Laboratory Guidelines for Patient Care Areas

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Policy # PCA S7/02/V3

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Laboratory Guidelines for Patient Care Areas

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Policy # PCA.S7.02.V3

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Prepared by:
Ruth Mougey MT(ASCP)SBB
Revised by:
Stacie Campbell, MLS (ASCP)
Transfusion Services Supervisor / Subject Title:
Blood Products, Use of & Policies
Revision Date: December , 2008
Latest Revision Date: April 13, 2010 / Date Put in Use:
Approved by: Melton Fish, D.O. Date: 5/25/10
Reviewed-- No Revisions: Melton Fish, D.O. Date: 12/19/11
Reviewed-- No Revisions: Melton Fish, D.O. Date: 12/20/12
(Printed and signed original found in the Laboratory)
Dr. Melton Fish, D.O. (FCAP) Medical Director – Laboratory

PURPOSE

To describe the blood products and derivatives available in the Transfusion Service

BLOOD PRODUCTS / DESCRIPTION
Cellular Products
LRBC / Leuko-Reduced, Red Blood Cells
Autologous RBCs / Red Blood Cells prepared from a whole blood donation by the recipient (special order & collection arranged thru patient’s physician)
Directed RBCs / Red Blood Cells prepared from a whole blood donation by a designated donor (special order & collection arranged thru patient’s physician)
Platelets Pheresis / Platelets harvested by apheresis, (equivalent amt. of platelets from 6 units of whole blood)
Granulocytes / (Special order) granulocytes harvested by apheresis
Special Needs –Cellular Blood Products
Irradiated / Products that have been subjected to gamma irradiation to kill lymphocytes that could engraft in immunocompromised patients.
CMV negative / Product prepared from a donor who tested as negative for antibodies to the Cytomegalovirus.
Leuko-reduced / Allogeneic RBCs & Platelets (apheresis) are leuko-reduced at GSMC
Volume- reduced / The volume of an LRBCis reduced so that product may be given over a longer period of time (>4 hr).
Plasma Products
FFP / Plasma, thawed from Plasma frozen within 8 hr of collection
FP / Plasma thawed from Plasma frozen within 24 hr of collection.
Plasma, Cryo-reduced / Plasma, thawed (made from FFP after the cryohas been removed - special order)
Cryo / Cryoprecipitated Factor VIII, pooled or single bags of cryoprecipitate.
Derivatives
RhIg / Rh Immune globulin – (Ortho’s brand is Rho Gam)

PRINCIPLE

Whole blood donations are made into various blood products (RBCs and Plasma) that are used to treat the specific needs of patients (RBCs for anemia, Plasma for patients needing coagulation factors).

Apheresis technology may also be used to collect a specific product from a donor. For example, an apheresis platelet contains the number of platelets that could be prepared from 6 units of whole blood but all from the same donor. Apheresis may also be used to collect 2 RBC units or several units of plasma from the same donor.

Rh Immune globulin is made from a pool of plasmas collected from donors immunized to the Rho D antigen.

Related Documents:

Procedure # / Procedure Name
TS503.0 / Blood Products & Test Descriptions
TS503.5 / Aliquots for Infant Transfusions
TS501.1 & TS501.6 / ABO Typing by Gel & Tube
Antigen Typing - D
TS402.1 / Autologous & Directed Donor Units

PROCEDURE

A. All blood products and derivatives are supplied from approved vendors who follow all applicable federal and accreditation guidelines.

1.The products and derivatives are received into the Laboratory’s Computer System and are tracked from the time of receipt to final disposition including “issued, destroyed, wasted or returned”.

2.All RBC products are quarantined until they are retyped and checked for suitability.

3.All testing performed on each blood product is recorded in the computer system.

B. Red Blood Cells

1.All allogeneic Red Blood Cells received at GSMC are Leukoreduced (LRBCs). LRBCs are processed by a closed system filtration that is performed at the time of processing the units to yield a unit of leukocyte-reduced red blood cells. The filtration step occurs within 24 hours of collection with less than 5 x 106 WBC remaining and at least 80 % RBC recovery. Autologous donor units are usually not leukoreduced but directed donors should be leukoreduced and if a relative of the patient, must beirradiated.

