This component is not available. Requests for Whole Blood will be referred to the Blood Bank Medical Staff for review. When exchange transfusion of a neonatal patient is required, the Blood Bank will provide Red Blood Cells resuspended in Fresh Frozen Plasma.

Crossmatch:

Required

Approximate Volume:

340-400 mL    AS-1 or AS-3 Additive sol.

200 mL ACD-A Apheresis

Outdate:

42 days (AS-1 or AS-3 additive solution)

35 days CPDA-1

21 days ADC-A

Hematocrit:

55-65 % Additive solutions

70-80 % CPDA-1

56-59% ACD-A Apheresi

Storage Conditions:

1-6°C in a monitored blood refrigerator

Minimum Preparation Time:

20 minutes

Dose Adult:

1 unit per 1 gm Hgb rise desired

Pediatrics:

5-15 mL/kgm body weight

Description: Contains red cells from one unit of whole blood plus a small amount of plasma and anticoagulant, and for AS-1 and AS-3 and AS-5 units, approximately 110 mL of additive solution. Apheresis Red cells contain red cells, and either anticoagulant ACD-A or sodium citrate. The transfusion of one unit of red cells is expected to increase the hemoglobin 1-1.5 g/dL in the 70 kG patient. All Red Blood Cells routinely issued have reduced leukocyte content through prestorage filtration by our blood supplier. Such processing reduced the risk of CMV transmission, febrile transfusion reactions and platelet transfusion refractoriness. Beginning May 1, 2006, requests for CMV seronegative blood components will be filled with prestorage leukocyte-reduced blood components. 5/1/06

Indications: Patients whose symptomatic deficit of oxygen carrying capacity cannot be corrected by alternative therapy. A hemoglobin or hematocrit should be measured before each transfusion except in the case of severe hemorrhage. Usually indicated when the Hgb is 10 g/dL.

Crossmatch:

Required

Appriximate Volume:

220 mL

Outdate:

24 hours after washing

Storage Conditions:

1-6°C in a monitored blood refrigerator

Minimum Preparation Time:

12-24 hours. Longer time intervals will be necessary if the component is ordered at night or on weekends. This component is ordered specially from the blood supplier.

Dose Adult: 1 unit per 1 gm Hgb rise desired

Pediatrics: 5-15 mL/kgm body weight

Description: A unit of Red Blood Cells that has been washed and resuspended in a saline solution. If RBC Washed are ordered for a patient and subsequently canceled, Blood Bank personnel will attempt to allocate the component to another patient

Indications::Prevention of severe allergic reactions to plasma proteins, as for patients with anti-IgA antibodies.

Crossmatch:

Required

Approximate Volume:

200 mL

Outdate:

24 hours after deglycerolization

Storage Conditions:

1-6°C in a monitored blood refrigerator

Minimum Preparation Time:

12-24 hours. Longer intervals will be necessary if the component is ordered at night and on weekends.

Dose Adult: 1 unit per 1 gm Hgb rise desired

Pediatrics: 5-15 mL/kgm body weight

Description: A unit of Red Blood Cells that was once frozen in glycerol and has subsequently been thawed, deglycerolized and resuspended in a dextrose-saline solution. Only indate units may be frozen.

Indications:: The provision of blood for patients with antibodies requiring rare units. The use of Frozen Deglycerolized Red Blood Cells to prevent febrile transfusion reactions has been supplanted by the use of Leukocyte Reduced Red Blood Cells.

Crossmatch:

Not required, a blood sample may be required to determine patient ABO and Rh type

Approximate Volume:

200-275 mL SDPL

Outdate:

5 days after thawing

Storage Conditions:

After thawing, 1-6°C in a monitored blood refrigerator;

Return to Blood Bank immediately if not needed

Minimum Preparation Time:

45 minutes unless processing of a blood specimen is required. Thawed plasma is available in 22 minutes, Of available, prethawed plasma is available in 15 minutes.

Dose:

10-15 mL/kg body weight

Description: Each unit of Plasmacontains the equivalent plasma obtained by centrifugation and separation from one unit of whole blood. Plasma has the same risk of disease transmission as Red Blood Cells. Plasma contains ABO anitbodies. While the levels of Factors V and VIII in thawed Plasma decreases slightly over 5 days, this is not clinically significant. Normal levels of coagulation factors including fibrinogen (300-500 mg/unit) are present.

