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Blood Transfusion Products

The Blood Banks at the Ä¢¹½tvÊÓƵ Teaching Hospitals provide a comprehensive range of transfusion products, nearly all of which are available on a 24/7 basis. The few exceptions to the 24/7 availability are generally due to processing exceptions or patient testing complications. Special requirements should be discussed with the laboratory in the first instance however some products will require the authorisation of a medical haematologist.

Red Blood Cells

• Red blood cells are used to replace the oxygen carrying capacity of either anaemic patients or those with acute blood loss.
• All donations are tested for HIV, Hepatitis B&C and Syphilis.
• All donations are filtered as a precaution against variant-CJD and are supplied in latex free bags.
• Filtration also reduces the incidence of febrile reactions and transmission of cytomegalovirus (CMV).
• Donations testing negative for CMV are available for selective patients -see local policies.
• Donations of irradiated red cells and platelets are available for selective patients – see local policies.
• Donations testing negative for sickle trait (Hb S) are available for selective patients – sickle cell disease (not trait).
• Red blood cells must be stored in an approved monitored blood bank refrigerator.

White Blood Cells (granulocytes and leukocytes)

•  White blood cells are used to combat bacterial and fungal infections in neutropenic patients, especially in those with neutropenia induced by cytotoxic chemotherapy.
• All donations are tested for HIV, Hepatitis B&C and Syphilis
• All donations are irradiated
• White blood cells are not available on Sundays due to processing constraints. On Mondays only single donations are available but these are supplied pooled on Tuesday to Saturday
• White blood cells expire at midnight on the day of issue

Platelets

• Platelets are used to prevent bleeding in thrombocytopenic patients
• Platelet donations have a shelf life of 5 days
• Platelet donations must be stored between 20 and 24^oC with gentle agitation in a monitored platelet agitator
• Transfusion should be completed within 30 minutes of commencement
• Platelet donations should preferably be ABO compatible or test haemolysin negative (contact local Transfusion Dept. if in doubt)
• Irradiated platelet donations are available for selective patients (see local policies)
• HLA matched platelets are available on a named patient basis only. Contact Sheffield BTS directly

Fresh Frozen Plasma (FFP)

• FFP is used for patients bleeding due to multiple clotting factor deficiency or for patients with inherited clotting factor deficiencies for which no factor concentrate is yet available (e.g. Factor V)
• FFP is sourced from male donors only to reduce the risk associated with TRALI
• FFP donations have a shelf life of 3 years. See FFP Guidelines
• FFP donations must be stored at minus 25^oC or below and are rapidly thawed on request
• Once thawed, transfusion must be completed within 4 hours
• FFP donations should be ABO compatible
• Clotting Screens should be performed prior and post FFP administration to indicate treatment efficacy
• Solvent Detergent FFP (SDFFP) is preferentially used in certain medical conditions such as C1-Esterase deficiency, Haemolytic Uraemic Syndrome (HUS) and Thrombotic Thrombocytopenic Purpura (TTP). Requests for SDFFP with these conditions should be discussed with a Clinical Haemotologist
• SDFFP should be given to all patients born after 01 January 1996 though small volume Methylene Blue treated FFP’s (MBFFP) are available
• MBFFP / SDFFP is given to neonates (depending on the volume required)
• Low titre anti-T FFP is available for selective paediatric patients but needs medical haematologist approval
• Total Prothrombin Complex (Octaplex) should be used in preference to FFP for warfarin reversal prior to theatre

Cryoprecipitate

• Cryoprecipitate is rich in fibrinogen, factor VIII and von Willebrands factor but has been superseded by factor VIII concentrate as the treatment of choice for haemophilia. Its main use now is as a source of fibrinogen in acute haemorrhage
• Cryoprecipitate donations have a shelf life of 3 years
• Cryoprecipitate donations must be stored at minus 25^oC or below and are rapidly thawed on request
• Once thawed, transfusion must be completed within 4 hours
• Cryoprecipitate is available as a pooled (5 singles = 1 adult dose) blood component
• Methylene Blue treated cryoprecipitate is available in single or pooled donations for patients born after 01 January 1996 depending upon the volume required
• Cryoprecipitate donations should preferably be ABO compatible
• Fibrinogen levels or Thrombo-elastograph testing (TEG) should be performed prior and post administration to indicate treatment efficacy.
• Riastap (fibrinogen concentrate) is used in preference to cryoprecipitate for obstetric haemorrhage

Clotting Factors (Factor VII, Factor VIII, Fibrinogen, etc.)

• Factor concentrates are used to treat inherited factor deficiencies and are safer than FFP or cryoprecipitate as recombinant clotting factors are free from viral or prion contamination.
• The shelf life and storage conditions of factor concentrates vary between manufacturers and products. Refer to packaging.
• Commonly available factor concentrates include factor VII, factor VIII and factor IX.
• Single factor concentrates are available for most inherited factor deficiencies except factor II and factor V deficiency. 
• Total Prothrombin Complex (TPC) is rich in factors II, VII, IX and X.
• All requests (except TPC) for factor concentrates must first be discussed with a medical haematologist.

Human Albumin Solution (HAS)

• Albumin is used to replace plasma volume loss in instances such as burns, pancreatitis or plasma exchange. It is not the first choice plasma expander and should not be used to low correct serum albumin levels in chronic disease
• The shelf life and storage conditions of HAS donations vary between manufacturers and products. Refer to packaging
• Infusion is to be completed within 3 hours of commencement
• HAS is available in 5% and 20% concentrations

Anti-D Injections

•  The shelf life and storage conditions of anti-D vary between manufacturers and products. Refer to packaging
• Anti-D is used in prevention of Haemolytic Disease of the Newborn (HDN) by stopping the formation of immune anti-D
• The requirement for prophylactic anti-D in pregnancy is now determined by the Free Foetal DNA (ffDNA) test
• Anti-D should be administered within 72 hours of a sensitising episode
• Administration is by intramuscular or intravenous (product dependant) injection
• Anti-D is commonly available in 500 and 1500iu doses though larger doses may be obtained if necessary