Guidelines for the administration of blood products

Summary of Amendments

• Revision to the 3rd Edition, February 2024

  ANZSBT thanks members for their feedback on the original third edition of these guidelines, based on which there have been some minor changes to the document. The changes have been approved by ANZSBT Council and correct some minor errors and also provide clarification where changes may have led to potential differences in
  interpretation.

  Change and rationale
  Section 3.1, dot point 8
  [t]he number of units or dose of blood product to be given, using appropriate units of measure (e.g. number of packs, volume in millilitres, units or weight in grams); blood component volumes should be stated in millilitres for neonatal patients and children less than 20kg
  Rationale: Correct unintentional error and clarification.

  Section 3.1, dot point 12
  [11] legibly written name and signature of the prescriber, and a contact telephone number or pager number
  [12] other details may be required by local health service or laboratory policies. A Medicare provider number and patient Medicare number is generally required, for Medicare funded services in Australia.
  Rationale: Clarify that Medicare details only necessary where testing is conducted under Medicare funding arrangements

  Section 4.1
  References to ACSQHC standards updated.
  Rationale: Update for current Australian National Standards.

  Section 6.2.1, dot point 4
  Platelets must not be transfused through a blood administration set that has been used for red cells, because red cell debris may trap infused platelets that may not be ABO compatible. Red cells may follow platelets through the same blood administration set, but not precede platelets.
  Rationale: Provide further clarity.

  Section 6.2.3, dot point 3
  Once the transfusion episode is complete, blood administration sets may be flushed with 0.9% sodium chloride to ensure that the patient receives the entire blood product. The minimum volume of 0.9% sodium chloride required to completely clear the IV line should be used, taking into account the individual circumstances of the patient where relevant (e.g. neonates, some paediatric patients or those at risk of fluid overload or on fluid restrictions). Where a transfusion is prescribed in millilitres for children less than 20 kg the IV cannula (not the line) should be flushed to maintain IV patency. This is to ensure the patient does not receive additional fluid than that prescribed.
  Rationale: To ensure that protocols prevent inadvertent administration of additional blood or saline flush in neonates and paediatrics patients with very small blood volumes and low tolerance for additional fluid.

  Section 6.6.1 & 6.6.3
  Clarified co-administration of albumin and other plasma products with fresh blood components and provide brief advice through which decisions about mixing of medications with manufactured plasma products may be made.
  Rationale: To improve guidance where there may be conflicts between prescribing information for medications, prescribing information and well established, often evidence based clinical practice.

  Section 7.2.1
  Children less than 20 kg should have the volume prescribed in millilitres. The volume should be calculated based on the child’s weight and the desired haemoglobin increment, to prevent transfusion-associated circulatory overload.
  Rationale: To improve guidance and align terminology with NBA Patient Blood Management Guidelines.

  Section 7.3, reference added
  National Blood Authority (NBA) (2016). Patient Blood Management Guidelines: Module 6: – Neonatal and Paediatrics. NBA, Canberra Australia. https://www.blood.gov.au/system/files/14523_NBA%20Module %206%20Neonat_Paediatrics_internals_5_FA_updated_15Feb2017.pdf

  Section 8.1, paragraph 2; clarification 8.1.1 ‘mild adverse transfusion events’
  A common adverse transfusion outcome is an unexpected rise in the patient’s temperature. This rise may be due to the transfusion or may be incidental (i.e. as a result of the patient’s underlying illness). A temperature rise of 1 °C or more above baseline and more than 38°C should prompt the interruption of the transfusion and a clinical assessment of the patient. Transfusions should also be interrupted and responded to, as per jurisdictional observation and response charts for the recognition of clinical deterioration, and in New Zealand as per the Early Warning Score.

  8.1.1 Mild adverse transfusion events
   an isolated temperature rise of 1 °C to less than 1.5 °C, above baseline and more than 38 °C without any
  signs of a serious event (including any of those listed below in Section 8.1.2). A lower temperature rise
  occurring early in the transfusion (eg. a 1 °C rise within the first 2 hours, to less than 38 °C) may also be a
  sign of an adverse transfusion reaction. Stopping the transfusion seeking medical assessment is
  recommended.
   localised rash or pruritus.
  If a mild adverse transfusion event is suspected:
   STOP the transfusion
   maintain IV access
   monitor and record the patient’s temperature, pulse, respirations, oxygen saturation and blood pressure
   repeat all documentation and identity checks of the patient and blood pack
   contact medical staff immediately for further management and investigation.
  If the temperature rise is less than 1.5 °C above baseline or the patient has only localised rash or pruritus, the patient observations are stable and the patient is otherwise well, an antipyretic or antihistamine may be administered at the discretion of the physician. The transfusion may then be continued with caution and close
  observation.
  If signs or symptoms persist or redevelop, or the patient’s condition subsequently deteriorates, the transfusion should be stopped and managed as for a moderate to severe adverse transfusion event (see Section 8.1.2).
  Rationale: The wording has been changed to align with international guidelines on minor reactions, in particular, febrile non-haemolytic transfusion reactions, while still encouraging clinicians to consider the significance of changes, particularly rapid changes during the early stages of a transfusion.

  Glossary, revised definition ‘double independent checking’
  Clinicians individually and without requiring direct involvement of each other, check the prescription, patient and blood product identification, and blood product characteristics (including expiry, compatibility and special requirements (if any)).
  This process must ensure that each clinician is individually satisfied that, and responsible for, the correct product is transfused in the correct way to the correct patient.
  The clinicians must agree before the transfusion is commenced. In a teaching environment the teacher may indicate what needs to be checked and where to find it, but the learner must still independently view each item and confirm the match to the patient.
  Rationale: The previous definition was obtained from high risk pharmaceutical administration. Members expressed concerns that this was not appropriate for transfusion, where independent checking of calculations away from the patient was not required. It has been modified to clarify the fundamental principle of two
  professionals independently carrying out and taking responsibility for the procedure, while allowing institutions to have different strategies to achieve this.