Indications::Plasma is indicated for patients with a documented deficiency of coagulation factor for which there is not specific concentrate available. Patients requiring coagulation factor VIII are best treated with coagulation factor VIII concentrate (available from the pharmacy) or cryoprecipitated antihemophilic globulin.

Plasma may be used for correction of coagulation factor deficiencies, Warfarin® reversal and microangiopathic hemolytic anemia such as thrombotic thrombocytopathic anemia.

Plasma is indicated for patients with coagulopathy due to massive transfusion and replacement of specific plasma proteins.

Contraindications:Plasma is not indicated for prophylactic use when the INR is < 1.5 and the APTT is

Infusion Instructions:

• Rate: 10 mL/minute

• Plasma components must be administered through a standard blood infusion

• The usual volume of Plasma is between 175 and 250 mL

• Previously frozen plasma does not contain red blood cells. Plasma from Rh positive donors may be given to patients who are Rh negative.

Crossmatch:

Not required; a blood sample may be required

Approximate Volume:

45-60 mL/unit; usually dispensed as a pool of 5 units for a total volume of -225 to325 mL

Outdate:

Single units or Prepooled-5d outdate five days after the date of collection

4 hours after pooling on-site.

Return component to Blood Bank immediately if component is no longer required

Storage Conditions:

20-24°C (room temperature), with constant, gentle agitation. DO NOT REFRIGERATE. Do not store on patient units or in the operating room.

Minimum Preparation Time:

10 minutes if prepooled, 20 minutes if pooled; 2 hours if volume reduced or washed

Dose Adult: 5 units

Pediatrics: 10-15 mL/kg body weight

Description: A minimum of 5.5 x 10 10th platelets harvested from one unit of fresh whole blood in approximately 50 mL of donor plasma. Pooled platelets usually represent a pool of five platelet units and contain 3.0 to 5.0 x 10 11th platelets in approximately 300 mL of plasma .The product is leukocyte-reduced at the time of preparation by the blood supplier. This results in the infusion of less than 8.3 x 105 white blood cells per component. Prepooled platelets are prepared in a standard dose of 5 units per pool and are tested for bacterial contamination by a culture method. Individual whole blood platelets are tested for bacterial contamination on site by the pH method.

Platelet Counts: A 10 minute or 1 hour and a 24-hour post-transfusion platelet count is recommended to assess patient response.

Indications:: Treatment of thrombocytopenia or defects of platelet function. Requests must be substantiated by appropriate coagulation tests and clinical data. Prophylactic use of this component for a thrombocytopenic patient who is not bleeding is not indicated if the platelet count exceeds 10 x 10 9th/L. Patients undergoing major operative procedures generally should have platelet counts above 70 x 10 9th/L for effective hemostasis. Each unit of random donor platelets will raise the platelet count of an adult approximately 5-10 x 10 9th/L under optimal conditions, although clinical response to platelet transfusions is diminished by fever, hypersplenism, infection, DIC, some drugs and preformed antibodies to platelet antigens. Rarely indicated if the platelet count is >100,000 unless there is platelet dysfunction. Persistent failure to respond to the product may indicate a refractory state.

Contraindications:: Transfusion of platelets to patients with thrombotic thrombocytopenic purpura (TTP) or heparin-induced thrombocytopenia is absolutely contraindicated, except in cases of life-threatening hemorrhage, because fatal intravascular coagulation may occur. Transfusion of platelets in idiopathic thrombocytopenic purpura (ITP), posttransfusion purpura, and highly alloimmunized patients is ineffective because of their shortened intravascular survival time, although they may be used at the time of splenectomy or to treat active bleeding.

Availability: Requests for platelet pooled components should be made only if the component is to be transfused immediately. To ensure maximum benefit and avoid unnecessary component loss, Pooled Platelets should be transfused as soon as available. Platelets must not be refrigerated.

Compatibility: ABO and Rh compatible platelets will be selected and released for transfusion. If this is not feasible because of limited inventory and/or emergent need for the component, ABO and/or Rh incompatible platelets may be issued.

Rh Incompatibility:It may be advisable to administer Rho (D) immune globulin to selected Rh-negative patients who receive platelets from Rh- positive donors, since sensitization to red cell antigens may occur from the few red cells present in platelets.

