathy or prior to surgery.
or preterm infant with symptomatic thrombocytopenia and major bleeding or
requiring major surgery (e.g. neurosurgery)
Indications for FFP transfusion
(thrombotic thrombocytopenic purpura)
bypass and bleeding
bypass and bleeding
DIC and major bleeding
disease and major bleeding
reversal and major bleeding e.g. ICH
to high risk surgery or high risk procedure e.g. lumbar puncture
DIC and bleeding
disease and bleeding
to surgery or invasive procedure
FFP is NOT
indicated for the following:
Formula for calculating transfusion volume: 10 - 20 mL/kg
Typical unit volume: ~284 mL. FFP pedipak ~69 mL
Transfusion rate: 10 - 20 mL/kg/hr
procedure with a risk of significant bleeding
DIC and bleeding
is NOT indicated for the following:
Formula for calculating transfusion volume: 5 - 10 mL/kg
Typical unit volume: ~36 mL
Transfusion rate: 10 - 20 mL/kg/hr
Consider a discussion with a haematologist if transfusing outside of the listed parameters.