Blood & Blood
Product Administration
The following are the Blood Products most commonly administered at ARMC
Blood
Component
Purpose
Leukocyte-poor
Packed Red Blood
Cells (PRBCs)
Platelets
This product is similar to Packed Cells
combined with the removal of approx. 9599%of the leukocytes.

Removal of leukocytes helps to prevent a
febrile reaction from leukocyte antibodies

Usually not considered unless Hgb < 7G/dl

Given to treat decreased platelet count due
to either decreased platelet production or
increased platelet destruction.

Abnormal bleeding with Massive RBC
transfusion or abnormal platelet count.

To treat acute leukemia and bone marrow
aplasia.

Fresh Frozen
Plasma
(FFP)
~OR~
Apheresis Collect
Plasma
(ACP)

Cryoprecipitate
RhoGAM

The plasma is separated from the RBC's
and is rich in coagulation factors V, VIII,
and IX. Monitor INR and PTT.

Indicated for urgent warfarin reversal, liver
disease with coagulopathy, and in burns
within 72 hours of admission.

May be given to expand plasma volume,
treat post-op hemorrhage /shock, massive
RBC transfusion, or to correct an
undermined coagulation factor deficiency.
Used for Fibrinogen disorders-DIC,
Hemophilia A, Hypofibronogenemia, & Von
Willebrands’s disease

Rich in FI, VIII, XIII, and vWF.

Massive RBC transfusion with abnormal
bleeding.

Rhophylac


Prevention of Rh immunization in any Rhnegative person after incompatible
transfusion of Rh-postitive blood or blood
products
Pregnancy and other obstetrical conditions in
Rh-Negative women, unless father or baby
are conclusively Rh-Negative
Idiopathic Thrombocytopenic Purpura (ITP)
Administration

Infuse at a rate of 50 mL/hour for the first 15
minutes

Infuse over 2-4 hours. Each unit must be
infused within 4 hours of leaving Blood Bank
(BBK)

In emergency, can increase rate as tolerated.
Rapid Infusion (i.e. rates exceeding 4ml/kg/hr)
requires use of PALL blood filter to prevent
microembolization-filter not utilized in NICU

May need to be warmed

Must use standard 200 micron filter tubing

Do not use a Leukocyte Removal Filter*

Usually 250ml-350ml volume*


* See Maternal-Child Health policies

Must use Y-Type Blood Component Set
provided by BBK

Use Leukocyte Removal Filter if not Leukopoor (provided by BBK)

Typically 250ml/unit depends on donor

1 pack usually = 6-8units of concentrated
platelets

Infuse over 30-45 minutes, or as pt tolerates

Use standard Y-Type tubing with in-line 200
micron filter

Do not use a Leukocyte Removal Filter

FFP usually 200ml

Note: ACP=600ml (1 unit of ACP is equivalent
to 3 units of FFP)

Infuse 1 unit over 3 mins. Each unit =15ml.

Adults: can infuse 150ml over 30mins, as
tolerated

Use Blood Component Infusion Set with in-line
80 micron filter (provided by BBK)

Do not use Leukocyte Removal Filter

Usually 120-160ml

RhoGAM-IM use only-Deltoid or upper thigh.

Rhophylac- IV or IM.

If larger IM doses are required (>5ml), divide
dose and administer into two different sites

A Single dose is supplied in prefilled syringe

Refer to blood bank procedure manual for
administration guidelines
Infuse over 30-45 minutes, up to 4 hours, per
physician order and as tolerated by patient
When administration of blood or blood products is indicated, the following are required:
1. Informed consent must be obtained by the physician and may be witnessed by the RN
An orange armband is placed on any patient who declines transfusion
2. A legible physician’s order, must include:

Written consent

Date and time of transfusion, rate of infusion or duration of transfusion.

Clinical indication for transfusion.

Type and quantity of blood product including specific product requirements or
modifications (e.g. irradiated or washed products)

Indication for the use of serologically incompatible blood when compatible blood is
unavailable

Indication for use of uncrossmatched blood in life-threatening situations

Pre-and post-transfusion medication orders related to transfusion
3. Compatibility must be checked

Before drawing blood for the Type and Crossmatch the patient must be positively identified by
1 Staff member (phlebotomist, nurse and/or physician) using the patient’s ID band and blood
tube labels.
The label must have:
4.

