Blood Products

Depending on the administration rate, red cells can be documented on either care pathways (Routine or Urgent), but the transfusion should commence within 30 minutes of removal from the Blood Bank fridge (controlled temperature of 2-6°C).

• Red Blood Cells (RBC's) can be stored in an unopened 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). The red cells transfusion should occur via a standard blood transfusion giving set.
• The line on the standard blood transfusion giving set should be primed with normal saline prior to the first unit.
• Each unit should 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 require an urgent transfusion.
• No drugs or other intravenous fluids should 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 MUST be performed to ensure a component transfusion and patient identity.
• Patients should be monitored during the transfusion according to Hospital guidelines.

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. 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 that a ‘blue light’ run is required. This will take approximately 55 minutes depending on traffic conditions (this requires consultant authorisation).

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

It is essential that:

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

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. The request form must be completed correctly and be signed by the relevant 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. The dose is dependent on the clinical situation and coagulation results. The response should be monitored by repeat coagulation tests.

Important points:

• FFP can be documented on a rapid or emergency blood transfusion
• The average adult therapeutic dose is one 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 the sample via a standard blood transfusion giving set
• There is no need to prime the line prior to transfusion
• Each unit should be administered over 20 to 30 minutes
• No drugs or other intravenous fluids to be added to the unit or administered via the same cannula during the transfusion
• Bedside checks to ensure a component transfusion, and patient identity should be performed
• Patients should be monitored during the transfusion according to the Hospital guidelines

Cryoprecipitate is rich in Factor VIII, Von Willebrand Factor (VWF), Factor XIII, fibronectin 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 °C).

Cryoprecipitate can be documented on an urgent blood transfusion care pathway.

Important points:

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

FFP and cryoprecipitate for paediatrics and neonates

Neonates under one year old should only receive pathogen-reduced FFP - such as 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 or cryoprecipitate required on the request form.

Please note – adult patients requiring plasma exchange will be issued Octaplas also.

Human albumin is available as a 5% solution in 500ml bottles. 20% (salt poor) is only available in 100ml bottles.

Both products have a physiological half-life of 5 to10 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 the Blood Bank, completed correctly and signed by the relevant Medical Practitioner. A sample for a group and screen is not required.

Important information about Albumin:

• Should be administered via a standard intravenous fluid giving set
• Each bottle should be infused over thirty minutes to two hours
• Albumin must be administered with caution - 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

PCC is indicated in treating emergency or overdose situations during oral anticoagulant treatment. PCC can be issued immediately from the Blood Bank without consultation with the Haematology Medical staff. This is only the case in life-threatening cases, such as patients on warfarin with intracranial or massive GI bleeds.

In all other cases, please discuss the case with the Haematology Clinician. The dose is dependent on the patient’s body weight and most recent INR (warfarin ONLY) and administered by intravenous Bolus injection. The use of beriplex to reverse life-threatening bleeds for patients taking DOAC anticoagulation therapy MUST be authorised by a Consultant Haematologist. Refer to Guidelines for the Management of Emergency Reversal of Oral Anticoagulants on Sharepoint for more information.

Reconstitution/Procedural information for Beriplex:

• 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
• PCC should not be mixed or administered with any other medicinal products
• Slowly inject the solution - start at 1ml/min and do not exceed 3ml/min - using a butterfly needle or through a free-flowing cannula
• The patient’s pulse rate must be measured before and during administration

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

Important information about NovoSeven:

• The recommended dose of NovoSeven is 90 micrograms/kg 
• To be given 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 it is indicated that there is no response after 2 doses, but further doses should not be administered
• Once reconstituted, it must be used within 3 hours or discarded

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 webpage was reviewed and updated by Mark Taplin, Blood Transfusion Manager, 22nd February 2024