Requests for some blood products may need to be discussed with the Consultant Haematologist as there are a variety of specialist products available.

Red Cells

Depending on the administration rate, red cells can be documented on either care pathways but Transfusion should commence within 30 minutes of removal from Blood Bank fridge (controlled temperature of 4°).

  • Can be stored in an un-opened cool box up to a maximum of 3 hours (However RBC’s must be returned to the issue fridge in Blood Bank if not used imminently). Transfused via a standard blood transfusion giving set.
  • Line to be primed with normal saline prior to first unit.
  • Each unit to be administered up to a maximum of 4 hours from removal from the issue fridge or from the cool box. STAT transfusions are only carried out for patients that clinically required urgent transfusion.
  • No drugs or other intravenous fluid to be added to the unit or administered via the same cannula during the transfusion
  • Flushing the line post transfusion is unnecessary and not recommended.
  • Bedside checks to ensure component/patient identity should be performed.
  • Patients should be monitored during the transfusion according to the hospital guidelines.

Platelets

Platelets are not routinely stocked in Blood transfusion and must be ordered on a named patient basis from Barnsley NHSBT. A sample for group and screen is required if the group is not known and the request form must be completed correctly and be signed by the Medical Practitioner. A minimum of 6 hours notice is required for non-urgent cases. Urgent requests may require a ‘blue light’ run is required which will take approximately 55 minutes depending on traffic conditions (Requires consultant authorisation)

Platelets have a short shelf life (maximum 7 days) and should not be requested on standby.

  • Platelets should be documented on a rapid / emergency blood transfusion
  • Should be commenced as soon as possible once removed from the agitator
  • Never stored in a cool box
  • Transfused via a platelet giving set (170-200μm ‘screen’ filter)
  • But in an emergency a standard blood giving set can be used but NOT if it is has already been used for RBC
  • Each unit is administered over around 30 minutes.
  • No drugs or other intravenous fluid to be added to the unit or administered via the same cannula during the transfusion
  • Bedside checks to ensure component/patient identity should be performed.
  • Patients should be monitored during the transfusion according to the hospital guidelines

Fresh Frozen Plasma

Fresh frozen plasma is obtained from whole blood or by apheresis from male donors (as far as possible, >90% currently) and frozen to -40 oC to maintain activity of labile coagulation factors. FFP is thawed as required. Once thawed FFP should be used immediately but can be stored at 4 oC for a maximum of 24 hours. All components are leucodepleted.

A sample for group and screen is required if the group is not known and the request form must be completed correctly and be signed by the Medical Practitioner.

The standard adult dose for FFP is usually 10 – 15 ml/kg. This is normally 1 litre (3 – 4 units)

This may have to be exceeded in massive bleeding and consumptive coagulopathies and the dose is dependent on the on the clinical situation and coagulation results. The response should be monitored by repeat coagulation tests.

  • FFP can be documented on a rapid / emergency blood transfusion
  • Average adult therapeutic dose is 1 litre (approx. 3-4 units)
  • Once thawed FFP must be transfused as quickly as possible as post-thaw storage will result in a decline of labile coagulation factors (maximum storage time 24 hours in the controlled blood bank fridge )
  • Units should not be stored in a cool box
  • Administer via a standard blood transfusion giving set. (No need to prime the line prior to transfusion)
  • Each unit administered over 20 – 30 minutes
  • No drugs or other intravenous fluid to be added to the unit or administered via the same cannula during the transfusion
  • Bedside checks to ensure component/patient identity should be performed.
  • Patients should be monitored during the transfusion according to the hospital guidelines.

Cryoprecipitate

Cryoprecipitate is rich in Factor VIII, Von Willebrand Factor (VWF), Factor XIII, fibrinonectin and fibrinogen.

The adult dose is 2 units of cryoprecipitate each containing 5 single units. A single dose contains a mean of 400-500mg fibrinogen, however, in cases of surgical or traumatic bleeding the amount given should be guided by coagulation studies. The response should be monitored by repeat coagulation tests. The infusion must be completed as soon as possible and within 4 hours of thawing. (May be stored for this time between 20 – 24 oC).

Cryoprecipitate can be documented on a rapid / emergency blood transfusion)

  • Average adult therapeutic does is 2 units (each unit contains 5units)
  • Once thawed must not be re-frozen and should be transfused immediately. If delay is unavoidable the unit must be transfused or discarded within 4hours.
  • Administer via a standard blood transfusion giving set. (No need to prime the line prior to transfusion)
  • Each unit can be transfused in around 15-20 minutes
  • No drugs or other intravenous fluid to be added to the unit or administered via the same cannula during the transfusion
  • Bedside checks to ensure component/patient identity should be performed.
  • Patients should be monitored during the transfusion according to the hospital guidelines.

FFP and Cryoprecipitate for Paediatrics/Neonates.

Neonates <1 year old should only receive pathogen-reduced FFP. i.e. Octaplas or Methylene Blue treated FFP or MB-treated Cryoprecipitate.

The paediatrician should calculate the required dose required for each product and state the amount of FFP/Cryoprecipitate required on the request form.

PLEASE NOTE – adult patients requiring plasma exchange will be issued Octaplas also

Albumin

Human Albumin is available as a 5% solution in 500ml bottles and 20% (Salt poor) is only available in 100ml bottles.

