Transfusion Medicine Quality Manual
Guidelines for
Blood Component Substitutions
in Adults
Provincial Blood
Coordinating Program
Guidelines for
Blood Component Substitutions
In Adults
1.0 Policy Statements
1.1
Transfusion of whole blood shall be ABO group specific.
1.2
Transfusion of red blood cells shall be ABO compatible.
1.3
Rh negative red cells shall be transfused to Rh negative female recipients (at
or below child bearing age) except in life threatening situations when Rh
negative red cells are not available.
1.4
There shall be an established facility policy, which comply with Provincial
Blood Coordinating Program (PBCP) policies, for the transfusion of Rh
positive red cells to an Rh negative recipient when the inventory of Rh
negative red cells is impacted such as in cases of trauma, massive
transfusion, and emergency situations or if red cells are in short supply.
1.5
The decision to transfuse Rh positive red cells to an Rh negative recipient
shall be approved by the attending physician or the physician on call for
Transfusion Medicine or the Medical Director/designate.
1.6
There shall be an established facility policy, that complies with PBCP
policies, for Rh Immune Globulin (RhIg) administration when Rh positive
red cells are inadvertently transfused to an Rh negative recipient
1.7
There shall be an established facility policy, which complies with PBCP
policies, for RhIg administration whenever Rh positive platelets are
transfused to an Rh negative recipient.
1.8
Recipients shall be transfused with plasma that is ABO compatible with the
recipient’s red cells. Approval by the Transfusion Medical Director or
designate and the patients physician is required for the administration of
incompatible plasma, a crossmatch is not required.
1.9
Blood components and blood products shall be administered according to
facility policy.
1.10 Rh positive red cells shall not be given if the recipient’s plasma contains
Anti-D.
_______________________________________________________________________
This document may be incorporated into each Regional Policy/Procedure Manual.
NL07-002 –TMQ
Version: 5.0
Effective Date: 2015-05-15
Page 2 of 9
Provincial Blood
Coordinating Program
Guidelines for
Blood Component Substitutions
In Adults
2.0 Linkages
Determining Specimen Suitability. Available at:
http://www.health.gov.nl.ca/health/bloodservices/pdf/determining_specimen_suitability.p
df
Issuing Blood Components. Available at:
http://www.health.gov.nl.ca/health/bloodservices/pdf/issuing_blood_components_ver_2.
pdf
Patient History Check. Available at:
http://www.health.gov.nl.ca/health/bloodservices/pdf/patient_history_check.pdf
Patient Identification and Specimen Labeling. Available at:
http://www.health.gov.nl.ca/health/bloodservices/pdf/patient_id_and_specimen_labeling.
pdf
Standard Operating Procedure for ABO Grouping. Available at:
http://www.health.gov.nl.ca/health/bloodservices/pdf/sop_for_abo_grouping.pdf
Standard Operating Procedure for Rh Typing. Available at:
http://www.health.gov.nl.ca/health/bloodservices/pdf/sop_for_rh_typing.pdf
3.0 Scope
3.1
All Transfusion Medicine Laboratory Technologists.
3.2
Responsible Physician/Designate or Hematologist/Hematopathologist.
_______________________________________________________________________
This document may be incorporated into each Regional Policy/Procedure Manual.
NL07-002 –TMQ
Version: 5.0
Effective Date: 2015-05-15
Page 3 of 9
Provincial Blood
Coordinating Program
Guidelines for
Blood Component Substitutions
In Adults
4.0 General Information
4.1
Rh positive recipients may receive either Rh positive or Rh negative whole
blood or red blood cells.
4.2
Rh negative whole blood or red cell components should be transfused to
recipients who are Rh negative.
4.3
Evaluation of the change to Rh positive should be made early so as to
conserve red blood cells for other recipients if the available supply of Rh
negative blood is less than the expected transfusion requirement.
4.4
Consideration of recipient age and gender, diagnosis and transfusion history
are important when planning to transfuse Rh positive red cells to an Rh
negative recipient.
