Blood and blood products

Each guideline has a summary of clinical guidance with recommendations and good practice statements.

Guidelines

1. Critical bleeding
2. Perioperative
3. Medical
4. Critical care
5. Obstetrics and maternity
6. Neonatal and paediatrics

Background

Patient blood management boost and conserve the patient’s own blood. This improves patient outcomes. Better managed patients usually require fewer transfusions of donated blood components, and thus avoid transfusion-associated complications.

The rationale for patient blood management addresses evidence-based transfusion medicine practice and stewardship of donated blood, to:

• view a patient’s own blood as a valuable and unique natural resource that should be conserved and managed appropriately
• acknowledge that altruistically donated blood is a valuable, unique and costly resource that is held in trust and will only be used as therapy when there is evidence for potential benefit and minimising potential harm
• consider transfusion alternatives
• ensure quality products are available in a timely and safe manner
• ensure potential hazards are considered and balanced against the benefits
• explain the benefits and risks to the patient, their family and carers.

Scope

• Decision to transfuse
• Consent for blood products
• Prescription of blood products
• Requests for blood products and pretransfusion sample collection
• Storage, collection and transport of blood products
• Administration of blood products
• Special transfusion circumstances
• Management of transfusion-related adverse events
• Clinical governance.

Guidelines for the Prescription of Blood and Blood Products by Nurse Practitioners can be accessed via the same link.

Suggested criteria for major haemorrhage protocol activation

• Systolic blood pressure <100mmHg
• Heart rate >100bpm
• Positive focused assessment with sonography for trauma
• Estimated blood loss >1L
• Pallor

A ratio-based approach of a transfusion ratio of at least 2:1:1 of red blood cells:plasma:platelets is recommended.

Haemorrhage control

• Identify source of bleeding early.
• Temporarily control bleeding, using:
  • compression
  • packing
  • tourniquet
  • pelvic binder.

Assess and definitively control haemorrhage control with early surgery or angiography to control bleeding.

Parameters

Monitor parameters prior to activation of the major haemorrhage protocol. Consider repeat pathology after at least every four units of red blood cells administered.

Values indicative of critical physiological derangement include:

• temperature <35°C
• pH <7.2, base excess <–6 mmol/L, lactate >4 mmol/L
• ionised calcium <1 mmol/L
• PT >1.5 × upper limit of normal
• INR >1.5
• APTT >1.5 × upper limit of normal
• fibrinogen level <2.0 g/L

Background

Critical bleeding results in decreased circulating volume and loss of oxygen-carrying capacity. It result in coagulopathy.

A major haemorrhage is considered life-threatening. It can occur in surgical, medical, obstetric or trauma patients. It is likely to result in the need for massive transfusion (greater than or equal to five units of red blood cells in four hours).

The management of major haemorrhage is clinically and logistically complex and is associated with significant morbidity and mortality. Data from the Australian New Zealand Massive Transfusion Registry demonstrated, that between 2011-2015, 19.4% of patients who received a massive transfusion died while in hospital. Over the past two decades there has been considerable evidence published evaluating different strategies to improve patient outcomes in major haemorrhage.

Background

Maternal Rh D antibodies may develop during pregnancy when an Rh D negative pregnant woman carries an Rh D positive foetus. Development of antibodies occurs when foetal red blood cells enter the maternal circulation, and antibodies are produced towards the foetal Rh D antigen.

Rh D immunoglobulin is manufactured from plasma of Rh D negative blood donors who are stimulated to produce elevated levels of anti-D antibodies. It is given to Rh D negative women with no preformed anti-D antibodies (during pregnancy and immediately postpartum) to prevent Rh D alloimmunisation.