Crossmatch:

May be required. See crossmatched platelets.

Appriximate Volume:

200-350 mL

Outdate:

24 hours or 5 days depending on collection system

Storage Conditions:

20-24°C (room temperature) with constant, gentle agitation. DO NOT REFRIGERATE

Minimum Preparation Time:

24-48 hours after initial order, Pathology review required

Dose Adult:

1unit

Description: Each unit of this component is obtained by automated apheresis from one donor and contains a minimum of 3 x 10 11th/L platelets (the equivalent of the number platelets contained in 5units of random donor platelets) plus 200-350 mL of plasma with acid citrate dextrose (ACD) as the anticoagulant. Leukocyte reduced Single Donor Platelets contain less than 5 x 10 6th residual leukocytes.

Indications:: For aplastic anemia and clinical refractoriness. Most surgical patients do not require platelet transfusion on a long-term basis and can be transfused successfully perioperatively with random donor platelets.

HLA-Matched Platelets: HLA-matched Single Donor Pheresis Platelets are available through the Southeastern Michigan Red Cross Blood Center. The patient's HLA type must be determined prior to or concurrent with the initial order. The diagnosis of this refractory state is based on both clinical considerations and the lack of the anticipated increase in the initial platelet count 10 minutes or l hour and 24 hours after transfusion with random platelets.

Ordering Procedure: Requests for HLA platelets require a Pathology consult and approval.

Crossmatch:

Performed at the Southeastern Michigan Red Cross.

Approximate Volume:

200-350 mL

Outdate:

24 hours or 5 days depending on collection system

Storage Conditions:

20-24°C (room temperature) with constant, gentle agitation. DO NOT REFRIGERATE

Availability:

24-48 hours after initial order

Description: Each unit of this component is obtained by automated apheresis from one donor and contains a minimum of 3 x 10 11th/L platelets (the equivalent of the number platelets contained in 5units of random donor platelets) plus 200-350 mL of plasma with acid citrate dextrose (ACD) as the anticoagulant. Leukocyte reduced crossmatched platelets contain less than 5 x 10 6th residual leukocytes. Crossmatched platelets are selected by a solid phase technique that tests the patient's serum against donor platelets. Only platelets considered non-reactive are issued as crossmatched platelets.

Indications:: For patients refractory to platelet transfusions. The diagnosis of this refractory state is based on both clinical considerations and the lack of the anticipated increase in the platelet count 10 minutes or l hour and 24 hours after transfusion with random platelets.

Ordering Procedure: Requests for crossmatched platelets require a Pathology consult and approval.

Crossmatch:

Required

Approximate Volume:

250-350 mL

Outdate:

24 hours

Storage Conditions:

20-24°C (room temperature) DO NOT REFRIGERATE

Minimum Preparation Time:

24-48 hours

Dose: 1 unit per day until afebrile or WBC is >0.9 x109

Description: Each unit contains approximately 1 x 10 10th granulocytes obtained from a single donor by automated apheresis. This component also contains 20-50 mL of red cells and may contain 2-3x10 11th platelets.

Indications:: Selected infected leukopenic patients with a granulocyte count of less than 0.5 x 109/L who have not responded to more than 48 hours of appropriate antibiotic therapy. Consult the Blood Bank before ordering granulocytes.

Contraindications:HLA alloimmunization, transfusion reactions to granulocytes. In some patients, granulocytes need to be collected from CMV seronegative or HLA matched donors. Granulocyte transfusions should be discontinued when the patient becomes afebrile, at the onset of transfusion reactions, when the granulocyte count exceeds 1.0 x 10 9th/L or in the absence of a clinical response after 14 days. Except in unusual circumstances, granulocyte transfusions are not indicated when there is no expectation that the patient's bone marrow will recover sufficiently to produce an adequate number of endogenous granulocytes to sustain life.

Ordering Procedure: Requests granulocytes require a Pathology consult and approval. Granulocyte transfusions must be ABO compatible with the recipient.

Availability: This component will not be available for transfusion until late evening or after midnight, yet should be transfused as soon as available to ensure maximum benefit.

