1. Blood Components
Dosage And Their
Administration
Fadi Khaizaran
Dallaa General Hospital
LD/BB Chief Technicians
Nov 2012

2. History of Transfusions
 Blood transfused in humans since mid-1600’s
 1828 – First successful transfusion
 1900 – Landsteiner described ABO groups
 1916 – First use of blood storage
 1939 – Levine described the Rh factor

3. Transfusion Overview
 Integralpart of medical treatment
 Most often used in Hematology/Oncology, but
other specialties as well (surgery, ICU, etc)
 Objectives
 Blood components
 Indications for transfusion
 Safe delivery
 Complications

4. Blood Components
 Prepared from Whole blood collection or apheresis
 Whole blood is separated by differential centrifugation
 Red Blood Cells (RBC’s)
 Platelets
 Plasma
 Cryoprecipitate
 Others
 Others include Plasma proteins—IVIg, Coagulation
Factors, albumin, Anti-D, Growth Factors, Colloid volume
expanders
 Apheresis may also used to collect blood components

5. Differential Centrifugation
First Centrifugation
Closed System
Whole Blood Satellite Satellite Bag
Main Bag Bag 2
1
First
Platelet-rich
RBC’s Plasma

6. Differential Centrifugation
Second Centrifugation
RBC’s Platelet-rich
Plasma
Second
Platelet Plasma
RBC’s Concentrate

7. Whole Blood
 Storage
 4° for up to 35 days
 Indications
 Massive Blood Loss/Trauma/Exchange Transfusion
 Considerations
 Use filter as platelets and coagulation factors will not be
active after 3-5 days
 Donor and recipient must be ABO identical

8. RBC Concentrate
 Storage
 4° for up to 42 days, can be frozen
 Indications
 Many indications—ie anemia, hypoxia, etc.
 Considerations
 Recipient must not have antibodies to donor RBC’s
(note: patients can develop antibodies over time)
 Usual dose 10 cc/kg (will increase Hgb by 2.5 gm/dl)
 Usually transfuse over 2-4 hours (slower for chronic
anemia

9. Platelets
 Storage
 Up to 5 days at 20-24°
 Indications
 Thrombocytopenia, Plt <15,000
 Bleeding and Plt <50,000
 Invasive procedure and Plt <50,000
 Considerations
 Contain Leukocytes and cytokines
 1 unit/10 kg of body weight increases Plt count by 50,000
 Donor and Recipient must be ABO identical

10. Plasma and FFP
 Contents—Coagulation Factors (1 unit/ml)
 Storage
 FFP--12 months at –18 degrees or colder
 Indications
 Coagulation Factor deficiency, fibrinogen replacement, DIC, liver
disease, exchange transfusion, massive transfusion
 Considerations
 Plasma should be recipient RBC ABO compatible
 In children, should also be Rh compatible
 Account for time to thaw
 Usual dose is 20 cc/kg to raise coagulation factors approx 20%

11. Cryoprecipitate
 Description
 Precipitate formed/collected when FFP is thawed at 4°
 Storage
 After collection, refrozen and stored up to 1 year at -18°
 Indication
 Fibrinogen deficiency or dysfibrinogenemia
 vonWillebrands Disease
 Factor VIII or XIII deficiency
 DIC (not used alone)
 Considerations
 ABO compatible preferred (but not limiting)
 Usual dose is 1 unit/5-10 kg of recipient body weight

12. Granulocyte Transfusions
 Prepared at the time for immediate transfusion (no
storage available)
 Indications – severe neutropenia assoc with
infection that has failed antibiotic therapy, and
recovery of BM is expected
 Donor is given G-CSF and steroids or Hetastarch
 Complications
 Severe allergic reactions
 Can irradiate granulocytes for GVHD prevention

13. Leukocyte Reduction Filters
 Used for prevention of transfusion reactions
 Filter used with RBC’s, Platelets, FFP,
Cryoprecipitate
 Other plasma proteins (albumin, colloid
expanders, factors, etc.) do not need filters—
NEVER use filters with stem cell/bone marrow
infusions
 May reduce RBC’s by 5-10%
 Does not prevent Graft Verses Host Disease
(GVHD)