2.All LRBC transfusions require a current type and screen tested from a sample labeled using the Typenex armband system for the sample and the patient.

a.A sample is good for 72 hours from the time of collection unless the patient is having pre-admission testing (Pre-Surg).

  1. Recipients receive ABO type specific or ABO compatible LRBCs.
  2. Rh-negative blood may be reserved for Rh negative female recipients of childbearing age in the event of an emergency or shortage of Rh-negative LRBC.
  3. Rh-positive recipients may receive either Rh-positive or Rh-negative blood at the discretion of the Blood Bank technologist without prior notification of the attending physician in order to avoid outdating a unit of Rh negative blood.
  4. Weak D recipients (positive by the Du test) will be transfused with Rh-negative red cells unless it has been determined that the patient is a male or a female over childbearing age.
  5. When there is an urgent need for RBCs before there is time to perform a type, antibody screen and crossmatch, uncrossmatched Gp. O Rh negative blood may be issued at the request of the attending physician. The crossmatch is completed as soon as possible.
  6. In a non-urgent situation if a patient is to be given LRBCs of Group compatible blood (not type specific) the attending physician is notified prior to transfusion.
  7. All Red Blood Cells are stored between 1ºC -6ºC in the Transfusion Service’s Blood Bank refrigerator.
  1. If the Transfusion Services Blood Bank refrigerator cannot be maintained at the proper storage temperature, Red Blood Cells and LRBC’s are moved to the Recovery Room Blood Bank refrigerator.
  1. Most of the LRBC units have adenine-saline added and have a shelf life of 42 days. If the anticoagulant is CPDA-1 the shelf life is 35 days.
  2. If a unit of Red Blood Cells or LRBCs expires, it will be discarded for incineration. The unit number will be recorded on the Wasted Unit Log.

C.Single Donor Fresh Frozen Plasma, (FFP), Frozen Plasma (Frozen Within 24 hours of Collection:

1. To be labeled Fresh Frozen Plasma (FFP), plasma must be separated from the cells and placed at -18o C or lower within 8 hours after collection.

2. Frozen Plasma (FP) is separated from the cells and placed at -18o C or lower within 24 hours after collection.

3. Frozen Plasma is 100% interchangeable with FFP. When FFP is ordered, FP can be substituted in all cases.

4. FFP and FPare stored at -18° C or lower in the Transfusion Services Forma Scientific Plasma freezer. If the freezer cannot be maintained at the proper temperature, the FFP or FP is shifted to the Back-up Freezer in the Transfusion Services.

5. FFP & FP expires 12 months from the date of donation.

6.All FFP or FP transfusions require a current blood type tested from a sample labeled using the Typinex armband system for the sample and the patient.

a.A sample is good for 72 hours from the time of collection unless the patient is having pre-admission testing (Pre-Surg).

7.The following procedure is to be followed when a physician orders FFP.

a. If possible nursing personnel must notify the Transfusion Services at least 30 minutes before a unit is needed to allow time for thawing.

b. FFP or FP that is ABO identical is selected if available. If not, plasma that is ABO compatible with the recipient’s red blood cells is given. FFP and FP can be given without regard to the Rh group. Crossmatching is not required.

c. Immediately before use, the plasma is thawed in the plasma-thawing bath and labeled as per the Fresh Frozen Plasma procedure in theTransfusion Services Policy & Procedure Manual.

d. The expiration date of FFP is changed to expire 5 days after thawing, and is stored at 1°-6oC until transfusion.

e. When FFP expires, it is discarded for incineration and the unit number will be recorded on the Wasted Units Log.

D.Plasma, Cryoprecipitate Reduced (CRYO Poor Plasma)