Infusion rate:Over 3-4 hours

Administration Instructions:

• Do not administer through a leukocyte- reduction or microaggregate blood filter. Administer through a Standard blood filter (Abbott No. 1871 or equivalent filter).

• Granulocytes MUST NOT be transfused within 4-6 hours of IV amphotercin or flucanazole administration.

• Premedication with an antipyretic (acetaminophen is recommended) to avoid the need to discontinue transfusion due to a severe febrile reaction.

• Infuse SLOWLY over 4 hours. The rate of infusion is ultimately dictated by the recipient's ability to tolerate the component volume and by adverse reactions

• Monitor the patient closely for moderate to severe symptoms such as urticaria, hives, wheezing, dyspnea, severe headache, cyanosis, hypotension, agitation and tachycardia.

• If such symptoms develop, stop the transfusion, keep the IV line open and notify the patient's physician and the Blood Bank physician on-call for further instructions.

• Document vital signs every 15 minutes during the entire procedure, every 30 minutes for four hours after the transfusion and then every four hours for 24 hours

Crossmatch:

Not required, a blood sample may be required

Approximate Volume:

5-10 mL per bag; may be dispensed as single units for neonatal patients and children or as pools for adults. As of January 2008, the prepooled dose is 5 per bag. For adults, two pools of 5 (PTCR5) are dispensed for the standard adult dose of 10 unit. . PTCRY (prepool of 10) has been discontinued by the blood supplier.

Outdate:

For Coagulation factor VIII: 6 hours after thawing;

P pooled CRYO: 4 hours after pooling

Storage Conditions:

20-24°C Do not store, transfuse immediately; DO NOT REFRIGERATE

Minimum Preparation Time:

45 minutes for thawing and pooling

Dose: Fibrinogen replacement: adult dose 10 pooled units

Pediatrics: One unit/3 kg up to 30 kg 

Description: CRYO is Cryoprecipitated protein derived from the fresh plasma separated from a unit of whole blood. Each individual unit (bag) has approximately 100 units of Factor VIII activity, as well as 150-250 mg of fibrinogen, suspended in 5-23 mL of plasma. A pool of 5 units is expected to raise the fibrinogen level 25 to 50 mg/dL.

Indications:: Treatment of patients with Von Willebrand's disease and the treatment of Factor XIII deficiency. Factor VIII concentrate, available from the Pharmacy, is the product of choice for most hemophiliacs.

CRYO serves as a therapeutic source of fibrinogen. It may be indicated when the fibrinogen is less than 100 mg/dL. It may also be of value for surgical patients with a hemorrhagic diathesis due to uremia. Consultation with the Blood Bank Medical Staff is required in these instances. CRYO may also be used to prepare "surgical fibrin glue" for topical hemostasis.

Pooling: Prepooled CRYO (PTCR5) is a standard dose of 5 units of CRYO as of January of 2008. If prepooled doses are not available CRYO is thawed and pooled by Blood Bank personnel before issue for the convenience of nursing staff and to ensure nearly complete transfer of the component to the patient. CRYO components must be transfused as soon as possible after thawing to ensure maximum patient benefit.

Infusion Instructions:

• CRYO from Rh positive donors may be given to patients who are Rh negative.

• Infusion Rate 10 mL per minute.

• Use either a standard blood administration set or a special blood component administration set.

• DO NOT REFRIGERATE CRYO as this causes reprecipitation and loss of Factor VIII activity.

• At the completion of transfusion, approximately 20-30 mL of isotonic saline should be fed into the cryoprecipitate bag to rinse product adherent to the walls of the bag. CRYO does not contain red blood cells.

• Clinical response to the component can be measured with post-transfusion coagulation studies.

Crossmatch:

Required for patients older than 4 months of age

Approximate Volume:

1/2 units: 100-150 mL/unit;

syringes: 10 - 50 mL

Outdate:

35 days (CPDA-1 anticoagulant)

4 hrs if dispensed in a syringe

Hematocrit:

55% AS-1 or

70-80%, CPDA-1

Storage Conditions:

1-6°C in a monitored blood refrigerator

Minimum Preparation Time:

45 minutes

Description: Red Blood Cells prepared from a unit of whole blood that is further divided into smaller volumes (aliquots). The hematocrit of each individual unit ranges from 55 to 80% depending on the anticoagulant.

