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CYWHS Blood Ordering Guidelines

These are guidelines for common procedures carried out at the Womens and Childrens Hospital and cover the following:

Pretransfusion Compatibility Testing - includes 72 Hour Rule Emergency Situations Neonatal Transfusion Paediatric Blood Order Guidelines Obstetric and Gynaecology Blood Order Guidelines

Any variations from the guidelines should be accompanied by a brief explanation on the request form, by the requesting medical officer.

Pretransfusion Compatibility Testing

Group and Screen Group and Screen is some time referred to as Group and Hold or Group and Save. Pretransfusion compatibility testing prior to transfusion is extremely important and involves the following;

Determines the ABO and Rh (D) group of the recipient. Performs a red cell antibody screen on the serum/plasma to detect red cell antibodies

For patients who have "no red cell antibodies detected", a crossmatch is performed when required to ensure compatibility of blood prior to issue of donor units For patients who have "red cell antibodies detected", further laboratory work is necessary to identify the specificity of the antibody, to type the patient and donor units in order to provide specific antigen negative blood and to perform a full serological crossmatch when required. For patients with multiple antibodies this work can take several hours to complete. All requests for crossmatching and group and save should also have a Hb level done (if not previously done). The serum/plasma is held in Transfusion Service for up to 1 month (Neonates are the exception - refer to Neonatal Transfusion Criteria page 3). The maximum availability for crossmatch is 1 month if the patient: is NOT pregnant has NOT been pregnant in the last three months has NOT been transfused in the last three months For other patients follow the 72 hour rule. See below for information about the 72 hour rule including exceptions to the rule.

Checks for previous transfusion and blood group records. The patient's current blood group must agree with any previous record of the patients group. Patient's who have previously had clinically significant red cell antibodies detected require antigen negative blood and full serological crossmatching.

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72 Hour Rule The 72 hour rule applies to patients who: are pregnant have been pregnant in the last three months have had a transfusion in the last three months A crossmatch specimen expires 72 hour after collection. The 72 hour rule applies whenever a patient has been transfused or is/has been pregnant within the last 3 months. This internationally accepted safeguard is used to prevent a transfusion reaction in patients who form antibodies to foreign red cell antigens in response to pregnancy or transfusion. A fresh crossmatch specimen will be required for any units not commenced within the 72 hour period for these patients. The group and save / crossmatch specimen expiry date is documented on the patients laboratory report which is usually filed in their medical record. If necessary contact the Transfusion Service on Ext: 16320 to check expiry dates of pretransfusion specimens. The only exceptions to the 72 hour rule are: Infants during the first four months of postnatal life. See Neonatal Transfusion information. Placenta Praevia women are covered for 7 days unless they have been transfused in the last 3 months, then 72 hour rule applies.

Emergency Situations

If a patient has a known (current) group and negative antibody screen - then group specific, unmatched blood will be available within 10 mins in an emergency. Unmatched O Neg blood is available immediately in emergency situations. See Emergency Blood

For urgent blood contact Transfusion Service on Emergency Blood Extension 18888. Remember to: collect specimen prior to administering any O Negative blood label specimen tubes correctly sign specimen tube and request form mark Transfusion Request Form as Urgent

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Neonatal Transfusion All neonates that require transfusion will need an initial group and screen. The Transfusion Service will make an assessment to determine if the neonate meets Neonatal Transfusion Criteria and whether to omit repeated serological crossmatching for infants during the first 4
months of life

Neonatal Transfusion Criteria: Baby less than 4 months of age Pretransfusion ABO and Rh(D) Group performed DAT performed No atypical maternal red cell antibodies detected (in the maternal specimen, or the babys specimen where a maternal specimen is not available) Continuous admission Note: For neonates where maternal antibodies are present, plasma from the mother (or baby) is held frozen (-30oC and aliquoted). A serological crossmatch is required each time red cell units are required - this is done using the thawed aliquot of plasma. The 4 month rule also applies to these neonates i.e. no further infant or maternal specimens are required after the initial specimens, except if all aliquots are used up within 4 months. Once a neonate is accepted as meeting the Neonatal Transfusion Criteria, further specimens are not required for pretransfusion testing. For subsequent transfusions only a request form is required (until baby reaches 4 months of age). If the neonate is discharged and readmitted during the first 4 months of their life, a new specimen is required determining if they requalify for neonatal transfusion criteria. It is very important to document any previous transfusion history, in particular intrauterine transfusions, or transfusions outside the Womens and Childrens Hospital (please indicate transferring hospital). Neonatal Crossmatched Blood If a crossmatch of packed red cells is ordered for top-up transfusion then usually four paediatric units will be matched. A paediatric unit is derived from dividing one adult unit into four paediatric units (prepared at Australian Red Cross Blood Service). Only one paediatric unit will be issued at a time. All packed red cells for top-up transfusion are CMV-negative and leucodepleted. For exchange transfusion (whole blood) or blood ordered for surgery (packed red cells), one red cell unit (< 5 days from collection), CMV-negative and leucodepleted is matched. Irradiated blood may be required in many of these cases. Contact Transfusion Service for further information on Extension 16320. These units are held for 5 days from collection date.

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Paediatric Blood Order Guidelines Junior staff MUST discuss transfusion requirements with the patients consultant.

