Transfusion of blood components should only be undertaken where appropriate staff and facilities are available to identify and manage any potential adverse transfusion reactions.
All transfusions should be planned to take place during business hours, whenever possible, for patient safety.
Overnight or out of hours transfusions should be avoided unless clinically indicated by the patient’s condition
The following is only a guide for administration of blood components as individual hospital guidelines should be followed.
- The final pretransfusion patient and component checks are a vital step in preventing transfusion errors. Staff must be vigilant in the checking procedure to ensure that the right blood is given to the right patient.
- The patient’s identity and pack details must be confirmed before transfusion, according to approved procedures. The checking procedure must be performed independently by two appropriately qualified staff, with each independently carrying out and taking responsibility for the procedure.
- The integrity of the pack and appearance of its contents should be inspected prior to use. Do not transfuse if the pack is compromised or there are clots, haemolysis, unusual discolouration or turbidity.
- Blood components should be thoroughly mixed by inversion before use.
- Blood components must be transfused using an administration set approved for this purpose. The set must incorporate a filter (170 to 200 µm) which removes large clots and aggregates and ensures an effective transfusion flow rate.
- Change blood administration set when the transfusion is completed, or every 12 hours if continuing to transfuse or with new IV fluids or in accordance with the manufacturer’s instructions,.
- One blood administration set may be used for multiple packs of red cells provided flow rate remains adequate and manufacturer's recommendations are not exceeded.
- Platelets must be transfused through a new blood administration set. In the setting of massive/rapid transfusion when platelets and plasma are both required they may be transfused sequentially through the same blood administration set.
- Platelets must not be transfused through a blood administration set which has previously been used for red cells, as red cell debris in the in-line filter may trap infused platelets.
- Red cells may follow platelets through the same blood administration set, but not precede platelets.
- Bedside leucocyte filters are not required in Australia as platelets and red cells are leucocyte depleted by Lifeblood. There is no evidence that microaggregate filters offer clinical benefit and so their use is not recommended.
- Blood components may rapidly infused or warmed just prior to or during transfusion if clinically indicated. Only approved blood devices should be used.
- All equipment used to administer blood components including volumetric infusion and external pressure or rapid infusion devices, syringe drivers and blood warmers must be operated according to the manufacturer’s instructions and be designated safe and appropriate for blood transfusion.
- Equipment must undergo constant monitoring, calibration and maintenance.
- Local health service policy should indicate whether should volumetric infusion and external pressure or rapid infusion devices and blood warmers can be used, including in which situations they are appropriate. Devices must be validated by the manufacturer for the administration of blood products and used exactly as specified by the manufacturer.
- The blood administration set may be primed with the blood component or 0.9% sodium chloride.
- Do not add medication to the pack, blood administration set or IV line, or infuse solutions other than 0.9% sodium chloride through the same tubing along with blood components. ABO-compatible plasma, 4% albumin or other suitable plasma expanders may be used only if approved by the patient’s physician.
- Electrolyte solutions containing calcium, such as Haemaccel®, Hartmann's solution, lactated Ringer's solution must never be added to, or administered through, the same IV line as blood components containing citrated anticoagulant.
- Priming or flushing blood administration sets with a small amount of 0.9% sodium chloride between red cell packs is not evidence-based and may be unnecessary. However, 0.9% sodium chloride may be required to maintain IV access if the next red cell unit is not readily available.
- Frequent visual observation of the patient before, during and after the transfusion is essential to identify possible adverse reactions.
- If an adverse transfusion reaction occurs, stop the transfusion immediately and initiate appropriate therapy. The transfusion should not restart unless the patient receives a satisfactory clinical review.
- Only one type of blood component should be administered at a time. Administering two different types of blood components concurrently (such as platelets and plasma) is not recommended in routine practice because in the event of an adverse reaction it is difficult to ascertain which component was responsible. This may be unavoidable in an emergency situation.
- Start the transfusion as soon as possible after removing the blood component from approved temperature-controlled storage. Transfusion of each pack should be completed prior to the labelled expiry or within four hours, whichever is sooner.
- The infusion should start slowly where clinically appropriate. The patient should be closely observed for the initial 15 minutes of the infusion as life-threatening reactions may occur after infusion of only a small volume. After 15 minutes the rate of infusion may be increased to the maximum prescribed rate, provided there are no signs or symptoms of an adverse reaction.
- Transfusion of each unit may proceed as fast as prescribed and tolerated. The infusion rate for blood components depends on the clinical context, age and cardiac status of the patient. In stable, non-bleeding adult patients, typical administrations durations are:
- Red cells: 1-3 hours
- Platelets: 15-30 minutes
- Fresh frozen plasma: 30 minutes
- Cryoprecipitate: 30-60 minutes per standard adult dose
- After completion of the transfusion blood administration sets may be flushed with 0.9% sodium chloride to ensure that the patient receives all of the blood component. Only the minimum volume of 0.9% sodium chloride required to completely clear the IV line should be used, taking into consideration the individual circumstances of the patient (for example neonates, some paediatric patients or patients at risk of fluid overload or on fluid restrictions).
For more details on specific aspects of blood component administration, consult the Guidelines for the Administration of Blood Components.
- ANZSBT/ACN Guidelines for the administration of blood products. 3rd edition, Revised October 2019.