Availability: Orders for partial units of Red Blood Cells should specify the volume required for transfusion. When components are packaged in syringes, unless otherwise requested, an additional 10 mL of component will be added routinely to the syringe to allow for transfusion tubing "dead space". The maximum volume to be contained in a syringe is 50 mL.

Only group O blood is routinely available in syringes. A limited number of prestorage leukocyte-reduced, sickle cell negative units are available for newborn infants. Partial units may also be ordered for patients with congestive heart failure when transfusion of a whole unit would be problematic.

Crossmatch:

Not required, a blood sample may be required

Approximate Volume:

variable; 50-100 mL in bags;

50 mL maximum in syringes

Outdate:

4 hours after thawing;

4 hrs after dispensing into a syringe

Storage Conditions:

After thawing, 1-6°C in a monitored blood refrigerator

Minimum Preparation Time:

15-30 minutes for thawing and unit preparation

Description: Many partial units of Plasma are prepared from group AB donors lacking anti-A and anti-B. The plasma is frozen within eight hours of collection to preserve coagulation factors V and VIII (see Fresh Frozen Plasma).

Indications:: When prepared from AB donors this component is suitable for transfusion to all neonates regardless of ABO type whenever a small volume of plasma is required. It can be made available for other pediatric patients by special request.

Crossmatch:

Required in some circumstances

Approximate Volume:

350-500 mL

Outdate:

24 hours after resuspension

Hematocrit:

42 or 50%

Storage Conditions:

1-6°C in a monitored blood refrigerator

Minimum Preparation Time:

1 hour

Description: Red Blood Cells from which the supernatant storage solution has been removed and resuspended in Fresh Frozen Plasma Liquid to approximately a 50% hematocrit.

Indication: Exchange transfusion of a neonate. Resuspended whole blood will not be prepared for other purposes unless approved by the Blood Bank Medical Staff.

Dose: 300 micrograms anti-D

Storage Conditions:

2-8°C

Description: A concentrated solution of gamma globulin with a high level of anti-D activity. Both an intramuscular and intravenous preparations are available. Both preparations are latex and thimerisol free.

Indication: Prevention of alloimmunization of Rh-negative women due to fetal maternal hemorrhage of Rh positive fetal cells, to prevent sensitization of an Rh negative patient who received Rh positive platelets,or to prevent sensitization due to the inadvertent administration of a small volume of Rh positive Red Blood Cells. A sterilization procedure immediately postpartum is not a contraindication to the administration of the product, if it is otherwise clinically indicated.Indications for RHIG include abortion, antepartum fetomaternal hemorrhage, amniocentesis, genetic amniocentesis, chorionic villus sampling (CVS), percutaneous umbilical blood sampling (PUBS), at approximately 26-28 weeks gestation and after delivery. The product circular should be consulted for additional indications. The component is administered intramuscularly within 72 hours of the potentially sensitizing event. It is generally appropriate to administer the product even if this 72-hour period has elapsed.It is necessary, on occasion, to administer platelets from Rh-positive donors to Rh-negative patients. Although the platelets themselves do not carry antigens of the Rh system, the component inevitably contains small amounts of donor red cells that may sensitize of the recipient to the D antigen. In some patients, particularly those who are young and non-immunosuppressed, it may be advisable to administer RHIG when such a situation occurs. Consultation with Blood Bank Medical Staff should be considered.

Intravenous Rh Immune Globulin (WRHO, RHIV)is indicated for the treatment of ITP in Rh positive adults and children. The product circular should be used for dosage and administration guidelines.

Specimen Requirements: Cord Blood Samples: When available, a cord blood sample from the fetus or infant will be tested for the presence of the D antigen.

Maternal Samples: All pregnant women should have their Rh type determined at the University of Michigan Hospitals Blood Bank. A blood specimen is required for all Rh-negative women prior to the issuance of RHIG. A maternal specimen collected one hour post procedure should be obtained for spontaneous or therapeutic abortions after the 20th week of pregnancy, after hypertonic solution pregnancy termination, or following delivery, in order to recognize the rare patient with a massive fetomaternal hemorrhage. Antepartum blood samples are satisfactory for spontaneous and therapeutic abortions before the 20th week of pregnancy.