  1. Plasma, Cryoprecipitate Reduced is the supernatant plasma remaining from FFP after cryoprecipitate is made. It is most often used for patients with TTP.
  2. The physician must specifically order this product and it will be ordered from the blood supplier. Plasma, CRYO-reduced is not routinely kept in the inventory.
  3. Plasma, CRYO-reduced is stored at -18o C or lower in the Transfusion Service’s Forma Scientific Plasma freezer. If the freezer cannot be maintained at the proper temperature, the Plasma, CRYO-reduced is shifted temporarily to the Back-up Freezer in the Transfusion Services.
  4. All Plasma, CRYO-reduced transfusions require a current blood type tested from a sample labeled using the Typinex armband system for the sample and the patient
  5. Plasma, CRYO-reduced expires 12 months from the date of donation.
  6. The following procedure is be followed when Plasma, CRYO-reduced is ordered:
  1. Since this product is a special order, it will not be available immediately.
  2. Plasma, CRYO-reduced that is ABO identical is selected if available. If not, plasma that is ABO compatible with the recipient’s red blood cells is given. Plasma, CRYO-reduced can be given without regard to the Rh group. Crossmatching is not required.
  3. Immediately before use, the plasma is thawed in the plasma-thawing bath and labeled as perthe Fresh Frozen Plasma procedure in the Transfusion Services Policy & Procedure Manual
  4. The expiration date of Plasma, CRYO-reduced is changed to expire 24 hours after thawing, and is stored at 1°-6o C until transfusion.
  5. When Plasma, CRYO-reduced expires, it will be discarded for incineration and the unit number will be recorded on the Wasted Units Log.

ECryoprecipitate (CRYO):

1. Cryoprecipitate is the cold-insoluble portion of plasma processed from Fresh Frozen Plasma. Each unit will have a minimum of 150 mg of fibrinogen and 80 IU of Factor VIII.

2. Cryoprecipitate is stored at -18o C or lower in the Transfusion Services Forma Scientific freezer. If the freezer cannot be maintained at the proper temperature, the cryoprecipitate will be shifted temporarily to the Back-up Freezer in the Transfusion Services.

3. All Cryoprecipitate transfusions require a current blood type tested from a sample labeled using the Typinex armband system for the sample and the patient

4. Cryoprecipitate expires 12 months from the date of donation.

5. The following procedure is be followed when cryoprecipitate is ordered:

  1. If possible nursing personnel must notify the Transfusion Services at least 30 minutes before a unit is needed to allow time for thawing.
  2. If possible, ABO identical cryoprecipitate is selected if available although all blood groups are acceptable. Cryoprecipitate may be administered without regard to Rh type. Crossmatching is not required.
  3. Immediately before use, the cryoprecipitate is thawed in the plasma-thawing bath, preparedand labeled as per the Cryoprecipitate AHF procedure in the Transfusion Services Policy & Procedure Manual.

6.Thawed Cryoprecipitate expires 6 hours after thawing or 4 hours after pooling, which ever is shorter.

7.Thawed Cryoprecipitate is stored at Room Temperature NOT in the Refrigerator.

8.If the CRYO expires, it is discarded for incineration and the unit number will be recorded on the Wasted Units Log.

F. Platelets Pheresis, Leuko-Reduced:

1. Platelets are obtained by automated collection methods that selectively harvest platelets and return all other portions of the donor’s blood back to the donor. The Platelets Pheresis are leuko-reduced during their preparation. The platelet count of the product will be at least 3.0 x 1011 and is equivalent to approximately 4-8 units of random donor concentrates prepared from whole blood collections.

2. GSMC Laboratory will refuse to receive visibly bloody platelet pheresis into inventory from any blood supplier.

3. All Platelets Pheresis transfusions require a current blood type tested from a sample labeled using the Typenex armband system for the sample and the patient

4. ABO type specific Platelets are preferred but are not always available. If the need is urgent, the use of what platelets are available is recommended.

5. For females of child bearing age, Rh negative platelets are recommended.

6. For infants in the NICU, a Gp. AB or A platelet pheresis, leuko-reduced, CMV negative, & irradiated, is always available.

7. Platelets Pheresis is stored in the platelet incubator at 20° - 24oC with continuous agitation in the platelet incubator.

  1. If the platelet incubator cannot be maintained at the proper temperature, the platelets will be taken out of the incubator and stored on the backup rotator at room temperature.
  2. The Temperature of the room air will be recorded every 4 hours until the incubator is operational.

8. Platelets Pheresis expire 5 days after collection.

9. If a PlateletsPheresis expires, it is discarded for incineration. The unit number is recorded on the Wasted Unit Log.

REFERENCES

  1. American Association of Blood Banks, Standards for Blood Banks and Transfusion ServicesCurrent ed., AABB, Bethesda, MD.2009.
  2. American Association of Blood Banks, Technical Manual, current ed., AABB, Bethesda, MD.2008.

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