Both products have a physiological half-life of 5-10 days and are principally of value to patients who require sustained oncotic support. There is little scientific justification for its use in chronic malnutrition, chronic cirrhosis, chronic nephritis and gastro-intestinal disorders.

All stock is held in Blood transfusion. A request form stating the exact product and amount required must be sent to Blood bank, completed correctly and signed by the Medical Practitioner. A sample for a group and screen is not required.

Albumin should be:

  • Administered via a standard intravenous fluid giving set
  • Each bottle should be infused over 30 minutes to 2 hours
  • Albumin must be administered with caution as a too rapid infusion can lead to circulatory overload or interstitial dehydration
  • Once the bottle has been ‘spiked’ the contents must be used or discarded after 4 hours.
  • Should not be added to any other IV solution

Prothrombin Complex Concentrate (Beriplex)

Indicated in treating emergency/overdose situations during oral anticoagulant treatment.

PCC can be issued immediately from Blood bank without consultation with the Haematology Medical staff in life-threatening cases i.e. patients on warfarin with intracranial or massive GI bleeds.

In all other cases, please discuss the case with the Haematology Clinician.

  • The does is dependent on the patient’s body weight and most recent INR (warfarin ONLY) and administered by intravenously Bolus injection.
  • The diluent (water for injection) and the concentrate should be at room temperature at the time of administration.
  • Using the Mix2vial provided insert the blue end into the water, then with the concentrate vial firmly on a surface, insert the transparent end into the concentrate allowing the vacuum inside the concentrate to draw in the water.
  • Swirl gently to mix and then unscrew the transfer set in the middle. Draw air into an empty sterile 50ml syringe, attach to the Mix2vial and inject vertically into the concentrate, invert and then draw the required amount of concentrate back into the syringe slowly.
  • Beriplex should not be mixed or administered with any other medicinal products.
  • Slowly inject the solution, start at 1ml/min and not exceed 3ml/min using a butterfly needle or through a free-flowing cannula.
  • The pulse rate must be measured before and during administration.

Recombinant activated Factor VII (rVIIa – NovoSeven)

** The use of rFVIIa is STRICTLY authorised for use after discussion with the Consultant Haematologist ONLY.**

The recommended dose of NovoSeven is 90 micrograms/kg – Give by bolus injection over 2-5 minutes through any available vein.

  • Using the diluent provided withdraw the quantity required for reconstitution, add to the powder and gently swirl the vial until all the material is dissolved.
  • Do not mix with infusion solutions.
  • The dose may be repeated at 2 hours if indicated if there is no response after 2 doses, further doses should not be administered.
  • Once reconstituted must be used within 3 hours or discarded.

Issue and use of Factor Concentrates for Emergency patient management

Clinical advice MUST only be provided by Haemostasis Consultant Haematologists at Sheffield Teaching Hospitals. Medical advice should be given by these Consultants who should liaise directly with clinical teams at Barnsley and authorise release of the product.

……………This section applies to Emergency Department Clinicians ONLY……………

Voncento (CSLBehring)

(Human coagulation factor VIII/von Willebrand factor complex) 500 IU and 1000 IU powder and solvent for solution for injection or infusion: The product reconstituted with 5ml or 10ml of water for injection contains approximately 500 IU or 1000 IU human coagulation factor VIII (FVIII:C) and 1200 IU or 2400 IU von Willebrand Factor (VWF:RCo) per vial, respectively.

Indications:

Prophylaxis and treatment of haemorrhage or surgical bleeding in patients with VWD, when desmopressin (DDAVP) treatment alone is ineffective or contraindicated.

Dosage and Administration:

On-demand treatment: Usually 40 – 80 IU/kg of von Willebrand factor (VWF:RCo)corresponding to 20 – 40 IU FVIII:C/kg of body weight (BW) are recommended to achieve haemostasis.

Advate

Indications and Usage:

ADVATE is a recombinant anti-haemophilic factor indicated for use in children and adults with haemophilia A for:

  • Control and prevention of bleeding episodes.
  • Perioperative management.
  • Routine prophylaxis to prevent or reduce the frequency of bleeding episodes.
  • ADVATE is not indicated for the treatment of von Willebrand disease.

Dosage and Administration

For intravenous injection after reconstitution only

Each vial of ADVATE contains the labelled amount of recombinant factor VIII in International Units (IU).

Control and prevention of bleeding episodes and perioperative management

  • Dose (IU) = body weight (kg) x desired factor VIII rise (IU/dL or % of normal) x 0.5 (IU/kg per IU/dL).
  • Determine treatment frequency based on type of bleeding episode.

Alprolix

Indication:

Alprolix, coagulation Factor IX (Recombinant) Fc Fusion Protein, is a recombinant DNA derived coagulation Factor IX concentrate indicated for use in adults and children with haemophilia B (congenital factor IX deficiency) for:

  • On demand treatment and control of bleeding episodes
  • Perioperative management of bleeding
  • Routine prophylaxis to reduce the frequency of bleeding episodes

Dosage and Administration

For intravenous use after reconstitution only

  • Dose and duration of treatment depend on the severity of the factor IX deficiency, the location and extent of bleeding and the patient’s clinical condition. One IU of Alprolix per kg body weight increases the circulating level of factor IX by 1% [IU/dL]. Estimate the required dose or the expected in vivo increase in Factor IX level expressed as IU/dL (or % of normal) using following formula:
Dose = body weight (kg) × desired factor IX increase (IU/dL or % of normal) × reciprocal of recovery (IU/kg per IU/dL)