4.5
ABO compatible units may be substituted for ABO specific units in the
following circumstances:
4.5.1 During massive transfusion;
4.5.2 During critical inventory shortages;
4.5.3 When phenotyped units are required and ABO specific is not
available;
4.5.4 When patients clinical condition indicates that red blood cells
should be irradiated or anti-CMV negative and ABO specific is
not available; and
4.5.5 To reduce the amount of product outdating.
4.6
ABO compatible platelets should be used for recipients requiring repeated
transfusions, but urgently needed transfusions should not be delayed in
order to obtain them.
4.7
In the event that a recipient will require repeated platelet transfusions or
other special circumstances, arrangements should be made with Canadian
Blood Services to obtain ABO compatible platelets where possible.
4.8
One vial of 300 µg (1500 IU) RhIg is required to counteract the immunizing
effects of approximately 15-17 mL of Rh positive red cells or 30 mLof
whole blood.
4.9
Each vial of 120 µg (600 IU) RhIg is sufficient for 6 ml of red blood cells or
12 mL of whole blood and lasts approximately 21 days.
_______________________________________________________________________
This document may be incorporated into each Regional Policy/Procedure Manual.
NL07-002 –TMQ
Version: 5.0
Effective Date: 2015-05-15
Page 4 of 9
Guidelines for
Blood Component Substitutions
In Adults
Provincial Blood
Coordinating Program
4.10 RhIg should be administered to Rh negative patients within 72 hours of
exposure to Rh positive red cells following Rh positive platelet transfusions.
4.11 RhIG treatment should only be administered if the transfused Rh positive
blood represents less than 20% of the total circulating red cells if clinically
indicated.
5.0 Process
5.1
Quality Control
5.1.1
5.1.2
A quality process should be in place to monitor appropriate
utilization of blood components and products.
Blood components and blood products shall not be
administered beyond the expiry date without documented
approval from the Transfusion Service Medical Director.
5.2
Procedure (NA)
5.3
Guidelines (NA)
5.4
Materials (NA)
6.0 Acronyms
CMV
RhIg
PBCP
Cytomegalovirus
Rh immune globulin
Provincial Blood Coordinating Program
7.0 Definitions
ABO compatible
Donor blood components that are nonidentical ABO group to the recipient ABO
group but do not have corresponding
antibodies.
_______________________________________________________________________
This document may be incorporated into each Regional Policy/Procedure Manual.
NL07-002 –TMQ
Version: 5.0
Effective Date: 2015-05-15
Page 5 of 9
Provincial Blood
Coordinating Program
Guidelines for
Blood Component Substitutions
In Adults
ABO group specific
Donor blood components of the same ABO
and Rh group as the recipient.
Blood Component
A therapeutic part of blood intended for
transfusion (RBC’s, platelets, plasma) that can
be prepared using the equipment and
techniques available in a blood center.
Donor blood components that are non-identical
Rh(D) group to the recipients Rh(D) group and
do not have corresponding anti-D
Rh (D) compatible
8.0 Records Management
8.1
The transfusion medicine laboratory shall retain the recipient administration
data file indefinitely.
8.2
All administration records in the recipient’s health record shall be retained
in accordance with the health care facility policy.
8.3
Temperature monitoring records for blood components shall be retained a
minimum of five years.
8.4
Each facility shall have a record system that ensures a copy of all
information relating to the patient and the administered blood component
forms a permanent transfusion record for the patient.
8.5
The records system shall be organized and maintained in such a way that it
is possible to trace blood components from distribution to final disposition.
The records system shall also provide a means to locate and access all
records in the facility related to a given product.
9.0 Key Words
ABO compatible, group substitution, component selection
_______________________________________________________________________
This document may be incorporated into each Regional Policy/Procedure Manual.