Cardiology

Group & Save

Crossmatch
Packed Red Cells

Cardiac Catheterisation Less than 1 year of age Older than 1 year of age Balloon Valvuloplasty (all ages) Closed Cardiac Surgery Pericardiocentesis Cranio Facial Transcranial Fronto-Orbital Advance Facial Osteotomies Major Rare Clefts Mandibular Osteotomy Gastroenterology Percutaneous Liver Biopsy No Coagulopathy CoagulopathySclerotherapy General Paediatric Surgery

G&S G&S 1 unit 1 unit G&S Group & Save Crossmatch


Packed Red Cells

1 to 4 units
Depending on age

2 units G&S Group & Save Crossmatch


Packed Red Cells

G&S Individual Assessment G&S Group & Save Crossmatch


Packed Red Cells

Major neonatal surgery: TOF CDH Bowel Atresias Malrotation NEC Nissen Fundoplication Pull through operation for imperforate anus or Hirschsprungs Laporatomy for Bleeding Trauma, etc G&S

1 unit
(Fresh - 5 days old)

1 unit

Individual Assessment

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Neurosurgery Craniotomy Laminectomy Shunt for Hydrocephalus New Revision Neonatal Meningomyelocele Intradural Spinal Operation Atrerio-Venous Malformation Cranioplasty Craniectomy Acute Subdural (neonate or infant) Orthopaedic Surgery C-D Instrumentation Hip Osteotomy Free Tissue Transfer Femoral Nailing Percutaenous Open Tumour Excision Synovectomy Multiple Injuries Forearm Plating Thoracic Surgery Decortication Other Surgery

Group & Save

Crossmatch
Packed Red Cells

2 units G&S

G&S G&S 1 unit 1 unit Individual Assessment G&S 1 unit 1 unit Group & Save Crossmatch
Packed Red Cells

3 units G&S 1 to 2 units

G&S G&S Individual Assessment Individual Assessment Individual Assessment Nil Group & Save Crossmatch
Packed Red Cells
(Guide - 2 units)

2 units Individual Assessment


(guide - 2 units)

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Urological Surgery

Group & Save

Crossmatch
Packed Red Cells

Nephrectomy Neonatal Pyeloplasty Reconstructive Urological Surgery Pyelolithotomy (complex stones) Bladder Extrophy Ureteric Reimplantation Renal Biopsy

G&S G&S Individual Assessment


(guide - 2 to 4 units)

1 unit

1 unit Nil G&S

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Obstetric and Gynaecology Blood Order Guidelines

Bleeding Obstetric/Gynaecology Patients Where a patient is bleeding and requires emergency surgery, oxygen administration and fluid resuscitation should commence immediately. Blood should be taken for crossmatch and the Duty Registrar and Obstetrician/Gynaecologist contacted. The Duty Obstetric Anaesthetist should be notified and theatre arranged, indicating clearly the urgency of the clinical situation, ie a booking category of E1. 16G cannula intravenous access is required. If IV access is difficult to achieve, inform the Duty Obstetric Anaesthetist immediately. For Massive Transfusion see CYWHS Massive Transfusion Guidelines. Obstetrics Case Group & Save Crossmatch
Packed Red Cells

Antenatal Cases: Antepartum Haemorrhage (see below) Intra-Uterine Foetal Death Premature Labour Premature Rupture of Membranes Placenta Praevia In labour with a high risk of caesarean: Vaginal Birth after Caesarean Section Induction of Labour Intra-Uterine Growth Retardation Pre-Eclampsia Meconium Stained Liquor Foetal Distress Breech Multiple Pregnancy Morbid Obesity Slow Progress in Labour In labour with a high risk of a post-partum haemorrhage: Previous Post-Partum Haemorrhage Grand Multipara All booked Caesarean Sections L.S.C.S for: Placenta Praevia Placenta Praevia with risk of Accreta, i.e. previous LSCS or actual Placenta Accreta Any other uterine abnormality with increased risk of haemorrhage Major Abruption
Post-partum Cases: Post-Partum Haemorrhage Manual Removal of Placenta Ante or Post-Partum Haemorrhage as determined by clinical assessment.
CYWHS Blood Ordering Guidelines

G&S G&S G&S G&S G&S

G&S G&S G&S G&S G&S G&S G&S G&S G&S G&S

G&S G&S G&S

2 units Up to 6 units 2 units or more - on a case by case basis

G&S G&S

Up to 4 units initially
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Gynaecology Case Group & Save Crossmatch


Packed Red Cells

Gynaecology: All modes of Hysterectomy Ectopic / query Ectopic Pregnancy (see below) Endometrial Ablation Genetic & Mid-trimester Termination of Pregnancy Pelvic Floor Repair Sling Procedures / Colposuspension Laparoscopy for Severe Endometriosis Myomectomy all routes Cold Knife Cone Biopsy

G&S G&S G&S G&S G&S G&S G&S G&S G&S

Miscarriage Threatened Spontaneous Incomplete Significant bleeding is suspected e.g. Laparotomy for a Ruptured Ectopic Pregnancy

Group only Group only Group only Up to 4 units Mark Urgent

Date Issued: Sept 2007 Date Revised: Review Date: Sept 2010 Authorised by: TCM Review Team: TCM

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