14. RBC Transfusions
Preparations
 Type
 Typing of RBC’s for ABO and Rh are determined for
both donor and recipient
 Screen
 Screen RBC’s for atypical antibodies
 Approx 1-2% of patients have antibodies
 Crossmatch
 Donor cells and recipient serum are mixed and
evaluated for agglutination

15. RBC Transfusions
Administration
 Dose
 Usual dose of 10 cc/kg infused over 2-4 hours
 Maximum dose 15-20 cc/kg can be given to hemodynamically
stable patient
 Procedure
 May need Premedication (Tylenol and/or Benadryl)
 Filter use—routinely leukodepleted
 Monitoring—VS q 15 minutes, clinical status
 Do NOT mix with medications
 Complications
 Rapid infusion may result in Pulmonary edema
 Transfusion Reaction

16. Platelet Transfusions
Preparations
 ABO antigens are present on platelets
 ABO compatible platelets are ideal
 This is not limiting if Platelets indicated and type specific
not available
 Rh antigens are not present on platelets
 Note: a few RBC’s in Platelet unit may sensitize the Rh-
patient

17. Platelet Transfusions
Administration
 Dose
 May be given as single units or as apheresis units
 Usual dose is approx 4 units/m 2—in children using 1-2
apheresis units is ideal
 1 apheresis unit contains 6-8 Plt units (packs) from a
single donor
 Procedure
 Should be administered over 20-40 minutes
 Filter use
 Premedicate if hx of Transfusion Reaction
 Complications—Transfusion Reaction

18. Time Limits for Infusion
Blood/ Start infusion Complete infusion
blood product
Whole blood/ within 30 min. of within 4 hour
red cells removing pack (less in high
from ambient temperature)
refrigerator
Platelet immediately within 20 min
concentrates
FFP within 30 min within 20 min
18

19.  Is the product clearly prescribed?
 Are any drugs required before or during
transfusion? i.e. antibiotics
 Is the rate of transfusion appropriate?
 Does the patients condition require medical
review prior to transfusion
All patients having a blood transfusion MUST
have a NAMEBAND containing all of their

20. 1st checkers
Registered Nurse/
Midwife, Doctor
2nd Checkers
Any of the above &
Qualified Theatre
Practitioner
or qualified nurse

21. Base line observations – Temperature, pulse
and blood pressure
Further observations (as above) at 15 minutes
A set of observations at the end of transfusion
More frequently if the patient is unwell,
unobservable, unconscious or a child.

22. Ensure the venflon is secure, patent and
there are no signs of inflammation
Give the patient the call bell
Patients should remain in a clinical area for
the duration of the Transfusion
Review the patients fluid balance and
medication.

23. Pre-administration Procedure
Step 1: Check the blood component has been prescribed
Step 2: Undertake baseline observations
Step 3: Undertake visual inspection
LEAKS
DISCOLOURATION
CLUMPING
EXPIRY DATE
If there is ANY discrepancy - DO NOT transfuse

24. Step 1: Ask the patient to tell you their:
Full Name + Date of Birth
Check this information
against the patient’s ID
wristband
Be extra vigilant when checking the identity of the
unconscious / compromised patient

25. Administration Procedure
Step 2: Check the patient’s
– First name
– Surname
– Date of birth
– Hospital number
on the compatibility/
traceability label against
the patient’s ID wristband

26. Administration Procedure
Step 3: Check the compatibility/traceability label with the
blood bag label
Any discrepancies DO
NOT TRANSFUSE !

27. Blood Component Bedside Check Procedure
SURNAME
FIRST NAME(s)
HOSPITAL
NUMBER
D.O.B.BLOOD
GROUP
(Patient and Unit)
DONOR
NUMBER
EXPIRY DATE
Special
Requirements

28.  Stop the Transfusion and seek Medical Input and inform the
Transfusion Laboratory staff
 Check the Blood component matches the patient details
 Replace the unit and giving set with Normal Saline 0.9%
 Send the discontinued unit with giving set attached back to
transfusion capped off at the end with a white venflon cap – and any
previous transfused bags sealed with the blue plugs all in biohazard
bags
 Documentation (complete the checklist)
 Complete a Trust Incident form