Renal: Protection of Blood Transfusion Induced Sensitization by Cyclosporin A Doc#
Guideline and
Procedure
Protection from Blood Transfusion Induced Sensitization by
Cyclosporin A
Document Number:
Sites where Guideline and Procedure
applies:
Target audience:
All HNE facilities where a patient undergoes
haemodialysis
Nephrology clinical staff, who provide care to
haemodialysis patients.
This document comprises part of the clinical information
package for care of Haemodialysis patients.
Haemodialysis,
Description:
Keywords:
Replaces Existing Guideline and
Procedure:
Yes
Registration Number(s) and/or name and JHH Nephrology SWP N.1.6
of Superseded Documents:
Relevant or related Documents, Australian Standards, Guidelines etc:
 NSW Health Policy Directive 2007_079 Correct patient, Correct procedure, correct site
http://www.health.nsw.gov.au/policies/pd/2007/pdf/PD2007_079.pdf
 NSW Health Policy PD 2005_406 Consent to Medical Treatment
http://www.health.nsw.gov.au/policies/PD/2005/pdf/PD2005_406.pdf
 NSW Health Policy Directive PD 2007_036 Infection Control Policy
http://www.health.nsw.gov.au/policies/pd/2007/pdf/PD2007_036.pdf
 NSW Health 2007_007 Medication Handling in NSW Public Hospitals.
http://www.health.nsw.gov.au/policies/pd/2007/PD2007_077.html
 John Hunter Hospital Nephrology Pharmacist
 Product Information Leaflet
Prerequisites (if required):
Registered or Endorsed Enrolled Nurses
Valid medication order
Procedure Summary:
This Guideline and Procedure sets out the steps to be followed when
administering Cyclosporin A to patients who are on the Transplant List and
require a blood transfusion. The procedural components of the document
such as, Preparation of patient, Preparation of equipment, Technique,
Cleaning up and Documentation are considered mandatory.
Guideline Note :
This document reflects what is currently regarded as safe and appropriate
practice. However in any clinical situation there may be many factors that
cannot be covered by a single document and therefore does not replace
the need for the application of clinical judgment in respect to each
individual patient.
Date authorised:
Authorised by:
HNEAHS Renal Clinical Stream Leadership Group
Contact Person:
Contact Details:
Review due date:
TRIM Number:
Version No. 1
December 2010
Page 1 of 3
Renal: Protection of Blood Transfusion Induced Sensitization by Cyclosporin A Doc#
OUTCOMES
1
Safe administration of Cyclosporin A to a patient who is on the transplant List
2
Avoid Blood Transfusion exposure to foreign HLA antigens
ABBREVIATIONS & GLOSSARY
mg
Milligram
kg
Kilogram
bd
Twice daily
CMV
Cytomegalovirus
HLA
Human leukocyte antigen
GUIDELINE
Blood Transfusion exposes the patient to foreign HLA antigens that may result in the development
of lymphocytotoxic antibodies that can interfere with transplantation by increasing the difficulty of
the tissue matching and increasing the risk of acute rejection.
All patients on the transplant list or those who are likely to be on the Transplant list at some time
should receive Cyclosporin A to protect from sensitization; the regime is a dose the day before, the
day of, and the day post transfusion . This is called peri-transfusion Cyclosporin.
As dialysis patients are more likely to require a blood transfusion at some point during their dialysis
treatment lifetime, it is vital that dialysis nursing staff remain up to date on their patients transplant
status.
If a patient requires an urgent blood transfusion, the Transplant Recipient Coordinator may be
contacted after hours for confirmation of the patient’s listing on the transplant waiting list or
undergoing assessment for the same (page 5266 through John Hunter Hospital switch board).
Dosing
Peri-transfusion Cyclosporin Dosing Schedule: Cyclosporin 4mg/Kg bd (rounded to the nearest
25mg) on day minus 1, day 0 and day 1, with respect to every transfusion. Gastric irritation is dose
related; hence the dose 8mg/kg/day (rounded to the nearest 25mg) is divided into two.
Note: When transfusion is urgent, as much as possible of this protocol should be achieved, but
there is no point in extending the treatment past day 1 after transfusion.
Note: If additional transfusions are indicated medically the additional Cyclosporin A will be given.
Note: All CMV negative recipients should receive CMV negative blood and this should be specified
on the pathology cross match for the blood product. In many rural areas staff will need to alert
blood bank to allow sufficient time to transport the CMV negative blood to their location.
APPENDICES
Five Moments for Hand Hygiene
REFERENCES
Daugirdas, Blake & Ing. Handbook of Dialysis 3rd ed. Philadelphia, Lippincott Williams & Wilkins
E-MIMS
Mathew J Cervelli, February 2007, The Renal Drug Reference Guide (first edition)
NSW Health PD 2007-077: Medication Handling in NSW Public Hospitals
Version No. 1
December 2010
Page 2 of 3
Renal: Protection of Blood Transfusion Induced Sensitization by Cyclosporin A Doc#
Appendix 1
Adopted from the World Health Organization and Hand Hygiene Australia.
Version No. 1
December 2010
Page 3 of 3