Patient’s full name and date of birth

Medical record number (M#)

Date and time specimen was collected

Initials of staff member identifying and collecting the specimen

Information on the band and the blood tube labels must match exactly
When Collecting and sending blood tubes to the lab:

Adult: two 6ml pink top tubes

Peds: two 3ml lavender top tubes

Neonate: two microtubes
5. An ABO/RH confirmation test will be generated for a patient when the patient does not
have a historical blood type in the computer system or during computer downtime
6. The laboratory will call the nurse or Phlebotomist to request the second blood
specimen to be drawn for the ABO/RH confirmation test
7. A Meditech requisition label or a downtime requisition slip and one 2ml pink top tube will be
sent to the nurse in charge of the patient or Phlebotomist (if applicable) for the second
confirmation blood sample collection
8. To avoid a delay in the transfusion of blood or blood products, the second blood
sample collection must be obtained and sent as soon as possible
The checks nursing personnel perform are only a portion of the process that ensures the patient receives the correct unit of blood and are
an integral part of the process
Patient Safety
Release of blood products from Blood Bank
To receive your blood you must bring

Blood Release Request

Blood Order

Consent

To print the order from Meditech:

Enter the Patient Order Management (POM) page.

Click or highlight blood transfusion order
5. Blood Release Request

The Laboratory Technologist circles the patient and donor ABO blood type and
draws a line across for the patient and down for the donor type

The Laboratory Technologist and the messenger verify that the two lines intersect
on the chart at a star indicating ABO Group compatibility
6. Verification of the blood or blood product with another licensed staff member

Before starting the infusion, two licensed people, one of whom is an RN, must verify the
patient’s identification (using the arm band and/or verbally with the patient) and the blood
product (blood product label) and sign on the transfusion sheet

The 3 patient identifiers are:
 M#
 Patient Name
 Patient DOB
Blood Verification Process: Adding the patient’s label
Before administration of blood or blood components, two licensed nurses (one of whom is to be a
Registered Nurse) must sign and date the Compatibility Record to verify the accuracy of the
following:

Confirmation of a written physician order that includes an ORDERED RATE!

Verification that the information on the Blood Compatibility Record and the label on the
blood product match

Verification that the three identification markers match on both the patient arm band and
the Blood Compatibility Record. The three required identification markers are:
 First and last name
 Date of birth
 Medical record number
**Place a patient label on the Blood Compatibility Record at the bottom left corner. Do not
cover or obliterate any pre-printed information. The two person team must verify that the
patient label matches the patient armband and printed information on the compatibility
record. All three identifiers must match exactly.
Blood Compatibility:
Plasma Compatibility:
Considerations for Infusing:
 Change the tubing after every 2 units, except for platelets.
 Use a PALL filter if infusing PRBCs at a fast rate (4ml/Kg/hr or faster) to prevent
microembolization.
 Each unit of PRBCs should be started within 30 minutes of leaving the Blood Bank and
must be completed within 4 hours.
 The initial rate must be 50 mL/hour for the first 15 minutes
 Blood products hung prior to their expiration at midnight may infuse to completion.
Vital Signs:

According to AOM Policy 660.04, vital signs must be minimally obtained and documented
on the blood slip, as follows:
 Within 15 minutes before starting the transfusion
 Within 15 minutes after the start of the transfusion
 When the transfusion is complete
 One hour post transfusion
Nurses may choose to monitor the vital signs more frequently for some patients,
i.e. when fluid overload is a concern, unstable patients, etc.
Documentation:
 Chart the volume on your I & O report
 On the compatibility record chart whether or not a reaction occurred or was suspected and sign
the form on the bottom right side
 Chart any physician notification
Monitor For Transfusion Reactions:
1. Febrile reaction:

Increase in temperature 1 degree Celsius
Fahrenheit) within two hours after
(2 degrees
transfusion
2. Hemolytic:
 Chills
 Respiratory distress
 Hypotension, tachycardia
 Chest pain
 Nausea, abdominal cramping
 Flushing, hives, itching
Take Action:
Immediately stop the transfusion.
 Change the IV tubing and start NS at 30cc/hr to maintain venous access.
 Notify the physician.
 Complete the Transfusion Reaction Report section on the Compatibility Record.
 Forward the blood bag and administration set to the blood bank in a clear plastic
specimen bag for a follow-up investigation as to cause.
 Collect a blood sample (two pink top tubes) and send to the lab
marked “Possible

Transfusion Reaction.”
 Care for the patient
 Care for and monitor the patient
 Monitor the intake and output carefully
 Administer O2
 Treat fevers as ordered by physician
 Reassure the patient and offer comfort measures
 Complete the Unusual Occurrence Report
 Document carefully your observations and interventions in the nursing notes.
Sentinel Events and Never Events:
Sentinel Events are unexpected events that result in (or could result in) serious injury or death of a
patient. The injury may be physical or psychological and includes hemolytic transfusion reactions
with significant adverse outcomes.
Hemolytic transfusion reaction is a Never Event, also known as a Serious Reportable Event. CMS
no longer reimburses for costs associated with the patient’s treatment when a hemolytic
transfusion is determined to have been reasonably preventable. Additionally, hospitals that delay
reporting or fail to report these events will be sited and fined.
Please let your manager or supervisor know immediately
if you know or suspect a hemolytic transfusion reaction has occurred.