NL07-002 –TMQ
Version: 5.0
Effective Date: 2015-05-15
Page 6 of 9
Guidelines for
Blood Component Substitutions
In Adults
Provincial Blood
Coordinating Program
10.0 Supporting Documents
10.1 Tables/Charts
Selection of ABO Compatible Donor Red Cells
Recipient
O
A
B
AB
1st Choice
Group O
Group A
Group B
Group AB
2nd Choice
none
Group O
Group O
Group A
3rd Choice
none
none
none
Group B
4th Choice
none
none
none
Group O
Suggested ABO Group Selection Order for Plasma
Recipient
ABO
O
A
B
AB
st
1 Choice
O
A
B
AB
Component ABO Group
2nd Choice
3rd Choice
A
B
AB
(B)
AB
(A)
(A)
(B)
4th Choice
AB
(O)
(O)
(O)
Blood groups in parenthesis represent choices with incompatible plasma (listed in
“least incompatible” order.)
Approval by the Transfusion Medical Director or designate and the patients
physician is required for the administration of incompatible plasma.
_______________________________________________________________________
This document may be incorporated into each Regional Policy/Procedure Manual.
NL07-002 –TMQ
Version: 5.0
Effective Date: 2015-05-15
Page 7 of 9
Provincial Blood
Coordinating Program
Guidelines for
Blood Component Substitutions
In Adults
Suggested ABO Group Selection Order for Platelets
ABOidentical platelets are preferred, although all ABO groups are acceptable.
Components that are compatible with recipient’s red cells are recommended.
In the instance a patient receives platelets that are not ABOidentical and the platelet
contains a high titre anti-A or Anti-B the patient may become sensitized and
hemolysis may occur with large volume transfusion (more than one adult dose per 24
hour period).
Suggested ABO Group Selection for Cryoprecipitate
Group specific if available.
All ABO groups are acceptable for transfusion of Cryoprecipitate. If pooling, ensure
only one (1) blood group per pool.
_______________________________________________________________________
This document may be incorporated into each Regional Policy/Procedure Manual.
NL07-002 –TMQ
Version: 5.0
Effective Date: 2015-05-15
Page 8 of 9
Provincial Blood
Coordinating Program
Guidelines for
Blood Component Substitutions
In Adults
References
British Columbia Provincial Blood Coordinating Program. Crossmatch. Retrieved from:
http://www.traqprogram.ca/index.php/en/resources/manuals/traqpbco-manuals/item/282tmp0004-crossmatch
British Columbia Provincial Blood Coordinating Program. Non Red Cell Component
Selection and Modification. Retrieved from:
http://www.traqprogram.ca/index.php/en/resources/manuals/traqpbco-manuals/item/290tmp0012-non-red-cell-component-selection-and-modification
Canadian Blood Services (2014) Circular of Information. Platelets. Retrieved from:
https://www.blood.ca/sites/default/files/PooledApheresisPlatelets.pdf
Canadian Blood Services. 2009 Visual Assessment Guide T05 021. Canadian Blood
Services. Retrieved from:
http://www.transfusionmedicine.ca/sites/transfusionmedicine/files/PDF/VAG_en.pdf
Canadian Society for Transfusion Medicine, (2011). Standards for Hospital
Transfusion Services, Version 3.0. Ottawa, ON: Author.
Canadian Standards Association, (2010). CAN/CSA-Z902-10, Blood and Blood
Components. Mississauga, ON: Author.
Katherine A. Downes/Ira A. Shulman (2014). Pretransfusion Testing. M. K. Fung (Ed.),
Technical Manual (18th ed,), pp. 375. Bethesda,MD, USA: AABB Press.
Melanie S. Kennedy/Megan Delaney/Scott Scrape (2014) Perinatal Issues in Transfusion
Practice. M.K. Fung (Ed.),Technical Manual (18th ed.), pp 565. Bethesda. MD, USA:
AABB Press.
_______________________________________________________________________
This document may be incorporated into each Regional Policy/Procedure Manual.
NL07-002 –TMQ
Version: 5.0
Effective Date: 2015-05-15
Page 9 of 9