For the treatment of ITP: The Rh type of the patient must be determined. If Rh is not known, a venous specimen in a pink top tube is reuqired..

Determination of Dose: The Blood Bank routinely performs a screening test for massive fetal-maternal hemorrhage postpartum to determine if additional testing is required to establish the appropriate dose of RHIG. On request, this screening test will be performed on specimens from antepartum patients.

Crossmatch:

Required for RBC components

Outdate:

21 days to 42 days depending on the anticoagulant

Storage Conditions:

1-6°C in a monitored blood refrigerator

Minimum Preparation Time:

Donations must be scheduled and units collected at least seven business days in advance of proposed date of use. At least two week prior donation is recommended.

Description: Whole Blood or Red Blood Cells collected from a patient/donor and stored for future use.

Requirements: Patient with a hemoglobin of at least 11 gm/dL (33% hematocrit) who is not bacteremic and who has an anticipated blood need greater than 2 units during the dating period of the component may donate. Patients should be given oral iron therapy.

Indication: Patient request when there is some reason to believe that there is a risk of blood transfusion for an upcoming operative procedure. In rare circumstances autologous blood may be collected when it is difficult to find compatible blood due to antibodies directed at red cell antigens.

Collection Sites:

The University of Michigan Hospitals does not collect Autologous Whole Blood. Donations may be made at any licensed or registered blood donor center in Michigan, at any hospital in Michigan that routinely collects donor units, or any U.S. hospital or donor center outside the state of Michigan that is licensed by the Office of Biologics, Food and Drug Administration (allows for the interstate shipment of blood). In order to coordinate shipping, payment and tracking of units, the University of Michigan Hospitals Blood Bank must be notified in advance that the patient is donating autologous blood.

There are additional fees assessed by the agency collecting the blood. These fees are charged regardless if the unit is transfused and are not generally reimbursed by healthcare insurance programs.

In rare circumstances autologous blood may be frozen and stored off site for up to three months. There are additional fees for freezing and deglycerolization.

Crossmatch:

Required for RBC components

Outdate:

21 days to 42 days depending on the anticoagulant

Storage Conditions:

1-6°C in a monitored blood refrigerator

Availability

Seven to ten business days from the time of donation must be allowed for processing and shipping of units

Indications:

There are few, if any, indications for the use of directed donor blood components. Directed donor units are collected for patients with an anticipated blood need, at the request of the patient (parent or guardian) and the patient's physician. Directed donor units must be fully processed, and only donor units meeting Food and Drug Administration regulatory requirements may be used for transfusion. Due to the special handling (including irradiation if the directed donor is related to the patient), an additional service fee is charged per unit donated. These fees are not covered under most health insurance plans and may be charged to the patient directly. 

Donations for patients being treated at the University of Michigan Hospitals may be made at any licensed or registered blood donor center in Michigan, at any hospital in Michigan that routinely collects directed donor units, or any U.S. hospital or donor center outside the state of Michigan that is licensed by the Center for Biologics Evaluation and Research arm of the Food and Drug Administration (allows for the interstate shipment of blood). In order to coordinate tracking, payment and shipping of units donated at other centers, the University of Michigan Hospitals Blood Bank must be notified in advance that the patient has selected his/her own donors.

Outdate:

Red Blood Cells and Whole Blood outdating reduced to no more that 28 days past the date of irradiation or the original outdate, whichever is sooner. The outdate of platelet components does not change with irradiation.

Preparation Time:

An additional 15 minutes is required to prepare irradiated components

Description: Blood components exposed to approximately 2500 cGy. All components except progenitor cell components, previously frozen plasma and cryoprecipitate should be irradiated.

Indications: Patients who are at high risk of graft-vs-host disease. This includes patients who are congenitally immunodeficient, have altered immune status secondary to malignant neoplasms, or are neonates who have received an intrauterine transfusion. It may also be indicated for bone marrow transplant recipients or patients undergoing treatment with chemotherapeutic agents. Directed donor units are irradiated to prevent graft-vs-host disease.

Contraindications: Irradiated Red Blood Cells have an increased plasma potassium and decreased in vivo survival

Availability: The physician must indicate irradiated components in the order for blood components.

Plasma derivatives such as serum albumin solutions, coagulation factor concentrates and other immune serum globulins are available by prescription from the Pharmacy.